ISL 40 REPORT ON THE SANITARY CONDITION of the Parish of Saint Mary, Islington, DURING THE YEAR 1871. by WILLIAM HENRY CORFIELD, M.A., M.D., (Oxon.) MEMBER OF THE ROYAL COLLEGE OP PHYSICIANS; MEDICAL FELLOW OF PEMBROKE COLLEGE, OXFORD; PROFESSOR OP HYGIENE AND PUBLIC HEALTH AT UNIVERSITY COLLEGE, LONDON. MEDICAL OFFICER OF HEALTH. J. & I. TIREBUCK, STEAM PRINTERS AND LITHOGRAPHERS, Monkwell Street, E.C., and Islington. 1872. TO THE VESTRY OF ST. MARY, ISLINGTON. Gentlemen, In this my first Annual Report, which I have now the honour of presenting to you, I have followed the arrangement adopted by my predecessor, less for the sake of uniformity, than because it appears to me a simple and excellent one. You will observe that the first part of the Report, headed "Births, deaths, and sickness," refers to the year 1871, including, therefore, only three months which belong to my period of office, and that the second part, headed "Sanitary work of the year,'' refers to the period between March 26th, 1871, and March 25th, 1872, which was equally divided between Dr. Ballard and myself. You will, therefore, at once understand, that this Eeport was prepared under exceptional and somewhat difficult circumstances. BIRTHS, DEATHS, AND SICKNESS. The births registered during the year are represented quarter by quarter in the following table:— West Sub-District. East Sub-District. Whole Parish. Males. Females. Total. Males. Females. Total. Males. Females. Total. 1st Quarter 485 475 960 530 512 1042 1015 987 2002 2nd „ 440 457 897 484 512 996 924 969 1893 3rd ,, 443 431 874 500 509 1009 943 940 1883 4th „ 442 461 903 500 474 974 942 935 1877 1810 1824 3634 2014 2007 4021 3824 3831 7655 This table is to be taken to mean that the births in the whole parish were, during the year, at the rate of about 35½ per thousand per annum, on the estimated population for the middle of the year; but that the rate was not the same for the two sides of the parish, that of the West SubDistrict being 36.8, and that of the East Sub-District, 34.1 per thousand per annum. 4 The birth-rate for the whole of London was 34.5 per thousand per annum on the estimated population for the middle of the year, so that the birth-rate of Islington has been above the average, and that of the West Sub-District considerably above it. The total number of deaths registered in the parish during the same period, (exclusive of those of non-residents, occurring in the Small Pox and Fever Hospitals, the Great Northern Hospital, St. Saviour's Lying-in Hospital, the temporary Hospital established for a time at the Islington old workhouse, and the West London Union Workhouse,) was 4626; it is very important to make the correction above indicated, as will be seen by referring to the Registrar-General's returns for the past year; from them it would be gathered that there had been no less than 6294 deaths in Islington during the year, or 1668 more than the actual number among residents, in other words, for every four deaths thus recorded by the EegistrarGeneral, only three really belonged to the parish. We must, however, add a certain number as our share of the deaths taking place in public institutions in London, other than those already included in our mortality tables; if we calculate this upon the population, a method which is perhaps as unfavourable an one as could be taken, we find it to be 297, a higher number than usual; adding this to the registered total given above, we get 4923 deaths as the extreme number due to the parish in the year, so that the births exceeded the deaths (thus corrected) by 2732. Of the 4626 deaths registered here, 2169 were deaths of males, and 2467 of females. The number of deaths of children under five years of age was 1966, or considerably less than half the total number. The (corrected) annual death-rate calculated on the population of the parish, as estimated for the middle of the year, was 228.7 per 10,000, while that for London generally was 247. Every large town in the kingdom, with the exception of Portsmouth, had a higher death-rate than Islington. Our death-rate is 5 per 10,000 higher than it was in 1870, the general London death-rate being 7 per 10,000 higher. According to the Eegistrar-General, the groups of London districts had the following rates per 10,000 during the year:—West, 225; North, 256; Central, 250; East, 262; South, 241. Thus the western districts alone 5 approached Islington in lowness of death-rate, having apparently a slightly lower one. I say apparently, because if the share of deaths in public institutions, and especially in the Small Pox hospitals, were added, the result would certainly be modified. The sickness returns, (Table II.), call for a special notice. In his monthly report for July last, Dr. Ballard said, "The table of sickness is imperfect this month, in consequence of some recent changes having been made in the mode of keeping the books of the Medical Officers of the Guardians, which cause them to be no longer available for my use." This continues to be the case, so that the column headed " Out patient paupers," in Table II., only represents six months' sickness, viz.: from January to June inclusive, except as regards Small Pox, the number for which (1082), represents the number of new cases occurring during the twelve months; as far as the other returns are concerned, the total number of new cases of sickness (27,104) is 639 less than the corresponding number last year. CAUSES OF SICKNESS AND DEATH. * The number of deaths registered according to their causes will be found in Table I., and the corresponding record of cases of sickness, as far as it goes, in Table II. While Scarlatina and Measles swelled the lists in 1870, it is Small Pox that has been most conspicuous in 1871; it was indeed the epidemic of the year. Small Pox.—It is difficult to say when the very serious epidemic of this disease, which had by no means ceased its ravages at the end of the year, began, but the signs of it were manifest in the middle of 1870; thus in June there were 3 deaths registered from it in the parish, in each of the months July, August, and September, 4 deaths; in October, 3; November, 13; and December, 17 deaths, from it. The cases occurring in public practice were, in October, 20; in November, 35; and in December, 104. 6 The following Table will show its progress during the year 1871:— Public Cases. Deaths. Public Cases. Deaths. January 121 28 July 98 23 February 123 42 August 75 22 March 198 50 September 64 30 April 249 55 October 20 4 May 236 51 November 27 4 June 178 68 December 40 9 The disease then attained its maximum fatality in June, though the epidemic, as indicated by the number of fresh cases, was at its culminating point early in May. Since that time there was a steady decrease in the number of fresh cases until November; when a slight recrudescence occurred. During the year then it caused 386 deaths, or nearly a ⅓rd of the deaths caused by all the miasmatic diseases; it is by observing the ages at which these deaths took place, that we shall best learn the practical lessons to be derived from the epidemic as far as these returns exhibit them: thus of the 386 deaths, 171, or less than one-half, were among children under ten years of age. Now in all the other Continued Fevers, (leaving Puerperal Fever out of the question for obvious reasons), with the exception of Typhoid Fever, the number of deaths before ten years of age is far greater than the number occurring at later periods of life. The following Statistics taken from Table I. show this clearly:— Under 10 years Over 10 yrs Under 10 years Over 10 yrs Measles 147 l Croup 21 0 Scarlatina 125 14 Hooping Cough 154 0 Diphtheria 28 2 Small Pox 171 215 This shows us that Small Pox for some reason or another behaves in an exceptional manner to all the other fevers with which it is allied, for 7 there are sufficient reasons for placing Typhoid Fever on another footing altogether. We should be led to think it likely that for some reason or another, fewer, far fewer children died of Small Pox than ought by analogy to die, or that it was a disease which was more fatal later in life and especially between the ages of 20 and 40 (see Table I.). Now there is no doubt that it is a disease that spares no age and therein differs in degree at any rate from the other fevers just mentioned, but from the vaccination statistics we are warranted in concluding that the comparatively small mortality among children is due to the effect of Vaccination, and that the large number of deaths between 20 and 40 points to the necessity of Re-vaccination at some earlier period, preferably between 10 and 15 years of age, as that is the period when least deaths occur, in other words the deaths which might have been prevented by Re-vaccination begin to be more numerous after that period is passed. Unvaccinated Children under one year old scarcely ever recover from Small Pox: of unvaccinated children under 5 years of age admitted to various Hospitals during the late epidemio 61.15 per cent. died, while of the vaccinated only 19.48 per cent. died; of unvaccinated persons of all ages 44.8 per cent. died, of vaccinated 10.15; this shows us that like the other contagious fevers, Small Pox is, apart from vaccination, more fatal to children than to adults; or to put it still more obviously, out of 708 unvaccinated children under 5 years of age, 433 died, or 61.15 per cent. while out of 2,926 unvaccinated persons of all ages over 5 years, 1195 died, or 40.84 per cent. The above facts I have gathered from the Report of a Committee of the Managers of the Metropolitan Asylum District, which has just been issued: now I also find there some very interesting statistics showing the effect of inefficient vaccination; among vaccinated persons the mortality varied gradually from 5.5 per cent. among those who had 5 or more vaccination marks, to 15.2 per cent., among those who had only one mark, showing conclusively the desirability of vaccination being so effectively performed as to produce several permanent cicatrices. Another very interesting fact related in the report is, that of upwards of 14,800 cases received into the Hospitals only four presented proofs of having been revaccinated. Cases of Small Pox after revaccination are rarer than second attacks of Small Pox, and are much less severe; this is a result that those who are most sanguine as to the advantages to be obtained from efficient vaccination and revaccination could hardly have hoped to obtain. 8 Scarlet Fever.—The severe epidemic of 1870, which, caused in that year no less than 465 deaths, (considerably more it will be observed than Small Pox has caused this year) lingered on through the first quarter of 1871, causing 35 deaths in Januarj, 20 in February, aud 13 in March; a few deaths were recorded in each month, amounting to 37 altogether in the six months from April to September inclusive: late in the autumn it as usual took a fresh start, and caused 11 deaths in October, 9 in November, and 14 in December; making a total of 139 deaths in the year. This disease spreads especially in badly ventilated houses. I have remarked that where there are no back windows and consequently no through ventilation, it often attacks the whole household. I have known a case in which it went from house to house all along one side of a street until it came to a cross street which it could not pass; doubtless one of the reasons why it is so fatal in the late autumn and winter is to be found in the fact that the houses are shut up to keep the cold winds out. The moral of all this is that ventilation, which is at all times necessary, is ten times more so in a house containing a Scarlet Fever patient, and it must be remembered that while draughts may be very injurious to the patient, fresh air immensely increases his chance of recovery. Disinfectants should be used in the manner indicated in the papers sent out by the Sanitary Department; and I may add here, that the plan of hanging a sheet across the doorway of the sick-room and sprinkling it occasionally with Carbolic Acid, should be resorted to more frequently than it is; it certainly tends to prevent the spread of tho infection to other parts of the house. Measles.—Up to the end of September only 17 deaths were registered from this disease, there being none at all in either March or August, but like Scarlet Fever it became severe in October, causing 11 deaths in that month, 22 in November, and 98 in December; thus giving a total of 148 for the year. Hooping Cough which was epidemic in the early months of the year, causing 23 deaths in March, and 22 in April, lingered on until November, when it caused 15 deaths, the fatality still further increasing to 42 in December; it gave a total of 154 deaths during the year. 9 So it will be seen then that while the early months of this year were charged with the end of the Scarlet Fever epidemic of 1870, the later months saw the commencement of the epidemics of Measles and Hooping Cough, which have since been so fatal. Now these two diseases kill indirectly; they predispose to lung diseases, especially Bronchitis and Pneumonia, of which the children die; consequently, as I have pointed out in my monthly reports, the mortality from them depends to a very great extent upon the weather; we may expect them to be especially fatal in weather which produces a high death-rate from lung diseases. "We find that of the 154 deaths from Hooping Cough, 42 (or more than a quarter) occurred in December alone, while of the 148 from Measles, no less than 98 (or two-thirds) took place in the same month. We shall presently see that this month was quite exceptional, both as regards its temperature and the number of deaths from lung disorders that occurred during it. Diarrhœa and Summer Cholera caused 248 deaths in the year; of these 219 were those of children under 5 years of age; these diseases were of course especially prevalent from July to October. It is often very difficult, if not impossible, to distinguish cases of Summer Cholera from true Asiatic Cholera, and the name Sporadic Cholera has been given to those scattered cases which are usually the precursors of an epidemic; it is of the highest importance that persons attacked with Diarrhœa should at once obtain medical advice and treatment, especially if it be at a time when Cholera is imminent or actually prevalent, and in all doubtful cases disinfectants should be thoroughly used, it being always kept in mind that they may turn out to be cases of true Asiatic Cholera. Diseases of the Organs of Respiration caused 872 deaths during the year, 384 being those of children under 5 years of age, and 414 those of persons over 40, so that only 74 occurred among persons between the ages of 5 and 40; of the 872 deaths, 549 were from Bronchitis and 228 from Pneumonia. These deaths were, as in 1870, almost equally divided between the two sub-districts, that is to say, that the mortality due to these diseases was proportionately greater in the West than in the East sub-district. Last year there were 818 deaths under this head. 10 The following table of the deaths which occurred month by month and quarter by quarter from these diseases shows some interesting facts:— January 118 April 54 July 24 October 33 February 73 May 41 August 22 November 81 March 121 June 44 September 25 December 236 Total 1st Qr. 312 Total 2nd Qr 139 Total 3rd Qr. 71 Total 4th Qr. 350 So that 662, or more than ¾ths of the deaths occurred in the 1st and 4th quarters of the year; there is nothing very remarkable in this of itself, were it not for the fact that no less than 236, or more than a quarter of the deaths registered under this head during the whole year, occurred during one single month, the month of December, which is, however, it must be noted, one of the months in which we reckon five weeks; in these five weeks 690 deaths were recorded, (460 was the greatest number ever registered before during the corresponding five weeks), and the death-rate was more than 33 per 1000 per annum; a third of this was due to diseases of the class we are considering. Now what was the cause of this ? I have already pointed it out in my Report for December. The first fortnight of that month was very cold, the week ending December 9th having a mean temperature no less than 12° Fahrenheit lower than the average temperature of the same week during fifty years, and this extreme cold was succeeded by warm damp weather. Cold weather is especially fatal to very young children and to old persons, and last December afforded us a very remarkable exemplification of this fact. MARRIAGES. I am indebted to Mr. Hicks the Superintendent Registrar for the following return of the number of marriages which took place in the parish during the year;— Quarter ending 31st March 341 „ 30th June 454 „ 30th September 477 „ 31st December 488 Total 1760 This is equivalent to a rate of over eight per thousand per annum, which is about the same as the rate for England generally. 