72 ISL35 REPORT on the SANITARY CONDITION OF ST. MARY, ISLINGTON, FOR JANUARY, 1866. No. CV. The registered mortality for January (354) has been close upon that obtained by computation, viz,:—359. There is still a good deal of typhoid fever prevalent in the parish, but, with that exception, the general health of the district has been, during the four weeks, satisfactory upon the whole. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, February 10 th,1866. TABLE A. Showing the Number of Cases of disease generally, and of Bowel Complaints particularly, recorded in the corresponding month for the last six years; and also the total of the deaths from all causes, and from Bowel Complaints. January Total Sickness. Total Deaths. Diarrhoea. Dysentery. Cholera. Bowel Complaints. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1866 2444 354 50 3 1 50 4 1865 2354 369 26 4 1 — — — 27 4 1864 2489 450 45 1 2 — — — 47 1 1863 2453 282 50 4 — — — — 50 4 1862 2390 230 40 — 3 — — — 43 - 1861 2136 331 39 4 6 1 — — 45 5 1860 2254 243 29 — 1 1 — — 30 1 TABLE B. Results of a Special Analysis of the Water supplied by the Metropolitan Water Companies during January, as made and published by the Metropolitan Association of Medical Officers of Health. Total solid matter per Imperial gallon. Loss by Ignition. Oxydisable Organic Matter. Hardness. Before Boiling. After Boiling. Thames Water Companies. grains. grains. grains. degrees. degrees. Grand Junction 20.95 1.57 0.76 13.6 4.0 West Middlesex 23.45 1.96 0.66 13.5 5.2 Southwark and Vauxhall. 21.46 1.89 0.73 13.6 4.0 Chelsea 19.79 1.00 0.93 13.5 4.2 Lambeth 19.36 1.80 1.03 11.4 5.0 Other Companies. Kent 26.12 0.86 0.19 17.5 7.0 New River 21.05 1.00 0.35 16.2 4.9 East London 24.25 1.28 0.59 15.7 6.4 TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FOUR WEEKS ENDING JANUARY 27th, 1866, (Deaths of Non-Residents in Hospitals excluded.) West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 4 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of Age. At 20 and under 40 years of ace. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. 158 196 All Causes 354 178 41 63 58 14 34 50 3. Respirat. Orgs. 84 45 4 12 19 4 2 2 Laryngitis 4 4 .. .. .. .. 35 43 (Classes.) I. ZYMOTIC DIS. 78 60 8 6 3 1 20 35 Bronchitis 55 25 3 9 15 2 .. 1 Pleurisy 1 .. .. .. 1 .. 10 12 Pneumonia 22 15 1 2 2 2 26 32 II. CONSTITUTE 58 16 18 19 5 .. 1 .. Asthma 1 .. 1 .. .. 1 .. Lung Diseases, &c. 1 1 .. .. .. .. 76 99 III. LOCAL 175 72 16 38 44 6 6 9 4.Digestive Orgs. 14 1 2 7 4 .. 20 17 IV. DEVELOPMNL. 37 24 •• •• 6 7 1 l Gastritis 2 .. .. 1 1 .. .. .. Enteritis .. .. .. .. .. .. 1 5 V. VIOLENT DTHS. 6 6 •• •• •• •• .. l Peritonitis 1 .. 1 .. .. .. •• •• Not Specified •• •• •• •• .. .. .. Ascitcs • • .. .. .. .. .. .. .. Ulceration of Intes. .. .. .. .. .. .. .. .. Hernia .. .. .. .. .. .. 33 41 (Orders.) I. 1. Miasmatic Sis. 74 57 7 6 3 1 .. .. Ileus .. .. .. .. .. .. .. .. Intussusception .. .. .. .. .. .. .. .. Stricture of Intest. .. .. .. .. .. .. 3 3 Small Fox 6 6 1 •• •• •• .. .. Fistula .. .. .. .. .. .. 7 3 Measles 10 10 •• •• •• •• 1 3 Stomach dis., &c. 1 .. 1 2 1 .. 2 5 Scarlatina 7 7 •• •• •• •• .. .. Pancreas Dis., &c. .. .. .. .. .. .. 3 3 Diphtheria 6 6 • • .. 1 Hepatitis 1 .. .. l .. .. •• • • Quinsey •• •• •• •• •• •• 1 .. Jaundice 1 1 .. .. .. .. 3 6 Croup 9 9 •• •• •• •• 2 3 Liver Disease 5 .. .. 3 2 .. 5 10 Hooping; Cough 15 15 •• •• •• •• .. .. Spleen Disease .. .. .. .. .. .. 6 6 Typhus & Typhoid 11 3 4 3 1 • • 2 5 5. Urinary Orgs. 7 .. 1 3 3 .. •• 2 Erysipelas 2 1 •• 1 •• • • .. .. Nephritis .. .. .. .. .. .. •• •• Pyæmia •• •• •• •• •• •• .. .. Disease of Bladder .. .. .. .. .. .. •• 2 Puerpera Fever 2 •• 1 1 •• • • .. 3 Nepheria 3 .. 1 1 1 .. •• •• Carbuncle •• •• •• •• •• •• .. .. Diabetes .. .. .. .. .. .. •• •• Influenza •• • • •• • • •• •• .. .. Stone .. .. .. .. .. .. 1 •• Dysentery 1 •• •• •• •• 1 .. 1 Prostrate Disease . 1 .. .. .. 1 .. 2 1 Diarrhœa 3 1 •• 1 •• 2 1 Kidney Disease,&c. 3 .. .. 2 1 .. •• •• Cholera •• •• •• •• •• •• 2 .. 6. Genera. Organs 2 .. 2 .. .. • • •• Ague •• •• •• •• •• •• .. .. Ovarian Dropsy .. .. .. .. .. .. 1 1 Rheumatism 2 •• 1 •• 1 •• 2 Uterine Diseases. 2 .. .. 2 .. .. 1 1 2. Enthetic 2 2 •• •• •• •• .. 1 7. Orgs. of Locomo. 1 1 .. .. .. .. 1 1 Syphitis 2 2 •• •• •• •• .. .. Spine Diseases .. .. ...... .. .. .. • • • • Structure of Urethra • • •• •• •• •• •• .. 1 Bone Diseases 1 1 .. .. .. .. • • •• Hydrophobia • • •• •• •• .. .. 8. Skin, &c .. .. .. .. .. .. • • •• Glanders • • •• •• •• •• •• .. .. Phlegmon & Abscess .. .. .. .. .. .. 1 1 3. Dietic 2 1 1 •• •• • • .. .. Ulcer .. .. .. .. .. .. •• 1 Privation Want of Br. Milk 1 l •• •• •• • • .. .. Skin Diseases •• •• •• •• •• •• •• .. Purpura and Scurvy •• •• 1 •• •• •• 2 4 IV. 1. Dis. of Childn. 6 6 •• •• •• •• 1 .. 4. Parasitic •• •• •• •• •• •• 2 4 Premature Birth 6 6 •• •• •• •• •• .... Thrush •• •• •• •• •• •• .. .. Cyanosis •• •• •• •• •• •• •• .. worms •• •• •• •• •• •• .. .. Spina Bifida .. •• •• •• •• •• •• .. .. Other Malformation •• •• •• •• •• •• .. .. Teething ..•• •• •• •• •• •• 3 6 II. 1. Diatheitc 9 •• •• 4 5 .. .. 2. Dis. of Adults •• •• •• •• •• •• .. .. Gout 2 • • • • •• 2 •• .. .. Paramenia •• •• •• •• •• •• 2 2 Dropsy 4 •• •• 3 1 •• .. .. Childbirth .. •• •• •• •• •• •• .. Haemorrhage .. • • •• •• •• •• .. .. 3. Dis. of Aged. 13 •• •• •• 6 7 1 2 Cancer 3 • • •• 1 2 .. 11 2 Old Age 13 •• •• •• 6 7 •• .. Noma .. • • • ' • • • • •• 11 2 4. Dis. of Nutritn. 18 18 •• •• •• •• .. Mortification •• .. •• •• •• •• 7 11 Atrophy & Debility 18 18 .. •• •• •• 23 26 2. Tubercular 49 l6 18 15 .. .. 7 11 •• 2 Scrofula 2 l •• 1 •• •• V. 1. Acci. of Neg. 6 •• .. •• •• •• •• 3 Tabes Mesenterica 3 3 •• •• •• 1 5 20 17 hthisis 37 6 18 14 •• •• .. .. Fract. and contus. •• •• •• •• •• •• 3 4 Hydrocephalus 7 7 •• •• •• •• .. Wounds •• •• • • •• •• •• .. • • Burns and Scalds •• •• •• •• •• •• .. • • Poison •• •• •• •• •• •• 24 20 III. 1. N'ervous Syat. 44 23 4 5 11 1 .. .. Drowning •• •• •• •• •• •• 1 1 Cephaititis 2 •• •• •• •• •• 1 4 Suffocation 5 5 •• •• •• •• 3 2 Apoplexy 5 •• •• 2 3 •• .. 1 Otherwise 1 1 •• •• •• •• 6 6 Paralysis 12 •• l 2 7 1 .. .. 2, Homicide •• •• .. •• •• •• •• Insanity •• •• .. •• •• •• .. •• 3. Suicids .. •• •• •• •• • • chorea •• •• •• •• •• •• •• .. Wounds •• •• •• •• •• •• 2 1 Epitepsy 3 1 1 1 •• •• .. .. Poison •• •• •• •• •• •• 8 10 Convulsions .. .. Drowning •• •• .. •• •• •• 4 • • Brain Diseases, &c. 4 1 2 .. 1 •• .. •• Suffocat. and Hang. •• •• •• •• •• •• 9 14 2. Organs of Circ. 23 2 4 9 7 1 • • • • Otherwise ••.. .. •• •• •• •• •• • • Pericarditis .. .. .. .. .. .. .. .. 4. Unclassed •• •• •• •• •• •• 1 Aneurism 2 .. .. 2 .. .. .. .. | 8 13 Heart Disease 21 2 4 7 7 1 TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FOUR WERKS ENDING SATURDAY, THE 27th DAY OF JANUARY, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison. Total. small pox .. .. 9 3 1 .. 13 chiken pox .. .. 5 3 1 .. 9 Measles .. .. 26 29 1 .. 56 Scarlatinas .. .. 9 1 1 .. 11 Whooping Cough .. 1 20 34 1 .. 56 Croup .. • • 3 2 .. .. 5 Diarrhoc 2 .. 25 19 3 .. 50 Dysentery .. .. .. .. • • .. .. Cholers . • .. .. .. .... •• .. Ague .. .. .. • • 1 .. 1 Continued Fever 2 .. 9 14 3 .. 28 Puerperal Fever • • .. .. .. .. .. .. Rheumatic Fever 2 .. .. 19 8 .. 29 Erysipeals 2 .. 12 1 1 .. 16 Diphtheria • • • • .. 1 .. .. 1 Sorethroat or tonsillitis • • .. 13 13 .. .. 34 Mumps .. .. 1 .. .. .. 1 Pyemia .. • • • • .. .. .. .. Bronchitis and Catarrh 17 1 266 126 65 29 504 Pneumonia .. .. 10 6 4 .. 20 Pleurisy 1 .. 5 1 .. .. 7 Delirium Tremens .. .. .. 2 .. .. 2 insanity 1 .. 2 .. • • .. 3 All other Diseases .. .. 1 1 1 .. 3 Total 42 10 478 476 470 119 1595 69 12 894 751 569 149 | 2444 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From December 31st, 1865, to January 27th, 1866. West SubDistrict East SubDistrict. Total. Number of houses inspected 125 162 287 Drains Constructed 5 9 14 Improved or repaired 22 28 50 Traps fixed 23 37 60 Cesspools Abolished .. .. .. Cleansed or disinfected .. .. .. Privies and Water Closets Pan, trap, and water supply furnished .. 3 3 pan and trap only furnished 3 .. 3 Water supply furnished 15 3 18 Dust bins Constructed 3 13 16 Repair and covers adapted 1 9 10 Surface Drains and Pavements of Yards Constructed .. 11 11 Relaid 17 13 30 General Water supply New receptacle provided 2 . . 2 Receptacle repaired and cleansed 6 11 17 Water supplyprovided 2 .. 2 Other Improvements House generally repaired 7 .. 7 ,, cleansed or limewashed 14 7 21 " ventilated .. .. .. Overcrowding abated 4 2 6 Illegal use of underground Rooms for sleeping discontinued 1 •• 1 73 REPORT on the SANITARY CONDITION OF ST. MARY, ISLINGTON, FOE, FEBRUARY, 1866. No.CV I. The mortality as registered during the four weeks ending February 24th has only been 296, a number which is 22 less than the mortality in the corresponding weeks of both 1864 and 1865, and also 22 less than the corrected mean mortality of the previous nine years. The principal reduction is in the class of " local diseases," and is due to the mild weather, chest affections mainly swelling the deaths at this period of the year. There were only 48 deaths recorded from diseases of the respiratory organs (excluding phthisis), the smallest number since 1859. There has been a slight increase since January in the number of deaths from measles and scarlet fever. The general amount of sickness has been somewhat in excess of that occurring in January—especially there has been some increase in the cases of measles, scarlet fever, hooping cough, and bronchitis. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, March 10th, 18GC. TABLE A. Showing the Number of Cases of disease generally, and of Bowel Complaints particularly, recorded in the corresponding month for the last six years ; and also the total of the deaths from all causes, and from Bowel Complaints. February Total Sickness. Total Deaths. Diarrhoea. \ Dysentery. Cholera. Bowel Complaints. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1866 2508 296 46 1 1 - - 1 47 2 1865 2069 318 21 3 1 — — — 22 3 1864 2093 318 54 2 — 1 — — 54 3 1863 2522 266 44 1 2 — — — 46 1 1862 2341 269 29 1 3 — — — 32 1 1861 2113 241 41 3 5 — — 1 46 4 1860 2109 264 39 3 2 — — — 41 3 TABLE B. Results of a Special Analysis of the Water supplied by the Metropolitan Water Companies during February, as made and published by the Metropolitan Association of Medical Officers of Health. Total solid matter per Imperial gallon. Loss by Ignition. Oxydisable Organic Matter. Hardness. Before Boiling. After Boiling. Thames Water Companies. grains. grains. grains. degrees. degrees. Grand Junction 20.99 0.94 0.56 13.9 4.1 West Middlesex 20.56 1.09 0.60 13.6 3.8 Southwark and Vauxhall 22.81 1.34 0.72 13.9 4.5 Chelsea 20.51 1.28 0.64 13.9 4.0 Lambeth 21.15 1.00 0.66 14.0 4.5 Other Companies. "Kent 26.38 1.45 0.19 14.0 8.5 New River 21.20 1.28 0.39 15.0 4.8 East London 22.20 1.00 0.49 15.5 5.0 TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FOUR WEEKS ENDING FEBRUARY 24th, 1866, (Deaths of Non-Residents in Hospitals excluded.) West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 50 years of age. At 80 years of age and upwards. West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of Age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age And. upwards. 150 | 146 296 160 37 41 49 9 27 21 3. Respirat. Orgs 48 27 4 5 11 1 4 2 Laryngitis 6 4 .. 1 l .. 12 13 Bronchitis 25 13 1 2 9 .. .. .. Pleurisy .. .. .. .. .. .. 44 31 I. ZYMOTIC DIS. 75 62 6 5 2 .. 9 5 Pneumonia 14 10 2 1 .. 1 31 28 II. CONSTITUTL 59 21 18 13 7 .. 2 1 Asthma 3 .. 1 1 1 .. .. . . Lung Diseases, &c. .. .. .. .. .. .. 60 69 III. LOCAL 129 56 13 22 36 2 6 8 4. Digestive Orgs. 14 5 2 4 3 .. 13 14 IV. DEVELOPMNL. 27 16 .. .. 4 7 .. .. Gastritis .. .. .. .. .. .. •• Enteritis .. .. .. .. .. .. 2 4 V. VIOLENTDTHS. 6 5 •• 1 •• •• l .. Peritonitis 1 .. 1 .. .. .. .. .. Net specified •• •• •• •••• •• •• l Ascites 1 .. .. 1 .. .. •• .. Ulceration of Intes. .. .. .. .. .. .. .. l Hernia 1 .. .. .. l .. (Orders.) 2 .. Ileus 2 2 .. .. .. .. 1 Intussusception 1 .. .. 1 .. .. 41 27 I. 1. Miasmatic Dis. 68 57 5 4 2 •• .. .. Stricture of Intest. .. .. .. .. .. .. 1 2 Small pox 3 3 •• •• •• •• .. .. Fistula .. .. .. .. .. .. 8 5 Measles 13 13 •• •• •• •• 2 l Stomach Dis., &c 3 3 .. .. .. .. 4 8 Scarlatina 12 12 •• •• •• •• .. .. Pancreas Dis., &c. .. .. .. .... .. 3 •• Diphtheria 3 2 •• 1 •• •• .. 1 Hepatitis 1 .. 1 .. .. .. .. •• 1 Quinsey •• •• •• •• •• •• .. .. Jaundice .. .. .. .. .. .. 2 2 Croup 4 4 •• •• •• •• 1 3 Liver Disease 4 .. .. 2 2 .. 14 1 Hooping Cough 15 15 •• •• •• •• .. .. spleen Disease .. .. .. .. .. .. 5 5 Typhus & Typhoid 10 4 3 2 1 • • .. 1 5. Urinary Orgs 1 .. .. .. 1 .. .. 2 Ervsipclas 2 2 •• •• •• •• .. .. Nephritis .. .. .. .. .. .. .. .. Pyaemia .. 1 .. •• •• •• •• .. .. Discate of Bladder .. .. .. .. .. .. 1 • • Puerperal Fever 1 •• 1 •• •• •• .. .. Nephria .. .. .. .. .. .. 1 •• Carbuncle 1 •• •• 1 •• •• .. Diabetes .. .. .. .. .. .. .. •• Influenza •• •• •• •••• •• .. .. Stone ,, .. .. .. .. .. •• •• Dysentery •• •• •• •• •• .. .. Prostrate Diseases .. .. .. .. .... 1 •• Diarrhoea 1 1 •• •• •• •• .. 1 Kidney Disease,&c. 1 .. .. .. 1 .. 1 •• Cholera 1 •• 1 •• •• •• l .. 6. Genera. Organs 1 .. 1 .. .. .. .. .. Ague •• •• •• •• •• •• 1 .. Overian Drophy 1 .. 1 .. .. .. .. 2 Rheumation 2 1 •• •• •• •• .. .. Uterine Disease .. .. .. .. .. .. 1 .. 2. Enthetic 1 •• •• •• •• 1 .. 7. Orgs of Locomo 1 1 .. .. .. .. 1 • • Syphilis 1 1 •• •• •• •• .. .. Spine Diseases .. .. .. .. .. .. •• •• Stricture of Urethra •• •• •• •• •• •• 1 .. Bone Diseases .. 1 .. .. .. .. •• •• Hydrophobia •• •• •• •• •• •• .. .. 8. Skin, &c .. .. .. .. .. .. •• .. Glanders .. •• •• •• •• .. .. .. Phlegmon & Abscess .. .. .. .. .. .. 2 3 3. Dietic 5 3 1 l •• •• .. .. Ulcer .. .. .. .. .. .. .. .. Privation .. •• •• •• •• •• .. .. Skin Diseases .. .. .. .. .. .. 2 l Want of Br. Milk 3 3 •• •• •• •• .. .. Purpura and Scurvy •• •• .. 2 Alcoholism 2 •• 1 1 •• •• 1 4 IV. 1. Dis. of Childn. 5 5 .. .. .. .. .. 1 4. Parasitic 1 1 •• •• •• •• .. 3 Premature Birth 3 3 .. .. .. .. .. 1 Thrush 1 1 •• •• •• •• 1 .. Cyanosis l 1 .. .. .. .. .. .. Worms •• •• •• •• •• •• .. .. Spina Bifida .. .. .. .. .. .. .. 1 Other Malformatiorn 1 1 .. .. .. .. .. .. Teething .. .. .. .. .. .. 6 5 II. 1. Diathetic 11 •• 1 4 6 •• .. .. 2. Dis. of Adults .. .. .. .. .. .. •• .. Gout •• •• •• •• •• •• .. .. Paramenia .. .. .. .. .. .. •• •• Dropsy ..•• •• •• •• •• •• .. .. Childbirth .. .. .. .. .. .. .. .. Hemorrhage •• •• •• •• •• •• .. 3. Dis of Aged 11 .. .. .. 4 7 5 5 Cancer 10 .. 1 l •• 7 4 Old Age 11 .. .. .. 4 7 •• • • Noma •• •• •• •• •• .. 7 4 4. Dis. of Nutritn. 11 11 .. .. .. .. 1 .. Mortification l •• •• •• 1 •• 5 6 Atrophy & Debility .. 11 .. .. .. .. 25 23 2. Tubercular 48 21 17 9 1 .. 5 6 .. 1 Scrotula 1 1 .. .. .. .. 4 .. .. .. .. I 4 Tabes Mesenterica 4 1 .. .. .. .. 2 2 V. 1. Acci. or Neg. 4 4 .. .. .. .. 18 14 hthsis 32 5 17 9 l .. .. .. Fract. and Contua. .. .. .. .. .. .. 7 4 Hydroce 11 11 •• •• •• •• .. .. Wounds .. .. .. .. .. .. .. .. Burns and Scalds .. .. .. .. .. .. •• Poison .. .. .. .. .. .. 19 24 III. 1. Nervous Syst. 43 21 5 4 12 1 .. •• downing 1 l .. .. .. .. .. 1 Cephalitis 1 1 •• •• •• .. 1 2 Suffocation 3 3 .. .. .. .. 5 4 Apoplexy 9 l 1 3 3 1 1 .. Otherwise .. .. .. .. .. .. 2 4 Paralysis 6 •• •• .. 6 .. .. .. 2. Homicide .. .. .. .. .. .. .. .. Insanity •• •• • • •• •• .. .. 2 3. Suicide 2 1 .. 1 .. .. .. .. Chorea •• •• •• •• •• .. .. .. Wounds .. .. .. .. .. .. .. 2 Epilepsay 2 •• l •• 1 .. .. .. Poison .. .. .. .. .. .. 9 8 Convulsions 17 17 •• •• •• •• .. .. Drowning .. .. .. .. .. .. 3 5 Brain Diseases. &c 8 2 3 l 2 •• .. .. Suffocat. and Hang 2 1 .. 1 .. .. 6 15 2. Organs of Circ. 21 2 1 9 9 •• .. 2 Otherwise .. .. .. .. .. .. .. .. Pericarditis . .. •• •• •• •• •• .. .. 4. Unclassed .. .. .. .. .. .. .. 1 Aneurism l •• •• •• 1 •• .. •• 6 14 Heart Disease 20 2 1 9 8 •• TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FOUR WEEKS ENDING SATURDAY, THE 24TH DAY OF FEBRUARY, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway , Dispensary. Islington Dispensary. Pentonville Convict Prison. Total. Small pox .. .. 8 .. .. .. 8 Chicken Pox .. 1 1 1 .. .. 3 Measles 1 .. 21 45 1 .. 68 Scarlatinas .. .. 17 2 2 .. 21 Whooping Cough .. 2 40 25 5 .. 72 Croup .. .. .. 1 .. .. 1 Diarrhea 3 .. 19 17 4 3 46 Dysentery .. .. .. .. 1 .. 1 Cholera .. .. .. • • .. .. .. Ague .. .. 1 .. .. .. 1 Continued Fever 3 .. 10 10 3 .. 26 Puerperal Fever .. .. .. .. .. .. •• Rheumatic Fever 1 .. 1 2 12 •• 16 Erysipeals 1 .. 5 2 .. .. 8 Diphtheria • • .. 3 .. .. .. 3 Sorethroat or tonsillitis .. .. 12 6 3 .. 21 Mumps .. .. .. .. .. .. .. Pyamia .. .. .. • • .. .. .. Bronchitis and Catarrh 15 .. 313 128 76 34 566 Pneumonia .. .. 4 3 3 .. 10 Pleurisy .. .. 3 1 2 .. 6 Delirium Tremens .. .. .. .. .. .. .. Insanity 4 .. 2 .. .. .. 6 Carbuncle .. .. 2 .. .. •• 2 All other Diseases 37 4 505 463 491 123 1623 Total 65 7 967 706 603 160 2508 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From January 2.8th. 1866, to February 24th, 1866. West SubDistrict. East SubDistrict. Total. Number of houses inspected 95 30 125 Drains Constructed 14 4 18 Improved or repaired 27 47 10 37 Traps fixed 15 62 Cesspools Abolished 1 .. 1 Cleansed or disinfected .. .. . . Privies and Water Closets Pan, trap, and water supply furnished .. 2 4 6 pan and trap only furnished 2 • • 2 Water supply furnished 6 6 12 Dust bins Constructed. 1 .. 1 Repair and covers adapted 4 12 16 Surface Drains and Pavements of Yards Constructed. 1 .. 1 Relaid 27 10 37 General Water Supply New receptacle provided 1 .. 1 Receptacle repaired and cleansed 13 10 23 Water supply provided • • .. .. Other Improvements House generally repaired 14 4 18 cleansed or limewashed 2 .. 2 ventilated 1 .. 1 Overcrowding abated 3 1 4 Illegal use of underground Rooms for sleeping discontinued 1 •• 1 74 REPORT on the SANITARY CONDITION OF ST. MARY, ISLINGTON, FOR MARCH, 1866. No. CVII. The registered deaths in the five weeks ending March 31 st, amounted to 452, a number which exceeds the corrected average of March by 54 deaths. This excess appears due to the unusual low temperature of the month, which has ranged week by week from 2 to 5.6 degrees below the mean of 50 years. A large portion of the mortality was amongst persons suffering in various ways from chronic diseases, such as consumption, and the maladies which specially afflict old age. The amount of general sickness has been comparatively high. One hundred and six deaths resulted from diseases of the organs of respiration. Thirteen are counted under the head "laryngitis." This is an unusually large number, but, with the exception of one, they were not strictly cases of laryngitis at all, but of a spasmodic disease (commonly indeed associated with more or less catarrhal inflammation of the larynx) known under the designation of "laryngismus stridulus," or "spasmodic croup." During the whole of the last ten years I have never had to record in any one month so many deaths from this affcction. Some of the deaths from fever were of tramps sent to the Fever Hospital, but still there has been a good deal both of typhus and typhoid fever in various parts of the parish. In two houses in Adam's Place nine cases of typhus occurred. The owner of the house, who had some time ago promised the Sanitary Committee to put the premises into a proper condition, but had not kept her promise, died some weeks back, and the new owner has consented to an order of the magistrate for the closure of the houses until made fit for human habitation. A case of fever has also occurred again in Mildmay Avenue, where it will be recollected fever broke out in April, 1864. There was then great overcrowding, and the same thing has recurred: the houses are again overflowing with inhabitants. There has been a great deal of small-pox in several parts of the parish. Altogether, forty-nine cases have been returned to me during the five weeks. In White Conduit District it commenced in an unvaccinated family residing next door to a school, and of course spread extensively and rapidly. I cannot comprehend why the compulsory clauses of the Vaccination Act, which have been successfully enforced elsewhere, are not enforced in this Parish. Had this family been properly vaccinated this outbreak might have been avoided, and lives now sacrificed might have been saved. No person has a right, either from indolence, the indulgence of an obstinate temper, or for the satisfaction of an ignorant prejudice, to imperil the health and lives of his neighbours, as such of our inhabitants do as refuse to accept the protection against small-pox which the law providently and inexpensively offers to them and to their families. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, April 9 th, 1866. TABLE A. Shewing the Number of Cases of disease generally, and of Bowel Complaints particularly, recorded in the corresponding month for the last six years ; and also the total of the deaths from all causes, and from Bowel Complaints. March. Total Sickness. Total Deaths. Diarrhoea. Dysentery. Cholera. Bowel Complaints. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1866 3028 452 47 2 - 1 - - 47 3 1865 2800 382 47 1 2 — - — 49 1 1864 2810 406 59 2 1 3 - — 60 5 1863 2926 422 52 3 2 — - — 54 3 1862 2651 285 54 3 2 1 - — 56 4 1861 2457 260 65 2 3 1 - — 68 3 1860 3052 309 52 3 3 — - — 55 3 TABLE B. Results of a Special Analysis of the Water supplied by the Metropolitan Water Companies during March, as made and published by the Metropolitan Association of Medical Officers of Health. Total solid matter per Imperial gallon. Loss by Ignition. Oxydisable Organic Matter. Hardness. Before Boiling. After Boiling. Thames Water Companies. Grand Junction grains. grains. grains. degrees. degrees. West Middlesex 20.25 0.86 0.48 13.6 3.5 Southwark and Vauxhall 20.72 1.01 0.49 14.1 4.0 Chelsea 19.99 0.94 0.41 12.8 4.0 Lambeth 20.29 1.01 0.56 13.7 3.1 Other Companies. Kent 24.78 1.11 0.05 18.6 7.0 New River 21.44 1.29 0.24 15.8 6.8 East London 23.25 1.14 0.41 16.5 4.5 TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FIVE WEEKS ENDING MARCH 31st, 1866, (Deaths of Non-Residents in Hospitals excluded.) West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of Age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 60 years of age and upwards. 36 216 452 228 59 58 88 19 57 49 3. Respirat. Orgs. 106 56 5 7 29 9 (Classes.) 5 8 Laryngitis 13 13 .. .. .. .. 31 27 Bronchitis 68 23 .. 5 22 8 4 .. Pleurisy 4 1 1 1 .. 1 55 31 I. ZYMOTIC DIS. 86 64 15 4 3 .. 12 14 Pneumonia 26 19 3 1 3 .. 46 46 II. CONSTITUTL 92 37 31 14 9 1 4 .. Asthma 4 .. 1 .. 3 .. 1 .. Lung Diseases, &c. 1 .. .. .. 1 .. 02 112 III. LOCAL 214 90 9 39 66 10 10 11 4. Digestive Orgs. 21 3 3 10 5 30 26 IV. DEVELOPMNL. 56 35 3 •• 10 8 •• .. Gastritis .. .. .. .. .. .. .. 1 Enteritis l 1 .. .. .. .. 3 .. V. VIOLENT DTHS. 3 1 1 1 • • • • 1 1 Peritonitis 2 l .. .. l .. .. 1 Not Specified 1 1 •• •• •• •• .. .... Ascites .. .. .. .. .. .. .. .. Ulceration of Intes. .. .. .. .. .. .. .... .. Hernia .. .. .. .. .. .. (orders.) 1 .. Ileus 1 1 .. .. .. .. 54 30 I. 1. Miasmatic Dis. 84 62 15 4 3 •• .. .. Intussusception .. .. .. .. .. .. .. .. Stricture of Intest. .. .. .. .. .. .. 2 3 Small Pox 6 4 1 •• •• •• .. .. Fistula .. .. .. .. .. .. 16 7 Measles 23 •• •• •• •• 2 .. Stomach dis., &c 2 .. .. 2 .. .. l 7 Scarlatina 8 7 •• •• •• •• .. .. Pancreas Dis., &c. .. .. .. .. .. .. .. • • Diphtheria •• •• •• •• •• •• .. 2 Hepatitis 2 .. 1 1 .. .. .. 1 Quinsey 1 1 •• •• •• •• .. .. Jaundice .. .. .. .. .. .. 4 • • Croup 4 4 •• •• •• •• 6 7 Liver Disease 13 .. 2 7 4 .. 15 3 Hooping Cough .. 18 18 •• •• •• •• .. .. Spleen Diseases .. .. .. .. .. .. 13 4 Typhus & Typhoid 17 4 9 1 3 •• .. 1 5. Urinary Orgs. 1 .. .. .. 1 .. .. •• Erysipelas •• •• •• •• •• •• .. .. Nephritis .. .. .. .. .. .. 1 .. Pyæmia l •• 1 •• •• •• .. .. Diseases of Bladder .. .. .. .. .. .. 1 2 Puerperal Fever 3 • • 3 •• •• •• .. 1 Nephria 1 .. .. .. 1 .. .. .. Carbuncle •• •• •• •• •• •• .. .. Diabetes .. .. .. .. .. .. .. .. Influenza •• •• •• •• •• •• .. ... Stone .... .. .. .. .. .. .. 1 Dysentery 1 1 •• •• •• •• .. .. Prostrate Disease .. .. .. .. .. .. 1 1 Diarrhoea 2 • • •• 2 •• •• .. .. Kidney Disease,&c. .. .. .. .. .. .. •• •• Cholera •• •• •• •• •• •• 1 3 6. Genera. Organs 4 .. .. 2 2 .. •• 1 Ague 1 •• •• •• •• .. 1 Ovarian Dropsy 1 .. .. 1 .. .. •• •• Rheumatism • • •• • • • • •• •• 1 2 Uterine Diseases 3 .. .. 1 2 .. •• 1 2. Enthetic 1 1 •• •• •• •• .. .. 7. Orgs, of Locomo. .. .. .. .. .. .. •• 1 Syphilis 1 1 •• • • •• •• .. .. Spine Diseases .. .. .. .. .. .. •• •• Stricture of Urethra .. •• •• .. .. Bone diseases .. .. .. .. .. .. •• •• Hydrophobia •• •• •• •• •• •• .. .. 8. Skin, &c .. .. .. .. .. .. •• •• Glanders •• •• •• •• •• •• .. .. Phlegmon & Abscess .. .. .. .. .. .. 1 •• 3. Dietic 1 1 •• •• •• •• .. .. Ulcer .. .. .. .. .. .. •• •• Privation •• •• •• •• •• •• .. .. Skin Diseases .. .. .. .. .. .. 1 •• Want of Br. Milk 1 •• •• •• •• •• •• •• Purpura and Scurvy •• •• •• •• •• •• IV. 1. Dis. of Childn. 20 20 .. .. .. .. •• •• Alcoholism •• •• •• •• •• •• 13 7 •• •• 4. Parasitic •• •• •• .. •• •• 12 5 Premature Birth 17 17 .. .. .. .. •• •• Thrush •• •• •• •• •• •• .. 