STGIL,7 1859. SANITARY STATISTICS and PROCEEDINGS in ST. GILES'S DISTRICT. BEING A REPORT ON THE SANITARY CONDITION OF THE DISTRICT IN 1859; AND ON THE MEANS THAT HAVE BEEN TAKEN FOR ITS IMPROVEMENT DURING THE YEAR ENDING MARCH 25th, 1863; ADDRESSED TO THE LOCAL BOARD OF WORKS. BY GEORGE BUCHANAN, M.D., LOND., Member of the Royal College of Physicians; Plijsician to the Western General Dispensary; Medical officer of health. London: PRINTED BY II. ELLIOT, 475, NEW OXFORD STREET. 1860. 1859-60. ANNUAL REPORT of The Medical officer of health. Gentlemen, I have found no reason to make the present report deviate materially from the form which it has assumed in two previous years. There is little scope for novelty of treatment, or for entertaining writing in an annual account of the sanitary state of Saint Giles's. Uniformity of arrangement has also the positive advantage of admitting easier comparison between the facts of different years. The present history of the vear 1859 will, therefore, comprehend, as heretofore, the following topics:— First the mortality and death-rate of the metropolis. Secondly, the mortality, from all causes, in Saint Giles's district. Next, the causes of death in our district. And, fourthly, the localization of disease, and its dependence apon local conditions. At the end of this chapter the births of 1859 are briefly considered. Then, after an investigation of the public institutions of the district, will follow a special chapter on the prevalence of small pox; and the report will conclude, as before, with an outline of the proceedings that have been taken for the security of the public health by the sanitary staff of the district. Chapter I.— Mortality and Death-rate of the Metropolis in 1859. The mortality of London as a whole, in the fifty-two weeks ending December 3lst, 1859, was considerably below that of 1858, and was, within a fraction, identical with the mortality of 1857. The number of deaths, from all causes, registered in each of the three years was 60,150 in 1857, 63,882 in 1858, and 61,617 in 1859. Correction being made for increasing population, and again for the various durations of the several registration years, these numbers represent respectively the death-rates of 22.20, 23.56, and 22.29, per thousand inhabitants. The average of these numbers is below the death-rate which prevailed in the preceding ten years by 176 in the thousand. About 13,000 lives have been saved to the Metropolis in these three years by this fall in the death-rate. The same statements are, in general, applicable to each of the five groups of districts into which the Metropolis is divided. They have all been healthier in 1859 than in the previous year, and rather resemble 1857, a peculiarly healthy year, in their rate of mortality. The central districts, among which our own is placed, were, in 1859, midway between the two preceding years as to their deathrate. (See Table I. Appendix.) The diseases of the Metropolis whose prevalence in 1853 entitles them to special comment, were those of the zymotic class, which numbered 16758, being as many as in the previous twelvemonth, when they were noticed as being particularly rife. Small-pox has risen from 154 in 1857, to 247 in 1858, aid to 4 1156 in 1859. Scarlatina, which killed 1587 persons only in 1857, was fatal to 4118 and 4197 in 1858 and 1859. Measles and whooping-cough fell from their high numbers in 1858 to the lower rate of 1857, whilst diarrhoea, following the same rule of reverting to the rate of 1857, underwent an increase. It is satisfactory to find that the diseases which most of all depend upon local circumstances, and least upon contagion, the group of typhus and other fevers, have been most steady in their decrease, deaths from these complaints numbering 2161, 1996, and 1890, in the three past years. Further details on the mortality of the Metropolis, and its causes, will be found ia the appended Tables. Chapter II.— Gross Mortality of St. Giles's District. Fourteen hundred and fourteen residents in the parishes of St. Giles and St. George died in the 52 weeks under consideration. Of these 1343 were registered by the local registrars (subject to a correction of three for errors in their returns), while the deaths of 74 persons, brought from houses in our district, appear on the death-books of hospitals situated in other parishes. Including these hospital deaths, the rate of mortality of our district in 1859, was 260 in the 10,000 against 258 in 1858 and 286 in 1857. Our total mortality, therefore, was practically the same in each of the two past years, and that was shown in my preceding report to be considerably below our average death-rate in former years. It would of course be more gratifying to chronicle a still decreasing death-rate, but even to maintain the mortality at the very much diminished rate of 1858 is not altogether unsatisfactory. If in the past two years our St. Giles's population had died at their customary rate, 292 persons would have lost their lives in addition to those who have actually perished. Of the 1414 deaths, 727 were of males, 687 of females. The preponderance of males is a recognised rule of mortality, and is partly accounted for by the greater exposure of this sex to weather and accident. Forty-seven out of the seventy-four who died in hospitals were males. To compensate for this greater mortality, there are usually more male children produced in a community than females. In St. Giles's, however, this was not the case last year, for 887 of the total births were females, 842 only were males. The ages at death will be seen in detail in Table III. appended to this report. Here it will be enough to observe that 237 male and 211 female children died before reaching their second year, and that the total number of children dying under five years of age was 602. These figures are almost identical with those of 1858, and indicate a maintenance of the improvement, such as it was, that that year had obtained over its predecessor. In the first quarter 367 deaths occurred, in the second 345, in the third 341, and in the last three months of the year 361 deaths. It is curious that the preponderance of male deaths should have been exclusively in the Autumn, the total amount, 341, being made up of 149 females and 192 males. The cold seasons, it will be observed, follow here the ordinary rule of being more fatal than the warm quarters. Proceeding to compare our own district with the Metropolis at large, and with the districts immediately adjacent to us, in respect of the aggregate death-rate of each, we find that St. Giles's has not yet risen out of the lowest place which we have had to assign to it in former years. Its death-rate is still in excess of Holborn and the Strand, as well as being considerably higher than St. Martin's, St. Pancras, and St; Marylebone. MORTALITY IN 1859. Districts. Population. Registered Mortality. Column A. Column B. (see Note.) Total Mortality in 1859, corrected for Cols. A and B. Districts. 1st Quarter, 13 Weeks. 2nd Quarter 13 Weeks. 3rd Quarter 13 Weeks. 4th Quarter 13 Weeks. Whole year, 52 Weeks. 1851 correctd for 1859 Actual number per 10,000 Actual number per 10,000 Actual number per 10,000 Actual number per 10,000 Actual number per j 10,000 (add) (subtract.) Actual number per 10,000 St. Pancras 166,956 206,825 1273 61.6 1043 50.4 1103 53.3 1002 48.4 4421 213.7 91 Hospitals, 113 Workh. Strand 139 252 4260 206.0 St. Pancras. St. Marylebone 157,696 176,080 957 54.3 851 48.3 962 54.7 922 52.4 3692 209.7 78 Hospital, 152 3618 205.5 St. Marv Inborn Metropolis. 2,362,236 2,774,338 16147 58.2 13724 49.5 16010 57.7 15736 56.7 61617 222.1 — — 61617 222.1 Metropolis. Holborn 46,621 48,440 344 71.2 253 52.2 250 51.6 277 57.2 1124 232.2 52 Hospital, 52 1124 232.2 Holborn. Strand 44,460 45,180 267 59.1 258 57.1 261 57.7 277 61.3 1063 235.2 Workh. 139 Hosps. 35 174 Hospital, 100 1137 251.7 Strand. St. Martin 24,640 24,700 189 76.5 130 52.0 140 56.6 144 58.3 602 243.4 23 Hospital, 57 668 230.0 St. Martin. St. Giles 54,214 54,300 351 64.6 318 58.6 322 59.3 352 64.8 1343 247.3 74 Subtract 3 (Deaths registd twice over) 1414 260.4 St. Giles. * Col.A, gives the number of tlie inhabitants of each District who expired in 1859, in the Public Institutions of other Distric's. These figures must be added to the Registered Mortality. Col.B, gives the. number of inhabitants of other Localities, who died in the same year in the Public Institutions of the Districts named. These Figures have to be subtracted from the Registered Mortality. (See Appendix, Table 2). 6 If the death.rate of seventeen per thousand, which is assumed to be the normal mortality for a town, had prevailed in St. Giles's we should have saved 488 lives out of the 1414 who died in the year. If we had been as healthy as London as a whole, we should have numbered 259 fewer deaths. Or if we had only reached the standard now attained by our neighbour, the Holborn district, 152 persons who died in 1859 wouid still have been alive. The following table will show that other districts have fluctuated more than our own between 1858 and 1859; the large parishes of St. Pancras and Marylebone exhibiting the same alteration in their death.rate that has been noted for the Metropolis as a whole, becoming more healthy in 1859. Among the districts that are more directly comparable with our own, the Strand, St Martin's, and Holborn, we see from the table that the two former have deteriorated, while the last has made a considerable advance from its standard of 1858. St. Giles's, therefore, in its stationary position, does not compare very disadvantageously with the progress of its neighbours, especially when we remember the alternations of excess and deficiency that are apt to be exhibited by certain of the fatal diseases of a community. Death.rate per 10,000 in St. Giles's and neighbouring Districts, in the past three years. 1857 1858 1859 St. Pancras 200.7 224.9 206.0 St. Marylebone 221.5 224.0 205.5 Metropolis 225.3 234.4 222.1 Holborn 240.8 247.7 232.2 Strand 244.0 226.6 251.7 St. Martin 247.7 218.6 230.0 St. Giles's 286.0 258.2 260.4 Chapter III.— Causes of death in St. Giles's, in 1859. In the subjoined scheme, I have compared the mortality from various causes, in London and in St. Giles's, estimating the number of deaths that would have fallen to our share if the same death.rate from each disease had prevailed in St. Giles's as in the town at large. More accurate detail as to the causes of our own mortality is of considerable interest to the medical enquirer, and is furnished at length in a table of the Appendix. From this Table (No. III.) may be learnt what are the diseases comprised in the several classes and orders mentioned in the following page. It will here be sufficient to consider at large those diseases only which have been unduly rife in our own district. With reference to the quota which has been adopted for the St. Giles's of 1-51.1 of the Metropolitan mortality, it may be well to remark that the estimate of this population varies from year to vetir. On the assumption that our own numbers have undergone no material variation, while the annual increase of London has been as 47 to 48, the population of residents in St. Giles's district to the whole population of the town was in 1857 as 1:49 1—in 1858 it was as 1:50.1— and in 1859 it is represented by the figure here adopted. Comparison of Mortality from various causes in London and in Saint Giles's. Whole Year, 1859. Classes. Classes and Orders or Disease. London. Population: 2,774,338. St. Giles's. Population 54,300. Estimated Quota. 