11 SANITARY WORK OF THE TEAR. Table III.—The first portion of this Table shows the work of inspection carried out by the Inspectors during the year, and the second portion contains a statement of the various improvements effected under their superintendence. With the consent of the Sanitary Committee, Carbolic Acid was again used every Saturday during the hottest part of the summer, in connexion with the watering of some of the streets in the closer neighbourhoods, and McDougall's Powder was once a week freely thrown about many of the courts, and also on the yards and into the dust-bins of a considerable number of the smaller houses, where such a course was most likely to prove beneficial. The Committee also gave authority for the road-side and channel of a portion of the Essex Road, and of two portions of the Caledonian Road to be cleansed and deodorized, and the refuse carted away after the Saturday night market, and this proceeding gave much satisfaction to the inhabitants. In the previous summer the Essex Road portion only was done. The thorough disinfection of infected premises as directed by the Sanitary Committee on the 6th of February, 1871, was continued throughout the year, in all cases of Small Pox, and subsequently in cases of Scarlet Fever, which came under our notice, and wherever else it was deemed to be necessary under the 22nd Section of the Sanitary Act, 1866. The mode of procedure in this respect is fully described in my predecessor's last annual Report, and has been on the whole very successful; in case of default by the owner, the work can be carried out by the Nuisance Authority, the expense incurred being recoverable from the owner in a summary manner. This step has not been so necessary now for some time, for where the owners fail to comply with the notice, a further intimation by letter of our purpose to disinfect, and to charge them with the expense, is almost invariably quite sufficient to cause it to be done. In the pressure however, arising from the great amount of work which was thrown upon the Inspectors during the most severe portion of the Small Pox epidemio, the Committee expended the sum of £108. 19s. 3d., on account of defaulting owners between the 6th of February and the 2nd of August, 1871. Of this amount, £77. 15s. 3d. was received on one or two applications boing made, and 16 summonses were issued for the recovery of the balanco of £31.4s. 12 which was all afterwards received with the single exception of a sum of £4, the payment of which was excused by the Committee on account of the poverty of the person liable. The destruction of infected beds, bedding, and other articles has been continued with the sanction of the Committee, when, from the condition of the things, it has been found impossible to disinfect them. In each case compensation is given, and although this becomes a charge upon the Yestry, it is certainly money well spent, as the result is of the most beneficial character in effectually preventing the spread of disease. While on this subject, I may mention that during the time that the old workhouse was being used by the Metropolitan District Asylum Board as a Convalescent Hospital for Small Pox patients, it was found necessary to secure the destruction there of a quantity of infected beds, &c., and the thorough disinfection of the rooms in which the articles had been stored. Subsequently, when the workhouse was handed over to the Guardians of the parish, they requested the Sanitary Committee to provide, at the cost of the Guardians, for the burning of a further quantity of bedding, and for the thorough disinfection of the whole of the premises. I was then consulted by the Committee as to the best means of securing a complete disinfection; and, after inspecting the premises, I prepared a specification, detailing the steps that would, in my opinion, be the most likely to accomplish the end in view. The work was carried out most thoroughly during the month of November last, at a cost to the Guardians of £107, and the propriety of this wise precaution cannot be better shown than by reminding you that the building has since been pulled down, and the materials 6old, a proceeding that would have been highly dangerous and reprehensible without previous disinfection. Two new disinfectant preparations have been lately brought under my notice, viz.: Chloralum, and a solution of Sulphurous Acid in Alcohol. I have not, however, thought it necessary to advise the Sanitary Committee to make any change in the method of disinfection heretofore adopted. I deem it desirable, on this occasion, to draw your attention to one branch of our sanitary work, which is of the utmost importance in tho prevention of disease, and upon which neither pains nor expense should be spared; I mean the efficient performance of a statutory obligation so essential to public health as the frequent and regular removal of dust and 13 house refuse from the inhabited houses in this large parish (about 27,000). The work is not a light one in itself, and from the altered circumstances under which it has been carried on of late years, it has become in each succeeding year increasingly onerous to all concerned. The principal change referred to, and which has been the cause of others, will be at once seen from the following Statement:— For the Removal The Vestry received from of Dust from Contractors the Sum of June, 1865 to June, 1866 £1285 ,, 1866 to „ 1867 £2200 „ 1867 to „ 1868 £140 Being in this latter case the difference between the sums which were both paid and received. June, 1868 to June, 1869 £200 The Vestry paid to Contractors the sum of June, 1869 to June, 1870 £1.795 „ 1870 to „ 1871 £2937 „ 1871 to „ 1872 £4057 And the Vestry have just contracted to pay for nine months, from June, 1872, to March, 1873, the sum of £3204 being at about the same rate as the year under review, if some allowance be made for the two winter quarters being included in the nine months' contract. It will be therefore noticed that the Vestry, in the year 1866-7, received from a Contractor the large sum of £2200 for the privilege of being allowed to collect the dust, which, at that time and previously, was without doubt a saleable commodity of considerable value. Under such conditions it is obvious that the Contractor himself would see that his men exercised diligence, in order that they might obtain for him that for which he had paid, and which would handsomely repay him for his trouble and labour. The inhabitants were generally well served, and the dustmen, who were much better paid than they are now, had then neither the time nor the necessity to seek other means of personal advantage, as it was to their own interest to collect for their employer as many loads as they could in the shortest possible time, and, as a consequence, only the smallest amount 14 of supervision was then required on the part of the Vestry, or their officers. In the two following years the Vestry still received money payments; but only small sums, as, although dust continued to be in demand, it fetched a much lower price; but in the third year, 1869 to 1870, and those succeeding, the Vestry had to pay heavily for the removal, dust gradually becoming so entirely valueless to the Contractors, that they are compelled to make arrangements with other parties who undertake to receive the dust when collected at a price per load, now varying from 8d upwards. The former conditions are, therefore, now entirely reversed, for while the Contractors receive large sums from the Vestry, the loss to the parish, in 1871 to 1872, being £6257, as contrasted with the year 1866-7, the work has been done more or less irregularly and inefficiently. It is well understood that, owing to the dustmen being so much worse paid than they used to be, boys or lads are often engaged in the work instead of men, all being allowed to engage in the practice technically known as "totting," i.e., picking out from the dust any saleable refuse, such as rags, bones, glass, &c,, to receive which bags are usually hanging upon their carts. This waste of time did not occur when dust was of value, as the price per load, received by the men, paid them better, and they were even fined for totting. The dustmen are, perhaps, still tolerably attentive to the wealthier localities, and to particular houses where they receive gratuities to call once a week or fortnight, as arranged; but they would, if allowed, entirely ignore the poorer districts, which they term " dead pieces." The Contractors themselves also having to pay others for receiving the refuse, as previously mentioned, instead of being themselves the receivers of a price for it, and being paid a lump sum by the Vestry for the work undertaken, very naturally endeavour to pay away as little of it as possible, as the amount of their profit is, unfortunately, no longer contingent upon their men's diligence, and the largest number of loads of dust which they can get out of the parish, but is altogether dependent upon their being able to get off with the smallest amount of work. This led in the beginning of the year 1871 to such neglect on the part of the Contractors, and such confusion arising out of repeated complaints from the inhabitants, that the entire supervision of the dusting contracts was given by the Vestry to the Sanitary Committee, and the Committee recognizing the changed circumstances, and the Dust Inspector (who held other offices) having resigned, they recommended the 15 Vestry, in May 1871, to temporarily appoint an Inspector of Dust, whose whole time should be devoted to the work. The Vestry having adopted this recommendation, the Inspector, who has been twice re-appointed, has ever since been constantly engaged, chiefly in inspecting from house to house those districts most likely to be neglected, and in obtaining evidence and making enquiries in all cases of alleged neglect or refusal on the part of the dustmen. Such an officer, it appears to me, has now become absolutely indispensable, and in my opinion it is very desirable that his services should be permanently retained, for in any case there must always be plenty of work, and his salary is only a small per centage upon the sums now paid to the Contractors. The Committee authorised the distribution of Cards stamped with the letter D, which the Contractors are bound under their contract to take notice of (when properly exhibited) under penalties. The Sanitary Inspectors, as well as the Inspector of Dust, observe these D's and report them in their Diaries, but of course, it is only possible for them to see those which may happen to be shewn in the several streets through which they may pass in the ordinary course of their other work. In connection with this D, the following circumstance is worthy of note. A private inhabitant recently summoned one of the Contractors to the Clerkenwell Police Court, alleging that a D had been exhibited in a window of his house for six consecutive days, and this having been proved, the magistrate, after taking time to consider his decision, convicted the defendant of neglect, and fined him 5s. and 4s. costs, the Magistrate however, at the same time offering to grant the defendant a case to be taken to a Superior Court, upon the point as to whether a private person has the right to prosecute a Contractor, but the offer of the Magistrate was declined. In another case which was brought before a Magistrate by a parishioner, it was decided that clinker or other refuse from fuel used in the process of manufacturing or for other trade purposes, was not the refuse of a trade ; and that, therefore, the contractors were obliged to remove it as dust. The Sanitary Inspectors have also continued to take cognizance of accu. mulations found by them from time to time upon premises which have come under their inspection, but in addition they have also been occasionally employed by the Committee in visiting from house to house, for the express purpose of securing the Contractors' attention to whole streets in neglected districts. From January, 1871, to the present time (June, 1872), the Committee have had to give a great deal of time to the investigation and consideration of 16 cases of complaint which have been laid before them by your Superintendent Inspector, Mr. Collingwood, against the Contractors, who have been fined by the Committee the sum of £202, if we include all the penalties which have beeninflicted from the 25th January 1871 up to the expiration of the Contracts just ended. But notwithstanding these measures taken by the Committee, and the fact that the contracts for the year have been as a consequence much better performed than in the preceding one, it has not been without a large number of applications for removal, 10,208 Letters and Postal Cards making this request having been recorded in the department from June, 1871, to June, 1872, as well as 4,633 entries which were made on personal representation at the Yestry Hall, making a total of 14,841 applications from inhabitants ; this number must have been very considerably increased, but that the work of the Inspectors caused 12,973 additional orders of removal to be given to the Contractors, who were thus required in writing from the Yestry to remove refuse from 27,814 premises. Of the 14,841 applications from parishioners, 9,339, or nearly two-thirds were received during the last half of the Contracts, a fact which speaks for itself. How much worse the condition of affairs would have been without some such steps being adopted may be easily imagined, even although they have admittedly not effected all that the Committee could have desired; this is, however, not surprising, for one thing is certain, that so long as it continues to be the interest of the Contractors to remove as little dust as possible, so long will the parishes of the Metropolis suffer more or less from their neglect, and it is to be regretted that no attempt has yet been successfully made to alter the mode of contracting so far at least as to make the profit of the Contractors to depend, as it used to do when dust was of value, on the removal of the largest obtainable quantity of refuse. The whole system of dusting may indeed, before long, have to be re-considered, as it is a growing opinion that it would be a wise sanitary measure to abolish entirely all dust bins, and substitute portable receptacles in their stead; the Metropolitan Vestries making provision for the daily removal of refuse from each houso. For the present, however, our etforts must be confined to enforcing as stringently, though as fairly as possible, the due performance of existing contracts. 