STGIL 10 1862 SANITARY STATISTICS and PROCEEDINGS in ST. GILES' DISTRICT. by GEORGE BUCHANAN, M.D., Medical Officer of Health. LONDON: H. ELLIOT, PRINTER, 475, NEW OXFORD STREET, W.C. 1863. 1862-3. ANNUAL REPORT OF THE Medical Officer of Health. SECTION I.—On the Mortality of the Metropolis in 1862. The year 1862 has been characterized by an unusually high mortality in London. Allowance being made for increase in population, the deaths were more numerous than in any year since 1858. Sixty-six thousand, nine hundred and fifty persons died in the year, giving a death rate of 23.41 in the thousand, or one in every forty-three inhabitants. Among the diseases that produced the high mortality in London in 1862, an epidemic of typhus first requires mention. Although every year large numbers of deaths are registered from so called typhus fever, the real typhus which especially occurs in an epidemic form had been practically absent from London for several years, until in the latter half of 1861 it again appeared with its well known epidemic characters. In the course of 1862, 3742 deaths from various fevers were registered in London, the highest number in any of the preceding five years having been 1996. Of the 3742 deaths it is probable that upwards of 2000 were from true typhus.* But though the reappearance of typhus has thus swollen the mortality from fever, still, the zymotic class of diseases taken as a whole, shows only a slight excess of deaths in 1862. Scarlatina, measles and whooping-cough each contributed their full annual average of deaths—not much beyond it. Small-pox was quiescent, waiting for another accumulation of unvaccinated persons before renewing its epidemic visitation in 1863. Another great member of this class, diarrhoea, was markedly less fatal than usual, and its subsidence mainly has prevented the zymotic mortality from being very high in London.—The other causes of death that exhibit material fluctuations from one year to another, being much affected by the atmospheric conditions that prevail, are Consumption and Diseases of the lungs. From diseases of the former kind the number of deaths recorded in 1862 was very much the average of the last five years, while from diseases * This disease usually causing about one death in every six persons that it attacks, it follows that the serious number of 12,000 persons have suffered from typhus fever in the year, almost the whole of whom belonged to the poorer classes of society. A special economic interest rttaches to the prevalence of typhus. It is the epidemic disease which ot all others carries off the heads of families. Most diseases of this sort find their victims chiefly in children. 2 of the lungs, the deaths were rather less numerous than common. The nature of the seasons in 1862, so far as they bear on the prevalent causes of death, may be summed up by saying that the temperature was more even, higher in the winter months, and lower in the summer months, than usual, and that there was throughout the year a larger rainfall than is common for the metropolis. It was especially the Eastern and Central divisions of the metropolis that suffered from the high mortality of 1862. In the Central districts, which include St. Giles' at the one end and the City Unions at the other, the death-rate was most especially high, exceeding not only that of any recent year but even exceeding the average of the ten years that preceded 1857. Table I. of the Appendix will show the incidence of mortality on each group of districts. The largest number of deaths occurred as usual during the first and last quarters of the year, the smallest number in the third quarter. This variation is mainly due to the unequal distribution of deaths from lung disease. But other disorders not so directly dependent on temperature, also exhibited notable fluctuations. Thus, measles and scarlatina were increasingly fatal through the year, so that in the fourth quarter these two disorders caused twice as many deaths as in the first quarter. Small-pox too was giving threats, before the year was out, of the epidemic character it was about to assume. On the other hand whooping-cough and typhus declined from the earlier to the later part of the year. Diarrhoea culminated of course in the hot season. The fourth of the tables appended to this report shows in detail the progress of each class of disease through the four quarters of the year. SECTION II.—On the Aggregate Mortality of Saint Giles' in 1862. Comparison with other Districts. The mortality of London and of the central districts being thus high, the death rate of St. Giles' was of course also in excess. In the year 1862, the large number of 1563 deaths occurred among residents in St. Giles' district. This number represents a rate of 28.9 per 1000 inhabitants, being a considerable increase above the death rate of any recent year. Of the 1563 deaths, 1483 were registered within the boundaries of St. Giles' and Bloomsburv; and 80 occurred in the Hospitals of other districts (Appendix II.) There was, as usual, a large excess of deaths among males, 814 of them having died to 749 of the other sex. Fifty-four of the 80 Hospital deaths were among males. The average age at death was 27 years and 10 months. Four hundred and seventy-six infants died before they were two years old, and 191 others between the age of two and five. Forty-three out of every hundred deaths therefore were those of children under 5 years old. In the Table on the opposite page, a detailed comparison is given of the mortalitv of St. Giles', with that of the several districts that surround it. Correction has been duly made in each instance for deaths in Hospitals and outlying Workhouses. It will be seen that there is, as usual, a higher death rate in St. Giles' than in any of the neighbouring districts, and no less than 5½ per 1000 above the average of London. In 1862, however, as in the preceding year, Holborn had a mortality so exceptionally high, as to rank this district MORTALITY IN 1862. Districts. Population, 1 862. REGISTERED MORTALITY. Column A (see Column B. Note.) Total Mortality in 1862 corrected for Cols A. & B Districts. 1st Quarter, 13 Weeks. 2nd Quarter, 13 Weeks. 3rd Quarter, 13 Weeks. 4th Quarter, 13 Weeks. Whole Year, 52 Weeks. Actual number. per 10,000. Actual number. per 1:0,000. Actual number. per 10,000. Actual number. per 10 000. Actual number. per 10,000. (add) ( subtract.) Actual number. per 10,000. St. Paneras 202,011 1273 63.0 946 46.8 1093 54.1 1210 59.9 4522 223.9 126 Hospls. 152 Workh. 144 Strand 296 4352 215.5 St. Pancras. St. Marylebone 162,000 1139 70.3 881 54.4 869 53.6 959 59.2 3848 237.5 140 Hospital, 147 3841 237.1 St. Marylebone. Metropolis 2,859,778 18,405 64.3 15,695 54.9 15,133 52.9 17,717 61.9 66,950 234.1 — — 66950 234.1 Metropolis. Holborn 44.685 361 80.8 298 66.7 256 57.3 295 66.0 1210 270.8 95 Hospital, 69 1276 285.5 Holborn. Strand 42,810 258 60.3 243 56.8 232 54.2 275 64.2 1008 235.5 Workh 144 Hosps. 