1: 51.1. Actual Registered Mortality. Corrected for Deaths in Hosps. All Causes 61617 1258.3 1340 1414 Specified Causes 60872 1191.2 1322 1396 (Classes.) I Zymotic Diseases 16758 327.9 361 374 II Constitutional „ 12455 243.7 324 347 III Local „ 22677 443.8 480 506 IV Developmental 6959 136.2 124 124 V Violent Deaths 2023 39.6 33 45 (Orders.) I 1 Miasmatic Diseases 15508 303.5 339 348 2 Enthetio „ 336 6.5 3 4 3 Dietic „ 762 14.9 19 22 4 Parasitic „ 152 3.0 0 0 II 1 Diathetic Diseases 2153 42.1 48 57 2 Tubercular „ 10302 201.6 276 290 III 1 Diseases of Nervous System 6557 128.3 161 164 2 „ „ Organs of Circulation 2679 52.4 46 51 8 „ „ Respiratory Organs 9305 182.2 217 224 4 ,, „ Digestive Organs 2645 51.7 41 43 5 „ „ Urinary Organs 837 16.4 8 14 6 „ „ Organs of Generation 231 4.5 4 4 7 „ „ Organs of Locomotion 160 3.1 1 4 8 „ „ Integumentary Organs 263 5.2 2 2 IV I Dev: Dis. of Children 1831 35.5 20 20 2 „ „ Adults 272 5.3 12 12 3 ., „ Old People 2279 44.1 62 62 4 Diseases of Nutrition 2577 50.0 30 30 V 1 Accident 1673 32.4 26 38 4 Suicide 256 5.0 5 5 All oiher Violent Deaths 94 1.8 2 2 Sudden Deaths 247 4.8 3 3 Cause unspecified 498 9.6 15 15 Certain Special Diseases of Zymotic Class and Miasmatic Order. I. 1. Small Pox 1156 22.4 22 22 Measles 1305 25.3 51 52 Scarlatina and Diphtheritis 4197 81.3 79 82 Whooping Cough 1741 33.7 66 66 Diarrhoea 3335 62.6 66 66 Typhus & other Fevers,continued and remittent 1890 36.6 25 26 8 It will be seen that diseases of the zymotic class and consumptive disease, presented a very considerable preponderance in St. Giles's, over the quota which its 54,300 inhabitants are calculated to furnish to the general mortality of the town. Also in excess, but to a minor degree, were diseases of the nervous and respiratory systems, and violent deaths. Of Zymotic disorders, the chief members appear at the foot of the foregoing table. Smail-pox, though its mortality has risen from 7 deaths in 1858, to 22 in 1859, has only observed the same rise that has been experienced by the town at large. To this disease, however, I intend to devote a special chapter.— Measles was twice as fatal in our district as in an equal population taken from the average of London. Its prevalence was most marked during the second quarter of the year. Here we have an instance of the fluctuation of a disease from one year to another, as affecting the comparative mortality of different parts of London. In 1857, St. Giles lost 59 children from measles, its quota being 28; in 1858, the disease was fatal to 25 only, though the rate at which measles was fatal to the whole town in that year, would have given 48 to our population. Now again, in 1859, we have 52 deaths instead of our quota of 25. Whooping Cough is another disease which was in excess last year. Fifteen more deaths from it were registered in 1859, than in 1858, but as the disease had subsided in the rest of London, our deaths from this complaint proved to be just double what ought to have been contributed by our population. The greater part of the deaths from whooping cough were in the former half of the year, so that St. Giles has partaken in the subsidence of this disease, though more tardily than other districts. Diarrhoea was in a little, but only a little excess of its quota. The actual number of deaths from it however, has seriously risen, for this was the case everywhere in London. The mortality from Scarlatina, including diphtheritis, remained at exactly the same high number (82), as in 1858, a proportionately high mortality continuing also to be maintained throughout the whole metropolis. Nine of our 82 deaths are registered as diphtheritis. Fevers, both typhus and typhoid, little fatal as they were in London in 1859, were happily still less fatal to St. Giles. Our quota was thirty-six, our actual number of deaths only twenty-six. As a class, zymotic diseases in St. Giles's, were fifty above their proportion for the population in 1859. In 1858, they were fifty below this quota, but in 1857 they were in the more serious excess of 65 above the estimate. Passing to the "Constitutional" class of diseases of the Registrar-General, we find from the foregoing table, that they were in the large excess of 347 deaths over a quota of 243. To one familiar with the diseases of St. Giles's this excess ceases to be surprising when it is said that this group comprehends the Tuberculous group of diseases; the mesenteric disease of children, consumption and water-on-the-brain, habitually affect the residents of St. Giles's, out of proportion to the other parts of London. Last year the surplus was represented by 290 instead of the estimated 199. Insufficient food, exposure, and crowded ill-ventilated rooms must be charged with the production of the disproportionate mortality from these diseases. Of diseases of the nervous system 164 are recorded instead of the quota 127. The surplus includes death from apoplexy and paralysis, and there were sixty deaths from convulsions in infants,where 39 only would have been expected from our population. Ignorant mismanagement of children and especially improper feeding, are here powerful additional causes of this great loss of life. Lung diseases are every year in excess in St. Giles's as surely as consumption, and they appear to owe their production to very similar causes. I am disposed to believe that they are also connected with bad drainage in a more direct manner than has generally been suspected. In 1852, these diseases produced 224 deaths. This is a much smaller number than in 1858, when 292 deaths from these maladies are recorded, but it is 44 in excess of the share that our population ought to have borne of the mortality from such causes. The excess in 1858 was fifty-four, and in 1857, seventy-two. Premature birth, teething, and atrophy in children, have been very exceptionally below the average. Our estimated number for the year was 85 deaths from 9 such causes: fifty deaths only are recorded. It is not to be forgotten that when epidemics are more rife than usual, the weakly children will be cut off by these, instead of lingering on and dying a little later, from the inherent defects in their constitutions. The sadly high number of twelve women died in child-bed. Old age appears as the only cause of death in 62 cases, 44 being the calculated number. For reasons that have before been dwelt on, I cannot be sure that their satisfactory excess of longevity is altogether real. Violent deaths are recorded in forty-five instances during the year, twelve such deaths occurring in the neighbouring hospitals. As would be expected from the occupations and character of our lower population, St. Giles's district contributes more than its share to this class of deaths. Five of the forty-five were suicides, all men. Fourteen children met their death by suffocation, an "accident" of so frequent occurrence in our district, that the culpability of the negligence which leads to it is scarcely recognized. Chapter IV.— Localization of Disease and Death in 1859. Enquiring more particularly into the causes of the mortality, and regarding especially those diseases which may be called, in a manner, the peculiar diseases of St. Giles's, I shall pursue the same course as in previous years, distributing the deaths into subdivisions smaller than the three registration sub-districts. A few remarks, however, on the gross mortality of these sub-districts will perhaps be interesting. The deaths from all causes among Bloomsbury parishioners numbered 317, of which 164 were in males, and 153 females. Eleven of these persons, however, expired in various hospitals, and seven within a short period of their admission into the parish infirmary ; so that 299 deaths only were returned by the registrar of this sub-district. (See table of registered deaths, No. V. of Appendix.)— In St. Giles, South, 699 deaths were registered, 353 males and 346 females. Subtracting fiftyone deaths among persons recently admitted into the infirmary from the other two sub-districts, but on the other hand including 33 residents of St. Giles, South, who died in hospitals, the corrected mortality of this sub-district becomes 681. This includes the deaths of 109 inmates of the workhouse, as welj as of sixty-six persons who migrated fiom various parts of the sub-district into the infirmary a short time before their death.— St. Giles, North, lost 417 of its inhabitants (221 males and 196 females), the registered moitality being 343, to which we must add thirty deaths in hospitals and forty-four iu the workhouse. The death-rates represented by these figures should be stated with a little reservation. On the eve of a new Census, the exact population of (he different parts of St. Giles's, derived from an enumeration of nine years ago, is not altogether certain. Assuming the same residents as at the last Census (in 1851), the death-rate of 1859 for Bloomsbury was 190 per ten thousand; of St. Giles South, 341.3; and of St. Giles North, 227.4 ner ten thousand. The corresponding figures for the two previous years may be usefully compared with these:- Death-rate per 10,000 of 1857 1858 1859 St. George, Bloomsbury 181 203 190 St. Giles, South 357 291 341 St. Giles, North 283 275 227 Whole district 280 258 260 Bloomsbury, then, has been more healthy than in 1858, and St. Giles's North has has made great and steady progress towards a better standard; but St. Giles's South has retrograded materially from the improved condition which it appeared to have assumed in 1858. Still it has not gone back altogether, for its mortality remains less, by 16 per ten thousand, than in 1857. 10 Exchanging now the three registration subilistricts for the ten localities employed in former reports, I shall refer to the appended diagram for a statement of their boundaries, area, density of population, and other preliminary facts. These ten subdivisions of St. Giles's stand in the following order in their general healthiness during 1859: the number of deaths from all causes determining their sequence. Comparison is here made with the corresponding data for 1857 and 1858. Ten Sub-divisions of St. Giles's; their order of Salubrity in 1859. Order of Sequence, 1859. Locality of Actual number of Deaths, 1859. Per 10,000 In Houses. In Works. In Hosps. 1857 1858 1859 Best 1st. B Russell Square 52 1 - 132 166 111 2nd. L Lincoln's Inn Fields 28 2 5 220 144 140 3rd. A Bedford Square 55 - 2 187 179 159 4th. D Bloomsbury Square 104 3 6 192 189 169 5th. C Coram Street 121 4 3 195 207 197 6th. E Church Lane 90 16 8 281 283 222 7th., 8th. K Southern Drury Lane . 