17 During the year, the Sanitary Committee have authorised the issue of 59 summonses; of these five were heard at the Clerkenwell Police Court. In three of them orders for the abatement of nuisances arising from defective drainage, were made and carried out. The fourth was a case of a man who was keeping Cows without a licence, in Gifford Street; in this a penalty of 40s. was inflicted; and in the fifth a conviction was not obtained, the Magistrate declining to grant an order. The remaining 54 summonses were heard before the Justices of the Peace sitting in Petty Sessions at the Vestry Hall, where they commenced to meet in June, 1871. It may here be stated that this arrangement has been found to be extremely convenient, and a great saving of time in the facilities which it offers for the transaction of this portion of the work of your Sanitary Officers. Out of these 54, sixteen were issued for the recovery of money expended for disinfection, and have been previously referred to. Twenty-eight were consequent upon either defective drainage or the generally bad condition of premises, and in some instances upon both. Pour were taken out for disobeying the orders of the Justices, which, however, have been generally complied with. Two others were for overcrowding, since abated. One was for the removal of an animal improperly kept. Of the three left, two were for the letting without previous disinfection of rooms which had been inhabited by persons suffering from infectious disorders, contrary to the 39th Section of the Sanitary Act, 1866. In one of these two a Medical Practitioner had given a certificate that the necessary disinfection had been carried out, but on being called as a witness for the prosecution, his explanation as to the certificate was not deemed to be satisfactory by the Justices, and a penalty was inflicted in both cases. The last summons to be mentioned was one in which a conviction was obtained and a penalty inflicted against a Master and Mistress residing in an adjoining parish (under the 38th section of the Sanitary Act, 1866) for sending home through the streets, into Islington, their servant, while she was actually-suffering from Small Pox, the girl when well being called as a witness, It will be seen that the 211 Bakehouses and the 178 Slaughter and CowHouses were not so frequently visited as usual during the year; this was owing to the great amount of extra work devolving upon the Inspectors during the pressure of the Small Pox epidemic, and was the case last year also. 18 The Workshop Regulation Amendment Act passed in the last Session of Parliament, relieved Vestries from the duty previously imposed upon them in reference to the hours of labour, and the employment of young persons, matters which now rest with H. M. Inspector of Factories, but the jurisdiction of the Vestry still remains intact so far as relates to the overcrowding or general insanitary condition of Workshops. In October I inspected the Slaughter Houses and Cow Houses of the parish previously to the Annual Licensing, at which the Justices granted Licences for 111 Slaughter Houses, and 67 Cow Houses; I found them, on the whole, well kept,but thought it necessary to report the condition of a certain number to the Sanitary Committee, who viewed these, and sent a report to the Vestry advising them to oppose absolutely the licensing of three Slaughter Houses and one Cow House; the report was adopted and the opposition maintained successfully in these cases. I found, however, that in four instances there were Wells in connection with Cow Houses, and perfectly agreeing with Dr. Ballakd as to the extreme undesirability of this arrangement by which water from the subsoil of London, which is liable to become impure at almost any time, and which always contains the results of the oxidation of organic refuse, may be distributed to a whole neighbourhood, with a possible repetition of the results that were so graphically described by Dr. Ballakd in his last Annual Report (it will be remembered that he traced an epidemic of Typhoid Fever to Milk, which had been diluted with water rendered impure by storage in an underground tank ) I advised the opposition of the renewal of the licences in these cases, until the Wells had been filled up and a proper supply of water obtained. The Vestry opposed on these grounds, but the Justices granted the licence in each case unconditionally. With regard to the private Slaughter Houses, the Metropolitan Buildings' Act of 1844, (Vic. 7 and 8, cap. 84, Sec. 55), provides that after the period of 30 years they shall be considered nuisances, and shall not be allowed to exist "at a less distance than 40 feet from any public way, or than 50 feet from any other such buildings of the first or Dwelling House class;" it leaves, 19 however, a certain amount of discretion in the hands of the Justices of the Peace. During the past Session of Parliament it has been proposed that duly licensed private Slaughter Houses shall not be considered nuisances under the Act, and the Vestry petitioned in favour of the Bill which was brought in with this object; but I may be permitted to point out that many of the private Slaughter Houses in the Parish are now in very undesirable situations, although licensed from year to year as a convenience to the trade, and so presumably in the interests of the public ; and it appears to me that the abolition of them all would be in the end advantageous not only to the parish at large, but also to the butchers themselves, although it is true that they are no longer the nuisances that they were before they were made subject to inspection by the officers of the Sanitary Authority. Since the last Annual Report, Messrs. Hatfield and Messrs. Wallis the Varnish Makers of Belle Isle, have in consequence of representations from the Sanitary Committee (under the 54th Section of the Metropolitan Buildings' Act, 1844,) discontinued the use of their premises for the purpose of Varnish making. In conclusion, I wish to express my entire satisfaction with the way in which both the office and the inspectorial work of the Department have been carried out by the officers appointed to those duties. June 29th, 1872, W. H. CORFEELD, Medical Officer of Health. TABLE I. DEATHS REGISTERED IN ISLINGTON DURING (Deaths of Non-Residents West. East. Causes of Death. All Ages. AGES. Un. 1. 1- 2- 3- 4- Under 5 yrs. 5- 10- 15- 20- 40- 60- 80 Up. 2076 2550 . All Causes 4626 1179 381 201 119 86 1966 200 83 113 663 5 663 764 174 (Classes.) 665 686 I. ZYMOTIC DIS. 1351 411 157 126 77 58 829 135 40 48 197 64 28 10 338 485 II. CONSTITUTE. 823 96 65 23 14 12 210 29 15 38 248 192 82 9 827 1016 III. LOCAL 1843 357 144 49 25 16 591 35 24 24 175 385 540 69 202 313 IV. DEVELOPMNL 515 274 11 ... 1 ... 286 ... 1 2 27 11 102 86 44 50 V. VIOLENT DTHS 84 41 4 3 2 ... 50 1 3 1 16 11 12 ... ... ... Not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... (Orders.) 636 653 I. 1. Miasmatic Dis. 1289 358 156 126 77 58 775 135 40 47 192 63 27 10 167 219 Small Pox 386 58 23 13 10 16 120 51 18 30 129 36 2 ... 99 49 Measles 148 22 4b 37 22 8 135 12 ... ... 1 ... ... ... 69 70 Scarlatina 139 12 18 31 17 19 97 28 6 1 7 ... ... ... 17 13 Diphtheria 30 2 1 3 4 3 13 15 ... ... 2 ... ... ... 1 ... Quinsey 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... 11 10 Croup 21 2 3 7 4 1 17 4 ... ... ... ... ... ... 89 65 Hooping Cough 154 61 42 27 11 7 148 6 ... ... ... ... ... ... 44 42 Typhus & Typhoid 86 3 2 3 5 4 17 11 11 11 25 7 4 ... 11 12 Erysipelas 23 7 ... ... ... ... 7 ... ... 1 3 5 6 l 2 4 Pyæmia 6 ... ... ... 1 ... 1 ... ... 1 1 2 1 ... 6 10 Puerperal Fever 16 ... ... ... ... ... ... ... ... ... 15 1 ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 Dysentery 4 ... ... ... ... ... ... ... ... ... 1 ... 2 1 96 139 Diarrhœa 235 185 20 3 2 ... 210 3 1 ... ... 4 9 8 7 6 Cholera 13 6 1 1 1 ... 9 ... ... ... ... 4 ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 12 Rheumatism 27 ... ... ... ... ... ... 5 4 3 8 4 3 ... 16 9 2. Enthetic 25 24 1 ... ... ... 25 ... ... ... ... ... ... ... 16 9 Syphilis 25 24 1 ... ... ... 25 ... ... ... ... ... ... ... ... ... Stricture of Urethrs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 19 3. Dietic 32 24 ... ... ... ... 24 ... ... 1 5 1 1 ... 1 ... Privation 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 9 15 Want of Br. Milk 24 24 ... ... ... ... 24 ... ... ... ... ... ... ... 2 2 Purpura and Scurvy 4 ... ... ... ... ... ... ... ... 1 3 ... ... ... 1 2 Alcoholism 3 ... ... ... ... ... ... ... ... ... 2 1 ... ... ... 5 4. Parasitic 5 5 ... ... ... ... 5 ... ... ... ... ... ... ... ... 5 Thrush 5 5 ... ... ... ... 5 ... ... ... ... ... ... ... ... ... Worms ... ... ... ... ... ... ... ... ... ... ... ... ... ... 47 111 II. 1. Diathetic 158 6 4 ... 1 ... 11 2 2 1 14 60 59 9 ... 8 Gout 8 ... ... ... ... ... ... ... ... ... ... 4 4 ... 12 16 Dropsy 28 1 ... ... ... ... 1 1 2 ... 1 5 13 5 3 1 Hæmorrhage 4 2 ... ... ... ... 2 ... ... ... ... 2 ... ... 25 66 Cancer 91 ... l ... 1 ... 2 ... ... ... 11 41 36 1 1 ... Noma 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... 6 20 Mortification 26 3 2 ... ... ... 5 l ... 1 2 8 6 3 291 374 2. Tubercular 665 90 61 23 13 12 199 27 13 37 234 132 23 ... 17 14 Scrotula 31 9 8 3 ... ... 20 2 2 ... 4 3 ... ... 20 37 Tabes Mesenterica 57 33 7 10 1 1 52 3 2 ... ... ... ... ... 199 275 Phthisis 474 9 18 2 4 6 39 10 7 36 230 129 23 ... 55 48 Hydrocephalus 103 39 28 8 8 5 88 12 2 1 ... ... ... ... 170 289 III. 1. Nervous Syst. 459 124 30 12 7 3 176 12 5 3 36 82 122 23 24 31 Cephalitis 55 19 9 4 1 3 36 6 3 1 3 3 3 ... 37 70 Apoplexy 107 ... 1 ... ... ... 1 ... ... ... 15 36 48 7 21 55 Paralysis 76 ... ... ... 1 ... 1 ... 1 1 2 14 44 13 ... 8 Insanity 8 ... ... ... ... ... ... ... ... ... 4 4 ... ... ... 1 Chorea 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 5 8 Epilepsy 13 ... ... ... ... ... ... 1 ... ... 4 6 2 ... 58 82 Convulsions 140 103 19 8 4 ... 134 3 ... ... 1 1 1 ... 25 34 Brain Diseases, &c. 59 2 1 ... 1 ... 4 2 ... 1 7 18 24 3 96 112 2. Organs of Circ. 208 ... 1 ... ... ... 1 2 7 4 37 64 88 5 3 5 Pericarditis 8 ... 1 ... ... ... 1 ... 2 ... 2 3 ... ... 2 2 Aneurism 4 ... ... ... ... ... ... ... ... ... 1 2 1 ... 91 105 Heart Disease 196 ... ... ... ... ... ... 2 5 4 34 59 87 5 TABLE I. FIFTY-TWO WEEKS ENDING 30th DECEMBER, 1871. in Hospitals excluded). West. East. Causes of Death. All Ages. AGES. Un. 1. 1- 2- 3- 4- Under 5 yrs. 5- 10- 15- 20- 40- 60- 80 Up. 430 442 3. Respirat. Orgs 872 213 107 36 18 10 384 10 5 8 51 161 232 31 21 13 Laryngitis 34 16 10 3 1 ... 30 ... ... ... 2 1 1 ... 278 271 Bronchitis 549 125 56 16 10 5 212 4 2 3 23 94 186 25 3 6 Pleurisy 9 ... ... ... ... ... ... ... ... ... 3 4 2 ... 107 121 Pneumonia 228 69 41 17 5 5 137 6 1 4 18 36 24 2 9 25 Asthma 34 ... ... ... ... ... ... ... ... 1 2 10 17 4 12 6 Lung Diseases, &c 18 3 ... ... 2 ... 5 ... 2 ... 3 6 2 ... 74 123 4. Digestive Orgs 197 16 2 ... ... 2 20 4 3 6 24 59 74 7 5 5 Gastritis 10 1 ... ... ... ... 1 ... ... ... ... 4 4 1 6 10 Enteritis 16 5 ... ... ... ... 5 1 1 2 2 2 3 ... 5 13 Peritonitis 18 1 1 ... ... ... 2 ... ... 3 4 4 5 ... 3 2 Ascites 5 ... ... ... ... ... ... ... ... ... ... 1 4 ... 2 5 Ulceration of Intes 7 ... ... ... ... ... ... ... 2 ... 2 1 2 ... 5 8 Hernia 13 ... ... ... ... ... ... ... ... ... ... ... 12 1 3 10 Ileus 13 2 ... ... ... ... 2 1 ... ... 1 4 4 1 4 3 Intussusception 7 1 ... ... ... ... 1 1 ... ... ... 3 2 ... ... ... Stricture of Inter ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Fistula . 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 17 Stomach Dis., &c 21 2 1 ... ... 1 4 ... ... ... 5 5 6 1 ... ... Pancreas Dis., &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 9 Hepatitis 10 ... ... ... ... ... ... ... ... ... 3 3 4 ... 4 8 Jaundice 12 3 ... ... ... ... 8 ... ... ... ... 2 5 2 31 32 Liver Disease 63 1 ... ... ... ... 1 1 ... 1 7 30 22 1 ... 1 Spleen Disease 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... 34 33 6. Urinary Orgs. 67 ... 2 ... ... 1 3 2 3 ... 19 19 19 2 6 4 Nephritis 10 ... ... ... ... ... ... 2 l ... 4 1 1 1 3 6 Disease of Bladde 9 ... ... ... ... ... ... ... ... ... 1 3 5 ... 17 14 Nephria 31 ... 2 ... ... ... ... ... 2 ... 9 10 8 ... 1 3 Diabetes 4 ... ... ... ... ... ... ... ... ... 1 2 1 ... ... ... Stone ... ... ... ... ... ... ... ... ... ... ••• ... 1 2 Prostrate Disease 3 ... ... ... ... ... ... ... ... ... ... ... 2 1 6 4 Kidney Disease,&c 10 ... ... ... ... 1 1 ... ... ... 4 3 2 ... 5 7 6. Genera. Organs 12 ... ... ... ... ... ... ... ... ... 5 5 1 1 4 5 Ovarian Dropsy .. 9 ... ... ... ... ... ... ... ... ... 2 5 1 1 1 2 Uterine Diseases.. 3 ... ... ... ... ... ... ... ... ... 3 ... ... ... 12 7 7. Orgs.of Locomo. 19 ... 2 1 ... ... 3 6 1 2 3 2 3 ... 9 3 Spine Diseases 12 ... 2 1 ... ... 3 1 l 2 2 ... 3 ... 3 4 Bone Diseases 7 ... ... ... ... ... ... 4 ... ... 1 2 ... ... 6 3 8. Skill, &tc 9 4 ... ... ... ... 4 ... ... 1 ... 3 1 ... ... ... Phlegmon&Abscess ... ... ... ... ... ... ... ... ... ... ... ... ••• ... 3 1 Ulcer 4 ... ... ... ... ... ... ... ... 1 ... 2 1 ... 3 2 Skin Diseases 5 4 ... ... ... ... 4 ... ... ... ... 1 ... ... 60 87 IV. 1. Dis. of Childn. 127 126 ... ... ... ... 126 ... 1 ... ... ... ... ... 47 54 Premature Birth 101 101 ... ... ... ... 101 ... ... ... ... ... ... ... 3 3 Cyanosis 6 5 ... ... ... ... 5 ... 1 ... ... ... ... ... 1 3 Spina Bifida 4 4 ... ... ... ... 4 ... ... ... ... ... ... ... 7 7 Other Malformation 14 14 ... ... ... ... 14 ... ... ... ... ... ... ... 2 ... Teething 2 2 ... ... ... ... 2 ... ... 1 ••• ••• ... ... 8 24 2. Dis. of Adults . 32 ... ... ... ... ... ... ... ... 1 27 4 ... ... ... ... Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 24 Childbirth 32 ... ... ... ... ... ... ... ... 1 27 4 ... ... 62 133 3. Dis. of Aged 195 ... ... ... ... ... ... ... ... ... 7 102 86 62 133 Old Age 195 ... ... ... ... ... ... ... ... ••• ... 7 102 86 72 89 4. Dis. of Nutritn. 161 148 11 ... 1 ... 160 ... ... 1 ... ... ... ... 72 89 Atrophy & Debility 161 148 11 ... 1 ... 160 ... ... 1 ... ... ... ... 28 35 V. 1. Acci.or Neg. 63 32 4 3 2 ... 41 1 3 ... 4 6 8 ... 8 5 Fract. and Contus. 13 1 1 1 ... ... 3 ... 2 ... 2 1 5 ... 1 1 Wounds 2 ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 5 Burns and Scalds.. 7 ... 3 2 ... ... 5 ... ... ... ... 2 ... ... 1 3 Poison 4 2 ... ... ... ... 2 ... ... ... 1 ... 1 ... 2 1 Drowning 3 1 ... ... ... ... 1 ... 1 ... 1 ... ... ... 8 12 Suffocation., 20 19 ... ... ... ... 19 ... ... ... ... 1 ... ... 6 8 Otherwise 14 9 ... ... 2 ... 11 1 ... ... ... 