STG IL8 1 86D. SANITARY STATISTICS and PROCEEDINGS in ST. GILES'S DISTRICT. BEING A REPORT ON THE SANITARY CONDITION OF THE DISTRICT IN 1860; AND ON THE MEANS THAT HAVE BEEN TAKEN FOR ITS IMPROVEMENT DURING THE YEAR ENDING MARCH 25TH, 1861 ; ADDRESSED TO THE LOCAL BOARD OF WORKS. GEORGE BUCHANAN, M.D., LOND., Member of the Royal College of Physicians; Medical officer of Health. LONDO : PRINTED BY T. PENNY, 121, LEMAN STREET, WHITECHAPEL. 1861. 1800 — 61. ANNUAL REPORT of the Medical Officer of TO THE BOARD OP WORKS FOR THE ST. GILES'S DISTRICT. June 1861. Gentlemen, I have the honour to present to you my Report for the year 1860. I know too well your anxiety for the Health of your district to fear that it will be deficient in interest to you, through any short-comings in its writer. For myself, your approbation will follow most securely, if future years shall confirm the promise of our recent experience, that St. Giles's suffers nigh a hundred deaths annually less than its average before I became your Officer of Health. I have the honour to be, Gentlemen, Your faithful Servant, GEORGE BUCHANAN, B.A., M.D.y LONDIN. Member of the Royal College of Physicians; Assistant Physician to the Hospital for Sick Children, and to the London Fever Hospital. 75, Gower Street. Medical Officer of Health. REPORT, &c. Chapter I.— On the Mortality of the Metropolis in 1860. Sixty-one thousand eight hundred and twenty-one persons died from all causes within the bills of mortality in the fifty-two weeks of 1860. In deducing from this number the death-rate of the town, our first step is to form an accurate estimate of the population of the year. The publication of the census of 1861. allows this to be done with much certainty, and a preliminary word on the results of this census has therefore an interest for us. The population of London increased between 1851 and 1861, by 440,798 persons, being at the rate of l.722 per cent, annually. Between 1841 and 1851, the rate of increase was greater, being 1.975 percent, annnally. The estimate that has been made of the population for the few past years was based on the last mentioned rate of increase, and requires now, therefore, to be somewhat reduced. In 4 all the districts with which this Report will have to deal, our new knowledge shows that the population has been similarly overestimated. Of the parishes immediately surrounding St. Giles's, we now find that. St. Pancras is the only one in which there has been much increase, (1.313 per cent, annually). Marylebone numbers in 1861, a bare four thousand more than in 1851, being an increase of only 0.299 per cent, yearly. Our other neighbouring districts, the Strand, Holborn, and St. Martin's, have not only not increased as heretofore in population, but have followed St. Giles's in showing an actual and material diminution in their numbers. St. Giles's itself shows, in 1861, a continuance of the decrease that was observed between 1841 and 1851, the population at the recent census being 53,981 against 54,214 in 1851. Knowing the rate of increase or decrease between the two last censuses, the population of each district for each of the few past years may be now accurately ascertained. It has been calculated in the present Report, not only for the year 1860, but also for several preceding years, and thus the statistical results of former reports are in some cases modified. The first three columns of the Table on the opposite page, and the Table VII. in the Appendix, relating to our own sub-districts, embody the chief results of the census with which we are at present concerned. The 61,821 deaths from all causes in London in 1860, represent a death-rate of 22-41 per thousand. Taking the death-rate as our index, the year may be regarded as healthy up to the average. It was, within a trifle, as healthy as 1859 or 1857, and a good deal healthier than 1858. The cold and wetness of the year 1860 were very remarkable, and these conditions exercised a notable influence over the nature of the diseases which were prevalent. Thus the zymotic class of diseases caused fewer deaths than in any one of the twelve preceding years, despite of increasing population. The great cause of these diseases—impurity of the air arising from putrefying organic matters—was, to a large extent, got rid of by the abundance of wet. The town was in fact better washed. The diseases of the zymotic class that depend most directly upon such atmospheric impurity, are probably diarrhoea and continued fever. These were precisely the diseases whose mortality was most remarkably below the average. Diarrhoea particularly, was not fatal to half its ordinary extent. Scarlet fever, which had been very prevalent in London in the two previous years, also received a decided check in 1860. Small-pox was less fatal than in 1859, the epidemic form of that year having gradually disappeared through the four quarters of 1860. Measles, however, and whooping cough, the former especially, have been in some excess over preceding years. In some parts of the town, measles assumed an epidemic character in the last quarter of the year. It is probable that 480 deaths from diphtheritis were more than have occurred in former years, but the returns of the Registrar-General have not distinguished this disorder before the year 1860. With these exceptions, then, every important member of the zymotic class of diseases was below its average fatality in the metropolis. On the other hand, the cold and wet of 1860, are chargeable with an increase in the mortality from other classes of disorders. Diseases'of the respiratory organs caused more deaths than in any of the twelve preceding years, and three thousand more than in 1859. Consumptive diseases, though scarcely more fatal than in 1859, were also much above the average. Diseases of the nervous system, of the heart, and of the kidneys, were also in conspicuous excess in their mortality over that of former veais. This excess is no doubt to be ascribed to the same climatic peculiarities of the year, as these have an acknowledged power of causing such diseases, and of bringing them to their fatal issue. The distribution of the total mortality over the five main sub-divisions of London, appears to have observed about the samp rule as in previous years. It is shown in the first Table of the Appendix. A detailed account of the causes of death of the 61,821 persons who died in 1860, will be found on page 26, and the MORTALITY IN 1860. Districts. Population. REGISTERED MORTALITY. Column A. Column B. (see Note.) Total Mortality n 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. 1861, Estimated for 1860. Actual number per 10,000. Actual number per 10,000. Actual number Per ! 10,000. Actual number per 10,000. Actual number per 10,000. (add) (subtract) Actual nnmber per 10,000. St. Pancras 166,956 198,882 195,690 1283 65.6 1025 52.4 904 46.2 1018 52.0 4230 216.2 82 Hospitals. 1ll Work. Strand 117 228 4084 208.7 St. Pancras. St. Marylebone 157,696 161,609 161,208 1150 81.3 961 59.6 783 49.2 841 52.2 3735 232.3 102 Hospital, 166 3671 227.7 St. Marylebone Metropolis 2,362.236 2,883,034 2.758,954 18814 68.2 14194 54.0 12916 46.8 15197 55.1 61821 224.1 — — 61821 224.1 Metropolis. Holborn 46,621 44,861 45,037 313 69.5 251 57.2 518 48.4 267 59.2 1049 233.0 76 Hospital, 50 1075 238.7 Holborn. Strand 44,460 42,956 43,106 274 63.5 253 58.7 211 49.0 213 59.4 951 220.6 Work. 117 Hosps. 41 158 Hospital, 111 998 231.5 Strand. St. Martin 24,640 22,636 22,636 177 77.5 144 530 94 41.2 151 66.1 566 247.8 23 Hospital, 67 522 228.6 St. Martin. St. Giles's 54,214 53,981 54,063 400 74.0 321 59.3 273 50.4 352 65.1 1346 248.8 82 Subtract 9 (Dths. Regsd twice over.) 1419 262.4 S t s's. * Col. A, gives the number of the inhabitants of each District who expired in 1860, in the Public Institutions of other Districts : 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.) The population for 1860 is estimated from the Census of 1861, a well as on the basis of the two preceding Censuses. 6 game account for the four quarters of the year in the fourth of the appended tables. To these the reader is referred for further particulars as to the mortality of London at large. Chapter II.