132 14 11 241 261 310 G Short's Gardens 178 22 7 349 295 316 Worst-9th 10th II Northern Drury Lane. 131 28 10 404 303 340 F Dudley Street 220 27 22 377 355 347 Workhouse Inmates — 109 — — — — Total District 1114 226 71 286 258 260 Here the parts about Russell-square maintain their character for being the healthiest of our district. This neighbourhood has had for the last three years an average mortality of 13 6 only per thousand. It is assumed by sanitary statisticians that 17 per thousand is the inevitable death-rate of a town population. Surely the standard is fixed too high, if a mixed community of nearly four thousand persons in the centre of London incur no higher mortality than 13^ per thousand annually. The remaining parts of Bloomsbury taken together, though they include a very large number of dirty streets and mews, and closed courts inhabited by a very poor population, have for the last three years had a death-rate under twenty per thousand. Each of the localities which make up the northern subdistrict of St. Giles's shows a certain reduction in its aggregate mortality. Even the Dudleystreet quarter is a trifle healthier than in 1858, when it had improved so much on the preceding year. But in none of my divisions is the advance so striking as ir; that which includes Church-lane. In 1857 and 1858 the deaths here were steady at 281 and 283 per thousand; in 1859 they sank to 222, It will presently be seen that this amendment has affected all the diseases which are most characteristic of St. Giles'; that fewer children have died, that there has been less zymotic mortality, that consumption and lung diseases have had fewer victims. In Church-lane and its courts alone, the actual deaths of 1859 were but twenty-nine against forty-eight in the year that went before. Who can doubt the cause ? In 1858 and the beginning of 1859 vigorous steps were taken to improve this locality, by securing better ventilation to the houses and rooms, cleaner privies and ampler water-supply: overcrowding was carefully prevented. One of the courts most affected by these measures was Kennedy-court. In 1858 six people died here, two from fever, one from erysipelas, another from consumption, and two were children under two years of age. In 1859 there was not a single death. In 1858 thirteen people from Church-lane and its purlieus died in the workhouse; in 1859, five only. Who will calculate for the economist the money-value of these sanitary measures ? 11 Of the localities that make up South St. Giles I have unhappily to render a different account. With the single exception of the Lincoln's Inn neighbourhood, they have all deteriorated. The two localities marked G and H on my diagram, extending from Little Queen-street to St. Andrew's-street, and lying between Holborn and Broad-street on the north, and Great Queen-street and Castle-street on the south, occupy in 1859 a medium position as to healthiness between that which they held in 1858 and 1859. But the district to the south of Great Queenstreet, which had before been healthier than the parts just named, rose in 1859 almost to a par with them in point of mortality. The rise, it will presently be seen, was exclusively from the prevalence of zymotic disorders; in regard of these, indeed, this neighbourhood has been pre-eminent over all other parts of St. Giles's. The rise in the death-rate of the adjacent Strand district, which was also in some measure from an increase in these same diseases, is a fact which may here be usefully recalled to mind. But the increase of mortality in this locality, about Great Wild-street, is at first sight the less to be expected, as, during the whole of 1859, Lincoln-court stood emptied of its six or seven hundred inhabitants. It appears very doubtful, however, whether the population was diminished by this number: it is even likely that the families who left Lincoln-court only added to the already crowded tenements in the immediate neighbourhood. Of such extra-crowding I have, indeed, no proof; but if it did occur, one can easily see that an effect opposite to our anticipations might be produced on the health of the locality by the closure of Lincoln-court. The mortality among children has so closely the same distribution as the mortality at other ages, that I need not comment on it in detail. The following table gives the order of the ten subdivisions of St. Giles's in this respect. In it the improvement about Church-lane, and the change for the worse in the southern parts about Great Wild-street, are strongly marked :— The Ten Localities, in their order of Mortality among Children. Order of Sequenee, 1859. Locality of Deaths among Children, 1859. Per 10,000 Under 2 years. Between 2 and 5. 1857. 1858. 1859. 1st. B Russell Square 11 4 38 49 30 2nd. to 3rd A Bedford Square 14 3 75 75 48 L Lincoln's Inn Fields 12 1 108 64 52 4th. to 5th. C Coram Street 31 12 73 92 67 D Blcomsbnry Square 37 9 82 69 69 6th. E Church Lane 34 14 123 129 84 7th H Northern DiuryLane 56 22 196 137 152 8th. G Short's Gardens 82 26 197 138 165 9th. K Southern Drury Lane 59 28 140 138 171 10th. F Dudley Street 110 35 199 167 186 Workhouse Inmates 3* — — — — Total District 448 154 130 111 111 I have already anticipated some of the facts that are shown on the next table. Here is given the mortality from each chief zymotic disease in the ten subdivisions of our district, and here is shown how these ten localities arranged themselves in 1859, in respect to the prevalence of these diseases as a class :— * Deaths among newly-born children, whose mothers enter the workhouse immediately before their confinement, are referrred to the previous habitation of the mother. 12 The Ten Subdivisions in the order of their Mortality from Miasmatic Diseases of the Zymotic Class. Order of Sequence, 1859. Locality of Deaths from Miasmatic Diseasps in 1859. Per 10,000 All Miasmatic Diseases. Small P x. Measles. Scarlatina. Diphtheritis. Whooping Cough. Diarrhoea. Coniinped Fever. 1857 1858 1859 lst. B. Russell Square 5 - - - 1 2 2 - 25 40 11 2nd. A. Bedford Square 8 — 1 4 — 1 1 1 36 28 22 3rd. L. Lincoln's len Fids. 7 — 1 1 — 3 — — 56 32 28 4th, 5tb, 6th. C. Coram Street 29 2 6 6 5 — 4 2 27 55 45 D. Bloomsbury Sqre. 31 2 2 9 1 2 12 1 47 39 46 E. Ctnircb Lane 25 — 7 7 — 2 6 1 65 66 48 7th. H. Nort. Drury Lane 42 3 10 7 — 10 7 3 89 55 83 8th. to 9th. G Short's Gardens 60 7 9 11 1 10 12 6 98 53 91 F. Dudley Street 71 2 7 12 1 20 18 6 99 56 91 10th. K. Sout. Drury Lane 65 6 9 14 1 16 8 7 11 41 128 Workhouse Inmates 4 — — — - 1 — 3 — — — Total District 347 22 52 71 10 67 70 30 64 48 64 A scrutiny of this table will show that several parts have improved since 1858 in regard of these diseases, while others have retrograded to the standard of 1857. One locality, that to the south of Great Queen-street, has had as many deaths from these complaints as in the two preceding years put together. Deferring for the present the consideration of smallpox, it will be noticed that measles and scarlatina spread pretty uniformly over the district, while whooping-cough was but little fatal in the northern half. Scarlatina prevailed steadily through the four seasons, whereas measles was most rife in the second quarter, and whooping-cough in the first six months of the year. Diarrhoea, of course occurring almost wholly in the autumn, underwent its chief increase above the previous year in the southern parts of St. Giles's, but also increased very strikingly in the streets between the lines of Holborn and Great Russell-street, fever was fatal in all the subdivisions, except in the two most open ones of Russell-square and Lincoln's-inn Fields, but it nowhere approached an epidemic form. With reference to the prevalence of zymotic disease in the southern Drury-lane locality, though a lamentable increase of it cannot be denied, there is one consideration to which weight should be attached before we venture to assert that the material conditions of disease were augmented in that nighbourhood. For two years that portion of our district had contrasted with its neighbours in respect of zymotic diseases in a manner for which there appeared no explanation; it could not be said that the lanes and alleys about Great Wild-street were in a condition specially adapted to resist disease. But after a season of such immunity there is a tendency, as I have before shown, for epidemic diseases to manifest greater virulence; perhaps from there being then more persons without the protection conferred by a previous attack of the disease. High as the death-rate of the locality in question was for 1859, the average mortality from epidemics in the three years is only brought up by this circumstance to that which has characterized the kindred subdivisions to the north of Great Queen-street and around Short's Gardens. As for Consumptive diseases, they appear to have been distributed in the several parts of our district much in the usual manner. Here is shown the relative mor- 13 tality from these diseases in 1859, tbe table being so arranged that different localities and different years mny be at once compared:— Mortality from Tubercular Diseases in the Ten Subdivisions. Order of Sequence, 1859. Locality of Deaths from Tuberer. Diseases. Total Tuberer. Diseas. Per 10,000. Scrofula, Mesentc. Disease & Consumpt. Water on the Brain, Total. 1857 1858 1859 1st. B. Russell Square 8 1 9 27 17 19 2nd, 3rd, 4th. D. RIoomsbury Sqre. 14 6 20 22 25 30 L. Lincoln's Inn Fids. 8 - 8 28 8 32 A. Bedford Square 10 2 12 17 25 33 5th. to 6th K. South Druiy Lane 16 5 21 45 63 41 C. Coram Street 21 7 28 29 31 43 7th. E. Church Lane 22 5 27 65 80 52 8th. G. Short's Gardens 36 8 44 67 68 66 9 th. F. Dudley Street 43 11 54 46 88 71 10th. H. Horth DruryLane 40 7 47 124 63 93 Workhouse Inmates. 19 .. 19 •• •• •• Total District 237 52 289 50 52 53 Church-lane district, here again, holds a much better position in 1859 than in former years. The neighbourhoods of Dudley-street and Short's Gardens still stand very low on the lists, but they are again, as in 1857, outdone by the northern Drury-lane locality, where many of the deaths from consumption are referable to the circumstance of very many common lodging-houses being situated here. Diseases of the Respiratory organs form another group permanently in excess in St. Giles's. Their distribution over its ten subdivisions in 1859 is shown below. Here, again, the streets around Dudley-street and those between Hoiborn and Great Queen-street vie with each other in mortality. The Ten Sub-divisions in the order of their mortality from Diseases of the Lungs. Order of Sequence, 1859. Locality of Deaths from Lung Diseases— 1859. Acute Lung Disease, per 10,000. Total Lung Disease, Per 10,000 Acute. Chronic. 