AC 432 (3) St Mary Islington ISL 25 REPORT on THE SANITARY CONDITION Of the Parish of St. Mary Islington DURING THE YEAR 1856. by EDWARD BALLARD, M. D., (Lond.) Licentiate of the Royal College of Physicians; Fellow of the Royal Medical and Chirurgical Society of London; and Lecturer on the Practice of Medicine at the School adjoining St. George's Hospital ; MEDICAL OFFICER OF HEALTH. LONDON: J. & I. TIREBUCK, PRINTERS AND LITHOGRAPHERS, Monkwell Street, City, and Islington. TO THE VESTRY OF SAINT MARY, ISLINGTON. Gentlemen, 1. The expiration of a year has left me in possession of an accumulation of facts bearing upon the Sanitary condition of your Parish, which could not have been conveniently classified before, nor so usefully communicated to you as at the termination of such a period. In the present Report, I shall confine myself to a statement of these facts, and to the conclusions which, in some instances, appear legitimately to follow their acceptance, avoiding as far as possible any mere expressions of opinion. The numerical details have been thrown into Tables. The time and labour requisite for the preparation of these will, doubtless, account satisfactorily for the rather late appearance of the Report. MORTALITY AND DEATH-RATE. 2. The number of Deaths which occurred in Islington, from January 1st to December 31st, 1856, was 2294. This does not include the deaths of strangers which took place in the Hospitals situated in the Parish. It requires correction also for the deaths of patients from Islington in the other General and Special Metropolitan Hospitals, in the Lying-in Hospitals, and in the Lunatic Asylums. There is every reason to believe that this correction will be as nearly accurate as it can be made, if we assume that the registered deaths of Islington patients in these institutions bore the same proportion to the whole of the deaths in them, as the population of Islington bore to the whole population of London in 1851. The number which it will be requisite thus to add is 142. This will make the corrected mortality 2436 3. The number of deaths which occurred in the West Sub-district was 1201, and in the East, 1093. If we distribute the 142 Hospital deaths between the Sub-districts in the proportion of the population of each, we shall have to add 74 deaths to the West, making its more correct mortality 1275, and 68 deaths to the East, making the mortality 1161. 4. The Births which have occurred during the year are 4309, and if the reproductive character of the population be the same as it was in 1851, the residents in Islington, which these births will represent, would not be less than 135,000. I feel myself compelled on this ground to abandon the hesitation which withheld me in my Preliminary Report from assuming that the population has augmented since the last Census, in the same ratio as in the ten years preceding it, and, subject to correction from the next Census, to calculate the Death-rate for the year as not exceeding 18.9 per 1000 living. This death-rate will bear most favourable comparison with that of the Metropolis generally (22 per 1090), as well as with that of the Northern Districts taken together (21 per 1000). The death-rate differed very slightly in the two Sub-districts, being about 18.8 per 1000 in the West, and 19.1 in the East. 5. In Table 2 I have arranged the deaths as they occurred in each week of the year, from December 30th, 1855, to December 27th, 1856; * and the mortality is also represented as it occurred in the Diagram, which represents the relation borne by the mortality generally, * This will not be found to correspond with my weekly tables of Mortality, nor yet with the numbers given in my Quarterly Reports, inasmuch as these represented the deaths as they were registered—the only course, for various reasons open to me, when recording the mortality at such intervals. 4 and under certain special circumstances, to the fluctuations of atmospheric temperature and other meteorological conditions. As respects the general mortality, these representations require no comment. AGE AT DEATH. 6. In Table 1, it will be observed that the Deaths are arranged as to age in a different manner to that adopted in my Quarterly Reports, being distributed into quinquennial and bi-quinquennial periods, so as to render the Table comparable with the annual Tables of Mortality for the whole country issued from the General Register Office. The Quarterly Tables are comparable with the Registrar-General's Quarterly Summaries of the weekly returns of Deaths in London. In order to establish this double correspondence, two distinct tabulations were necessary. I have also tabulated separately the deaths which took place from every disease, at each period of age, in each sub-district; but, in order to economise space, have presented you only with the general results in association with the Table for the whole Parish. I shall have occasion, nevertheless, to refer to some of the details in these secondary Tables. 7. The most striking feature in the horizontal column of Ages at Death from all causes, is the number 1066, as representing the deaths which took place under 5 years of age. They formed as much as 46.4 per cent. of all the deaths which occurred in the Parish; 87 per 1000 of the number living under 5 years of age in 1851 (viz. 12,190), and 64.9 per 1000 of the estimated number living in Islington under 5 years of age in 1856 (viz. 16,418). The annual mortality under 5 years of age in England during the 10 years 1845-54, was 68.49 in the 1000 living. * In the East Sub-district the per centage of deaths under 5 years of age was 47.3; in the West, 45-6. Comparing the mortality with the number living under 5 years (1851), it is found that in the West Sub-district the deaths were at the rate of 89 per 1000, and in the East, 85 per 1000. Mure than half of the 1066 deaths took place in the first twelve months of existence, and 305 are stated to have occurred before the infants had reached the age of three months. I shall take another opportunity of again calling your attention to this most serious waste of infant life. CAUSES OF DEATH. The three Classes of Disease in the Nosology of the Registrar-General to which the largest proportion of deaths was assigned (Table 1.), are the Zymotic, the Tubercular, and those affecting the organs of Respiration. In respect of the first of these, I propose entering into some detail. a. Diseases of the Zymotic Class. 8. The Zymotic class of Diseases † was fatal to 542 persons, thus causing 23 6 per cent. of all the Deaths in Islington during the year. (Table 4, col. 4.) In this respect there was a great disproportion between the Sub-districts. In the West Sub-district, 20 4 per cent. of the deaths were thus referred, while in the East, the number was 27 per cent. The zymotic mortality of the whole Metropolis was 22 6 per cent.; so that, compared with the entire number of deaths, the zymotic mortality of Islington was 1 per cent. higher. 9. The zymotic mortality which had undergone great and frequent variations, between 5 and 17 per week, during the first half of the year, was permanently high (Table 2 & Diagram), * 17th Annual Report of Registrar-General, p. xvi., Table xiii. † "This class comprises diseases which have been observed to be epidemic, endemic, or contagious. The blood is probably, ill the greater lumber of them, the primary seat of disease: and they may be considered by hypothesis, the result of specific poisons, of organic origin, either derived from without, or generated within the body."—Statistical Nosology, 1845, p. 14. 5 from the last week in July to the first week in September. In the fourth week of August, out of 50 deaths, 21 were attributed to zymotic disease. The number of zymotic deaths was low during the remainder of September and October; and then another remarkable rise took place in the latter weeks of November. This, however, was to a less extent than that just referred to; the highest number of deaths was 19, out of a total mortality of 56. It will be observed that the first rise was coincident with the elevation of atmospheric temperature, the second, with its depression. The first was mainly due to summer diarrhoea, the second, to measles and other diseases associated with pulmonary complications. 