45 189 Hospital, 107 1090 254.6 Strand. St. Martin's 22,436 162 72.2 126 56.2 141 62.8 141 62.8 570 254.0 31 Hospital, 67 534 238.0 St. Martin's. St. Giles's 54,026 413 76.5 347 64.3 352 65.1 .368 68.1 3480 274.0 80 Hosps. and 3† — 1563 289.0 St. Giles's. *Col. A. gives the number of the Inhabitants of each District who expired in 1862, in the Public Institution of other Districts; these figures must be added to the Registered Mortality. Col. B. gives the number of Inhabitans 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 II.) t This number 3 requires to be added as the balance of certain errors in the Registered Mortality. Since this table and those of the Appendix were constructed, however, there has been found reason to believe that five deaths (three registered in the District and two in Hospitals) have been entered by mistake, the persons having resided beyond the limits of St. Giles's. 4 almost with our own. The Strand, with an unusually high death-rate, still had much fewer deaths than Holborn or St. Giles'. St. Martin's and St. Marylebone were close on the average of London, and St. Pancras was the only one of the districts under review that held a better position than that average. The death-rates of these districts, in 1862, are compared with those witnessed in former years in the subjoined Table. Death-rate per 10.000* in St. Giles's and neighbouring Districts. districts. 1857. 1858. 1859. 18C0. 1861. 1862. St. Pancras 197.0 224.9 221.4 208.7 228.3 215.5 St. Marylebone 217.3 224.0 225.0 227.7 242.5 237.1 Metropolis 221.0 234.4 227.0 224.1 231.8 234.1 Holborn 236.3 247.7 248.6 238.7 270.4 285.5 Strand 239.4 226.6 262.9 231.5 233.7 254.6 St. Martin 243.0 218.5 246.7 228.6 233.7 238.0 St. Giles's 280.0 258.2 260.1 262.4 270.3 289.0 * Correction is here made for the longer duration of the registration year, 1857. Also for all deaths in hospitals and outlying workhouses. SECTION III.—On the causes of Death in St. Giles' District. Passing from the consideration of the gross mortality of St. Giles' to investigate the particular diseases that caused it, it is instructive first to examine them side by side with the same diseases as prevailing in other parts of London. The population of St. Giles' in 1862, being 1÷ 52.6th part of that of the whole metropolis, this proportion of deaths from each class of causes would be expected to fall to our share. Some diseases, however, show a higher mortality than this quota, while others were fatal to less than the calculated degree. Zymotic Diseases have of course the first interest for us. They are the class of disorders whose prevention has been regarded as specially within the province of sanitary science, and they form one of the chief groups of diseases from which St. Giles' suffers to a greater degree than other parts of London. In 1862, the miasmatic order of these diseases produced 327 deaths in St. Giles', a slight excess above the average number of recent years. Comparing this number with the quota for St. Giles' population in the year, the excess is about what is generally observed. The mortality of London at large, from this group of disorders, was such that 310 deaths would have been reckoned to our population. The actual deaths were therefore, on this standard, in some but not in considerable excess. Small Pox caused only four deaths.* Measles and Scarlatina increased much in prevalence through the year in St. Giles', as elsewhere in London, but Measles produced fewer deaths, while Scarlatina caused a few more than would be calculated for the population. While Diphtheritis was little fatal to our district, Croup† is stated to have caused 26 deaths instead of the estimated quota of 18. Whooping Cough affected St, Giles' much like the rest of London. Diar. hoea was singularly little fatal, only 25 deaths being returned from it—the * Again it must be noted that some deaths of rieketty children, where "crowing respiration" appears as a main symptom, are probably inserted under this head. Such deaths would be likely to happen with particular frequency in St. Giles'. † There is some doubt about one of these cases; in the distribution of mortality into localities, three Small-pox deaths only could be placed. 5 smallest number recorded for many years. The various forms of Continued and remittent fever caused 93 deaths, the average of the five preceding years being only 39. The increase of 54 deaths was doubtless due to the reappearance of true Typhus, which had been absent from St. Giles' for several years, as absolutely as from the rest of the town.* Typhus being a disease that affects the poor classes especially, it is of interest to note that of the 93 fever deaths, 27 occurred in the workhouse, and 7 were among parishioners of St. Giles' and Bloomsbury who had been taken to neighbouring hospitals. Of these 34 fever deaths in public institutions, 29 were recorded as being "typhus." The other 25 deaths that may be reckoned as resulting from this particular form of contagious fever, took place in the houses of the district. The great group of Consumptive or Tubercular diseases, always reckons in St. Giles's more victims than in an equal population of the rest of London. The excess in 1862, was somewhat greater than usual—297 deaths from these causes being registered instead of the estimated quota of 201. That our population is ill fed and ill-housed beyond the average of other districts appears the cause of this disproportionate mortality. Diseases of the several parts and organs of the body form the third class of causes of death. In St. Giles', as usual, a large mortality was witnessed in 1862, from Diseases of the Brain. Many of these diseases, but especially infantile convulsions, depend upon causes that are particularly common in the poor of St. Giles. Bad management and improper feeding of infants is the great cause of convulsions among them. In the adult, intemperance adds much to the prevalence of this set of diseases. A large mortality from Heart Disease, again, is a usual feature of the death-rate of St. Giles'. This year the excess has been marked, but not in a degree that requires detailed comment.—It is the important class of Diseases of the Breathing Organs that demands our most earnest attention. From these diseases, St. Giles' lost 346 inhabitants against an estimated number of 213. This is the largest mortality from such causes that has been ever recorded in their reports. The excess is alike, as far as can be seen, in the acute and chronic forms of lung disease. It affected males (as is generally the case, but still especially so this year), considerably more than females, and fell chiefly of course, on the colder quarters of the year. In these circumstances are indicated the chief causes why St. Giles' suffers especially from such complaints. A poor labouring population cannot avoid exposure to all sorts of weathers, and is often not fortified by adequate clothing and food to resist its inclemencies. But why the district has suffered more in 1862 than usual from these lung complaints is not so easily explained. In the class of Developmental diseases, the 'experience of St. Giles' in 1862 is identical with that of former years. A large excess in the mortality of its children is observed from the causes that are reckoned under this head. The number of children prematurely born seems, not unexpectedly, to be very high in St. Giles'. And weakly children, succumbing to small ailments in the course of their teething, also swell high the number of deaths referred * In certificates that are given by medical practitioners as to the cause of death, it often happens that the nature of a fever is not properly designated. Thirty-six of the 90 deaths only were registered as occurring from Typhus. There is no doubt, however, that many of the deaths returned under vague designations (perhaps some of those returned as Typhoid), were real cases of Epidemic Typhus. Comparison of Mortality from various causes in London and in Saint Giles'. Whole Year, 1862. Classes. Cusses and Orders of Disease. London. Sr Giles's, Population, 54,026. Population, 2,859,778. Estimated Quota.