1857 1858 1859 1857 1858 1859 1st. 2nd. & 3rd. L. Lincolnninn Fids 3 1 16 39 12 32 52 16 B. Russell Square 5 3 17 19 11 21 28 17 D. Bloomsbury Sq. 6 6 13 16 9 25 25 18 4th. A. Bedford Square 5 3 20 39 13 42 48 22 5th. 6th. & 7th. C. Coram Street 7 11 22 29 11 39 45 29 G. Short's Gardens 17 5 29 24 26 47 44 33 E. Church Lane 8 10 33 32 15 70 47 35 8th. K. Sthrn Drury Lane 15 12 23 43 29 49 63 52 9th. F. Dudley Street 27 19 54 58 35 76 83 60 10th. H. Nthrn Drury-lane 22 15 44 35 43 79 63 72 Workhouse Inmates 2 20 - - - - - - Total District 117 105 30 33 21 55 53 40 14 There appears some interest in knowing where the violent deaths have happened. Including deaths from intoxication and delirium tremens under this head, they have been as follows :— A. Around Bedford Square 3 B. „ Russell Square 1 C. „ Coram Street 3 D. „ Blooms bury Square 6 E. „ Church Lane 3 F. „ Dudley Street 13 G. „ Short's Gardens 9 H. „ Northern Drury Lane 4 K. „ Southern Drury Lane 8 L. „ Lincoln's Inu Fields 3 Workhouse 0 Whole District 53 In the diagram to which I have before adverted, the chief results of the forego ing inquiry are given in a form which appeals readily to the eye. Having finished my account of the diseases and deaths of St. Giles's, I am desirous to find place for a few words on the Births of 1859. The numbers in each quar ter of the year, of each sex, and for each of our subdistricts are given in Table VI. of the Appendix. The tolal Births in St. Giles's in 1859 numbered seventeen hundred and twenty nine. Though more numerous than in 1858, they continue to be materially below the average of the ten preceding years. The chief rise from 1858 was found in St. Giles's South. This was not due to any change in the admissions into the Endell-street Hospital, for the number of women there delivered was about the usual number for several years past. The increase in the births of St. Giles's Souih in 1859 corresponds to the increase that has appeared in the death-rate of this district in the same period. This might be held to furnish a corroboration of the surmise previously made, that there has been no decrease in the population of that subdistrict. Unfortunately, however, in the present state of our registration laws, no safe deduction as to the number of children actually born in a district can be founded on the number whose births are registered. In Scotland every birth must be recorded, or a penalty is incurred; for Ireland the same provision is made, in a bill now before Parliament; but in England the present law leaves registration optional only, and indeed prohibits it altogether, if it is not effected within the first six months of a child's birth. Hence it is probable that the number of registered births is only a fraction of those which actually take place; and there is no security that this fraction shall not vary materially from one year to another. (Appendix IX.) Chapter V.— On the Diseases and Deaths of Public Inslitutions of St.Giles in 1859. The following table shows the prevalence and fatality of disease in the medical practice of the workhouse, in the same manner as the similar tables of 1857 and 1858. A comparison of the three years may thus be so readily made that I shall only add a very few words of comment : — * 112 or 130; there are 18 cases against, which no sufficient entry is made in llie hospilal books. Of this total number of children horn here, about 13 only thouId be reckoned a-i belonging to St. Giles' Distiict. Cases of Disease and Deaths, occurring in the Practice of the Workhouse, in the Four Quarters of 1859. Cases occurring— Within Walls of Workhouse, (Infirmary and Inmates.) Among Out-Patients attending at Workhouse. Among Patients visited at their own homes. Quarters of the Year. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. First. Second Third. Fourth' Whole Year. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. Cases. New Cases. Deaths New Cases. Deaths New Cases. Deaths New Cases. Deaths New Cases. Deaths New Cases. No Deaths. New Cases. Deaths New Cases. Deaths New Cases. Deaths New Cases. Deaths New Cases. Deaths Of all Diseases 265 56 184 46 241 54 284 72 974 228* 1385 1767 2231 1335 6718 461 31 499 37 407 30 455 39 1822 137 Small Pox - - 4 - 8 1 11 1 23 2 2 - 3 15 20 5 1 13 — 18 — 53 4 89 5 Measles — — 1 — 9 — — — 10 — 5 66 57 3 131 7 — 102 4 63 — 10 1 182 5 Scarlet Fever 1 — 1 — 2 — 4 — 8 — 5 2 4 8 19 23 6 16 3 6 — 29 2 74 11 Whooping Cough 2 2 — — 1 — 1 — 4 2 56 89 29 5 179 11 1 20 5 — — 2 — 33 6 Diarrhoea 1 — 6 — 7 — 2 — 16 — 78 157 920 126 1281 3 — 11 — 39 5 16 1 69 6 Feverf and Febricula 12 — 9 2 14 — 14 1 49 3 167 245 177 101 690 59 — 68 — 47 1 48 2 222 3 Ague — — 1 — 4 — 1 — 6 — 4 3 4 4 15 8 — 2 — — — 1 — 11 — Bronchitis (acute and chronic) 43 8 19 6 15 6 67 16 144 36 481 309 175 387 1352 54 3 21 2 15 — 111 10 201 15 Inflammation of the Lungs & Pleura 4 1 — — 3 1 1 — 8 2 7 1 2 12 21 14 3 11 6 13 1 7 2 45 12 Consumptive diseases 27 15 31 19 17 17 24 18 99 69 19 24 15 24 82 16 5 20 2 14 6 27 6 77 19 Ophthalmia 12 — 3 — 3 — 15 — 33 — 14 26 7 7 54 — — 1 — 1 — 2 — 4 — * Returned by the Registrar General at 226, in the 52 weeks. † The term "Fever," here includes symptomatic as well as idiopathic fevers. It is impossible to separate the one class from the other in the Registers ot tue Workhouse. There is a large proportion of idiopathic cases in the first and last divisions of the table; while in the middle division the so called "fevers" are for the most part only symptomatic. 16 The total number of persons treated within the workhouse was greater than in 1858, but considerably less than in either of the two years preceding. The high mortality of 23 per cent, of the cases treated resulted as usual from the nature of those diseases which compel their victims to seek shelter in the workhouse. A hundred and nine deaths were among persons who had been resident for some length of time in the house. Among these were three deaths from fever, which was presumably contracted within the workhouse walls. Although twenty-three cases of smallpox were treated in the infirmary, the disease did not spread at all among the inmates of the house; a very gratifying fact, and one which furnishes excellent proof of oar ability to prevent the spread of this most contagious of diseases. I myself had no share in the merit of these successful hygienic measures, which were effected wholly under Mr. Bennett's superintendence.* The great rise in the number of persons attending for medical advice at the workhouse is partly due to the prevalence of measles, whooping-cough, and slight febrile attacks in the first half of the year, but chiefly to the large amount of summer diarrhoea, of which there was more in three weeks of July, 1859 than in the whole three summer months of 1858. The same prevalence of the class of zymotic diseases is the cause to which we must also ascribe the increase in the number of patients visited at home. Here I beg to be allowed a moment's digression. I wish to add my tribute of regret to that of the whole of our poor population, at the loss which the parishes have sustained in the premature death of the Visiting Surgeon of the Workhouse. Mr. Knaggs's loss will be greatly felt by the sick poor of St. Giles's, to whom he was endeared by his great assiduity and kindly sympathy. The following scheme shows the amount of relief afforded to the poor by the Bloomsbury Dispensary in each quarter of the year. As might be expected from the manner in which medical assistance is here granted, the numbers do not vary so much from one quarter to another as in the practice of the workhouse :— New Cases treated at Bloomsbury Dispensary, 1859. Quarter ending Physician's Cases. Surgeon's Cases. Total. Admitted. Visited at home. Died. Admitted. Visited at home. Died. Admitted. Visited at home- Died. March 25th 600 111 12 191 30 - 791 141 12 June 24th 652 80 19 207 24 1 759 104 20 Sept. 29th 614 93 18 232 22 1 846 115 19 Dee. 25th 557 138 16 261 47 5 818 185 21 Whole year. 2323 422 65 891 123 7 3214 545 72 In my report for 1858 I found that after allowance made for the propensity of patients to seek medical aid at the place nearest them, little information was got from an examination of the localities from which sick persons came to the public institutions of the district, beyond what had already been ascertained from the death returns of the year; I have therefore not entered on this examination in the present report, except in the case of smallpox, and the result of my inquiries as to this disease will be found in the following chapter. * It is curious to remark that in October, just before tbe great rise in Small-pox, there was quite a little epidemic of Cuieken-pox treated in the infirmary, of which disease there was none before or since. Constant experience seems to show that the localities affected by true Chicken-pox are those that suffer most from Small-pox. 17 In tlie British Lying-in Hospital two mothers and six children died in 1859, out out of 112 (or 130, see Note, p. 29) women delivered. Some considerations on the cause of certain of these deaths are offered in the last pages of this report. In the Streatham-street Model Houses for Families three children died of scarlatina in the middle of the year. These, with one death from hydrocephalus, were all that occurred there. As far as I have been able to ascertain, these buildings had absolute immunity from smallpox in the months of the epidemic. I can only learn of one resident of the model lodging-houses of George-street who died in 1859. His name is on the books of Middlesex Hospital as dying of apoplexy. Chapter VI.— On the prevalence of Smallpox. I have chosen to consider this subject in a chapter by itself, partly on account of its importance and the direct dependence of the disease oil the want of known preventive measures, and partly because it would be bootless to consider the outbreak of 1859 without also tracing it to its end in the year 1860. In each of my former annual reports I have had occasion to comment on the existence of smallpox in St. Giles' district. It was recorded that in 185S the disease was becoming tnore frequent in various parts of the town, and that our own district experienced a disproportionate share of the increase over 1857. In the first three quarters of 1859 the disease manifested itself here and there without being more fatal than in the preceding twelvemonth; but in the last quarter it became more frequent, until in December it was the exception for a week to pass without several deaths being registered from smallpox. The whole number who died in this quarter was fourteen. In January, 1860, ten deaths occurred from this disease; in February there were four, and in March none. In its earlier manifestations the disease did not appear to be much localised, but towards the end of the year 1859 it had taken firm root in the streets leading eastward from Drury-lane. If proof had been wanted that the extension of the disease was due to neglect of vaccination, it was found in the fact that all those who died of it* were unprotected by this operation. As soon, therefore, as the disease threatened to assume an epidemic character, in the middle of December, I drew up a handbill (which is copied in the Appendix) warning people of the danger, and begging them not only to see to the vaccination of their children, but to let the operation be repeated on every member of their family whose safety was not assured beyond all reasonable doubt. At the end of December, and in the first weeks of January, six thousand of these handbills were tirculated by direction of the Board. Our rectors and clergy, ministers of religion of every denomination throughout the district, district-visitors and scripture-readers, aided in their distribution with a zeal for which I most heartily thank them ; and they thus enabled me to put my warning into the hands of the poor, backed by all the authority which they had acquired in long years of charitable ministrations. Many of the principal employers of labour, also, gave me the opportunity of addressing the handbill to their men. At the same time I myself examined the children of the schools. Besides nine public schools I visited several private ones, always examining every child's arms, and noting the quality of the vaccine cicatrices. The following aggregate result was obtained :— Total Children examined, 905. Without any vaccine mark 127 Doubtful if any mark 11 Unprotected . 