10. The more common Epidemic diseases are those to the varying fatality of which the highest interest attaches—Table 4 exhibits the number of deaths from each, which occurred in Islington and its Sub-districts. In order to facilitate comparison with the whole Metropolis, it was necessary to bring all the numbers to an uniform standard: the percentage of deaths from each disease in London and Islington has consequently been introduced. Small-Pox only occasioned 8 deaths, the proportion to the entire mortality being greatly under that of London at large (Cols. 9 & 10). The per centage of deaths from other epidemic diseases of infancy, measles, scarlatina, hooping-cough, and diarrhoea was in each case greater. Typhus, on the other hand, was about one-fourth less fatal than in the metropolis generally. With the single exception of hooping cough, all the epidemic diseases mentioned were proportionally more fatal in the East than in the West Sub-district (Cols. 9 to 22). This difference was most manifest in the instance of scarlatina, diarrhoea, and typhus. It is to be further remarked that, in the West Sub-district, the per centage of mortality from each of the epidemic diseases, except measles and hooping cough, was smaller than in all the Metropolitan districts taken together. In the case of typhus it was only one-half. The greatest mortality from measles occurred (Table 2) in the months of November and December, especially in the last week of the former and the first week of the latter month. This did not appear due to any malignancy of the disease, but to the pulmonary complications which were present in nearly every instance, and it corresponded, as will be seen by the Diagram, to a great diminution of the atmospheric temperature in those weeks, and to a high mortality from other diseases, involving primarily the organs of respiration. The mortality from scarlatina was rather higher during the early than the latter half of the year, and that from hooping cough was chiefly observed during the first seven months. Out of the 109 deaths from diarrhoea, 78 occurred during the months of July, August, and September. The mortality from typhus was less during the months of April, May, and June, than during other months of the year, over which it was pretty equally diffused. The highest mortality from fever however occurred in the summer months, at a time when the zymotic mortality generally as well as that from diarrhoea, was greatest. 11. Why was the zymotic mortality of Islington so high as to exceed, in proportion to the entire mortality, that of London at large ? The endeavour to reply to this will raise another question of still greater importance to you, viz.: the cause of the remarkable difference in this respect between different parts of your Parish. 12. The zymotic mortality of any district may be expected to be high when young persons form an unusally large proportion of the population. No less than 71 per cent. of all the deaths from zymotic disease occurred to children under 5 years of age, and Table 4 (Col. 6) shows that, at the census in 1851, for every 1000 living at all ages in Islington, 127.8 were under 5 years of age, while in the whole metropolis they formed 124.2 per 1000 of the population. It also appears from the same Table that of the more common epidemic diseases, those which specially affect young persons, produced a proportional mortality in excess of London, while typhus, a disease more frequent at more advanced periods of life, was proportionally less fatal. That this is not the explanation, however, appears first, from the fact that it would only account for half of the disproportion between Islington and the Metropolis ; and secondly, from the fact that the Sub-district, in which the proportion of children under 5 years in 1851 was lowest, is that in which the proportion of zymotic deaths has been highest (Col. 6). It further appears (Cols. 7 & 8) that, for every 1000 of the population under 5 years (1851), the mortality under 5 years from zymotic diseases was very much higher in the Eastern than in the Western Sub-district. It is then in the East Sub-district that wa must look particularly for the circumstance on which the excess of zymotic mortality we are considering depends. If there be local causes in operation, they might be expected to influence 6 adults as well as children. That this was the case is shown by (Col. 22) the proportion of deaths by typhus being twice as great as in the West Sub-district. 13. But the East Sub-district extends over 1899 acres of land; taken altogether it is less densely populated than the West (Preliminary Report, p. 18), and it embraces localities of high salubrity. In order therefore more closely to define the special seats of zymotic mortality, I made a further and additional distribution of 2069 of the deaths* into smaller districts, taking for convenience the division into wards. The result of this tabulation appears, in part, in Table 3.† The lowest zymotic mortality, 18.65 per cent. of all deaths, occurred in No. 5 (Barnsbury), a ward situated in the West Sub-district, whose entire zymotic mortality was 20.4 per cent. The highest was noticed in No. 8 (St. Peter's), viz., 26'5 per cent., and No. 3 (Highbury) presented a close approximation, 26.08. Both these wards are situated in the East Sub-district, whose general zymotic mortality was 27'0 per cent. The Table 3 enables you to compare the zymotic mortality of each ward with that of the Parish generally, and of the Subdistrict in which lies. 14. But even this does not give sufficiently definite information, and I consequently made a more minute distribution of the deaths to the streets, etc. in which they occurred; and it at once became clear that the cause of the mortality we are considering lay within very narrow limits; since in each ward, the number of streets in which a zymotic death occurred at all, formed but a small portion of all the streets in contained, though this proportion varied in the several wards. In No. 3, for instance, out of abcut 147 streets, &c., separately named,‡ there were 108 in which not a single zymotic death of any kind took place all the year, and in No. 8, out of about 161 streets, &c., there were 92 similarly favoured. The number of streets, in fact, which, in each ward, contributed in excess to the zymotic mortality was really very small.— In the following list the lower number in the attached fractions represents the total mortality, the upper that from zymotic diseases. It is to be borne in mind that the average proportion for the Parish was under ¼th Ward 1.—Bowman's-place North, 5. Ward 2.—Albert Square, ¾—Blundell Street, ¾—Burnard Place, 2/3—Hollingswortli Street, —St. James' Cottages, 2/4—Upper Victoria Road, 3/6—Victoria Place, Queen's Road, 2/2 Ward 3.—Albany Place, Hornsey Road, 2/2—Ann's Place, Balls Pond, 2/3—Aston Buildings, 2/2—Brand Street, 4/8—Hornsey Road, 5/15—Blackstock Lane and King's Road, 4/5—Lowndes Place, Mildmay Street, 3/8 Ward 4.—Albion Place, ¾—Almina Road, -|—Canal Terrace, 2/5—Catherine Street, 2/4 —Clayton Street, 7/19.—Freeling Street, —Huntington Street, 2/5—Princes Terrace, 2/6— Stanmore Cottages, 2/2—Thornhill Place, 5/12—Upper Freeling Street, 2/6Upper North Street, 2/3—William Street North, 5/15 Ward 5.—Barnsbury Row, 2/5—Gainford Street, 2/4—Matilda Street, 2/6—Payne Street,8/19 —Pulteney Street, 3/7—St. James Street, —White Conduit Street,3/5 Ward 6.—Church Passage, 2/3—Cross Street, 5/8—Little Cross Street, 2/4—Sebbon Place, 2/3 Sebbon Street, 2/2 Ward 7.—Albion Place, 3/5—Charles Street, 2/3—New Norfolk Street, 2/3—Shepperton Street, 2/3 Ward 8.