* Actual Registered Mortality. Corrected for Deaths in Hospitls. All Causes 66950 1273.0 1483 1563 Specified Causes 66075 1256.3 1462 1539 I. Classes Zvmotic Diseases 17869 339.7 344 357 II. Constitutional ,, 12903 245.5 321 342 III Local „ 25423 483.3 596 629 IV. Developmental, 7671 145.8 175 177 V. Violent Deaths 2209 42.0 26 34 I. Orders. 1 Miasmatic Diseases 16678 309.9 314 327 2 Erithetic „ 343 6.5 15 15 3 Dietic „ 706 13.5 12 12 4 Parasitic „ 142 2.7 3 3 II. 1 Diathetic Diseases 2329 44.6 40 45 2 Tubercular Diseases 10574 200.9 281 297 III. 1 Diseases of Nervous System 6924 131.6 139 146 2 ,, Organs of Circulation 2993 56.9 57 67 3 „ Respiratory Organs 11190 212.8 337 346 4 „ Digestive Organs 2745 52.2 43 48 5 ,, Urinary Organs 958 18.2 13 15 6 , Organs of Generation 203 3.8 4 4 7 ,, Organs of Locomotion 184 3.5 3 3 8 „ Integumentary Organs 226 4.3 ... ... IV. 1 Dev: Dis. of Children 1964 37.4 62 62 2 „ „ Adults 252 4.8 6 6 3 ,, ,, Old People 2631 50.0 53 54 4 Diseases of Nutrition 2819 536 54 55 V 1 Accident or Negligence 1829 34.8 23 31 4 Suicide 266 5.0 2 2 All other Violent Deaths 114 2.2 1 1 Sudden Deaths 256 4.9 ... ... Cases unspecified 619 11.8 21 24 Certain Special Diseases of Zymotic Class and Miasmatic Order- 1.1. Small Pox 345 6.5 4 4 Measles 2281 43.4 37 37 Scarlatina 3457 65.7 68 70 Diphtheritis 734 13.9 7 9 Croup 937 17.8 24 26 Whooping Cough 2150 40.9 42 42 Diarrhoea 1735 32.9 25 25 Typhus & other Fevers, continued and remittent 3742 71.1 86 93 * l÷52.6th part of the entire mortality of the Town. As to the exact number of Deaths registered in the District, see note (*) to table on page 3. 7 to this class At the other extreme of life, it is again observed that St. Giles' has its full share of persons who die of nothing but old age. One woman is even recorded to have reached the age of 104 years. Oil the other hand, nine of the persons who are said to have died of old age, had not reached the age of fourscore years and ten, and one woman is registered as dying of "natural decay,"—that was very unnatural —at the age of 50 years. Of Deaths from Violence, it does not appear that so many occurred in St. Giles' as the number of its residents would lead us to expect. On the other hand, deaths from Causes that were not specified, or badly defined, were twice as common in our district as in the average of the town, and it is to be feared that among them some deaths occurred that were open to the suspicion of being caused by violence. To recapitulate then, the high mortality of St. Giles' in the year 1862, resulted firstly, from a small excess (5.5 per cent., and less than the average excess of former years) in the class of miasmatic or contagious diseases, of which typhus fever was the only member contributing an exceptional mortality above other districts. Secondly, from a large excegs, (47.8 percent.) in the important class of consumptive disorders. Thirdly, from a great excess (54.3 per cent.) in the equally important group of lung diseases, acute and chronic; and fourthly, from a great excess (65.8 per cent.) in such children's diseases as are not comprised in the foregoing classes. The causes of the diseases thus in excess are to some extent such as public sanitary measures can deal with, but are to a greater degree dependent on conditions of exposure, destitution, and ignorance, that cannot be dealt with directly by the Officer of Health. SECTION IV.—On the Localization of Disease and Death in St. Giles' in 1862. A. In Sub-districts. Before a death-rate can be obtained for each of the sub-districts of St. Giles', correction has to be made for deaths in Hospitals, while deaths occurring in the Workhouse must be considered apart. In so far as the mortality in the Workhouse resulted from recent disease that was taken into the Infirmary for treatment, this mortality may be distributed among the streets from which the patients were brought. These corrections lead to the following results :— Sub-districts of St. Giles's, Deaths in 1862. Deaths of residents in sub-district of Dying at own Homes Dying in Hospitals. Dying ill Worhouse. Total. Bloomsbury 342 18 16 376 St Giles's South 441 38 116 595 (Workhouse Inmates, & c.) ... ... 108 108 St. Giles's North 404 24 56 484 Whole District 1187 80 296 1563 The death-rate of persons resident in each sub-district, without reference to the place where they happened to die, is therefore, in St. George Bloomsbury, 21.6 per 1000; in St. Giles' South 31.7 per 1000; and in St. Giles' North 28.2 per 1000. Herein the Workhouse with its residents is excluded. 8 Comparing these figures with the results of former years (and taking the rate per ten thousand to avoid fractions) we have the following Death-rate per 10,000 in Sub-districts* districts. 1857. 1858. 1859. 1860. 1861. 1862. St. George, Bloomsbury 180 198 184 185 205 216 St. Giles's South 357 292 349 346 291 317 St. Giles's North 283 277 240 247 279 282 Whole District 280 258 260 262 270 289 * Correction has been made for the extra length of the registration year 1857. The progressive rise in the mortality of Bloomsbury is only to a small extent accounted for by the increase of its population. The death-rate of St. Giles' South is slightly below the average of the preceding five years, while that of St. Giles' North is (like Bloomsbury) in excess of its usual amount. Here for convenience of reference it is well to show the Births in the same sub-districts, in so far as they have been registered each year. Registered Births in Sub-districts. sub-districts. 1857. 1858. 1859. 1860. 1861. 