1 1 ... 5 4 2. Homicide 9 9 ... ... ... 9 ... ... ... ... ... ... ... 10 11 3. Suicide 21 ... ... ... ... ... ... ... ... 1 11 5 4 ... 2 5 Wounds 7 ... ... ... ... ... ... ... ... ... 4 1 2 ... 1 1 Poison 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 3 Drowning 5 ... ... ... ... ... ... ... ... 1 1 2 1 ... 5 2 Suffocat. and Hang. 7 ... ... ... ... ... ... ... ... ... 4 2 1 ... ... ... Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ••• 4. Uuclassed 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... TABLE 11. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FIFTY TWO WEEKS ENDING SATURDAY, THE 30th DAY OF DECEMBER, 1871, A1 THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary* Islington Dispensary. Pentonville Convict Prison Total. Small Fox .. 13 1082 146 170 18 1429 Chicken Fox .. 4 16 74 116 .. 210 Measles .. .. 41 68 384 1 494 Scarlatina .. .. 54 69 77 .. 200 Whooping Cough .. .. 81 165 242 .. 492 Croup .. .. 3 14 20 .. 37 Diarrhoea .. .. 128 629 507 320 1584 Dysentery .. .. 4 8 20 .. 32 Cholera .. .. •• 2 2 • • 4 Ague .. .. 4 4 2 2 12 Continued Fever .. .. 29 176 217 • • 423 Influenza .. .. • • •• .. <. • • Puerperal Fever .. .. 1 •• • • .. 1 Rheumatic Fever .. 9 11 28 • • 48 Erysipelas .. .. 41 42 57 4 144 Diphtheria .. • • 4 5 9 .. 18 Sorethroat or Tonsillitis .. .. 79 209 398 26 714 Mumps .. • • 4 1 36 .. 41 Pysæmia .. • • •• •• •• • • •• Bronchitis and Catarrh .. .. 1027 1955 2559 470 6025 Pneumonia • • .. 15 57 86 • • 158 Pleurisy • • • • 16 73 99 • • 188 Delirium Tremens • • • • 2 2 1 • • 5 Insanity .. * • 33 2 2 .. 37 Carbuncle .. • • 2 7 27 1 37 All other Diseases .. 318 2478 6775 8941 1412 19924 Total .. 356 *5153 10494 14000 2254 3-257 • This number represents only six months sickness with the exception of Small Pox (1082), which represents the number of new cases occurring during the twelve month* TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED. * From March 26th, 1871, to March 25th, 1872. - South East District. South "West District. North District. Total. Number of Houses inspected 1412 1766 1294 4472 Re-inspections, Calls made, &c 6470 4446 3671 14587 Visits to 211 Bakehouses 126 119 177 422 Do. 67 Cowhouses 85 185 135 405 Do. Ill Slaughter-houses 154 197 143 494 Do. Stables and Yards 38 43 114 195 Do. Factories and Workshops 3 4 9 16 Do. Fields, Lanes, &c. 76 1 32 109 Factories,Horse Slaughter-houses,Piggeries, &c., D°- 48 Belle Isle •• 201 • • 201 Do. 110 Courts and Alleys 2992 426 825 4243 Total Inspections, &c 11356 7388 6400 25144 IMPROVEMENTS. Drains Constructed 20 81 23 124 mproved or repaired 123 246 59 428 Traps fixed 126 268 52 446 Cesspools Abolished 10 10 15 35 Cleansed or disinfected . . .. .. .. Privies and Water Closets Pan, trap, and water supply furnished 15 12 17 44 Pan and trap only furnished 11 14 ' 21 46 Water supply furnished 55 35 65 155 Dust bins Constructed. 7 13 6 26 Repaired and covers adapted 10 6 33 49 Surface Drains and Pavements of Yards Constructed .. 3 1 4 Relaid 93 285 103 481 General Water Supply New receptacles provided 8 14 4 26 Receptacles repaired and cleansed. 260 42 63 365 Water supply provided 1 2 1 4 Other Improvements Houses generally repaired 49 39 194 282 ,, &c., cleansed or limewashed 526 788 463 1777 1 „ ventilated .. 7 6 13 6 8 5 19 Illegal use of underground Rooms for sleeping discontinued 1 4 1 6 Other Amendments, or Nuisances abated 86 58 595 739 Houses or Rooms Disinfected 568 640 223 1431 Total Improvements 1975 2575 1950 6500 Total Premises Improved 839 978 822 2639 * During the greater part of this period the Inspections, Disinfections, Burnings, &o., in connection with the Small Pox Epidemic, and the necessary attention to Complaints, engrossed more than the ordinary time of the Inspectors, to the unavoidable neglect of much other Sanitary work. N.B.—From the 31st May, 1872, to the 25th March, 1872, the Inspector of Dust Visited 23,484 houses and found that Dust was required to bo removed from 7,430 of these houses. TABLE IV. MONTHLY RESULTS OF METEROLOGICAL OBSERVATIONS MADE AT COMPTON TERRACE. THERMOMETER. Mean Admospheric Humidity. Saturation = 100. Rainfall in Inches. Number of Days on which Rain fell in appreciable quantity. Periods embraced. Adopted Mean Temperature. Mean of Highest Daily Readings. Mean of Lowest Daily .Headings. Mean Daily Range. January 34.0° 37.5° 30.1° 7.30 83 1.91 16 * 1871. 4 wks Jan. 1—Jan. 28 February 41.0° 45.8° 36.7° 9.0° 87 0.89 9 4 „ Jan. 29—Feb. 25 March 45.1° 54.4° 38.7° 15.6° 81 1.19 15 5 „ Feb. 26—Apr 1 April 48.6° 67.6° 42.3° 15.2° 75 2.84 17 4 „ Apr. 2—Apr. 29 May 52.5° 65.2° 43.1° 22.0° 62 0.85 8 4 „ Apr. 30—May 27 June 56.3° 68.6° 48.6 20.0° 72 3.57 16 6 „ May 28—July 1 July 61.9° 72.7° 56.6° 17.1° 71 3.79 17 4 „ July 2—July 29 August 65.1° 78.5° 65.2° 23.3° 68 0.91 7 4 „ July 30—Aug. 26 September 69. 1° 69.7° 51.1° 18.6° 73 5.53 12 5 „ Aug. 27—Sept. 30 October 49.0° 58.5° 41.6° 16.9° 86 1.24 10 4 „ Oct. 1—Oct. 28 November 38.9° 45.0° 33.8° ll.l° 83 0.49 9 4 „ Oct. 29—Nov. 25 December 38.7° 42.0° 34.4° 7.5° 84 1.13 13 5 ,, Nov. 26—Dec. 30 Means of Year. 49.1° 57.9° 42.6° 15.3° 77 Sum. 24.34 Sum. 148 1871. 1871. January 1 to December 30. The highest temperature in the shade attained was 91.5° on August 13th. The lowest temperature reached was 17.5° on January lst. Snow fell in the 2nd, 4th, 6th, 11th, 46th and 49th weeks of the year. Thunder storms occurred on May 8th, May 27th, June 19th, June 20th, July 25th and October 1st. • Instead of stating the Means of Observations for cacti Calendar Month, I have stated them in periods corresponding with those used in my monthly Tables, which alone can serve any useful purpose for comparison with the accompanying Sickness and Mortality. REPORT on the SANITARY CONDITION OF ST. MARY, ISLINGTON FOB, JANUARY, 1871. No. CLXXXV. The very inclement weather which we have of late experienced has produced a decided effect upon our mortality table. The total deaths registered were 438. This number contrasts very unfavorably with the numbers registered in January during the last three years; namely, 338 in 1868, 350 in 1869, and 379 last year. The mortality from pulmonary affections (bronchitis, pnuemonia, &c.,) amounted to 158. With the exception of one year, the general and pulmonary mortality have not been so high in my experience here. The January I allude to was that of 1861' when 450 deaths were registered, of which 149 were due to diseases of the respiratory organs. The mortality on that occasion was referable to a severe frost. The epidemic of Small-pox has extended very seriously during the month. Thirty deaths (including two at the Hampstead Hospital) have been registered during the month. Taking the new cases seen by public officers only, that is by the parochial surgeons, the officers of the dispensaries and of institutions which furnish me with returns, I have recorded 121 in the course of the four weeks. The progress of the disease may be judged of by stating the public cases on my record, in a fortnightly series, beginning from the middle of October. Public Cases. Fortnight ending Oct. 22nd 4 „ Nov. 5th 20 „ „ 19th 15 „ Dec. 3rd 34 „ „ 17 th 47 „ ,, 31st 40 , ,, Jan. 14th 54 „ „ 28th 67 2 The largest weekly number of fresh cases, viz. 44, was registered in the week ending January 28th. This number corresponds with the weekly maximum (public cases) attained in the last severe epidemic in 1863, namely 43 cases. On that occasion the disease began to show an epidemic tendency towards the end of November or beginning of December, 1862, but did not attain its full epidemic proportions until the months of April and May. The maximum was attained in the last week of May, 1863. The fortnightly progress of the disease prior to that date was as follows :— Public Cases. Fortnight ending Feb. 14th, 1863 ,, „ 28th ,, „ Mar. 14th ,, „ 28th „ ,, April 11th „ ,, ,, 25 th „ „ May 9th „ „ „ 23rd „ 13 15 12 18 34 13 52 79 We are, therefore, pretty nearly where we were at the height of the epidemic in May, 1863. The prospect before us is certainly not encouraging, experience showing that the early months of the year are favourable to the continuance of the spread of this disease. I have no returns of the cases occurring in the private practice of the district, but I learn enough from private scources to satisfy me that Small-pox is widely sown among all classes of the community; the upper classes, however, are very generally protecting themselves by re-vaccination. Since my last report was written, the Guardians have opened some wards at the Old Workhouse for the reception of pauper cases. This temporary Hospital was opened January 18th, and between this and the 28th, 31 cases were admitted for isolation and treatment. This proceeding, together with the extension of the accommodation at Hampstead, the establishment of local parochial hospitals elsewhere, and now the opening of the Asylum Board's new hospitals at Homerton and Stockwell, has so far liberated the Highgate hospital from pressure, that I have had facilities for getting patients, who can afford to pay, into the latter institution. Those I have sent, on the payment of 3 guineas, have been at once received, and hence the necessity of resorting to the establishment of wards for paying patients at the old workhouse, under the permission obtained from the Vestry and Guardians respectively, has been for the present avoided. For patients who cannot pay the stipulated amount, accommodation is found by the Guardians. 3 My chief concern just now lies in the matter of disinfecting infected rooms, bedding, and clothing. I have a list of 155 houses of poor people where Small-pox has occurred during the months of December and January, and to present date, and where these disinfections ought to have been speedily carried out. Of these, up to now, only 45 hav? have been disinfected satisfactorily, (40 under the direct observation of our Inspectors), 18 are said to have been disinfected (no proof being forthcoming), and 92 yet remain to be done. The disinfection of houses, and articles of bedding, clothing, &c., is too important a thing to be performed in a nominal, perfunctory, and imperfect manner, or to be left to the ignorance of poor tenants, or the delays of owners of property. At the present time its importance cannot be exaggerated. Each of these 92 houses is a centre of infection. Each should be disinfected, with everything in the infected rooms, thoroughly and with minute detail, or they might as well be left unattended to altogether. And this can only be done satisfactorily under our own direction and supervision. We have no disinfecting chamber, and hence everything has to be done tediously in the poor houses themselves. Our staff of inspectors needs to be temporarily reinforced by some intelligent men as disinfectors, if the accumulation of work of this kind is to be overtaken and dangerous delays avoided for the future, so long as the the epidemic lasts. METEOROLOGY OF JANUARY. Thermometers 4 feet from ground. Degree of Atmospheric Humidity, Saturation being represented by 100. Rain in inches read at 9 a.m., Collected on the ground. Sum. Number of day 8 on which Rain fell in appreciable quantity. Sum. Mean of Daily Values. Mean of Highest Temperatures. Mean of Lowest Temperatures. Mean Daily Range of Temp. Week ending Jan. 7th 31.9° 36.1° 27.3° 8.8° 80 0.17 3 „ 14th 33.3° 37.7° 28.5° 9.2° 82 0.14 3 „ „ 21st 38.0° 40.6° 35.0° 5.6° 89 1.11 7 „ 28th 32.8° 35.6° 29.7° 5.7° 84 0.49 3 Means. 34.0° 37.5° 30.1° 7.3° 83 Sum. 1.91 Sum. 16 The highest day temperature, observed on January 6th was 45.5° The lowest night temperature, observed on January 1 3th, was 21.5° Snow fell on the 11th and 24th. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, February 6th, 1871. TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FOUR WEEKS ENDING 28th JANUARY, 1871. (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. 183 255 All Causes (Classes.) 438 188 64 67 97 22 59 59 3. Respirat. Orgs. 118 33 11 28 43 3 2 2 Laryngitis 4 4 ... ••• 45 36 Bronchitis 81 18 7 ' 22 32 2 ... 1 Pleurisy 1 ... 1 46 60 I. ZYMOTIC DIS 106 81 17 4 3 1 10 17 Pneumonia 27 11 3 6 7 34 33 II. CONSTITUTL 67 30 18 12 6 1 2 3 Asthma 5 ... ... 4 1 91 124 III. LOCAL 215 54 24 49 77 11 ... ... Lung Diseases,&c. ... ... ... 5 10 4. Digestive Orgs. 15 3 2 b 3 1 10 30 IV. DEVELOPMNL 40 17 3 1 10 9 ... ... Gastritis ... ... ... ... 1 Enteritis 1 ... ... i ... 2 8 V. VIOLENT DTHS 10 6 2 1 1 ... 1 1 Peritonitis 2 ... ... 2 ... ... ... Not Specified ... ... ... ... ... ... l 1 Ascites 2 ... ... 1 l ... ... Ulceration of Intes. ... ... ... ... ... Hernia ... ... ... 1 2 Ileus 3 1 ... ... 44 58 I. 1. Miasmatic Dis. 102 77 17 4 3 1 ... ... Intussusception ... ... ... ... ... ... ... Stricture of Intes ... ... ... 11 17 Small Pox 28 1/ 8 3 ... ... ... ... Fistula ... ... ... 4 1 Measles 5 5 ... ... ... ... l 4 Stomach Dis., &c. 5 1 2 1 1 14 21 Scarlatina 35 31 4 ... ... ... ... ... Pancreas Dis., &c ... ... ... 1 2 Diphtheria 3 ... ... ... ... ... ... ... Hepatitis ... ... ... ... ... Quinsey ... ... ... ... ... ... ... ... Jaundice ... ... ... ... 2 Croup 2 2 ... ... ... ... 1 1 Liver Disease 2 1 ... 1 5 2 Hooping Cough 7 7 ... ... ... ... ... ... Spleen Disease ... ... ... 5 3 Typhus & Typhoid 8 4 3 ... 1 ... 3 4 5. Urinary Orgs. 7 1 3 9 1 1 5 Erysipelas 6 3 ... ... 2 1 ... ... Nephritis ... ... ... ... 1 Pyœmia 1 ... ... 1 ... ... ... ... Disease of Bladder ... ... ... ... 2 Puerperal Fever . 2 ... ... ... ... ... l 2 Nephria 3 ... l ?, ... ... Carbuncle ... ... ... ... ... ... ... ... Diabetes ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... Stone ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... Prostrate Disease . ... ... ... 2 ... Diarrhoea 3 ... ... ... ... ... 2 2 Kidney Disease,&c. 4 1 2 1 ... ... Cholera ... ... ... ... ... ... ... ... 6. Genera. Organs ... ... ... ... ... Ague ••• ... ... ... ... ... ... ... Ovarian Dropsy ... ... ... 1 1 Rheumatism 2 2 ... ... ... ... ... ... Uterine Diseases. ... ... ... 2 1 2. Enthetic 3 3 ... ... ... ... 1 ... 7. Orgs, of Locomo. 1 1 ... 2 1 Syphilis 3 3 ... ... ... ... 1 ... Spine Diseases 1 l ... ... ... Stricture of Urethra ... ... ... ... ... ... ... ... Bone Diseases ... ... ... ... ... Hydrophobia ... ... ... ... ... ... 1 ... 8. Skin, &c 1 1 ... ... ••• Glanders ... ... ... ... ... ... ... ... Phlegmon & Abscess ... ... ... ... 1 3. Dietic 1 1 ... ... ... ... ... ... Ulcer ... ... ... ... ... Privation ... ... ... ... ... ... 1 ... Skin Diseases 1 1 ... ... 1 Want of Br. Milk.. 1 1 ... ... ... ... ... ... ... ... Purpura and Scurvy ... ... ... ... ... ... 3 3 IV. 1. Dis. of Childn. 6 6 ... ... ... Alcoholism ... ... ... ... ... ... 1 3 Premature Birth 4 4 ... ... ... 4.Parasitic ... ... ... ... ... ... ... ... Thrush ... ... ... ... ... ... ... ... Cyanosis ... ... ... Spina Bifida ... ... ... ... ... ... ... Worms ... ... ... ... ... ... ... ... Other Malformation 2 ... 2 2 ... 5 7 11. 1. Diathetic 12 1 ... 6 4 1 ... ... Teething ... ... ... ... 3 2. Dis. or Adults . 3 ... 3 ... 1 Gout 1 ... ... ... 1 ... ... ... Paramenia ... ... ... 1 ... | Dropsy 1 ... ... ... ... 1 ... 3 Childbirth 3 ... 3 1 ... Hæmorrhage 1 ... ... 1 ... ... 4 16 3. Dis. of Aged 20 ... ... 1 10 9 2 ... Cancer 6 ... ... 5 1 ... 4 16 Old Age 20 ... ... 1 ... 4 Noma ... ... ... ... ... ... 3 8 4. Dis. of Nutritn. 11 11 ... 1 2 Mortification 3 1 ... ... 2 ... 