—Arlington Square, 3/6—Britannia Place, 2/2—Blakeney's Buildings, 2/2—City Gardens, 6/14—Coleman Street, 2/6—Dame Street, 2/5—Elder Walk, 7/12—Frederick's Place, 1 2 Goswell Road, 3/9—Frog Lane, 2/3—Greenman's Lane,2/6—Grosvenor Street, 4/10—Halton Place, 3/7—King Street Terrace, 2/2—Lower Street 2/6—Popham Street, 4/9—Rose and Crown Court, 2/3—St. Paul's Street, 3/9—Shepperton Street, 2/6—Sidney Street, 2/4—Smith's Buildings,± —South Place, 3/6—Ward's Place, 4/10—William Street, 2/6—Windsor Street, * The whole of the deaths registered in the year, with the exception of those occurring in the Workhouse and Infant-Poor house, and a very small number which I had a difficulty in thus referring correctly. † No conclusion can be drawn from the total mortality in the several Wards, on account of the absence of any enumeration of their population. ‡ According to lists published for Election purposes. 7 It is very important to observe that the greater number, by far, of the above places are tenanted by a labouring or poor population. These are the leading facts of the case. The following propositions appear to embody the reply which must be made to my original inquiry. 15. I.—The proportion of zymotic mortality was highest in the Sub-district which is situated at the lowest general elevation, and in the lowest ward in that Sub-district. But that elevation had really little to do directly with the difference, however it may have assisted the operation of other causes, appears on arranging the wards in the order of their lowest zymotic mortality, placing side by side the list of these arranged in the order of their general elevation. Wards in the order of lowest Zymotic mortality. Wards in the order of their general Elevation. Barnsbury. Upper Holloway. Canonbury. Barnsbury. Thorn hill. Lower Holloway. St. Mary's St. Mary's Lower Holloway. Highbury. Upper Holloway. Canonbury. Highbury. St. Peter's. St. Peter's. Thornhill. In fact, in Thornhill ward, which most closely corresponds in elevation with St. Peter's, the zymotic mortality was below the average for the Parish generally (Tables 3 & 4), although slightly above that of the West Sub-district in which it lies: while Upper Holloway, which stands low on the list of zymotic mortality, is the highest situated ward in the Parish. 16. II.—Throughout the Parish, the zymotic mortality, where above the average, occurred almost exclusively in the streets and houses occupied by the lower classes. 17. III.—There appears no reason for believing that there is a larger proportion of poor persons residing in the East than in the West Sub-district. 18. IV.—The difference in the zymotic mortality of the two Sub-districts corresponds with a remarkable difference in the conditions under which the lower classes exist in them, viz.: with the existence in the East Sub-district, to a much greater extent than in the Western, of various causes of atmospheric impurity in and about their habitations, and with the absence, in a more marked degree of the necessary appliances for cleanliness, comfort, and health. This will appear on reading Table 4 with Table 6. The latter table shows that not only are the houses inhabited by the poorer classes, smaller in the East Sub-district than in the West (and the size of the house usually regulates that of the rooms) (Col. 3), but that more persons occupy the same space (Cols 3, 8, 9) , and as if this were insufficient to spread and aggravate disease, the houses altogether are in a very much worse condition as to airiness and ventilation. (Cols. 24, 25,). The lower classes of the East Sub-district are thus more exposed than in the West to poisoning of the atmosphere which they breathe, by the emanations from their own bodies. This condition, as a fact, operated remarkably in the instance of the mortality from croup, measles, scarlatina, diarrhoea, and hooping cough. It is further to be observed, that the streets, &e., inhabited by the lower classes in the East Sub-distrct, are closer, narrower, and less airy, on the whole, than in the West. Again, the conditions which favour the production of a poisonous atmosphere from extraneous causes are present amongst the poor and labouring population to a greater extent in the East Subdivision.—Dirty houses (Cols. 10, 11.); dampness rising from the foundation of the houses (Cols. 12, 13), and carrying with it, into the walls, and exhaling into the rooms, in some instances, the decomposing and pestiferous matters from cesspools and leaky drains ; cesspools and unwholesome privies (Cols. 20, 21); the former, on theone hand contaminating the soil more or less extensively around them, and on the other, throwing off most noxious gases into the atmosphere ; the latter little less injurious from their constant liability to retention of Excrement in the pans, and in the drains with which they communicate; wet, dirty, and unwholesome yards (Cols. 16, 17); untrapped drains, (Cols. 22, 23), from which sewer gases rise unopposed into the yards and dwelling-houses ; these, as it appears from Table 6, are sanitary defects, much more commonly discovered in the poorer habitations of the East Sub-district, In many of the houses, again, the dust and vegetable and animal refuse of the families is obliged 8 to be stored, as best it may be, in the dwelling and sleeping rooms, for the lack of an appropriate receptacle outside the house; or where a dust bin has been provided, it was more frequently found unenclosed and overflowing with its contents, adding another to the various causes of miasma already enumerated (Cols. 14, 15). And lastly, there is the water supply (Cols. 18, 19); in some instances there is no water supplied to the houses at all, in others the quantity is very insufficient, and in some, what is supplied is unfit for drinking purposes, from the impurities it has gathered in the butts or tanks in which it is preserved. 19. It can scarcely be argued that this coincidence is fortuitous. Such a conclusion would be opposed to all medical observation and experience, and in this instance might be successfully combated by the results of special inquiries. Still, I am not prepared to say that all the sanitary defects enumerated are of equal importance; nor would it be easy to attribute fatal disease specifically to any one of them, but the difficulty vanishes when we group these conditions into a class as agreeing in their physical results. Neither would I be understood, while laying stress upon this class of causes, as ignoring the operation (perhaps even the local operation), of a variety of other circumstances† which may predispose to zymotic disease and promote its fatal termination. It is not to be concealed, however, that some of the conditions I hint at may arise out of domestic discomfort, or the negligence and apathy which it engenders. 20. The law, restraining the licence of the few for the advantage of the many, places the remedy in your hands. In "pointing out the local causes," my duty is nearly performed. I have only further to show one direction in which it would appear your efforts may be made with the greatest probability of success. In the principle, I hope to carry the Vestry with me; in matters of detail and in the application of the principle to individual cases, there will always be abundant room for the exercise of discretion. 1° Enforcing the law against over-crowding of the dwellings of the poor—and as far as possible, promoting their ventilation. 2° Insisting on landlords keeping the houses of the poor in a cleanly condition, and furnishing the inhabitants with covered and enclosed receptacles, outside the houses, for dust and other refuse; a further advantage would be gained, if certain days in each week could be fixed, on which the contractor should be expected to remove all accumulations of dust from certain streets and other localities. 