1862. St. George Bloomsbury 398 403 411 430 416 383 St. Giles's South 860 717 780 786 808 772 St. Giles's North 592 557 538 562 532 583 Whole District 1850 1677 1729 1778 1756 1738 B. Reverting, for the more detailed conditions of the localization of disease in St. Giles', to the Ten Localities into which it has been customary in these reports to divide the district, we find that the gross mortality has been distributed in the manner shown by the table on the top of the next page. Here it may be observed that while most of the localities have contributed to the rise in mortality in 1862, those about Church Lane and Short's Gardens are especially above their numbers of the preceding year, and both now occupy a position even below the neighbourhood of Dudley Street. The order of salubrity of the different localities, on the test of the death-rate, remains much as in former years. About one of the localities, however, special mention must be made. The angle of the parish of Bloomsbury about Coram Street, consisting of the parts to the East of Woburn-place, has habitually a much higher mortality than the rest of the parish. This would be no matter for surprise when we remember that the poorest people live in the 9 locality in question. But it further appears that of recent years the mortality is seriously increasing there, the deaths for the past six years having been respectively 127, 133, 128, 127, 151, and 161, in this locality. Ten Sub-divisions of St. Giles's; their order of Mortality from all causes, 1862. Order of Sequence, 1862. Locality of Actual number of Deaths in 1862. Total Mortality per 10,000 In Houses. In Workh. In Hosptls. Total. Best 1st B. Russell-square 72 1 2 75 135 2nd A. Bedford-square 64 — 3 67 170 3rd L. Lincoln's Inn-fields 42 — 3 45 199 4th D. Bloomsbury-square 108 1 6 115 218 5th.-6th C. Coram-square 145 11 8 164 270 K, Southern Drury-lane. 112 18 8 138 272 7th.-8th H. Northern Drury-lane. 108 44 9 161 310 F. Dudley-street 245 25 12 282 311 9th K. Church-lane 116 34 11 161 342 Worst 10th. G. Short's gardens 175 54 18 247 391 Workhouse Inmates, &c. — 108 — 108 — Whole District 1187 296 80 1563 289 The continually deteriorating state of the Courts about Little Coram Street has probably the main share in the increase of mortality, and it is to be feared that this increase will continue until some thorough sanitary improvements are here made. The Coram Street neighbourhood has already attained the evil distinction of being bracketted with Southern Drury Lane in its mortality. The Ten Sub-divisions—their Order of Infantile Mortality in 1862. Order of Sequence, 1862. Locality of Deaths among Children in 1862. Infantile mortality per 10,000 residents. Under 2 years. 2 years to 5 years. Total under 0 5 ears. Best 1st B. Russell-square 16 6 22 40 2nd A. Bedford-square 14 10 24 61 3rd D. Bloomsbury-square 35 15 50 95 4th.-5th L. Lincoln's Inn fields 16 9 25 110 H. Northern Drury lane 43 15 58 112 6th K. Southern Drury-lane 48 16 64 126 7th C.coram-street 68 17 85 138 7th.-8th G. Short's-gardens 72 25 97 154 F. Dudley-street 97 47 144 159 Worst 10th E. Church-lane 49 28 77 166 Workhouse Inmates, &c 18 3 21 — Whole District 476 191 667 123 In the above table are shown the districts in the order in which they suffer loss of children. The disproportion between the best and the worst localities in this respect is as usual very striking, four children dying in the poorer parts of St. Giles' to every one that dies in the better parts of Blooms- 10 bury. This difference is only accounted for to a small degree by the different proportion of the children in the two populations. The great bulk of the difference arises from preventible causes, unwholesome circumstances and ignorant management necessarily affecting chiefly the most tender and helpless ages. The Ten Localities—their Order of Mortality from Zymotic Diseases, (Miasmatic Order) 1862. 0rder of Sequence, 18 6 2. Locality of Deaths from Miasmatic Diseases in 1862. Zymotic mortality per 10,000 All miasmatic diseases. Small-pox. Measles. | Scarlet Fever. Diphtheritis. Whooping Cough. Continued fevers, of which ( ) registered as "typhus." Diarrhoea. Other miasmatic diseases. Best 1st B Kussell-square 11 — 2 3 1 1 1 (0) 2 1 18 2-3 1). Bloomsbury-square 26 — — 3 1 10 7 (1) 3 2 49 L. Lincoln's Inn-fields n — 2 2 — — 4 (2) — 3 49 4-5-6 H. Northern Drury-la. 27 — 4 7 — 6 8 (5) 1 1 52 K. Southern Drury-la. 27 2 5 1 1 4 8 (3) 3 3 53 A. Bedford-square 23 — 2 1 1 3 8 (2) 5 3 58 7th G. Short's-gardens 41 — 2 9 — 3 17 (4) 6 4 65 Worst 8-9-10 E. Church-lane 34 — 3 9 — 3 13 (5) 3 3 73 C. Coram-street 46 1 11 8 2 6 10 (4) 1 7 75 IF Dudley-street 70 — 9 24 2 7 18 (5) 3 7 78 Workhouse Inmates 10 — — 1 — — 7 (7) — 2 — Whole District 326 3 40 68 8 42 101 (38) 27 36 60 * The totals will not always be found to correspond exactly with those in Table III. of the Appendix, This arises partly from the different ways in which a complicated disease may be recorded on two occasions; partly from some correction having been made in the one set of Tables, after the other was compiled. In the column of "fevers," puerperal fever is here included. In the above table it will be seen that measles culminated about Coram Street, scarlatina about Dudley Street, and whooping-cough in the neighbourhood of Bloomsbury Square. But with the exception of scarlet fever and continued fever all diseases, of the zymotic class were less unevenly distributed than usual throughout the di trict. Continued fever, including epidemic tvphus, was seen especially in the four localities that are at the bottom of the list. In the poor and thickly populated districts of Dudley Street, Short's Gardeus, and Church Lane, it is to be expected that this disease, depending as it does on privation and crowding, would attain its maximum of fatality. It was less to be expected that the neighbourhood of Coram Street should stand below both of the Drury Lane localities in its total mortality from fever. Typhus, once produced by the causes just mentioned, spreads with great rapidity by contagion. It is therefore of the utmost importance to get persons suffering from this disease removed whenever possible from their homes. ' This was done, as has been before stated, in one third of the fatal cases of "fever" and probably in more than half of the fatal cases of true typhus. Probably there would have been a much smaller mortality if the typhus patients had been removed universally from their homes. 11 With reference to the place into which fever cases are taken for treatment, it has been observed that 27 deaths from fever occurred in the Workhouse, and 7 in various neighbouring Hospitals—none in the London Fever Hospital, the establishment specially devoted to the care of this class of diseases. It is within the province of this report to point out that there is much danger in treating tvphus cases in Infirmaries and Workhouses where patients are received suffering from other diseases, and in which the staff of the establishment is not acclimatized to fever. In the Workhouse of St. Giles and in at least one of the general Hospitals into which our patients were received, typhus in 18C2 spread to other inmates in a serious degree. ^ hat most concerns our own district is, that in the Workhouse of St. Giles' seven inmates died of this fever, being a, quarter of the whole number of typhus deaths that occurred in the Infirmary. The seven deaths were mostly among imbecile or infirm persons. This spread of typhus is not peculiar to our Workhouse, but represents very closely the degree to which the disease habitually spreads if it is treated in the same wards with other diseases.