138 With one faint mark 41 „ one good mark ll5 Imperfectly pro- „ two faint marks 53 teCted 209 * With one exception tnore apparent than real; a woman suffered from smallpox after vaccination, and was convalescing satisfactorily when she died suddenly without appareut cause. 18 With two good marks 157 „ three marks 213 „ four marks 126 „ five or more marks 62 Protected 558 The large proportion, therefore, of 15 percent. was found wholly unprotected. In others of the metropolitan districts this per-centage has been usually found to be ten or twelve only. Another twenty-three per cent., too, were very imperfectly secured against smallpox. Every house that became infected was anxiously examined, the vaccination of its inmates assured, and means suggested for preventing contagion. The Sanitary Inspector, meanwhile, was busily inquiring from house to house in the infected neighbourhoods as to the existence of new cases, and as to the performance of vaccination , and he brought to light nearly a hundred cases where the operation had been omitted. In these steps that were taken for the detection of unvaccinated persons, and for rousing them to a sense of their danger, I was greatly assisted by the advice and co-operation of Dr. Seaton, who was appointed by the Privy Council to make inquiries on the epidemic of smallpox, and the state of vaccination in the metropolis. The greatest facilities for vaccination were afforded to every one who applied by the Public Vaccinators, Messrs. Bennett and Knaggs; and in order to meet the requirements, frequently urged, of people who object to apply at the workhouse, Mr. Cooper, the Surgeon of the Bloomsbury Dispensary, kindly undertook to vaccinate at that institution. Moreover, in the third week of January, finding that smallpox was continuing its ravages, Dr. Seaton prevailed on the Public Vaccinators to visit systematically, lancet in hand, from room to room, through the infected streets. Large numbers of children were thus reached whose parents had been too supine to take them to the operator. The number of vaccinations by the Public Vaccinators now rose from an average of fifty in the fortnight, at which they had stood during the last quarter of 1859, to a hundred and forty-three in the first half of January, and five hundred and sixtyseven in the second half. In addition to these, 76 persons were vaccinated in January, at the Bloomsbnry Dispensary, making a total of 786 persons gratuitously vaccinated within the month. Of the cases operated on by Messrs. Bennett and Knaggs two-thirds were above one year of age, and 169 of those vaccinated in January were entirely unprotected. Considerable arrears and long neglect were therefore made up in a few weeks, and nearly 100 persons whose scars showed them to be imperfectly kept from smallpox received the benefit of a second vaccination. These figures do not include 126 children of the Refuges in Great Queen-street and George-street, who were vaccinated later on, in February, by Mr. Spencer Watson. Of these 126, fifteen only were wholly without vaccine marks, yet the operation was perfectly successful in 39 cases, and partially successful in forty-two. The result of this great extension of vaccination was shown in the diminution of Small-pox mortality between January and February. That this diminution did result directly from the vaccinations, and not from the epidemic spontaneously exhausting itself, is shown by some very interesting considerations derived from the medical practice of the workhouse, which were first pointed out to me by Dr. Seaton:— Of the cases of smallpox that came under treatment by the workhouse surgeons, the number among unvaccinated persons fell very remarkably just at the time when the community had become better protected by the measures above detailed. It was in this class of patients exclusively that the deaths occurred. We may therefore conclude that the fall in the mortality of small-pox resulted from the extinction of this class of unprotected persons, unless it should be shown that the epidemic itself had notably abated its violence at this very moment. This, however, was positively not the case, for among those who were partially protected by vaccination, and therefore had the disease more mildly, as large a number of smallpox cases occurred for some time after this wholesale vaccination as before. It seems, therefore, certain that the only circumstance to which we can ascribe the saving of some 19 dozens of lives, and the rapid disappearance of the epidermic, was the energetic use of that wonderful means which Providence has placed at our disposal for the prevention of smallpox. The following are the figures on which this conclusion is founded. The new cases of smallpox in the workhouse practice were: — In October, eleven. Previously vaccinated six, no death; unvaccinated five, one death. In November, twelve new cases. Among the vaccinated five, no death; unvaccinated seven, two deaths. In December, the disease being more virulent and localized, thirty-seven cases. Previously vaccinated, twenty-one, one death (see note; p. 32); unvaccinated, sixteen, of whom six deaths. In the earlier half of January, twenty-eight new cases. In the vaccinated, sixteen, and no death; in the unvaccinated twelve, and five deaths; The disease increasing, and the proportion of unprotected persons attacked also being on the rise. Now the activity of vaccination at the workhouse was at its height, and here is the result In the latter half of January there were 19 new cases. Previously vaccinated, seventeen (not less than in the former half of the month), and no death; unvaccinated only two, and one death. In the first half of February the new cases of smallpox among persons previously vaccinated were fourteen, no death ; among unvaccinated persons two cases* and no death. The disease now became every day less prevalent, and by the beginning of March it had almost lost its epidemic character. How many scarred faces as well as deaths were saved by these vaccination measures may be judged of from the fact that of persons previously vaccinated, only tone in forty had the confluent disease, while the unvaccinated were seamed by the severest form of smallpox in three cases out of four. Another consideration, corroborative of the conclusion to which we have been drawn, as to the persistence of the epidemic influence over our district after the mortality had fallen, may be derived from examining the death-returns of other parts of London. The deaths from smallpox in the metropolis were, in January, 142, and in February 151, a rise instead of a decline. In the central districts of the town, excluding St. Giles, they were 19 in January, and 21 in February—again a rise. In our own district, as has been said, the deaths that were ten in January numbered only three in February. The situation of the epidemic of smallpox is indicated by the numbers accompanying the letters S. P. on the appended diagram, the fatal cases being distinguished from the others. All cases occurring between Sept. 29,1859, and Feb. 20, 1860, in the practice of the workhouse and Bloomsbury Dispensary are there noted. The cases of the latter institution were much scattered, and have no bearing on the epidemic in South St. Giles's; There was no death among the smallpox patients of this dispensary. On the giving way of the epidemic in South St. Giles's, measures were at once taken to have the infected houses well cleaned, limewhited, and fumigated with burning sulphur, and these means appear to have assisted in removing the contagion. Chapter VII.—The Sanitary Proceedings of the Year. House Improvement.—The figures of the subjoined table will be found to be much larger than those of the preceding year. The increase is a great measure *Two only in the infected neighbourhood. Three other cases in a single family in another locality do not affect the argument. House improvements in the several Localities of St. Giles's, effected under the superintendences or Inspector Webb, between March 25th, 1859, and March 25th, 1860. House improvements in localities. A. B. C. D. E. F. G. H. K. L. Whole District of St. Giles. Unclassified houseimprovements, and Remarks. Around Bedford Square. Around Russell Square. Around Coram Street. Around Bloomsbury-sq. Around Church Lane. Around Dudley Street. Around hort's Gardens Around Northern part of Drury Lane. Around Southern part of Drury Lane. Around Lincoln's Inn Fields. Number of houses improved. 13 40 94 28 55 74 37 103 78 6 528 Fevedilapidated houses pulled down by direction of Police, at instance of Sanitary Inspector; 3 in locality F, and two in H. In subdivision E, behind Church Lane, two tenements removed fur belter ventilation. Improvements in Drainage. Drains constructed 11 11 20 15 7 18 10 13 2 2 109 Improved or Repaired 1 2 16 2 16 15 5 6 36 2 101 Traps fixed 9 29 40 12 20 51 18 51 63 2 285 Cesspools abolished 6 11 6 13 2 9 3 5 7 1 63 Cesspools cleaned only — — — — — 1 — — - - 1 Stables drained and Horsepools abolished 4 29 18 1 — 1 — — — 53 In Water Closets. Pap, trap, and water provided 7 18 8 5 11 11 6 10 32 2 110 Water and apparatus only provided 2 8 27 9 9 33 8 38 19 - 153 Cleaned or repaired. — — 5 3 14 7 3 23 23 - 78 Newly constructed or re-built 3 8 5 1 4 1 3 3 10 2 40 In Dust Bins. Newly constructed - 12 3 1 2 8 2 8 - 1 37 Two privies removed: one in B, one in K. 1 Repaired or covered — — 9 4 4 14 9 24 30 2 96 Paving. Re-laid — 13 10 5 12 3 3 10 24 — 80 Two large new cisterns in Church Lane, E, to supply between twelve and twenty houses with water. In General Water Supply. Receptacles provided 2 12 10 10 6 7 10 26 18 2 103 Receptacles repaired — 5 4 1 4 11 7 3 25 1 bl Water supply provided where none in house before - 1 1 — 4 — — — 1 — 7 In Cleanliness and Repair. Generally repaired . . . - 1 - - 18 8 1 2 24 - 54 Cleansed and Lime-whited 4 23 49 15 46 64 29 83 73 2 388 Numbers on Table include many arrears from 1858-59; comparatively few works stand over at date of this report. Various accumulations removed from Cellars, &c. 1 1 2 1 11 10 5 10 18 - 59 In Ventilation &c. Ventilation improved - 6 2 - 15 4 1 - 23 1 52 Overcrowding reduced - - - 29 1 1 1 1 - 33 Kitchens disused - - 5 — 2 3 1 4 2 - 17 „ made legally habitable - - 25 1 - - 2 3 - 31 Other rooms disused — 1 1 1 — — 1 — — — 4 Proceedings taken. First notices 12 35 98 26 20 140 40 122 50 26 569 "First Notices" include orders about underground dwellings. Second notices, letters, &c. 4 7 11 5 1 8 7 5 7 - 55 Summoned - 1 1 - 2 2 1 - - 7 Reported to Police or District Surveyor - 1 - — — 4 1 2 5 - 13 Total Improvements 150 191 266 110 236 270 128 323 421 20 2015 21 artificial, arising from large arrears of 1858-59 being included in the return of the year ending Lady Day, 1860. But a larger number of houses than usual have really been dealt with in the course of this year, owing to the necessity which arose, after the prevalence