3 8 Atrophy & Debility l1 11 ...... ... 29 26 2. Tubercular 55 29 18 6 2 ... l 2 Scrotula 3 2 1 ... ... ... ... — 1 1 Tabes Mesenterica 2 2 ... ... ... ... 1 6 V. 1. Acci. or Neg. 7 5 ... 1 1 Ml 18 21 Phthisis 39 14 17 6 2 ... ... ... Fract. and Contus. ... ... ... 1 Wounds 1 ... ... 9 2 Hydrocephalus 11 11 ... ... ... ... ... l Burns and Scalds 1 1 ... 13 34 III. 1. Nervous Syst. 47 14 4 6 17 6 ... ... Poison ... ... ... ... ... ... ... Drowning ... ... ... 2 i Cephalitis 3 1 1 1 ... 1 3 Suffocation 4 3 ... 1 4 6 Apoplexy 10 ... 1 2 6 1 ... 1 Otherwise 1 1 ... 3 13 Paralysis 16 ... ... 3 8 5 ... 1 2.Homicide 1 1 ... ... 2 Insanity 2 ... 2 ... ... ... 1 1 3.Suieide 2 ... ... ... 1 Chorea 1 1 ... ... ... ... ... ... Wounds ... ... ... ... ... ... ... Epilepsy ... ... ... ... ... ... ... ... Poison ... ... ... 3 10 Convulsions 13 12 ... ... 1 ... ... ... Drowning ... ... ... ... 1 1 Brain Diseases, &e. 2 ... 4 ... 2 ... 1 ... Suffocat.and hang 2 ... 2 9 17 2. Organs of Circ. 26 1 ... 7 13 1 ... ... Otherwise ... ... ... ... ••• ... ... Pericarditis Aneurism 2 ... 1 ... .. .... 1 ... ... ... ... ... ... 4. Unclassed ... ... ... ... ... 9 15 Heart Disease 24 ... 4 6 13 1 TABLE II. NEW CASES OK DISEASE COMING UNDER TREATMENT DURING THE FOUR WEEKS ENDING SATURDAY, THE 28th DAY OF JANUARY, 1871, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small Pox .. 1 89 12 18 1 121 Chicken Pox • • .. 1 6 7 .. 14 Measles .. .. 8 5 15 .. 28 Scarlatina .. .. 22 15 3 .. 40 Whooping Cough .. 1 12 15 2 .. 30 Croup .. .. 1 2 3 .. 6 Diarrhœa .. .. 20 12 12 13 57 Dysentery .. .. 1 1 .. .. 2 Cholera .. .. .. .. .. .. .. Ague .. .. 1 .. .. 1 2 Continued Fever .. .. 9 10 27 .. 46 Influenza .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. Rheumatic Fever .. .. 2 3 4 .. 9 Erysipelas .. .. 6 7 4 .. 17 Diphtheria .. .. .. 1 .. .. 1 Sorethroat or Tonsillitis .. .. 24 18 18 .. 60 Mumps .. .. .. .. 3 • • 3 Pyaemia .. .. .. .. .. .. .. Bronchitis and Catarrh .. 1 265 208 222 40 736 Pneumonia .. .. 7 1 9 .. 17 Pleurisy .. .. 2 8 11 .. 21 Delirium Tremens .. .. .. .. .. .. .. Insanity .. .. a .. .. .. 5 Carbuncle .. .. 1 1 1 .. 3 All other Diseases .. 17 471 518 585 61 1652 Total .. 20 947 843 944 116 j 2870 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED. From January 2nd, 1871, to January 28th, 1871. South East District. South West District. North District. Total. Number of houses inspected 83 152 30 1 265 Drains Constructed 4 .. 2 6 Improved or repaired 13 18 5 36 Traps fixed 19 .. 9 37 Cesspools Abolished 2 .. 2 4 Cleansed or disinfected .. .. .. .. Privies and Water Closets Pan, trap, and water supply furnished .. .. .. .. Pan and trap only furnished .. 1 .. 1 Water supply furnished 6 1 1 8 Dust bins Constructed 2 .. .. 2 Repaired and covers adapted 1 .. 4 5 Surface Drains and Pavements of Yards Constructed .. .. 1 1 Relaid 9 14 9 32 General Water Supply New receptacles provided .. .. .. .. Receptacles repaired and cleansed 16 4 1 21 Water supply provided • • .. .. .. Other Improvements Houses generally repaired .. 4 6 10 „ &c., cleansed or limewashed 20 12 21 53 ventilated .. .. .. Overcrowding abated .. .. 2 2 Illegal use of underground Rooms for sleeping discontinued 2 .. .. 2 Other Amendments, or Nuisances abated 5 4 36 45 REPORT on the SANITARY CONDITION OF ST. MAM, ISLINGTON FOR FEBRUARY, 1871. No. CLXXXVI. The registered mortality for the four weeks ending February 25th was 370, pretty nearly the same as in the corresponding weeks last year. With the exception of the first week of the month, the temperature has heen above the average for February and correspondingly the mortality from pulmonary affections, which was high in. the previous month, has fallen from 118 to 73; but this is still a high number. Small-pox continues to extend; it would extend still more were it not for the protection obtained by hundreds of all classes who are every week in this parish renewing their vaccination, and the activity with which primary vaccination is being urged on at all the public stations. The number of fresh cases recorded in the practice of the Parochial Surgeons and Dispensaries in the four weeks was 123, while the deaths registered from Small-pox were 42. To this must be added three other deaths which occurred in the Hampstead Hospital, making 45. The weekly numbers of new cases were:— Public Cases. Week ending Feb. 4th, 20 „ 11th, 34 „ 18th, 38 „ 25th, 31 I am sorry to have to add that the week which ended last Saturday, March 4th, the public cases recorded were double the last number, namely 65. Of the 123 cases only 68 were removed to Hospital, the others being treated at home, where they cannot fail to spread the contagion. It is true that under certain circumstances there are powers of compulsory removal, but for all practical purposes, the provisions for this form of public protection have broken down under the stress of 2 | . the epidemic pressure. After the removal of all who are willing to be removed, foci enough of contagion yet remain to keep up the disease among our crowded population. Notwithstanding the number of persons vaccinated Weekly also, there are thousands remaining who are unprotected by neglect of primary or secondary vaccination, and who will furnish victims for this hideous malady for some time to come. The numbers of fresh cases I have reported refer only to those among the poorest classes. The 45 deaths (at the current death-rate from smallpox, about 17 per cent, of those attacked,) represent not 123 but 264 cases, so that we may calculate that the cases which come under my cognizance are less than the half of what actually occur in all classes of our community. The plan we are now adopting to get disinfections performed in infected houses, under the directions of the Sanitary Committee, is working tolerably. We serve the owners of premises with 48 or 24 hours' notice to disinfect premises, and supply disinfectants for use where articles of clothing are worth preservation, and there are facilities for washing and boiling. Where the owners have not commenced at the expiry of the notice, we employ workmen to perform the disinfections, charging the expense on the owners. Our Inspectors look after the work as well as their time will permit. In many instances we have destroyed by burning, bedding and clothing which could not be conveniently disinfected, or which were so old and filthy as not to be worth the trouble of preservation. From the commencement of December to the present date I have a record of 318 houses which have become infected. Under the plan adopted 172 have, with their contents, been more or less satisfactorily disinfected, leaving 146 yet to be dealt with. The continuance of one or more cases of small-pox in some of the latter prevents our dealing with them at present. Nearly the whole of the time of our Inspectors is taken up with the control of the epidemic; their ordinary systematic work, (such as the regular inspection of slaughter-houses, cow-sheds, and bake-houses, together with the systematic inspection of the dwellings of the poor,) has had to stand over. On January 18th the Guardians opened the Old Workhouse in the Liverpool Road, as an extempore Hospital for small pox. Between this date and February 25th, 96 patients were admitted, of whim 15 died. The death rate there was 15.6 per cent. On the night of February 25th there were 50 patients in this Hospital, including convalescents, and on the night of March 4th, 82. METEOROLOGY OF FEBRUARY. Thermometers 4 feet from ground. Degree of Atmospheric Humidity, Saturation being represented by 100. Rain in inches read at 9 a.m., Collected on the ground. Sum. Number of days on which Rain fell in appreciable quantity. Sum. Mean of Daily Values. Mean of Highest Temperatures. Mean of Lowest Temperatures. Mean Daily Range of Temp. Week ending Feb. 4th 34·4° 37·9° 31·3° 6·6° 97 0·29 4 „ „ 11th 42·5° 47·6° 38·0° 9·5° 86 0·51 3 „ 18 th 43·0° 47·9° 37·8° 10·1° 85 0·02 1 „ 26th 44·2° 49·8° 39·8° 10·0° 82 0·07 1 Means. 41·0° 45·8° 36·7° 9·0° 87 Sum. 0·89 Sum. 9 The highest day temperature, observed on February 19th was 54·3° The lowest night temperature, observed on February 11th and 12th, was 26·0° EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, March 6th, 1871. TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FOUR WEEKS ENDING 25th FEBRUARY, 1871. ^Deaths of Non-Kesidents in Hospitals excluded). West 8.D. East S.D. Causes of Death. 1 At all Ages. Under 20 years of age. At 20 and under 40 years of aee. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. West 8.D. East S.D. Causes of Death. At all Ages. Under 20 years of Age. At 20 and under 40 1 years of age. At 40 and under 60 1 years of age. | At. ou and under 80 1 Tears of age. At 80 years of age 1 and upwards. 182 188 j All Causes (Classes.) 370 154 53 68 78 17 37 36 3. Kespirat. Orgs 7f 23 2 ?0 9.4 4 3 1 l.arvngiiis •i 4 25 26 Bronchitis 51 13 2 13 20 3 ] Pleurisy 1 1 48 53 I. ZYMOTIC DIS. • 101 73 19 5 4 7 5 Pneumonia 11 6 5 1 31 42 II. CONSTITUTL. 73 18 20 24 9 V 2 3 Asthma 5 1 3 1 74 77 III. LOCAL 151 41 11 37 53 9 Lune Diseases, &r. 7 8 4- Digestive Orgs 16 1 3 5 6 20 12 IV. DEVELOPMNL. 32 16 1 1 8 6 1 Gastritis 1 1 ... 1 Enteritis i 1 9 4 V. VIOLENT DTHS 13 b 2 1 4 1 Peritonitis 1 i ... ... Not Specified ... ... — — Ascites Ulceration of Intes 1 Hernia 1 1 1 i Ileus 2 1 l 45 51 I. 1. Miasmatic Dis. 96 69 19 5 3 ... Intussusception 13 29 Small Pox 42 10 4 I 2 Measles ......... 3 I Stomach Dis., &c 1 1 13 Scarlatina i Pancreas Dis., &c ... • • Diphtheria I Hepatitis 1 1 ... ... •* I Jaundice ........ 1 1 ... 3 3 Liver disease .. . 6 1 3 2 ... * 11\ ■■■ Spleen disease... Iyphus ft Typhoid *•• 4 2 5. Urinary Orgs. 6 1 1 1 2 1 2 Nephritis 2 1 1 ... Pyceinia 1 Disease 01 Bladde 1 l 1 1 Puerperal Fever • 2 1 1 Nephria 2 1 l ... Diabetes Influenza ... St< - 1 Diarrhoea ........ 1 1 1 Cholera . 6. Genera. Organ Ague Ovarian Dropsy . 3 2 Rheumatism...... 5 1 2 ... i 2. Enthetic 2 2 2 Syphilis " Stricture of Urethra Hydrophobia .... 1 8. Skin, &c 2 1 1 Glanders Phlegmon&Abscess ... 1 2 3. Eietic 3 2 1 1 Ulcer i 1 1 Privation 1 1 1 Skin Diseases .... l 1 ... \\ ant of Br. Milk.. Purpura and Scurv\ 10 1 IV. 1. Di«. of Childn. 11 11 ... Alcoholism ... 4. Parasitic 2 ... Thrush CyanoMs 2 2 ... Worms ... ... ... Otuer Malformation . Teething ........ 7 16 Gout ........ .. •GO 3 8 2 1 1 2. Dis. of Adults . 2 1 1 ... 2 1 Dropsy 1 1 1 1 1 n 1 1 1 Haemorrhage .... 1 g 6 14 6 2 io Cancer 1 3 6 Noma 1 4 5 5 2 3 Mortification 1 2 'i 24 26 2. Tubercular ... 5U 16 16 2 1 Scrofula 3 3 8 4 V. 1. Acci. orNeg. 12 5 2 1 4 M. Tabes Mesenterica 18 n Phthisis 39 5 16 4 3 Fract. and Contus. i 2 1 4 ... 4 4 Hydrocephalus .. 8 8 Wounds ... ... Burns and Scalds.. 13 23 ill. 1. NervousSysi 3b 10 1 b 15 4 1 Poison l 1 ... ? 1 l ... 1 1 Cephalitis 2 2 1 1 Surlocation 2 2 ... •« 2 6 Paralysis 8 ... 6 2 1 2. Homicide 1 1 ... Chorea 1 1 Epilepsy ....... 2 7 2 Convulsions ..... 9 8 1 ... 1 4 Brain Diseases, 5 ... 5 12 7 2. Organs of Circ. 19 b 4 4 6 ... 1 l 2 l 1 4. Unciassed • •• ... 1 Aneurism 1 1 ... 10 6 Heart Disease .. 16 4 2 4 6 " TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FOUR WEEKS ENDING SATURDAY, THE 25th DAY OF FEBRUARY, 1871, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small Pox .. .. 101 £0 13 9 .. 123 Chicken Pox .. .. 4 5 18 .. 27 Measles .. .. 3 .. 2 .. 5 Scarlatina .. .. 11 9 7 .. 27 Whooping Cough .. .. 15 25 10 .. 50 Croup .. .. 1 1 .. .. 2 Diarrhœa .. .. 16 23 9 6 54 Dysentery .. .. 2 1 2 .. 5 Cholera .. .. .. .. .. .. .. Ague .. .. .. 1 .. .. 1 Continued Fever .. .. 7 14 21 .. 42 Influenza .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. Rheumatic Fever .. .. 2 1 3 .. 6 Erysipelas .. .. 14 6 5 .. 25 Diphtheria .. .. .. .. .. .. .. Sorethroat or Tonsillitis .. .. 13 19 30 .. 62 Mumps .. .. .. .. 1 .. 1 Pyaemia .. .. .. .. .. .. .. Bronchitis and Catarrh .. 1 235 192 197 85 710 Pneumonia .. .. 2 4 8 .. 14 Pleurisy .. .. 2 7 10 .. 19 Delirium Tremens .. .. 2 .. .. .. 2 Insanity .. .. 7 .. 1 .. 8 Carbuncle .. .. .. 1 2 .. 3 All other Diseases .. 13 468 631 699 98 1909 Total .. 14 905 953 1034 189 3095 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED. From January 30th, 1871, to February 25th, 1871. South East District. South West District. North District. Total. * Number of houses inspected 238 131 79 448 Drains Constructed .. .. 3 3 Improved or repaired .. 3 4 7 Traps fixed •• .. 3 3 Cesspools Abolished .. • • 1 1 Cleansed or disinfected .. .. •• •• Privies and Water Closets Pan, trap, and water supply furnished .. .. .. .. Pan and trap only furnished .. .. .. .. Water supply furnished .. .. .. .. Dust bins Constructed .. .. .. .. Repaired and covers adapted .. • • 4 4 Surface Drains and Pavements of Yards Constructed .. .. .. .. Relaid .. 3 3 6 General Water Supply New receptacles provided .. .. .. .. Receptacles repaired and cleansed .. .. 1 1 Water supply provided .. 1 .. 1 Other Improvements Houses generally repaired .. .. 6 6 „ &c., cleansed or limewashed 3 15 12 30 „ ventilated .. .. .. .. Overcrowding abated .. .. .. .. Illegal use of underground Rooms for sleeping discontinued .. .. .. .. Other Amendments, or Nuisances abated .. .. 