1 Cyanosis 1 l .. .. .. .. •• •• Worms •• •• •• •• •• •• .. .. Spina Bifida .. .. .. .. .. .. •• 1 1 Other Malformation 2 2 .. .. .. .. .. .. Teething .. .. .. .. .. .. 5 5 II. 1. Diathetic 10 •• 2 2 5 1 .. 3 2. Dis. of Adults . 3 .. 3 .. .. .. l •• Gout 1 • • •• •• 1 •• .. .. Paramenia .. .. .. .. .. .. •• 1 Dropsy 1 •• •• •• 1 •• .. 3 Childbirth 3 .. 3 .. .. .. •• •• Haemorrhage •• •• •• •• •• •• 9 9 3. Dis of Aged. 18 .. .. .. 10 8 4 2 Cancer 6 •• 2 2 2 •• 9 9 Old Age 18 .. .. .. 10 8 •• •• Noma •• •• •• •• •• •• 8 7 4. Dis. of Nutritn. 15 15 .. .. .. .. •• 2 Mortification 2 •• •• •• 1 1 8 7 Atrophy & Debility 15 15 .. .. .. .. 41 41 2. Tubercular 82 37 29 12 4 •• •• 2 Scrofula 2 2 •• •• •• •• V. 1. Acci. or Neg, 2 1 .. 1 .. .. 1 2 Tabes Mesenterica 3 3 .. .. •• •• 2 .. 34 26 hthisis 60 15 29 12 4 •• 1 .. Fract. and Contus. l .. .. 1 .. .. 6 11 Hydrocephalus 17 17 •• •• •• •• .. .. wounds .. .. .. .. .. .. .. Burns and Scalds. i 1 .. .. .. .. 28 31 III. 1. Nervous Syst. 59 29 1 10 19 1 .. Poison .. .. .. .. .. .. •• .. .. Drowning .. .. .. .. .. .. •• 2 Cephalitis 2 2 •• .. •• •• .. .. Suffocation .. .. .. .. .. .. 4 8 Apoplexy 12 1 •• 3 8 •• .. .. Otherwise .. .. .. .. .. .. 3 a Paralysis 9 .. •• 2 7 •• .. .. 2. Homicide .. .. .. .. .. •• Insanity •• •• • • •• •• •• .. .. 3. Suicide 1 .. 1 .. .. .. •• • • Chorea •• •• •• •• •• •• .. .. Wounds .. .. .. .. .. .. •• 2 Epilepsy 2 •• •• 2 •• •• .. Poison .. .. .. .. .. .. 14 8 Convulsions 22 22 •• •• •• •• 1 .. Drowning i .. 1 .. .. .. 7 5 Brain Diseases,&c 12 4 1 3 4 •• .. .. Suffocat. and Hang .. .. .. .. .. .. 6 17 2. Organs of Circ. 23 2 •• 10 10 1 •• .. Otherwise .. .. .. .. .. .. •• .. Pericarditis •• .. •• •• •• •• •• .. 4. Unclassed .. .. .. .. .. .. •• .. Aneurism •• .. .. •• •• •• •• .. .. .. .. .. .. .. 6 17 Heart Disease 23 2 •• 10 10 1 •• TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FIVE WEEKS ENDING SATURDAY, THE 31ST DAY OF MARCH, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison. Total. Small pox .. .. 41 5 3 .. 49 Chiken pox .. .. .. 5 2 .. 7 Meales .... .. 36 43 2 .. 81 Scarlatins .... .. 7 3 3 .. 13 Whooping Cough .... 1 29 36 3 .. 69 Croup .... .. 4 2 1 .. 7 Diarrhaes 4 .. 25 10 4 4 47 Dysentery .... .. .... •• •• .. .. Cholera .... .. • • .. .. .. Ague .... .. .. .. .. .. .. Continued Fever 8 .. 15 10 5 .. 38 Puerperal Fever .... .. .. 1 .. .. 1 Rheumatic Fever 3 .. 6 5 8 .. 23 Erysipeals 1 .. 8 5 1 .. 15 Diphtheria • • .. .. 2 1 •• 3 Sorethroat or Tonsillitis .•. .. 12 23 12 .. 47 Mumps .. .. .. .. .. .. Pyamia .... .. .. .. .. .. Bronchitis and Catarrh 32 .. 401 154 79 .. 708 Pneumonia .. .. 3 4 .. .. 7 Pleurisy .... .. 2 5 6 .. 13 Delirium Tremens .. .. 2 .. ... .. 2 Insanity 7 .. 8 1 ... .. 16 Carbuncle .. .. 1 .. .. .. 1 All other Diseases 37 3 517 542 634 148 1881 tOTAL 92 4 1117 856 764 195 3028 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From February 25th. 1866, to March 31st, 1866. West SubDistrict. East SubDistrict. Total. Number of house inspected 77 148 225 Drains Constructed 6 1 7 Improved or repaired 25 19 44 Trap fixed 19 8 27 Cesspools Asolished 2 2 4 Cleansed or disinfected 1 • • 1 Privies and Water Closets Pan, trap, and water supply furnished .. 1 1 Pan and trap only furnished .. .. .. Water supply furnished 4 10 14 Dust bins Constructed 3 13 16 Repaired and covers adapted 5 .. 5 Surface Drains and Pavements of Yards Constructed .. 1 1 Relaid 16 2 18 General Water Supply New receptable provided .. .. . . Receptacle repaired and cleansed 7 .. 7 Water supply provided .. • • .. Other Improvements House generally repaired 4 6 10 " cleansed or limewashed 17 .. 17 ' ventilated .. .. .. Overcrowding abated 2 1 3 Illegal use of underground Rooms for sleeping discontinued 10 •• 10 75 REPORT on the SANITARY CONDITION OF ST. MARY, ISLINGTON, FOE, APRIL, 1866, No. CVIII. The mortality of the Parish during the four weeks ending the 2Sth of April has been below the average. As registered, it amounted to 236 deaths—the corrected mean mortality of April of the last ten years being 314. The deaths from small-pox have been about twice as numerous (taking the number of weeks into consideration) as they were in March, and hooping-cough has also increased somewhat in fatality. The deaths from fever, however, have been considerably reduced. The warm weather which succeeded the first week of the month has been effectual in largely reducing the mortality from chest diseases. But the laws which govern sickness and mortality, in their relation to weather, are not the same, and hence, it is not to be inferred that, because the mortality has been reduced, the general health of our population has been influenced in a corresponding manner. The best index of healthiness is the table of sickness which 1 invariably append to my reports. As a matter of fact, our sickness during the four weeks was excessive. The mild weather of the past autumn and winter, although it has kept down our death rate during these seasons, has, at the same time, deprived us of the benefit which a winter's cold effects, in raising the amount of vitality, to be opposed to the depressing influences of the succeeding summer. The public announcement of cases of imported cholera at Liverpool and Bristol, and the issue of Privy Council Orders for the quarantine of vessels coming from Rotterdam, warrant me, I think, in breaking silence now upon this subject. The public must look the approaching epidemic fairly in the face. Since the local outbreaks last year, cholera has not receded beyond the western shores of the European continent, where it has continued its ravages through the winter months. Strict quarantine regulations may delay its advent amongst us, but experience shows of how little avail they are likely to be in preventing the importation of the disease. As the sanitary authority in this Parish, you have much to do—the general public, and those amongst them that possess influence and sanitary knowledge, still more. I myself, and the staff at my disposal, shall be chiefly occupied with the dwellings of the poor and ill-informed; those of our population who are otherwise situated, must themselves see, under the direction of their private medical advisers, that their own houses are set in order. Unfortunately, I am aware, that many of those conditions which promote outbreaks of cholera in families are to be found, partly from the negligence, and partly from the ignorance of householders in the dwellings of persons far above the rank of those with whom we have most officially to do. I shall shortly lay before the Sanitary Committee a joint memorandum upon the subject issued by the Metropolitan Medical Officers of Health, a copy of which I propose, with the sanction of the Committee, to forward to each member of the Vestry and Board of Trustees. Some of its recommendations have already been adopted, others will have to be considered in due time. For my own part, I propose occupying the next few weeks in looking to the following specific points in respect to the dwellings of the poor, viz.:—their cleanliness, the removal of refuse matters, the trapping of house drains, and the condition of the water receptacles. I would earnestly beg of the owners of such property to push on all necessary amendments of this character, as they may depend upon it, it will be to their own pecuniary interest that their tenants shall be placed under favourable conditions at the commencement of the anticipated outbreak. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, May 7th, 1866. TABLE A. Shewing the Number of Cases of disease generally, and of Bowel Complaints particularly, recorded in the corresponding month for the last six years; and also the total of the deaths from all causes, and from Bowel Complaints. April. Total Sickness. Total Deaths. Diarrhoea. Dysentery. Cholera. Bowel Complaints. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1866 2555 296 42 2 1 - - - 43 2 1865 2267 313 40 6 — — — — 40 6 1864 2219 316 47 5 — — — — 47 5 1863 2287 300 45 4 - - - - 45 4 1862 2024 212 44 3 — — — — 44 3 1861 2006 237 50 3 4 2 — — 53 5 1860 1935 263 35 4 4 1 — — 38 5 TABLE B. Results of a Special Analysis of the Water supplied by the Metropolitan Water Companies during April, as made and published by the Metropolitan Association of Medical Officers of Health. Total solid matter per Imperial gallon. Loss by Ignition. Oxydisable Organic Matter. Hardness. Before Boiling. After Boiling. Thames Water Companies. grains. grains. grains. degrees. degrees. Grand Junction 20.43 1.31 0.34 15.5 4.5 West Middlesex 19.41 0.90 0.40 14.0 3.0 Southwark and Vauxhall 20.40 0.80 0.36 15.0 4.0 helsea 20.39 0.95 0.30 15.0 4.5 Lambeth 20.00 1.25 0.38 14.0 3.5 Other Companies. Kent 27.62 0.72 0.02 20.0 7.5 New River 19.00 1.10 0.18 13.5 4.5 East London 21.60 1.42 0.37 15.5 4.0 TABLE I. DEATHS REGISTERED IN ISLINGTON DURING POUR WEEKS ENDING APRIL 28th, 1866, (Deaths of Non-Residents in Hospitals exclude.) West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 4 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. West S.D. East S.D. Causes of Death. At all Ages. under 20 years 0f Ages. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. 63 133 All causes 298 161 33 48 42 12 35 18 3. Respirat. Orgs 53 25 4 8 14 2 (Classes.) 3 .. Laryng.tis 5 4 .. 1 .. •• 18 13 Bronchitis 31 13 1 3 12 2 1 .. Pleurisy 1 •• •• 1 •• •• 2 25 L ZYMOTIC DIS 67 58 6 3 .. .. 9 3 Pneumonis 12 8 2 1 1 •• 4 33 II. CONSTITUTL 57 22 17 14 3 1 2 Asthma 2 •• •• 1 1 •• 2 Lung Diseases, &c. 2 •• 1 1 •• •• 3 53 III. LOCAL 126 48 10 29 34 5 11 3 4. Digestive Orgs. 14 2 .. 4 6 2 11 15 IV. DEVELOPMNL. 36 24 .. 1 5 6 .. .. Gastritis •• •• •• •• •• •• •• .. Enteritis •• •• •• •• •• •• 3 7 V. VIOLENTDTHS. 10 9 .. 1 .. .. 2 .. Peritonitis 2 .. .. 1 1 •• •• .. Not Specified . •• .. .. •• .. .. .. .. Ascites .. •• •• •• •• •• .. .. Ulceration of Intes. •• •• •• •• •• •• (Orders.) •• .. Hernia .. •• •• •• •• •• •• 1 Ileus 1 •• •• •• •• •• .. •• instussusception ..•• •• •• •• •• •• 39 22 I. 1. Miasmatic Dis. 61 53 6 2 •• •• .. •• Stricture of intest •• •• •• •• •• •• 5 3 Small Pox 8 2 5 1 •• •• .. •• Fistula •• •• •• •• •• •• 9 4 Measles 13 13 •• •• •• •• 3 1 Stomach Dis., &c. 4 1 •• 1 1 2 1 Scarlatina 3 3 •• •• •• •• .. •• Pancreas Dis., &c. •• •• •• •• •• •• .. 1 Diphtheria 1 1 •• •• •• •• 1 •• Hepatitis 1 •• •• •• 1 •• .. .. Quinsey .. •• •• •• •• •• .. 1 Jaundice 1 1 .. •• •• •• .. 2 Croup 2 2 •• •• •• •• 5 •• Liver Disease 5 .. .. 2 3 •• 14 7 Hooping Cough 21 21 •• •• •• •• .. •• spleen Diseases ..•• •• •• •• •• •• 6 • • Typhus & Typhoid 6 5 •• 1 •• .. 2 4 5. Urinary Orgs. 6 1 1 3 1 •• .. 2 Erysipelas 2 2 •• •• •• •• .. •• Nepbritis •• •• •• •• •• •• l .. Pyœmia 1 1 •• •• •• •• 1 •• Disease of Bladder 1 1 •• •• •• •• .. .. Puerperal Fever .. .. •• •• •• •• .. 2 Nepnria 2 •• •• 2 •• •• .. •• Carbuncle .. •• •• •• •• •• .. 1 Diabetes 1 .. 1 •• •• •• • • •• influenza .. .. •• •• •• •• .. •• Stune •• •• •• •• •• •• .. •• Dysentery .. .. •• •• •• .. .. •• Prostrate Disease . ..•• •• •• •• •• •• 1 1 dysentery 2 2 •• •• •• •• 1 1 Kidney Disease,&c. 2 •• •• 1 •• .. .. Cholera .. .. •• • • •• .. 1 •• 6. Genera. Organs 1 •• •• 1 •• •• .. •• Ague .. .. •• •• •• •• .. •• Ovarian ..•• •• •• •• •• •• 1 1 Rheumatism 2 1 1 •• •• •• 1 •• Uterine Diseases 1 •• 1 •• •• 1 1 2. Enthetic 2 2 •• •• .. •• 1 •• 7.Orgs of locomo 1 •• 1 •• •• •• l 1 Syphilis 2 2 •• •• •• 1 1 •• Spiue Diseases. 1 •• 1 •• •• •• •• .. Stricture of Urethra .. .. •• •• .. •• .. •• Bone Diseases ••.. •• •• •• •• •• .. .. Hydrophobia .. .. .. .. .. .. 1 1 8.Skin &c 2 1 •• •• 1 •• .. .. Glanders .. .. •• •• •• .. 1 1 phlegmon&Abscess 2 1 .. •• 1 •• 2 2 3. Dietic 4 3 •• 1 .. .. •• Ulcer .. •• •• •• •• •• .. .. Privation .. .. . • .. .. .. •• skin Diseases •• •• •• •• •• •• 2 1 Want of Br. Milk 3 3 .. .. •• IV.1.Dis of childn .. .. .. Purpura and Scurvy .. .. .. .. premature 9 9 •• •• •• •• ... 1 Alcoholism 1 .. •• 1 .. .. 7 2 spina bikda 8 8 •• •• •• •• •• •• 4. Parasitic .. •• •• •• • • .. 7 1 other malformation 1 1 •• •• •• •• .. .. Thrush .. • • • • •• .. .. .. 1 Teeting ..•• •• •• •• •• •• •• •• Worms .. •• •• •• •• .. .. •• Other Malformation ..•• •• •• •• •• •• .. .. •• Teething .. •• .. •• •• •• 4 1 II. 1. Diathetic 5 .. 1 2 1 1 .. •• 2. Dis. of Adults . .. •• •• •• •• •• •• .. Gout .. .. .. .. •• .. .. •• Paramenia .. •• •• •• •• •• •• .. Dropsy .. .. .. .. .. .. .. •• childourth .. •• •• •• •• •• .. .. Haemorrhage .. .. •• •• •• .. 7 5 3. Dis. of Aged 12 .. .. 1 5 6 3 l Cancer 4 .. 1 2 1 .. 7 5 Old Age 12 .. .. 1 5 6 • • .. Noma .. .. • • •• .. .. 7 8 4. Dis. of Nutrin 15 15 •• •• ••..•• •• 1 .. Mortification 1 .. .. .. •• 1 7 8 Atrophy& Devility 15 15 •• •• .. .. 20 32 2. Tuborcular 52 22 16 12 2 .. 7 •• .. .. 1 Scrofula 1 1 .. .. .. .. .. V. 1. Acci. or Neg 4 4 •• •• .. •• 2 6 Tabes Mesenterica 8 8 .. .. .. .. 2 2 17 18 hthisis 35 5 16 12 2 .. .. .. Fract. and Contus. .. .. •• •• .. •• 1 7 Hydrocephalus 8 8 .. .. .. .. 2 •• wounds 2 2 •• •• .. •• ••17 20 III. 1. Nervous Syst. 37 19 1 9 8 1 .. .. Burns and Scalds .. .. •• •• •• •• .. poison 1 1 •• •• •• •• 4 1 cephalitis 5 5 •• ... •• .. 1 Drowning .. .. .. •• •• •• 4 3 Apoplexy 7 .. •• 4 2 1 .. .. Suffocation 1 1 •• •• •• •• 4 6 Paralysis 10 .. •• 4 6 •• 1 1 Otherwise 5 5 •• •• •• •• •• .. Insanity .. • • •• •• •• •• .. 4 2. Homicide 1 .. .. 1 •• •• •• .. Chorea .. .. .. •• .. •• •• 1 3.Suicide 1 .. .. 1 •• •• •• 1 Epilepsy l .. .. 1 .. •• •• 1 Wounds .. .. •• •• •• •• 5 9 Convulsions 14 14 .. •• .. •• •• •• Poison .. .. •• •• •• •• •• .. Brain Diseases, &c. .. .. .. •• .. •• •• •• Drowang .. .. •• •• •• •• 5 7 2. Organs of Circ. 12 .. 4 4 4 •• •• •• Suffocat. and Hang. .. .. •• •• •• •• •• •• Pericarditis .. •• •• •• •• •• .. Otherwise .. •• •• •• •• •• .. .. Aneurism .. .. •• •• •• •• •• 4. Unclssad .. •• •• •• •• •• 5 7 Heart Disease 12 .. 4 4 4 .. .. .. TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING] THE FOUR WEEKS ENDING SATURDAY, THE 28TH DAY OF APRIL, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Hollo way Dispensary. Islington Dispensary. Pentonville Convict Prison. Total. Small pox .. .. 30 .. .. .. 30 Chicken Pox . . .. 1 4 .. .. 5 Measles .. .. 22 13 3 .. 38 Scarlatinas . . 1 9 1 9 .. 20 Whooping Cough .. 1 38 30 6 .. 75 Croup • • .. 1 3 .. .. 4 Diarrhea 5 .. 17 15 2 3 42 Dysentery .. .. • • • • 1 .. 1 Cholera • • .. • • • • • • .. .. Ague .. .. 1 .. .. .. 1 Continued Fever 5 .. 7 10 4 .. 27 Puerperal Fever .. .. .. • • .. .. 12 Rheumatic Fever 1 .. .. 7 4 .. 6 Erysipeals .. .. 4 1 1 .. 6 Diphtheria .. .. .. 1 • • .. 1 Sorethroat or tonsillitis .. .. 19 11 9 .. 39 Mumps .. .. 2 .. • • .. 2 Pyamia .. .. • • .. .. .. .. Bronchitis and Catarrh 12 .. 289 87 44 32 464 Pneumonia 3 .. 5 .. 3 .. 11 Pleurisy • • .. 2 .. 2 .. 6 Delirium Tremens 3 .. 1 .. .. .. 4 Insanity .. .. 4 • • • • .. 4 Carbuncle .. .. 1 ... 1 .. 2 All other Diseases 51 4 512 494 569 131 1761 Total 80 7 965 679 658 166 2555 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From April 1st, 1866, to April 28th, 1866 West SubDistrict. East SubDistrict. Total. Number of houses inspected 80 32 112 Drains Constructed 13 8 21 Improved or repaired 62 .. 62 Traps fixed 30 5 35 Cesspools Abolished 1 5 6 Cleansed or disinfected .. 4 4 Privies and Water Closets Pan, trap, and water supply furnished 2 6 8 Pan and trap only furnished .. .. .. Water supply furnished 3 8 11 Dust bins constructed 1 10 11 Repaired and covers adapted 2 .. 2 Surface Drains and Pavements of Yards Constructed .. .. .. Relaid 66 2 68 General Water supply New receptacle provided .. .. .. Receptacle repaired and cleansed 2 .. 2 Water supply provided .. .. .. Other Improvements Houses generally repaired 2 .. 2 ,, cleansed or limewashed 1 .. 1 „ ventilated • • • • .. Overcrowding abated 13 .. 13 Illegal use of underground Rooms for sleeping discontinued 4 •• 4 * Tramps. 76 REPORT on the SANITARY CONDITION OF ST. MAM, ISLINGTON, FOR MAY, 1866. No. CIX. Taking the death-rate of May for the last ten years as our standard of comparison, the number of deaths registered during the four weeks ending the 26th ultimo should have been about 280; instead of this the deaths actually registered amounted to 360. This high mortalityis probably due, in a great measure, to the low atmospheric temperature of the month. In the first week the temperature was 7.8 degrees below the mean of 50 years (Greenwich), in the third week it was 4,2 degrees, and in the fourth 2.4 degrees below the mean. The excess of mortality is noticeable in every one of the principal classes among which the causes of death are distributed. Among the zymotic diseases, measles and hoopiDg cough have both been more fatal than they usually are in May. An unusually large number of persons have succumbed to phthisis and acute and chronic affections of the chest; and a much larger number than usual of deaths of young infants have been registered under the headings of "convulsions," "atrophy." "inanition," and "premature birth." I cannot avoid suspecting that there is some additional cause in operation, depressing vital power. I am strengthened in this belief by observing, that not only has the death-rate been larger than usual, but that the sickness has alsobeen nearly as great as it was at the same season in the sickly year, 1863—far higher than it should have been, in my observation, considering the most important meteorological characters of the month. 2 The high mortality which we notice here has been observable throughout London. One or two deaths from what is termed "English cholera" and "choleraic diarrhoea" have been recorded each week by the Registrar General. Another warning consists in the prevalence of " influenza" pretty generally in London—a disease which has commonly in this country been the precursor of epidemic cholera. It has not been of a severe type, and although cases have been tolerably numerous in the practice of private medical men here, the disease either has not been so marked in its character, or has not been recognized in the public practice in the parish. I have recorded two deaths of old people from this disease during the month. I desire, especially, to urge upon all householders in the parish the paramount necessity there is at the present time, that they should see to the careful cleansing of their water cisterns and water-butts—that they should lose no time in taking this very simple and easy precaution— and having cleansed them now, that they should repeat the operation every two or three weeks, at the furthest, during the coming summer; for although.the water is delivered by the New River Company, as pure as a public system of filtration can be well expected to rendej it, a deposit invariably occurs in the private receptacles after a short time, and this deposit, always deleterious, is in certain seasons absolutely poisonous. Within the last week I have seen, in a family where my opinion was asked, symptoms arise from this cause which were very similar to those commonly produced by the irritant poisons, and my experience has led me to observe a similar result on several former occasions. Five cases of "enteric fever" also have just been sent to the hospital from a tidy and well-drained house in Upper Holloway, due to no other cause than the use of drinking water from a cistern which, to judge by the appearance of the water, could never have been cleansed since the house was built. The cistern was most inconveniently situated for cleansing. Another thing that householders should do, is to insist upon the dustmen removing frequently from their premises all the household refuse, and in case of neglect on their part, or in case of absolute refusal to do so, or refusal without some payment being made, to make known the neglect or refusal, by letter, to the Sanitary Committee, or to myself. Although the dustmen are bound by contract to remove vegetable and other household refuse, it is always advisable that such matters should be burned, instead of being placed in the dust-hole to undergo decomposition. 3 The great excess of sickness, above the average, has consisted principally in the comparatively great prevalence of chest affections. The weather, or rather the temperature of the month, will not account for this, although it will account, in a great measure, for the high fatality. Again I am compelled to recognize an unusual cause of vital depression. Probably many of these cases were of the nature of "influenza " (catarrhal fever). I must repeat that I am very much dissatisfied with the irregular manner in which the collection of dust and refuse is carried out. It is necessary that the Vestry should really take some more decided measures with regard to this matter, either by amending the contracts, so as to make them more stringent, or by compelling the contractors to exercise a better supervision over their labourers. Many scandalous instances of neglect and refusal on the part of the dustmen have come to my knowledge, and some of the members of the Sanitary Committee have, at my request, visited a few of the low neighbourhoods with me, so as to see the state of affairs with their own eyes. Our own system of dust inspection, as hitherto carried.out by the special officer appointed for that purpose, is nothing better than a delusive pretence. I lay no particular blame on him on this account, because he is quite unable, with his other avocations, to inspect the dusting of the Parish as it ought to be inspected, and as it must be, if we are to make a proper preparation for the coming summer; and he has himself requested more than oncc to be relieved from this duty. There are over 21,000 houses in this Parish, all of which make dust and refuse, which in most cases should be removed from the premises every week. I would ask any man of common sense how the performance of this work can be supervised by one officer properly, even if he had nothing else to do, in a Parish with an extent of 3127 acres? The truth is that it is not done, and never will be done, even tolerably, until a competent person is appointed, with nothing else to do than this. During the past month I have directed the Sanitary Inspectors to report to Mr. Stanwell, streets that they have observed in their systematic inspection to be badly dusted; but to lay the duty upon them of looking after the dustmen, would have the effect of taking them from the performance of work, of a character equally important, especially at the present time. I beg to assure the Vestry that I have no wish to press upon them the multiplication of officers. If I do so at any time, it is not without what I regard as ample justification, and only in the discharge of a paramount duty to the parishioners. Every addition to my staff has the effect of increasing my own labours in a commensurate degree. 4 The unusually large number of houses Inspected during the last month will probably attract attention, and I must explain that it is no proof of former dilatoriness. The fact is that I have given directions to the Inspectors to confine their attention, as much as possible, for the present, to a few only of the points they habitually report upon, those matters having a more direct relation than others to the localization of cholera. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, June 4th, 1866. TABLE A. Showing the Number of Cases of disease generally, and of Bowel Complaints particularly, recorded in the corresponding month for the last six years; and also the total of the deaths from all causes, and from Bowel Complaints. May. Total Sickness. Total Deaths. Diarrhoea. Dysentery. Cholera. Bowel Complaints. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1866 2375 360 67 2 1 - - - 68 2 1865 2141 272 62 3 2 - — - 64 3 1804 2145 294 47 4 - 1 - - 47 5 1863 2402 280 42 2 - - — — 42 2 1862 2198 188 65 1 2 1 — — 67 2 1861 1973 225 56 2 6 1 — — 62 3 1860 1792 208 53 2 2 — — — 55 2 TABLE B. Results of a Special Analysis of the Water supplied hy the Metropolitan Water Companies during May, as made and published hy the Metropolitan Association of Medical Officers of Health. Total solid matter per Imperial gallon. Loss by Ignition. Oxydisable Organic Matter. Hardness. Before Boiling. After Boiling. Thames Water Companies. erains. grains. grains. degrees. degrees. Grand Junction 19.10 1.04 0.31 14.0 3.5 West Middlesex 18.39 0.80 0.29 14.0 3.5 Southwark and Vauxhall 19.06 1.04 0.39 14.5 3.5 Chelsea 18.87 0.81 0.27 14.0 3.5 Lambeth 18.99 0.99 0.32 14.0 3.5 Other Companies. Kent 28.32 1.13 0.05 18.5 7.5 New River 17.84 0.68 0.22 14.0 4.5 East London 21.68 0.79 0.38 14.5 4.0 TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FOUR WEEKS ENDING MAY 26th, 1866, (Deaths of Non-Residents in Hospitals excluded.) west S.D. East S.D. Causes of Death. At all Ages. Under 20 year of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years 0 age and upwards. West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of Age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 yeats of age. At 80 yeats of age and upwards. 190 170 All causes 360 201 47 44 51 16 24 27 3. Respirat. Orgs 51 28 3 5 12 3 (Classes.) 2 2 Laryngitis 4 4 .. .. .. .. 13 15 Bronchitis 28 11 1 3 11 2 .. .. Pleurisy .. .. .. .. .. .. 53 45 I. ZYMOTIC DIS 98 84 7 4 1 2 9 8 Pneumonia 17 13 2 2 .. .. 31 37 II. CONSTITUTL. 71 22 28 15 6 .. .. 2 Asthma 2 .. .. l 1 .. .. Lung Diseases, &c. .. .. .. .. .. .. 66 64 III. LOCAL 130 56 9 23 36 6 9 6 4. Digestive Orgs. 15 6 1 4 4 .. 30 20 IV. DEVELOPMNL. 