— On the Mortality of St. Giles's District, from, all Causes, in 1860. Fourteen hundred and nineteen deaths occurred in this year among persons belonging to the district of St. Giles's. This number is five greater than in 1859, and seventeen greater than in 1858. It is, however, less by a hundred and thirtytwo than the deaths of 1857, when the death-rate was the same as had prevailed in St. Giles's for the ten years preceding. Within a very small limit, therefore, the improvement of the previous two years was maintained in 1860. The 1419 deaths were not ail returned by the local registrars. Eighty-two of them were registered in other parishes, among the patients of various hospitals who had resided in St. Giles's immediately before their admission. The deaths returned by the registrars of our own district numbered 1346, but from these a deduction of nine must be made for duplicate entries. According to the ordinary law of mortality, the majority of those who died in 1860 were of the male sex, the total being made up of 742 males and 677 females. The hospitals, where accident and exposure are often the direct reason for admission, show the preponderance of male deaths still more markedly, forty-eight of the deaths in hospitals being of males, thirty-four among females. The compensating law of births that more children are bom of the male than of the female sex, was also illustrated in St. Giles's last year. The former numbered 926, the latter 852. Of the 1419 deaths, 449 or 32 per cent, were of children under two years of age : and 141 others, giving a sum of 590 or 42 per cent, of the total deaths, died before reaching their fifth birthday. These numbers, large as they are, are somewhat below those of previous years ; probably in consequence of the infrequency of zymotic diseases in 1860. The age of those who died from each disease, and from each class of disease, are given at length in the third of my appended Tables. In the first quarter of the year, 417 deaths occurred, 215 males and 202 females ; in the second quarter 336 deaths, 179 males and 157 females; in the third quarter 288, males and females in equal number; and in the last quarter 378 deaths, 204 males and 174 females. The very small proportion contributed by the third quarter of the year, owing to the absence of diarrhoea, is here to be noticed. The cold quarters, for the reason before pointed out, are even more conspicuously than usual in excess of the rest of the year in their mortality. The deaths from all causes in 1860 represent a death-rate for St. Giles's district of 26'2 in the thousand. This is as usual considerably above the death-rate of the town at large, which we have seen was 22'4 in this year. Of the districts which immediately surround our own, we find that the rate of mortality of St. Pancras and Marylebone were 20'8 and 22'7 respectively. Of course we do not expect St. Giles's to compare favourably with districts that hare so many more natural and social advantages. But with the neighbouring districts which more nearly resemble our own, we continue as in former years to contrast disadvantageously. The deathrates of Holborn 23"8, of the Strand 23*1, and of St. Martins 22"8 per thousand, are greatly below that of St. Giles's. Each year these districts have been found much healthier than our own, and though the sanitary progress of St. Giles's has been as decided as of any of them, we are still very far from having attained to their standard of health. The Table on the preceding page gives the actual deaths and the death-rate of our own district and of our neighbours for each quarter of the year. Correction is made in each district for the hospitals it contains and for the deaths of its inhabitants occurring in the public institutions of other districts. It will be seen, among other 7 interesting facts, that the mortality of St. Giles's was in relative as well as in absolute excess in the two colder quarters of the year. And it may be observed that the magnitude of the death.rate of St. Giles's doe3 not become apparent on the mere returns of the registrars, but only after allowance has been made for our parishioners dying in hospitals. To such an extent are our poor dependent on the public charities of other districts. What hospitals they were that afforded relief to our own parishes and to our neighbours may be learnt from Table II. of the Appendix. The following scheme gives a summary of our death.rate in the past four years, and indicates, as far as this is a test, the sanitary progress made by our district an l its neighbours. Eighteen.fifty.seven may be considered as representing approximately the rate of mortality that had prevailed in the average of previous years. Death.rate per 10,000* in St. Giles's and neighbouring Districts. DISTRICTS. 1857. 1858. 1859. 1860. St. Pancras 197.0 224.9 221.4 208.7 St. Marylebone 217.3 224.0 225.0 227.7 Metropolis 221.0 234.4 227.0 224.1 Holborn 236.3 247.7 248.6 238.7 Strand 239.4 226.6 262.9 231.5 St. Martin 243.0 218.5 246.7 228.6 St. Giles's 280.0 258.2 260.1 262.4 Chapter III.— Causes of Death in St. Giles's District, in 1860. Each death of the 1419 that occurred in St. Giles's has been classified according to the disease and under the proper sex and age at which it occurred. The causes of death in detail with the ages are given at length in the third appended Table, where, however, except in the columns of totals, the two sexes are put together. For present comment, the natural groups of diseases assumed by the Registrar.General, are, however, more compendious than the individual maladies that have produced death. These classes of disease may be most usefully studied for our own district by the side of the returns from the Metropolis as a whole. Taking 1 ÷ 51.1 part of the total deaths from each cause, occurring in the town, we obtain the number which should be furnished to the register of 1860 by the population of St. Giles's. The number of deaths that did actually occur from each cause is placed side by side with the number so estimated. Thus we see at a glance the nature of the maladies to which the excessive mortality of St. Giles's is to be ascribed. (Seefollowing Table.) Taking the causes of death according to the above five classes, let us examine first the class of Zymotic diseases. St. Giles's has usually been found in very notable excess in this respect, but it appears that in 1860 it scarcely experienced a greater number of deaths from these diseases than its quota, and this at a time when the quota itself was remarkably low. The number, 264, is materially below the zymotic mortality of any previous year on which report has been made, and it represents a very considerable fall from the number, 374, of the year 1859. It will been seen from following the figures at the foot of the Table, compared with those of the earlier year, that the decline is chiefly in diarrhoea and scarlet fever, herein resembling the decline of the town at large. It will also be found that measles and whooping-cough, * In this Table the population for the years 1859 and 1860 have been estimated on the basis of the census of 1861, and on the rate of increase which has been thereby ascertained. The year 1857 is corrected to the same duration as other years. Comparison of Mortality from various causes in London and in St. Giles's. Whole Year, 1860. Classes. classes and orders of disease. London. Population: 2,758,954 St. Giles's. Population 54,063. Estimated Quota. 1÷51.1. Actual Registered Mortality. Corrected for Deaths in Hospit. All Causes 61821 1209.8 1337 1419 Specified Causes 61148 1196.6 1323 1402 (Classes.) I Zymotic Diseases 13001 254.4 255 264 II Constiutional „ 12523 245.0 301 314 III Local „ 26246 513.7 575 613 IV developmental „ 7240 141.7 171 172 V Violent Deaths 2138 41.8 21 39 (Orders.) I 1 Miasmatic Diseases 11923 233.3 231 242 2 Enthetic „ 322 6.3 12 12 3 Dietic „ 661 13.0 9 10 4 Parasitic „ 95 1.8 0 0 II 1 Diathetic Diseases 2148 42.0 29 33 2 Tubercular „ 10375 203.0 272 281 III 1 Diseases of Nervous Svstem 6749 132.1 140 144 2 „ Organs of Circulation 2911 57.0 54 63 3 Respiratory Organs 12444 243.5 301 311 4 „ Digestive Organs 2611 51.1 60 66 5 „ Urinary Organs 888 17.4 15 23 6 „ Organs of Generation 193 3.8 2 2 7 „ Organs of Locomotion 176 3.4 1 1 8 „ Integumentary organs 274 5.4 2 3 IV 1 Dev: Dis. of Children 1914 37.5 50 50 2 „ „ Adults 262 5.1 7 7 3 „ „ Old People 2388 46.7 69 70 4 Diseases of Nutrition 2676 52.4 45 45 V 1 Accident 1715 33.5 17 31 4 Suicide 285 5.6 3 6 All other Violent Deaths 138 2.7 1 2 Sudden Deaths 138 2.7 1 1 Cause unspecified 535 10.5 13 16 Certain Special Diseases of Zymotic Class and Miasmatic Order. [1. Small-pox 877 17.2 18 18 Measles 2054 40.2 38 40 Scarlatina and Diphtheritis 2457 48.1 36 37 Whooping Cough 2023 39.8 43 43 Diarrhœa 1383 27.1 36 37 Typhus and other Fevers, tinued and remittent 1634 32.0 30 31 9 diseases unduly prevalent in St. Giles's in 1859, underwent a reduction and were in i860 no more fatal than in the average of the town. By typhus and typhoid fever and their congeners, the district did not incur more losses than we should calculate for its population. Diphtheritis is stated to have been the cause of ten deaths in St. Giles's, a number which pretty nearly corresponds for our population with the 480 deaths from this disease in the whole of London. The epidemic of small-pox that invaded St. Giles's in 1859 leaves evidence of its ravages on this Table. A long account of the outbreak was given in the Report of last year, and the means employed for arresting the disease were fully stated. To the present Report is appended (No. VIII,) an extract from Dr. Seaton's Report to the Medical Officer of the Privy Council relating to this epidemic. Here and in other parts of the same Report, the value of the proceedings of the parochial authorities is forcibly indicated and acknowledged. Secondly.—Constitutional Diseases.—These comprise cancer and similar diseases, along with a group of more interest for us, the Tubercular order, which includes consumption, scrofula, tabes, and water on the brain in children. It is well ascertained that this group of diseases is habitually and remarkably fatal to our district. In the year 1860, as in the preceding year, there was an excess of some eighty deaths above the quota, high as the mortality from these disorders was in the whole town. Two hundred and eighty-one is a very serious excess above two hundred and three. Whenever a cold wet season aggravates the mortality from consumption in London at large, then do such deaths in St. Giles's undergo a still more rapid increase. Poverty, with its concomitants of exposure, bad air, and poor food, is sure to be also attended by an undue mortality from the tubercular disorders. Thirdly.