3° Requiring that the yards attached to the houses should be properly drained, so that the surface water should flow away from the walls, instead of towards them, as is the case in many instances. Much good might be anticipated from a more general paving of the yards. 4° Enforcing the abolition of cesspools, wherever practicable, in the neighbourhood of the residences of the poor, at least, and the supply, in their place, of wholesome privies, communicating by impervious drains with the sewer, effectually trapped, and furnished with appliances for cleanliness and flushing with water, of such a nature that ignorance and idleness shall be unable to excuse their neglect* 5° The amendment of badly constructed, defective, and untrapped house drains. 6° Compelling an ample supply of water to be furnished, and until the system of conitant supply be generally adopted, insisting upon proper receptacles for water being provided, and upon the abolition of tanks and tubs, sunk into the earth, both of which are certain to gather impurities, which render the water they contain unwholesome, and calculated to promote disease. b. Diseases of the Tubercular Class: 21. The diseases included in this class, carried off 414 individuals, or 18.0 per cent. of those who died during the year.—The per centage of the tubercular mortality in the West Subdistrict was 18.8—in the East it was 17.2. In London generally these diseases occasioned 17.1 per cent. of the whole of the deaths. The excess of tuburcular deaths was thus only remarkable in the West Sub-district. Table 5 represents the mortality from this class of diseases, and from each disease included within it, in Islington and its Sub-districts, and in the Metropolis generally. The largest number of deaths was occasioned by Phthisis or * In respect to the particular arrangement applicable in any individual case, I can say nothing; I have no prejudice upon the subject, and have hitherto, in doubtful cases, been willing to be guided by the skilled opinion of your Surveyor of Sewers and Drains. † It may indeed happen, in any future year, that these "other circumstances" may predominate in their operation over those causes now under discussion. 9 any Consumption. Taking the Parish as the whole, the fatality of phthisis was less than in the Metropolis at large, but taking the Sub-districts separately, the West contrasts unfavourably, both with the East Sub-district, and with the whole of London. I do not propose to discuss the causes of this difference in the present report; but will content myself with calling your attention again to the Table 3, from which it appears that the tubercular deaths in Ward 4 alone, greatly exceeded the average for the Parish ; a less excess being observed in Ward 3. In Wards 2, 5, 6, 7, 8, the per centage of tubercular deaths was more or less below that of the whole parish, and in all but Ward 6, materially below that of the whole Metropolis. Barnsbury Ward was in this respect situated most satisfactorily, the tubercular deaths forming only 13 per cent. of the deaths from all causes. St. Peter's and Canonbury stood next in rank, the per centage in the former being 15 08, in the latter 15-83. The street lists I have drawn up seem to confirm the conclusion, which this table appears to suggest, that the localities of excessivezymotic mortality (compare Wards 4 and 8), are not necessarily those for which tubercular disease shows the highest preference. c. Diseases of the Organs of Respiration. 22. These were chiefly inflammatory, and the deaths included are only those in which the disease is registered as the primary affection from which the individual suffered. They occasioned 392 deaths, or 17 0 per cent. of the deaths from all causes. In the Metropolis generally, the mortality from this class formed 16.6 per cent. of the whole. In the West Subdistrict of Islington, the per centage was 17.8, in the East 16.2. In the summer quarter of the year, the deaths from this class of disease were of course very few; in the remaining quarter, (Table 2), there was little variation, the number which occurred in the first and last quarters being precisely the same. The influence of meteorological conditions upon the deaths from this class is exhibited in the Diagram. SANITARY IMPROVEMENTS EFFECTED DURING THE YEAR. 23. The amount of sanitary improvements accomplished during the year must be regarded with satisfaction, and especially, as the larger part of it has been effected at private expense, and with little delay, on the necessity for it being pointed out to the owners of the property complained of. In a great number of instances, where a death from disease of the Zymotic class, or a severe illness of the same character, has been ascertained to have occurred, the Inspectors, under my direction, have made a systematic inquiry upon the spot, as to the existence of any of those local causes which I have recently alluded to, and which experience assures us are operative in such cases. Of the 1431 inspections made during the year, 456 were made under these circumstances, and the results of the inquiry, with my recommendation thereon, submitted for the orders of your Sanitary Committee. The remaining house inspections referred to localities which were ascertained to be the favourite haunts of Fever and Epidemic disease. The improvements effected in respect of the dwellings have been mentioned in my Quarterly Reports. They embrace altogether the cleansing and whitewashing of 276 dirty houses, the filling up and abandonment of 760 cesspools, the amendment by trapping, cleansing and communicating with drains, of 816 privies—the laying on of water to 812 privies which were deficient in this respect, the construction or enclosure of 657 receptacles for dust and other refuse, the ventilation, principally by the introduction of air-bricks, of 21 houses, and the supply of water cisterns to the inhabitants of two courts, who were previously dependent upon a very temporary flow from a stand-pipe, and who were under the necessity of storing what little water they were fortunate enough to collect in the close rooms they were compelled to occupy. 24. In several instances I have had occasion to recommend the construction of Sewers, where the want of such an outlet has been an obstacle to some necessary house-drainage. The work of this kind, which has been accomplished, has been already reported to you by your Surveyor, I look forward to the time when the determination of the Government 10 upon the general Drainage scheme for the Metropolis, will permit the abolition of one of the greatest nuisances in the Parish, the Hackney Brook open sewer, which in Highbury Yale runs at a very few feet distance from a number of houses of a low class, in one of which two deaths from Scarlet Fever have recently occurred. 25. I must not neglect mentioning, among the most important provisions made during the year against the spread of disease, the construction of a carriage for the conveyance of patients labouring under Small-pox. Happily, the very small number of cases which have occurred, has hitherto occasioned but little necessity for its use. 26. I may add, that as the 132nd Section of the Metropolis Local Management Act directs, as a part of my duties, that I should " point out the most efficient mode for the ventilation of churches, chapels, schools, lodging-houses, and other public edifices in the Parish," I addressed a letter, in the month of May, to all the Clergy and Dissenting Ministers, whose residences I could ascertain, calling their attention, among other things, to this subject, and proffering my services, as their adviser. There is no question of the necessity, in several of these buildings, for improvement in this respect; but I have hitherto received no communication upon the matter, from either the Clergy or their lay-associates. BURIAL GROUND IN CHURCH STREET.—VAULTS UNDER THE ISLINGTON CHURCHES. 