* On the other hand, in the London Fever Hospital, in the same epidemic, the deaths among the persons vho caught the fever in the wards was only one in 37 of the whole number of deaths. It is much to be hoped that, if fever should continue in our district, the experience of the past year may induce the adoption of a system of rigorous isolation for all cases of contagious tyjiiius. The Ten Localities—their order of Mortality from Tubercular Diseases, 1862. Order of Sequence, 18 62. Locality of Deaths from Tubercular Diseases. Tubercular Mortality per 10.000. From Consumption, Tabes, and Scrofula. From Water-on-the Brain. Total. Best1st B. Russell-square 11 2 13 23 2nd A. Bedford-square 10 1 11 28 3rd D. Bloomsbury-square 16 5 21 40 4th L. Lincoln's Inn-fields 7 3 10 44 5th C. Coram-street 24 4 28 46 6th F. Dudley-street 42 3 45 50 7-8-9 E. Church-lane 27 5 32 68 K. Southern Drury-lane 33 2 35 69 G. Short's-gardens 40 4 44 69 Worst 10th H. Northern Drury-lane 37 2 39 76 Workhouse Inmates 20 — 20 — Whole District 267 31 298 55 * Thus six general Hospitals of London into which typhus patients were admitted in 1862, and when the spread of the disease was investigated by Dr. Murchison, it was found that 21 out of 80 deaths from this fever were in nurses or other patients in proximity to the sick. c 1 12 The deaths from Tubercular Disease were as usual very diversely distributed, the poorer parts of St. Giles', in which there are many common lodging houses, suffering to an extreme degree. It has been said that the general mortality of the district from this class of causes was high in 1862. There is nothing worthy of remark in the special distribution of the excess. The Ten Localities--their order of Mortality from Diseases of the Lungs, 1862 Order of Sequence, 186 2. Locality of Deaths from Lung Diseases. Mortality per 10,000. Acte Bronchitis, Inflammation of Lungs and Pleura. Chronic Bronchitis and Asthma. Total. From acute lung diseases. From all lung diseases. Best 1st A. Bedford-square 4 3 7 10 18 2nd B. Russell-square 8 4 12 14 22 3rd D. Bloomsbury-squnre 12 7 19 23 36 4th L. Lincoln's Inn-fields 9 I 10 40 44 5th K. Southern Drury-lane 22 6 28 43 55 6th C. Coram-street 22 15 37 36 61 7th H. Northern Drury-lane 20 15 35 39 68 8th F. Dudley-street 43 23 66 47 73 Worst 9-10 E. Church lane 21 17 38 45 81 G. Short's-gardens 29 28 57 46 90 Workhouse Inmates 5 28 33 - - Whole District 195 147 342 37 63 Here are shewn the neighbourhoods that have suffered most in 1862 from lat enormous mortality from Lung Diseases that has been seen to character??? our district. The two districts lowest on the list were also lowest in the preceding year, gain may be observed the vast preponderance of these disorders in the nfortunate districts of St. Giles, where poverty necessitates constant exposure ??? the vicissitudes of weather, and forbids the system from being adequately rotected by clothing and food against the ill effects of such exposure. The distribution of Deaths from Violence needs no particular discussion. It is allotted a column in the following table, where for the first time an investigation is made into the localization of a class of disease which is especially prevalent in our district. It will be seen from the second column of the subjoined table that Brain diseases are much more fatal in the poor districts than in the more prosperous parts. But the third column will prove that this disproportion applies to Brain diseases scarcely otherwise than as it applies to the mortality from all causes. Convulsions in children being so prominent a member of this class of diseases, and all the disorders fatal to children being so especial rife among the poor, this negative result is about what would have been anticipated. 13 Distribution of Mortality from Brain Diseases in 1882. Also of Deaths from Violence and Intemperance. Deaths from Brain Diseases. Deaths from Violence and Intemperance. Actual number in 1862. In Locality of Actual mortality. Per 10.000 of population. Per cent. of total mortality. A. Bedford-square 4 10 6 2 B. Russell square 8 14 11 1 C. Coram street 10 16 10 1 D. Bloomsbury-square 5 10 11 2 K. Church-lane 18 33 11 2 K. Dudley street 30 33 lo½ 6 G. Short's-gardens 31 49 12½ 11 H. Northern Drury-lane 14 27 9 8 K. Southern Drurv lane 10 20 7 6 L. Lincoln's Inn-fields 4 18 9 1 Workhouse Inmates 21 ' 19 2 Whole District 155 29 10 42 SECTION V.—On the Diseases and Deaths in the Practice of the Public Medical Institutions of St. Giles's in 1862. In the subjoined tables are furnished numerical data as to the amount of sickness attended by the Medical Officers of the Workhouse and of the Bloomsbury Dispensary.* New Cases treated at Bloomsbury Dispensary, 1862. Quarter ending. Physician's Cases. Surgeon's cases. Casualties. Total. Admitd. Visited at home. Died. Admitd. Visited at home. Died. Admitd. Visited at home. Died. Mar. 25th. 843 213 26 362 66 1 232 1437 279 27 June 24th. 785 146 15 320 52 2 255 1360 198 17 Sept. 29th. 729 148 38 341 48 3 212 1282 196 41 Dec. 25th. 744 193 18 324 80 4 193 1261 273 22 Whole Yr. 3101 700 97 1347 246 10 892 5340 946 107 At the Bloomsbury Dispensary then the total number of patients was almost identical with the number treated in 1861, but a notably greater number of persons required attendance at their own homes. From the nature of the prevailing disorders this would be expected. Affections of the air-passages were observed by the physician to have been strikingly prevalent throughout the year, herein confirming the experience derived from the register of deaths. * In using these numbers it must be remembered that the proximity of a prevailing disease to one or other of these Institutions is habitually found to bring that disease into special prominence in the records of that Institution. c 2 Cases of Disease and Deaths, occurring in the Practice of the Workhouse in 1862, and its four Quarters. Cases occurring. Within Walls of Workhouse, (Infirmary and Inmates.) Among Out- Patients attending at Workhouse. Among Patients visited at their own homes. Quarters or the Year. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. First. Second Third. Eourth. 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 1 Cases. Deaths. Of all Diseases 466 110 365 54 390 55 358 74 1579 293 672 909 1088 1072 3741 512 57 547 30 >75 27 689 30 2323 144 ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... 2 1 1 2 ... ... ... ... ... 3 1 Measles 1 ... 6 ... 1 ... 2 ... 10 ... 2 12 17 12 43 7 2 47 ... 41 ... 65 ... 160 2 Scarlet Fever ... ... ... ... 5 1 20 ... 25 1 4 4 9 11 28 7 ... 9 1 19 5 27 2 62 8 Whooping Cough 2 ... ... ... 7 1 ... ... 9 1 11 6 3 3 23 5 3 3 ... ... ... 4 ... 12 3 Diarrhoea 1 ... ... ... 1 ... 2 ... 4 ... 49 109 304 173 635 7 ... 6 ... 27 ... 5 ... 45 ... "Fever and Febricula " 12 ... 10 ... 8 ... 7 ... 37 ... 70 87 105 83 345 77 11 102 ... 112 4 66 1 357 23 "Typhus Fever " 134 12 87 5 72 2 66 8 359 27 ... ... ... ... ... 2 ... ... ... 10 ... ... ... 12 ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis (acute and chronic) 61 33 32 12 39 10 71 19 203 74 148 225 197 264 834 65 3 52 2 50 1 105 1 272 7 Inflammation of the Lungs & Pleura 13 4 3 1 4 1 8 2 28 8 7 7 6 6 26 16 5 16 1 14 2 6 2 52 10 Consumptive Diseases 32 19 36 19 30 15 29 15 127 68 9 23 21 11 64 15 9 17 11 15 5 17 9 64 34 Ophthalmia 6 ... 3 ... 3 ... ... ... 12 ... 1 1 6 3 11 ... ... ... 1 ... 2 ... 3 ... 