—Local Diseases.—It has already been stated that diseases of the lungs, and to a less extent of the heart, of the brain, and of the kidneys, were especially fatal in London in 1860. If we were right in assigning the peculiar climate of the year as the cause of this excess, we should expect to find that cold and wet had produced the same results in St. Giles's, in a still greater degree. And we do, indeed, find that the year's quota for our population, high as it is, is considerably exceeded by the actual mortality of our district from each of these four groups of diseases. Diseases of the respiratory organs exhibit the enormous number of 311 deaths, which is seventy-eight above the quota for 1860, and eighty-seven above the number which occurred in St. Giles's in 1859. Both acute and chronic lung diseases appear as ctie causes of this high mortality, but the acute diseases, as might have been expected, are those which have undergone by far the greater share of the increase. Fourthly.—Developmental Diseases were much more fatal in St. Giles's than would be calculated for its population. That this class includes many of the maladies incidental to young children, at once, unhappily affords a partial reason for the excess. On the other hand " old age" is another of the causes of death included under this head, and it may be some satisfaction to know that this is assigned as the sole cause of death in several more instances than the numbers of our parishioners would lead us to expect. In the class of, fifthly, Violent Deaths, we find the large number of thirty-nine deaths recorded. Eighteen of these took place in the wards of neighbouring hospitals. Of six suicides, five were men, Lastly, of Diseases Unspecified returned as the cause of death, there have been more in St. Giles's, and there generally are a few more, than in an equal population elsewhere in London. This may be rerre nbered in connexion with what will follow in this Report on the registration of deaths. 10 Chapter IV.—Localization of Disease and Death in St. Giles's, in 1860. For the Officer of Health this is still the most important portion of our statistical enquiry. It indicates to him the neighbourhoods which stand in most need of sanitary improvement, and affords him important information as to the causation of disease. It has been customary in these Reports to consider first the three registration sub-districts, and then to follow out the investigation in a manner more available for practical purposes, by the use of smaller and more natural sub-divisions of the district. This course will still be adopted. It will not be profitable, however, at the present moment, to enter into an estimate of the death-rate of each of these smaller sub-divisions with the same detail that has before been found so advantageous. To compute the mortality per thousand on the basis of an old census, when the returns of the new one will shortly be forthcoming, would be labour of little worth. Of the registration sub-districts, the population at the recent census is already published. The numbers in the three districts along with an estimate of their population in the three preceding years, more exact than has been heretofore possible, are appended to this Report (No. VII.) We have, therefore, the data for an accurate calculation of the death-rate of 1860, as well as for making some corrections in our reckonings of former years. The aggregate mortality of persons resident in the parish of Bloomsbury was 320. This number includes fourteen who died in hospitals, and nineteen who died within a few weeks of their admission from Bloomsbury into the workhouse. The deaths of this sub-district returned by the Registrar were 287 (144 males and 143 females)—St. Giles's South, lost by death 674 of its residents in the year. Seven hundred and ten were registered, but from this number must be subtracted severity-nine residents of the other two sub-districts who died in the workhouse shortly after their admission; and on the other hand we have to add forty-three for residents in St. Giles's South, who died in various hospitals. The males and females who made up the registered number of deaths, were 378 and 332 respectively. The corrected total, 674, is composed of 501 residents of the sub-district, who died at their own homes, 108 of them who died soon after their admission into the workhouse, together with sixty-five persons who died in the workhouse after a protracted residence there.—St. Giles's North, which is, both in its population and in its habitual death-rate, intermediate between the other two sub-districts, had 425 deaths, 340 being returned by the Registrar (172 males and 168 females), twenty-five others occurring in hospitals and sixty in the workhouse. The death-rates represented by these figures, computed upon the population, stated in Appendix VII., are:—For Bloomsbury 185 per ten thousand; for St. Giles's South, 346, and for St. Giles's North, 247, in the same number of residents. In these figures the first matter for remark is that they are practically identical with the corresponding results for 1859, after correction made in the latter year for our better knowledge of the population. A comparison of the four past years is given in the following scheme:—* Death-rate per 10,000, in sub-districts. DISTRICTS. 1857 1858. 1859 1860. St. George, Bloomsbury 180 198 184 185 St. George Bloomsbury 357 292 349 346 St. Giles's North 283 277 240 247 Whole District 280 258 260 262 * Several differences will be found between these figures and those in the Table given in last year's Report. This is owing to the population of each sub-district having been newly calculated for each year. Correction has been made, as before, for the extra length of the year 1857. 11 A conscientious scrutiny of the results obtained in former Reports has always left some misgiving that the diminution in the mortality below the death-rate that was prevailing at and before 1857, might be due rather to removal of the population than to a real decrease in deaths among the residents. This Table, as now corrected, may, however, be taken as evidence that the fall in the rate of deaths in the past three years, is real and substantial. The improvement is not, indeed, so progressive as might be wished, and we may still expect, with the means at our disposal, to see further progress made. The obstacles in the way of sanitary authorities, are doubtless serious, arising from the imperfection of the powers conferred on them bv the Legislature, and from the great and stubborn apathy of a poor population. That thirty-two deaths occurred in St. Giles's from small-pox, in the course of the winter of 1859-60, may serve to illustrate the effect of inefficient legislation and popular ignorance in fostering a disease which may, with perfect certainty, be prevented. Let us now pass to the smaller sub-divisions of our district that have served us in former years as the basis of our remaining statistical enquiries. We may here repeat the boundaries of these sub-divisions—their houses and inhabitants at the census of 1851 are given in the first of the following Tables. It has not appeared worth while in the present Report to use these latter particulars except as still indicating roughly the closeness of population in each locality.* A. Bedford-square locality—bounded by Gower-street, Tottenham Courtroad, and Great Russell-street, comprising 29 acres, of which four may be deducted for Bedford-square. B. Russell-square locality.—Between Gower-street, Great Russell-street, Southampton-row, and Woburn-place, 67 acres, 21 being deducted for Squares, and for the open space of the British Museum. C. Great Coram-street locality.—From Woburn-place to the north and east boundaries of the district, 28 acres. D. Bloomsbury-square locality.—Between the lines of Great Russell-street and Bloomsbury place on the north, and of Oxford-street and Holborn to the south, 30 acres, of which 3 may be taken out for Bloomsbury-square. E. Church-lane locality.—Between Oxford-street, Holborn, Broad-street, and High-street, 12 j acres. F. Dudley - street locality.—Bounded by Crown - street, High-street, and Great and Little St. Andrew's-streets, 13 acres. G. Short's-gardens locality.—The group of houses between Broad-street, Drury-lane, Castle-street, and St. Andrew's-streets, 14½ acres. Here are the Workhouse and Lying-in Hospital. H & K. Northern Drury-lane and Southern Drury lane localities.