27. The condition of the Burial Ground in Church-street, known as " Jones's Burial Ground," and as the " New Bunhill Fields," and the disinterments and other proceedings occurring there, were, on several occasions, brought prominently under my notice. The extent of the ground is estimated at 4300 square yards, and, at the time of Mr. Chadwick's special inquiry in 1843 into the "Practice of Interments in Towns," it is alleged that 520 burials annually took place in it, or at the rate of 585 burials per acre. The land was appropriated for a Cemetery in 1817, and closed by an order in Council in January, 1855. If we assume that the annual number of burials mentioned above only took place during the latter half of these 38 years, and that but half the number took place during the first 19 years, which would probably be not far from the truth, no less a number than 14,820 bodies are lying in various stages of decomposition beneath the surface of that ground. And all this organic matter has been, or is being now converted into gases, fœtid, and deleterious to animal life, which, dissolved in the moisture of the soil, permeate the latter, become diffused more or less extensively about the neighbourhood of the grave yard, * or, whenever the encrusted surface of the ground is disturbed, pass out abundantly into the atmosphere. † To purify the soil, and at the same time to prevent the rise of miasmata, which must, even in an undisturbed condition of the ground, have a constant tendency to escape, the only effectual remedy is careful turfing and planting. It has been announced, that it is the intention of the proprietors to devote this land to building purposes, and should it be attempted thus to apply it, I shall appeal to you, as the guardians of the Public Health in Islington, to interpose.—I warn you that residences, thus founded on putrefaction, will, with certainty, be tenanted by disease and death. The indecent exhumations which have taken place during the year on that ground have, as is known, been a source of much public annoyance. Unhappily, the law which applies to consecrated cemeteries, will not meet such a case as this; and even your own Local Act, under the 109th Section of which your Vestry Clerk proceeded by summons on the 25th of See evidence of Mr. Roe, respecting contamination of a well on the premises of Mr. Jacob Post, in Church Street.—Chadwick's Report, on Interment in Towns, p. 25. † At the hearing on October. 25th, at the Clerkenwell Police Court, on the summons of Mr. Jones under the Local Act for Islington, Mr. Adamson, of Church Street, stated, that his men were frequently struck down with nausea and sickness by the effluvia proceeding from the ground. A clerk of Mr. Adamson's testified to a similar effect produced upon himself, as also did a man who was at work near the spot where a grave was being opened for a disinterment. 11 October, at a time when the nuisance was at its height, failed to provide a remedy, although the evidence both of the public annoyance and of the injury inflicted upon health was of the most conclusive description. It is earnestly to be hoped that the Legislature will turn its attention to this glaring deficiency in its Burial enactments. 28. I hare further thought it my duty, during the year, to examine into the condition of the Vaults beneath those Churches, under which Burials were until lately permitted. The following is the general result of my examination:— 1. St Mary's.—The vaults have altogether a cubic capacity of about 29,700 feet, and are freely ventilated. Some of the coffins have, from their weight, sunk partially into the earth, others are so closely packed, that I had great difficulty in counting them. I estimate the number at about 460. All that I examined were sound; a great many, however, were quite out of my reach. The last interment was in January 1853. There is no communication between the vaults and the interior of the church. The air in the vaults was offensive in many places, but not oppressively so; and the smell appeared to arise from the excrements of dogs and cats, who have free access by the barred windows, and who have scratched up the earth in several places. I would suggest the propriety of adopting some plan for preventing the entrance of these animals, and the advisability of lime-washing the vaults. I was informed that there were 11 or 12 coffins bricked up at the East end. Can any objection be offered, now that no further interments may take place, to bricking up all the others, and clearing the remaining space ? It would be a decided sanitary improvement. 2. Chapel of Ease.—There is one public vault beneath this church, the cubic capacity of which is about 2560 feet. It is very dry and well ventilated. It contains 114 coffins in a good state of preservation. There was no offensive smell. There was no opening from the vaults into the body of the church. There are, in addition, three private vaults communicating freely with the remaining large space beneath the church, and containing altogether 15 coffins. In one of these vaults, a coffin, bearing date, 1833, had burst. At the time of my visit no offensive odour was proceeding from it; but, nevertheless, it should be attended to. The last interment in the public vault was in 1854. The last in the private vaults was in January 1855. 3. Trinity Church.—The total cubic capacity of these vaults, of which there are four, communicating by a transept, is about 35,300 feet. The total number of coffins 173. The ventilation is sufficient, and the air in the vaults not offensive. There is no communication with the body of the church. All the coffins are sound. One of them burst some years ago, and gave off a very offensive odour, but the breach was immediately restored. I should suggest here, as with the Parish Church, especially as it is situated in the centre of a small square, the desirability of lime washing, and of preventing the ingress of small animals. 4. St. John's, Holloway.—I found here again nothing to complain of—there are four vaults communicating by a transept. The total cubic capacity is about 38,500 feet. There are 106 coffins, all sound. The vaults are tolerably ventilated, presented no offensive smell, and do not communicate in any way with the body of the church. The last interment was in December, 1854. TRADE NUISANCES. 29. That certain businesses and manufactures were being carried on in Islington in a manner highly offensive to many of the inhabitants, was matter of some notoriety at the time when I had the honour of being appointed your Medical Officer of Health. The most objectionable of these were located at Belle Isle, and against several of the proprietors legal proceedings had been instituted by the Police Authorities. The suppression of these nuisances very shortly devolved upon the Vestry. It became therefore incumbent upon me to make myself familiar with the nature of the manufactures complained of, in order that I might be in a position to determine the cause of offence, and to ascertain whether or not the best means had been adopted in each instance to remove occasion for complaint. This 12 is a subject, therefore, to which, during the past year, I have devoted much time and attention, taking every opportunity which presented itself of visiting the works in Belle Isle, and elsewhere, and making myself, as far as practicable, acquainted with the necessities and difficulties of each case. In effecting this, I have, in the majority of instances, met with no obstacle on the part of the proprietors of the establishments, to whom I have always been ready to impart any information I might possess, and to give my opinion, whenever desired, upon any proposed plan of amendment. In the following account I shall confine myself to the trades which are carried on at Belle Isle, and to the methods which have been adopted to obviate the annoyance to which the neighbourhood has so long been subjected. 30. I.