of smallpox, of having all the infected houses cleaned and purified. The total of the houses subjected to improvement through the proceedings of the sanitary officers was 528 in 1859-60, against 432 in 1858-59; and the total number of works executed was 2,0l5, in place of 1,347 in the previous year. The largest amount of sanitary work was done in the localities lettered H. and K. on the diagram—those lying east of Drury-lane. In the latter of these is included the radical improvement of twenty-two houses in Lincoln-court, which became re inhabited only in January, 1860. Much labour was also given to the parts around Dudley-street, where there is always an inexhaustible field for improvement. Church-lane district, too, contributes much to the numbers of this table, from the systematic improvements begun in 1858 being here recorded. We have seen the good fruit that has already been borne by these sanitary measures, In other districts, too, there has been ample scope for improvement. The mews of Bloomsbury will be found to occupy a conspicuous position on the foregoing list. Fifty-three stables have been properly drained, many of them being supplied with water-closets, and the ventilation of the dwelling-rooms above has been made efficient. In several instances, rather than effect the alterations required to fit such rooms for a dwelling place, the owners have chosen to discontinue letting them. Five houses, which were in every sanitary respect extremely faulty, have been condemned by the police authorities on representations from this Board, and have been rebuilt in a satisfactory manner. An old house at the corner of Endell-street and Broad-street, which had been a nursery of disease for years, has lately been replaced by a structure of very different characters. In this place I cannot refrain from expressing the gratification I reoeive, as Healthofficer, from witnessing the rapid progress of the new Schools in Broad-street. On the one hand the parish has gained materially by the displacement of a number of squalid, unwholesome tenements; and on the other hand, the children of the schools will exchange a most unhealthy, confined atmosphere for the free air and admirable arrangements provided by the new structure. The practice of overcrowding rooms occupied by single families has been combatted with success in the neighbourhood where this evil prevailed most seriously. After a few proceedings had been successfully taken before the magistrate, an enumeration of the inhabitants showed that the rooms of the Church-lane quarter were less thickly tenanted than previously. This reduction in the actual number of residents has doubtless contributed to make the deaths fewer : but the improvement of the death register for this neighbourhood is mainly to be ascribed to the effect of this and other sanitary measures on the health of those left behind. In other localities few flagrant instances of overcrowding have come to light, the handbill that was so industriously circulated in 1858 seeming still to be remembered by the holders of the poorest houses. The occupation of underground dwellings, not possessing the legal requirements of area and ventilation, has steadily engaged the attention of the Sanitary Committee. Where a trifling alteration sufficed to bring a kitchen into conformity with the law, notice was given to the owners to do the required works. Between Lady Day, 1859, and Lady Day, 1860, such alterations were made in, the following places:— (C) Little Coram-street, Nos. 4, 6, 20, 28, 31. (C) Colonnade, No. 37. (C) Marchmont-place, Nos-1, 2, 3, 4, 5,6, 7, 9,11,13,18,19. (C) Chapel-place, Little Coram-street, Nos, 3,5, 6, 9. (H) Smart's-buildings, Nos. 4,5,6. 22 While in the following instances an improvement to meet the letter of the law did not appear at all adequate to meet the sanitary requirements of the underground rooms, and could not be undertaken without injuriously interfering with the streetpaving, which is the property of the Board. In these cases, therefore, the underground rooms were simply disused as dwelling places, no alternative of alteration being allowed by the order of the Board. They were— (C) Colonnade, Nos. 35 and 36. (C) Chapel-place, Nos, 22 and 23. (E) Maynard-street, Nos. 3 and 4. (F) Dudley-street, Nos. 29 and 31. (F) High-street, No. 52. (G) Lascelles-place, No. 9. (G) Short's Gardens, Nos. 18 and 19. (H) Coal Yard, Nos. 19 and 20. (H) Smart's-buildings, Nos. 4,5, 6. (H) Newton-street, Nos. 22 and 26. (K) Little Wild-street, Nos. 8 and 9. In the prosecution of these measures a not unexpected difficulty has arisen. The profit derived from letting the basement of these houses as dwelling-rooms was too strong a temptation for their owners, and many of the kitchens were let again almost as soon as the inspector had reported them emptied. In Dudley-street particularly, many of the cellars that were reported empty in my last return, speedily became again occupied. Much time and pains have been unnecessarily consumed in preventing the infringement of the law. The heavier fine attendant on second convictions will operate, it is hoped, to keep these cellars empty.* While speaking of the resistance met with in enforcing sanitary requirements, it may here be mentioned that the extreme step of imprisoning the owner of a certain house has been had recourse to, for his obstinate refusal to comply with a magistrates order. Though the Board exercises its functions so tenderly that 500 houses have been improved with only seven applications to the magistrate, it is well that recusants should know that it has an authority which cannot safely be set at defiance. In the coprse of the year a multitude of most instructive instances have arisen, illustrating the connexion between zymotic disease and bad local arrangements. Two or three may be cited with profit.—In a house in Tottenham-court-road three persons died from scarlatina. Two cesspools were found, with an old defective drain. Into the untrapped pan of the closet opened the waste-pipe of the water butt, so that the effluvia of the cesspool were directly guided upwards to befoul the only drinking fluid of the household.— In a house in Duke-street, Lincoln's-inn-fields, a young woman died of typhoid fever; other inmates had lately suffered from the same disease. I was shown 9. large airy room on the first floor, with the unusual advantage of windows back and front, yet in which never a year passed without seriousillness, often of the character that had lately prevailed. Cholera was here in the epidemic of 1849. The cause of this illness did not appear in the drainage of the basement, nor until we had mounted to the top of the house. Immediately under the roof was a room let out to some very poor people at a trifling rent; into this room entered one of the heads of the waterspout, and this ended below by an open channel, without any incline, under the sill of the first floor window. What matters were thrown down this pipe to stagnate under the careless nostrils of the dwellers below, need not be specified to those who know the customs of our ignorant poor.— These are every-day sort of cases. Another that I shall adduce is exceptional, but very illustrative of the need of an intelligent watchfulness. The Endell-street Lying-in Hospital, which has usually such an excellent character for salubrity, lost, *Since tbe time to which this report refers, Lady-day, 1860, the owners of eight houses in Dudley-street have been summoned, and convicted of letting cellars illegally. The example has operated so well that at the present time (June, 1860), not a single cellar iu the street is occupied at night. 23 in July, 1859, two children from erysipelas. No other similar case occurred, but in December a mother died from puerperal peritonitis. Rendered suspicious by these cases, I took the opportunity of the next death, in April, 1860 (which was also, though perhaps erroneously, registered as erysipelas,) to address a letter to one of the physicians, my friend Dr. Hewitt, begging him to investigate the general sanitary state of the hospital, and offering my assistance. Then the following history came out: On the building of the present hospital, in 1849, the drainage of the new building was made as complete as possible; but it was considered sufficient simply to cover over an old cesspool that had belonged to the houses formerly on the site. This was done with a pavement of asphalte, and the cesspool was forgotten, until Dr. Hewitt's investigation. Then it was ascertained that the pavement of the yard was cracked. The date of this crack could not be exactly learned, only that it must have begun nearly a year ago. At the time of examination the fissure was upwards of an inch in breadth, and it communicated directly with the mass of ever-active poison below. The emptying of this old cesspool was nowise a safe or pleasant business, but with the precautions employed, happily no ill results ensued from its disturbance. In this instance I will not say that complete proof is yet afforded of the relation of cause and effect between the exposed cesspool and the deaths from zymotic disease; but I think that connexion will be placed beyond doubt if we find that, in succeeding years, the hospital returns to its ordinary immunity from such diseases. There is nothing material to record about the slaughter-houses of the district. The drainage of one or two has been improved, but in one instance not until two cases of diphtheritis had occurred in a neighbouring cottage, under the flooring of which the leakage of the slaughter-house had stagnated. The cowhouses continue to be as great a nuisance as ever. A faithful delineation of one of them, in the Builder of last year, showed a place that no one unacquainted with the establishment itself could have imagined possible to find in the heart of London in 1859. Yet the Builder's drawing only gave the more favourable aspect of the matter, the outside of the cowhouse. Some of the proprietors have, indeed, made improvements, but as a rule these establishments must be regarded as unmitigated nuisances. There is no occasion for their existeuce in the central districts of London, for country milk can be easily and regularly supplied to the town at all seasons, as the experience of several large dairies has shown. A bill is at present before Parliament requiring all cowsheds to be licensed in the same way as slaughterhouses; and I trust we shall soon be enabled to get rid of those, at any rate, which are most offensive. Only two other nuisances arising in the operations of trade have been brought under investigation iu 1859. Dealing with these cases in the spirit of the Nuisances Removal Act, the Board has not seen occasion to interfere for the protection of the public. I need, therefore, report no further on the subject. A drinking-fountain, erected at the cost of Mr. Langdale, in Endell-street, afforded pure water to the passers-by through the whole of last summer. The trustees of the British Museum, I believe at the suggestion of the Board, have also erected two very tasteful fountains under the portico of the Museum. Such facts cannot be omitted from a sanitary report, and the contrast between the wholesome water of these fountains, and