15 Of epidemic diseases none occurred in a way to require special mention, except that Small-pox began to show itself at the end of the year, after many months total absence. This was the beginning of the epidemic which has since spread so formidably, and it is to be noted that the epidemic shows itself on the books of this Dispensary earlier than in the records of the Workhouse. In the table on the opposite page is given a summary of the practice of the Parochial Medical Staff in the year 1862. A decrease will be noted in the number of those patients whose slighter ailments permitted of their attending at the Workhouse. This result was obtained from an almost absolute abeyance of whooping cough,—23 children only having been brought by this disease in 1862 against 424 in 1861. The class of patients seen at their own homes has much increased since 1861, but as the increase in number is accompanied by a much smaller mortality,* it would appear possible that the present Assistant-Surgeon visits the sick at their homes when suffering from slight ailments more freely than was the practice in 1861. Or the increased prevalence of lung diseases which need to be treated without exposure to the weather, may be the cause why this class of patients was more numerous. In the Workhouse Infirmary however, the number of patients has not only been unusually high, but the number of deaths has been considerably higher than in other years. In 1862, half as many persons again were admitted into the Infirmary as in 1861, and nearly double the numbers that were admitted in 1858. Lung diseases here again helped materially to swell the numbers, but the principal cause of the increased admissions is found in fevers of various forms. Three hundred and ninety-six patients suffered from continued fever, 359 of them being stated to have had typhus. Against these large numbers there were only 39 fever cases admitted in 1861, and 26 in 1860. It has before been mentioned that several inmates were attacked in the Workhouse by the contagion of typhus, and that 7 of them died. Considering how exceedingly important it is for the treatment of the sick and the prevention of contagion, to remove patients from their close rooms, it cannot be doubted that more advantage was gained than injury done by the removal of these typhus cases to the Infirmary. Still as it is possible (page 11) to get all this advantage without the same risk of contagion to other inmates, by the plan of treating the sick in a special Hospital, it is to be hoped that in future years typhus patients may be sent to the Fever Hospital or into special isolated wards instead of into the Workhouse. SECTION VI.—On the Deaths in St. Giles's where there was no Certificate of the Cause from a Medical Man or Coroner. Forty-five deaths were registered in St. Giles' in 1862, and the corpse in each case interred, about which there ought to have been enquiry. In 36 of these instances there was no medical certificate of the cause of death. In 11 of the 36 cases, this omission is stated to have occurred through the absence of any medical attendant in the fatal illness. In the other 25 cases, it is simply recorded that the alleged cause of death was not certified. Here are samples of this kind of entry. *The mortality in this class of patients which had averaged 8½ per cent, in the four preceding years, rose in 1861 to 14 per cent.; in 1962 it was only 6½ per cent. 16 At 31, Colonnade, on December 18th, 1861, the wife of a porter, aged 37, died of " exhaustion from drink," not certified. At 57, Dudley Street, on February 24th, 1862, a portmanteau maker, aged 50, died of " pain in the stomach not certified. At 11, Little Saint Andrew's Street, on May 21st, 1862, the son of a hatter, aged 3 months, died of " consumption;" not certified. At 22, Little Earl Street, on June 8th, a domestic servant, aged 25 years, died of " pain in the bowels;" not certified. At 1, Little Wild Street, on June 15th, a woman aged 21, occupation and cause of death " unknown;" no medical attendant. At 31, Dudley Street, on September 29th, the daughter of a tailor, aged 9 weeks, died of " convulsions;" not certified. It is intolerable in a civilized country parading its respect for human life that persons dying in this way should be interred without any scruple or enquiry. In at least two of these cases there is prima facie ground for suspecting poison. Again, there were no fewer than 20 infanta, under a week old, whose deaths were registered in 1862, as occurring from "premature birth," "convulsions," and so forth, without a particle of medical evidence ot the cause. "The Alarming Increase of Infanticide" that we read of daily in the papers is encouraged by nothing so much as by the scandalous facility with which burial certificates may be obtained in the present state of the law. Furthermore, if the law is careless as to the manner in which people die, it is not surprising that there is carelessness in obeying its scanty provisions relating to the registration of death. In February, l862, the Registrar of Bloomsbury received information that on the 24th of the preceding December a man aged 36, a domestic servant, had died at 3, Bedford Square; that he was removed from the house to the undertaker's immediately after death, and was buried in the Roman Catholic Cemetery at Kensal Green. No notice had ever been sent to the Registrar (as required by law) of the burial without his certificate. The informant, one of the deceased's fellow servants, could not state the cause of death, and did not know what had become of the medical certificate. Similar cases to this have occurred in former years. There is another class of Deaths, where the deceased has been seen by a medical practitioner, that equally require an investigation into the cause of death. Nine persons were certified in 1862 to have died of an "unknown" cause, the object of the surgeon who certified being (probably in all instances) that further enquiry should be made. Eight out of these nine deaths are entered on the registers of the Workhouse as follows :— Jan. 25. A man, aged 65, "dying when admitted;" certified. Feb. 11. A woman, aged 29, "dying when admitted;" certified. Mar. 22. A child, aged 4 months, "found dead;" certified. April 7. A woman, aged 58, "unknown;" certified. July 2. An infant, aged 4 days, "asphyxia, found dead;" certified. Sept. 26. A woman, aged 03, " dying when admitted;" certified. Oct. 3. An infant, aged 3 weeks, "died in the street;" certified. Dec. 17. A man, aged 60, " dying when admitted;" certified. Every one of these deaths was however registered, a certificate for burial given, and the body interred. Now in every one of these cases the law should have provided for information being sent to the Coroner, and none of these bodies should have been buried without his warrant. Whenever a Registrar 17 receives information of a death concerning whose cause there is no medical certificate, or receives a medical certificate in which the cause of death is not satisfactorily specified, and generally in all cases of doubt, it ought to be his function to communicate with the Coroner. Enquiry is needed in such cases, not necessarily for the purpose of criminating anybody, but with the object of getting at the real cause of such deaths. By the Coroner's enquiry not only is a moral influence exercised to restrain crime, and in many cases are groundless suspicions allayed, but important information is obtained and diffused that leads to the prevention, in other instances, of disease, of violence and of death. SECTION VII.