34 34 * Inspections, Disinfections, Burnings, &c., in connection with the Small-Pox Epidemic, and the necessary attention to complaints have engrossed more than the ordinary time of the Inspectors to the unavoidable neglect of much other sanitary work. I fi *1 A n ' ' ' "■ ' \ : : ' : -...,j . . ..... . . , REPOKT on the SANITARY CONDITION OF ST. MARY, ISLINGTON FOR MARCH, 1871. No. CLXXXVII. Four hundred and sixty-eight deaths (including six registered at Hampstead) were recorded by the Registrar during the five weeks ending April 1st. This number is only 10 more than was recorded in March last year. It includes 50 deaths from Small-pox, and. 23 from Hooping Cough. The death-rate from the former disease then has been rather less than in the month of February, but that from the latter has greatly increased. The epidemic of Small-pox has spread more extensively in Islington since the month of February closed. In the course of the five weeks 198 cases were recorded upon the books of the Parochial Medical Officers and the two Dispensaries, against 123 similarly recorded in the four weeks of February. There were considerable fluctuations, however, week by week, as will appear from the following table:— Public Cases. Week ending March 4th 61 „ „ 11th 26 „ 18th 38 „ 25th 48 ,, April 1st 25 Since the end of March a sudden and extensive outbreak of the disease has occurred at the north-eastern part of the parish, coincidently with a similar outburst in the adjoining parish of St. Pancras. Of the 198 cases mentioned above, not more th m half, viz.: 98, were sent to the Small-pox Hospitals, the remaining 100 being treated at home. This arose in some instances from the unwillingness of the patients to be removed, in other instances from the lack of sufficient hospital accommodation. Notwithstanding the strenuous and praiseworthy efforts of the Asylum Board to perform the function allotted to them, the accommodation they have provided has still been below the necessities of this 2 epidemic, unparalleled for extent and severity in the memory of any of the existing race of medical practitioners. The reason seems to be that there is just above the pauper class, for whom the Board was bound to provide, a class of persons, artisans, shopmen, clerks, laundresses, petty tradesmen, and such like, who, although never in the receipt of parochial relief, have been driven to seek refuge in the Hospitals of the Asylums' Board, when attacked with Small-pox. To have refused such persons admission would have been to compromise one of the grand objects with which theEe Hospitals were founded, namely the isolation, not otherwise procurable, of cases of contagious disease. Such persons when, as is commonly the case, occupying with their families a single room of a house let in tenements, or only a portion of their own house, while the remainder is let to other families, are as likely to disseminate the contagion to those about them as a pauper would be under similar circumstances. They have no convenience for isolating themselves, and cannot afford the payment of three guineas demanded at the Highgate Hospital, even supposing there were room to receive them there. The occasion appears to me to be one on which local supplemental action would be appropriate. Since March 13th arrangements made by the Guardians for receiving Islington patients at the Old Workhouse have been at an end, in consequence of the occupation of the building by the Asylum Board for conversion into a Convalescent Hospital; and no new local Hospital has been established, or so far as T know contemplated. Yet one is needed, and, if the experience of former epidemics is to be trusted, will be needed for some weeks and perhaps some months to come, if only to receive the surplus cases, willing and desirous of removal from home, which the Asylum Boards' Hospitals cannot accommodate. There ought at any rate to be such hospital accommodation available as would permit of my putting into operation the 2Gth section of the Sanitary Act, 1866. I should also mention another matter which is subject for regret, namely, the greatly diminished number of persons now seeking revaccination; a fact which is obvious to all our medical men engaged in private practice, and demonstrable at every one of our public stations. This is not because all who require it have been re-vaccinated—very far from this—it is simply because the first panic has subsided, and people have become accustomed to the presence in their midst of an enemy who has hitherto spared them, and who, they hope, will continue to overlook their unprotected condition. As fear subsides reason ought to take its place. But perhaps this is too much to expect. 3 From the commencement of December to the date of this report, I have a record of 592 houses which have become infected. Of these 434 have been more or less satisfactorily disinfected, together with the contents of infected rooms, under orders from our office or by our own workmen in default of the owners, thus leaving 158 yet to be dealt with. Several of these are standing over until the cessation of the Small-pox in the houses where cases are being treated at home. The "Old Workhouse" Convalescent Hospital now contains about 300 women and children, including a limited number of acute cases from Islington and adjoining parishes. METEOROLOGY OF MARCH. Thermometers 4 feet from ground. Degree of Atmospheric Humidity, Saturation being represented by 100. Rain in inches read at 9 a.m., Collected on the ground. Sum. Number of days on which Rain fell in appreciable quantity. Sum. Mean of Daily Values. Mean of Highest Temperatures. Mean of Lowest Temperatures. Mean Daily Range of Temp. Week ending Mar. 4th 45·2° 55·6° 38·1° 17·5° 84 0·14 3 „ „ 11th 46·6° 52·9° 42·0° 10·9° 82 0·51 5 „ „ 18th 42·7° 60·3° 37·5° 12·8° 83 0·51 5 „ „ 25th 46·4° 60·1° 37·5° 22·6° 86 0·00 0 „ April 1st 44·9° 63·4° 38·7° 14·6° 74 0·03 2 Means. 45·1° 54·40 38·7° 15·6° 81 Sum. 119 Sum. 15 The highest day temperature, observed on March 26th was 69·3° The lowest night temperature, observed on March 2nd, was 30·3° EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, April 13th, 1871. TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FIVE WEEKS ENDING 1st APRIL, 1871. (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 a ears of age. At 80 years of age and upward. 192 276 All Causes 468 231 66 75 78 18 56 65 3. Respirat. Orgs. 121 52 11 23 29 6 5 6 Laryngitis 11 9 1 1 ... ... 33 36 Bronchitis 69 18 4 16 26 5 1 ... Pleurisy 1 ... ... 1 ... ... 55 61 I. ZYMOTIC DIS. 116 87 17 11 1 ... 14 18 Pneumonia 32 24 5 2 1 ... 2 4 Asthma 6 ... 1 2 2 1 35 60 II. CONSTITUTE 95 39 25 21 9 1 1 1 Lung Diseases, &c. 2 1 ... 1 ... ... 83 119 III. LOCAL 202 76 20 40 56 10 5 11 4. Digestive Orgs. 16 1 2 5 6 2 13 30 IV. DEVELOPMNL. 43 22 3 1 10 7 1 ... Gastritis 1 ... ... ... ... ... 1 1 Enteritis 2 ... 1 1 ... ... 6 6 V. VIOLENT DTHS. 12 7 1 2 2 ... ... 1 Peritonitis 1 ... ... ... 1 ... ... ... Not Specified ... ... ... ... ... ... 1 ... Ascites 1 ... ... ... 1 ... ... 1 Ulceration of Intes. 1 ... ... 1 ... ... ... 2 Hernia 2 ... ... ... 1 1 (Orders.) ... 1 Ileus 1 ... ... ... ... 1 1 ... Intussusception 1 ... ... l ... ... 50 60 I. 1. Miasmatic Dis. 110 81 17 11 1 ... ... ... Stricture of Intes ... ... ... ... ... 18 32 Small Pox 50 26 15 8 1 ... ... ... Fistula ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... Stomach Dis., &c. ... ... ... ... ... ... 7 6 Scarlatina 13 13 ... ... ... ... ... ... Pancreas Dis., &c. ... ... ... ... ... ... 3 ... Diphtheria 3 3 ... ... ... ... ... ... Hepatitis ... ... ... ... ... ... ... ... Quinsey ... ... ... ... ... ... ... 1 Jaundice 1 ... ... ... 1 ... 4 1 Croup 5 5 ... ... ... ... 1 4 Liver Disease 5 1 1 2 1 ... 12 11 Hooping; Cough 23 23 ... ... ... ... ... ... Spleen Diseas ... ... ... ... ... ... 3 4 Tvphus & Typhoid 7 5 ... 2 ... ... 4 3 5. Urinary Orgs. 7 2 ... ... 4 1 ... 1 Erysipelas 1 1 ... ... ... ... 1 ... Nephritis 1 ... ... ... 1 ... ... 1 Pyœmia 1 1 ... ... ... ... ... ... Disease of Bladdei ... ... ... ... ... ... 1 1 Puerperal Fever 2 ... 1 1 ... ... 2 2 Nephria 4 2 ... ... 2 ... ... ... Carbuncle ... ... ... ... ... ... ... ... Diabetes ... ... ... ... ... ... ... ... influenza ... ... ... ... ... ... ... ... Stone ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... 1 1 Prostrate Disease 2 ... ... ... 1 1 ... 1 Diarrhœa 1 1 ... ... ... ... ... ... Kidney Disease,&c. ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... 2 ... 6. Genera. Organs 2 ... 1 1 ... ... ... ... Ague ... ... ... ... ... ... 1 ... Ovarian Dropsy 1 ... ... 1 ... ... 2 2 Rheumatism 4 3 1 ... ... ... 1 ... Uterine Diseases 1 ... 1 ... ... ... 2 ... 2. Enthetic 2 2 ... ... ... ... ... 2 7. Orgs.of Locomo. 2 1 ... 1 ... ... 2 ... Syphilis 2 2 ... ... ... ... ... ... Spiue Diseases ... ... ... ... ... ... ... ... Stricture of Urethra ... ... ... ... ... ... ... 2 Bone Diseases 2 1 ... 1 ... ... ... ... Hydrophobia ... ... ... ... ... ... ... 1 8. Skin, &c 1 ... ... l ... ... ... ... Glanders ... ... ... ... ... ... ... ... Phlegmon & Abscess ... ... ... ... ... 3 1 3. Dietic 4 4 ... ... ... ... ... ... Ulcer ... ... ... ... ... ... ... ... Privation ... ... ... ... ... ... ... 1 Skin Diseases 1 ... ... 1 ... ... 3 1 Want of Br. Milk 4 4 ... ... ... ... ... ... ... ... Purpura and Scurvy ... ... ... ... ... ... 3 6 IV. 1. Dis. of Childn. 9 9 ... ... ... ... ... ... Alcoholism ... ... ... ... ... ... 2 5 Premature Birth 7 7 ... ... ... ... ... ... 4 Parasitic ... ... ... ... ... ... ... ... Cyansis ... ... ... ... ... ... ... ... Thrush ... ... ... ... ... ... ... ... Spina Bifida ... ... ... ... ... ... ... ... Worms ... ... ... ... ... ... 1 1 Other Malformation 2 ... ... ... ... ... 4 13 II. 1. Diathetic 17 2 1 7 6 1 ... ... Teething ... ... ... ... ... ... 1 2 2. Dis. of Adults . 3 ... 3 ... ... ... ... 1 Gout 1 ... ... 1 ... ... ... ... Paramenia ... ... ... ... ... ... ... 1 Dropsy 1 ... ... ... ... 1 1 2 Childbirth 3 ... 3 ... ... ... ... ... Hæmorrhage ... ... ... ... ... ... 5 13 3. Dis. ol Aged . 18 ... ... 1 10 7 3 10 Cancer 13 ... 1 6 6 ... 5 13 Old Age 18 ... ... 1 10 7 ... ... Noma ... ... ... ... ... ... 4 9 4. Dis. of Nutritn. 13 13 ... ... ... ... 1 1 Mortification 2 2 ... ... ... ... 4 9 Atrophy 6c Debility 13 13 ... ... ... ... 31 47 2. Tubercular 78 37 24 14 3 ... - 2 5 Scrofula 7 6 ... 1 ... ... 2 2 V. 1. Acci. or Neg. 4 3 ... 1 ... ... 2 3 Tabes Mesenterica 5 5 ••• ... ... ... 1 ... Fract. and Contus. 1 1 ... ... ... ... 20 33 Phthisis 53 13 24 13 3 ... ... ... Wounds ... ... ... ... ... 7 6 Hydrocephalus 13 13 ... ... ... ... ... 2 Burns and Scalds. 2 1 ... 1 ... ... 9 26 III. 1. Nervous Syst. 35 18 1 5 10 1 ... ... Poison ... ... ... ... ... ... ... ... Drowning ... ... ... ... ... ... 1 5 Cephalitis 6 8 6 ... 2 6 ... 1 ... Suffocation 1 1 ... ... ... ... 2 6 Apoplexy 5 ... 1 1 2 1 2 2 2. Homicide 4 4 ... ... ... ... 1 4 paralysis 1 ... ... 1 ... ... 2 2 3. suicide 4 ... 1 1 2 ... ... 1 Chorea ... ... ... ... ... ... 1 1 Wounds 2 ... ... ... 2 ... ... ... Epilepsy ... ... ... ... ... ... ... ... Poison ... ... ... ... ... ... 4 6 Convulsions 10 10 ... ... ... ... ... 1 Drowning 1 ... 1 ... ... ... 1 4 Brain Diseases, &c. 5 2 ... 1 2 ... 1 ... Suffocat. and Hang. 1 ... ... 1 ... ... 7 11 2. Organs of Ciroc 18 2 5 4 7 ... ... ... Otherwise ... ... ... ... ... ... ... 1 Pericarditis 1 1 ... ... ... ... ... ... 4. Unclassed ... ... ... ... ... ... ... ... Aneurism ... ... ... ... ... ... 7 10 Heart Disease 17 1 5 4 7 ... TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FIVE WEEKS ENDING SATURDAY, THE 1st DAY OF APRIL, 1871, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Conviot Prison Total. Small Pox .. .. 155 20 23 .. 198 Chicken Pox .. .. .. 3 18 .. 21 Measles .. .. 2 1 .. .. 3 Scarlatina .. .. 4 3 11 .. 18 Whooping Cough .. .. 19 23 8 .. 50 Croup .. .. .. 2 6 .. 8 Diarrhœa .. .. 16 21 18 7 62 Dysentery .. .. .. .. 3 .. 3 Cholera .. .. .. .. .. .. .. Ague .. .. 1 .. 1 .. 2 Continued Fever .. 1 6 14 18 .. 39 Influenza .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. Rheumatic Fever .. .. 2 .. 2 .. 4 Erysipelas .. .. 7 5 3 .. 15 Diphtheria .. .. 1 1 .. .. 2 Sorethroat or Tonsillitis .. .. 15 14 38 .. 67 Mumps .. .. 2 .. 2 .. 4 Pyæmia .. .. .. .. .. .. .. Bronchitis and Catarrh .. 1 192 250 326 45 814 Pneumonia .. .. 4 6 7 .. 17 Pleurisy .. .. 7 9 16 .. 32 Delirium Tremens .. .. .. .. .. .. .. Insanity .. .. 5 .. .. .. 5 Carbuncle .. .. .. .. 4 .. 4 All other Diseases .. 17 466 752 897 101 2233 Total .. 19 904 1124 1401 153 3601 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED. From February 27th, 1871, to March 25th, 1871. South East District. South West District. North District. Total. *Number of houses inspected 102 199 87 388 Drains Constructed .. .. 2 2 Improved or repaired 2 5 .. 7 Traps fixed 3 4 .. 7 Cesspools Abolished .. .. .. .. Cleansed or disinfected .. .. .. .. Privies and Water Closets Pan, trap, and water supply furnished 1 .. .. 1 Pan and trap only furnished .. 1 .. 1 Water supply furnished .. .. 1 1 Dust bins Constructed 1 .. .. 1 Repaired and covers adapted .. .. 1 1 Surface Drains and Pavements of Yards Constructed .. .. .. .. Relaid 1 4 .. 5 General Water Supply New receptacles provided .. .. .. .. Receptacles repaired and cleansed .. .. 1 1 Water supply provided .. .. .. .. Other Improvements Houses generally repaired 1 .. 7 8 „ &c., cleansed or limewashed 19 47 44 110 „ ventilated .. .. .. .. Overcrowding abated .. .. .. .. Illegal use of underground Rooms for sleeping discontinued .. .. .. .. Other Amendments, or Nuisances abated 2 4 95 101 *Inspections, Disinfections, Turnings, Sc., in connection with the Small-Pox Epidemic, and the necessary attention to complaints have engrossed more than the ordinary time of the Inspectors to the unavoidable neglect of much other sanitary work REPORT on the SANITARY CONDITION OF ST. MARY, ISLINGTON FOR APRIL, 1871. No. CLXXXVIII. Were it not for the continued prevalence of Small Pox—a shame and a disgrace to any British population—the month of April just elapsed must have been designated as fairly healthy. As it is, the mortality registered was not in excess of that registered last year, and the total amount of general public sickness was less than in any April during the previous three years. The deaths were 342, and the new cases of sickness recorded were 2,730. No specific form of disease has increased among us except Small Pox, and some forms have considerably lessened. With respect to the epidemic of Small Pox, I am sorry to have to say that up to the end of April it has continued to extend among our population. In the five weeks of December I recorded 104 public cases of this disease, in the four weeks of January 121 cases, in the four weeks of February 123 cases, in the five weeks of March 198 cases, and now in the four weeks ending April 29th, I have to record 249 fresh cases. It amounts to a veritable plague. In no April in any year have I recorded anything like so large a number of fresh cases of any epidemic disease whatever, the largest number of cases of Small Pox recorded in April being 60 in 1863, the largest number of cases of Measles in April being 104 last year, the largest number of cases of Scarlet fever in April being 44 in 1863, and the largest number of cases of Whooping Cough in April being 90 in 1869. And a similar observation may be made about the deaths from Small Pox. Including those persons from Islington who died at the Hampstead Hospital, the deaths from Small Pox registered in the four weeks of April were 55. In the five weeks of December they were 17, in the four weeks of January they were 28, in the four weeks of February they were 42, and in the five weeks of March they 2 were 50. The largest number of deaths from Small Pox I have ever before recorded in April was 10 in 1863, from Measles 15 in April, 1864, from Scarlet Fever 34 in April, 1863, and from Whooping Cough 36 in April, 1861. I may even go a step further to show the magnitude of the epidemic and add that in no month of four weeks in any year from 1856, when I entered upon my duties here, has so large a number of fresh cases of any contagious epidemic disease whatever been recorded. The largest monthly number of fresh public cases of Small Pox I have ever recorded before this year was 134 in the four weeks of May, 1863, of Measels 264 in five weeks of June, 1870, of Scarlet Fever 135 in the four weeks of October, 1867, and of Whooping Cough 161 in the jive weeks of June, 1869. On only four occasions has a larger number of deaths than 55 been registered within the same fifteen years from any contagious epidemic disease, namely from Scarlet Fever 60 in October, 1870, 65 in November, 1870, and 68 in December, 1869, and from Whooping Cough 58 in June, 1869. And December and June are months into which we count five weeks, instead of four as in the months just closed. The largest number of deaths from Small Pox I have ever registered in any month was 23 in the jive weeks of June, 1863, from Measles 38 in the jive weeks of December, 1862, from Scarlet Fever 68 in the jive weeks of December, 1869, and from Whooping Cough 58 in the jive weeks of June, 1869. The disgrace of all this lies, not in the fact that there is an unparalleled epidemic of contagious disease, but that the disease is one against which we might have a protection did we choose to avail ourselves of it, such as we cannot have against any other disease. The weekly numbers of new public cases were as follows :— Week ending April 8th 54 cases. „ „ „ 15th 69 „ „ „ „ 22nd 67 ,, „ „ „ 29th 59 „ During the past month the delays in removing cases of Small Pox to the Hospitals have been most embarassing and dangerous. The public Hospitals have been full to overflowing, and we have no local accommodation to supplement them, such as has been provided in some other large parishes. As a result of all this and the incomprehensible apathy of the lower classes in the matter of vaccination and revaccination, we have been having in some instances as many as six and eight consecutive cases in a house. 