the impure fluid of the street pumps cannot be too often impressed on our minds. The erection of other drinking-fountains has been delayed, but next year I hope to report several additions to these valuable and healthful institutions, If the functions of the Health Officer were solely for the service of the poor, and if he were not often called upon to advise the better classes, I should hesitate in congratulating, from a sanitary point of view, the united parishes on the formation of their Volunteer Rifle Corps. Besides the advantage of exercise and discipline to the "physique" of Londoners, I believe a most salutary use of the movement will be to hasten on, by the knowledge it will diffuse and the contrasts it will furnish, the progress of sanitary reform in the regular army. 24 Of the measures employed in subduing the late outbreak of smallpox, I have already said enough; but to prevent such an epidemic for the future, we must secure the complete vaccination of every child in the parish. As a preliminary to this, it is essential that the Birth of every child should be registered; and a petition to Parliament has lately been adopted by the Board, (Appendix VIII.) urging the desirability of a measure to this effect. If this first step should be gained, other more exact legislative measures will then be required to ensure the protection of vaccination being extended to every child born. At present it is nobody's business to-enforce the law which forbids the caprice or ignorance of a parent exposing his child to disease and death, and the community to a constant source of danger. The Association of Health Officers have had this defect of the law under their most anxious consideration, and their representations to Government on the subject have been very well received. In a matter of this kind, however, the action of Government requires to be preceded by an expression of public opinion, It is quite as right and as needful that the Legislature should protect a man against the danger of an unvaccinatcd family next door, as against a neighbour who should choose to keep barrels of gunpowder in his house. Petitions to Parliament should be adopted, praying that the laws relating to vaccination may be made more efficient, and Government would thus be justified in advancing—what I know them to be anxious for—a scheme for the effectual prevention of the ravages of smallpox.* GEORGE BUCHANAN, B.A., M.D., Londin, Member of the Royal College of Physicians; Physician to the Western General Dispensary, Medical Officer of Health. *By the repeal of Clause VIII. in the Public Health Act of 1858, the authority of the Directors of the Poor to appoint persons to enforce the Vaccination Laws is at an end. APPENDIX TABLE I.—Mortality per Thousand in London, in the Divisions of London, and in St. Giles, in 1859, and in preceding Years. Note.—The numbers are computed on the population of the period named, and comparison made throughout from the printed returns of the Registrar General. Mean of Ten years, 1847 to 1857. Death rate of three last years, each corrected to 365¼ days. 1857. 1858. 1859. London 24.46 22.20 23.56 22.29 West Districts.—(Kensington, Chelsea, St. George, Hanover-square, Westminster, St. Martin, St. James) 22.76 20.81 21.77 20.83 North Districts— (Marylebone, Hampstead, Pancras, Islington, Hackney) 22.15 21.22 22.48 21.16 Central Districts.—(St.Giles, Strand, Holborn, Clerkenwell, St. Luke, East London, West London, London City) 24.35 22.93 23.16 22.64 East Districts.—(Shoreditch,Bethnal Green, Whitechapel, St. George's East, Stepney, 25.84 24.35 25.30 23.31 South Districts.—(St. Saviour St. Olave Bermondaey, St. George Southwark, Newington, Lambeth, Wands worth, Camberwell, Rotherhithe, Greenwich, Lewisham) 26.28 21.60 24.26 22.92 St. Giles's 26.89 26.58 24.89 24.81 TABLE II.— Deaths in Hospitals among Patients brought from St, Giles's and neighbouring Districts, 1859. Distrets. Total ascertained | Deaths in London Hospitals. King's College. Hospital (Strand). Middlesex Hospital (Marylebone.) | Charing Cross | Hospl. (St. Martin, University College Hosp. (St.Pancras.) | Children's Hospital (Ho: born.) St. Bartholomew's Hospl. (W.London) Royal Free Hospl. (St. Pancras.) | London Fever Hosp (Islington.) Westminster Hosp. (Westminster.) St. Mary-Hospital, (Padding on.) Deaths in Hospitals out of the district. St. Pancras 191 5 37 2 75 13 21 25 13 ... ... 91 St. Marylebone 138 2 60 1 17 3 2 2 4 ... 47* 78 Metropolis 3358 147 212 73 147 60 543 66 112 ... ... ... Holborn 60 16 1 0 1 8 21. 7 6 ... ... 52 Strand 72 47 11 14 0 3 2 2 3 ... ... 35 St. Martin 39 8 0 16 1 1 3 1 1 8 ... 23 St. Giles 74 26 16 9 7 5 9 1 1 ... ... 74 The figures in the above table were obtained by personal inspection of the books of the several Hospitals, with the exception of those marked with a star, and for these I have to thank Dr. Thomson and Mr. Beale, the Officers of Health of the respective districts. † Besides these, I have informal ion since this table was made, of 10 deaths of St. Giles's patients in the Westminster Hospital in 1859. TABLE III.—Causes of Deaths in St. Giles's, in 1859, with the Ages at Death. DISEASES IN CLASSES. Class. Causes of Death. At all ages. Under 2 years. 2 and under 5. 5 and under 10. 10 and under 20. 20 and under 30. 30 and under 40. 40 and under 50. 50 and under 60. 60 and under 70. 70 and under 80. 80 and under 90. 90 and upwards. Male. female. Total. All causes 727 687 1414 451 152 70 45 71 110 138 119 125 85 45 3 Specified causes 723 673 1396 442 152 70 44 71 108 137 115 124 85 45 3 (Classes.) I. Zymotic Diseases 200 174 374 174 101 39 10 9 10 14 9 4 4 ... ... II. Constitutional „ 201 146 347 56 21 7 23 39 55 64 44 29 7 2 III. Local „ 247 259 506 146 27 10 8 17 34 53 56 83 50 15 1 IV. Developmental „ 47 77 124 48 1 1 1 3 7 ... 3 6 24 28 2 V Violent Deaths 28 17 45 18 2 7 2 3 2 6 3 2 ... ... ... (Orders,) I. 1. Miasmatic Diseases 184 164 348 1G4 100 39 9 8 8 8 6 2 4 ... ... 2. Enthetic „ 2 2 4 3 ... ... ... ... ... 1 ... ... ... ... ... 3. Dietic „ 14 8 22 7 1 ... 1 1 2 5 3 2 ... ... ... 4. Parasitic „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... II. 1.Diathetic „ 18 39 57 1 ... ... 1 3 6 9 18 10 7 2 ... 2. Tubercular „ 183 107 290 55 21 7 22 36 49 55 26 19 ... ... ... III. 1. Diseases of Nervous System 78 86 164 69 11 5 ... 7 10 11 9 20 16 5 1 2. „ of Organs of Circulation. 27 24 51 ... ... 1 3 4 8 13 10 7 4 1 ... 3. „ of Respiratory Organs 107 117 224 72 13 6 8 2 9 12 30 42 26 9 ... 4. ,, of Digestive Organs 23 20 43 4 2 1 ... 2 5 9 5 13 2 ... ... 5. „ of Urinary Organs 9 5 14 ... ... 1 1 1 1 7 1 ... 2 ... ... 6. „ of Organs of Generation. ... 4 4 ... ... ... ... 1 1 I ... 1 ... ... ... 7. „ of Organs of Locomation. 1 3 4 ... 1 2 ... ... ... ... 1 ... ... ... ... 8. „ of Integumentary System 2 ... 2 1 ... ... 1 ... ... ... ... ... ... ... ... IV. 1. Devl. Diseases of Children 12 8 20 20 ... ... ... ... ... ... ... ... ... ... ... 2. „ of Adults ... 12 12 ... ... ... 1 3 7 ... ... 1 ... ... ... 3. „ of Old People 22 40 62 ... ... ... ... ... ... ... 3 5 24 28 2 4. Diseases of Nutrition 13 17 30 28 1 1 ... ... ... ... ... ... ... ... ... V. 1. Accident or Negligence 21 17 38 16 2 7 2 2 1 5 2 1 ... ... ... 3. Homicide 2 ... 2 2 4. Suicide 5 ... 5 ... ... ... ... 1 1 1 1 1 ... ... ... 5. Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths not classed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Deaths, cause unascertained 1 2 3 1 ... ... 1 ... ... ... 1 ... ... ... ... Causes not specified 3 12 15 8 ... ... ... ... 2 1 3 1 ... ... ... TABLE III.—(continued). DISEASES IN ORDERS. Class. Causes of Death. At all ages. Under 2 years. 2 and under 5. 5 and under 10. 10 and under 20. 20 and under 30. 30 and under 40. 40 and under 50. 5l and under 60. 60 and under 70. 70 and under 80. 80 and under 90. 90 and upwards. Male. Female. Total. I. Order 1. 1. Small Pox 13 9 22 5 5 7 1 2 1 1 ... ... ... ... ... 2. Measles 26 26 52 27 21 4 ... ... ... ... ... ... ... ... ... 3. Scarlatina 47 35 82 24 33 17 1 2 1 3 ... 1 ... ... ... 4. Quinsy 1 1 2 1 ... 1 ... ... ... ... ... ... ... ... ... 5. Croup 6 2 8 2 2 3 1 ... ... ... ... ... ... ... ... 6. Whooping Cough 30 36 66 39 26 1 ... ... ... ... ... ... ... ... ... 7. Typhus & lnfte Fvr. 16 10 26 2 4 6 3 3 3 2 3 ... ... ... ... 8. Erysipelas 6 5 11 7 1 ... ... ... 1 1 1 ... ... ... ... 9. Metria ... 2 2 ... ... ... ... 1 1 ... ... ... ... ... ... 10. Carbuncle ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... 11. Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Dysentery 1 1 2 2 ... ... ... ... ... ... ... ... ... ... ... 13. Diarrhoea 34 32 66 53 7 ... ... ... ... ... 2 1 3 ... ... 14. Cholera 1 1 2 1 ... ... ... ... ... ... ... ... 1 ... ... 15. Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16. Remittent Fever 1 1 2 1 1 ... ... ... ... ... ... ... ... ... ... 17. Rheumatism 2 2 4 ... ... ... 3 ... ... 1 ... ... ... ... ... Order 2. 1. Syphilis 1 2 3 3 ... ... ... ... ... 1 ... ... ... ... ... 2. Stricture of Urethra 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 3. Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 3. 1. Privation ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... 2. Want of breast-milk 2 4 6 6 ... ... ... ... ... ... ... ... ... ... ... 3. Purpura and Scurvy 1 2 3 1 1 ... 1 ... ... ... ... ... ... ... ... 4. Alcoholism a Del Tremens. 8 ... 8 ... ... ... ... 1 2 3 2 ... ... ... ... b Intempera ce 3 1 4 ... ... ... ... ... ... 1 1 2 ... ... ... Order 4. 1. Thrush ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Worms, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... II. Order 1. 1. Gout 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 2. DropSy 7 9 16 ... ... ... ... 1 1 2 4 4 4 ... ... 3. Cancer 10 25 35 ... ... ... ... 2 5 6 13 6 3 ... ... 4. Noma ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 5. Mortification ... 4 4 ... ... ... 1 ... ... 1 ... ... ... 2 ... Order 2. 1. Scrofula 1 1 2 ... ... ... 1 ... 1 ... ... ... ... ... ... 2. Tabes Mesenterica. 12 7 19 12 6 ... ... ... 1 ... ... ... ... ... ... 3. Phthisis 135 81 216 6 2 5 20 36 47 55 26 19 ... ... ... 4. Hydrocephalus 35 18 53 37 13 2 1 ... ... ... ... ... ... ... ... III. Order 1. 1. Cephalitis 7 7 14 7 4 1 ... 2 ... ... ... ... ... ... ... 2 Apoplexy 12 18 30 ... ... ... ... 1 5 4 4 7 7 2 ... 3. Paralysis 13 19 32 ... 1 1 ... 1 2 1 4 11 8 3 ... 4. Insanity ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 5. Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Epilepsy 7 3 10 ... ... ... ... 2 2 3 1 1 1 ... ... 7. Couvuls ons 34 36 71 62 6 2 ... ... ... ... ... ... ... ... ... 8. Brain Disease, &c. 5 2 7 ... ... 1 ... 1 1 '3 ... 1 ... ... ... Order 2. 1. Pericarditis 2 1 3 ... ... ... 2 ... ... ... ... ... 1 ... ... 2. Aneurism 1 1 2 ... ... ... ... ... ... 1 1 ... ... ... ... 3. Heart Disease, &c 24 22 46 ... ... 1 1 4 8 12 9 7 3 1 ... Order 3. 1. Laryngitis 4 1 5 3 1 ... ... ... ... ... ... ... 1 ... ... 2. Bronchitis 61 70 131 19 7 1 ... ... 5 7 24 39 22 7 ... 3. Pleurisy 2 2 4 ... 1 1 ... ... 1 1 ... ... ... ... ... 4. Pneumonia 33 40 73 50 4 4 3 1 3 1 4 ... 1 2 ... 5. Asthma 5 2 7 ... ... ... ... ... ... 2 2 1 2 ... ... G. Lung Disease, &c. 2 2 4 ... ... ... ... 1 ... 1 ... 2 ... ... ... Order 4. 