50 35 .. .. 7 8 1 .. Gastritis 1 1 .. .. .. .. 2 .. Enteritis 2 2 .. .. .. .. 7 4 V. VIOLENTDTHS. 11* 4 3 2 1 .. 1 3 Peritonitis 4 2 .. 1 1 .. .. .. Not Specified .. .. .. .. .. .. .. .. Ascites .. .. .. .. .. .. .. .. Ulceration of Intcs. .. .. .. .. .. .. (Orders.) .. 1 Hernia 1 .. .. .. 1 .. .. .. Ileus •• .. .. .. .. .. .. .. Intussusception •• .. .. .. .. .. 49 43 I. 1. Miasmatic Dis. 92 81 4 4 1 2 .. .. Stricture of Intest. •• .. .. .. .. .. 3 1 Small pox 4 4 .. .. .. .. .. .. Fistula •• .. .. .. .. .. 16 2 Measles 18 18 .. .. .. .. 1 Stomach Dis., &c. 1 .. 1 .. .. .. 6 3 Scarlatina 9 9 .. .. .. .. .. .. Pancreas Dis., &c. •• .. .. .. .. .. •• •• Diphtheria .. .. .. .. .. .. .. 1 Hepatitis 1 .. .. 1 .. .. •• •• Quinsey .. .. .. .. .. .. 2 .. Jaundice 2 1 .... .. 1 .. 1 2 Croup 3 3 .. .. .. .. 3 .. Liver Disease 3 .. .. 2 1 .. 13 24 Hooping Cough 37 37 .. .. .. .. .. .. Spleen diseases •• •• •• •• •• .. 6 6 Typhus & Typhoid 12 6 3 3 .. .. 2 3 5. Urinary Ores. 5 •• •• 3 2 •• 1 •• Erysipelas 1 .. .. 1 .. 1 .. Nephritis 1 •• •• •• 1 •• 1 •• Pyœmia 1 .. .. 1 .. .. .. .. Disease of Bladder •• •• •• •• •• •• .. •• Puerperal Fever .. .. .. .. .. .. .. 1 Nephria 1 •• •• 1 •• •• .. •• Carbuncle .. .. .. .. .... .. .. .. Diabetes •• •• •• •• •• •• 1 1 Influenza 2 .. .. .. .. 2 .. .. Stone| ••.. •• •• •• •• •• .. •• Dysentery .. .. .. .. .. .. .. Prostrate Disease •• •• •• •• •• •• .. 2 Diarrhœa 2 2 .. .. .. .. 1 2 Kidney Disease,&c. 3 •• •• 2 1 •• .. •• Cholera • • .. .. .. .. .. .. 1 6. Genera. Organs 1 •• .. 1 •• •• •• •• Ague .. .. .. .. .. .. .. 1 Ovarian Dropsy 1 •• .. 1 .. •• l 2 Rheumatism 3 2 1 .. .. .. .. .. Uterine Diseases •• •• •• •• •• •• •• 1 2. Enthetic 1 1 .. .. .. .. 2 .. 7. Orgs.of Locomo. 2 1 1 •• •• •• .. 1 Syphilis 1 1 .. .. .. .. 1 .. Spine Diseases 1 1 •• •• •• •• •• •• Stricture of Urethra .. .. .. .. .. .. 1 .. Bone Diseases 1 •• 1 •• •• •• •• •• Hydrophobia .. .. .. .. .. .. .. .. 8. Skin, &c •• •• •• •• •• •• .. •• Glanders .. •• .. .. .. .. .. .. Phlegmon & Abscess •• •• •• •• •• •• 4 1 3. Dietic 5 2 3 .. .. .. .. .. Ulcer •• •• ••.. •• •• •• •• •• Privation .. .. .. .. .. .. .. .. Skin Diseases •• •• •• •• •• •• 2 •• Want of Br. Milk 2 2 .. .. .. .. •• •• •• Purpura and Scurvy •• .. 3 .. .. .. 9 4 IV. 1. Dis. of Childn. 13 13 •• •• •• •• 2 1 Alcoholism 3 .. .. .. .. .. 9 4 Premature Birth 13 13 •• •• •• •• •• •• 4. Parasitic .. .. .. .. .. .. .. .. Cyanosis •• •• •• •• •• •• •• •• Thrush .. .. .. .. .. .. .. .. Spina Bifida •• •• •• •• •• •• •• •• Worms .. .. .. .. .. .. .. Other Malformation •• •• •• •• •• •• .. .. .. Teething •• •• •• •• •• •• 2 6 II. 1. Diathetic 8 1 .. 3 4 .. .. .. 2. Dis. of Adults. •• •• •• •• •• •• .. .. Gout .. .. .. .. .. .. .. Paramenia •• •• •• •• •• •• .. 2 Dropsy 2 1 .. 1 .. .. .. .. Childbirth •• •• •• •• •• •• .. .. Hæmorrhage .. .. .. .. .. 10 5 3. Dis. of Aged 15 •• •• •• 7 8 2 3 Cancer 5 .. .. 2 3 .. 10 5 Old Age 15 •• •• •• 7 8 .. •• Noma .. .. .. •• .. .. 11 11 4. Dis. of Nutritn. 22 22 •• •• •• •• •• 1 Mortification 1 .. .. .. 1 .. 11 11 Atrophy & Debility 22 22 •• •• •• •• 32 31 2. Tubercular 63 21 28 121 2 .. 2 •• Scrofula 2 1 1 .. .. .. V. 1. Acci. or Neg. 6 3 1 1 •• •• .. 1 Tabes Mesenterica .. 1 .. .. .. .. 3 3 23 25 hthisis 48 7 27 12 2 .. 1 1 Fract. and Contus. 2 •• 1 •• •• •• 7. 5 Hydrocephalus 12 12 .. .. .. .. .. .. Wounds •• •• •• •• •• •• .. .. Burns and Scalds. •• •• •• •• •• •• 21 19 III. 1. Nervous Syst. 40 20 2 4 12 2 .. .. Poison •• •• •• •• •• •• 1 .. Drowning 2 1 •• •• •• •• 1 3 Cephalitis 4 3 1 .. .. .. 1 l Suffocation 2 2 •• •• •• •• 4 2 Apoplexy 6 1 .. .. 4 1 .. .. Otherwise •• •• •• •• •• •• 7 4 Paralysis 1 .. .. 3 7 1 1 .. 2. Homicide 2 1 1 •• •• •• .. •• Insanity .. .. .. .. .. .. 3 1 3. Suicide 3 •• l 1 1 •• .. •• Chorea .. .. .. .. .. .. 1 •• Wounds 1 •• 1 •• •• •• •• 2 Epilepsy 2 .. 1 1 .. .. .. .. Poison. •• •• •• •• •• •• 8 8 Convulsions 16 16 .. .. .. .. .. .. Drowning •• •• •• •• •• •• 1 •• Brain Diseases, &c. 1 .. .. •• 1 .. 2 .. Suffocat. and Hang 2 •• •• 1 1 •• 8 8 2. Organs of Circ. 16 1 2 6 6 1 .. .. Otherwise •• •• •• •• •• •• • •• Pericarditis .. .. .. .. .. .. .. .. 4. Unclassed •• •• •• •• •• •• 1 •• Aneurism 1 .. .. 1 .... .. .. .. •• 7 8 Heart Disease 15 1 2 5 6 1 * 1 Age not specified, TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FOUR WEEKS ENDING SATURDAY, THE 26th DAY OF MAY, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small pox • • 14 2 1 • • 17 Chicken Pox • • • • 6 12 .. • • 18 Measles • • • • 43 10 2 • • 55 Scarlatina • • • • 6 10 5 • • 21 whooping cough • • • • 28 27 6 • • 61 Croup • • • • 1 • • • • .. 1 Diarrhoea 1 • • 37 21 2 6 67 Dysentery • • • • •• • • 1 • • 1 cholera • • • • • • •• • • • • • • Ague • • • • • • • • • • 1 1 continued Fever 6* 1 13 14 • • • • 34 Influenza • • • • 1 .. • • • • 1 Puerperal Fever • • • • .. .. • • • • • • Rheumatic fever 2 • • 3 1 • • • • 6 Erysipelas 1 • • 4 3 1 • • 9 diphtheria • • • • • • 3 • • • • 3 Sorethroat or Tonsillitis 1 • • 12 3 5 • • 21 Mumps .. •• 1 1 • • • • 2 Pyæmia .. • • • • .. • • • • .. Bronchitis and Catarrh 11 • • 237 119 47 33 447 Pneumonia • • 1 1 4 8 • • 14 Pleurisy .. • • 5 2 3 • • 10 Delirium Tremens 1 • • . • • .. • • • • 1 Insanity 4 • • 1 .. • • • • 5 Carbuncle .. • • • • 1 1 1 3 All other diseases 62 9 449 477 458 122 1577 Totals 89 11 862 710 540 163 2375 *5 Tramps. TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From April 29th, 1866, to May 26th, 1866. South West District.* South East District. North West District North East District. Total. Number of houses inspected 257 286 245 292 1080 Drains Constructed 3 1 .. .. 4 Improved or repaired 22 22 4 11 59 Traps fixed 16 19 19 9 63 Cesspools Abolished 2 .. .. .. 2 Cleansed or disinfected .. .. • • .. .. Privies and Water Closets Pan, trap, and water supply furnished 2 1 • • .. 3 Pan and trap only furnished .. .. .. .. .. Water supply furnished 5 23 9 9 39 Dust bins Constructed 6 7 7 9 39 Repaired and covers adapted .. 11 4 20 35 Surface Drains and Pavements of Yards Constructed 2 11 .. .. 13 Relaid 28 13 .. .. 41 General Water Supply New receptacle provided 4 16 1 .. 21 Receptacle repaired and cleansed 9 9 12 10 40 Water supply provided .. .. .. .. .. Other Improvements Houses generally repaired 2 22 .. 24 48 „ cleansed or limewashed 11 22 32 39 104 ,, ventilated .. .. .. .. .. Overcrowding abated 4 1 .. .. 5 Illegal use of underground Rooms for sleeping discontinued 2 .. • • .. 2 * For the purposes of Sanitary Inspection, I have divided the Parish into four Districts by two lines—one passing from East to West along Paul's Road and the line of the North London Railway the other from South to North along the Upper Street to Ring Cross, and then along the Hornsey Road. The South-West District is retained by Mr. Mayes, together with Belle Isle, and the South-East by Mr. Dunham; while the North-West has been assigned to Mr. flitcroft, and the North-East to Mr. Powell. 77 REPORT on the SANITARY CONDITION OF ST. MARY, ISLINGTON, FOR JUNE, 1860. No. CX. During the past month both the sickness and the mortality have been greater than usual. The deaths in the parish, excluding those of strangers in the hospitals, amounted to 351, a number which, although less than that observed in June last year, nevertheless exceeds the corrected average of ten years by 20 deaths. Among the diseases of the zymotic class, hooping cough and measles have been, not only very prevalent, but unusually fatal; and chest affections have been more prevalent, and also more fatal than they usually are at this season of the year. Small-pox also is extending. The number of cases of bowel complaint, and the mortality from this cause, have not been excessive—a result attributable, in part, to the fact that the month was, altogether, not a hot one until the last week, when the mean temperature rose nearly five degrees above the average. A severe case of cholera occurred in Lower Holloway, fatal in 33 hours, but it exhibited no distinctive characters beyond those of the ordinary summer cholera of this country. There was registered a death from hydrophobia, said to be the result of a bite from a rabid animal, inflicted five months previously. I am glad to be able to state, from the reports made to me by our Inspectors, that the collection of the dust is being carried out, under the new and altered contract, much more satisfactorily than it has been for some time past. This being the case, it appears to me that it is needless to take any further steps, at present, in regard to alterations of the system of dust inspection; but I shall take the liberty of recalling your attention to my recommendations upon this subject, should a necessity for it again arise. You have probably observed in the public papers statements to the effect that Asiatic Cholera has broken out afresh in certain parts of the country, under circumstances which lead to the apprehension that the cases which have occurred must be regarded as the first in an epidemic outbreak. Probably in consequence of having taken this view of them, an Order in Council has been issued, putting into force, throughout all England, the Diseases Prevention Act, 1855. Under the 134th section of the Metropolitan Local Management Act, and the 11th section of the Amended Diseases Prevention Act, 1860, the Vestry is the local authority for carrying out the provisions of this Act. We may now expect that such directions and regulations will be shortly issued by the Privy Council as they may consider necessary.* One of the most important matters for the public to attend to is the condition of their water cisterns, which should be cleansed at short intervals throughout the summer. One thing is worthy of observation in the Table showing the results of the analysis of the Metropolitan waters, namely:—the comparatively high degree of purity of the water supplied to us by the New River Company, and especially its comparative freedom from those oxydisable organic matters which are believed in this country to be, in some way, energetic in propagating choleraic maladies. It is indeed sad to think, that with water supplied so free from dangerous elements, our population are so little impressed as they are with the importance of keeping it free from contamination after its delivery at their houses. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, July 14th,1866. TABLE A. Showing the Number of Cases of disease generally, and of Bowel Complaints particularly, recorded in the corresponding month for the last six years; and also the total of the deaths from all causes, and from Bowel Complaints. May. Total Sickness. Total Deaths. Diarrhoea. Dysentery. Cholera. Bowel Complaints. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1866 2892 351 133 12 — 1 1 1 134 14 1865 2757 367 229 46 1 — — 2 230 48 1864 2701 310 115 6 — — — 1 115 7 1863 3059 320 114 9 1 — — — 115 9 1862 2558 238 94 7 7 — — — 101 7 1861 2715 243 129 5 5 — — 1 134 6 1860 2101 216 84 2 2 — — — 86 2 TABLE B. Results of a Special Analysis of the Water supplied by the Metropolitan Water Companies during June, as made and published by the Metropolitan Association of Medical Officers of Health, Total solid matter per Imperial gallon. Loss by Ignition. Oxydisable Organic Matter. Hardness. Before Boiling. After Boiling. Thames Water Companies. grains. grains. grains. degrees. degrees. Grand Junction 18.05 0.67 0.62 13.5 3.0 West Middlesex 17.02 0.71 0.40 13.0 3.0 Southwark and Vauxhall 18.12 0.68 0.62 13.5 4.0 Chelsea 17.73 0.74 0.48 13.5 3.5 Lambeth 18.60 0.80 0.72 13.5 3.0 Other Companies. Kent 28.23 1.00 0.00 17.5 8.0 New River 16.06 0.56 0.14 12.0 3.0 East London 17.70 0.94 0.23 12.5 4.0 * Since the above was written, a further Order has been put forth, and it is necessary that it should receive the speedy attention of the Vestry. TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FIVE WEEKS ENDING JUNE 30th, 1866. (Deaths of Non-Residents in Hospitals excluded). West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of Age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age end upwards. 181 170 351 188 39 56 57 11 22 28 3. Respirat. Orgs 50 27 3 6 11 3 3 2 Laryngitis 5 4 .. 1 .. .. (Classes.) 15 15 Bronchitis 30 11 2 4 10 3 .. .. Pleurisy .. .. .. .. .. .. 55 43 I. ZYMOTIC DIS. 98 80 8 5 4 1 4 11 Pneumonia 15 12 1 1 1 .. 38 37 II. CONSTITUTE. 75 25 20 81 8 1 .. .. Asthma .. .. .. .. .. .. .. Lung, diseases, &c. .. .. .. .. .. .. 64 67 III. LOCAL 131 84 11 28 35 3 10 8 4. Digestive Orgs. 18 2 2 9 6 .. 18 18 IV. DEVELOPMNL. 36 23 .. 1 6 6 .. .. Gastritis .. .. .. .. .. .. 1 .. Enteritis 1 .. .. 1 .. .. 6 6 V. VIOLENT DTES. 11 6 •• 1 4 •• .. .. Peritonitis .. .. .. .. .. .. .. 1 Ascites 1 .. .. .. 1 .. .. .. Not Specified •• .. •• .. .. .. .. .. Ulceration of Intes. .. .. .. .. .. .. (Orders.) 2 .. Hernia 2 1 .. .. 1 .. 3 1 Ileus 4 • • .. 1 2 .. .. .. Intussusception .. .. .. .. .. .. 53 42 I. 1. Miasmatic Dis. 95 78 8 5 4 .. .. .. Stricture of Intest. .. .. .. .. .. .. 2 1 Small pox 4 2 2 .. .. .. .. .. Fistula .. .. .. •• • • .. 12 7 Measles 19 19 .. .. .. .. .. .. Stomach dis. &c. .. .. .. .. .. .. 10 4 Scarlatina 14 13 1 .. .. .. .. .. Pancreas dis., &c. .. .. .. .. .. .. .. l Diphtheria 1 1 •• • • • •• .. .. Hepatitis .. .. .. •• •• .. .. .. Quinsey .. •• .. .. .. .. .. 1 Jaundice .. .. .. .. .. .. 1 2 Croup 3 3 .. .. .. .. 4 5 Liver Disease 9 .. 1 7 1 .. 10 14 Hooping Cough 21 24 .. .. .. .. .. Spleen diseases .. .. .. .. .. .. 4 4 Typhus & Typhoid 8 4 3 1 •• .. 2 2 5. Urinary Orgs. 4 1 1 .. 2 .. .. 2 Erysipelas 2 1 • • .. 1 .. .. .. Nephritis .. .. .. .. .. .. 1 .. Pyœmia 1 .. 1 .. .. .. .. l Diseases of Bladder 1 l .. .. .. .. 1 .. Puerperal Fever 1 .. 1 .. .. .. i .. Neparia l .. .. .. 1 .. 1 .. Carbuncle 1 .. .. .. 1 .. l .. Diabetes i .. 1 .. .. .. .. .. Influenza .. .. .. .. .. .. .. l Stone l .. .. .. 1 .. 1 .. Dysentery 1 1 .. .. .. .. .. .. Prostrate diseases .. .. .. .. .. .. 7 5 Diarrhœa 12 9 .. 2 1 .. .. .. Kidney Disease, &c. .. .. .. .. .. .. 1 .. Cholera 1 i .. .. .. .. 1 .. 6. Genera. Organs 1 .. .. l .. .. .. .. Ague .. .. .. .. .. .. l .. Ovarian Dropsy l .. .. 1 .. .. 1 2 Rheumatism 3 •• •• 2 1 .. .. .. Uterine Diseases .. .. .. .. .. .. 1 1 2. Enthetic 2 1 .. .. •• 1 .. .. 7. Orgs, of Locomo. .. .. .. .. .. .. 1 .. Syphilis l 1 .. .. .. •• •• .. Spine Diseases .. .. .. .. .. .. .. .. Stricture of Urethra .. .. .. .. .. •• •• .. Bone Diseases .. .. .. .. .. .. .. 1 Hydrophobia l .. .. .. .. 1 1 1 8. Skin, &c. 2 1 .. .. 1 .. .. .. Glanders .. .. .. •• •• •• •• l Phlegmon&Abscess 1 1 .. .. .. .. .. .. 3. Dietic 1 1 .. .. .. •• •• .. Ulcer .. .. .. .. .. .. .. .. Privation .. .. .. .. .. •• l .. Skin Diseases l .. .. .. l .. 1 .. Want of Br. Milk l 1 .. .. .. •• .. .. Purpura and Scurvy .. .. .. .. .. •• 4 4 IV. 1. Dis. of Chiidn. 8 8 .. .. .. .. .. .. Alcoholism .. .. .. .. .. •• 4 4 Premature Birth 8 8 .. .. .. .. .. .. 4. Parasitic • • •• .. .. •• •• •• Cvanosis .. .. .. .. .. .. .. .. Thrush • • •• •.. .. •• •• •• •• Spina Bifida .. .. .. .. .. .. .. .. Worms • • •• .. .. •• •• •• Other Malformation .. .. .. .. .. .. •• •• Teething .. .. .. .. .. .. 6 5 II. 1. Diathetic 11 l .. 4 6 1 1 .. 2. Dis. of Adults . 1 .. .. 1 .. .. 2 .. Gout 2 .. .. 2 •• •• .. Paramenia .. .. .. .. .. .. 1 2 Dropsy 3 i .. l 1 •• 1 .. Childbirth 1 .. .. 1 .. .. .. l Hæmorrhage 1 .. .. .. 1 •• 8 4 3. Dis. of Aged 12 .. .. .. 6 6 3 2 Cancer 5 .. .. 3 1 1 8 4 Old Age 12 .. .. .. 6 6 .. .. Noma .. •• .. .. .. •• 5 10 4. Dis. of Nutritn. 16 15 .. .. .... .. .. Mortification .. .. .. .. .. •• 5 Atrophy & Debility 15 15 .. .. .. .. 32 32 2. Tubercular 64 84 20 17 1 .. Scrofula l .. .. l .. .. 4 3 V. 1.Acci, or Neg. 7 3 .. .. 4 .. 1 4 Tabes Mesenterica 5 5 Fract, and contus. 5 3 .. .. 2 .. 25 24 Phthisis 49 10 20 16 •• 4 1 Wounds 1 .. .. .. 1 .. 5 4 Hydrocephalus 9 9 .. .. .. .. .. 1 Burns and scalds.. .. .. .. .. .. .. .. .. Posion .. .. .. .. .. .. 23 18 III. 1. Nervous Syst. 41 23 4 6 8 .. .. .. Drowning 1 .. .. .. 1 .. 4 2 Cephalitis 6 5 l .. .. .. .. 1 Suffocation. .. .. .. .. .. .. 4 3 Apoplexy 7 1 2 1 3 .. .. .. Otherwise .. .. .. .. .. 6 2 Paralvsis 7 .. .. 2 5 .. 1 2 2. Homicide 3 3 .. .. .. .. .. .. Insunity .. .. .. .. .. .. 1 .. 3. Suicide 1 .. .. l .. •• .. Chorea •. •• .. .. .. .. .. .. Wounds .. .. .. .. .. .. 1 .. Epilepsy 1 .. 1 .. .. .. .. .. Poison. .. .. .. .. .. 6 8 convulsions 14 14 .. .. .. .. 1 .. Drowning i .. .. 1 .. .. 3 3 Brain Diseases, &c. 6 3 .. 3 .. .. .. .. Suffocat. and Hang .. .. .. .. .. .. 5 10 2. Organs of Circ. 15 .. 1 6 8 .. .. Otherwise .. .. .. .. .. .. .. .. Pericarditis •• .. • • .. •• •• .. .. 4. Unclassed .. .. .. .. .. .. .. .. Aneurism .. • • .. .. •• .. 5 10 Heart Disease 15 .. 1 6 8 .. TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FIVE WEEKS ENDING SATURDAY, THE 30th DAY OF JUNE, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small Pox .. .. 25 3 .. .. 28 Chicken Pox .. .. 4 9 .. .. 13 Measles .. .. 72 43 23 .. 138 Scarlatina .. .. 11 6 5 .. 22 Whooping Cough .. .. 37 38 11 .. 86 Croup .. .. .. 2 .. .. 2 Diarrhœa 3 .. 71 40 6 13 133 Dysentery .. .. .. .. .. .. .. Cholera .. .. .. 1 .. .. 1 Ague .. .. 1 .. .. .. 1 Continued Fever 4 .. 9 6 1 .. 20 Influenza .. .. 2 .. .. .. 2 Puerperal Fever .. .. .. .. .. .. .. Rheumatic Fever 1 .. 3 7 .. .. 11 Erysipelas 2 .. 10 3 1 .. 16 Diphtheria .. .. 1 1 .. .. 2 Sorethroat or Tonsillitis .. .. 24 13 8 .. 45 Mumps .. .. 1 .. .. .. 1 Pyaemia .. .. .. .. .. .. .. Bronchitis and Catarrh 13 1 196 72 38 32 352 Pneumonia .. .. 3 1 3 .. 7 Pleurisy .. .. 3 1 2 1 7 Delirium Tremens 1 .. 1 .. .. .. 2 Insanity 5 .. 4 .. .. .. 9 Carbuncle .. .. .. .. 1 .. 1 All other Diseases 64 7 535 611 612 134 1993 Total 93 8 1013 857 741 180 2892 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From May 27th, 1866, to June 30th, 1866. South West District. South East District. North West District. North East District Total. Number of houses inspected 273 262 272 137 944 Drains Constructed 2 13 .. .. 15 Improved or repaired 33 32 4 25 94 Traps fixed 3G 41 28 57 162 Cesspools Abolished 2 .. .. .. 2 Cleansed or disinfected .. .. .. .. .. Privies and Water Closets Pan, trap, and water supply furnished 2 6 2 1 11 Pan and trap only furnished .. .. .. 1 1 Water supply furnished 13 29 19 40 101 Dust bins Constructed .. 7 18 41 66 Repaired and covers adapted 32 14 • • 55 101 Surface Drains and Pavements of Yards Constructed .. 11 .. 1 12 Relaid 19 15 .. 2 36 General Water Supply New receptacle provided .. 14 5 1 20 Receptacle repaired and cleansed 41 29 31 36 137 Water supply provided .. 1 .. .. 1 Other Improve- ments Houses generally repaired 7 17 2 10 42 „ cleansed or limewashed 32 47 14 82 175 „ ventilated .. .. .. .. .. Overcrowding abated .. 2 1 1 4 Illegal use of underground Rooms for sleeping discontinued •• 1 .. .. 1 * For the purposes of Sanitary Inspection, I have divided the Pariah into four Districts by two lines—one passing from East to West along Paul's Road and the line of the North London Railway; the other from South to North along the Upper Street to Ring Cross, and then along tho Hornsey Road. The South-West District is retained by Mr. Mayes, together with Belle Isle, and tho South-East by Mr. Dunham; while the North-West has been assigned to Mr. Flitcroft, and the North-East to Mr. Powell. 78 REPORT ON THE SANITARY CONDITION OF ST. MARY, ISLINGTON. FOR, JULY, 1866. No. CXI. Three hundred and sixteen deaths were registered in the four weeks ending July 28th, the mean mortality of July being represented by 306 deaths. The number of deaths from ordinary diarrhoea and infantile cholera were by no means excessive. The first cases of unquestioned epidcmic cholera (putting aside the case of a woman from the East end of London, who was taken ill and died on July 23rd, in the White Conduit District) appeared, without warning, on Friday, July 27th. On this day, five cases altogether were reported to me, and on the next day, July 28th, five more. Of these first ten cases all but one were met with in the streets and courts to the East of the Essex Road. All are dead but one. From the 27th July to the date of presentation of this Report (August 9th), I have recorded 38 cases of confirmed cholera, of which 23 have died, the remainder being still labouring under the disease, or in various stages of convalescence. I have a record also of 63 cases of what is designated choleraic diarrhoea, a condition which differs from the diarrhoea that ordinarily prevails at this season of the year, and has a distinct and well-recognised relation to true cholera, of which it is but a milder and less fatal form. Although cholera may enter the families of the wealthy, and in its fiercest onsets spares neither noble nor peasant, yet it flourishes chiefly amid filth, especially excrementious filth, and where destitution has impoverished the blood. But these conditions alone will not produce cholera. The soil is indeed prepared, but the seed or germ of the malady must be introduced also. What that germ precisely is, science 2 has not yet determined, but where it exists is well known, and so are some of the media of its transmission from district to district, from family to family, and from person to person. If not absolutely existent in the matters discharged by vomiting and purging, the specific virus or germ of cholera is developed in them as soon as they undergo, as they do after a short time, a process of decomposition. Hence the danger of transmission of the disease by bedding, clothing, dust, and dirt soiled by the discharges thrown or falling upon them. It is a disgusting truth, but one which ought not to be concealed, that the chief danger consists in the reception of these germs of cholera by the mouth into the digestive canal, in water, and (perhaps from soiled hands) upon articles of food. The earliest result of the introduction of cholera poison is diarrhoea, which, in the majority of cases, precedes for some hours the choleraic attack. It is in this early diarrhœal stage that it is most amenable to medical treatment. If then we would, in what is called an epidemic season, prevent the invasion of cholera into a district, the following things must be done. ].—Filth of all kinds must be removed from houses, yards, rooms, and persons, and more especially excrementitious or foecal filth must be cleansed away. 2.—Destitution must be relieved with an open hand. Not only should none be in want, but all should be liberally fed. 3. —Great care should be taken that the water drunk is pure, and contains no dangerous organic contamination. The addition of a table-spoonful of Condy's Disinfecting Fluid to the water in a clean cistern is calculated to ensure this, and will not damage the water. 4.—Should the existence of cholera poison manifest itself anywhere in the production of cholera or choleraic diarrhoea, disinfectants should be freely used, in the manner directed on the handbills which I have drawn up for circulation. 5.—Every case of diarrhoea must receive immediate medical treatment. The principle must be accepted and acted upon, that any and every diarrhœa that occurs may be premonitory of a choleraic attack. Thus only can we avoid overlooking those which really are so. Half-an-hour's delay in obtaining the relief of the earliest symptoms, and the line may be passed which separates recovery from death. 3 It is on this ground that I feel bound to urge the multiplication in the Parish of places where the poor may obtain medicines in the event of a sudden attack of diarrhœa. They should be able to obtain it immediately. In former epidemics, every chemist's shop in the Parish was a dispensary for this purpose. Some similar arrangement might be made now. Some of the clergy and non-conformist congregations have kindly offered me the use of rooms for the same purpose, in different parts of the Parish. EDWARD BALLARD, M.D., Medical' Officer of Health. Vestry Offices, August 9th, 1866. TABLE A. Showing the Number of Cases of disease generally, and of Bowel Complaints particularly, recorded in the corresponding month for the last six years ; and also the total of the deaths from all causes, and from Bowel Complaints. July. Total Sickness. Total Deaths. Diarrhoea. Dysentery. Cholera. Bowel Complaints. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1866 2536 316 376 43 3 — 3 4 382 47 1865 2447 329 397 91 1 — 1 3 399 94 1864 2152 277 249 42 - — - 2 249 44 1863 2567 295 325 43 — — 1 3 326 46 1862 1964 231 110 7 1 — — 2 111 9 1861 2214 196 267 28 2 — 3 1 272 29 1860 1753 170 80 6 4 1 — — 84 7 TABLE B. Results of a Special Analysis of the Water supplied by the Metropolitan Water Companies during July, as made and published by the Metropolitan Association of Medical Officers of Health. Total solid matter per Imperial gallon. Loss by Ignition. Oxydisable Organic Matter. Hardness. Before Boiling. After Boiling. Thames Water Companies. grains. grains. grains. degrees. degrees. Grand Junction West Middlesex Southwark and Vauxhall Chelsea Lambeth Not yet published. Other Companies. Kent New River East London TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FOUR WEEKS ENDING JULY 28th, 1866. (Deaths of Non-residents in Hospitals excluded). West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of Age. At 20 and under 40 years of age. At 40 and under 60 years of age. at 60 and under 8o years of age. At 80 Tears of age and upward.. 157 159 All Causes 316 206 26 43 34 7 12 15 3. Respirat. Orgs. 27 14 3 6 3 1 .. 