—The two extending between Drury-lane, Holborn, Little Queen-street, and Lincoln's Innfields, to the southern extremity of the district, the two being divided by Great Queen-street, and comprising 14 acres each. L. Lincoln's Inn fields locality—taking in all the houses of Lincoln's Innfields, and of the streets around up to the boundaries of the district. Of the 23 acres, ten are to be deducted in estimating the habitable space. The mortality from all causes, in I860, in each of these localities is indicated below. Cases dying in the workhouse and hospitals, are distinguished for each. * The population of these ten sub-divisions for 1861 has since been ascertained, and is placed at the end of the Appendix, No. IX. 12 The deaths among infants and children under five years, in each locality, are also separately shown. A comparison with the corresponding figures of previous Reports will show several differences between the distribution of deaths in this vear and its predecessors—differences that were not apparent from a consideration of the larger sub-districts. (See Table " Deaths from all Causes, —Page 31.) The broad fact disclosed by these figures is that the deaths were last year more evenly distributed than usual. The poorer localities with the highest mortality were not quite so fatal as usual, the more favoured localities sharing a portion of their excessive death-rate. Thus Dudley-street and Southern Drury-lane sub-divisions have materially fewer deaths than in 1859. This equable distribution results mainly from the absence of epidemic disease. Three of the poorer localities, however, show an advance in their deaths in 1860 over 1859. These are the neighbourhoods of Church-lane, Short's-gardens, and Northern Drury-lane, and it is remarkable that the rise was less among those persons who died at their own homes than in those who left their homes for the workhouse and for hospitals. In all of these three localities there are numerous common lodging houses, and these always furnish large numbers of sick to the infirmary. In an inclement season, such as 1860, these persons were sure to be beyond the average. The deaths among children enumerated in the foregoing Table, are also fewer and more evenly spread over the ten localities than usual. This again arises from the small amount of those epidemic diseases of children which peculiarly affect the poorer localities. It is a remarkable fact, gained from this Table and the next, that in the better districts, this year, there were not only relatively but absolutely more infantile deaths and more zymotic deaths, the mortality of both kinds being remarkably low in the poorer neighbourhoods. The Causes of Death in each of the ten sub-divisions is shown with sufficient minuteness on the following Table. Here the fall in the mortality of zymotic diseases from 1859 may be studied. In the former year the districts lettered F, G and K were in the worst position in regard of these diseases, showing respectively, 71, 60 and 65 deaths from them. In 1860 these numbers were reduced to 47, 32 and 35. The subsidence of epidemic influence over a community is always apt to be followed by a temporary immunity from zymotic disease; but the extent to which this has been the case in these three localities appears unusual, and is probably to be ascribed to our sanitary work. (See Table "Causes of Death, &c."—Page )14 Consumptive diseases have, in previous years, been found to exhibit a great excess in the Northern Drury-lane, the Short's-gardens, and the Dudley-street districts. The disproportionate fatality of such diseases in these three localities was especially strongly marked in I860, when the whole district suffered from these complaints so much above the average. The high mortality of lung diseases appears to have been distributed according to a similar rule. The law of distribution of disease which appears to obtain in an exceptional year, is probably well recognized, but in this Report there have been so many illustrations of it that it may be well to state it in definite terms:—Given, a number of localities habitually affected to different degrees by the diseases of a certain class. Let these diseases occur with exceptional prevalence, either in the way of increase or subsidence. Then it is those localities which habitually suffer most from such diseases that are chiefly affected by their exceptional incidence, in whichever direction the exception may be. A year of prevalence of a class of disease, therefore, shows up more strongly the localities generally affected by that class, and a year of subsidence of a class of disease tends to obliterate the distinctive peculiarities of districts with respect to those diseases. We have seen this to have happened in 1860, in respect of the metropolis and of St. Giles's, and in respect of the various sub-divisions of St. Giles's. We have seen it for diseases of children, for zymotic diseases, for diseases of the lungs and for consumption. Our experience even seems to point in Deaths from all Causes in Ten Localities, distinguishing those of Children.— 1860. locality of Inhabited Area in Acres, Houses inhabited 1851. Population 1851. deaths from all causes, 1860. deaths of children. Deaths at other Ages. In Houses. In Workhouse. In Hospitals. Total. Under two years. Two to five years. A. Bedford-square 25 493 3568 60 1 6 67 17 3 47 B.Russell-square 46 627 4756 60 — 3 63 12 6 45 C. Coram-street 28 716 6387 113 9 5 127 42 15 70 D. Bloomsbury-square 27 668 6657 106 5 6 117 33 8 76 E. Church-lane 12§ 229 5119 97 29 6 132 46 9 77 F. Dudley-street 13 498 7776 191 35 13 239 86 26 127 G. Short's-gardens 14} 443 6551 179 45 12 236 67 31 138 H. Northern Drury-lane 14 378 5052 120 48 15 183 66 16 101 K. Southern Drury-lane 14 309 5064 114 15 13 142 58 17 67 L. Lincoln's Inn-fields 13 270 2498 46 — 2 48 17 9 22 Workhouse Inmates — — 776 — 64 1 65 5 1 59 Total District 207 4700 54214 1086 251 82 1419 449 141 829 Causes of Death in the Ten Localities, 1860. LOCALITY OF Total Zymotic Diseases Small pox. ZYMOTIC DISEASES. TUBERCULOUS DISEASES. DISEASES OF THE LUNGS. Violent Deaths including those from in temperance. Deaths from all other causes. Measles Scarlet Fever. Diphtheritis. Whooping Cough. Fever. Diarrhoea. Other Zymotic Diseases Total. Tuberculous Diseases Consumptn. Scrofula and Tabes. Water on the Brain. Total Lung Diseases Chronic Bronchitis and Asthma, Acute Bronchitis. Inflammation of the Lungs. A. Bedford-square 9 — — 2 1 1 1 1 3 12 12 — 14 4 6 4 - 32 B. Russell-square 14 2 3 1 1 2 2 2 1 3 2 1 14 2 4 8 1 31 C. Coram-street 29 — 6 2 2 4 2. 9 4 21 18 3 34 9 8 17 2 41 D. Bloomsbury-square 12 — 4 4 — 1 1 1 1 24 20 4 25 11 8 6 7 49 E. Church-lane 22 2 3 — 1 3 7 2 4 28 27 1 34 15 6 13 1 47 F. Dudley-street 47 — 8 4 — 17 2 7 9 46 37 9 55 19 13 23 11 80 G. Short's-gardens 32 4 4 3 — 7 4 3 7 55 43 12 56 25 12 19 8 85 H, Northern Drury-lane 37 7 4 8 — 1 6 5 6 45 40 5 27 7 11 9 7 67 K. Southern Drury-lane 35 3 5 1 1 6 4 8 7 26 20 6 35 15 10 10 7 39 L. Lincoln's-inn-fields IS — 3 2 4 1 2 1 2 5 3 2 10 5 1 4 2 16 Workhouse Inmates 2 — — 1 — — — — 1 8 8 — 12 11 — 1 1 42 Total District 254 18 40 28 10 43 31 39 45 273 230 43 316 123 79 114 47 529 15 one direction a little farther than this law, and to show that the absence of a class of diseases from their favourite seat is perfectly compatible with an increase in their prevalence in neighbourhoods usually more free from them. Chapter V.—On the Births of 1860; and on the Registration of Births and Deaths. The births of St. Giles's in 1860, numbered seventeen hundred and seventy-eight, giving an excess of 359 over the deaths. As the district is nearly stationary in its population, it follows that emigration, or rather an excess of emigration over immigration has taken place in the year to an extent represented by the same figure. Of the children born 926 were males, 852 females; each of the sub-districts exhibiting a majority of males. (Appendix VI). The total of births is above that of either of the two preceding years, but it has not yet reached the large number of eighteen hundred and fifty, registered in the year 1857. In the sub-district of Bloomsbury the births are steadily on the rise, correspondently with the increase in population of this parish. In St. Giles's parish there have been much more violent changes in the numbers of registered births, as will be seen from the subjoined enumeration. Births in Sub-districts. SUB-DISTRICTS. 1857. 1858. 1859. 1860. St. George, Bloomsbury 398 403 411 430 St.Giles's South 860 717 780 786 St. Giles's North 592 557 538 562 Whole District 1850 1677 1729 1778 The present provisions for the registration of births in England are so radically defective that it is impossible to draw any reliable conclusion from a variation in their yearly numbers. An efficient registration law should provide that every birth should be notified to the Registrar within a given period, and a penalty should be incurred by the omission of such registration. Such a law is in force in Scotland. Registration in England, instead of being compulsory, is only optional. It is, indeed, only permitted during the first six months after birth, for after that time it is actually prohibited altogether. In England the accident of more or less ignorant people caring to register their children, and the greater activity of a Registrar one year than another, are, under present arrangements, the most potent causes of variation in a birth-rate. In certain investigations arising out of the census of 1861, the Registrar-General acknowledges the imperfection of our present system. The fallacies and inconveniences to which it gives rise appear to be so serious, that we may hope to see a move made in this influential quarter for procuring a better plan of registration. It is not only the registration of births, however, that is defective in England. The laws relating to the Registration of Deaths are in a condition of the utmost laxity and inefficiency. It is scarcely credible how much the practice of the community is in advance of legislation in this respect. The utmost that the law insists on is, that a person burying a dead body shall send notice thereof to the 16 Registrar, unless he is provided with a Registrar's certificate. There is no machinery whatever for ensuring that in each case the deceased has met with his death from natural causes, and that enquiry shall be made when this is not established. The Coroner's Court