—On the Sanitary Work of 1802. It appears now by the experience of several past years that about a ninth part of the houses in the district of St. Giles's come under the charge of the Sanitary Inspector every year. Inasmuch as few better class houses are included in his inspection, the 532 houses improved in 1862 represent a continuance of supervision of the poorer streets and courts of the district, that is tolerably thorough and efficient. The total of 1,724 nuisances about houses abated during the year, includes improvements in drainage and cleanliness, and in the necessaries surrounding the several dwellings. Increased attention has been paid to the ventilation of dwelling rooms, particularly such as are situate over stables in mews. House Improvements in St. Giles's, effected under the superintendence of Inspector Webb, between March 25th. 1862, and March, 25th, 1863. Number of houses improved 532 Improvements in Drainage. Drains constructed 111 Improved or repaired 90 Traps fixed 219 Cesspools abolished 39 Stables drained and horse-pools abolished 45 In Water Closots. Pan, trap, and water provided 46 Water and apparatus only provided 170 Cleaned or repaired 135 Newly constructed or re-built 18 In Dust Bins. Newly constructed 18 Repaired or covered 44 Paving. He-laid 75 In General Water Supply. Receptacles provided 30 Receptacles repaired 66 Water provided where none in house before 6 In Cleanliness and Repair. Generally repaired 30 Cleansed and lime-whited 320 Various accumulations removed from cellars, &c. 73 In Ventilation, &c. Ventilation improved 140 Overcrowding reduced 20 Kitchens disused, or made legally habitable 25 Other rooms disused 4 Proceedings taken. First notices 312 Second notices, letters, &c. 96 Summoned 3 Reported to Police or District Surveyor 36 Total Improvements 1724 18 New Public Sewers have been constructed in the course of 1862, in Nottingham Court, in Ashlins Place and in Whetstone Park; in each instance houses on the line of the new sewer have been connected therewith with very great advantage to their wholesomeness. An important new sewer has also been lately constructed to Keppel Mews South. Among places whose sewerage requires early consideration may be mentioned Dudley Street, New Compton Street, and Lincoln Court. In none of these streets can the houses now be drained with complete efficiency, owing to the defects of the central sewer. In Dudley Street, the sewer has been partially repaired, but it is understood still to be very inadequate to the requirements of the street. As far as practicable, the occupation has been prevented of those underground dwellings of the district that are not in conformity with the provisions of the Metropolis Local Management Act. A little more obedience has been shewn to the law by the parties interested since the enforcement of a penalty against the owners of certain cellars in Dudley Street. An inspection of the School Children of St. Giles's and Bloomsbury with reference to their Vaccination has been made, but a statement of the results will come with more interest into the next report, when the epidemic of Small Pox in 1863 will have to be noticed. Here it may be said, however, that the proportion of un-vaccinated children detected was much less than on the occasion of the former inspection in 1859. In the year 1862, an amendment of the law, (25 & 26 Vict., cap. cii. s. 93) gave to Justices of the Peace the power of licensing places to be used as Cowhouses in London, and provided that the District Board might shew cause against the granting of such license. The Board of Works of St. Giles's determined to oppose the granting of any license to Cow-houses within their district, on the f round that their establishments could not be conducted in crowded neighbourhoods without injury to the health of human residents. Other arguments might easily be adduced against London Cow-houses, viz, that the milk of the animals in London sheds was not as wholesome as that of cows in country pastures; and further, that Central London could easily be supplied with milk from the country; but the main point that appeared needful CHURCHYARD LLOYD'S COURT. cowsheds and yard. NEW COMPTON STREET. DUDLEY STREET. 10 9 8 7 £ 5 4 3 2 1 STACEY STREET. 11 12 13 14 15 PHOENIX ST. 16 17 18 19 20 19 to be established in evidence before the Magistrates was that injury was inflicted on the health of the neighbourhood by the presence of Cow-sheds in St. Giles's. To those who had been engaged in observing the sanitary state of the people through a series of years, this did not appear at all doubtful, but it seemed desirable to get, if possible, some numerical proof of such injury to health. With this view, the sanitary statistics of nearly six years (the whole time for which the returns have been furnished by the Registrar-General) were examined with reference to one particular Cow house, that in Stacey Street, which was so situated that its influence on health could be measured. The end of Stacey Street, at which the Cow-house is situate, would be expected, prima facie, to have sanitary advantages over the other end, which abuts on the middle of Dudley Street, a neighbourhood which the readers of these reports will know to be unhealthy beyond most other parts of the Parish of St. Giles. Now on analysis of the mortality it was found that, three houses excepted, there had been an average of 3 deaths in each inhabited house, and in none, a higher mortality than G in the six years. But in the three houses, Nos. 6, 7 and 9, there had been an average mortality of 10 deaths each, viz., in No. 6, 7 deaths; in No. 9, 9 deaths; and in No. 7, actually 14 deaths in the period under examination. Now No. 7 is the house most directly connected with the Cow-sheds; Nos. 6 and 9 are the two houses flanking it, as will he seen on the diagram given above; No. 8 consists only of workshops and the entrance to the cow-yard. In these three houses, Nos. 6, 7 and 9, 30 deaths occurred, while the other 14 inhabited houses had only 40 deaths between them. The only two fever deaths in the street were in these houses abutting on the cowyard. Three out of the 5 deaths from diarrhoea were in them. Out of 10 deaths from acute lung disease, which follow (as has been often shewn) the zymotic diseases in their distribution, and depend upon similar impurity of air, eight occurred in these three houses. The Stacey Street cow-house was the only one in which a numerical estimate was attempted of the influence on the health of the neighbourhood. But on the strength of the facts here ascertained, the reply was not difficult to the question of the counsel who had been retained in the interests of these nuisances,—"Do you mean to say that a cow-house and yard is more detrimental to the health of a neighbourhood than if the same space were covered