—The manufacture of Varnish, of Enamel Black, and of various kinds of Japan, together with the boiling of Linseed Oil, is one of the businesses carried on the most extensively in this locality. The effluvia consisting of volatile principles from the melting of gums, &c,, employed, and of an acrid vapour given off from the boiling oil, are of a very penetrating and diffusive character, and have hitherto been permitted to pass freely into the atmosphere. At the present time, of about 10 manufactories of this kind, in seven, more or less effectual means were in operation at the close of the year for arresting the escape of the vapour. In the remainder, I could take no steps to enforce similar improvements, as work was not ascertained to have been in progress, on any occasion that the Inspector or myself were present. Two principal methods of abating this nuisance are in action. The one method consists in the condensation of the vapours by a very ingenious contrivance patented by Mr. J. S. C. Heywood, * one of the Belle Isle manufacturers. It is most complete and effectual in its action, the only objection to its use being the hand-labour requisite where there is no steam engine upon the premises, and the consequent temptation occasionally to neglect its employment. The other is self-acting, and consists in the combustion of the vapours given off. I confess that I am not at present satisfied with the result of the employment of this contrivance, which has the additional disadvantage of rendering the contents of the pot liable to ignition.')" 31. II.—Manufacture of Blood Manure.—There were two large establishments for this manufacture at Belle Isle. At the present time there is but one. The principal cause of the offensive effluvia was the admixture with the blood (sometimes putrid) of oil of vitriol; the mixture was often made in the open air, and the vapour given off at an elevated temperature rose to a considerable height into the atmosphere, and was wafted to long distances. Since the proprietors of these works were convicted and fined in June last, there has been up to the close of the year, little ground for complaint. 32. III.—Fat and Stuff Melting.—The offensive nature of this process varies with the substances employed. The melting down of good and finely-chopped butcher's fat is the least offensive; the principal nuisance which arises at Belle Isle from this source occurs at the houses where kitchen stuff and grease of other kinds are melted. I have required each fat-melter in Belle Isle to carry the vapours from his boiler into the ash-pit of the fire place, and thus, during the period of melting, the vapours are consumed. There is still, however, one part of the process unremedied, and I believe it is that which occasionally gives rise to complaints from the neighbourhood. It is the removal and pressing of the graves:—it cannot be believed that the nuisance thus arising is incapable of being obviated. 33. IV.—Boiling-Houses.—Three of these are attached to knackeries, and in each instance, a similar contrivance to that adopted by the fat-melters has been put in force for the consumption of the offensive vapours. Still the steam arising from the hot horseflesh was considered a nuisance, and in each establishment it is now required that the flesh shall be immersed into a tank of cold water immediately it is removed from the boilers. A fourth boiling house is of a rather different character, and has been the cause of much trouble during the year, the proprietor having been three times summoned to the Police Court, upon my certificate, under the Nuisances' Removal Act. At this house, situated in the Brandon Road, condemned meat is received from the Markets in the City, and in the summer, when much meat became putrid, the effluvia from the boilers was of the most disgusting description. * (No. 452.—1856.) † A superior method of this kind was patented by Messrs. East and Mills (No. 397—1855). 13 I have no hesitation in saying, that such a business as this should not be permitted to be carried on in the neighbourhood of inhabited houses at all. I think it may be maintained that this business is now carried on contrary to law. * It has only recently been brought into the Parish, having been removed from Cow-Cross at the time of the Clerkenwell improvements. 34. V.—Gut-Scraping for the preparation of sausage skins is another most disgusting business carried on at Belle Isle. The nuisance principally arises from the delay used, and the putrefaction of the intestines and their contents, before the operation of cleaning is commenced. It appears, from inquiries I have made into this subject, that this putrefaction is not necessary, but that it is allowed to take place because it facilitates the scraping. This trade ought to be completely forbidden at Belle Isle on account of the want of proper drainage there. I know nothing that can be compared to the horribly fætid odour which I have perceived to proceed from one of these scraping-houses, the proprietor of which I was compelled to summon. 35. VI.—Piggeries.—There appears little question, that under proper regulations as to the construction and size of the styes or houses which they occupy, a good system of drainage, scrupulous attention to cleanliness, and a proper system of feeding, it is possible that pigs may be so kept that, in an open locality, they may produce a minimum of nuisance f. But at Belle Isle, where there were last year six piggeries, with a number of animals, varying from twenty to above a hundred in each, none of these conditions are present, or appear capable of being maintained. The two principal objections lie in the absence of any proper or efficient drainage, and in the nature of the food on which the pigs are kept, and which, consisting mainly of 'tavern-wash,' often in a sour and fermenting condition, is prepared for consumption by boiling: the odour proceding from the open boilers is sometimes most sickening. It is often a long time before pigs brought from the country will eat the food presented to them at Belle Isle. Two of the above-mentioned piggeries have been removed, but the largest establishments yet remain. An attempt was made by your Sanitary Committee to dislodge them under the 109th Section of the Local Act for Islington; but some technical difficulties which were raised have hitherto prevented the accomplishment of this most desirable clearance. I have the honour to be, Gentlemen, Your very obedient Servant, EDWARD BALLARD. M.D. 42, Myddelton Square, Medical Officer of Health. March 16th, 1857. * The 7 & 8 Vict. Cap. 81, Sect. 55, which is specially exempted from repeal (18 & 19 Vict. Cap. 122, Sec. 109), after enumerating several offensive and noxious businesses, provides, "That it shall not be lawful for any person to establish or newly carry on any such business, either in any building or vault, or in the open air, at a less distance than 40 feet from any public way, or than 50 feet from any other buildings of the first or dwelling-house class." There are other offensive businesses carried on in the Parish which might be removed under this Statute. † There appear some reasons to believe, however, that this is not all that is necessary to insure the wholesomeness of the flesh for food.—See a Paper by Dr. Fleming, on the " Heasle" of the Pig, &c.—Dublin Quarterly Journal of Medicine, February, 1857, p. 100. TABLE I. DEATHS WHICH HAVE OCCURRED IN ISLINGTON AND ITS SUB-DISTRICTS DURING THE YEAR 1856, Births 4309 All Ages. AGES. Und 1 1- 2- 3- 4- Under 5 5- 10- 15- 25- 35- 45- 55- 65- 75- 85- 95 Up. West Sub-district. Population, 1851 47881 •• •• •• •• •• 6135 4911 4254 9646 9188 6010 3958 2355 1050 331 4 2 Deaths, all causes 1201 321 1-21 49 36 21 548 35 14 56 84 105 82 103 99 58 17 •• East Sub-district. Population, 1851 47448 •• •• •• •• •• 6055 5021 4457 9457 8544 5860 4134 2325 1164 379 47 5 Deaths, all causes 1093 291 119 55 31 22 518 37 19 54 62 71 76 85 89 69 12 1 Whole Parian. Population, 1851 95329 •• •• •• •• •• 12190 9932 8711 19103 17732 11870 8092 4680 3214 710 86 7 Deaths, all Causes. 