1 Laryngitis 1 1 .. .. .. .. (Classes.) 5 5 Bronchitis 10 3 1 2 3 1 1 .. Pleurisy 1 .. 1 .. .. .. 50 54 I. ZYMOTIC DIS. 104 95 5 1 3 .. 5 6 Pneumonia 11 8 1 2 .. .. 37 28 II. CONSTITUTE 65 26 13 17 8 1 .. 1 Asthma 1 .. .. 1 .. .. 1 2 Lung Diseases, &c. 3 2 .. 1 .. .. 47 55 III. LOCAL 102 48 8 23 20 3 4 9 4 Digestive Orgs. 13 5 2 5 1 .. 21 20 IV. DEVELOPMENT. 41 34 •• 1 3 3 l .. Gastritis 1 • • .. 1 .. .. .. 1 Lnteritis 1 1 .. .. .. .. 2 2 V. VIOLENTDTHS. 4 3 .. 1 .. .. .. 3 Peritonitis 3 2 .. l .. .. .. .. Not Speecified .. .. .. .. .. .. .. .. Ascites .. .. .. .. .. .. .. .. Ulceration of Intcs. .. .. .. .. .. .. .. .. Hernia .. .. .. .. .. .. (Orders.) 2 1 Ileus 3 .. .. .. 1 .. .. 1 Intussusception 1 .. .. .. .. .. 48 52 I. 1. Miasmatic Dis. 100 91 5 1 3 .. .. Stricture of Intest. .. .. .. .. .. .. 1 1 Small Pox 2 1 1 .. .. .. .. .. Fistula .. .. .. .. .. .. 4 12 Measles 16 16 .. .. .. .. .. .. Stomach Dis., &c. .. .. .. .. .. .. 6 3 Scarlatina 9 9 .. .. .. .. .. .. pancreas Dis.,&c. .. .. .. .. .. .. 1 1 Diphtheria 2 2 .. .. .. .. .. .. Hepatitis .. .. .. .. .. .. .. .. Quinsey • • • • .. .. .. .. .. .. Hepatitis .. .. .. .. .. .. 2 .. Croup 2 2 .. .. .. .. 1 3 Liver Disease 4 .. .. 3 .. .. 5 9 Hooping Cough 14 14 .. .. .. .. .. .. Spleen Disease .. .. .. .. .. .. .. 3 Typhus & Typhoid 3 2 l .. .. .. 2 4 5. Urinary Orgs. 6 .. .. 3 2 .. .. 1 Erysipelas 1 1 .. .. .. .. .. .. Nephritis .. .. .. .. .. .. .. .. Pyœmia .. .. .. .. .. .. .. 2 Disease of Bladder 2 .. .. l .. .. 1 1 Puerperal Fever 2 •• 2 .. .. .. .. 2 Nepheria 2 .. .. l 1 .. .. .. Carbunela .. .. .. .. .. .. .. .. Diabetes .. .. .. .. .. .. •• .. Influenza .. .. •• .. .. .. .. .. Stone .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. Prostrate Disease .. .. .. .. .. .. 25 18 Diarrhœa 43 40 1 •• 2 •• 2 .. Kidney Disease,&c. 2 .. .. 1 1 .. 2 2 Cholera 4 .. .. .. .. .. 1 .. 6. Genera. Organs 1 1 .. .. .. .. .. .. Ague .. .. .. .. .. .. .. .. Ovarian Dropsy .. .. .. .. .. .. 1 1 Rheumatism 2 .. .. .. 1 .. 1 .. uterine disease 1 1 .. .. .. .. .. 1 2. Enthetic 1 1 .. • .. .. 2 1 7. Orgs.ofLocomo. 3 1 .. 2 .. .. .. 1 Syphilis 1 1 .. .. .. .. .. .. Spine Diseases .. .. .. .. .. .. .. .. Stricture of Urethra .. .. .. .. .. .. 2 1 Bone Diseases 3 .. .. 2 .. .. .. .. Hydrophobia .. .. .. .. .. .. 1 1 8. Skill, &c 2 2 .. .. .. .. .. .. Glanders .. .. .. .. .. .. 1 .. Phlegmon&Abscess 1 3 .. .. .. .. 2 .. 3. Dietic 2 2 .. .. .. .. .. .. Ulcer .. .. .. .. .. .. .. .. Privation .. .. .. .. .. .. .. 1 Skin Diseases l 1 .. .. .. .. 2 .. Want of Br. Milk.. 2 2 .. .. .. .. .. .. .. .. .. .. .. Purpura and Scurvy .. .. .. .. .. .. 3 10 IV. 1. Dis. of Childn. 13 13 .. .. .. .. .. .. Alcoholism .. .. .. .. .. .. 3 8 Premature Birth 11 11 .. .. .. .. •• 1 Parasitic 1 1 .. .. .. .. .. .. Cyanosis .. .. .. .. .. .. .. 1 Thrush 1 1 .. .. .. .. .. 1 Spina Bifida 1 1 .. .. .. .. .. .. Worms .. .. .. .. .. .. .. 1 Other Malformation 1 .. .. .. .. .. .. .. Teething .. .. .. .. .. .. 9 5 II. 1. Diathetic 14 2 .. 4 7 1 .. .. 2. Dis. of Adults . .. .. .. .. .. .. .. •• Gout .. .. .. .. .. .. .. .. Paramenia .. .. .. .. .. .. 4 .. Dropsy 4 l .. 1 1 1 .. .. Childbirth .. .. .. .. . .. .. 1 Haemorrhage 1 .. .. .. 1 •• 4 3 3. Dis. of Aged 7 .. .. 1 3 3 5 3 Cancer 8 .. .. 3 5 •• 4 3 old Age 7 .. .. 1 3 3 •• 1 Noma 1 1 .. .. .. .. 14 7 4. Dis. of Nutritn. 21 21 .. .. .. .. .. .. Mortification .. .. .. .. .. .. 14 7 Atrophy & Debility 21 21 .. .. .. 28 23 2. Tubercular 51 24 13 13 1 .. l 3 Scrofula 4 4 .. .. .. .. 1 2 V. 1. Acci. or Neg. 3 3 .. .. .. .. 1 2 Tabes Mesenterica 3 3 .. .. .. .. 1 Fract. and Contus. 1 1 .. .. .. .. 20 11 Phthisis 31 4 13 13 1 .. .. .. Wounds .. .. .. .. .. .. 6 7 Hydrocephalus 13 13 •• .. .. .. .. .. Burns and Scalds.. .. .. .. .. .. .. .. .. Poison .. .. .. .. .. .. 20 19 III. 1. NervousSyst. 39 24 1 4 10 .. .. .. Drowning .. .. .. .. .. .. 2 • • Cephalitis 2 2 •• .. •• .. 1 1 suffocation 2 2 .. .. .. .. 3 4 Apoplexy 7 3 .. 2 2 ... .. .. Otherwise .. .. .. .. .. .. 5 3 Paralysis 8 .. .. 2 6 .. .. .. 2. Homicide .. .. .. .. .. .. .. .. Insanity .. .. .. .. .. •• 1 .. 3 Suicide 1 .. .. 1 .. .. .. .. Chorea .. .. .. .. .. .. .. .. Wounds .. .. .. .. .. .. .. 1 Epilepsy 1 .. 1 .. .. .. .. .. poison .. .. .. .. .. .. 7 9 Convulsions 16 16 .. .. .. .. .. .. Drowning .. .. .. .. .. .. 3 2 Brain Diseases, &c. 5 3 .. .. 2 .. 1 .. suffocat. and Hang. 1 .. .. 1 .. .. 5 6 2. Organs of Circ- 11 1 2 3 4 1 .. .. Otherwise .. .. .. .. .. .. 1 • • Pericarditis 1 1 .. .. .. .. .. .. 4. Unclassed .. .. .. .. .. .. .. .. Aneurism .. .. .. .. .. .. 4 6 Heart Disease 10 .. 2 3 4 1 TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FOUR WEEKS ENDING SATURDAY, THE 28th DAY OF JULY, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small Pox 1 .. 14 2 .. .. 17 Chicken Pox .. .. 2 3 • • 5 Measles .. .. 60 14 24 .. 98 Scarlatina 1 .. 17 6 1 25 Whooping Cough .. .. 26 24 6 .. 56 Croup .. .. 1 .. • • .. 1 Diarrhœa 16 .. 184 121 27 28 376 Dysentery .. .. 1 1 1 .. 3 Cholera .. .. 2 1 • • .. 3 Ague .. .. .. 2 .. .. 2 Continued Fever 1 .. 6 4 2 .. 13 Influenza .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. Rheumatic Fever 3 .. 2 1 3 .. 9 Erysipelas .. .. 5 2 .. .. 7 Diphtheria .. .. .. 4 .. .. 4 Sorethroat or Tonsillitis .. .. 17 5 5 .. 27 Mumps .. .. 1 .. .. .. 1 Pyaemia .. .. .. .. .. .. .. Bronchitis and Catarrh 3 .. 101 43 12 24 183 Pneumonia .. .. .. 3 3 .. 6 Pleurisy .. .. 1 1 2 .. 4 Delirium Tremens 1 .. 1 2 .. .. 4 Insanity 4 .. 1 .. .. 1 6 Carbuncle 1 .. .. .. .. .. 1 All other Diseases 49 8 464 485 552 127 1685 total 80 8 906 724 638 180 2536 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From July 1st, 1866, to July 28th, 1866. South West District. South East District. North West District. North East District Total. Number of houses inspected 247 196 276 130 849 Drains Constructed 1 6 .. 2 9 Improved or repaired 30 23 3 32 88 Traps fixed 33 34 14 37 118 Cesspools Abolished 2 .. .. 1 3 Cleansed or disinfected .. .. .. 4 4 Privies and Water Closets Pan, trap, and water supply furnished 8 .. .. 1 9 Pan and trap only furnished .. .. .. 2 2 Water supply furnished 23 29 10 14 76 Dust bins [Constructed 4 3 7 23 37 Repaired and covers adapted 20 17 14 29 80 Surface Drains and Pavements of Yards Constructed .. 19 .. 2 21 Relaid 34 29 .. 3 66 General Water Supply New receptacle provided 8 3 .. 2 13 Receptacle repaired and cleansed 22 21 20 19 82 Water supply provided 8 .. .. .. 8 Other Improve- ments Houses generally repaired 11 11 2 9 33 ,, cleansed or limewashed 15 32 6 32 85 „ ventilated .. .. .. .. .. Overcrowding abated .. 2 .. 3 5 Illegal use of underground Rooms for sleeping discontinued •• 1 .. .. 1 * For the purposes of Sanitary Inspection, I have divided the Parish into four Districts by two lines—one passing from East to West along Paul's Road and the line of the North London Railway; the other from South to North along the Upper Street to Ring Cross, and then along the Hornsey Road. The South-West District is retained by Mr.Mayes, together with Belle Isle, and the South-East by Mr. Dunham; while the North-West has been assigned to Mr. Flitcroft, and the North-East to Mr. Powell. 79 REPORT ON THE SANITARY CONDITION OF ST. MAM, ISLINGTON, FOR AUGUST, 1866. No. CXII. The number of deaths registered daring the four weeks ending August 25th amounts to 368, a number which is in excess of the mean registered mortality of August for ten years past (when corrected for increase of population) to the extent of 91 deaths. The next largest number of deaths which I have recorded in August was 288 in August, 1863, a year which was remarkable for the great amount of sickness and mortality which prevailed throughout the kingdom. Of the whole number of deaths, 199 were of children under five years of age, and there were ten of persons over eighty years of age. It is true, as I shall presently have to show, that our mortality has been swollen by deaths from cholera and diarrhœa, but these alone will not account for the very great excess; in fact, in 1863, the August mortality from diarrhœa was as large as this year, although there were only four deaths from cholera registered. Every class of disease has indeed contributed an excess of deaths, showing that iu addition to the existence of the specific virus of cholera amongst our population, there has been present also some general wide-spread influence which has exhibited its operation in a variety of ways upon the human system. The presence of this cause of vital depression I have recognised ever since the month of April, (see No. CVIII.) preparing the way for the then approaching epidemic. I may mention, among the diseases which have carried off an unusual number of persons, besides diarrhoea and cholera, whooping cough, mesenteric disease, the heterogeneous group of conditions registered as atrophy and debility of infants, consumption, hydrocephalus, pneumonia, and heart diseases. 2 Four thousand one hundred and fourteen cases of disease have been treated at the various public institutions for the medical relief of the poor —the largest number hitherto treated in any August for ten years past being 2722 cases in August, 1863. Here again we find the amount swollen, not only by an excessive number of diarrhceal and choleraic affections, but by an unusual number of cases of small-pox, measles, ague, and (let it be remarked also) of chest diseases. The last fact is important, inasmuch as in ordinary seasons an excess of diarrhœa is associated with a small amount of chest disease. But the chief event of the month has been the outbreak of cholera and its associated epidemic diarrhoea. Altogether there have been reported to me up to Saturday, the 25th of August, 56 cases of cholera, (including 7 cases in the practice of private practitioners) of which, up to the present time, 34 have died; 133 cases of the milder disease which passes under the term "choleraic diarrhœa," of which 6 died; and 1665 cases of diarrhoea. Indeed there is a large additional number of cases of diarrhoea which were not entered in the books of the Holloway and Islington Dispensaries, but which applied there for medicine, all probably mild cases yet in the former institution counting by hundreds. Making then every allowance for mild cases, which probably in another season we should have heard nothing about, there can be no question that, together with cholera and choleraic diarrhoea, simple diarrhoea has prevailed also to a very unusual extent. Happily and, I think, not fortuitously, cholera has not prevailed with us, either to the same extent as in other less favoured parishes, nor yet to anything like the extent of former epidemic visitations. It is too early at present to congratulate ourselves, although the fact is thus far a ground for thankfulness. The worst of the outbreak in London appears to have passed, but yet the disease lingers as if loth to depart from the metropolis. We are not even now safe, although we have reason to be hopeful. The weekly progress of the disease and its allied affections during the four weeks has been as follows:— Week ending— CASES. Aug. 4. Aug. 11. Aug. 18. Aug. 25. Total. Cholera 36 9 6 5 56 Choleraic diarrhoea 41 33 26 33 133 Diarrhœa and dysentery 203 467 552 443 1665 3 In the above table I include 7 private cases and all the cases of cholera which happened in the last days of July. Of the 36 first cases 26 proved fatal; of the 9 in the next week, 4 were fatal; and of the 6 next, 4 were fatal. None of the 5 last have yet died. Of the 41 first cases of choleraic diarrhoea, 6 died, all the rest have recovered. Now there is something very remarkable in the above Table, and that is the sudden outburst of cholera, almost confined to two small districts, viz,: the neighbourhood of Elder Walk and a limited portion of Lower Holloway, and the almost equally sudden subsidence of the disease in the week following August 4th. This is not the ordinary progress of Cholera. It looks very much like the result of the energetic process of "stamping out" which I took the liberty of adopting immediately on the occurrence of the earliest cases, upon my own responsibility, which the Diseases' Prevention Committee, at their first meeting, approved, and which has since then been actively pursued with their concurrence. I believe that the establishment of the Dispensary in the centre of the infected district at Elder Walk, and the active house-to-house visitation there have been of incalculable service in the detection and treatment of of premonitory symptoms, and, with the other measures adopted, have saved the parish from an outbreak in that neighbourhood to which our 56 cases would have been a bagatelle. With the aid of the additional sanitary staff now at my disposal, sanitary wants which have long been needed, are being supplied; my own time for the last six weeks has been wholly devoted, I hope not fruitlessly, to the public service; and I am happy to be able to add that during the entire time I have received the hearty co-operation, whenever I needed it, of all the principal Officers of the Vestry, as well as of my own staff. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, September 6 th, 1866. 4 TABLE A. Shewing the Number of Cases of disease generally, and of Bowel Complaints particularly, recorded in the corresponding month for the last six years; and also the total of the deaths from all causes, and from Bowel Complaints. August. Total Sickness. Total Deaths. Diarrhoea. Dysentery. Cholera. Bowel Complaints. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. Oases. Deaths. 1866 4114 368 1794 56 4 - 49 31 1847 87 1865 2059 215 189 22 1 2 - 4 190 28 1864 2219 260 398 52 - - 2 1 400 53 1863 2722 288 407 55 - - 1 4 408 59 1862 2082 202 212 23 1 - 4 1 217 24 1861 2407 235 428 45 2 1 3 6 433 52 1860 1561 177 119 22 4 2 1 2 124 26 TABLE B. Results of a Special Analysis of the Water supplied by the Metropolitan Water Companies during August, as made and published by the Metropolitan Association of Medical Officers of Health. Total solid matter per I mperial gallon. Loss by Ignition. Oxy disable Organic Matter. Hardness. Before Boiling. After Boiling. Thames Water Companies. grains. grains. grains. degrees. degrees. Grand Junction 18.13 0.81 0.60 13.5 4.0 West Middlesex 16.80 0.59 0.48 13.0 3.5 Southwark and Vauxhall 18.67 1.00 0.64 14.0 3.5 Chelsea 18.43 0.65 0.56 13.0 3.5 Lambeth (not received) — — — — Other Companies. Kent 27.36 0.70 0.03 17.5 8.5 New River 17.09 0.54 0.22 13.0 3.5 East London 18.19 0.88 0.56 13.0 4.0 TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FOUR WEEKS ENDING AUGUST 25th, 1866. (Deaths of Non-Residents in Hospitals excluded). West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of Age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards.  185 183 All Causes 368 217 44 49 48 10 12 10 3. Respirat. Orgs. 22 13 1 4 2 2 .. .. Laryngitis .. .. .. .. .. .. (Classes.) 6 3 Bronchitis 9 4 .. 2 2 1 1 .. Pleurisy 1 .. .. 1 .. .. 73 79 I. ZYMOTIC DIS. 152 114 13 15 10 .. 4 6 Pneumonia 10 9 1 .. .. .. 35 32 II. CONSTITUTL 67 33 17 14 3 .. .. 1 Asthma 1 .. .. .. .. 1 1 .. Lung Diseases, &c. 1 .. .. 1 .. .. 64 47 III. LOCAL 101 36 12 19 28 6 10 8 4- Digestive Orgs. 18 6 .. 7 5 .. 21 19 IV. DEVELOPMNL. 40 29 •• • • 7 4 .. .. Gastritis .. .. .. .. .. .. .. 2 Enteritis 2 2 .. .. .. .. 2 6 V. VIOLENT DTHS. 8 5 2 1 .. .. .. 1 Peritonitis 1 .. .. .. .. .. •• •• Not specified .. .. .. .. .. .. .. .. Ascites .. .. .. .. .. .. .. .. Ulceration of Intes. .. .. .. .. .. .. .. .. Hernia .. .. .. .. .. .. (Orders.) 1 .. Ileus 1 1 .. .. .. .. 1 .. Intussusception 1 1 .. .. .. .. 67 73 I. 1. Miasmatic Dis. 140 103 13 14 10 .. .. .. Stricture of Intest. .. .. .. .. .. .. 2 1 Small Pox 3 1 1 1 .. .. .. Fistula .. .. .. .. .. .. 1 8 Measles 9 8 1 •• .. 1 1 Stomach Dis., &c. 2 1 .. 1 .. .. 5 3 Scarlation 8 7 1 .. .. .. .. .. Pancreas Dis., &c. .. .. .. .. .. .. .. •• Diphtheria .. .. .. . .. .. 2 .. Hepatitis 2 1 .. .. 1 .. ..• .. Quinsey .. .. .. .. .. .. .. .. Jaundice .. .. .. .. .. .. 3 2 Croup 5 5 .. .. .. .. 5 4 Liver Disease 9 .. .. 5 4 .. 10 7 Hooping Cough 17 17 .. .. .. .. .. .. Spleen Disease .. .. .. .. .. .. 4 3 Typhus & Typhoid 7 1 4 1 1 .. 4 1 5. Urinary Orgs. 5 1 1 1 2 .. 1 .. Erysipelas 1 1 .. .. .. .. 1 .. Nephritis 1 1 .. .. .. .. .. .. Pyœmia .. .. .. .. .. .. .. .. Disease of Bladder .. .. .. .. .. .. .. 1 Puerperal Fever 1 . 1 .. .. .. 1 .. Nepheria 1 .. .. .. 1 .. .. .. Carbuncle .. .. .. .. .. .. .. .. Diabetes .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. Stone .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. Prostrate Disease .. .. .. .. .. .. 33 23 Diarrhœa 56 51 .. 1 4 .. 2 1 Kidney Disease,&c. 3 .. 1 1 1 .. 6 25 Cholera 31 12 5 9 5 .. .. 1 6. Genera. Organs 1 .. .. 1 .. .. .. .. Ague .. .. .. .. .. .. .. .. Ovarian Dropsy .. .. .. .. .. .. 2 .. Rheumatism 2 .. .. 2 .. .. .. 1 Uterine Diseases 1 .. .. 1 .. .. 2 2 2. Enthetic 4 4 .. .. .. .. .. 2 7. Orgs. of Locomo. 2 1 1 .. .. .. 2 2 Syphilis 4 4 .. .. .. .. .. 2 Spine Diseases 2 1 1 .. .. .. .. .. Stricture of Urethra .. .. .. .. .. .. .. .. Bone Diseases .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. 1 2 8. Skin, &c 3 3 .. .. .. .. .. .. Glanders .. .. .. .. .. .. 1 1 Phlegmon&Abscess 2 2 .. .. .. .. 4 1 3. Dietic 5 4 .. 1 •• .. .. .. Ulcer .. .. .. .. .. .. .. .. Privation .. .. .. .. .. .. .. 1 Skin Diseases 1 1 .. .. .. .. 3 l Want of Br. Milk 4 4 .. .. .. .. •• .. Purpura and Scurvy .. .. .. .. .. .. 3 4 IV. 1. Dis. of Childn. 7 7 .. .. .. .. 1 .. Alcoholism 1 .. .. 1 .. .. 1 4 premature Birth 5 5 .. .. .. .. .. 3 4. Parasitic 3 3 .. .. .. .. 1 .. Cyanosis 1 1 .. .. .. .. .. 3 Thrush 3 3 .. .. .. .. .. .. Spina Bifida .. .. .. .. .. .. .. .. worms .. .. .. .. .. .. 1 .. Other Malformation 1 1 .. .. .. .. .. .. Teething .. .. .. .. .. .. 2 5 II. 1. Diathetic 7 .. 1 4 2 .. .. .. 2. Dis. of Adults . .. .. .. .. .. .. .. .. Gout .. .. .. .. .. .. .. .. Paramenia .. .. .. .. .. .. .. 2 Dropsy 2 .. 1 .. 1 .. .. .. Childbirth .. .. .. .. .. .. .. •• Haemorrhage .. .. .. .. .. .. 7 4 3. Dis. of Aged 11 .. .. .. 7 4 2 3 Cancer 5 .. .. 4 1 .. 7 4 Old Age 11 .. .. .. 7 4 .. .. Noma .. .. .. .. .. .. 11 11 4. Dis. of Nutritn. 22 22 .. .. .. .. .. .. Mortification .. .. .. .. .. .. 11 11 Atrophy & Debility 22 22 .. .. .. .. 33 27 2. Tubercular 60 33 16 10 1 .. 2 l Scrofula 3 2 1 .. .. .. 4 7 Tabes Mesenterica 11 11 .. .. .. .. .. 6 V. 1. Acci. or Neg. 6 4 1 1 .. .. 25 12 Phthisis 37 11 15 10 1 .. .. 4 Fract. and Contus. 4 2 1 1 .. .. 2 7 Hydrocephalus 9 9 .. .. .. .. .. .. Wounds .. .. .. .. .. .. Burns and Scalds .. .. .. .. .. .. • .. .. Poison 1 1 .. .. .. .. 13 11 III. 1. Nervous Syst 24 11 3 3 6 1 .. 1 Drowning .. .. .. .. .. .. 1 1 Cephalitis 2 2 .. .. .. .. .. .. Suffocation .. .. .. .. .. .. 1 4 Apoplexy 5 .. 2 .. 2 1 .. 1 Otherwise 1 1 .. .. .. .. 6 .. Paralysis 6 .. 1 2 3 .. 1 .. 2. Homicide 1 1 .. .. .. .. .. .. Insanity .. .. .. .. .. .. 1 .. 3. Suicide 1 .. 1 .. .. .. .. .. Chorea .. .. .. .. .. .. .. .. Wounds .. .. .. .. .. .. .. .. Epilepsy .. .. .. .. .. .. .. .. Poison .. .. .. .. .. .. 4 5 Convulsions 9 9 .. .. .. .. .. .. Drowing .. .. .. .. .. .. 1 1 Brain Diseases, &c. 2 .. .. 1 1 .. 1 .. Suffocat. and Hang. 1 .. 1 .. .. .. 14 12 2. Organs of Circ. 26 1 6 3 13 3 .. .. Otherwise .. .. .. .. .. .. • • .. Pericarditis .. .. .. .. .. .. .. .. 4. Unclassed .. .. .. .. .. .. 1 .. Aneurism 1 .. .. 1 .. .. 13 12 Heart Disease 25 1 6 2 13 3 TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FOUR WEEKS ENDING SATURDAY, THE 25th DAY OF AUGUST, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers.* Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small Pox 2 .. 17 .. 1 .. 20 Chicken Fox .. 1 4 3 .. .. 8 Measles .. .. 34 32 27 .. 93 Scarlatina .. .. 8 4 5 .. 17 Whooping Cough .. .. 13 16 7 .. 36 Croup .. .. 1 •• .. .. 1 Diarrhœa 11 .. 1516† 196 42 29 1794 Dysentery .. .. 1 2 1 •• 4 Cholera • • .. 46 3 • • .. 49‡ Ague .. .. 3 2 1 .. 6 Continued Fever 1 2§ 16|| 7 3 •• 29 Influenza .. .. .. .. .. .. .. Puerperal Fever .. .. 1 .. .. .. 1 Rheumatic Fever 3 .. 1 .. .. .. 8 Erysipelas 2 .. 6 .. .. .. 8 Diphtheria .. .. .. 1 • • .. 1 Sorethroat or Tonsillitis 1 .. 19 13 3 .. 36 Mumps .. .. 1 .. .. .. 1 Pyaemia .. .. .. .. .. .. .. Bronchitis and Catarrh 15 .. 135 66 8 21 245 Pneumonia .. .. 6 2 .. • • 8 Pleurisy .. .. 3 1 4 Delirium Tremens 1 .. 1 .. .. .. 2 Insanity 3 .. 5 .. • • .. 8 Carbuncle .. .. .. 1 1 .. 2 All other Diseases 58 14 503 526 470 162 1733 total 97 17 2340 875 573 212 4114 * The cases attended by Messrs. Macleod and Turner, on behalf of the Yestry are included in this coloumn, + Of these, 133 cases are returned as "Choleraic Diarrhœa." ‡ In addition to this number, there have been 7 " private " cases. || Four of these were cases of "Typhus" from No. 1, Birch Place, Elder Walk. § " Typhoid" Fever. TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From July 29th, 1866, to August 25th, 1866. South West District. South East District. North "NVest District. North East District Total. Number of houses inspected 580 665 241 152 1638 Drains Constructed 1 7 .. 4 12 Improved or repaired 37 13 .. 36 86 Traps fixed 45 29 20 42 136 Cesspools Abolished 2 .. .. 3 5 Cleansed or disinfected .. .. .. 7 7 Privies and Water Closets Pan, trap, and water supply furnished 4 .. 14 3 21 Pan and trap only furnished 7 7 .. 1 15 Water supply furnished 28 34 10 21 93 Dust bins Constructed 3 11 6 17 37 Repaired and covers adapted 21 23 10 19 73 Surface Drains and Pavements of Yards Constructed .. 19 .. 1 20 Relaid 19 37 .. 2 58 General Water Supply New receptacle provided 4 2 .. 4 10 Receptacle repaired and cleansed 40 53 30 14 137 Water supply provided 1 2 .. .. 3 Other Improve ments Houses generally repaired 8 11 2 17 38 „ cleansed or limewashed 26 36 4 40 146 „ ventilated .. .. .. 3 3 Overcrowding abated 5 4 1 9 19 Illegal use of underground Rooms for sleeping discontinued 1 2 .. .. 3 80 REPORT ON THE SANITARY CONDITION OF ST. MAM, ISLINGTON, FOR SEPTEMBER, 1866. No. CXIII. Three hundred and forty-eight deaths were registered during the five weeks ending September 29th. The mean mortality for the corresponding weeks of ten previous years, corrected for increased population, is 335, so that our mortality has amounted to 13 above the average. Small-pox, scarlet fever, and hooping cough have all been prevailing to a greater extent than during August, and the mortality from hooping cough has been above the average of the month. Fever has also been more fatal, and especially it is to be observed that we have had more cases of typhus than is customary in this parish, where this form of fever is not very commonly met with. The mortality from diseases of the nervous system, and especially from apoplexy, has been also unusually high, and the deaths of young infants from what are termed in the certificates of death " debility," " marasmus," "atrophy," &c., have been more numerous than usual. Necessarily my principal anxiety has been in connection with the epidemic of cholera, the control of which has taxed to the utmost all the resources at my disposal. It is not to be supposed that the labour which it involves is at all to be measured by the number of cases, which has hitherto been much smaller than in former epidemics. The Diseases Prevention Committee have very judiciously largely increased my staff of inspectors, and sanitary work is going on very actively in all parts of the parish; besides which, they have recently, at my request, furnished me with a body of men whom I employ at the disinfection of closets and drains wherever cholera shows itself, and also in places where from the character of the population it is 2 most likely to break out. The remarkable feature of the present epidemic is its course. At first it was very much confined to certain districts at the East of London, where investigation has shown that a local cause existed, on the removal of which the disease steadily and quickly declined. But while lessening in that part of the metropolis which had been supplied with contaminated water, it has become more generally diffused over London, parts previously free from attack have been invaded, and now no parish can be regarded as even comparatively safe. Every case that happens therefore, scattered as the cases are, must be regarded, and is regarded by me, as a possible focus from which the disease may be spread through a neighbourhood; and I have consequently felt it my duty to do all in my power to extinguish the first small spark wherever it has happened to fall. Happily my efforts have hitherto been successful, a fact which I attribute in great measure to the early information I have, up to the present time, received from my professional brethren, especially from those whose practice takes them among the poorer classes of our population. The uncertainty which just now prevails as to the progress of the disease is calculated to inspire some uneasiness as to our prospects. The disease certainly is not following the ordinary course of decline, indeed the tendency at present is towards increase, as if the outbreak in the East of London had been but a special local development,under peculiar circumstances, of what has been steadily spreading by slow steps over the metropolis. The prospect is not cheering, but we must look at it fairly, and act judiciously, varing our proceedings as the circumstances of the case appear to require from time to time. In the intervals of the meetings of the Committee, I have thus taken upon myself, now and then, to vary the arrangements which they had made, both as respects the re-engagement of assistance which they had considered no longer necessary, and in the discontinuance of that for which I had no immediate occasion. I have every reason to be thankful under the great anxieties I have to encounter, for the confidence they have manifested in my judgment in matters where I have in this way exceeded the limits of their direction. I believe they feel, as I do myself, that a broad margin of discretionary power must be left in my hands. Since the date of the last report, I have received information of S3 new cases of fully developed cholera, and 46 of choleraic diarrhoea among the class of persons usually met with as patients either of a parochial or dispensary surgeon. Notice of nine additional private 3 cases of choleraic diarrhœa have been forwarded to me by private practitioners, but I do not count them into the following weekly table because I wish the comparison with former weeks to be as undisturbed as possible. The cases of cholera, choleraic diarrhoea, and diarrhcea were thus distributed— Week ending— CASES. Sep. 1. Sep. 8. Sep. 15. Sep.22. Sep.29. Total. Cholera 4 5 8 6 10 33 Choleraic diarrhcea 21 4 8 9 4 46 Diarrhcea and dysentery 452 401 363 229 197 1642 Up to the 29th of September then we have had in the parish 89 cases of cholera,* of which 55 proved fatal, and 179 cases of choleraic diarrhcea, of which 8 proved fatal. Diarrhœal affections also, although not so common as in August, were yet vastly more prevalent than in ordinary seasons, as will be seen from the Table A. at the end of the report. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, October 13 th, 1866. * Up to the day of presenting this Report to the Sanitary Committee (October 15th), our total cases amounted to 105. TABLE A. Shewing the Number of Cases of disease generally, and of Bowel Complaints particularly, recorded in the corresponding month for the last six years; and also the total of the deaths from all causes, and from Bowel Complaints. Sept. Total Sickness. Total Deaths. Diarrhoea.* Dysentery. Cholera. Bowel Complaints. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1866 4507 348 1682 26 6 - 33 25 1721 51 1865 2019 306 214 24 1 — 1 — 216 24 1864 2754 320 205 40 1 2 2 — 208 42 1863 3053 357 272 28 1 1 — 2 273 31 1862 2805 234 198 18 1 1 — 3 199 22 1861 2743 255 345 37 6 - 2 — 353 37 1860 2173 220 168 15 3 1 1 - 172 15 * Including " Choleraic Diarrhœa." 4 TABLE B. Results of a Special Analysis of the Water supplied by the Metropolitan Water Companies during September, as made and published by the Metropolitan Association of Medical Officers of Health. Total solid matter per Imperial gallon. Loss by Ignition. Oxy disable Organic Matter. Hardness. Before Boiling. After Boiling. Thames Water Companies. grains. grains. grains. degrees. degrees. Grand Junction 19.33 0.76 0.68 13.0 4.5 West Middlesex 15.89 0.84 0.80 14.5 4.5 Southwark and Vauxhall 17.83 0.91 0.72 13.0 4.0 Chelsea 19.00 0.85 0.56 13.0 4.5 Lambeth 18.54 1.00 0.79 13.5 4.0 Other Companies. Kent 25.89 1.01 0.28 18.0 7.5 New River 16.38 0.98 0.21 13.5 3.5 East London 18.52 1.00 0.39 14.0 5.0 TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FIVE WEEKS ENDING SEPTEMBER 29th, 1866. (Deaths of Non-Residents in Hospitals excluded). West S.D. East 8.D. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of Age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. 179 169 All Causes 348 192 58 48 45 5 12 20 3. Respirat. Orgs. 32 15 2 4 10 1 1 2 Laryngitis 3 2 .. 1 .. .. (Classes.) 9 10 Bronchitis 19 9 1 2 7 .. .. 2 Pleurisy 2 1 1 .. .. .. 66 55 I. ZYMOTIC DIS 121 85 20 10 5 1 1 6 Pneumonia 7 3 .. 1 2 1 37 25 II. CONSTITUTL 62 24 19 15 4 .. .. .. Asthma .. .. .. .. .. .. 1 .. Lung Diseases, &c. 1 .. .. .. 1 .. 52 63 III. LOCAL 115 38 17 23 35 2 11 9 4. Digestive Orgs. 20 4 4 8 4 .. 20 17 IV. DEVELOPMNL. 37 34 .. .. 1 2 .. .. Gastritis .. .. .. .. .. .. 1 .. Enteritis 1 .. .. 1 .. .. 4 8 V. VIOLENT DTHS. 12 11 ] .. .. .. 3 1 Peritonitis 4 1 3 .. .. .. .. 1 Not Specified 1 .. 1 .. .. .. .. .. Ascites .. .. .. .. .. .. .. .. Ulceration of Intes. .. .. .. .. .. .. .. .. Hernia .. .. .. .. .. .. (Orders.) 2 .. Ileus 2 .. .. .. .. .. 63 53 I. 1. Miasmatic Dis. 116 81 19 10 5 1 .. .. Intussusception .. .. .. .. .. .. .. .. Stricture of Intest .. .. .. .. .. .. 4 1 Small Pox 5 3 2 .. .. .. .. .. Fistula .. .. .. .. .. .. 3 5 Measles 8 8 .. .. .. .. .. 1 Stomach Dis., &c. 1 .. .. .. 1 .. 7 4 Scarlatina 11 11 .. .. .. .. .. .. Pancreas Dis., &c. .. .. .. .. .. .. 3 1 Diphtheria 4 4 .. .. .. .. .. 1 Hepatitis 1 .. .. .. l .. .. .. Quinsey .. .. .. .. .. .. .. 2 Jaundice 2 2 .. .. .. .. .. 1 Croup 1 1 .. .. .. .. 5 4 Liver Disease 9 1 1 6 l .. 8 10 Hooping Cough 18 18 .. .. .. .. .. .. Spleen Disease .. .. .. .. .. .. 10 6 Typhus & Typhoid 16 5 9 1 1 .. 2 3 5. Urinary Orgs. 5 1 1 1 1 1 1 .. Erysipelas 1 .. .. .. 1 .. .. .. Nephritis .. .. .. .. .. .. .. .. Pyœmia .. .. .. .. .. .. .. 1 Disease of Bladder 1 .. .. .. .. 1 1 .. Puerperal Fever 1 . 1 .. .. .. .. 1 Nephria 1 .. .. 1 .. .. .. .. Carbuncle .. .. .. .. .. .. 1 .. Diabetes 1 1 .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. Stone .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. Prostrate Disease .. .. .. .. .. .. 14 12 Diarrhœa 26 21 1 3 .. 1 l 1 Kidney Disease,&c. 2 .. 1 .. 1 .. 12 13 Cholera 25 10 6 6 3 .. 2 1 6. Genera. Organs 3 .. 2 1 .. .. .. .. Ague .. .. .. .. .. .. .. 1 Ovarian Dropsy 1 .. .. 1 .. .. .. .. Rheumatism .. .. .. .. .. .. 2 .. Uterine Diseases 2 .. 2 .. .. .. 2 1 2. Enthetic 3 3 .. . .. .. 1 .. 7. Orgs. of Locomo. 1 1 .. .. .. .. 2 1 Syphilis 3 3 .. .. .. .. 1 .. Spine Diseases 1 1 .. .. .. .. .. .. Stricture of Urethra .. .. .. .. .. .. .. .. Bone Diseases .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. .. 8. Skin, &c .. .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. Phlegmon&Abscess .. .. .. .. .. .. 1 .. 3. Dietic 1 .. 1 .. .. .. .. .. Ulcer .. .. .. .. .. .. .. .. Privation .. .. .. .. .. .. .. .. Skin Diseases .. .. .. .. .. .. .. .. Want of Br, Milk .. .. .. .. .. .. .. .. Purpura and Scurvy .. .. .. .. .. .. 1 .. Alcoholism 1 .. 1 .. .. .. 9 3 IV. 1. Dis. of Childn. 12 12 .. .. .. .. .. 1 4. Parasitic 1 1 .. .. .. .. 7 3 Premature Birth 10 10 .. .. .. .. .. 1 Thrush 1 1 .. .. .. .. .. .. Cyanosis .. .. .. .. .. .. .. .. Worms .. .. .. .. .. .. 1 .. Spina Bifida 1 1 .. .. .. .. 1 .. Other Malformation 1 1 .. .. .. .. .. .. Teething .. .. .. .. .. .. 5 3 II. 1. Diathetic 8 2 .. 2 4 .. .. .. 2. Dis. of Adults .. .. .. .. .. .. .. 1 Gout 1 .. .. .. .. .. .. .. Paramenia .. .. .. .. .. .. .. .. Dropsy .. .. .. .. .. .. .. .. Childbirth .. .. .. .. .. .. .. .. Hœmorrhage .. .. .. .. .. .. .. 3 3. Dis. of Aged 3 .. .. .. 1 2 3 2 Cancer 5 .. .. 1 4 .. .. 3 Old Age 3 .. .. .. l 2 1 .. Noma 1 1 .. .. .. .. 11 11 4. Dis. of Nutritn. 22 22 .. .. .. .. 1 .. Mortification 1 1 .. .. .. .. 11 11 Atrophy & Debility 22 22 .. .. .. .. 32 22 2. Tubercular 54 22 19 13 .. .. 2 .. Scrotula 2 .. .. 2 .. .. 2 4 Tabes Mesenterica 6 6 .. .. .. .. 4 6 V. 1. Acci.or Neg. 10 9 1 .. .. .. 19 18 Phthisis 37 7 19 11 .. .. l 3 Fract. and Contus. 4 3 1 .. .. .. 9 .. Hydrocephalus 9 9 .. .. .. .. .. .. Wounds .. .. .. .. .. .. l .. Burns and Scalds 1 1 .. .. .. .. .. .. Poison .. .. .. .. .. .. 14 23 III. 1. Nervous Syst. 37 15 4 5 13 .. .. .. Drowning .. .. .. .. .. .. 2 2 Cephalitis 4 3 .. .. 1 2 3 Suffocation 5 5 .. .. .. .. 7 7 Apoplexy 14 .. 3 5 6 .. .. Otherwise .. .. .. .. .. .. 2 6 Paralysis 8 1 1 .. 6 .. .. 2 2. Homicide 2 2 .. .. .. .. .. .. Insanity .. .. .. .. .. .. .. .. 3. Suicide .. .. .. .. .. .. .. .. Chorea .. .. .. .. .. .. .. .. Wounds .. .. .. .. .. .. .. .. Epilepsy .. .. .. .. .. .. .. .. Poison .. .. .. .. .. .. 3 8 Convulsions 11 11 .. .. .. .. .. .. Drowning .. .. .. .. .. .. .. .. Brain Diseases, &c. .. .. .. .. .. .. .. .. Suffocat. and Hang. .. .. .. .. .. .. 10 7 2. Organs of Circ. 17 2 4 4 7 .. .. .. Otherwise .. .. .. .. .. .. .. .. Pericarditis .. .. .. .. .. .. .. .. 4. Unclassed .. .. .. .. .. .. .. .. Aneurism .. .. .. .. .. .. 10 7 Heart Disease 17 2 4 4 7 .. TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FIVE WEEKS ENDING SATURDAY, THE 29th DAY OF SEPTEMBER, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small Fox .. .. 28 4 .. .. 32 Chicken Fax .. 3 9 4 2 .. 18 Measles .. .. 53 15 38 .. 106 Scarlatina .. 1 16 13 6 .. 36 Whooping Cough 1 .. 24 14 7 .. 46 Croup • • .. 1 2 .. .. 3 Diarrhœa 11 .. 1490* 121 41 19 1682 Dysentery • • .. 2 4 • • .. 6 Cholera .. .. 33† .. • • .. 33 Ague .. .. .. 1 .. .. 1 Continued Fever • • 2‡ 5 7 5 .. 19 Influenza • • .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. Rheumatic Fever .. .. 1 11 2 .. 14 Erysipelas 2 .. 6 2 2 .. 12 Diphtheria • • .. .. 3 • • .. 3 Sorethroat or Tonsillitis .. .. 14 16 11 .. 41 Mumps .. .. 1 1 • • .. 2 Pyaemia • • .. .. .. • • .. .. Bronchitis and Catarrh 21 .. 159 96 40 37 353 Pneumonia .. .. 6 1 .. .. 7 Pleurisy • • .. 4 .. • • .. 4 Delirium Tremens 2 .. 1 .. .. .. 3 Insanity 4 .. 2 .. .. .. 6 Carbuncle .. .. .. .. 5 .. 5 All other Diseases 107 44 665 537 535 187 2075 total 148 50 2520 852 694 243 4507 * Of which. 46 were "Choleraic Diarrhœa." + Some of these cases were attended at first, or throughout, by Private Medical Men: but as all either ultimately were pent to the Hospital, or claimed compensation, through their friends, for articles destroyed, I have included them in this column. ‡ "Typhoid." TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From August 27th, 1866, to September 29th, 1866. West District. East District. Total. Number of houses inspected 551 525 1076 Drains Constructed 1 28 29 Improved or repaired 5 86 91 Traps fixed 32 76 108 Cesspools. Abolished .. 11 11 Cleansed or disinfected 3 5 8 Privies and Water Closets Pan, trap, and water supply furnished 1 27 28 Pan and trap only furnished .. 29 29 Water supply furnished 19 96 115 Dust bins Constructed 12 90 102 Repaired and covers adapted 23 102 125 Surface Drains and Pavements of Yards Constructed 8 28 36 Relaid 13 87 100 General Water Supply New receptacle provided 2 37 39 Receptacle repaired and cleansed 12 26 38 Water supply provided .. 19 19 Other Improve- meuts Houses generally repaired 17 59 76 „ cleansed or limewaahed 16 85 101 „ ventilated • • 6 6 .. 24 24 Illegal use of underground Rooms for sleeping discontinued • • 5 5 81 REPORT ON THE SANITARY CONDITION OF ST. MAM, ISLINGTON, FOR OCTOBER, 1860. No. CXIV. The registered mortality of the four weeks ending October 27th, has been excessive. The deaths recorded amount to 320, a number which is 46 above the corrected mean mortality of the corresponding weeks of the last ten years. Although cholera furnishes 10 deaths towards this excess, it does not account for a fourth of it; other diseases were unusually fatal. Foremost of these stand the disorders of the organs of respiration. The mean corrected mortality from bronchitis, pneumonia, &c., for the last ten Octobers is 41; this year the deaths from these diseases have amounted to 63,—47 of which occurred in children under four years of age. This high chest mortality was not due to any unusual degree of cold, inasmuch as during nearly all the month the temperature of the atmosphere was above the average. But chest diseases have not stood alone in this respect; small-pox, fever, and the various conditions registered as atrophy, debility, &c., of infants have all added to the deaths more largely than is customary in October. As regards smallpox, my attention has been directed to the crowded and unwholesome manner in which navvies are living in some of the new streets in Upper Holloway; among these persons small-pox has been rife during the month, and thus the disease comes to infect a whole neighbourhood. A common and most contagious disease like this ought to be extinguished as we have recently been extinguishing cholera, by the adoption of proper measures for the destruction of the specific virus in bedding, clothes, and dwellings. Infected rooms and dwellings we can indeed deal with under the new Sanitary Act, but this statute is most defective in the appliances it furnishes for destroying the virus, attaching as it 2 does pertinaciously to bedding, clothing, and articles of furniture. We have no means of purifying these except by chemical agencies, which are not always applicable, and we cannot (so far as I see) compensate the owners for such things as I should otherwise feel disposed to burn, And so, what with these faults in the Statute and the non-enforcement of Vaccination throughout the country, the virus remains amongst our population to do its work upon the unprotected. I hope it is not premature to say that cholera, as an epidemic visitation, is at an end with us for this year, although it is not improbable that occasional cases may yet occur. Since my last Report the weekly cases have gradually lessened, and the last two fresh cases happened on the 26th and 27th of October; they were comparatively mild, were sent early to the Hospital, and are recovering The weekly cases of cholera, choleraic diarrhoea, and diarrhoea not distinguishable by any special character from what is ordinarily met with, were as follows ;— Week ending— CASES. Oct. 6. Oct. 13. 0ct.20. Oct.27. Total. Cholera 9 5 2 2 18 Choleraic diarrhœa 21 20 5 3 49 Diarrhœa, 133 109 63 48 353 Altogether we have had, during this season, 107 cases of fullydeveloped cholera, of which 65 have been fatal—and 228 cases of what is termed "choleraic diarrhœa" that have come to my knowledge, of which 9 proved fatal. I think I may truly say that not one of the cases of cholera happened, in which appropriate steps were not taken to destroy the specific virus cast off by the individuals attacked, and to arrest the spread of the disease from the centre which each case was liable to become during the period of epidemic prevalence. In many of the cases of choleraic diarrhoea—in all that came early enough under my notice—similar measures have been adopted. Feeling strongly the extreme importance of these measures of "disinfection" (as it is termed), I have not hesitated to direct them personally, and thus to ensure a completeness that would not otherwise have been attained. I have left nothing to be done or directed by my assistants but that which I could not well do or direct myself. With the permission of the Diseases Prevention Committee, the disinfection of the closets and drains in the low neighbourhoods was continued, so long as there 3 appeared any chance of cholera re-entering our parish from neighbouring districts. This proceeding, as well as the house-to-house visitation, was discontinued about a week or ten days before the end of the month. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, November 3rd, 1866. TABLE A. Shewing the Number of Cases of disease generally, and of Bowel Complaints particularly, recorded in the corresponding month for the last six years ; and also the total of the deaths from all causes, and from Bowel Complaints. Oct. Total Sickness. Total Deaths. Diarrhœa.* Dysentery. Cholera. Bowel Complaints. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1866 3069 320 402 7 - 18 10 420 17 1865 2275 290 164 14 — - - 2 164 16 1864 2370 216 70 8 2 1 - — 72 9 1863 2581 282 92 7 — — — 2 92 9 1862 2352 205 146 10 4 — — 1 150 11 1861 2301 223 94 6 7 — — — 101 6 1860 1999 215 87 9 1 — — — 88 9 * Including "Choleraic Diarrhœa." TABLE I, DEATHS REGISTERED IN ISLINGTON DURING FOUR WEEKS ENDING OCTOBER 27tb, 1866. (Deaths of Non-Residents in Hospitals excluded). West S.D, East S.D. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. West S.D. East S.D. Causes of Death. At all Ages. Under 2o years of age. At 20 and under 40 Years of age. At 40 and under 60 years of age. At 60 and under 80 Years of age. At SO years of age  154 166 All Causes 320 184 51 36 35 14 29 34 3. Respirat. Orgs 63 50 7 .. 5 .. 2 1 Laryngitis 3 3 .. .. .. .. (Classes.) 19 11 Bronchitis 30 25 1 .. 3 .. .. l Pleurisy 1 .. 1 .. .. .. 40 40 I. ZYMOTIC DIS. 80 59 14 5 2 .. 6 19 Pneumonia 25 21 3 .. 1 .. 35 29 II. CONSTITUTL. 64 18 24 13 8 1 1 1 Asthma 2 1 .. .. 1 .. 1 1 Lung Diseases, &c. 2 .. 2 .. .. .. 67 71 III. LOCAL 128 70 12 17 24 5 5 10 4. Digestive Orgs 15 3 3 6 2 .. 21 23 IV. DEVELOPMNL. 44 34 .. 1 1 8 .. .. Gastritis .. .. .. .. .. .. .. 1 Enteritis 1 1 .. .. .. .. 1 3 V. VIOLENT DTHS 4 3 1 .. .. .. .. 2 Peritonitis 2 2 .. .. .. .. .. .. Not Specified .. .. .. .. .. .. .. .. Ascites .. .. .. .. .. .. .. 1 Ulceration of Intes 1 .. 1 .. .. .. .. .. Hernia .. .. .. .. .. .. (Orders.) 1 .. Ileus 1 .. .. 1 .. .. .. .. Intussusception .. .. .. .. .. .. 37 39 I. 1. Miasmatic Dis. 76 55 14 5 2 .. .. .. Stricture of Intest. .. .. .. .. .. .. 6 l Small Pox 7 4 3 .. .. .. .. .. Fistula .. .. .. .. .. .. .. 7 Measles 7 7 .. .. .. .. 1 1 Stomach Dis., &c. 2 .. .. 1 1 .. 4 4 Scarlatina 8 8 .. .. .. .. .. .. Pancreas Dis., &c. .. .. .. .. .. .. 1 1 Diphtheria 2 2 .. . .. .. .. 1 Hepatitis 1 .. .. .. l .. .. .. Quinsey .. .. .. .. .. .. .. .. Jaundice .. .. .. .. .. .. 1 2 Croup 3 3 .. .. .. .. 3 4 Liver Disease 7 .. 2 4 l .. 5 8 Hooping Cough 13 13 .. .. .. .. .. .. Spleen Disease .. .. .. .. .. .. 7 8 Typhus & Typhoid 15 8 5 2 .. .. 6 1 5. Urinary Orgs. 7 1 .. 3 3 .. l 1 Erysipelas 2 2 .. .. .. .. .. .. Nephritis .. .. .. .. .. .. .. .. Pyœmia .. .. .. .. .. .. 3 .. Disease of Bladder 3 .. .. 2 1 .. .. .. Puerperal Fever .. . .. .. .. .. 1 1 Nephria 2 1 .. .. l .. 1 .. Carbuncle 1 .. 1 .. .. . . 1 .. Diabetes 1 .. .. 1 .. .. .. .. Influenza .. .. .. .. .. .. .. .. Stone .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. Prostrate Disease . .. .. .. .. .. .. 4 3 Diarrhoea 7 6 .. .. 1 .. 1 .. Kidney Disease,&c. 1 .. .. .. 1 .. 7 3 Cholera 10 1 6 3 1 .. 1 .. 6. Genera. Organs 1 .. 1 .. .. .. .. .. Ague .. .. .. .. .. .. 1 .. Ovarian Dropsy 1 .. 1 .. .. .. .. 1 Rheumatism l 1 .. .. .. .. .. .. Uterine Diseases.. .. .. .. .. .. .. 1 1 2. Enthetic 2 2 .. . .. .. 1 1 7. Orgs.of Locomo. 2 2 .. .. .. .. l 1 Syphilis 2 2 .. .. .. .. 1 .. Spine Diseases 1 1 .. .. .. .. .. .. Stricture of Urethra .. .. .. .. .. .. .. 1 Bone Diseases 1 1 .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. 1 1 8. Skin, &c 2 1 .. .. .. .. .. Glanders .. .. .. .. .. .. 1 .. rhlegmon&Abscess 1 1 .. .. .. .. 1 .. 3. Dietic 1 1 .. .. .. .. .. .. Ulcer .. .. .. .. .. .. .. .. Privation .. .. .. .. .. .. .. 1 Skin Diseases 1 .. .. .. .. .. l .. Want of Br. Milk.. 1 1 .. .. .. .. .. .. Purpura and Scurvy .. .. .. .. .. .. 3 6 IV. 1. Dis. of Childn. 9 9 .. .. .. .... .. .. Alcoholism .. .. .. .. .. .. 3 4 Premature Birth 7 7 .. .. .. .. 1 .. 4. Parasitic 1 1 .. .. .. .. .. l Cyanosis 1 1 .. .. .. .. 1 .. Thrush 1 1 .. .. .. .. .. .. Spina Bifida .. .. .. .. .. .. •• .. Worms .. .. .. .. .. .. .. l Other Malformation 1 1 .. .. .. .. .. .. Teething .. .. .. .. .. .. 7 7 II. 1. Diathetic 14 .. 2 4 7 1 1 .. 2. Dis. of Adults . 1 .. .. 1 .. .. .. .. Gout .. .. .. .. .. .. .. .. Paramenia .. .. .. .. .. .. 1 2 Dropsy 3 .. .. 1 2 .. 1 .. Childbirth 1 .. .. 1 .. .. .. 1 Hæmorrhage 1 .. .. 1 .. .. 5 4 3. Dis. of Aged 9 .. .. .. 1 8 5 4 Cancer 9 .. 2 2 5 .. 5 4 Old Age 9 .. .. .. 1 ??? .. .. Noma .. .. .. .. .. .. 12 13 4. Dis. of Nutritn. 25 25 .. .. .. .. 1 .. Mortification 1 .. .. .. .. 1 12 13 Atrophy & Debility 25 25 .. .. .. .. 28 22 2. Tubercular 50 18 22 9 1 .. l l Scrofula 2 2 .. .. .. .. 1 3 V. 1. Acci. or Neg. 4 3 1 .. .. .. 2 2 Tabes Mesenterica 4 4 . .. .. .. 1 .. Fract, and contus. 1 .. 1 .. .. .. 20 17 Phthisis 37 5 22 9 1 .. .. .. Wounds .. .. .. .. .. .. 5 2 Hydrocephalus 7 7 .. .. .. .. .. 2 Burns and Scalds 2 2 .. .. .. .. .. .. Poison .. .. .. .. .. .. 10 16 III. 1. Nervous Syst. 26 8 1 5 10 2 .. .. Drowning .. .. .. .. .. .. 2 1 Cephalitis 3 3 .. .. .. .. .. .. Suffocation .. .. .. .. .. .. 2 7 Apoplexy 9 .. .. 4 4 1 .. 1 Otherwise 1 1 .. .. .. .. 3 2 Paralysis 5 .. .. 1 3 1 .. .. 2. Homicide .. .. .. .. .. .. 1 .. Insanity 1 .. 1 .. .. .. .. .. 3. Suicide .. .. .. .. .. .. .. .. Chorea .. .. .. .. .. .. .. .. Wounds .. .. .. .. .. .. 1 .. Epilepsy 1 .. .. .. 1 .. .. .. Poison .. .. .. .. .. 1 4 Convulsions 5 5 .. .. .. .. .. .. Drowning .. .. .. .. .. .. .. 2 Brain Diseases, &c. 2 .. .. .. 2 .. .. .. Suffocat. and Hang. .. .. .. .. .. .. 4 8 2. Organs of Circ. 12 5 .. 3 3 1 .. .. Otherwise .. .. .. .. .. .. .. .. Pericarditis .. .. .. .. .. .. .. .. 4. Unclassed .. .. .. .. .. .. .. .. Aneurism .. .. .. .. .. .. 4 8 Heart Disease 12 5 .. 3 3 1 TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FOUR WEEKS ENDING SATURDAY, THE 3rd DAY OF NOVEMBER, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small Pox 1 .. 13 8 1 .. 23 Chicken Pox 5 6 .. .. 11 Measles .. .. 21 17 12 .. 50 Scarlatina .. 1 7 11 3 .. 22 W hooping Cough .. .. 25 26 5 .. 56 Croup .. .. 4 2 .. .. 6 Diarrhœa 3 .. 313* 65† 11 10 402 Dysentery .. .. .. .. .. .. .. Cholera .. .. 18‡ .. .. .. 18 Ague .. .. 1 .. .. .. 1 Continued Fever 3 2 15 12 1 .. 33 Influenza .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. Rheumatic Fever 5 .. 3 7 1 .. 16 Erysipelas .. .. 6 4 2 .. 12 Diphtheria .. .. .. 2 .. .. 2 Sorethroat or Tonsillitis .. .. 19 10 3 .. 32 Mumps .. 1 .. .. •• .. 1 Pyæmia .. .. .. .. .. .. .. Bronchitis and Catarrh 17 .. 335 192 43 38 625 Pneumonia .. .. 8 6 .. .. 14 Pleurisy .. .. 1 3 .. .. 4 Delirium Tremens .. .. .. .. .. .. .. Insanity 2 .. 7 .. .. .. 9 Carbuncle .. .. .. 1 .. .. 1 All other Diseases 51 24 500 552 434 1701 1731 Total 82 28 1301 924 516 218 3069 * Of which 46 were " Choleraic Diarrhoea." + 4 " Choleraic," ‡ All but 2 of these cases were attended at first, or throughout, by Private Medical Men ; but as all either ultimately were sent to the Hospital, or claimed compensation, through their friends, for articles destroyed, I have included them in this column. TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From September 30th, 1866, to October 27th, 1866. West District. East District. Total. Number of houses inspected 925 273 1198 Drains Constructed 6 23 29 Improved or repaired 72 46 118 Traps fixed 117 39 156 Cesspools Abolished 1 1 Cleansed or disinfected • • 1 1 privies and Water Closets' Pan, trap, and water supply furnished 20 21 41 Pan and trap only furnished 7 20 27 Water supply furnished 25 31 56 Dust bins Constructed 27 22 49 Repaired and covers adapted 60 28 88 Surface Drains and Pavements of Yards Constructed 7 9 16 Relaid 45 34 79 General Water Supply New receptacle provided 6 8 14 Receptacle repaired and cleansed 39 26 65 Water supply provided 11 1 12 Other Improvements Houses generally repaired 56 32 88 ,, cleansed or limewashed 70 59 129 „ ventilated 3 I 4 Overcrowding abated 32 17 49 Illegal use of underground Rooms for sleeping discontinued 19 5 24 82 REPORT on the SANITARY CONDITION OF ST. MARY, ISLINGTON, FOR NOVEMBER, 1866. No. CXV. The mortality as registered during the four weeks ending November 24th, was 333 deaths, or 12 deaths above the average of the ten previous Novembers corrected for increase of population. The deaths resulting from the zymotic class of maladies was by no means large, the principal excess happening from those diseases classed together as " local," and especially from diseases of the respiratory organs. Eightyeight of the 333 deaths occurred in persons over 60 years of age. Of the zymotic diseases, hooping-cough and fever have been less fatal than they were in October, but there have been eight deaths from small-pox. Four cases only of cholera have come under my observation during the month, of which two were fatal. The circumstances under which these two cases happened were such as to confirm very forcibly the opinion I have formed as to the efficacy of the measures of prevention adopted in other cases, because, since our arrangements were perfected, such a thing as two deaths in any house from cholera has not happened. The facts were briefly these: A gentleman living in an excellent and well-ordered house, was seized with cholera on the night of Saturday, November 3rd, having been engaged in transacting business all Friday at the East End of London. He was attended by a private practitioner and died on the 4th. No information was forwarded to me, and the first I heard of the occurrence was from the daily return of deaths transmitted to me on the Wednesday evening (Nov. 7th) from the Registrar-General. Early the next morning I communicated with the wife of the deceased, who could not believe that her husband had died of cholera, and refused to allow the destruction of the soiled bedding. In the evening of the same day she was herself attacked, and died in 24 hours. This time we were permitted to take away and destroy all the infected articles, and no further case occurred in the house. The general amount of sickness has been on the whole greater than usual, and diarrhœal affections have been more prevalent than is customary in the month of November. The cases of small-pox recorded are more than twice as numerous as they were in October. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, December ??? 1866 TABLE A. Shewing the Number of Cases of disease generally, and of Bowel Complaints particularly, recorded in the corresponding month for the last six years; and also the total of the deaths from all causes, and from Bowel Complaints. Nov. Total Sickness. Total Deaths. Diarrhœa.