1. Gastritis 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 2. Enteritis 2 4 6 2 ... ... ... ... ... 1 2 1 ... ... ... 3. Perionitis 4 ... 4 ... ... 1 ... 1 1 ... ... 1 ... ... ... TABLE III.—(continued.) DISEASES IN ORDERS (Continued) Class. Causes of Death. At all ages. Under 2 years. 2 and under 5. 5 and under 10. 10 and under 20. 20 and under 30. 80 and under 40. 40 and under 50. 50 and under 60. 60 and under 70. 70 and under 80. 80 and under-90. 90 and upwards. Male. Female. Total. III. 4. Ascites 1 1 2 ... ... ... ... ... ... 1 ... 1 ... ... ... Con. 5. Ulceration of lutes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Hernia 1 1 2 ... ... ... ... ... ... ... 1 1 ... ... ... 7. Ileus 1 1 2 ... 1 ... ... 1 ... ... ... ... ... ... ... 8. Intussusception 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 9. Strict. of Intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Fistula 4 ... 4 ... ... ... ... ... ... 2 1 1 ... ... ... 11. Stom. Disease, &c. 2 4 6 ... ... ... ... ... ... 1 1 2 2 ... ... 12. Pancreas Disease, ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Hepatitis 1 1 2 ... ... ... ... ... ... ... ... 2 ... ... ... 14. Jaundice ... 2 2 ... ... ... ... ... ... 1 ... 1 ... ... ... 15. Liver Disease, &c. 4 6 10 1 ... ... ... ... 4 2 ... 3 ... ... ... 16. Spleen Disease, &c. 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... Order. 5. 1. Nephritis 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 2. Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Nephria 3 1 4 ... ... ... 1 1 ... 2 ... ... ... ... ... 4. Diabetes 2 ... 2 ... ... ... ... ... ... 2 ... ... ... ... ... 5. Stone 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 6. Cystitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7. Kidney Disease. &c 2 4 6 ... ... 1 ... ... 1 2 1 ... l ... ... Order 6. 1. Ovarian Dropsy ... 2 2 ... ... ... ... l ... ... ... 1 ... ... ... 2. Uterus Disease, &c. ... 2 2 ... ... ... ... ... 1 1 ... ... ... ... ... Order 7. 1. Arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Joint Disease, &c. 1 3 4 ... 1 2 ... ... ... ... 1 ... ... ... ... Order 8. 1. Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Ulcer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Skin Disease, &c. 2 ... 2 1 ... ... 1 ... ... ... ... ... ... ... ... IV. Order 1. 1. Premature Birth 7 7 14 14 ... ... ... ... ... ... ... ... ... ... ... 2. Cyanosis 2 1 3 3 ... ... ... ... ... ... ... ... ... ... ... 3. Spina Bifida 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 4. Other Malformations 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 5. Teething 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... Order 2. 1. Paramenia ... 2 2 ... ... ... ... ... 1 ... ... 1 ... ... ... 2. Childbirth see Metria ... 10 10 ... ... ... 1 3 6 ... ... ... ... ... ... Order 3. 1. Old Age 22 40 62 ... ... ... ... ... ... ... 3 5 24 28 2 Order 4. 1. Atrophy & Debility. 13 17 30 28 l 1 ... ... ... ... ... ... ... ... ... V Order 1. Accident or Negligence 1 1. Fractures and Contu 7 4 11 1 ... 2 2 ... 3 2 ... ... ... ... 2. Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Burns and Scalds 4 4 8 1 2 4 ... ... ... 1 ... ... ... ... ... 4. Poison 2 1 3 ... ... 1 ... ... ... 1 ... 1 ... ... ... o. Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Suffocation 8 8 16 14 ... ... ... 1 1 ... ... ... ... ... ... 7. Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order3. (Homicide.) 1. Murder and slaughter 2 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... Order 4. (Suicide.) 1. Wounds Gunshot, 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... Cut, Stab 2 ... 2 ... ... ... ... ... ... ... 1 ... ... ... ... 2. Poison 1 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... 3. Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Hanging 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 5. Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 5. (Execution) 1. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths (not classed) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suddin Deaths (Cause unascertained) l 2 3 1 ... ... 1 ... ... ... 1 ... ... ... ... Causes not specified or ill-defined 3 12 15 8 ... ... ... ... 2 1 3 1 ... ... ... TABLE IV.—Comparison of Mortality from various causes in London and in St. Giles's. Four Quarters, 1859. Class. Classes and Orders op Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. London. St. Giles. London. St. Giles. London. St. Giles. London. St. Giles. Estimated Quota. Actual Number. Estimated Quota. Actual Number. Estimated Quota. Actual Number. Estimated Quota. Actual Number. All causes 16147 15967 323.0 368 13724 274.5 344 16010 320.2 341 15730 314.6 361 Specified causes 319.4 364 13580 271.6 339 15755 315.1 338 15570 311.4 355 (Classes.) I. Zymotic Diseases 3796 75.9 77 3135 62.7 94 6978 119.6 121 3849 77.0 82 II. Constitutional „ 3096 61.9 91 3182 63.6 94 3213 64.3 81 2964 69.3 81 III. Local „ 6772 135.5 155 5249 105.0 114 4222 84.4 93 6434 128.7 144 IV. Developmental „ 1778 35.6 3i> 1526 30.5 28 1872 37.4 32 1783 35.6 34 V. Violent Deaths 525 10.5 11 488 9.8 9 470 9.4 11 540 10.8 14 (Orders.) I. 1. Miasmatic Diseases 3549 71.0 73 2857 57.2 85 5566 111.3 115 3536 70.7 75 2. Enthetic „ 79 1.5 1 89 1.8 3 83 1.7 85 1.7 3. Dietic „ 144 2.9 3 159 3.2 6 255 5.1 204 4.1 7 4. Parasitic „ 24 .5 ... 30 .6 74 1.5 ... 24 .5 ... II. 1. Diathetic „ 540 10.8 12 542 10.8 19 539 10.8 6 532 10.6 20 2. Tubercular „ 2556 51.1 79 2640 52.8 75 2674 53.5 5 2432 48.7 61 III. 1. Dis. of Nervous System . 1849 37.0 51 1589 31.8 45 1485 29.7 32 1634 32.7 36 2. „ Organs of Circulation 716 14.3 18 667 13.3 12 567 11.3 10 730 14.6 11 3. „ Respiratory Organs 3188 63.8 71 1974 39.5 41 1073 21.5 27 3070 61.4 85 4. „ Digestive ditto 629 12.6 11 632 12.7 8 744 14.9 16 640 12.8 8 5. „ Urinary ditto 211 4.2 2 220 4.4 6 203 4.0 4 203 4.1 2 6. „ Organs of Generation 59 1.2 2 61 1.2 1 51 1.0 1 60 1.2 ... 7. „ „ Locomotion 40 .8 ... 55 1.1 1 39 .8 2 26 .5 1 8. „ Integumentary System 81 1.6 ... 51 1.0 ... 60 1.2 1 71 1.4 1 IV. 1. Dev. Dis. of Children 495 9.9 7 454 9.1 5 437 8.7 5 445 8.9 3 2. „ „ Adults 73 1.5 2 52 1.0 4 56 1.1 5 91 1.8 1 3. „ „ Old People 614 12.3 14 483 9.7 16 525 10.5 10 657 13.1 22 4. Diseases of Nutrition 596 11.9 7 537 10.7 3 854 17.1 12 590 11.8 8 V. 1. Accident 436 8.7 9 395 7.9 8 395 7.9 8 447 9.0 12 4. Suicide 64 1.3 ... 71 1.4 1 54 1.1 2 67 1.3 2 All other Violent Deaths 25 .5 2 22 .5 ... 21 .4 ... 26 .5 ... Sudden Deaths 84 1.7 1 50 1.0 1 57 1.1 ... 56 1.1 1 Cause unspecified 96 1.9 3 94 1.9 4 198 4.0 3 110 2.2 5 I.1 Certain Special Disease Small Pox 201 4.0 2 233 4.7 2 287 5.7 4 435 8.7 14 Measles 373 7.5 2 304 6.1 25 231 4.6 14 397 7.9 11 Scarlatina and Diphtheritic 1167 23.3 27 794 15.9 13 968 19.4 14 1268 25.4 28 Whooping Cough 702 14.0 26 485 9.7 24 248 4.9 11 311 6.2 5 Diarrhoea 153 3.1 2 189 3.8 1 2743 54.8 57 250 5.0 6 Typhus & other Fev. continued and remit- tent 454 9.1 4 430 8.6 11 535 10.7 8 471 9.4 5 TABLE V.—Registered Deaths in 52 Weeks of 1859. Sub-Districts of St. Giles's, Here Four Deaths registered a second lime are omitted, and one is included that was not registered by an error. Deaths in Sub-Districts. [Population, 1851.] First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year, 1859. M F. M. F. M. F. M. F. M. F. Both Sexes. St. George, Bloomsbury. [1G807] 43 45 31 30 43 28 37 42 154 145 299 St. Giles's South. [19951.] 91 86 88 85 82 72 92 104 353 346 699 St. Giles's, North. (17456.) 38 48 37 47 56 42 42 33 173 170 343 Whole District. (54214.) 172 179 156 162 181 142 171 177 680 660 1340 TABLE VI.—Registered Births in 52 Weeks of 1859. Sub-Districts of St. Giles's. Births in Sub-Districts. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Tear, 1859. M. F. M. F. M. F. M. F. M. F. Total Childn. St. George, Bloomsbury 61 54 38 46 47 56 56 53 202 209 411 St. Giles's, South 101 101 86 87 111 97 83 114 381 399 780 St. Giles's, North 56 54 55 77 88 89 60 59 259 279 538 Whole District 218 209 179 210 246 242 199 226 842 887 1729 APPENDIX VII. SMALL POX AND VACCINATION. LOOK TO YOUR CHILDREN. December, 1859. There is a great deal of Smallpox about St. Giles's at present, and people are dying from it every week. This comes of their not being thoroughly Vaccinated. Only half the population is rightly protected in this way. If every body were properly vaccinated, there would be very little smallpox or none at all, and if people did catch it, they would be almost sure to get well, without any scars on their faces. A person who has not been vaccinated, or if he have no mark of vaccination on his arm, is extremely likely now-a-days to catch smallpox and to have it badly. You cannot tell how soon such a person may be attacked. A person with one or two marks on his arm is not so safe from smallpox as if he had three or four; and if the marks are faint and difficult to find, such a person also is very likely to get the complaint at the present time. Look to your own Arms and your Children's Arms, and remember that it is in your own power, and that it is your own duty, to preserve yourselves and them from the terrible disease of smallpox. You are earnestly recommended to have all your children Vaccinated again, unless they have three or four vaccination marks, plain and easy to sea. Do not trust to one or two marks, nor to any number of faint ones ; let your children be vaccinated again. It will only cause a little redness and itching of the arm, and will make them safe against a very fearful disease which might carry them to their graves. Vaccination is performed without charge, by Mr. Bennett, Public Vaccinator, at No. 7, Vinegar-yard, Broad-street, St. Giles's, daily, between the hours of 10 and 11 in the morning. Or, if preferred, persons may be vaccinated, also without charge, and without any letter of recommendation, at the Bloomsbury Dispensary, 62, Great Russtreet, at one o'clock every Wednesday aud Friday. This warning is issued by Dr. Buchanan, Medical Officer of Health, who will receive information as to the outbreak of smallpox or other contagious (catching) disease. He will always be ready to point out the best means of preventing the spread of these diseases. Apply to him at the Office of the Board of Works, 199* Holborn, any morning at nine o'clock. APPENDIX VIII. The Humble Petition of the Board of Works for the St. Giles District in the County of Middlesex. Humbly Sheweth, That the present system of Rgistering Births in England is imperfect, inasmuch as the law does not require information of every birth to be given to the Registrar. That in consequence of this imperfection, a large proportion of births are not registered, and that many fallacies and inconveniences hence arise. That the operation of the Vaccination Laws cannot be ascertaiued without a complete system of registering births. That in Scotland the registration of births is at present compulsory by the Act 17 and 18 Vic., cap. 80, and that no objections are known to exist in that country to the operation of this law. Your petitioners therefore humbly pray your Hon. House to pass a measure for the complete and efficient Registration of Births in England, And your petitioners will ever pray. (The above petition was presented to the Houses of Lords and Commons.)