2294 612 240 104 67 43 1066 72 33 110 146 176 158 188 188 127 29 l West S.D. East S.D. Class 246 296 I. Zymotic 542 164 100 54 39 28 385 35 11 24 18 16 18 11 18 5 •• 54 45 II. Dropsy, &c. 99 3 3 1 2 2 11 1 1 •• 6 12 21 20 13 14 •• •• 226 188 III. Tubercular 414 50 36 22 10 5 123 15 9 60 85 64 39 16 3 •• •• •• 152 101 IV. Brain and Nerves. 253 64 23 4 9 3 103 6 3 5 6 15 15 42 38 16 4 •• 35 39 V. Heart, &c. 74 2 •• •• •• •• 2 1 2 6 4 15 9 14 13 8 •• 214 178 VI. Lungs, &c. 392 98 54 21 6 4 183 8 2 6 10 21 27 51 50 20 4 1 80 63 VII. Digestive Organs 143 38 13 •• •• •• 51 •• 3 1 9 17 14 20 21 4 3 •• 15 14 VIII. Kidney, &c. 29 •• •• •• •• •• •• 1 •• •• 1 9 6 3 6 3 •• •• 6 5 IX. Childbirth, &c. 11 •• •• •• •• •• •• •• •• 2 3 1 2 1 l 1 •• •• •• •• X. Joints, Bones, &c. •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 2 1 XI. Skin, &c. 3 •• •• •• •• •• •• •• •• •• •• •• •• 2 1 •• •• •• 11 5 XII. Malformations 16 12 1 •• •• •• 13 2 1 •• •• •• •• •• •• •• •• •• 57 43 XIII. Prem: Birth and Debility. 100 67 1 •• •• •• 68 •• •• •• •• •• •• •• •• •• •• •• 24 1 •• •• •••• 25 •• •• •• 1 •• 3 3 •• •• •• •• 32 36 XIV. Atrophy 68 58 6 •• •• •• 64 1 •• •• •• 1 •• 2 •• •• •• •• 38 46 XV. Old Age 84 •• •• •• •• •• •• •• •• •• •• •• •• •• 23 45 16 •• •• •• XVI. Sudden •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 32 27 XVII. Violent Death. 59 28 2 2 •• 1 33 2 1 5 3 5 4 2 1 2 1 •• 1 6 XVIII. Not Specified 7 4 •• •• l •• 5 •• •• 1 •• •• •• •• •• •• •• •• 4 4 1. Small Pox 8 1 2 •• •• •• 3 •• •• 2 1 2 •• •• •• •• •• •• 34 37 Measles 71 14 24 13 9 5 65 5 1 •• •• •• •• •• •• •• •• •• 33 43 Scarlatina 76 3 16 17 13 9 58 11 1 4 1 1 •• •• •• •• •• •• 49 40 Hooping Cough 89 33 32 9 7 4 85 4 •• •• •• •• •• •• •• •• •• •• 13 18 Croup 31 6 8 6 5 2 27 4 •• •• •• •• •• •• •• •• •• •• 4 4 Thrush 8 8 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 39 70 Diarrhœa 109 77 13 1 1 1 93 1 1 •• •• •• 4 2 6 2 •• •• 3 3 Dysentery 6 2 1 •• •• •• 3 •• •• •• 2 •• •• •• 1 •• •• •• 3 2 Cholera 5 2 •• •• •• •• 2 •• •• •• 1 •• 1 •• 1 •• •• •• 1 2 Influenza 3 1 1 •• •• •• 2 •• •• •• •• •• •• •• 1 •• •• •• 2 •• Scurvy and Purpura 2 •• •• •• •• •• •• 1 •• •• •• •• 1 •• •• •• •• •• •• •• Ague •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 2 1 Remittent Fever 3 •• •• •• •• •• •• •• •• 1 1 •• •• •• 1 •• •• •• 10 2 Infantile Fever 12 2 2 4 1 2 11 1 •• •• •• •• •• •• •• •• •• •• 28 46 Typhus Fever 74 •• •• 1 3 5 9 5 7 13 7 8 9 6 7 3 •• •• 3 3 Puerperal Fever 6 •• •• •• •• •• •• •• •• 1 4 1 •• •• •• •• •• •• 7 2 Rheumatic Fever 9 •• •• 1 •• •• 1 3 1 1 1 1 1 •• •• •• •• •• 7 12 Erysipelas 19 6 1 2 •• •• 9 •• •• 1 •• 3 1 3 1 •• 1 •• 4 5 Syphilis 9 7 •• •• •• •• 7 •• •• 1 •• •• 1 •• •• •• •• •• •• 2 Noma (Canker) 2 2 •• •• •• •• 2 •• •• •• •• •• •• •• •• •• •• •• •• •• Hydrophobia •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 4 4 II. Hæmorrahge 8 •• •• •• •• 1 1 •• 1 •• 1 1 2 •• 2 •• •• •• 7 13 Dropsy 20 2 •• •• •• •• 2 1 .. •• •• 1 1 4 4 6 •• •• 8 3 Abscess 11 .. 2 1 1 1 5 .. .. .. 1 2 1 1 •• 1 •• •• 2 •• Ulcer 2 •• 1 •• •• •• 1 •• •• •• .. •• •• •• 1 •• •• •• •• •• Fistula .. .. •• .. .. .. .. .. •• •• •• •• •• •• •• 3 3 Mortification 6 •• •• •• 1 •• 1 •• •• •• •• 1 •• 1 .. 3 •• •• 29 21 Cancer 50 1* •• •• •• •• 1 •• .. . . 2 7 17 14 6 3 •• •• 1 1 Gout 2 •• •• •• •• •• •• •• •• •• 1 •• •• •• •• 1 •• •• 13 15 III. Scrofula 28 3 2 1 2 2 10 5 2 3 •• 3 1 3 1 •• •• •• 20 20 Tabes Mesenterica 40 17 4 7 4 2 34 1 1 2 1 •• •• 1 •• •• •• •• 163 110 Pathises (Consumpn.) 273 4 5 2 1 12 5 4 55 84 61 38 12 2 •• •• •• 30 43 Hydrocephalus 73 26 25 12 3 1 67 4 2 •• •• •• •• •• •• •• •• •• 41 18 IV. Cephalitis 59 12 10 1 4 2 29 6 3 3 2 4 3 4 3 1 2 •• 20 20 Apoplexy 40 •• •• •• 1 •• 1 •• •• •• •• 3 5 17 10 4 •• •• 38 15 Palsy (Paralysis) 53 •• •• •• •• •• •• •• •• •• 1 2 4 12 22 10 2 •• 1 2 Delirium Tremens 3 •• •• •• •• •• •• •• •• •• 1 2 •• •• •• •• •• •• 1 .. Chorea 1 •• •• 1 .. •• 1 •• •• •• •• •• •• •• •• •• •• •• 5 3 Epilepsy 8 •• •• •• 1 •• 1 •• •• 1 •• 3 •• 2 •• 1 •• •• 1 •• Tetanus 1 •• •• •• •• •• •• 1 .. •• •• •• •• •• •• •• •• •• •• •• Insanity •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 36 28 Convulsions 64 49 11 2 2 •• 64 •• •• •• •• •• •• •• •• •• •• •• 9 15 Disease of Brain, &c. 24 3 2 •• 1 1 7 •• •• 1 2 1 3 7 3 •• •• •• * "Tumour on Abdomen." TABLE I. DISTINGUISHING THE AGES AND CAUSES OF DEATH (Deaths of Strangers in Hospitals excluded.) Annual Report, Excess of Births over Deaths, (corrected.) 1873. 1856. West s.d. East s.d. Causes of Death. All Ages. AGES. Und 1 1- 2- 3- 4- Und 5 5- 10- 15- 25- 35- 45- 55- 65- 75- 85- 95 Up. •• 2 V. Pericarditis 2 •• •• •• •• •• •• •• •• •• •• •• 1 1 •• •• •• •• •• 1 Aneurism 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 35 36 Disease of Heart, &c. 71 2 •• •• •• •• 2 1 2 6 3 15 8 13 13 8 •• •• 12 8 VI. Laryngitis 20 7 2 1 2 1 13 2 •• 1 •• 1 2 1 •• •• •• •• 133 91 Bronchitis 224 46 23 10 2 1 82 2 1 2 6 10 19 35 39 24 4 •• 1 1 Pleurisy 2 •• •• •• •• •• •• •• •• •• •• 1 •• 1 •• •• •• •• 88 6l Pneumonia 119 45 28 8 2 2 85 4 1 3 2 7 4 5 3 4 •• 1 6 12 Asthma 18 •• •• •• •• •• •• •• •• •• 1 1 2 6 7 1 •• •• 4 5 Disease of Lungs 9 •• 1 2 •• •• 3 •• •• •• 1 1 •• 3 1 •• •• •• 13 15 VII. Teething 28 16 12 •• •• •• 28 •• •• •• •• •• •• •• •• •• •• •• 2 •• Quinsey 2 1 •• •• •• •• 1 •• •• •• •• •• 1 •• •• •• •• •• 2 1 Gastritis 3 1 •• •• •• •• 1 •• •• •• •• 1 •• 1 •• •• •• •• 5 7 Enteritis 12 6 •• •• •• •• 6 •• 1 •• •• 1 1 1 2 •• •• •• 4 8 Peritonitis 7 1 •• •• •• •• 1 •• 2 •• 1 1 1 •• •• 1 •• •• 3 5 Ascites 8 •• •• •• •• •• •• •• •• •• •• 1 1 3 3 •• •• •• 2 2 Ulceration of Intest. 4 •• •• •• •• •• •• •• •• •• 1 1 •• •• 2 •• •• •• 3 2 Hernia (Rupture) 5 •• •• •• •• •• •• •• •• •• •• •• •• 1 4 •• •• •• 5 3 Ileus 8 3 •• •• •• •• 3 •• •• •• 1 •• •• 2 •• 1 1 •• •• 1 Intussusception Stricture of Intestinal 1 1 •• •• •• •• 1 •• •• •• •• •• •• •• •• •• •• •• 1 1 Canal 2 •• •• •• •• •• •• •• •• •• •• •• •• 1 •• 1 •• •• 2 5 Dis. of Stomach, &c. 7 2 •• •• •• •• 2 •• •• •• 1 1 •• •• 2 •• 1 •• 1 Disease of Pancreas . 1 •• •• •• •• •• •• •• •• •• •• •• 1 •• •• •• •• •• 6 5 Inflammation of Liver 11 •• •• •• •• •• •• •• •• 1 2 3 1 1 3 •• •• •• 6 4 jaundice 10 5 •• •• •• •• 5 •• •• •• 1 •• 1 1 1 •• 1 •• 25 7 Disease of Liver 32 2 •• •• •• •• 2 •• •• •• 2 8 6 9 4 1 •• •• 1 1 Disease of Spleen 2 •• 1 •• •• •• 1 •• •• •• •• •• 1 •• •• •• •• •• 1 1 VIII. Nephritis 2 •• •• •• •• •• •• 1 •• •• •• •• •• •• 1 •• •• •• 4 2 Nephria(Bright'sDis) 6 •• •• •• •• •• •• •• •• •• •• 5 1 •• •• •• •• •• •• 1 Ischuria 1 •• •• •• •• •• •• •• •• •• •• •• •• •• 1 •• •• •• •• 1 Diabetes 1 •• •• •• •• •• •• •• •• •• •• •• 1 •• •• •• •• •• 1 2 Stone 3 •• •• •• •• •• •• •• •• •• •• 1 •• 1 •• 1 •• •• •• •• Cystitis •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 2 2 Stricture of Urethra 4 •• •• •• •• •• •• •• •• •• 1 1 l 1 •• •• •• •• 7 5 Disease of Bladder &c 12 •• •• •• •• •• •• •• •• •• •• 2 3 1 4 2 •• •• •• •• IX. Paramenia •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 1 2 Ovarian Dropsy 3 •• •• •• •• •• •• •• •• •• •• •• 2 •• •• 1 •• •• 3 3 Childbh. (see Metria) 6 •• •• •• •• •• •• •• •• 2 3 1 •• •• •• •• •• •• 2 •• Dis. of Uterus, &c. 2 •• •• •• •• •• •• •• •• •• •• •• •• 1 1 •• •• •• •• •• X. Rheumatism •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• .. •• Arthritis •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Dis. of Joints, &c. •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 1 1 XI. Carbuncle 2 •• •• •• •• •• •• •• •• •• •• •• •• 2 •• •• •• •• •• •• Phlegmon •• .. .. •• .. •• .. .. •• •• •• •• •• •• •• •• •• •• 1 •• Disease of Skin, &c. 1 •• •• •• •• •• •• •• •• •• •• •• •• •• 1 •• •• •• 4 2 XII. Cyanosis 6 4 •• •• •• •• 4 2 •• •• •• •• •• •• •• •• •• •• 1 1 Spina Bifida 2 2 •• •• •• •• 2 •• •• •• •• •• •• •• •• •• •• •• 6 2 Other Malformations 8 6 1 •• •• •• 7 •• 1 •• •• •• •• •• •• •• •• •• •• •• XIII. Intemperance •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• .. .. Privation of Food •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 13 4 Wane of Breast Milk 17 16 1 •• •• •• 17 •• •• •• •• •• •• •• •• •• •• •• .. •• Neglect •• •• •• .. •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 1 Cold 1 1 •• •• •• •• 1 •• •• •• •• •• •• •• •• •• •• •• 1 1 Poison 2 •• •• •• •• •• •• •• •• •• 1 •• 1 •• •• •• •• •• 3 2 Burns and Scalds 5 •• 1 •• •• 1 2 2 •• •• •• •• •• •• •• 1 •• •• 2 •• Hanging 2 •• •• •• •• •• •• •• •• •• •• 1 •• 1 •• •• •• •• •• •• Suffocation •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 2 3 Drowning 5 .. .. 