* Dysentery. Cholera. Bowel Complaints. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1866 2506 333 124 5 1 - 2 2 127 7 1865 2372 277 68 7 2 — — — 70 7 1864 2286 308 40 6 - — — 1 40 7 1863 2511 290 55 3 - — — — 55 3 1862 2519 282 86 8 2 1 — — 88 9 1861 2217 215 69 3 4 — . — 1 73 4 1860 2004 . 226 67 8 2 — — — 69 8 * Including " Choleraic Diarrhoea." TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FOUR WEEKS ENDING NOVEMBER 24th, 186S. (Deaths of Non-Residents in Hospitals excluded). West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At so years of age and upwards. West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of Age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. 159 174 All Causes 333 168 33 44 76 12 35 48 3. Respirat. Orgs. 81 47 7 6 20 1 1 1 Laryngitis 2 1 .. 1 .. .. (Classes.) 23 27 Bronchitis 50 27 .. 3 19 1 1 l Pleurisy 2 .. 1 1 .. .. 24 38 I. ZYMOTIC DIS. 62 50 4 5 3 .. 8 16 Pneumonia 24 18 6 .. .. .. 27 28 II. CONSTITUTL 55 20 14 14 6 1 1 1 Asthma 2 .. .. 1 1 .. 1 .. Lung Diseases, &c. 1 1 .. .. .. .. 82 89 III. LOCAL 171 70 12 23 62 4 11 9 4. Digestive Orgs. 20 1 2 7 10 .. 21 18 IV. DEVELOPMNL. 39 25 2 2 3 7 .. .. Gastritis .. .. .. .. .. .. .. .. Enteritis .. .. .. .. .. .. 5 1 V. VIOLENT DTHS. 6 3 1 .. 2 .. 4 .. Peritonitis 4 1 .. 1 2 .. .. .. Not Specified .. .. .. .. .. .. 1 .. Ascites 1 .. .. 1 .. .. .. .. Ulceration of Intes. .. .. .. .. .. .. 1 .. Hernia 1 .. .. .. 1 .. (Orders.) .. 1 Ileus 1 .. .. 1 .. .. .. .. Intussusception .. .. .. .. .. .. 21 35 I. 1. Miasmatic Dis. 56 44 4 5 3 .. .. .. Stricture of latest. .. .. .. .. .. .. 4 4 Small Pox 8 7 .. 1 .. .. .. 1 Fistula 1 .. .. .. 1 .. 1 8 Measles 9 9 .. .. .. .. .. 1 ! Stomach Dis., &c. 1 .. 1 .. .. .. 2 3 Scarlatina 5 5 .. .. .. .. .. .. Pancreas Dis., &c. .. .. .. .. .. .. .. 4 Diphtheria 4 4 .. . .. .. 1 3 Hepatitis 4 .. 1 2 1 .. .. .. Quinsey .. .. .. .. .. .. 1 1 Jaundice 2 .. .. 1 1 .. 1 1 Croup 2 2 .. .. .. .. 3 2 Liver Disease 5 .. .. 1 4 .. 3 5 Hooping Cough 8 8 .. .. .. .. .. .. Spleen Disease .. .. .. .. .. .. 6 2 Typhus & Typhoid 8 2 4 .. 2 .. .. .. 5. Urinary Orgs. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. Nephritis .. .. .. .. .. .. .. .. Pyœmia .. .. .. .. .. .. .. .. Disease of Bladder .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. Nephria .. .. .. .. .. .. .. .. Carbuncle .. .. .. .. .. .. .. .. Diabetes .. .. .. .. .. .. .. 1 Influenza 1 1 .. .. .. .. .. .. Stone .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. Prostrate Disease .. .. .. .. .. .. 2 3 Diarrhœa 5 4 .. .. 1 .. .. .. Kidney Disease,&c. .. .. .. .. .. .. .. 2 Cholera 2 .. .. 2 .. .. .. 1 6. Genera. Organs 2 .. .. .. 2 .. .. .. Ague .. .. .. .. .. .. .. .. Ovarian Dropsy .. .. .. .. .. .. 2 2 Rheumatism 4 2 .. 2 .. .. .. 1 Uterine Diseases 2 .. .. .. 2 .. 1 1 2. Enthetic 2 2 .. . .. .. .. .. 7. Orgs.of Locomo. .. .. .. .. .. .. 1 1 Syphilis 2 2 .. .. .. .. .. .. Spine Diseases .. .. .. .. .. .. .. .. Stricture of Urethra .. .. .. .. .. .. .. .. Bone Diseases .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. 1 8. Skin, &c 1 1 .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. Phlegmon&Abscess .. .. .. .. .. .. 2 1 3. Dietic 3 3 .. .. .. .. .. .. Ulcer .. .. .. .. .. .. .. .. Privation .. .. .. .. .. .. .. 1 Skin Diseases 1 1 .. .. .. .. 2 1 Want of Br. Milk 3 3 .. .. .. .. .. .. Purpura and Scurvy .. .. .. .. .. .. 9 6 IV. 1. Dis. of Childn. 11 15 .. .. .. .. .. .. Alcoholism .. .. •• •• •• •• 7 6 Premature Birth 13 13 .. .. .. .. .. 1 4. Parasitic 1 1 .. .. .. .. 1 .. Cyanosis 1 1 .. .. .. .. .. 1 Thrush 1 1 .. .. .. .. .. .. Spina Bifida .. .. .. .. .. .. .. .. Worms .. .. .. .. .. .. .. .. Other Malformation .. .. .. .. .. .. 1 .. Teething 1 1 .. .. .. .. 4 4 II. 1. Diathetic 8 .. .. 2 5 1 3 .. 2. Dis. of Adults 3 .. 2 1 .. .. .. .. Gout .. .. .. .. .. .. .. .. Paramenia .. .. .. .. .. .. 1 .. Dropsy 1 .. .. .. 1 .. 3 .. Childbirth 3 .. 2 1 . .. .. .. Hæmorrhage .. .. .. .. .. .. 3 8 3. Dis. of Aged 11 .. .. 1 3 7 3 3 Cancer 6 .. .. 2 4 .. 3 8 Old Age 11 .. .. 1 3 7, .. .. Noma .. .. .. .. .. .. 6 4 4. Dis. of Nutritn. 10 10 .. .. .. .. .. 1 Mortification 1 .. .. .. .. 1 6 4 Atrophy & Debility 10 10 .. .. .. .. 23 24 2. Tubercular 47 20 14 12 1 .. .. .. Scrofula .. .. .. .. .. .. 4 1 V. 1. Acci. or Neg. 5 3 1 .. 1 .. .. l Tabes Mesenterica 1 1 .. .. .. .. 1 1 Fract. and Contus. 2 2 .. .. .. .. 15 17 Phthisis 32 5 14 12 1 .. .. .. Wounds .. .. .. .. .. .. 8 6 Hydrocephalus 14 14 .. .. .. .. 1 .. Burns and Scalds 1 1 .. .. .. .. 2 .. Poison 2 .. 1 .. 1 .. 23 24 III. 1. Nervous Syst. 47 21 2 6 17 1 .. .. Drowning .. .. .. .. .. .. 3 .. Cephalitis 3 3 .. .. .. .. .. .. Suffocation .. .. .. .. .. .. 6 2 Apoplexy 8 .. .. 2 6 .. .. .. Otherwise .. .. .. .. .. .. 3 8 Paralysis 11 .. .. 3 7 1 .. .. 2. Homicide .. .. .. .. .. .. 1 .. Insanity 1 1 .. .. .. .. 1 .. 3. Suicide 1 .. .. .. 1 .. .. .. Chorea .. .. .. .. .. .. .. .. Wounds .. .. .. .. .. .. .. .. Epilepsy .. .. .. .. .. .. .. .. Poison .. .. .. .. .. .. 7 6 Convulsions 13 13 .. .. .. .. .. .. Drowning .. .. .. .. .. .. 3 8 Brain Diseases, &c. 11 4 2 1 4 1 .. Suffocat. and Hang. 1 .. .. .. 1 .. 12 8 2. Organs of Circ. 20 .. 1 4 13 2 .. .. Otherwise .. .. .. .. .. .. .. .. Pericarditis .. .. .. .. .. .. .. .. 4. Unclassed .. .. .. .. .. .. .. .. Aneurism .. .. .. .. .. .. 12 8 Heart Disease 20 .. 1 4 13 2 TABLE 11. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FOUR WEEKS ENDING SATURDAY, THE 24th DAY OF NOVEMBER, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small pox .. 1 42 6 1 .. 50 Chicken Pox .. 2 4 3 1 .. 10 Measles .. .. 32 15 6 .. 53 Scarlatina .. 2 10 10 .. .. 22 "Whooping Cough .. .. 34 14 4 .. 52 Croup .. .. 1 .. .. .. 1 Diarrhœa 6 .. 80 23 6 9 124 Dysentery .. .. .. 1 .. .. 1 Cholera .. .. 2 .. .. .. 2* Ague .. .. .. 1 .. .. 1 Continued Fever 13 .. 13 9 1 .. 36 Influenza .. .. .. .. .. .. .. Puerperal Fever 4 .. .. .. .. .. 4 Rheumatic Fever .. .. 3 2 1 .. 6 Erysipelas .. .. 9 2 •• .. 11 Diphtheria .. .. 1 4 •• .. 5 Sorethroat or Tonsillitis .. .. 19 19 15 .. 53 Mumps .. .. .. •• •• .. •• Pyæmia .. .. .. .. .. .. .. Bronchitis and Catarrh 12 2 265 157 47 15 498 Pneumonia .. .. 4 3 2 .. 9 Pleurisy .. .. 3 1 1 .. 5 Delirium Tremens .. .. .. .. .. .. .. Insanity 1 .. 4 .. .. .. 5 Carbuncle .. .. 1 .. 1 .. 2 All other Diseases 65 12 415 497 431 136 1556 Total 101 19 942 767 517 160 2506 * There were 2 additional cases in a private family. TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From October 28th, 1866, to November 24th, 1866. West District. East District. Total. Number of houses inspected 140 149 289 Drains Constructed 9 12 21 Improved or repaired 21 34 55 Traps fixed 36 27 63 Cesspools Abolished .. 1 1 Cleansed or disinfected 3 3 6 Privies and Water Closets Pan, trap, and water supply furnished 5 16 21 Pan and trap only furnished 7 8 15 Water supply furnished 27 31 58 Dust bins 'Constructed 10 19 29 Repaired and covers adapted 33 29 62 Surface Drains and Pavements of Yards Constructed 9 12 21 Relaid 21 22 43 General Water Supply New receptacle provided .. 5 5 Receptacle repaired and cleansed 14 18 32 Water supply provided • • .. .. Other Improvements Houses generally repaired 39 25 64 ,, cleansed or limewashed 32 35 67 „ ventilated .. 2 2 Overcrowding abated 7 6 13 Illegal use of underground Rooms for sleeping discontinued. •• •• •• REPORT on the SANITARY CONDITION OF ST. MAM, ISLINGTON, FOR DECEMBER, 1866. No. CXVI. During the five weeks of December the rate of mortality continued to decrease. The estimated mortality of these weeks, as calculated upon the previous 10 years, is 440; but the actual deaths that occurred fall short of the number by 62, the number registered being 378, nearly the same as was registered in the corresponding weeks of last year. Two nonagenarians—females—have died, one aged 98, the other 93 years. A hundred and six deaths, however, have been recorded in the class of zymotic diseases, among which we find 12 deaths from small-pox, 22 from scarlet fever, 20 from hooping cough, and 12 from fever. Two of the last-mentioned were nurses in the London Fever Hospital. Although small-pox has been thus unusually fatal, it is to be observed that the mortality is swollen by the illnesses which took place in November, for the disease has not been quite so prevalent among us as it was last month. The number of new cases that came to my knowledge in the four weeks of November was 50, and during the last 5 weeks 45. I have before pointed out how much—in common with other Health Officers—I have to contend against in combating this disease, in consequence of the neglect of vaccination among the poor, and also of re-vaccination, as well as of the lack of the necessary appliances for destroying the virus as it attaches itself to persons' clothing, bedding, &c. To disinfect houses, where the contents of a room and the clothing, bedding, &c. of the occupants are reeking with infection, you cannot fail to perceive is merely labour thrown away. 2 I meet with a similar obstacle in respect to scarlet fever and typhus. I beg most respectfully, but earnestly, to submit this subject to your consideration. Cholera has happily left us; but its place has been occupied by diseases more decidedly contagious and equally destructive. During the four months of July, August, September, and October, we lost 65 of our population from cholera; during November and December we have lost 67 from small-pox, scarlatina, and fever. During the prevalence of cholera—an unusual disease—we combated its spread effectually by the means pointed out by science and experience. Common diseases—such as those I have mentioned—are better understood, and the means of preventing their extension well known to scientific men; and yet one epidemic outbreak after another sweeps over us until the susceptibility of the population is exhausted. I think you must see that more remains to be done than has hitherto been attempted. To take small-pox alone, what science and experience indicate by way of checking its diffusion is this:— 1. That every person—not protected by a former attack—should be thoroughly protected by a good and effectual vaccination, and that care should be taken that re-vaccination should be performed on arrival at adult age. 2. That, at once, immediately an epidemic outbreak is announced, house to house visitation should be instituted in such low neighbourhoods as cases of small-pox may appear in, with a view to discover unvaccinated children—to enforce the law as regards vaccination, and to press re-vaccination upon adults where necessary. The administration of the Vaccination Acts lie, however, in the hands of the Board of Trustees. On a former occasion, they adopted this course with excellent results. 3. That every case of small-pox, occurring among the poor, should be removed at the earliest possible period to the Hospital,—and not returned to the healthy until thoroughly free from personal uncleanness, or until the clothing has undergone a process of thorough disinfection. At the present time, I have reason to fear that some of the good anticipated from removal to the Hospital has been counteracted by a neglect of this precaution. 4. That the articles likely to retain infection in any room that has been occupied by a small-pox patient, including the bedding, clothing, carpets, &c., should be disinfected in the most appropriate manner, 3 such as can be washed in hot water, being first steeped in some harmless disinfecting solution, and then boiled, and such woollen articles as cannot be thus treated being exposed to a dry heat of 212° or 220°, after the manner recommended by the late Dr.Henry, and adopted at Liverpool. To do this would require the provision by the Vestry of the necessary apparatus in some convenient place; and the Vestry is empowered to make such a provision by the 23rd section of the Sanitary Act. I beg to recommend that it should be made. Sometimes bedding is so horribly filthy and old that destruction by fire is the only method of disinfection that could be applied. Possibly the Board of Trustees—on the representation of this necessity having arisen in any special instance—might not object to replace the articles destroyed. On every occasion that I have sought their co-operation, they have assisted my efforts as far as they considered that their power to do so extended, and I cannot doubt that some arrangement might be entered into as to this matter also. In that case, the Sanitary Committee might, perhaps, see fit to order the destruction of what could not well be otherwise treated. 5. That the room or house—if necessary—in which small-pox has broken out, should be disinfected in a similar manner to cholera houses or rooms. The Sanitary Act enables us to effect this readily enough. The means of disinfection being provided by the Vestry, outbreaks of scarlatina and fever could also be met with more satisfactory results than they are at the present time. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, January 7th, 1867. TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FIVE WEEKS ENDING DECEMBER 29th, 1866. (Deaths of Non-Residents in Hospitals excluded). West S.D, East S.D. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At SO years of age and upwards. West S.D. East S.D. Causes of Death. At all Ages. Under 20 years of Age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 ears of age. At 80 years of age 197 181 All Causes 378 204 52 48 61 13 43 32 3. Respirat. Orgs 75 43 6 9 16 2 .. Laryngitis 2 2 .. .. .. (Classes.) 27 20 Bronchitis 47 24 •• 7 15 1 .. Pleurisy 1 .. 1 .. .. 57 49 I. ZYMOTIC DIS. 106 77 20 3 .. •• 11 9 Pneumonia 20 1 5 5 .. .. 2 .. Asthma 2 .. .. 1 1 34 31 II. CONSTITUTE 65 21 21 17 5 1 .. 3 Lung Diseases, &c. 3 2 .. 1 .. 81 75 III. LOCAL 156 72 11 26 40 7 8 5 4. Digestive Orgs. 13 4 1 7 1 .. .. Gastritis .. .. .. .. .. 23 17 IV. DEVELOPMNL. 40 25 .. •• 10 5 1 1 Enteritis 2 2 .. .. .. 2 7 V. VIOLENT DTHS. 9 7 •• 2 •• .. 1 .. Peritonitis 1 1 .. .. .. .. .. Ascites .. .. .. .. .. .. 2 Not Specified 2 2 •• .. .. .. .. .. Ulceration of Intes. .. .. .. .. .. .. 2 Hernia 2 1 .. 1 .. (Orders.) 1 .. Ileus 1 .. .. .. 1 .. .. Intussusception .. .. .. .. .. 55 47 I. 1. Miasmatic Dis. 102 74 19 3 6 .. .. .. Stricture of Intest. .. .. .. .. .. 2 10 Small pox 12 8 4 .. .. .. .. .. Fistula .. .. .. .. .. 2 5 Measles 7 7 .. .. .. .. l 2 Stomach Dis., &c. 3 .. .. 3 .. 11 11 Scarlatina 22 22 .. .. .. .. .. .. Pancreas Dis., &c. .. .. .. .. .. .. .. Diphtheria .. .. .. .. .. .. .. .. Hepatitis .. .. .. .. .. .. .. Quinsey .. .. .. .. .. .. .. .. Jaundice .. .. .. .. .. 3 2 Croup 5 5 .. .. .. .. 4 .. Liver Disease 4 .. 1 3 .. 13 7 Hooping Cough 20 20 .. .. .. .. .. .. Spleen Disease .. .. .. .. .. 9 3 Typhus & Typhoid 12 3 8 1 .. .. 1 3 5. Urinary Orgs. 4 1 1 1 .. 4 1 Ervsipelas 6 1 1 .. 3 .. .. .. Nephritis .. .. .. .. .. 1 1 Pycemia 2 1 1 .. .. .. .. .. Disease of Bladder .. .. .. .. .. 3 .. Puerperal Fever 3 .. 3 .. .. .. 1 2 Nephria 3 1 1 1 .. .. 1 Carbuncle 1 .. .. 1 .. .. .. .. Diabetes .. .. .. .. .. .. 1 Influenza 1 .. .. .. 1 .. .. .. Stone .. .. .. .. .. 2 .. Dysentery 2 1 .. .. 1 .. .. 1 Prostrate Disease 1 .. .. .. .. 4 2 Diarrhœa 6 5 .. .. 1 .. .. .. Kidney Disease,&c. .. .. .. .. .. .. 1 Cholera 1 1 .. .. .. .. .. .. 6. Genera. Organs .. .. .. .. .. .. .. Ague .. .. .. .. .. .. .. .. Ovarian Dropsy .. .. .. .. .. 1 2 Rheumatism 3 .. 2 1 .. .. .. .. Uterine Diseases .. .. .. .. .. 1 .. 2. Euthetic 1 1 .. . .. .. .. 1 7. Orgs. of Locomo. 1 1 .. .. .. 1 .. Syphilis 1 1 .. .. .. .. .. 1 Spine Diseases 1 1 .. .. .. .. .. Stricture of Urethra .. .. .. .. .. .. .. .. Bone Diseases .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. .. 8. Skin, &c .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. Phlegmon & Abscess .. .. .. .. .. .. 1 3. Dietic 1 .. 1 .. .. .. .. .. Ulcer .. .. .. .. .. .. .. Privation .. .. .. .. .. .. .. .. Skin Diseases .. .. .. .. .. .. .. Want of Br. Milk.. .. .. .. .. .. .. .. .. Purpura and Scurvy .. .. .. .. .. .. 7 6 IV. 1. Dis. of Childn. 13 13 .. .. .. .. 1 Alcoholism 1 .. 1 .. .. .. 7 5 Premature Birth 12 12 .. .. .. 1 1 4. Parasitic 2 2 .. .. .. .. .. .. Cvanosis .. .. .. .. .. 1 1 Thrush 2 2 .. .. .. .. .. 1 Spina Bifida 1 1 .. .. .. .. .. Worms .. .. .. .. .. .. .. .. Other Malformation .. .. .. .. .. .. .. Teething .. .. .. .. .. 5 3 II. 1. Diathetic 8 .. .. 4 3 1 .. .. 2. Dis. of Adults .. .. .. .. .. .. .. Gout .. .. .. .. .. .. .. .. Paramenia .. .. .. .. .. 1 1 Dropsy 2 .. .. .. 1 l .. .. Childbirth .. .. .. .. .. .. .. Hæmorrhage .. .. .. .. .. .. 9 6 3. Dis. of Aged 15 .. .. .. 10 4 2 Cancer 6 .. .. 4 2 .. 9 6 Old Age 15 .. .. .. 10 .. .. Noma .. .. .. .. .. .. 7 5 4. Dis. of Nutritn. 12 12 .. .. .. .. .. Mortification .. .. .. .. .. .. 7 5 Atrophy & Debility 12 12 .. .. .. 29 28 2. Tubercular 57 21 21 13 2 .. 2 l Scrolula 3 2 .. 1 .. .. 2 5 V. 1. Acci. orNeg. 7 5 .. 2 .. 1 3 Tabes Mesenterica 4 4 .. .. .. .. .. .. Fract. and Contus. .. .. .. .. .. 22 20 Phthisis 42 7 21 12 2 .. .. .. Wounds .. .. .. .. .. 4 4 Hydrocephalus 8 8 .. .. .. .. .. 3 Burns and Scalds.. 3 3 .. .. .. .. .. Poison .. .. .. .. .. 20 28 III. 1. Nervous Syst. 48 21 2 4 16 5 .. .. Drowning .. .. .. .. .. 4 1 Cephalitis 5 5 .. .. .. .. 1 2 Suffocation 3 1 .. 2 .. 4 10 Apoplexy 14 .. l 2 10 l 1 .. Otherwise 1 1 .. .. .. 6 4 Paralysis 10 .. .. 2 5 3 .. 2 2. Homicide 2 2 .. .. .. 1 .. Insanity 1 .. 1 .. .. .. .. .. 3. Suicide .. .. .. .. .. .. .. Chorea .. .. .. .. .. .. .. .. Wounds .. .. .. .. .. .. .. Epilepsy .. .. .. .. .. .. .. .. Poison .. .. .. .. .. 2 12 Convulsions 14 14 .. .. .. .. .. .. Drowning .. .. .. .. .. 3 1 Brain Diseases, &c. 4 2 .. .. .. 1 .. .. Suffocat. and Hang. .. .. .. .. .. 9 6 2. Organs of Circ. 15 2 1 5 7 .. .. .. Otherwise .. .. .. .. .. .. 1 Pericarditis 1 1 .. .. .. .. .. .. 4. Unclassed .. .. .. .. .. .. .. Aneurism .. .. .. .. .. .. 9 5 Heart Disease 14 1 l 5 7 .. - ' ■ '"""JWPW'IfWlHIIll .1! Il||i ? 83 REPORT ON THE SANITARY CONDITION of The Parish of St. Marg, Islington, DURING THE YEAR 18 6 6. BY EDWARD BALLARD, M.D. (Lond.) member of the royal college of physicians; fellow of the royal medical and chirurgical society of london, etc. MEDICAL OFFICER OF HEALTH. J. & I. TIREBUCK, STEAM PRINTERS AND LITHOGRAPHERS, Monkwell Street, E.C., and Islington. 1867. TO THE VESTRY OF SAINT MARY, ISLINGTON. Gentlemen, The year 1866 has been characterised by the epidemic visitation of the Metropolis with Cholera, which had approached very near to it in 1865. A great part of this Report will necessarily be occupied with the history of the epidemic as it affected us in Islington. In order to avoid, therefore, undue extension, I shall abridge, as much as possible, the remarks which I have to make upon the general mortality and sickness of the district under your charge. MORTALITY, DEATH-RATE, and SICKNESS. The number of deaths of residents registered in Islington, (omitting those of persons from other districts, taking place in Hospitals, and also those occurring in the Clerkenwell Infant Poor House), amounted, during the fifty-two weeks ending December 29th, to 4172. Adding to these 252 deaths, our share (proportionally to our population) of the deaths taking place in the Hospitals, &c.,in London, we arrive at a corrected mortality of 4424 persons. I estimate our population in the middle of the year as numbering 190,992 persons; that is, as augmented by an addition of 5 per cent. upon the population of 1865. Our corrected mortality for 1865 was 4035. Hence we had, in 1866, 389 more deaths than in the previous year. In London generally, the death-rate of 1866 was 264.7 per 10,000 of the population : our deathrate in Islington was 231.6 per 10,000. The following table shows the births which have taken place in the parish during 1866 1866 West. East. Total. 1st Quarter 874 924 1798 2nd Quarter 873 840 1713 3rd Quarter 824 823 1647 4th Quarter 865 885 1750 Total 3436 3472 6908 The births which took place thus exceeded the deaths by 2873. 4 Table II. shows the number of new cases of sickness entered during the year upon the books of the medical officer of the parish, and those of the two Dispensaries and the Pentonville Convict Prison. It amounts to 35,430, being swollen, as I shall have occasion to observe, by an excess of cases of bowel complaint, from which, as is customary in similar epidemic seasons, the population at large suffered more than in ordinary seasons. CAUSES OF DEATH, and NATURE OF PREVAILING SICKNESS. I will take these in order, as they are mentioned in tables I. and II. Small Pox, to our disgrace as a nation which gave to the world the preventive of vaccination, has throughout the year been prevailing to an unusual degree in London, and we in Islington have had our share. The deaths from this disease amounted to 67, which, at the current rate of fatality, viz.:— one case in ten, is equivalent to saying that throughout the parish there happened about 670 cases. No doubt the vaccination and re-vaccination of a population so unwieldy as that of the Metropolis is a difficult thing to manage satisfactorily ; but this is no excuse for lukewarmness in so important a public duty. It is said that some special legislation is contemplated to meet the exceptional circumstances of London in this respect. Certainly a change is needed; and no change can very well be a change for the worse. Of the other diseases of infancy, Measles and Hooping Cough, especially the former, have been very prevalent during the year; the deaths from measles amounted to 152, and those from hooping cough to 220. The deaths from Diarrhoea amounted to 165, by no means an excessive number; and 142 of them occurred in children under three years of age. These 142 deaths are probably the representative of the ordinary diarrhoeal influence at work every summer. I have no doubt that early treatment had a good deal to do with the low fatality. The deaths from Cholera, during the year, are stated on the table at 75. I include in this heading cases of Choleraic Diarrhoea. CHOLERA. History of the origin and progress of the epidemic in Islington. The first case of cholera which occurred in this parish was on July 23rd, at No. 17, Henry Place, in the White-Conduit sanitary district. The woman who was attacked had, as it appears from information subsequently obtained, just come from the east end of London, where cholera was at that time prevailing to a great 5 extent. She had undergone great privation. By occupation, she was a washerwoman, and so might possibly have been exposed to the operation of the cause of the disease in a manner perhaps the most dangerous of all. On the 20th and 21st of July it is said she had very little food; but on the 22nd, having come to reside with her sister at the above-mentioned house, she ate largely of some stale hash or soup. Here was an additional cause of bowel disturbance, but not such a cause as would suffice to produce an attack like hers in ordinary seasons; yet such a cause as does suffice to determine an attack in persons otherwise exposed to the epidemic influence. She was shortly seized with diarrhoea, which was, after a time, associated with vomiting. On the morning of the 23rd both these symptoms abated, but otherwise she became worse, and at 4 p.m. she was laid in the passage of the house; no medical assistance being obtained until 9 or 10 o'clock p.m. She was seen by Mr. Harston and Dr. Lamb, and on her removal to the workhouse at night, was seen also by Dr. Ede; all three of whom assured me that they recognised the case as one of unquestionable cholera. The woman died at 2 a.m. on the 24th, and the body was removed to the parish dead-house. Subsequently, some doubts were thrown upon the choleraic nature of the attack; but this being an afterthought, and the opinions when the facts were fresh in the minds of the observers having been most decided, I am warranted in holding this to have been the first true case occurring within our parish. No further case occurred until Friday the 27th July, when the disease broke out in a virulent manner in the neighbourhood of Elder Walk, in the Essex Ro&d. This is a part of the parish occupied by a poor population, and very much crowded. On that day five cases happened simultaneously. One in Pickering Street, one in Gifford's Buildings, Elder Walk; one in a neighbouring house in the main thoroughfare of Elder Walk ; one in Clarke's Place, Anglers' Gardens, adjoining; and one in a distant part of the parish, namely, Palmer Street, Holloway. Of these five cases four were fatal. It was clear we had cholera amongst us. It was the day of the meeting of the Vestry to decide upon the adoption of the preventive measures ordered by the Privy Council. I came direct to the Vestry from visiting some of these cases, and information of others came to me while I was in the room. On the next day, July 28th, five more cases were reported to me. One in Rotherfield Street, Essex Road, by a private practitioner ; two at the same house in Elder Walk, where a case occurred the day before ; one in Windsor Street, Essex Road; and one in Popham Place, not far distant. All of these quickly died. On the 29th three cases occurred. One in an infant in St. Paul's Road; one at the same house in Popham Place, where the previous case happened; and one in Popham Street. All these also were fatal. 