and the spontaneous services of medical practitioners are the only means by which the cause of death is ascertained. It is true that in the great majority of cases, the cause of death is certified to the Registrar in one or other of these ways, but the registration of a death may be effected and a certificate for burial obtained without any evidence as to the cause of death being demanded, except the statement of some inmate of the house. Unless suspicion should arise, and some one should set in action the office of the coroner or police, there appears nothing to prevent secret murder passing undetected on the largest scale. Nothing more can possibly be done in the existing state of the laws of registration, than is now done under the excellent arrangements of the RegistrarGeneral, but it is lamentably certain that at present many persons buried in London, as having died from natural causes, may easily have come by their deaths unfairly; and that this number would be vastly larger, if it were not for administrative management unrecognized by the law. In St. Giles's in 1860, there were twenty-four deaths registered without either inquest or medical certificate, where the burial took place without enquiry. And it is to feared that this facility of registration and burial is getting more widely appreciated, for in the six months that have already elapsed of the present year, 1861, there were as many uncertified deaths entered by the Registrars as in the whole of 1860. The causes of death assigned in these cases is, of course, of the most unsatisfactory kind. "Unknown," occurs in about one instance out of four. "Consumption," "decline," and "convulsions," are samples of a kind of entry often met with. And in other cases, without medical certificate, the cause of death is registered as "apoplexy" "pleurisy," and even "diphtheria." There is absolutely no evidence that a death returned as "aged 46, apoplexy, no medical attendant," was not a case of poisoning by opium, or that a number of children, from a few hours to a month old, dying of an "unknown "cause, had not met with their deaths by foul play. Chapter VI.—On the Diseases-and Deaths in the Practice of the Workhouse and of the Bloomsbury Dispensary. In a parish so poor as St. Giles's, the amount of relief afforded by the public medical institutions is large enough to constitute another kind of criterion, though a rough one, of the comparative healthiness of different years. The diseases that are observed in such practice, supply also important supplementary information to the causes of death returned by the Registrar-General. As affording accurate statistical information, the returns of these institutions are of course not so universally available as the register of mortality, which applies to all ranks of the community, and which is besides subject to a far smaller number of artificial disturbing influences. Still there is interest in noting the correspondence or discrepancy between the inferences yielded by these two sets of data as to the health and diseases of our population. The prevalence of some ailments that are never or rarely fatal, may also be ascertained from these institutions. The practice of the workhouse resolves itself, as usual, into three portions. The first comprises patients treated in the infirmary, in whom, from the often incurable nature of their complaints, the mortality is higher than in ordinary hospitals. The second part is among persons who apply for relief at the dispensary of the workhouse, and among these there is scarcely ever a death, as * The above was written before I had seen a letter from the Registrar-General to the Board, in which he suggests that I attribute to the Local Registrar more power than he really possesses to ascertain the cause of death. It will be seen how fully I recognize his inability to do so under the present law.—G.B. Causes of Disease and Deaths, occurring in the Practice of the Workhouse, in the Four Quarters of 1860 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 312 85 225 53 210 50 219 69 966 257* 1814 1548 1236 1148 5746 512 64 393 47 453 37 557 68 1915 216 Small-pox 18 2 3 ... 3 ... 11 ... 25 2 12 ... ... ... 12 68 7 18 2 4 ... 2 ... 92 9 Measles ... ... ... ... 6 ... ... ... 6 ... 12 20 7 27 66 12 • •• 16 ... 18 2 96 14 142 16 Scarlet Fever 5 ... 2 1 ... ... ... ... 7 1 ... 2 2 3 7 2 1 3 1 13 1 15 3 33 6 Whooping Cough ... ... ... ... 8 ... ... ... 8 ... 29 28 15 15 87 5 3 2 1 2 ... 5 4 14 8 Diarrhœa ... ... ... ... 1 ... ... ... 1 ... 103 70 269 101 543 8 1 12 • •• 33 3 7 4 60 8 Fever† & Febricula. 5 ... 10 ... 7 ... 4 1 26 1 162 119 85 72 438 82 3 39 2 58 4 52 1 231 10 Ague 3 ... 1 ... ... ... ... ... 4 1 4 10 3 1 18 2 ... 6 ... 3 ... 1 ... 12 ... Bronchitis (acute and chronic) 71 16 43 15 24 7 39 15 177 53 611 297 193 407 1508 102 7 34 8 39 6 88 9 263 30 Inflammation of the Lungs and Pleura 2 1 1 1 8 2 ... ... 11 4 4 12 6 9 31 21 10 25 3 17 ... 18 3 81 16 Consumptive Dises. 34 18 33 13 23 14 29 19 119 64 19 68 13 19 119 31 13 8 15 15 7 18 12 92 47 Ophthalmia 16 ... 13 ... 2 ... 4 ... 35 ... 21 20 43 28 112 2 ... 1 ... 12 ... 1 ... 6 ... * Returned by the Registrar-General at 251, in the 52 weeks. † The term "Fever," includes symptomatic as well as idiopathic fevers. It is impossible to separate the one class from the other, on the Registers of the Workhouse. There is a large proportion There is a large proportion of idiopathic cases in the first and last division of the table; while in the middle division the so-called "Fevers" re for the most part only symptomatic. ‡ There was one death among these Patients in the year. 18 they are transferred, if severely ill, to the former category, or into the third class of patients, who are treated at their own homes. Among these last there is a proportion of deaths varying from about eight to twelve per cent. In the Table for the present year, on the preceding page, the numbers that express the total cases under treatment, are found to differ very little from those of 1859. Fewer persons were treated as out-patients, and more were visited at their own houses than in the previous year, the nature of the prevailing diseases furnishing the reason for this fact. It will be seen that the mortality of persons treated in the parish infirmary was greater than in 1859, on an almost identical number admitted. The incurable diseases here received were hastened to a fatal termination by the inclemency of the seasons in 1860. The remarkable fall in diarrhoea, and the rise in bronchitis and consumption from the preceding year, are among the more striking of the facts that this Table furnishes, in corroboration of the conclusions that have been drawn from the death register. The number of cases of small-pox under treatment, and the subsidence of the disease as the year advanced, may be here seen; the vaccination-returns that have chief interest in connexion with the epidemic, will be found in the appended extract (VIII.) A much large number of persons received medical relief at the Bloomsbury Dispensary, in 1860, than in any recent year. The new patients of the past three years have numbered 2,618, 3,214, and in 1860, 4,293. Deductions from these figures can have little regard to the health of the year, but can be relied on to show that the charity is steadily increasing its usefulness. The number in each quarter, distinguishing those who were visited at home and noting the deaths which occurred, is seen in the following scheme:— New Cases treated at Bloomsbury Dispensary, 1860. Quarter ending physician's cases. surgeon's cases. total. Admitd. Visited at home. Died. Admitd. Visited at home. Died. Admitd. Visited at home. Died. March 25th 827 179 22 450 33 3 1277 212 25 June 24th 741 121 21 295 33 2 1036 154 23 Sept. 29th 802 135 20 301 38 2 1103 173 22 Dec. 25th 641 158 20 236 35 4 877 193 24 Whole Year 3011 593 83 1282 139 11 4293 732 94 Chapter VII.— On the Sanitary Work of 1860. It now remains to consider what the means have been by which the improvement in the health of St. Giles's has been maintained in 1860. How the year opened with an epidemic, and what were the means that succeeded in subduing its virulence, have been so fully considered in a previous Report, that I need not here do more than refer to Dr. Seaton's account of the matter. He shows clearly that it was to the sanitary work done that the subsidence of smallpox is to be ascribed. Between March 1860 and March 1861, the year for which sanitary improvements are to be reported, the health of the district has presented few occasions 19 for deviating from the unassuming routine of house-inspection. Periodical visits have been made to cow-houses, slaughter-houses, and to premises where trades are carried on that cause annoyance to neighbours. A partial investigation has also been made into the condition of the Bakehouses of the district, and of the men employed in them. Ten or a dozen bakehouses, representing different types of these establishments, were visited, and a multitude of details were noted. As far as the enquiry extended, it led to the conclusion that no special interference of the Board was required for the improvement of the bakeries, beyond what ordinarily sufficed in the case of other houses. And among the journeymen employed, very little disposition was found to complain of their relation to their employers or to the public. Their work habitually encroached largely on the night, but there was hardly ever an occasion when