3 From the commencement of December to the date of this Report I have a record of 883 houses which have become infected: of these 709 have been more or less satisfactorily disinfected together with their contents, thus leaving 174 yet to be dealt with. METEOROLOGY OF APRIL. Thermometers 4 feet from ground. Degree of Atmospheric Humidity, Saturation being represented by 100. Rain in inches read at 9 A.M., Collected on the ground. Sum. Number of days on which Rain fell in appreciable quantity. Sum. Mean of Daily Values. Mean of Highest Temperatures. Mean of Lowest Temperatures. Mean Daily Range of Temp. Week ending Apr. 8th 44.2° 54.5° 36.5° 18.0° 72 0.01 1 „ „ 15th 48.3° 58.6° 40.5° 18.1° 73 0.50 4 „ „ 22nd 50.7° 57.3° 47.0° 10.3° 81 1.45 7 „ „ 29th 51.5° 60.1° 45.4° 14.7° 74 0.88 5 Means. 48.6° 57.6° 42.3° 15.2° 75 Sum. 2.84 Sum. 17 The highest day temperature, observed on April 12th was 65.3° The lowest night temperature, observed on April 7th, was 28.8° EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, May 12th, 1871. TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FOUR WEEKS ENDING 29th APRIL, 1871. (Deaths of Non-Residents in Hospitals excluded). West S.D. East S.D. Causes of Death. At all Ages. | Under 20 years of aee. At 20 and under 40 years of age. j At 40 and under CO 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 rears of age. At 80 years of age and upwards. 140 202 All Causes 342 76 41 55 57 13 23 31 3. Respirat. Orgs. 54 28 ... 11 13 2 3 ... Laryngitis 3 3 ... ... ... ... (Classes.) 16 19 Bronchitis 35 15 ... 5 13 2 ... ... Pleurisy ... ... ... ... ... ... 49 62 I. ZYMOTIC DIS. 111 81 19 6 2 3 3 9 Pneumonia 12 9 ... 3 ... ... ... 2 Asthma 2 ... ... 2 ... ... 21 23 II. CONSTITTUTL. 49 17 12 11 8 1 1 1 Lung Diseases, &c. 2 1 ... 1 ... ... 3 10 4- Digestive Orgs. 13 2 1 6 4 ... 59 86 III. LOCAL 145 58 7 35 40 5 ... ... Gastritis ... ... ... ... ... ... 8 24 IV. DEVELOPMNL. 32 18 1 2 7 4 ... ... Enteritis ... ... ... ... ... ... ... 1 Peritonitis 1 ... ... ... 1 ... 3 2 V. VIOLENT DTHS. 5 2 2 1 ... ... ... ... Ascites ... ... ... ... ... ... Not Specified ... ... ... ... ... ... ... ... Ulceration of Intes. ... ... ... ... ... ... ... 1 Hernia 1 ... ... ... 1 ... (Orders.) ... ... Ileus ... ... ... ... ... ... ... 2 Intussusception 2 1 ... 1 ... ... 46 69 I, 1. Miasmatic Dis. 105 76 18 6 2 3 ... ... Stricture of Intest. ... ... ... ... ... ... ... ... Fistula ... ... ... ... ... ... 22 33 Small Pox 55 36 17 2 ... ... ... ... Stomach Dis., &c. ... ... ... ... ... ... ... 1 Measles 1 1 ... ... ... ... ... ... Pancreas pis., &c. ... ... ... ... ... ... 2 6 Scarlatina 8 8 ... ... ... ... ... ... Hepatitis ... ... ... ... ... ... .. 1 Diphtheria 1 1 ... ... ... ... 1 1 Jaundice 2 1 ... 1 ... ... ... ... Quinsey ... ... ... ... ... ... 2 5 Liver Disease 7 ... 1 4 2 ... ... 1 Croup 1 1 ... ... ... ... ... ... Spleen Disease ... ... ... ... ... ... 11 11 Hooping Cough 22 22 ... ... ... ... 2 5 5. Urinary Orgs. 7 1 1 2 3 ... 6 ... Typhus & Typhoid 6 5 ... 1 ... ... ... 1 Nephritis 1 1 ... ... ... ... 1 Erysipelas 1 ... ... 1 ... ... ... 1 Disease of Bladder 1 ... ... ... 1 ... 1 Pyœmia 1 ... 1 ... ... ... 1 1 Nephria 2 ... 1 1 ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... 1 Diabetes 1 ... ... 1 ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... Stone ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... 1 Prostrate Disease 1 ... ... ... 1 ... ... 1 Dysentery 1 ... ... ... ... 1 1 ... Kidney Disease,&c. 1 ... ... 1 ... 3 3 Diarrhœa 6 2 1 l 2 1 2 6. Genera. Organs 3 ... ... 2 ... 1 ... Cholera ... ... ... ... ... 1 2 Ovarian Dropsy 3 ... ... 2 ... 1 ... Ague ... ... ... ... ... ... ... Uterine Diseases ... ... ... ... ... ... ... *2 Rheumatism 2 ... 1 l ... 2 ... 7. Orgs.of Locomo. 2 2 ... ... ... ... 2 1 2. Enthetic 3 3 ... ... ... ... 1 ... Spine Diseases 1 1 ... ... ... ... 2 1 Syphilis 3 3 ... ... ... 1 ... Bone Diseases 1 1 ... ... ... ... ... ... Stricture of Urethra ... ... ... ... ... 1 1 8. Skin, &c 2 2 ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... Phlegmon&Abscess ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... 1 ... Ulcer 1 1 ... ... ... ... 1 2 3. Dietic 3 2 1 ... ... ... ... 1 Skin Diseases 1 1 ... ... ... ... ... ... Privation ... ... ... ... ... ... 1 ... Want of Br. Milk.. 1 1 ... ... ... ... 4 5 IV. 1. Die. of Childn. 9 9 ... ... ... ... ... 1 Purpura and Scurvy 1 1 ... ... ... ... ... l Alcoholism 1 ... 1 ... ... ... 4 4 Premature Birth 8 8 ... ... ... ... ... ... 4. Parasitic ... ... ... ... ... ... ... Cyanosis ... ... ... ... ... ... ... ... Thrush ... ... ... ... ... ... ... 1 Spina Bifida 1 1 ... ... ... ... ... ... Worms ... ... ... ... ... ... ... ... Other Malformation ... ... ... ... ... ... ... ... Teething ... ... ... ... ... ... 5 4 II. 1. Diathetic 9 2 ... 2 4 1 ... 2 2. Dis. of Adults. 2 ... 1 1 ... ... Paramenia ... ... ... ... ... ... ... ... Gout ... ... ... ... ... ... ... Childbirth 2 ... 1 1 ... ... 2 1 Dropsy 3 2 ... ... l ... ... 2 3. Dis. of Aged 12 ... ... 1 7 4 ... ... Hæmorrhage ... ... ... ... ... ... 3 9 Old Age 12 ... ... 1 7 4 3 1 Cancer 4 ... ... 2 2 ... 3 9 4. Dis.of Nutritn, 9 9 ... ... ... ... ... ... Noma ... ...... ... ... ... ... 1 8 ... 2 Mortification 2 ... ... ... 1 1 1 8 Atrophy & Debility 9 9 ... ... ... ... 16 24 2. Tubercular 40 15 12 9 4 ... 2 ... V. 1. Acci.or Neg. 3 2 1 ... ... ... ... ... Scrofula ... ... ... ... ... ... 2 2 Tabea Mesenterica 4 4 ... ... ... ... 1 ... Fract. and Contus. 1 ... 1 ... ... ... 10 19 Phthisis 29 4 12 9 4 ... ... ... Wounds ... ... ... ... ... ... 4 3 Hydrocephalus 7 7 ... ... ... ... ... ... Burns and Scalds.. ... ... ... ... ... ... 17 30 III. 1. Nervous Syst. 47 21 3 8 14 l ... ... Poison ... ... ... ... ... ... ... ... Drowning ... ... ... ... ... ... ... 1 Suffocation 1 1 ... ... ... ... 2 5 Cephalitis 7 5 1 1 ... ... 4 8 Apoplexy 12 ... 2 4 6 ... 1 ... Otherwise 1 1 ... ... ... ... 1 7 Paralysis 8 ... ... ... 8 ... ... ... 2. Homicide ... ... ... ... ... ... ... 1 Insanity 1 ... ... 1 ... ... 1 1 3. Suicide 2 ... 1 1 ... ... ... ... Chorea ... ... ... ... ... ... 1 ... Wounds l ... 1 ... ... ... Poison ... ... ... ... ... ... ... ... Epilepsy ... ... ... ... ... ... ... ... Drowning 1 ... ... 1 ... ... 7 8 Ccnvulsions 15 15 ... ... ... ... ... 1 Suffocat. and Hang. ... ... ... ... ... ... 3 1 Brain Diseases, &c 4 1 ... 2 ... 1 ... ... 10 7 2. Organs of Circ 17 2 2 6 6 1 ... ... Otherwise ... ... ... ... ... ... ... ... Pericarditis ... ... ... ... ... ... ... ... 4. Unclassed ... ... ... ... ... ... 1 1 Aneurism 2 ... ... 2 ... 9 6 Heart Disease 15 2 2 4 6 1 TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FOUR WEEKS ENDING SATURDAY, THE 29th DAY OF APRIL, 1871, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small Pox .. 10 162 40 35 2 249 Chicken Pox .. .. .. 5 7 .. 12 Measles .. .. .. 1 2 .. 3 Scarlatina .. .. 9 3 5 .. 17 Whooping Cough .. .. 12 17 7 .. 36 Croup .. .. .. .. .. .. .. Diarrhœa .. .. 10 23 18 .. .. Dysentery .. .. 1 .. 2 .. .. Cholera .. .. .. .. .. .. •• Ague .. .. 1 .. .. .. 1 Continued Fever .. .. 4 1 14 .. 33 Influenza .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. Rheumatic Fever .. .. .. .. 2 .. 2 Erysipelas .. .. 4 4 5 .. 13 Diphtheria .. .. .. • • .. .. •• Sorethroat or Tonsillitis .. .. 7 12 23 .. 42 Mumps .. .. .. .. 1 .. 1 Pyæmia .. .. .. .. .. .. .. Bronchitis and Catarrh .. 3 135 153 213 .. 565 Pneumonia .. .. 1 3 11 .. 15 Pleurisy .. .. 1 5 6 .. 12 Delirium Tremens .. .. .. 1 1 .. 2 Insanity .. .. 3 1 1 .. 5 Carbuncle .. .. .. .. .. .. .. All other Diseases .. 14 335 516 799 91 1655 Total .. 27 685 799 1052 167 2730 TABLE III HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED. From March 27th, 1871, to April 29th, 1871. South East District. South "West District. North ! District. Total. *Number of houses inspected 109 212 95 416 Drains Constructed 1 3 .. 4 Improved 2 9 1 12 Traps fixed 3 8 .. 11 Cesspools Abolished .. 1 .. 1 Cleansed or disinfected .. .. .. .. Privies and Water Closets Pan, trap, and water supply furnished .. 1 .. 1 Pan and trap only furnished .. 3 .. 3 water supply furnished .. 2 .. 2 Dust bins Constructed .. 1 .. 1 Repaired and covers adapted .. 2 .. 2 Surface Drains and Pavements of Yards Constructed .. .. .. .. Relaid 1 10 .. 11 General Water Supply New receptacles provided .. 3 .. 3 Receptacles repaired and cleansed .. 2 .. 2 Water supply provided .. .. .. .. Other Improvements Houses generally repaired .. .. .. .. ,, &c., cleansed or limewashed 49 60 43 152 ,, ventilated .. .. .. .. Overcrowding abated 1 2 .. 3 Illegal use of underground Rooms for sleeping discontinued .. 1 .. 1 Other Amendments, or Nuisances abated .. 1 93 94 *Inspections, Disinfections, Burnings, &c., in connection with the Small-Pox Epidemic, and the necessary attention to complaints have engrossed more than the ordinary time of the Inspectors to the unavoidable neglect of much other sanitary work REPORT ON THE SANITARY CONDITION OF ST. MAM, ISLINGTON FOR MAY, 1871. No. CLXXXIX. The deaths registered in the four weeks ending May 27th were 299. Almost precisely the same number was registered in May last year; and it indicates a very low general death rate. The general public sickness also has only been slightly in excess of that in the corresponding weeks of last year. Small Pox is the only disease of the epidemic class which has given us any cause for anxiety. It is ten years since we have had so little Scarlet Fever in May. The number of public cases of Small Pox has been 236, and the deaths registered from this disease have been 51. Both numbers are nearly the same as were recorded in the four weeks of April, the difference representing a trifling decline. The weekly number of fresh cases were— Public Cases. In week ending May 6 72 „ „ 13 67 „ „ 20 49 „ „ 27 48 The first week in May then appears to have been the culminating point of the epidemic in Islington. A decided diminution was noticed in the last two weeks of the month. This corresponds as precisely as possible with my anticipations expressed early in the epidemic outbreak—and which were based upon my observations here during the last fifteen years. There is every reason to hope now, that as the atmospheric temperature rises with the approach of summer, we shall see that continued decline of the epidemic which we have so long been waiting 2 for. Still, it is not to be expected that the decline will continue steadily without fluctuations. The atmospheric temperature is the principal factor, and the cold weather experienced lately is not unlikely at the expiration of the fortnight of incubation, to raise the number of fresh cases temporarily. Up to the present date we have a list of 1,023 houses infected. Of these the houses and their contents have been disinfected in 853 instances, leaving 170 yet to be dealt with. METEOROLOGY OF MAY. Thermometers 4 feet from ground. Degree of Atmospheric Humidity, Saturation being represented by 100. Rain in inches read at 9 a.m., Collected on the ground. Slim. Number of days on which Rain fell in appreciable quantity. Sum. Mean of Daily Values. Mean of Highest Temperatures. Mean of Lowest Temperatures. Moan Daily Range of Temp. Week ending May 6th 50.8° 62.8° 41.5° 21.2° 62 0.13 3 „ „ 13 th 49.7° 63.2° 41.0° 22.2° 66 0.25 2 „ „ 20th 50.9° 63.0° 42.2° 20.8° 61 0.18 1 „ „ 27th 68.8° 71.8° 47.9° 23.9° 59 0.29 2 Means. 62.5° 65.2° 43.1° 22.0° 62 Sum. 0.85 Sum. 8 The highest day temperature, observed on May 24th, was 80.5° The lowest night temperature, observed on May 12th, was 36.3° Brief thunder storms on May 8th and 27th. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, June 5th, 1871. TABLE I. DEATHS REGISTERED IN ISLINGTON DURING POUR WEEKS ENDING 27th MAY, 1871. (Deaths of Non-Residents in Hospitals excluded). West B.D. East B.D. Causes of Death. 1 At all Ages. j 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.n. 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 v ears of age. At 80 years of age and upwards. 140 159 All causes 299 145 60 39 39 16 19 22 3. Respirat. Orgs. 41 22 ... 5 12 2 2 1 Laryngitis 3 2 ... ... 1 ... (Classes.) 11 12 Bronchitis 23 12 ... 2 8 ... ... ... Pleurisy ... ... ... ... ... ... 50 44 I. ZYMOTIC DIS. 94 62 23 7 1 1 6 4 Pnemonia 10 6 ... 1 2 1 ... 3 Asthma 3 1 ... 1 1 ... 24 27 II. CONSTITUTE. 51 13 21 10 5 2 ... 2 Lung Diseases. &c. 2 1 ... l ... ... 51 66 III. LOCAL. 117 48 14 22 28 5 6 12 4- Digestive Orgs. 18 4 3 5 5 1 ... 1 Gastritis 1 ... ... ... ... 1 15 18 IV. DEVELOPMNL. 33 18 2 ... 5 8 ... 1 Enteritis 1 l ... ... ... ... ... 4 V. VIOLENT DTHS. 4 4 ... ... ... ... l 2 Peritonitis 3 1 1 ... 1 ... ... ... Ascites ... ... ... ... ... ... ... ... Not Specified ... ... ... ... ... ... 1 Ulceration of Intes. 1 ... ... ... l ... ... 1 Hernia 1 ... ... ... 1 ... (Orders.) ... ... Ileus ... ... ... ... ... ... ... ... Intussusception ... ... ... ... ... ... 45 44 I. 1. Miasmatic Dis. 89 59 21 7 1 1 ... ... Stricture of Intest. ... ... ... ... ... ... 22 29 Small Pox 51 29 17 5 ... ... ... ... Fistula ... ... ... ... ... ... 1 ... Measles 1 1 ... ... ... ... ... 1 Stomach Dis., &c. 1 ... ... ... ... ... 3 4 Scarlatina 7 7 ... ... ... ... ... ... Pancreas Dis., &c. ... ... ... ... ... ... 1 3 Diphtheria 4 4 ... ... ... ... ... ... Hepatitis ... ... ... ... ... ... 1 ... Quinsey 1 1 ... ... ... ... ... ... Jaundice ... ... ... ... ... ... 2 ... Croup 2 2 ... ... ... ... 5 4 Liver Disease 9 1 ... 4 2 ... 6 2 Hooping Cough 8 8 ... ... ... ... ... 1 Spleen Disease 1 l ... ... ... ... 55 ... Typhus & Typhoid 5 2 3 ... ... ... 1 2 5. Urinary Orgs. 3 ... ... 2 ... ... ... 1 Erysipelas 1 1 ... ... ... ... ... ... Nephritis ... ... ... ... ... ... 1 1 Pyœmia 2 1 ... 1 ... ... ... ... Disease of Bladder ... ... ... ... ... ... ... 1 Puerperal Fever 1 ... 1 ... ... ... 1 1 Nephria 2 ... 1 1 ... ... ... ... Carbuncle ... ... ... ... ... ... ... l Diabetes 1 ... ... 1 ... ... ... ... Influenza ... ... ... ... ... ... ... ... Stone ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... Prostrate Disease . ... ... ... ... ... ... 1 2 Diarrhœa 3 2 ... ... ... 1 ... ... Kidney Disease,&c. ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... 1 6. Genera. Organs 1 ... 1 ... ... ... ... ... Ague ... ... ... ... ... ... ... ... Ovarian Dropsy ... ... ... ... ... ... 2 1 Rheumatism 3 1 ... 1 ... ... ... 1 Uterine Diseases 1 ... 1 ... ... ... 2 ... 2. Enthetic 2 2 ... ... ... ... 1 1 7. Orgs.of Locomo. 2 1 l ... ... ... 2 ... Syphilis 2 2 ... ... ... ... ... ... Spine Diseases ... ... ... ... ... ... ... ... Stricture of Urethra ... ... ... ... ... ... 1 l Bone Diseases 2 1 1 ... ... ... ... ... Hydrophobia ... ... ... ... ... ... 1 ... 8. Skin, &c. 1 ... ... ... 1 ... ... ... Glanders ... ... ... ... ... ... ... ... Phlegmon & Abscess ... ... ... ... ... ... 3 ... 3. Dietic 3 1 2 ... ... ... 1 ... Ulcer 1 ... ... ... 1 ... ... ... Privation ... ... ... ... ... ... ... ... Skin Diseases ... ... ... ... ... ... 