6 On the 30th two cases were reported. One in the same house in Clarke's Place, in the wife of a man then ill with cholera; and the other in Palmer Mews. Both of these, too, were fatal. On the 31st I find, by the Registrar General's return, that a child was attacked in Highbury Place, with what was returned as " English cholera," and died on August 3rd; and two cases, both of which recovered, were reported to me : one in Caledonia Street, Battle Bridge; and the other in Blundell Street, Caledonia Road. The causative principle of the disease was therefore widely diffused, by this time, over the parish; and I felt that no part of our district was likely to remain very long free from its operation. On August 1st another burst of cases was reported. One in Palmer Street again; one in Hope Place West, near the George's Road, Holloway; one somewhere in Upper Holloway, brought to the Fever Hospital; one (of a cholera nurse) in the Fever Hospital itself; and four in the same house in Gifford's Buildings, where a case had happened on the 27th July. Of these seven patients all died but one. On the 2nd a single case only was reported—the wife of the man attacked in Popham Street. She ultimately recovered. On August 3rd, however, six more cases occurred. Two in Gifford's Buildings again; one in Rufford's Buildings, High Street; one in Grosvenor Street, St. Peter's, near the canal; one in the Queen's Road; and one in Brand Street. The two last recovered : the four others died. By this time most of our preventive measures had got into operation; and although one, two, or three cases occurred on some days subsequently up to the end of November, we met with no more of those alarming outbreaks of the epidemic which had rendered me so anxious previously. I saw that we had it in hand, and that, if properly carried into effect, the means which we were adopting would probably be sufficient to prevent any extensive spread of the disease from the houses invaded. Nor was I disappointed. From this time it became a rare event to see more than a single case occur in a house; and when it did happen, the cause was very apparent in the neglect of the measures recommended for adoption. The following table represents the operation of the epidemic influence week by week, as it resulted in the production of cases of cholera, and what has been termed "choleraic diarrhoea." I must premise that this term has been throughout vaguely used; and it is only by grouping together the reported cases of undoubted cholera, and of the less severe affection, that a fair estimate can be formed of the extension and operation of the morbid influence. O 7 Week ending. Attacks. Of which Died. Cholera. Choleraic Diarrhoea. Total. Cholera. Choleraic Diarrhoea. Total. Cases of Diarrhoea recorded. July 28 th 11 i 12 10 1 11 379 in all July. August 4th 25 40 65 17 5 22 203 „ 11th 9 33 42 4 0 4 467 „ 18th 5 27 32 3 0 3 552 „ 25th 4 33 37 0 0 0 443 September 1st 4 21 25 2 0 2 452 „ 8th 6 5 10 4 0 4 401 „ 16th 8 8 16 4 0 4 363 „ 22nd 6 13 19 3 2 5 229 „ 29th 10 6 16 7 0 7 197 October 6th 9 21 30 4 0 4 133 „ 13th 5 16 21 3 1 4 109 „ 20th 2 4 6 2 0 2 63 „ 27th 2 3 5 0 0 0 48 November 3rd 3 0 3 1 0 1 125 „ 10th 1 0 1 1 0 1 „ 17th 0 0 0 0 0 0 „ 24th 0 0 0 0 0 0 December 1st 1 0 1 1 0 1 110 231 341 66 9 75 Fatality of attacks designated " Cholera " 60 per cent. „ „ "Choleraic Diarrhoea" 3.8 „ „ all attacks together 21.9 „ There were, then, between the 23rd of July and the 27th of November, 110 cases of cholera, with a fatality of 60 per cent.; and 231 cases of the milder form of choleraic seizure, with a fatality of nearly 4 per cent.; and the disease swept over our parish as it were in two waves, the first the highest and most overwhelming, the second lower. The first began to rise in the week ending July 28th, rapidly attained its climax in the following week, ending August 4th, and declining, attained its lowest elevation five weeks later, namely, in that ending September 8th. This wave overwhelmed 46 persons, of whom 33 were destroyed in the course of the rise during the first two weeks, and 13 in the fall of the wave during the following five weeks. Altogether in the course of these first seven weeks we recorded 223 seizures of a choleraic character, of which 63, or 28 per cent., were cases of complete fully-developed cholera. The second wave began to rise in the week ending September 15th, attained its maximum in the fourth week, that ending October 6th, and gradually declined from this during five weeks. This wave overwhelmed 28 persons, of whom 20 were 8 destroyed in the course of its four weeks rise, and the remaining 8 in the course of its five weeks fall. Altogether, in the course of these 9 weeks, we recorded 117 seizures of a choleraic character, of which 46, or 39 per cent., were cases of completely developed cholera. The remaining case, which happened on November 27th—three weeks, at least after the epidemic had died out—was a stray one, due to a special cause. Here, then, we recognise two waves of epidemic influence, the first bringing under its operation nearly twice the number of persons as the second wave, and in a shorter space of time producing a much larger number of fully-developed and fatal cases, and a larger proportion of less severe cases designated "choleraic diarrhoea." Out of 63 cases of cholera, 40, or 63.4 per cent. died. „ 160 „ choleraic diarrhoea, 6, or 3.7 per cent. died. „ 223 „ choleraic seizure, 46, or 20.6 per cent. died. The second wave brought under its operation about half as many persons during a longer period of time, produced fewer fully-developed and fatal cases, and a smaller proportion of less severe cases. That is to say, the cases of choleraic attack observed were, although fewer in number, on the whole more severe in character. Out of 46 cases of cholera, 25, or 54.3 per cent. died. „ 71 „ choleraic diarrhoea, 3, or 4.2 per cent. died. „ 117 „ choleraic seizure, 28, or 23.9 por cent. died. In further comparing the operation of the two waves, we must say, then, that in the first the influence affected more people, but was, on the whole, rather less severe in the intensity of its operation, where it fell, than the second wave; and that the second wave affected fewer people; but that where it fell its intensity of operation was somewhat greater than the first wave of epidemic influence. It was checked, somehow, in its extension; but its force, where it was free to operate, was more violent. Localities affected. Looking at a map of the parish, on which has been marked in spots the cases of cholera that occurred, it appears that there were three principal foci towards which the epidemic influence appeared to gravitate. The principal of these was situated at the southern extremity of the parish; the second constituted by Lower Holloway, the Queen's Road, and Palmer Place sanitary districts; and the third was the immediate neighbourhood of the Back Road, KingsJand. 1st focus.—This includes streets and places in the following sanitary districts :— " Lower Road," " St. Peter's," " City Road," " Irish Courts," " Theberton," '' Trinity," and " White Conduit" districts. In this focus there occurred altogether 53 out of the 110 cases of fully-developed cholera that were observed in the parish; that is, about half the cases. It was in this focus that the disease first broke out: it was 9 to this that it returned at the second wave of epidemic influence which passed over us. Out of the 53 cases iu this focus, 28 took place within a very limited area, which may be described as bounded by the Essex Road, Packington Street, and a line drawn from the junction of Packington Street and Frog Lane to the Peabody Buildings. And of these 28 cases on a very few acres of land, 21 proved fatal; that is, no less than 75 per cent. The intensity of the operation of the cause of the disease, then, was greater here than in any other part of the parish—here where the greatest concentration of cases took place. Out of the whole 53 cases in this southern focus, only 17 recovered, 36 being fatal, or about 68 per cent. 2nd focus.—This includes the Queen's Road and the streets about it, Palmer sanitary district, and the part of the Lower Holloway district, which lies lowest in level. In these three districts there occurred 24 cases, of which 11, or nearly half, were fatal. The diffusion of the epidemic influence in this part of the parish was not accompanied by so great an intensity of operation as it was at the 1st or principal focus. 3rd focus.—This was situated in the Back Road, Kingsland, and the streets between it and St. Jude's church. Only 7 cases occurred here, but 5 of them, or 71 per cent. were fatal. The attack of this neighbourhood was due to an extension of the epidemic influence concentrated at the time in the neighbouring part of Hackney parish. Now, there is this in common in these three foci—they are all localities occupied by the lower class of our population, and situated at comparatively low levels. All to the south of the Essex Road is under 100 feet of elevation. The second focus is situated at 100 of feet elevation, or a trifle above it; and the third focus at and below 80 feet of elevation. Let us, then, further inquire now as respects the parish at large, what is observable as respects the oases of cholera and their fatality, in their relation to the elevation at which they occurred, the character of the houses in which they occurred, and the condition of life of the families in which they occurred. As regards elevation, all I can say is this—that out of 108 cases, of which I have precise information as to locality of attack, 73 resided in parts of the parish situated at or below 100 feet of elevation; while of the remainder 24 resided at an elevation of above 100 and below 120 feet, and 11 between 120 and 130 feet of elevation. Above 130 feet no case at all occurred. Out of the 73 attacked at an elevation under 100 feet, 43 or 58 per cent. died ; and out of the 35 residing above 100 feet of elevation, 22 or 62 per cent. died. This does not tell us much; but, as I have no data respecting the population residing at these several levels, it is nearly all I can say upon the subject. Judging by the fatality, I should be disposed to consider that other causes were more potent than this in determining the precise seats of outbreak in this parish, as well as the intensity of operation of the causes of the disease. 10 Taking, however, a more broad view of our position in Islington, and viewing it in its relation to the eastern districts of London, where cholera broke out in great severity, one remarkable fact is obvious. Cholera broke out in the east of London in the 28th week of the year, that ending July 14th. In the week ending July 21st, it became very severe there, and several deaths from choleraic diarrhoea occurred in Hackney and Shoreditch. The influence was spreading westward along the low level, gradually rising, as a ground mist would do, towards our higher level. Towards the close of the following week it had reached the part of our parish which was just above the level of 80 feet, and broke out at the first clump of close crowded streets and houses, and the first low population it would reach in such a progress, viz:— the vicinity of Elder Walk. Pursuing the same course, and guided by the conformation of the ground, it passed into the stratum of 100 to 120 feet, and proceeded along the side of the rise to 120 feet in the north westerly direction to Lower Holloway, Palmer Street, Hope Place West, and the Queen's Road district—all the nearest crowded, close, and poor localities that it would meet with in such a course, at such a level. It was not until a later period—during the second epidemic wave—that localities at and above 120 feet of elevation were attacked; such as Theberton district, the Brandon Road, Henry Place, &c. (with the exception of the first isolated imported case). And thus, having surmounted the ridge of elevated land running northward from Sermon Lane to Barnsbury Park, persons on the west side of this ridge became attacked, and we met with the cases in Richard Street, Buckingham Place, Gifford Street, Belle Isle, &c. It is difficult to describe this course in words, but with a map marked with the levels of the district, the course of the disease is seen at a glance in its relation to them. Let us see, then, what we can learn as to the character of the houses in which the attacks occurred. Four cases out of the number originated in the London Fever Hospital. These must be excluded; as also two, the locality of whose origin I do not precisely know. Of the remaining 104 attacks, 23 only occurred in houses with fairly large and airy rooms, and of these 14 or 60 per cent., were fatal. Eighty-one occurred in houses with small, close, confined rooms, and of these 49 or 60 per cent., were fatal. The only conclusion I can draw from this is, that the epidemic influence was most felt in the houses of the latter class ; but when the attack occurred, the result was not apparently influenced by any circumstance of this nature. Again, of the 104 attacks 56, or more than half, occurred in houses more or less remarkable for neglect of general cleanliness. Of these, 36 cases were fatal or 66 per cent. On the other hand, 48 occurred in houses not thus remarkable; some of them very clean, even where the rooms were small; and of these 27 or 56 per cent., were fatal. The uncleanliness of the habitations, then, had a distinct influence, both in favouring the occurrence of cholera and imparting to the disease a severe and fatal character. * I have had the lines of elevation marked in red upon my old " Sanitary Map," with the position of the cases of cholera in red dote (fatal cases), and little circles (oases which recovered). 11 Lastly, as to the circumstances of the families in which the attacks took place. Twenty of the cases of fully developed cholera occurred in families either with all the conveniences and comforts of life about them, or in such circumstances as precluded the idea of neediness. Of these 15 or 75 per cent., were fatal. Fifty-four of the cases, on the other hand, occurred in families in which there were more or less distinct evidences of poverty; some of them being without blankets or other bedclothes ; others receiving aid from the parish; others unable to procure proper food, &c. Of these 40 or about 74 per cent., were fatal. In the remaining cases it was not apparent whether there was any need—such as families of mechanics and artizans in work, &c. In these cases the fatality was less than in the classes better and worse off. It appears, therefore, that the attacks of cholera were less frequent in proportion as families were better off in worldly circumstances; but that the fatality was highest where there was distinct poverty ; and, on the other hand, where the luxuries of life were attainable. The weather, in its relation to the two waves of epidemic influence. The three weeks preceding the 27th July, when our Elder Walk outbreak occurred, had been remarkable for two things as respects the weather. There had been no rain and not much wind; indeed, for several days in each week a calm had been observed, no movement in the air being perceptible. It was at the end of this period that our outbreak occurred—a period particularly favourable to the uninterrupted extension of an influence (such as a ground mist would be) spreading along the low levels, and gradually rising towards our higher ground from the east end of the metropolis. In the second week of our outbreak, that ending August 4th, there was twice as much movement of the air, and rain fell to the extent of half an inch. Rain now fell, fortunately, every week; and in the week ending September 8th, when our choleraic attacks first abated at the end of the first wave, nearly two inches fell, and there was considerable movement of the air. Week after week, from this time, the movement of the air became less; and with this lessened movement cholera became more frequent—our second wave was rising as the aerial motion lessened. In the week preceding the week corresponding to the top of this second wave, and in that week itself, little or no rain fell; and the movement of the air was again slight, with several days of perfect calm. These were the weeks ending September 29th and October 6th. In the week ending October 13th, when we had 21 choleraic cases, there was no rain, but rather more wind; but in the next week, when there fell 0.85 in. of rain, our cases fell from 21 to 6. In the next week, when more than an inch of rain fell, our cases continued to lessen. From other observations I have made upon the influence exerted by rainfall or drought, and by movement of air upon sickness, as well as from the experience of former epidemics, I cannot avoid regarding the fluctuations I have attempted to describe as etiologically associated with the origin and progress, the recession and subsequent advance, and final recession a second time, of the epidemic amongst us. Had the weather, from the 4th of August 12 onwards, been other than it was—had drought and calm with heat prevailed—I have no doubt whatever that the first recession would not have occurred when it did, and that we should have experienced a mortality very much greater than we did experience. Diarrhoea during the epidemic season. It was perfectly clear that during the whole period, from the beginning of August until the end of November, bowel complaints, usually recorded under the term "diarrhœa," were vastly more prevalent than they are accustomed to be in the same months. The months of May, June, and July, showed nothing remarkable in this way. In May, only 68 cases were recorded; the numbers in the six preceding Mays varying from 42 to 67. In June, only 134 cases were recorded; the numbers in the six previous years varying from 86 (1860) to 230 (1865). In July, only 379 cases were recorded; the numbers in the six previous Julys varying from 84 (1860) to 399 (1864). But in August we had 1847 cases recorded, and an additional number of persons obtained medicine for it whose names were not taken down; in the six previous Augusts the number varied from 124 to 433. In September we recorded 1721 cases; the numbers in the six previous Septembers varying from 172 to 353. In October we recorded 420 cases; the numbers in the six previous Octobers varying from 72 to 164. In November we recorded 127 cases; the numbers in the six previous Novembers varying from 40 to 88. Some of this increase might have been little more than the result of alarm—perhaps some of it was—but the alarm was nothing like what some people are apt to fancy. Except at the first outbreak in Elder Walk, when the people certainly were, and had good reason to be alarmed, it was absolutely nil; and even here it abated in a few days, as soon as it was seen that provision was made for the immediate relief of those who were attacked. I watched the effect of the outbreak upon the minds of the people most narrowly, and I am positive that alarm had very little indeed to do with the augmentation in the amount of recorded diarrhoea. The people, without exception, behaved most courageously throughout these three months—none refused their kind offices to the sick through fear of catching their complaint—the only difficulty I had was to keep them out of the sick rooms. There was no cowardly fear—I vouch for it. More than this, there was a general obedience to directions as to cleanliness and so on, which I scarcely expected to meet with. All helped, in their measure, to do away with the attractive causes of an outbreak, as soon as they were pointed out by myself or my assistants. No,—the excess of prevailing diarrhoea, which no excessive heat or drought were present to account for, was the veritable result of the epidemic influence dwelling upon London during those months. This, then, being the case, what relation do we find between the progress of diarrhœal affections and that of choleraic attacks? Did they follow the same line of increase and decline? No, they did not. There was but one wave of diarrhoea, increasing from the end of July to the end of the third week in August, when, in the 13 decline of the first choleraic wave, it attained its maximum; and then, steadily declining, but much more slowly than it rose, to the end of November. Relation of Choleraic Diarrhœa to Cholera. I have said that "choleraic diarrhœa," as it is vaguely termed, is but a choleraic attack which fails to undergo a complete development in the system. Our own experience demonstrates that such is the case. For, 1st—it is seen from the table that whereas ordinary diarrhoea formed only one wave of increase and decrease, "choleraic diarrhoea," like the true cases of cholera, formed two waves—the first high and more overwhelming ; the second lower and less overwhelming. 2nd—It increased and diminished as cholera increased and diminished, attaining its maximum and minimum in the same weeks, or as nearly as possible so. 3rd—It affected chiefly the localities principally affected by fully-developed cholera, concentrating itself mostly in the localities I have designated as the chief foci of cholera, and most of all in the grand cholera focus to the south of the Essex Road. 4th—There are numerous instances in my records of the epidemic, where cholera, having attacked one or more persons in a house, others have suffered, at the time or immediately afterwards, with an attack of "choleraic diarrhœa;" or where the first choleraic attack in the house has been designated "choleraic diarrhœa" after which some one else has had an attack of true cholera, and died from it. Again,—in has been, over and over again, noticed that persons who have been in association with cholera patients have suffered from the milder attack, while others have suffered from the fully-developed disease. It is not necessary to lengthen out my report by the details of these instances. It is not my intention to enter at any length into the evidence afforded by our limited outbreak, of the method in which cholera propagates itself when the specific virus of the disease gains access to a neighbourhood or a house. This is a subject which more befits those whose districts suffered more than that which it was my duty to superintend. But there is one point to which I must not fail to draw attention, because, although a negative fact, it has a force of instruction which must not be lessened by any omission on my part. And this is, that certain parts of our parish, which suffered very severely in former epidemics, scarcely suffered at all on this occasion. I have never seen an epidemic of cholera in this parish before; but the leading particulars of those which have occurred have been detailed to me by several medical men who were professionally engaged in their suppression. The parts I particularly allude to are the Irish Courts, the White Conduit district, and Brand Street, Hornsey Road. In the actual Irish Courts themselves, which suffered greatly on former occasions, not a single case of cholera happened. In Brand Street only two cases, one of which was a mild case and recovered; and in the streets of the White Conduit district, about Henry Place and Payne Street, only three cases, of which one recovered. I might mention other of the older streets in the parish occupied by poor people, where a similar remarkable contrast was observable. Now, whatever the specific virus of cholera may be, and however it may become diffused from place 14 to place, it is a matter which admits of little doubt that it propagates itself with remarkable readiness wherever it finds a nidus in collections of fœcal filth; and that one, at least, of the modes in which it gains access to the system, is through the contamination of drinking water by the virus of the disease. Is it not fair to infer that amongst the causes which prevented an outbreak to the extent of former outbreaks in these places, may be placed the very important sanitary improvements which, since the passing of the Metropolis Local Government Act, have been effected in these places as well as throughout all the poorer localities in the parish? I do not pretend that they are in a state of perfection even now—they are very far, yet, from that—but two things certainly have been done. Cesspools have been universally destroyed, which used to fester under the very windows, and sometimes under the floors of the houses in these places; and in a large number rotten water butts have been replaced by new ones; water supplied where there was none formerly; butts, in many places, as in the White Conduit district, replaced by covered cisterns; and active endeavours kept up to maintain some amount of cleanliness in receptacles of all kinds. In two of the worst of the Irish Courts—Waters Court and Rose and Crown Court—special amendments were made, not very long before the outbreak, as regards water supply, which I cannot avoid thinking were very useful in preserving the inhabitants of these places when the disease was raging so near to them, as the Elder Walk district. The exemption of these people is most remarkable. In Waters Court a constant supply was furnished from the main; and in Rose and Crown Court a large cistern was erected, so thoroughly well covered that not a particle of extraneous matter of any kind could possibly get into it. Measures adopted for preventing the spread of the disease—and their results. On the occurrence of the first case of cholera on the 23rd of July, my earliest care was to make such provisional arrangements, pending the action of the Vestry under the Privy Council order, as in the event of an immediate extension of the disease would enable me to remove any cases that might happen to one of our local Hospitals, and in other ways to facilitate the arrangements which it was clear would have to be made. In this I was much assisted by the advice and concurrence of the Chairman of the Sanitary Committee, whom I at once consulted, and whose experience of every epidemic outbreak which had formerly occurred here rendered his advice and opinion valuable. The outbreak in Elder Walk occurred on the day on which the Vestry met to put in force the order of the Privy Council; and as it was left to me to make any temporary arrangements to meet an emergency, I sent a medical visitor, Mr. Macleod, to Elder Walk the next morning, with a supply of medicine, and directions to visit every house in the neighbourhood with a view to discover cases of diarrhoea, and to treat them at once. In nearly all cases it happens that some ordinary looseness of the bowels precedes, by some few hours, true choleraic symptoms; and it is in this premonitory* stage that most good can be * Where preceding the more violent symptoms by only' "a few hours," this stage is more correctly designated the initiatory stage. Tho diarrhoea can only be termed "premonitory" when it precedes them for a day or two. However, I use the term "premonitory " as it is, I believe, ordinarily employed in this country. 