they were unable to take, if they chose it, seven to nine hours' rest out of the twentyfour. A part of their work was in the open air. The really deleterious part of the business appears to be the inhaling of gas-light vapours and of particles of flour. The bakeries are generally so hot that in any weather plenty of external air might be admitted by day and night, and if this were contrived judiciously, it would be the best remedy for these injurious inhalations. Complaints having again arisen of the condition of the Burial vaults at the cemetery in the Old St. Pancras-road, they were again inspected by Mr. Grainger and myself, in December last. As a school assembled in the rooms above, it appeared to us desirable that more thorough precautions should be taken than had before been considered necessary, to preclude all possibility of harm if a coffin should burst in these vaults. By direction of the Home Secretary, the coffins were accordingly well covered with sand and charcoal, and the apertures to the vault bricked up. There appears to be now no probability of any of the burial vaults belonging to St. Giles's ever being heard of again as a source of nuisance or ill-health. The remainder of the sanitary work of the year has consisted entirely in the removal of various causes of disease from the dwelling houses of the district. The nature and the numbers of the improvements that have been made are seen on the following page, where the localities in which the improvements were effected are also exhibited. All the figures in this Table have an interest for those who are charged with the sanitary welfare of the district, but for special comment a few only need to be singled out. Over-crowding of rooms occupied by single families is stated to have been abated in twenty-one instances. In none of these cases was an appeal to the magistrate necessary. The Inspector uses a steady vigilance in detecting this most important cause of ill-health, and keeps landlords and others informed of the law on the subject. For this purpose a handbill, drawn up in a former year, is still distributed with good effect. In connexion with this subject, a fear may be expressed that inaccuracies have crept into the recent census, through the information of house-owners as to the law of overcrowding being in advance of their inclination to obey it. The underground kitchens of Dudley-street and elsewhere, have formed the subject of proceedings on two chief occasions during the year. The owners of the houses find it worth their while to take the chance of an occasional fine in consideration of the profit they are regularly gaining by the illegal occupation of their kitchens. In the course of the present year, (1861), however, very decisive verdicts of the magistrates have tended to discourage these speculations. The Board of Works has, indeed, thought proper to remit the fines that were imposed, but on the distinct understanding that no such clemency is to be expected for the future. House improvements in the several Localities of St. Giles's, effected under the superintendence of Inspector Webb, between March 25th, 1860, and March 25th, 1861. House improvements in Localities. A. Around Bedford Square. B. Around Russell Square. C. Around Coram Street. D. Around Bloomsbury-sq. E. Around Church Lane. F. Around Dudley Street. G. Around Short's Gardens H. Around North ern part of Drury Lane. K. Around South ern part of Drury Lane. L. Around Lincoln's Inn Fields. Whole District of St. Giles. Number of houses improved 29 58 60 36 50 106 55 65 61 32 552 Improvements in Drainage Drains constructed 13 36 8 11 3 11 15 16 3 21 137 Improved or repaired 4 5 14 7 6 20 13 16 15 8 108 Cesspools abolished 8 22 26 16 8 27 21 16 31 7 182 Cesspools cleaned only 8 4 2 10 2 2 8 6 5 ... 47 Stables drained and horse-pools abolished ... 2 ... ... ... ... ... ... ... ... 2 Stables drained and horse-pools abolished 8 24 3 ... ... ... ... 1 ... ... 36 In Water Closets. Pan, trap, and water provided 5 10 3 7 2 2 8 11 3 ... 51 Water and apparatus only provided 5 4 20 10 18 24 18 20 35 5 159 Cleaned or repaired 3 ... 10 9 17 22 14 12 28 1 116 Newly constructed or re-built 2 5 3 4 2 1 3 2 1 ... 25 In Dust Bins. Newly constructed ... 2 2 1 ... 3 2 3 5 2 20 Repaired or coverd ... ... 11 2 1 9 7 5 15 ... 50 Paving. Re-laid 7 10 14 3 3 3 4 13 11 1 69 In General Water Supply. Receptacles provided 3 6 4 4 4 7 6 9 1 1 45 Receptacles repaired +1 3 10 4 9 5 5 11 16 ... 64 Water suply. provid. where none in house before ... ... 2 ... 3 ... ... 1 ... 1 7 In Cleanliness and Repair. Generally repaired ... 5 8 1 4 7 4 4 6 ... 39 Cleansed and lime-whited 6 12 33 22 27 45 31 46 59 4 285 Various accumulations removd, from cellars, &c. 1 ... 4 10 7 15 9 5 15 4 70 Ventilation, &c. Ventilation improved 4 3 4 2 5 2 1 1 ... 1 23 Overcrowding reduced ... ... ... ... 10 2 1 3 5 ... 21 Kitchens disused ... ... 2 ... 1 43 10 3 1 ... 60 „ made legally habitable ... ... 1 ... ... 9 1 ... ... ... 11 Other rooms disused 2 1 ... ... ... ... 2 ... ... ... 5 Proceedings , taken. First notices 27 17 34 18 18 104 35 20 19 29 321 Second notices, letters, &c 3 10 14 5 4 2 5 ... 10 ... 53 Summoned ... 2 ... ... 2 17 2 2 ... ... 25 Reported to Police or District Survey or ... ... ... ... 1 4 1 2 2 ... 10 Total improvements 80 154 184 123 132 259 183 204 255 56 1630 21 An instauce has occurred where question has been made as to the activity of the Board. It deserves to be cited as showing what their powers are in an extreme case, and what difficulties and obstacles to sanitary improvement are occasionally met with. In January, 1859, the Sanitary Inspector reported that there was an open privy with a cesspool, at No. 30—31, Southampton Mews, and that there were very foul smells in the premises. Notice was given to the owner on Feb. 2nd, and a second notice in March. In April, the owner was summoned. In May a magistrate's order was made to effect the necessary improvements, and meanwhile to close the premises as unfit for human habitation. In August the owner was summoned to show cause why the order was disobeyed. In December (some delay having occurred through an informality of the order) a penalty was inflicted for allowing the house to be still occupied without alteration. This was not paid, and in January, 1860, the owner was imprisoned for a month in default. In April, he was again imprisoned after a repetition of these proceedings. Still nothing was done, and the rooms continued to be occupied. As the measures against the owner failed to procure any improvement, the man having no objection to the alternative of prison, application was made by the Board for assistance to the steward of the Duke of Bedford, but even up to the date of the present Report, the same conditions remain. Meanwhile, in the summer of 1859, the houses of Bloomsbury-place and Bloomsbury-square, on which these premises in the mews abut, were pervaded by bad smells and by zymotic diseases, referred by the medical attendants of the cases to the miasms of the mews. In the summer of 1860, again the same smells, and again the same outbreak in the neighbouring houses, this time taking the form of diphtheritis. In November, a child from the house itself, died of diphtheritis in University College Hospital. Aud now, in the summer of 1861, among other complaints, a medical practitioner writes from Bloomsbury-square—" As usual, now that the abominations of Southampton Mews are upon us, and the smell has been most unpleasant, diphtheria has broken out at No. 25 in this square, also at No. 27." The Board will not fail to view with regret their inability to afford, even with the extreme measures taken, due protection to their parishioners in a case of such criminal obstinacy. APPENDIX. TABLE I.—Mortality per Thousand in London, in the Divisions of London, and in St. Giles's in 1860, and in preceding Years. Note.—The numbers are computed on an estimate of 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 1860 London [See below] 24.46 22.20 23.56 22.29 21.93 West Districts (Kensington, Chelsea, St. George, Hanoversquare, Westminster, St. Martin, St. James) 22.76 20.81 21.77 20.83 21.32 North Districts (Marylebone, Hampstead, Pancras, Islington, Hackney) 22.15 21.22 22.48 21.16 20.51 Central Districts (St. Giles's Strand, Holborn, Clerkenwell, St. Luke, East London, West London, London City) 24.35 22.93 23.16 22.64 21.52 East Districts (Shoreditch, Bethnal Green, Whitechapel, St. George's East, Stepney, Poplar) 25.84 24.35 25.30 23.31 23.21 South Districts (St. Saviour. Saint Olave, Bermondsey, Saint George, Southwark, Newington, Lambeth, Wandsworth, Camberwell, Rotherhithe, Greenwich, Lewisham) 26.28 21.60 24.26 22.92 22.47 St. Giles's [See below] 26.89 26.58 24.89 24.81 24.86 In the above Table the estimate of population in each year is based on the census of 1851, and on the rate of increase then ascertained. A more correct estimate can be made now that the census of 1861 is published. Calculating the population afresh, the above figures need a little modification, the following being the result for London and St. Giles's. 1847—57 1857 1858 1859 1860 London 24.46 22.38 23.90 22.68 22.47 St. Giles's 26.89 26.58 24.89 24.94 24.98 TABLE II.