1 ... Want of Br. Milk.. 1 1 ... ... ... ... ... ... IV. 1. Dis. of Childn. 9 9 ... ... ... ... 2 ... Purpura and Scurvy 2 ... 2 ... ... ... 3 6 ... ... Alcoholism ... ... ... ... ... ... 2 6 Premature Birth 8 8 ... ... ... ... ... ... 4. Parasitic ... ... ... ... ... ... ... ... Cyanosis ... ... ... ... ... ... ... ... Thrush ... ... ... ... ... ... ... ... Spina Bifida ... ... ... ... ... ... ... ... Worms ... ... ... ... ... ... 1 ... Other Malformation 1 1 ... ... ... ... 2 6 II. 1. Diathetic 8 ... 1 2 3 2 ... ... Teething ... ... ... ... ... ... ... 2 2. Dis. of Adults 2 ... 2 ... ... ... ... ... Gout ... ... ... ... .... ... ... ... Paramenia ... ... ... ... ... ... 1 1 Dropsy 2 ... ... ... ... 2 ... 2 Childbirth 2 ... 2 ... ... ... ... ... Hæmorrhage ... ... ... ... ... ... 7 6 3. Dis. of Aged 13 ... ... ... 5 8 1 3 Cancer 4 ... 1 ... 3 ... 7 6 Old Age 13 ... ... ... 5 8 ... ... Noma ... ... ... ... ... ... 5 4 4. Dis. of Nutritn. 9 9 ... ... ... ... ... 2 Mortification 2 ... ... 2 ... ... 5 4 Atrophy & Debility 9 9 ... ... ... ... 22 21 2. Tubercular 43 13 20 8 2 ... ... 3 V. 1. Acci. or Neg. 3 3 ... ... ... 4 ... Scrofula 4 2 1 1 ... ... 1 3 Tabes Mesenterica 4 4 ... ... ... ... ... ... Fract. and Contus. ... ... ... ... ... ... 13 17 Phthisis 30 2 19 7 2 ... ... ... Wounds ... ... ... ... ... ... 4 1 Hydrocephalus 5 5 ... ... ... ... ... ... Burns and Scalds.. ... ... ... ... ... ... 14 27 III. 1. Nervous Syst. 41 21 7 3 8 2 ... ... Poison ... ... ... ... ... ... ... 1 Drowning 1 1 ... ... ... ... 2 3 Cephalitis 5 4 ... ... 1 ... ... 1 Suffocation 1 1 ... ... ... ... 2 9 Apoplexy 11 ... 5 2 3 1 ... 1 Otherwise 1 1 ... ... ... ... 2 4 Paralysis 6 1 ... 1 3 1 ... 1 2. Homicide 1 1 ... ... ... ... ... 1 Insanity 1 ... 1 ... ... ... ... ... 3. Suicide ... ... ... ... ... ... ... ... Chorea ... ... ... ... ... ... ... ... Wounds ... ... ... ... ... ... ... 1 Epilepsy 1 ... 1 ... ... ... ... ... Poison ... ... ... ... ... ... 7 9 Convulsions 16 16 ... ... ... ... ... ... Drowning ... ... ... ... ... ... 1 ... Brain Diseases, &c. 1 ... ... ... 1 ... ... ... Suffocat. and Hang. ... ... ... ... ... ... 9 1 2. Organs of Circ. 10 ... 1 7 2 ... ... ... Otherwise ... ... ... ... ... ... 2 ... Pericarditis 2 ... 1 1 ... ... ... ... 4. Unclassed ... ... ... ... ... ... ... ... Aneurism ... ... ... ... ... ... 7 1 Heart Disease 8 ... ... 6 2 ... TABLE II NEW CASES OK DISEASE COMING UNDER TREATMENT DURING THE FOUR WEEKS ENDING SATURDAY. THE 27th DAY OF MAY, 1871, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Paupers. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small Pox .. 2 175 15 29 15 236 Chicken Pox .. .. 3 2 6 .. 11 Measles .. .. 9 5 8 1 23 Scarlatina .. .. 2 4 8 .. 14 Whooping Cough .. .. 2 10 12 .. 24 Croup .. .. 1 1 1 .. 3 Diarrhœa .. .. 17 27 13 12 69 Dysentery .. .. .. .. 2 .. 2 Cholera .. .. .. .. .. .. .. Ague .. .. .. .. .. .. .. Continued Fever .. .. 1 17 16 .. 34 Influenza .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. Rheumatic Fever .. .. 1 .. .. .. 1 Erysipelas .. .. 3 3 4 .. 10 Diphtheria .. .. 3 .. .. .. 3 Sorethroat or Tonsillitis .. 1 7 11 18 .. 37 Mumps .. .. 1 .. 5 .. 6 Pyæmia .. .. .. .. .. .. .. Bronchitis and Catarrh .. .. 114 123 164 28 429 Pneumonia .. .. .. 3 3 .. 6 Pleurisy .. .. 1 7 4 .. 12 Delirium Tremens .. .. .. .. .. .. .. Insanity .. .. 6 .. .. .. 6 Carbuncle .. .. 1 .. 2 .. 3 All other Diseases .. 28 315 603 894 117 1957 Total .. 31 662 831 1189 173 2886 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED. From May 1st, 1871, to May 27th, 1871. South East District. South West. District. North District. Total. *Number of Houses inspected 80 218 69 367 Drains Constructed .. .. .. .. Improved or repaired 1 3 2 6 Traps fixed .. 2 .. 2 Cesspools Abolished .. .. .. .. Cleansed or disinfected .. .. .. .. Privies and Water Closets Pan, trap, and water supply furnished .. .. .. 1 1 Pan and trap only furnished .. .. .. .. Water supply furnished .. 1 .. 1 Dust bins Constructed .. .. .. .. Repaired and covers adapted .. .. .. .. Surface Drains and Pavements of Yards Constructed .. .. .. .. Relaid .. 2 .. 2 General Water Supply New receptacles provided .. .. .. .. Receptacles repaired and cleansed .. 2 .. 2 Water supply provided .. 1 .. 1 Other Improvements Houses generally repaired .. .. 1 1 „ &c., cleansed or limewashed 43 46 57 146 „ ventilated .. .. .. .. Overcrowding abated .. .. .. .. Illegal use of underground Rooms for sleeping discontinued .. .. .. .. Other Amendments, or Nuisances abated .. .. 12 12 *Inspections, Disinfections, Burnings, &c., in connection with the Small-Pox Epidemic, and the necessary attention to complaints have engrossed more than the ordinary time of the Inspectors to the unavoidable neglect of much other sanitary work. REPORT ON THE SANITARY CONDITION OF ST. MARY, ISLINGTON FOR JUNE, 1871. No. CLXXXIX 2 190 If we could put the epidemic of Small-pox out of the question, the public health of the parish during the five weeks ending July 1, must be considered satisfactory. The new cases of sickness in the public practice, namely, 2978, is the smallest number recorded in June since 1867, when the number was practically the same. The comparative coolness of the season, and the abundant rainfall has had much to do with this. The deaths registered, including deaths of our parishioners in the Hampstead Small Pox Hospital, amounted to 366. The mean number of deaths in June during the last ten years was 325. In order to correct this for comparison with this year's deaths in June, we must add, as an allowance for increase of the population during the decenniad, 15.2 per cent., which brings the number up to 374, so that our mortality in June was rather below the average. There has been a slight increase in the number of cases of measles and hooping cough, but nothing like an epidemic increase. Bowel complaints, too, have only been moderately frequent for the season of the year. It will be observed, with satisfaction, that Small-pox has continued to abate in the parish. The number of fresh cases in the public practice was 178 in the five weeks, against 236 in the four weeks of May. The deaths recorded were 68 against 51, but it is to be recollected that many of these were of persons attacked with the disease in May. The weekly cases, as recorded, were,— Public Cases In week ending June 3 41 „ „ 10 53 „ „ 17 30 „ „ 24 28 „ July 1 26 Up to the present date we have a list of 1,278 houses infected. Of these, the houses and their contents have been disinfected in 1,212 instances, leaving 66 yet to be dealt with. METEOROLOGY OF JUNE. Thermometers 4 feet from ground. Degree of Atmospheric Humidity, Saturation being represented by 100. Rain in inches read at 9 A.M., Collected on the ground. Sum. Number of days on which Rain fell in appreciable quantity. Sum. Mean of Daily Values. Mean of Highest Temperatures. Mean of Lowest Temperatures. Mean Daily Range of Temp. Week ending June 3rd 55.7° 70.1° 46.0° 24.2° 70 0.00 0 „ „ 10th 51.6° 63.4° 43.9° 19.5° 68 0.30 3 „ „ 17th 59.2° 71.9° 52.9° 19.0° 85 1.49 5 „ „ 24th 58.2° 68.3° 52.3° 16.1° 74 1.73 5 „ „ July 1st 57.1° 69.4° 48.0 21.3° 67 0.05 2 Means. 56.3° 68.6° 48.6° 20.0° 72 Sum. 3.57 Sum. 15 The highest day temperature, observed on May 30th, was 78.50 The lowest night temperature, observed on June 4th and 15th, was 39.5° Thunderstorms on June 17th, 19th,and 20th. EDWARD BALLARD, M.D., Medical Officer of Health. Vestry Offices, July 10th, 1871. TABLE I. DEATHS REGISTERED IN ISLINGTON DURING FIVE WEEKS ENDING 1th JULY, 1871. (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 80 years of age and upwards. 169 197 All causes 36 164 8 60 62 12 20 24 3. Respirat. Orgs 44 17 3 10 11 3 1 ... Laryngitis l 1 ... ... ... ... (Classes.) 10 12 Bronchitis 22 8 1 6 5 2 ... 1 Pleurisy 1 ... ... ... 1 ... 63 50 1. ZYMOTIC DIS. 113 71 31 8 3 ... 5 8 Pneumonia 13 8 ... 3 2 ... 2 2 Asthma 4 ... ... 1 2 1 21 42 II. CONSTITUTL 63 22 20 17 4 ... 2 1 Lung Diseases, &c. 3 ... 2 ... 1 ... 57 76 III. LOCAL 133 40 15 31 43 4 9 9 4. Digestive Orgs. 18 4 2 5 6 1 20 23 IV. DEVELOPMNL. 42 25 ... 1 9 8 1 ... Gastritis 1 ... ... 1 ... ... 2 ... Enteritis 2 2 ... ... ... ... 8 6 V. VIOLENT DTHS. 14 6 2 3 3 ... 1 ... Peritonitis 1 1 ... ... ... ... ... ... Not Specified ... ... ... ... ... ... ... ... Ascites ... ... ... ... ... ... ... ... Ulceration of lutes ... ... ... ... ... ... (Orders.) ... ... Hernia ... ... ... ... ... ... ... 2 Ileus 2 ... ... 1 1 ... 1 1 Intussusception 2 1 ... ... 1 ... 60 46 I. 1. Miasmatic Dis. 106 64 31 8 3 ... ... ... Stricture of Inte. ... ... ... ... ... ... 39 29 Small Pox 68 36 26 6 ... ... ... ... Fistula ... ... ... ... ... ... 1 ... Measles 1 1 ... ... ... ... ... 1 Stomach Dis., &c 1 ... 1 ... ... ... 4 6 Scarlatina 10 8 2 ... ... ... ... ... Pancreas Dis., &c. ... ... ... ... ... ... 4 ... Diphtheria 4 4 ... ... ... ... 1 2 Hepatitis 3 ... 1 1 1 ... ... ... Quinsey ... ... ... ... ... ... 2 2 Jaundice 4 ... ... 1 2 1 5 1 Croup 6 6 ... ... ... ... 1 1 Liver Disease 2 ... ... 1 1 ... 3 3 Hooping Cough 6 5 1 ... ... ... ... ... Spleen Disease ... ... ... ... ... ... 2 1 Typhus & Typhoid 3 ... 1 1 1 ... 2 3 5. Urinary Orgs. 5 1 1 2 1 ... ... ... Erysipelas ... ... ... ... ... ... ... 1 Nephritis 1 ... 1 ... ... ... ... ... Pyœmia ... ... ... ... ... ... ... ... Disease ot Bladder ... ... ... ... ... ... ... 1 Puerperal Fever 1 ... 1 ... ... ... 2 2 Nephria 4 1 ... 2 1 ... ... ... Carbuncle ... ... ... ... ... ... ... ... Diabetes ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... Stone ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... Prostrate Disease ... ... ... ... ... ... 1 4 Diarrhœa 5 3 ... ... 2 ... ... ... Kidney Disease,&c. ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... 6. Genera. Organs ... ... ... ... ... ... ... .. ...i Ague ... ... ... ... ... ... ... ... Ovarian Dropsy ... ... ... ... ... ... 1 1 Rheumatism 2 1 ... 1 ... ... ... ... Uterine Diseases ... ... ... ... ... ... 3 1 2. Enthetic 4 4 ... ... ... ... ... ... 7. Orgs.of Locomo. ... ... ... ... ... ... 3 1 Syphilis 4 4 ... ... ... ... ... ... Spine Diseases ... ... ... ... ... ... ... ... Stricture of Urethra ... ... ... ... ... ... ... ... Bone Diseases ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... 8. Skin, &c ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... Phlegmon & Abscess ... ... ... ... ... ... ... 3 3. Dietic 3 3 ... ... ... ... ... ... Ulcer ... ... ... ... ... ... ... ... Privation ... ... ... ... ... ... ... ... Skin Diseases ... ... ... ... ... ... ... 3 Want of Br. Milk 3 3 ... ... ... ... IV. 1. Dis. of Childn. 12 12 ... ... ... ... ... ... Purpura and Scurvy ... ... ... ... ... ... 6 6 ... ... Alcoholism ... ... ... ... ... ... 6 4 Premature Birth 10 10 ... ... ... ... ... ... 4. Parasitic ... ... ... ... ... ... ... 2 Cyanosis 2 2 ... ... ... ... ... ... Thrush ... ... ... ... ... ... ... ... Spina Bifida ... ... ... ... ... ... ... ... Worms ... ... ... ... ... ... ... ... Other Malformation ... ... ... ... ... ... ... 6 II. I. Diathetic 6 ... ... 3 3 ... ... ... Teething ... ... ... ... ... ... ... ... 2. Dis. of Adults. ... ... ... ... ... ... ... ... Gout ... ... ... ... ... ... ... ... Paramenia ... ... ... ... ... ... ... 1 Dropsy 1 ... ... ... 1 ... ... ... Childbirth ... ... ... ... ... ... ... ... Hæmorrhage ... ... ... ... ... ... 6 12 3. Dis. of Aged 18 ... ... 1 9 8 ... 5 Cancer 5 ... ... 3 2 ... 6 12 Old Age 18 ... ... 1 9 8 ... ... Noma ... ... ... ... ... ... 8 5 4. Dia. of Nutritn. 13 13 ... ... ... ... ... ... Mortification ... ... ... ... ... ... 8 5 Atrophy & Debility 13 13 ... ... ... ... 21 36 2 Tubercular 57 22 20 14 1 ... 4 4 V. 1. Acci. or Neg. 8 6 .. 1 1 ... ... 1 Scrofula 1 ... ... 1 ... ... 1 4 Tabes Mesenterica 5 5 ... ... ... ... ... ... Fract. and Contus. ... ... ... ... ... ... 15 24 Phthisis 39 5 20 13 1 ... 1 ... Wounds 1 ... ... 1 ... ... 5 7 Hydrocephalus 12 12 ... ... ... ... 1 ... Burns and Scalds.. 1 1 ... ... ... ... 17 ... 2 Poison 2 2 ... ... ... ... 26 III.I. Nervous Syst. 43 18 4 8 13 ... ... ... Drowning ... ... ... ... ... ... 2 Cephalitis 2 2 ... ... ... ... 1 1 Suffocation 2 2 ... ... ... ... 5 6 Apoplexy 11 ... 2 3 6 ... 1 1 Otherwise 2 1 ... ... 1 ... 1 3 Paralysis 4 ... 1 1 2 ... ... ... 2. Homicide ... ... ... ... ... ... ... ... Insanity ... ... ... ... ... ... 14 2 3. Suicide 6 ... 2 2 2 ... ... ... Chorea ... ... ... ... ... ... ... 1 Wounds 1 ... 1 ... ... ... 2 ... Epilepsy 2 1 ... 1 ... ... ... ... Poison ... ... ... ... ... ... 5 10 Convulsions 15 15 ... ... ... ... 2 ... Drowning 2 ... ... 1 l ... 4 5 Brain Diseases, &c. 9 ... 1 3 5 ... 2 1 Suffocat. and Hang. 3 ... 1 1 l ... 9 14 2. Organs of Circ. 23 ... 5 6 12 ... ... ... Otherwise ... ... ... ... ... ... ... ... Pericarditis ... ... ... ... ... ... ... ... 4. Unclassed ... ... ... ... ... ... ... ... Aneurism ... ... ... ... ... ... 9 14 Heart Disease 23 ... 5 6 12 ... TABLE II. NEW CASES OF DISEASE COMING UNDER TREATMENT DURING THE FIVE WEEKS ENDING SATURDAY. THE 1st DAY OF JULY, 1871, AT THE FOLLOWING INSTITUTIONS:— Workhouse. Infant Poor House. Out Patient Pauperfc. Holloway Dispensary. Islington Dispensary. Pentonville Convict Prison Total. Small Pox .. .. 134 18 26 .. 178 Chicken Pox .. .. 8 6 11 .. 25 Measles .. .. 19 5 25 .. 49 Scarlatina .. .. 6 4 5 .. 15 Whooping Cough .. .. 21 10 7 .. 38 Croup .. .. .. 2 1 .. 3 Diarrhœa .. .. 49 24 49 9 131 Dysentery .. .. .. 2 1 .. 3 Cholera .. .. .. .. .. .. .. Ague .. .. 1 1 .. .. 2 Continued Fever .. .. 2 14 17 .. 33 Influenza .. .. .. .. .. .. .. Puerperal Fever .. .. 1 .. .. .. 1 Rheumatic Fever .. .. 2 1 .. 4 Erysipelas .. .. 7 4 1 .. 15 Diphtheria .. .. .. .. 4 .. 4 Sorethroat or Tonsillitis .. .. 13 25 4 .. 77 Mumps .. .. 1 .. 1 .. 2 Pyæmia .. .. .. .. .. .. .. Bronchitis and Catarrh .. .. 86 105 158 33 382 Pneumonia .. .. 1 3 4 .. 8 Pleurisy .. .. 3 8 7 .. 18 Delirium Tremens .. .. .. .. .. .. .. Insanity .. .. 7 .. .. .. 7 Carbuncle .. .. .. .. 3 .. 3 All other Diseases .. 31 423 614 818 94 1980 Total .. 31 784 846 1181 136 2978 TABLE III. HOUSES INSPECTED AND SANITARY IMPROVEMENTS EFFECTED. From May 29th, 1871, to July 1st, 1871. South East District. Southa West. District. North District. Total. *Number of Houses inspected 174 249 76 499 Drains Constructed 2 .. .. 2 Improved or repaired 14 12 2 28 Traps fixed 9 5 •• 14 Cesspools Abolished .. .. .. .. Cleansed or disinfected .. .. .. •• Privies and Water Closets Pan, trap, and water supply furnished 1 .. 1 2 Pan and trap only furnished .. 1 .. .. Water supply furnished l .. .. 1 Dust bins Constructed .. 1 .. 1 Repaired and covers adapted .. •• •• .. Surface Drains and Pavements of Yards Construected .. .. .. .. Relaid 3 5 •• 8 General Water Supply New receptacles provided .. .. .. .. Receptacles repaired and cleansed 12 .. .. 12 Water supply provided .. .. .. .. Other Improvements Houses generally repaired 5 .. .. 5 ,, &c., cleansed or limewashed 47 163 36 246 „ ventilated .. .. .. • • Overcrowding abated .. .. .. .. Illegal use of underground Rooms for sleeping discontinued .. .. .. .. Other Amendments, or Nuisances abated 22 1 11 34 Inspections, Disinfections, Burnings, &c., in connection with the Small-Pox Epidemic and the necessary attention to complaints have engrossed more than the ordinary time of the Inspectors to the unavoidable neglect of much other sanitary work. N.B.—From the 31st of May to the 1st of July the Inspector of Dust visited 2058 houses.