15 effected by medical treatment. Experience has demonstrated that a local outbreak of cholera may be prevented, and, when it has happened, kept very much under check by the discovery and immediate medical treatment of all cases of looseness of the bowels that occur. On the 30th of July the Diseases Prevention Committee held its first meeting; and a deputation from the congregation at Hare Court Chapel having offered their school room in Elder Walk as a temporary dispensary station, it was inexpensively furnished and opened as such on August 2nd; Mr. Macleod, the visitor appointed for the district, with Mr. Hurford, an assistant, also placed there on that day, residing there during the whole period of the epidemic outbreak. On this day, also, Mr. Turner was appointed to visit in Lower Holloway; and arrangements were made by which he resided at the Holloway Dispensary; and the staff and material of the institution were placed by its Committee at my disposal during the succeeding months. The dispensary arrangements of the two chief foci of epidemic influence being thus settled, hand-bills were prepared and distributed extensively throughout all the poor neighbourhoods, and placed in the hands of the clergy, for the use of their visitors. On August 7th, Mr. Lamb was appointed as medical visitor in Thornhill Ward; but at the end of the month, it was thought to be unnecessary to continue his services. I have no doubt that the services rendered by these gentlemen, especially in the two principal foci, were very effectual in arresting the spread of cholera, by putting a stop to a very large number of cases of diarrhœa, some, at least, of which, experience assures us must be regarded as cases of the premonitory diarrhœa of cholera. I made it my duty to visit our two stations every day—or oftener sometimes—and to see for myself every case of cholera reported to me, as it occurred. I must add that the appointment of these visitors, and the establishment of the stations, especially that in Elder Walk, was received very thankfully by the poor people for whose benefit they were made; and in my own domiciliary visits I heard frequent expression given to this feeling. The position of Messrs. Macleod and Hurford, in the very centre of the most affected streets, was not a very enviable one; and they were compelled to take night duty alternately. But they did their work earnestly and admirably. Hospital Accommodation. By an arrangement made with the London Fever Hospital, a new wing of that building, adjoining the male fever wards, was devoted to the reception of any patients that we might send, and the staff of the Institution, under the special superintendence of Dr. Horace Jeaffreson, were employed in the ward. I was also empowered by arrangement with the Committee of Management, to act as necessity might require, in association with that gentleman. At the Great Northern Hospital, also, arrangements were made for the reception of our cases; and several were sent there from the neighbouring parts of the parish. At first I found a great objection on the part of the poor people to have their relations removed; and in some cases the removal was not effected before collapse had set in: they thought that they could 16 attend to them best at home. But when they found that cases treated thus in their own homes were fatal, and that other members of the family became attacked one after the other, this objection faded away; and whenever the case was seen sufficiently early, and the locality was not too distant, removal to the hospital became a rule of our practice. Prior to this, the labour and anxiety of the attendance fell upon the District Medical Officers of the parish, or at a later period, upon the Medical Visitor— whichever first saw the case. Out of the 110 cases which I have tabulated, 40 were treated in one or other of the hospitals, and the remainder either by one of these gentlemen, or by private practitioners at their own homes. Of the 40 treated in the hospitals, 26 died, that is 65 per cent; while of the 70 treated at home, 40 died, or 57 per cent. It must not be concluded at once, from these numbers, that it was a bad thing to remove the patients to the hospital, for it is to be kept in mind that it was just the cases which were most severe and alarming, and those who where the most poverty stricken, and from the most fatal neighbourhood, which were thus removed. Such cases would have probably died just the same had they remained at home; and it is quite certain from the experiences of what happened in the same family, that some of the patients were saved by removal to the airy wards who would most assuredly have died had they not been removed. Disinfection, &c. The object of what is termed disinfection is the destruction of the specific virus of the disease. What this precisely is, science has not determined, but enough is known of its nature and characters to guide our practice. Thus it is believed, like other viruses of specific diseases to be something living, and it is known to be given off from the person attacked, mixed with the specific discharges of the disease, the stools and the vomit. It is further believed to be harmless, or probably so, when these are tolerably fresh, but to acquire especial activity when they become alkaline as they do after a time. It is further believed that it, (the virus mixed with particles of dry discharges or otherwise may be wafted by the air), may generate probably in collections of filth, and may be received by other persons in the air they breathe, or in the food and drink they partake of. It is certain that those are most endangered who are most with the sick; especially when the surrounding circumstances are such, or the ignorance is such, that it becomes impossible to adopt those precautions which are necessary for safety. Apart then from the treatment of persons attacked with what may be the premonitory diarrhoea of cholera, and apart from ordinary measures of cleanliness, it becomes an important part of the duty of a Sanitary Officer to use his utmost endeavours, not only to remove the person whose continual discharges give rise to danger to other persons in a house or room, but also to prevent the further extension of the specific cause of the disease by destroying the energy of the virus given off in the discharges from the sick, wherever he has reason to believe they have fallen. The selection of the "disinfectant" for use, is also a matter in this view of the case of very great importance. Free exposure to the air, the action 17 of water, especially boiling water, the arrest or neutralisation of alkalinity in the discharged matters, by the use of chemical substances, the oxidation of the virus by the use of the permanganates, and lastly the destruction of the vitality of the specific virus by means of carbolic acid, or fire, are all means which are applicable in their several degrees to particular cases, and to special circumstances. A supply of carbolic acid was kept and distributed to medical men having charge of cases of cholera and diarrhoea, to be placed in the utensils into which the discharges were received; sometimes, however, other chemical substances were employed for this purpose by private practitioners, such as Burnett's Solution of Zinc, or Sulphate of Iron, or Condy's Solution of Permanganate. But, whether these were used or not, the discharges thrown into the closets were always followed up immediately under my directions by a quantity of carbolic acid, poured into the closets and house drains, both of the house where the case of cholera or choleraic diarrhoea occurred, and into those of adjoining houses. I commenced to do this from the very first case that happened, and I kept it up through the whole epidemic. On the 31st July, a systematic disinfection of the gully openings and sewers throughout the parish, by means of carbolic acid, was commenced, and in this way not only were the sewers disinfected, and the discharge of noxious exhalations from their openings in the streets prevented, but where house drains were untrapped, the vapour became diffused even into them. Wherever cholera happened, a systematic disinfection of privies and drains in the whole street and neighbourhood, at intervals of a few days, was kept up, until the epidemic was at an end; labourers being at one time especially engaged for the purpose. It was upon carbolic acid that I placed my own trust as the best disinfectant of choleraic matters, as it had been proved to be in the case of cattle plague in the previous year. It was then the only chemical disinfectant that we supplied as a rule. I made it a point, wherever a case of cholera was removed from a house or died, to direct, personally, what measures of disinfection should be adopted; and where the clothing or bedding were soiled, unless they were good enough to be preserved, and such as chemical disinfectants could be satisfactorily applied to, I was in the habit of directing their destruction by burning. In carrying this out we met with some difficulties, since, although the articles to be burned were always soaked with carbolic acid before removal, and thus all danger of infection avoided, we could not obtain a place in the parish where our officers could destroy them without molestation; and they had to be carried to Finchley. In some cases it was necessary, in order to pursue the necessary disinfection, to remove persons from the room where they resided; and in a few instances I found it necessary to clear entire houses of their inhabitants. The persons removed were lodged and kept at the expense of the Vestry, in such lodgings as could be obtained from time to time. In no instance in which such removal of families was carried out, did any second case occur in them; neither did a second case occur in any house where the carbolic acid disinfection was carried 18 into effect. In several instances delays arose in the removal of soiled bedding, &c. for destruction; but no harm followed the delay when the articles had been soaked with carbolic acid. On the other hand, where such previous disinfection was not effected, either at the earlier stage of our operations, before our arrangements were fully made, or from refusal of parties to allow of our interference, such second, and even third and fourth cases did occur. Special supply of Drinking Water. On the third of August the Secretary of the New River Company intimated that they were ready to give a continuous supply of water for drinking purposes during the ensuing six months, in any places where it should be considered necessary. It was referred to me to select the localities; and inexpensive standpipes were erected in the two principal foci of epidemic eruption, namely, at each end of the Elder Walk, in Waters Court, and in Madras Place, opposite Palmer Street. I have no doubt myself that this supply of uncontaminated water assisted in lessening the extension of the disease in these localities. During the whole period of the epidemic, instructions were given to the inspectors to pay special attention to the condition of the ordinary water receptacles in poor localities; and in some instances, in order to save time, they were, in emergency, cleansed and disinfected by our own workmen. I must say this, further, that the poor people themselves, in many places, became impressed with the importance of this precaution; and spontaneously set about cleansing them. SANITARY WORK EFFECTED. Table III. shows, in the customary form, the house amendments made with a sanitary object during the year, under directions issued by the authority of the Sanitary Committee. In the month of May two additional inspectors were permanently appointed; and they did good service in preparing us for the advent of the epidemic, which arrived here in July. On the 23rd of August, four more sanitary inspectors were temporarily engaged by the Diseases Prevention Committee. The table shows that a very large amount of work was got through. But, in addition, a good deal was done, in the way of cleansing and lime-washing, respecting which no notices whatever were served from our office. The annual licencing of cow sheds and slaughter houses took place in October; and, as usual, I viewed all those places myself. Licences were granted to 61 establishments for cows, and to 108 slaughter houses. The rule of requiring 1000 cubic feet of space, in cow sheds, for each animal was brought into operation this 19 year, for the first time, by our magistrates. The number of cows found in the sheds was only 474. I have the honour to remain, Gentlemen, Your very obedient servant, EDWARD BALLARD, M.D., M.R.C.P. June 2nd, 1867. Medical Officer of Health, TABLE I. DEATHS REGISTERED IN ISLINGTON DURING (Deaths of Non-Residents West. East. Causes of Death. All Ages. AGES. Und. 1 1- 2- 3- 4- Under 5 yrs. 5- 10- 15- 20- 40- 60- 80 Up. 2109 2063 All Causese 4172 1170 434 201 126 79 2010 135 63 79 520 578 644 142 594 533 (Classes.) I. ZYMOTIC DIS. 1127 342 191 112 79 47 771 70 27 20 126 66 42 5 404 386 II. CONSTITUTE 790 89 59 30 17 14 209 27 13 36 240 186 72 7 814 864 III. LOCAL 1678 391 158 50 25 12 636 30 21 23 139 310 460 59 259 224 IV. DEVELOPMNL. 483 306 21 4 3 1 335 2 1 ... 5 6 63 71 38 52 V. VIOLENTDTHS. *90 39 5 5 2 5 56 6 1 ... 9 10 7 ... ... 4 Not Specified 4 3 ... ... ... ... 3 ... ... ... 1 ... ... ... 560 504 (Orders.) I. 1. Miasmatic Dis. 1064 291 190 | 112 79 47 719 70 27 20 119 63 42 4 36 31 Small Pox 67 14 6 3 4 30 7 4 3 20 3 ... ... 79 73 Measles 152 27 65 29 16 2 139 12 ... ... 1 ... ... ... 60 56 Scarlatina 116 6 24 24 18 17 89 17 6 1 3 ... ... ... 11 12 Diphtheria 23 2 2 6 3 3 16 4 2 ... ... 1 ... ... ... 1 Quinsey 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... 21 22 Croup 43 7 11 7 14 2 41 ... 1 1 ... ... ... ... 115 105 Hooping Cough 220 95 60 34 20 5 214 5 l ... ... ... ... ... 76 49 Typhus & Typhoid 125 3 2 1 3 8 17 16 5 9 53 16 9 ... 8 11 Erysipelas 19 5 2 ... 1 1 9 1 ... 1 1 1 6 ... 5 1 Pyœmia 6 ... ... ... ... ... ... ... 2 ... 3 l ... ... 8 6 Puerperal Fever 14 ... ... ... ... ... ... ... ... ... 13 1 ... ... 3 1 Carbuncle 4 ... ... ... ... ... ... ... ... ... 1 2 1 ... 1 3 Influenza 4 1 ... ... ... ... 1 ... ... ... ... ... 1 2 4 1 Dysentery 5 ... 1 ... ... ... 1 ... 1 1 ... ... 1 1 94 71 Diarrhœa 165 120 15 7 ... ... 142 ... ... ... 2 9 11 1 29 46 Cholera 75 11 1 1 1 3 17 6 3 3 17 20 9 ... ... 1 Ague 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 10 14 Rheumatism 24 ... ... ... ... 2 2 2 2 1 5 8 4 ... 11 11 2. Enthetic 22 21 ... ... ... ... 21 ... ... ... ... ... ... 1 11 10 Syphilis 21 21 ... ... ... ... 21 ... ... ... ... ... ... ... ... ... Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Hydrophobia 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 10 3. Dietic 31 21 ... ... ... ... 21 ... ... ... 7 3 ... ... ... ... Privation ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 5 Want of Br. Milk 21 21 ... ... ... ... 21 ... ... ... ... ... ... ... ... ... Purpura and Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 5 Alcoholism 10 ... ... ... ... ... ... ... ... ... 7 3 ... ... 2 8 4. Parasitic 10 9 1 ... ... ... 10 ... ... ... ... ... ... ... 2 8 Thrush 10 9 1 ... ... ... 10 ... ... ... ... ... ... ... ... ... Worms ... ... ... ... ... ... ... ... ... ... ... ... ... ... 58 55 II. 1. Diathetic 113 3 1 ... ... 2 6 ... ... ... 7 39 54 7 3 3 Gout 6 ... ... ... ... ... ... ... ... ... ... 1 5 ... 10 12 Dropsy 22 2 ... ... ... 1 3 ... ... ... 1 7 9 2 ... 3 Hæmorrhage 3 ... ... ... ... ... ... ... ... ... ... 1 2 ... 40 32 Cancer 72 ... ... ... ... ... ... ... ... ... 6 30 35 1 1 1 Noma 2 ... 1 ... ... 1 2 ... ... ... ... ... ... 1 4 4 Mortification 8 1 ... ... ... ... 1 ... ... ... ... ... 3 ... 346 331 2. Tubercular 677 86 58 30 17 12 203 27 13 36 233 147 18 4 11 12 Scrofula 23 5 3 2 1 1 12 2 2 ... 2 5 ... ... 14 39 Tabes Mesenterica 53 26 16 3 6 1 52 1 ... ... ... ... ... ... 258 219 Phthisis 477 15 6 7 2 3 33 9 9 35 231 142 18 ... 63 61 Hydrocephalus 124 40 33 18 8 7 106 15 2 1 ... ... ... ... 232 253 III.1.NervouSyst. 485 144 51 10 3 4 212 11 4 8 29 65 | 142 14 24 15 Cephalitis 39 12 7 3 1 2 25 5 3 3 2 ... | 1 ... 47 56 Apoplexy 103 4 ... ... ... ... 4 1 1 1 3 28 53 6 52 51 Paralysis 103 ... ... ... ... ... ... ... ... 2 3 23 68 7 3 ... Insanity 3 ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 9 Epilepsy 13 ... 1 ... ... ... 1 ... ... ... 5 5 2 ... 74 95 Convulsions 169 122 38 7 1 ... 168 1 ... ... ... ... ... ... 28 27 Brain Diseases,&c. 55 6 5 ... 1 2 14 4 ... 1 8 9 18 1 93 118 2. Organs of Circ. 211 4 1 ... 1 6 5 5 2 26 66 91 10 l 1 Pericarditis 2 1 ... ... ... ... 1 ... 1 ... ... ... ... ... 3 2 Aneurism 5 ... ... ... ... ... ... ... ... ... ... 4 1 ... 89 115 Heart Disease 204 3 1 ... ... 1 5 5 4 2 26 62 90 10 * 1 Age net specified. TABLE I THE YEAR ENDING DECEMBER 29th, 1866. in Hospitals excluded). West. East. Causes of Death. All Ages. AGES. Und. 1 1- 2- 3- 4- Under 5 yrs. 5- 10- 15- 20- 40- 60- 80 Up. 342 350 3. Respirat. Orgs. 692 213 98 38 20 6 375 7 6 2 49 72 | 152 | 29 25 23 Laryngitis 48 23 13 2 2 1 41 ... 1 ... ... 5 1 ... 198 194 Bronchitis 392 109 49 14 9 4 185 ... 1 2 11 42 129 22 9 5 Pleurisy 14 ... ... 1 ... ... 1 ... l ... 6 4 1 1 88 115 Pneumonia 203 78 36 20 8 l 143 5 3 ... 27 11 10 4 13 7 Asthma 20 ... ... ... ... ... ... 1 ... ... 2 6 9 2 9 6 Lung Diseases, &c. 15 3 ... 1 1 ... 5 1 ... ... 3 4 2 ... 100 95 4.Digestive Orgs. 195 24 3 2 1 ... 30 3 3 6 22 78 51 2 3 1 Gastritis 4 ... 1 ... ... ... 1 ... ... ... ... 2 1 ... 5 6 Enteritis 11 7 ... ... ... ... 7 1 ... 1 ... 2 ... ... 13 12 Peritonitis 25 1 ... 1 1 ... 3 2 2 3 5 5 5 ... 1 2 Ascites 3 ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 1 Ulceration of Intes. 1 ... ... ... ... ... ... ... ... ... 1 2 ... ... 3 4 Hernia 7 2 ... ... ... ... 2 ... ... ... ... 1 4 ... 13 4 Ileus 17 4 ... ... ... ... 4 ... ... 1 2 4 5 1 1 2 Intussusception 3 2 ... ... ... ... 2 ... ... ... ... 1 ... ... ... Stricture of Intest. ... ... ... ... ... ... ... ... ... ... ... ... ... ... l Fistula 1 ... ... ... ... ... ... ... .... ... ... ... 1 ... 11 12 Stomach Dis., &c. 23 3 1 ... ... ... 4 ... ... 1 3 10 4 1 ... ... Pancreas Dis., &c. ... ... ... ... ... ... ... ... ... ... .. ... ... ... 4 10 Hepatitis 14 1 ... ... ... ... 1 ... ... ... 3 5 5 ... 4 5 Jaundice 9 4 ... 1 ... ... 5 ... 1 ... 1 2 ... 42 35 Liver Disease 77 ... 1 ... ... ... 1 ... ... ... 8 45 23 ... ... ... Spleen Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 28 5. Urinary Orgs. 51 ... 1 ... 1 ... 2 1 1 2 6 18 18 3 2 ... Nephritis 2 ... ... ... 1 ... 1 ... ... ... ... .. 1 ... 4 *4 Disease of Bladder 8 ... 1 ... ... ... 1 ... ... 1 ... 3 1 2 4 13 Nephna 17 ... ... ... ... ... ... 1 1 ... 2 7 6 ... 3 1 Diabetes 4 ... ... ... ... ... ... ... ... 1 2 1 ... ... ... 1 Stone 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 Prostrate Disease . 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 10 7 Kidney Disease,&c. 17 ... ... .. ... ... ... ... ... ... 2 7 8 ... 11 7 6. Genera. Organs 18 ... ... ... ... ... ... ... ... 1 4 9 4 ... 3 3 Ovarian Dropsy 6 ... ... ... ... ... ... ... ... ... 2 4 ... ... 8 4 Uterine Diseases 12 ... ... ... ... ... ... ... ... 1 2 5 4 ... 8 6 7. Orgs. of Locomo. 14 ... 3 ... ... 1 4 2 2 1 3 2 ... ... 4 3 Spine Diseases 7 ... 2 ... ... 1 3 1 1 ... 2 ... ... ... 4 3 Bone Diseases 7 ... 1 ... ... ... 1 1 1 1 1 2 ... ... 5 7 8. Skin, &c 12 6 1 ... ... ... 7 1 ... 1 ... ... 2 1 4 3 Phlegmon &Abscess 7 3 1 ... ... ... 4 1 ... 1 ... ... 1 ... ... 1 Ulcer 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 Skin Diseases 4 3 ... ... ... ... 3 ... ... ... ... ... 1 ... 70 60 IV. 1. Dis. of Childn. 130 128 2 ... ... ... 130 ... ... ... ... ... ... ... 62 51 Premature Birth 113 113 ... ... ... ... 113 ... ... ... ... ... ... ... 3 3 Cyanosis 6 6 ... ... ... ... 6 ... ... ... ... ... ... ... 1 2 Spina Bifida 3 3 ... ... ... ... 3 ... ... ... ... ... ... ... 3 4 Other Malformation 7 6 1 ... ... ... 7 ... ... ... ... ... ... ... 1 Teething 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... 5 3 2. Dis. of Adults . 8 ... ... ... ... ... ... ... ... ... 5 3 ... ... ... ... Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 3 Childbirth 8 ... ... ... ... ... ... ... ... ... 5 3 ... ... 80 57 3. Dis. of Aged 137 ... ... ... ... ... ... ... ... ... ... 3 63 71 80 57 Old Age 137 ... ... ... ... ... ... ... ... ... ... 3 63 71 104 104 4. Dis. of Nutritn. 208 178 19 4 3 1 205 2 1 ... ... ... ... 104 104 Atrophy & Debility 208 178 19 4 3 1 205 2 1 ... ... ... ... ... 26 38 V. 1. Acci. or Neg. 64 26 4 5 2 5 42 5 1 ... 5 5 5 ... 9 11 Fract. and Contus. 20 ... ... 3 1 3 7 3 1 ... 4 3 2 ... ... 1 Wounds 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 5 5 Burns and Scalds 10 l 4 2 1 2 10 ... ... ... ... ... ... ... 2 1 Poison 3 l ... ... ... ... 1 ... ... ... 1 ... 1 ... 2 3 Drowning *5 1 ... ... ... ... 1 2 ... ... ... ... 1 ... 7 13 Suffocation 20 18 ... ... ... ... 18 ... ... ... ... 2 ... ... 1 4 Otherwise 5 5 ... ... ... ... 5 ... ... ... ... ... ... ... 4 11 2.Homicide 15 13 1 ... ... ... 14 ... ... ... 1 ... ... ... 8 3 3. Suicide 11 ... ... ... ... ... ... 1 ... ... 3 5 2 ... 1 1 Wounds 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... Drowning 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... 5 2 Suffocat. and Hang. 7 ... ... ... ... ... ... 1 ... ... ... ... 2 ... ... ... Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Unclassed ... ... ... ... ... ... ... ... ... ... ... ... ... ... * 1 Age not specified. TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FIFTY-TWO WEEKS ENDING SATURDAY, THE 29th DAY OF DECEMBER, 1866, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. . Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small Pox 4 1 277 41 9 .. 332 Chicken Pox .. 7 51 53 6 .. 117 Measles 1 .. 445 302 146 .. 894 Scarlatina 1 7 137 89 48 .. 282 Whooping Cough 1 6 338 296 68 .. 709 Croup .. .. 17 15 1 .. 33 Diarrhœa 72 .. 3821 665 151 139 4848 Dysentery .. .. 4 9 5 .. 18 Cholera .. .. 101 5 .. .. 106 Ague .. .. 7 6 2 1 16 continued Fever 54 .. 141 119 31 .. 353 Influenza .. .. 3 .. .. .. 3 Puerperal Fever 4 .. 1 1 .. .. 6 Rheumatic Fever 24 .. 24 63 46 1 158 Erysipelas 14 .. 84 27 15 .. 140 Diphtheria .. .. 6 23 1 .. 30 Sorethroat or Tonsillitis 2 .. 190 157 111 1 461 Mumps .. 1 10 2 .. .. 13 Pyæmia .. .. .. .. .. .. .. Bronchitis and Catarrh 200 4 2981 1392 583 367 5527 Pneumonia 3 1 56 35 27 .. 122 Pleurisy 1 .. 38 19 25 1 84 Delirium Tremens 9 .. 7 5 .. .. 21 Insanity 42 .. 44 1 .. 1 88 Carbuncle 1 .. 9 4 11 1 26 All other Deseases 700 152 6067 6197 6178 1749 21043 Total 1133 187 14859 9526 7464 2261 35430 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED, From March 26th, 1866, to March 25th, 1867. West District. East District. Total Number of houses inspected 5109 3799 8908 Drains Constructed 53 128 181 Improved or repaired 393 427 820 Traps fixed 591 500 1091 Cesspools Abolished 16 24 40 Cleansed or disinfected 12 28 40 Privies and Water Closets Pan, trap, and water supply furnished 102 83 185 Pan and trap only furnished 34 68 102 Water supply furnished 285 414 699 Dust bins Constructed 119 283 402 Repaired and covers adapted 308 404 712 Surface Drains and Pavements of Yards Constructed 37 139 176 Relaid 353 293 646 General Water Supply New receptacle provided 53 103 156 Receptacle repaired and cleansed 403 314 717 Water supply provided 24 23 47 Other Improve Houses generally repaired 188 285 473 " cleansed or limewashed 365 569 934 " ventilated 5 13 18 Overcrowding abated 96 81 177 Illegal use of underground Rooms for sleeping discontinued 40 23 63