1 •• •• 1 •• •• 2 •• 1 •• 1 •• •• •• •• 5 2 Fractures & Contus. 7 2 •• •• •• •• 2 •• •• 2 1 •• •• •• 1 I •• •• 2 5 Wounds 7 1 •• •• •• •• 1 •• 1 •• 1 3 1 •• •• •• •• •• 4 9 Other Violence 13 8 •• 1 •• •• 9 •• •• 1 •• •• 2 •• •• •• 1 •• TABLE II. DEATHS OCCURRING IN EACH WEEK AND QUARTER, DISTINGUISHING CERTAIN IMPORTANT DISEASES AND AGES. [Deaths of Non-Residents in Hospitals, and of Islington Patients in Hospitals elsewhere, not included.] 1 2 3 4 5 6 7 8 9 10 11 121 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Weeks ending Inn 5 Jan. 12 Jan. 19 Jan 26 Feb 2 Feb. 9 Feb. 16 Feb. 23 Mar 1 Mar 8 Mar 15 Mar 22 Mar 29 1st Quarter. Apr. 5 Apr. 12 Apr. 19 Apr 26 May 3 May 10 May 17 May 24 May 31 Jun 7 Jun 14 Jun 21 Jun 28 2nd Quarter. Total 42 60 39 45 40 47 51 43 39 29 39 52 48 574 46 57 40 42 43 49 45 41 31 48 50 45 35 572 Under 3 years 19 26 11 20 15 21 19 21 12 10 14 19 20 227 21 24 18 16 18 16 22 22 16 18 17 17 15 240 70 years and upwards 4 8 3 8 3 3 6 3 6 4 5 4 5 62 4 7 5 7 2 5 8 1 1 6 3 3 53 Zymotic 10 9 6 10 13 10 7 8 12 5 7 9 8 114 10 17 6 5 8 10 7 6 8 11 13 8 9 118 Measles •• •• •• . . •• .. l 1 2 •• l 1 •• 6 1 5 1 .. 2 •• 1 1 1 1 1 2 •• 16 Scarlatina 3 3 1 1 3 1 1 3 •• 2 1 1 1 21 9 4 1 1 •• 2 •• 1 4 4 2 2 1 24 Hooping Cough 3 2 1 4 5 5 4 3 3 1 2 .. 3 36 4 2 1 •• 3 3 1 3 1 2 4 1 3 28 Diarrhœa 1 1 •• 2 •• 1 •• •• •• •• 1 •• •• 6 1 1 •• 1 •• 3 •• •• •• 1 2 •• 2 11 Cholera •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Typhus 2 1 1 .. 3 1 1 1 4 •• 3 2 3 22 3 1 2 1 .. 3 1 1 1 2 •• 15 Phthisis 2 6 7 2 4 5 10 4 1 3 2 3 5 54 5 8 9 3 12 4 6 5 3 8 7 4 1 75 Respiratory Organs 10 9 9 9 8 11 9 9 7 5 10 12 8 116 10 6 8 14 5 9 8 13 5 5 7 6 6 102 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Weeks ending July 5* July 12" July 19 July 26 Aug 2 Aug 9 Aug 16 Aug 23 Aug 30 Sep. 6 Sep. 13 Sep. 20 Sep 27 3rd Quarter. Oct. 4 Oct. 11 Oct. 18 Oct. 25 Nov 1 Nov 8 Nov 15 Nov 22 Nov 29 Dec 6 Dec 13 Dec 20 Dec 27 4th Quarter. Total 39 52 31 33 52 37 52 50 48 49 40 40 39 562 33 36 41 30 42 44 56 54 50 54 37 39 49 565 Under 3 years 20 17 13 22 26 17 31 17 26 27 16 18 14 264 11 20 15 12 19 19 22 18 18 22 12 16 15 219 70 years and upwards 4 5 5 4 7 4 4 5 4 6 •• 9 4 61 3 2 4 4 4 4 6 6 2 5 6 7 7 60 Zymotic 10 14 6 13 14 lb 19 21 14 15 8 9 6 165 7 8 8 4 9 11 19 12 13 14 5 7 10 127 Measles 2 3 •• .. 3 2 1 1 1 •• •• •• 2 14 •• •• 2 •• 2 2 1 2 6 7 2 2 6 32 Scarlatina 3 2 •• 1 1 1 1 2 1 •• 1 •• •• 13 1 2 •• 1 1 3 2 1 2 l •• •• 1 15 Hooping Cough 1 3 •• 3 1 .. 1 •• 2 •• 1 1 1 14 1 •• 1 •• •• •• 2 2 2 2 •• 1 •• 11 Diarrhœa 2 1 3 6 5 8 15 12 9 11 2 3 1 78 1 3 •• •• 1 2 1 1 •• 2 •• 1 •• 12 Cholera •• .. •• •• 1 1 1 2 •• •• •• •• •• 5 •• •• •• •• •• •• •• •• •• •• •• •• •• •• Typhus •• 3 2 1 1 5 •• 4 •• 2 3 2 1 24 3 1 1 2 2 2 3 3 1 1 •• •• 1 20 Phthisis 4 8 2 4 3 4 6 6 3 6 1 6 53 8 4 6 6 3 9 8 8 3 7 4 7 12 85 Respiratory Organs.. 7 3 5 3 5 2 2 3 2 5 3 4 4 48 1 5 7 4 5 8 13 12 21 12 8 10 10 116 TABLE III. SHEWING THE NUMBER OF DEATHS REGISTERED EACH QUARTER, IN EACH WARD OP THE PARISH, DISTINGUISHING THOSE FROM ZYMOTIC AND TUBERCULAR DISEASES, AND SUCH AS TOOK PLACE IN INFANCY, AND THE PROPORTION BORNE BY THESE DEATHS TO THE TOTAL MORTALITY OF THE WARD. (Omitting Workhouse and Infant Poor-House.) 18 5 6. WARD 1. WARD 2. WARD 3. WARD 4. Total. Zymotic. Tubercular. Under 5. Total. Zymotic. Tubercular. Under 5. Total. Zymotic. Tubercular. Under 5. Total. Zymotic. Tubercular. Under 5. 1st Quarter 23 4 3 10 38 7 7 19 41 8 6 18 124 31 20 70 2nd Quarter 19 3 1 10 42 10 6 17 44 10 10 14 125 22 37 74 3rd Quarter 26 10 7 10 39 7 7 18 54 21 9 28 108 27 23 64 4th Quarter 20 3 5 6 41 12 7 17 68 15 15 27 116 20 26 54 Yearly Total 88 20 or per cent 2272 16 or per cent 18.18 36 or per cent. 40.90 160 36 or per cent 22 50 27 or per cent 16.87 71 or per cent 44.37 207 54 or per cent 26 08 40 or per cent 19.32 87 or per cent 42.02 473 100 or per cent 21.14 106 or per cent 22.41 262 or per cent 55.39 WARD 5. WARD 6. WARD 7. WARD 8. Total. Zymotic. Tubercular. Under 5. Total. Zymotic. Tubercular. Under 5. Total. Zymotic. Tubercular. Under 5. Total. Zymotic. Tubercular. Under 5. 1st Quarter 74 9 12 32 60 20 8 27 54 5 11 22 118 24 15 52 2nd Quarter 72 9 13 31 46 9 11 16 59 14 9 24 109 22 22 66 3rd Quarter 66 18 5 30 38 9 5 18 59 15 8 22 116 47 17 79 4th Quarter 156 14 5 26 44 4 8 15 49 12 7 21 121 30 16 53 Yearly Total 268 50 or per cent 18.65 35 or per cent 1305 119 or per cent 44.40 188 42 or per cent 22.34 32 or per cent 17.02 76 or per cent 40.42 221 46 or per cent 20.81 35 or per cent 15.83 89 or per cent. 40.27 464 123 or per cent 26 50 70 or per cent 1508 240 or per cent 51.72 TABLE IV. SHEWING THE NUMBER OF DEATHS IN THE METROPOLIS AND IN ISLINGTON AND ITS SUB-DISTRICTS FROM ZYMOTIC AND EPIDEMIC DISEASES. Epidemic Diseases especially affecting Children. 1 Population 1851 2 Deaths 1856 3 Deaths fr Zymotic Disease. 4 Per ct. of all deaths 5 . Population 1851 under 5 years. 6 Per 1000 of Popn. under 5. 7 Zymtc deaths undr 5 8 Per 1000 of Popn. under 5. 9 Small Pox. 10 Per ct. of all deaths 11 Measles. 12 Per ct. of all deaths 13 Scarlatina 14 Per ct. of all deaths 15 Hooping Cough 16 Per ct. of all deaths 17 Diarrhoea. 18 Per ct. of all deaths 19 Total. 20 Per ct. of all deaths 21 Typhus. 22 Per ct. of all deaths LONDON 2362236 * 56786 12859 22.6 293562 124.2 522 0.919 1445 2.544 1795 3.160 2078 3.659 2251 3.964 8091 14.2 2645 4.657 ISLINGTON 95329 2294 542 23.6 12190 127.8 385 31.5 8 0.348 71 3.095 76 3.312 89 3.879 109 4.751 353 15.3 74 3.225 I. WEST 47881 1201 246 20.4 6135 128.1 175 28.5 4 0.333 34 2.830 33 2.747 49 4.079 39 3.247 159 13.2 28 2.331 I. EAST 47448 1093 296 27.0 6055 127.6 210 34.6 4 0.365 37 3.385 43 3.934 40 3.659 70 6.404 194 17.7 46 4.208 * The Deaths in London are stated as Registered in the 52 weeks ending December 27th, both in this and succeeding table. TABLE V • SHEWING THE NUMBER OF DEATHS IN THE METROPOLIS AND IN ISLINGTON AND ITS SUB-DISTRICTS FROM THE TUBERCULAR CLASS OF DISEASES. All deaths, 1856 Tubercular Disease. Per cent of all deaths. Scrofula Per cent of all deaths. Tabes Mcsenterica. Per cent of all deaths. Phthisis Per cent of all deaths. Hydrocephalus Per cent of all deaths. LONDON * 56786 9731 17.1 380 0.669 804 1.415 7196 12.672 1351 2.379 ISLINGTON 2294 414 18.0 28 1.220 40 1.743 273 11.900 73 3.182 I. WEST 1201 226 18.8 13 1.082 20 1.665 163 13.572 30 2.497 I. EAST 1093 188 17.2 15 1.372 20 1.829 110 10.064 43 3.934 TABLE VI. SHEWING THE SANITARY CONDITION OF TWELVE HUNDRED DWELLINGS OF THE LOWER CLASSES IN ISLINGTON. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 No. of Houses systematically inspected. No. of inhabited Rooms. Mean No. of Rooms in a house. No. of Inmates. No. of separate Holdings. Mean No. of Holdings to a House. Mean No. of Individuals in a house. Mean No. of Individuals in a Room. Mean No. of Individuals to one Holding. Dirty Houses. Per cent of Total. Houses damp, chiefly from foundation. Per cent of Total. Dust-bins wanting or defective. Per cent of Total. Yards wet, dirty or unwholesome. Per cent of Total. Unwholesome or defective Water supply. Per cent of Total. Cesspools and unwholesome Privies. Per cent of Total. Houses with untrapped Drains. Per cent of Total. Ventilation very defective. Per cent of Total. Sum of Defects. Divided by No. of Houses. West Sub-District. 544 2676 4.9 4490 1203 2.2 8.2 1.6 3.7 123 22.6 44 8.0 329 60.4 74 13.6 44 8.0 330 60.6 255 46.8 22 4 1221 2.24 East Sub-District 656 2176 3.3 5027 1267 1.9 7.6 2.3 3.9 239 36.4 216 32.9 481 73.3 110 16.7 252 38.4 475 72.4 312 47.5 246 37 2531 3.85