—Deaths in Hospitals among Patients brought from St. Giles's and neighbouring Districts 1860. Districts. Total ascertained Deaths in London Hospitals. King's College Hospital (Strand). Middlesex Hospital (Marylebone) Charing Cross Hosptl. (St. Martin). University College Hosptl, (St. Pancras) Children's Hospital, (Holborn). St. Bartholomew's Hospital, (W. London) Royal Free Hospital (St. Pancras). London Fever Hospitl. (Islington). Westminster Hospital (Westminster). St. Mary's Hospital (Paddington). Deaths in Hospitals out of the district. St. Pancras 159 11 48 3 63 11 7 14 2 ... ... 8-2 St. Marylebone 156 4 54 2 16 5 4 2 8 ... *61 102 Metropolis 3039 127 220 85 121 58 633 67 69 123 156 ... Holborn 84 17 10 2 3 8 32 5 7 ... ... 76 Strand 57 16 15 14 2 2 3 5 0 ... ... 41 St. Martin 36 12 4 18 0 1 0 1 0 *5 ... 23 St. Giles's 82 26 20 13 11 5 4 3 0 ... ... 82 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, which are estimated from the returns of former years. The number 5, in the column of the Westminster Hospital, should be 8 (Mr. Beale), and 61, under St, Mary's Hospital, should be 44 (Dr.Thomson). There were no deaths among St, Giles's patients in the Small Pox Hospital TABLE III.—Causes of Deaths in St. Giles's, in 1860, 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 25. 25 ana under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and under 85. 85 and upwards. Male. Female. Total. All causes 742 677 1419 449 141 50 32 36 71 129 154 143 126 73 15 Specified causes 735 667 1402 144 139 50 32 36 71 127 148 143 124 73 15 Classes. I. Zymotic Diseas 141 123 264 128 77 18 4 5 7 12 5 6 2 ... ... II. Constitutional 175 139 314 46 26 13 13 21 36 59 60 26 11 3 ... III. Local 316 297 613 164 31 15 12 7 26 49 74 109 98 25 3 IV. Developmental 84 88 172 93 1 1 1 2 2 2 ... ... 13 45 12 V. Violent Deaths 19 20 39 13 4 3 2 1 ... 5 9 2 ... ... ... I. Orders. 1 Miasmatic Diseases 120 113 242 114 77 18 4 4 5 9 3 6 2 ... ... 2 Enthetic 6 6 12 11 ... ... ... 1 ... ... ... ... ... ... ... 3 Dietic 6 4 10 3 ... ... ... ... 2 3 2 ... ... ... ... 4 Parasitic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... II. 1 Diathetic 7 26 33 ... ... 1 ... ... 1 5 10 7 7 2 ... 2 Tubercular 168 113 281 46 26 12 13 21 35 54 50 19 4 1 ... III. 1 Diseases of Nervous System 72 72 144 47 3 5 3 1 6 9 15 22 22 9 2 2 „ Organs of Circulatn. 32 31 63 1 ... ... 2 2 7 11 14 15 10 1 ... 3 ,, Respiratory Organs 166 145 311 110 26 6 1 2 4 18 30 57 47 9 1 4 „ Digestive Organs 27 39 66 6 1 4 3 1 7 5 11 8 15 5 ... 5 „ Urinary Organs 17 6 23 ... ... ... 1 1 2 5 3 7 3 1 ... 6 „ Organs of Generatn. ... 2 2 ... ... ... ... ... ... 1 1 ... ... ... ... 7 „ Organs of Locomatn. 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 8 „ Integumentary Systm 1 2 3 ... 1 ... 1 ... ... ... ... ... 1 ... ... IV. 1 Developmtl. Dis.of Childn. 29 21 50 50 ... ... ... ... ... ... ... ... ... ... ... 2 „ Adults ... 7 7 ... ... ... ... 2 2 2 ... ... ... ... ... 3 „ Old People 28 42 70 ... ... ... ... ... ... ... ... ... 13 45 12 4 Diseases of Nutrition 27 18 45 43 1 1 ... ... ... ... ... ... ... ... ... V. 1 Accident or Negligence. 14 17 31 11 4 3 2 ... ... 2 7 2 ... ... ... 3 Homicide ... 2 2 2 ... ... ... ... ... ... ... ... ... ... ... 4 Suicide 5 1 6 ... ... ... ... 1 ... 3 2 ... ... ... ... 5 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths not classed. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Deaths cause unascertained ... 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... Causes not specified 7 9 16 5 2 ... ... ... ... 2 5 ... 2 ... ... 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 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and under 85. 85 & upward. Male. Female. Total. I. Order 1. 1 Small Pox 10 8 18 8 6 3 ... ... ... 1 ... ... ... ... ... 2 Measles 27 13 40 20 18 2 ... ... ... ... ... ... ... ... ... 3 Scarlatina 11 17 28 10 11 6 1 ... ... ... ... ... ... ... ... 4 Diphtheritis 5 4 9 3 4 ... ... 1 ... ... ... ... 1 ... ... 5 Quinsy 2 ... 2 1 1 ... ... ... ... ... ... ... ... ... ... 6 Croup 10 6 16 10 6 ... ... ... ... ... ... ... ... ... ... 7 Whoopg.Cough 25 18 43 23 19 ... ... ... ... ... ... ... ... ... ... 8 Typhs. & Inftle. Fever 8 18 26 1 5 4 2 3 1 6 ... 3 1 ... ... 9 Erysipelas 1 6 7 4 ... ... ... ... ... 1 ... 2 ... ... ... 10 Metria ... 3 3 ... ... ... ... ... 3 ... ... ... ... ... ... 11 Carbuncle 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 12 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Dysentery 2 1 3 2 1 ... ... ... ... ... ... ... ... ... ... 14 Diarrhœa 21 16 37 30 4 ... ... ... ... ... 2 1 ... ... ... 15 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Remittent Fevr 2 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... 18 Rheumatism 3 3 6 ... 1 2 1 ... 1 ... 1 ... ... ... ... 19 Other Zymotic Diseases 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Order 2. 1 Syphilis 6 6 12 11 ... ... ... 1 ... ... ... ... ... ... ... Order 3. 1 Privation ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... 2 Want of breastmilk 1 1 2 2 ... ... ... ... ... ... ... ... ... ... ... 3 Purpura & Scvy 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 4 Alcoholism:— a Del. Tremens 3 1 4 ... ... ... 1 2 1 ... ... b Intemperance. 1 1 2 ... ... ... ... ... 1 ... 1 ... ... ... ... 11. Order 1. 1 Gout 2 2 4 ... ... ... ... ... ... ... 3 1 ... ... ... 2 Dropsy 2 3 5 ... ... 1 ... ... ... 1 ... 1 1 1 ... 3 Cancer 3 16 19 ... ... ... ... ... 1 3 6 4 4 1 ... 4 Mortification ... 5 5 ... ... ... ... ... ... 1 1 1 2 ... ... Order 2. 1 Scrofula 5 5 10 5 2 1 1 1 ... ... ... ... ... ... ... 2 Tabes mesenterica 9 4 13 8 3 ... 2 ... ... ... ... ... ... ... ... 3 Phthisis 124 89 213 8 4 8 10 20 35 54 50 19 4 1 ... 4 Hydrocephalus 30 15 45 25 17 3 ... ... ... ... ... ... ... ... ... III. Order 1. 1 Cephalitis 7 11 18 4 ... 1 2 ... 3 1 3 1 2 1 ... 2 Apoplexy 8 14 22 ... ... ... ... ... 1 ... 5 7 5 3 1 3 Paralysis 23 16 39 ... ... 1 ... ... ... 3 6 10 13 5 1 4 Insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Chorea ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... 6 Epilepsy 6 7 13 ... ... 1 ... 1 1 4 1 3 2 ... ... 7 Convulsions 25 22 47 42 3 2 ... ... ... ... ... ... ... ... ... 8 Other Brain dis. 3 1 4 1 ... ... ... ... 1 1 ... 1 ... ... ... Order 2. 1 Pericarditis 1 1 2 ... ... ... ... ... ... 2 ... ... ... ... ... 2 Aneurism 4 1 5 ... ... ... ... ... 1 1 2 1 ... ... ... 3 Heart Dis., &c. 27 29 56 1 ... ... 2 2 6 8 12 14 10 1 ... Order 3. 1 Laryngitis 1 2 3 2 ... 1 ... ... ... ... ... ... ... ... ... 2 Bronchitis 95 89 184 39 10 3 ... 1 1 10 23 45 42 9 1 3 Pleurisy 2 2 4 ... ... ... ... ... ... ... 2 2 ... ... ... 4 Pneumonia 58 46 104 68 15 2 ... 1 3 4 1 7 3 ... ... 5 Asthma 7 5 12 ... ... ... 1 ... ... 4 3 2 2 ... ... 6 Other Lng. Dis. 3 1 4 1 1 ... ... ... ... ... 1 1 ... ... ... Order 4. 1 Gastritis ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... 2 Enteritis 5 3 8 1 1 2 1 ... ... ... ... ... 2 1 ... 3 Peritonitis 4 2 6 3 ... 1 ... ... ... 1 ... 1 ... ... ... TABLE III.—(Continued.) DISEASES IN ORDERS. (Continued.J 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 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and under 85. 85& up\vards Male. Female. Total. III. 4 Ascites 1 6 7 ... ... ... ... ... 1 ... 2 1 3 ... ... Con. 6 Ulcrtn.of Intes. ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... 6 Hernia 2 2 4 ... ... ... ... ... ... ... 1 2 1 .. . ... 7 Ileus 1 2 3 1 ... ... 1 ... ... ... ... ... ... 1 ... 8 Intussusception 2 ... 2 ... ... ... ... ... ... ... ... ... 1 1 ... 9 Strict of Intes. ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... 10 Fistula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Stom. Dise. &c. 4 4 8 1 ... 1 ... ... 2 1 1 ... 2 ... ... 12 Pancreas Dis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Hepatitis 1 1 2 ... ... ... 1 ... ... 1 ... ... ... ... ... 14 Jaundice ... 2 2 ... ... ... ... ... ... ... 1 ... 1 ... ... 15 Liver Dis. &c. 7 13 20 ... ... ... ... ... 3 2 5 4 4 2 ... 16 Spleen Dis. &c. ... 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... Order 5 1 Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Nephria 4 2 6 ... ... ... ... 1 1 3 ... 1 ... ... ... 4 Diabetes 2 ... 2 ... ... ... ... ... 1 ... ... 1 ... ... ... 5 Stone 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 6 Cystitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Kidney Dis. &c. 10 4 14 ... ... ... 1 ... ... 2 3 4 3 1 ... Order 6 1 Ovarian Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Uterus Dis. &c. ... 2 2 ... ... ... ... ... ... 1 1 ... ... ... ... Order 7 ... 1 Arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Joint Disease &c 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... Order 8 1 Skin Disease &c 1 2 3 ... 1 ... 1 ... ... ... ... ... 1 ... ... Order 1 1 Premature Bth 13 14 27 27 ... ... ... ... ... ... ... ... ... ... ... IV. 2 Cyanosis 1 ... 1 1 ... ... ... ... ... ... ... ... . . . ... ... 3 Spina Bifida 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 4 Other Malfmtns 3 1 4 4 ... ... ... ... ... ... ... ... ... ... ... 5 Teething 11 6 17 17 ... ... ... ... ... ... ... ... ... ... ... Order 2 1 Childbirth, see Metria ... 7 7 ... ... ... 1 2 2 2 ... ... ... ... ... Order 3 ... 1 Old Age 28 42 70 ... ... ... ... ... ... ... ••• ... 13 45 12 Order 4 1 Atrop.& Debilty 27 18 45 43 1 1 ... ... ... ... ... ... ... ... ... Order 1 A ccidt.or Neglgce 1 Fractres.&Cont 5 6 11 1 2 1 ... ... ... 1 4 2 ... ... ... V. 2 Wounds 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 3 Burns & Scalds 1 6 7 1 1 2 1 ... ... 1 1 ... ... ... ... 4 Poison 1 2 3 1 1 ... ... ... ... ... 1 ... ... ... ... 5 Drowning ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 6 Suffocation 5 2 7 7 ... ... ... ... ... ... ... ... ... ... ... 7 Otherwise 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... Ordr.3. Homicd 1 Murder & Manslaughter ... 2 2 2 ... ... ... ... ... ... ... ... ... ... ... Ordr. 4. Suicide ... 1 Wnds. Gnshot ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stb ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Poison 2 ... 2 ... ... ... ... ... ... 2 ... ... ... ... ... 3 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Hanging 3 1 4 ... ... ... ... 1 ... 1 2 ... ... ... Sudn. Dths. (cause unascertained) ... 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... Cause not specifid or ill-defined 7 9 16 5 2 ... ... ... ... 2 5 2 2 ... ... TABLE IV—Comparison of Mortality from various causes in London, and in St. Giles's. Four Quarters, 1860. Class. Classes and Orders or 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 18814 368.2 417 14894 291.5 336 12916 252.7 288 15197 297.4 378 Specified Causes 18581 363.6 409 14714 287.9 334 12782 250.1 286 15071 295.0 373 (Classes.) I Zymotic Diseases 3380 66.1 54 2917 57.1 47 3312 64.8 76 3392 66.4 87 II. Constitutional „ 3245 63.5 82 3409 66.7 86 2902 56.8 71 2967 580 75 III. Local „ 9204 180.1 208 6051 118.4 147 4520 88.5 98 6471 126.7 160 IV Developmental „ 2145 42.0 53 1779 34.8 48 1582 30.9 31 1734 34.0 40 V. Violent Deaths 607 11.9 12 558 10.9 6 466 9.1 10 507 9.9 11 (Orders.) I. 1. Miasmatic Diseases 3087 60.4 45 2664 52.1 43 3035 59.3 68 3137 61.5 86 2. Enthetic „ 93 1.8 6 74 1.5 1 71 1.4 5 84 1.6 0 3. Dietic „ 172 3.4 3 165 3.2 3 176 3.5 3 148 2.9 1 4. Parasitic „ 28 .5 0 14 .3 0 30 .6 0 23 .4 0 II. 1. Diathetic ,, 566 11.1 9 542 10.6 6 511 10.0 7 529 10.3 11 2. Tubercular „ 2679 52.4 73 2867 56.1 80 2391 46.8 64 2438 47.7 64 III. 1. Dis. of Nervous Syst. 2029 39.8 48 1714 33.5 34 1437 28.1 27 1569 30.7 35 2. „ Organs of Circulation 873 17.0 19 716 14.0 12 610 12.0 20 712 14.0 12 3. „ Respiratory Organs 5178 101.3 115 2610 51.1 75 1467 28.8 31 3189 62.3 90 4. ,, Digestive ditto 719 14.1 18 640 12.5 18 642 12.5 15 610 12.0 15 5. ,, Urinary ditto 229 4.5 8 220 4.4 5 213 4.1 5 226 4.4 5 6. „ Organs of Generation 58 1.1 0 43 .8 1 45 .9 0 47 1.0 1 7. „ „ Locomotion 48 .9 0 42 .8 1 37 .7 0 49 1.0 0 8. ,, Integumentary System 70 1.4 0 66 1.3 1 69 1.4 0 69 1.3 2 IV. 1. Dev. Dis. of Children. 545 10.7 13 523 10.2 18 389 7.6 10 4 57 9.0 9 2. „ „ Adults 79 1.5 2 65 1.3 2 55 1.1 1 63 1.2 2 3. ,, „ Old People 790 15.5 25 615 12.0 15 411 8.0 10 572 11.2 20 4. Diseases of Nutrition 731 14.3 13 576 11.3 13 727 14.2 10 642 12.6 9 V. 1. Accident 507 10.0 12 437 8.5 6 356 7.0 5 415 8.0 8 4. Sucide 63 1.2 0 80 1.6 0 79 1.5 3 63 1.3 3 All other Violent Dths 37 .7 0 41 .8 0 31 .6 2 29 .6 0 Sudden Deaths 48 .9 0 32 .6 1 26 .5 0 32 .7 0 Cause unspecified 185 3.7 8 148 3.0 1 108 2 .1 2 94 1.7 5 I. Certain Special Diseases. Small Pox 464 9.1 14 240 4.7 3 99 2.0 1 74 1.4 0 Measles 274 5.4 1 571 11.2 3 579 11.3 5 630 12.3 31 Scarlatina and Diphtheritis 685 13.4 5 463 9.1 10 542 10.6 8 767 15.0 5 3 1 0 5 Whooping Cough. 612 12.0 7 506 10.0 10 350 6.9 13 555 10.9 13 Diarrhœa 148 2.9 2 168 3.3 2 754 14.8 23 513 6.1 10 Typhus and other) Fever continued & remittent 503 9.9 9 391 7.6 5 361 7.1 8 379 7.4 9 TABLE V.—Registered Deaths in 52 Weeks of 1860. Sub-Districts of St. Giles's Here Nine Deaths registered a second time are omitted. Deaths in SUb-Districts. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year, 1860. [Population 1861.] M. F. M. F. M. F. M. F. M. F. Both Sexes. St. George, Bloomsbury. [17392.] 41 37 42 38 27 34 34 34 144 143 287 St. Giles's, South. [19474.] 119 105 81 80 72 66 106 81 378 332 710 St. Giles's, North. [17115.] 46 49 42 36 37 36 47 47 172 168 340 Whole District. [53981.] 206 191 165 154 136 136 187 162 694 643 1337 TABLE VI.—Registered Births in 52 Weeks of 1860. Sub-Districts of St. Giles's Births in Sub-Districts. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. 1860. M. F. M. F. M. F. M. F. M. F. Total Children. St. George, Bloomsbury 63 57 48 55 56 47 50 54 217 213 430 St. Giles's, South 110 95 95 87 87 89 130 93 422 364 786 St. Giles's, North 78 84 65 50 90 75 54 66 287 275 562 Whole District 251 236 208 192 233 211 234 213 926 852 1778 28 TABLE VII. Estimate of the population of the three sub-districts of St. Giles's, in the four years 1857-1860. The year 1861 from the census. sub-district of 1857. 1858. 1659. 1860. 1861. Census. St. George, Blmsby. 17160 17218 17276 17334 17392 St. Giles, South 19951 19900 19500 19500 19474 St.Giles, North 17456 17343 17343 17229 17115 Whole District 54567 54461 54119 54063 53981 This estimate is based on what is known of the movements of the population, as well as on data derived from the three last censuses. APPENDIX No. VIII. Extract from the Third Report of the Medical Officer of the Privy Council, 1860. "In the district of South St. Giles's, soon after this inquiry commenced, the small-pox mortality increased at such a rate, as showed the full force of epidemic influence. The deaths, which in the quarter ending September, 1859, had been but two, amounted in the succeeding quarter to 13, and in the first two weeks of January to 6: inquiries of the registrar showed, that, besides these deaths, three others had been registered as occurring before the 15th January: and it was ascertained by the medical officer of health and his sanitary inspector that many unvaccinated persons were suffering at that time from the disease, and that in these infected localities, often in the very infected houses, there were, notwithstanding the activity with which, since the commencement of the year, vaccination had been carried on, unvaccinated persons and children. The disease was so evidently gaining power, and was so thoroughly in-rooted in many localities, that Dr. Buchanan and I were quite satisfied the ordinary means of repression would be found inadequate, and that a thorough visitation of the infected spots was imperatively required. Strong representations made on this point to the chairman of the directors of the poor, and other members of the Board, led to the determination that this should be done in the most complete manner, 'from nouse to house, room to room, and child to child;' the parish being quite prepared, as stated by the vestry clerk, to put on any amount of force which might be required for attaining this necessary object. Messrs. Bennett and Knaggs, the medical officers and public vaccinators of the parish, undertook this work; and so completely and with such energy was it carried out, that in a few days all the worst localities had been thoroughly visited, and the vaccinations, which in the fortnight ending January 4, had been 61, and in the succeeding fortnight 143, rose during the next fortnight—the period of this visitation—to 472: 169 of the entire number operated on in January being wholly unprotected, yet living in, or closely contiguous to, the most infected spots. And from the time this step was taken to the end of the epidemic in London in September, (if we except the cases which were known when it was begun, or were ascertained in its progress, to be already suffering from the disease), the deaths from small-pox in the whole of South St. Giles's were but three, only one of which was in parochial practice, and this did not occur till four months afterwards. Now that this result was wholly due to the measures employed, and not to the sudden cessation of epidemic influence, there was the most conclusive proof: for the number of modified cases of smallpox in vaccinated individuals continued as great for many weeks after this exten- 29 sive vaccination as before; the number of fresh cases of this class admitted in parochial practice from December 21 to January 21 being 28, and from January 21 to February 21, 29. I am much indebted to Mr. Bennett for the kindness with which he furnished me with a complete copy of his small-pox register, an abstract of which, for the half-year during which the epidemic prevailed in South St. Giles's (from October 1359 to March 31, 1860), is subjoined, arranged in two periods—before and after the house to house vaccination date. CASES OF SMALL-POX ADMITTED. In Vaccinated Persons. In Unvaccinated Persons. Confluent. Discrete Total, Deaths. Confluent. Discrete. Total. Deaths. October 1 to January 21. 2 49 51 1 (a) 29 12 41 14 January 21 to March 31. — 41 41 — 4 2 6(b) — (a) Not from small-pox, but from superadded disease. The case was that of a young woman, aged 20, whose attack of small-pox had been discrete and modified; she was convalescent, when she died suddenly without apparent cause. Examination alter death was not allowed. (b) Of which three occurred in a part of the district distant from that which had been visited from house to house. APPENDIX No. IX. Houses and population of the Ten Sub-divisions of St. Giles's. From the census of 1861. (Ascertained since the completion of this Report.) locality of Inhabited houses. residents. A Bedford-square 508 3948 B Russell-square 810 5551 C Coram-street 649 6104 D Bloomsbury-square 536 5251 E Church-lane 324 4674 F Dudley-street 511 9047 G Short's-gardens 384 6306 H Northern Drury-lane 370 5155 K Southern Drury-lane 274 5057 L Lincoln's-inn-fields Workhouse 308 1 2261 695 Total 4675 54049 Here Eve-terrace, Old St. Pancras-road (thirteen houses and eighty-eight residents) is, for brevity's sake, included in locality A. The enumerator's returns on which this Table is based, were kindly furnished to me by the Registrar-General.—G.B.