with poor houses ?" "Yes, it positively is so." Nevertheless, the Magistrates were unwilling to interfere with established trade so far as to abolish altogether the cow-houses of St. Gdes's. But they warned the cow keepers that such orders as the Board might make for the regulation of the sheds must be obeyed, or else on another occasion the licenses would be refused. The regulations that have since been issued by the Board were framed after carefud consultation with the Surveyor and with experienced members of the Board. Mr. Bellamy was kind enough to give the weight of his great authority in determining the dimensions and cubic space to be demanded in the sheds. These regulations were successively adopted by the Sanitary Committee, and by the Board. (See Appendix VIII.) It is not believed that these rules can hinder cow-sheds from being a nuisance and an injury to health in St. Giles's. But if they were strictly observed, it was hoped that this nuisance might be reduced. Hitherto however, in June, 1863, any improvement that may have been made in the cow-houses is scarcely 20 appreciable. The decision of the Magistrates that retained the cowhouses seems to have been construed by most of their proprietors into an assertion of their right to continue -the nuisance of their establishments unmolested. One at least of the sheds is actually in a worse state than before the recent regulations were issued. This defiance of authority appears another argument for suppressing, instead of attempting to regulate, the nuisance of cow-houses in St. Giles's. GEORGE BUCHANAN. 75, Gower Street.. June, 1863. APPENDIX. TABLE I —Mortality per Thousand iu London, in the Divisions of London, and in St. Giles's in 1862 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 1856. Death-rate of Five last years, each corrected to 356¼ days. 1857. 1858. 1859. 1860. 1861. 1862. London 24.46 22.07 23.98 22.77 22.57 23.26 23.49 West Districts—(Kensington, Chelsea, St. George, Hanover-Square, Westminster, St. Martin, St. James) 22.76 20.86 22.44 21.50 22.24 22.5 22.21 North Districts.—(Marylebone, Hampstead, Pancras, Islington, Hackney) 22.15 21.16 22.96 21.74 21.24 22.4 21.96 Central Districts—St. Giles Strand, Holborn, Clerkenwell, St. Luke, East London, West London, London City) 24.35 23.40 24.55 24.22 23.42 25.11 25.78 East Districts—(Shoreditch. Bethnal Green, Whitechapel, St George East, Stepney, Poplar) 25.84 24.24 25.87 24.03 24.16 24.11 25.92 South Districts.— St. Saviour, St. Olave, Bermondsey, St. George Southwark, Newington, Lambeth, Wandsworth, Camberwell, Rotherhithe, Greenwich, Lewisham.) 26.28 21.15 24.04 22.69 22.22 22.87 22.61 St. Giles's 26.89 26.58 24.89 24.94 24.98 25.55 27.40 TABLE II.—Deaths in Hospitals among Patients brought from St. Giles's and neighbouring Districts, 1862. Districts. Total ascertained Deaths in London Hospitals. Kings College Hospital, (Strand). Middlesex Hospital (Marylebone). Charing Cross Hospital (St. Martins) University College Hospital (St Pancras) Children's Hospital (Holborn). St. Bartholomew's Hospital (W London) Royal Free Hospital (St. Pancras). London Fever Hospital (Islington). Westminster Hospital (Westminster). St. Mary's Hospital (Paddington) Deaths in Hospital out of the district. St. Pancras 224 12 45 1 83 18 12 15 38 ... ... 126 St. Marylebone 221 4 81 1 23 4 6 3 42 .. 57 140 Metropolis 3857 159 268 81 155 73 633 95 466 186 168 ... Holborn 99 21 2 4 4 4 32 2 30 ... ... 95 Strand 97 52 10 17 2 2 2 0 12 ... ... 45 St. Martin's 45 11 0 14 0 1 1 0 18 0 ... 31 St. Giles's 80 18 26 13 9 6 8 0 0 0 ... 80 The figures in the above table were obtaine I by personal in spection of the books of the several Hospitals, with the exception of those marked with a star, and for these 1 have to thank Or. Thomps n, and Mr Beale, the Officers of Health of the respective districts. TABLE IV.—Comparison of Mortality from various causes in London, and in St. Giles Four Quarters, 1862. Class. Classes and Orders of Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quart 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. all Causes 18405 350.0 433 15695 298.3 369 15133 287.6 370 17717 336.7 Specified Causes 18046 343.0 421 15482 294.3 364 14985 284.8 368 17562 333.8 I (Classes.) Zymotic Diseases 4174 79.3 89 3919 74.5 75 4721 89.7 96 5055 96.1 II. Constitutional „ 3345 63.0 90 3390 67.4 85 3017 57.3 90 3151 59.9 III. Local ,, 7747 147.3 190 5678 108.0 139 4953 94.1 137 6955 132.2 IV. Developmental ,, 2198 41.8 43 1839 34.9 56 1749 33.2 38 1894 36.0 V Violent Deaths 591 11.2 9 566 10.7 9 545 10.3 7 507 9.6 I. (Obders.) 1. Miasmatic Diseases 3901 74.2 82 3626 68.9 68 4396 83.5 86 4755 90.4 2. Enthetic 84 1.6 3 87 1.6 5 78 1.4 4 94 1.7 3. Dietic ,, 169 3.2 3 165 3.1 2 197 0.7 4 175 3.3 4. Parasitic „ 20 .4 1 41 .7 ... 50 .9 2 31 .6 II 1. Diathetic ,, 614 11.7 6 587 11.1 12 573 10.9 17 555 10.5 2. Tubercular „ 2731 51.9 84 2803 53.3 73 2444 46.4 73 2596 49.3 III. 1. Dis. of Nervous Syst. 1978 37.6 47 1669 31.7 29 1592 30.2 41 1685 32.0 2. „ Organs of Circulation 848 16.1 24 711 13.5 18 614 11.6 10 820 15.6 3. ,, Respiratory O gans 3828 72.8 100 2343 44.5 76 1688 32.0 66 3331 63.3 4. ,, Digestive ditto 697 13.2 12 647 12.3 11 707 13.4 15 694 13.2 5. ,, Urinary ditto 260 4.9 4 231 4.4 5 213 4.0 2 254 4.8 6. „ Organs of Generation 59 1.1 2 53 1.0 ... 41 .7 1 50 .9 7. ,, Locomotion 29 .5 1 60 1.1 ... 47 .9 2 48 .9 S. Integumentary System 48 .9 ... 54 1.0 ... 51 1.0 ... 73 1.4 IV 1. Dev. Dis. of Children 577 10.9 15 512 9.7 24 427 8.1 12 453 8.6 2. ,, ,, Adults 71 1.3 2 69 1.3 1 58 1.1 1 54 1.0 3. ,, ,, Old People 854 16.2 15 575 10.9 9 519 9.8 14 6S3 13.0 4. Diseases of Nutrition 687 13.0 11 688 13.0 22 745 14.1 11 704 13.3 V 1.Accdt. or Negligence 500 9.5 9 452 8.6 9 449 8.5 6 428 8.1 2. Suicide 61 1.1 ... 81 1.5 ... 70 1.3 1 54 1.0 All other Violent Dths. 30 .5 ... 33 .6 ... 26 .5 ... 25 .5 Sudden Deaths 46 .8 ... 64 1.2 ... 55 1.0 ... 55 1.0 Cause unspecified 55 1.0 12 149 2.8 5 93 1.7 2 100 1.9 I. Certain Special Diseases. Small Fox 37 .7 1 39 .7 1 77 1.4 ... 192 3.6 Measles 235 4.4 7 501 9.5 7 645 12.2 11 900 17.1 Scarlatina 14.7 10 677 12.8 6 841 15.9 26 1165 22.1 Diphtheritis 216 4.1 2 172 3.2 3 144 2.7 1 202 3.8 Croup 284 5.4 6 193 3.7 5 220 4.1 8 240 4.5 Whooping Cough 814 15.5 22 519 9.8 12 327 6.2 3 490 9.5 Diarrnœa 171 3.2 4 217 4.1 1 956 18.1 14 391 7.4 Typhus and other Fevers, continued & remittent 1015 19.3 21 1046 19.8 30 848 16.1 20 863 15.8 Deaths in Hospitals here included. Population of St. Giles, -: 52.6 part of the Population of London in 1862. TABLE III - Causes of Deaths in St. Giles's in 1862, with the Ages at Death. (Deaths in Hospitals are here included.) Class. Causes op 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 and upwards. Males. Femls. Total. All causes 814 749 1563 476 191 55 44 43 108 145 150 141 126 72 12 Specified causes 803 736 1539 467 191 54 44 42 106 144 146 136 125 72 12 I. (Classes.) Zymotic Diseases 188 169 357 125 104 25 14 6 17 27 17 17 3 2 ... II Constitutional ,, 171 171 342 56 29 13 20 25 64 57 40 22 13 3 ... III. Local ,, 347 282 629 160 47 15 9 9 21 52 86 93 99 35 3 IV Developmental,, 78 99 177 109 7 1 ... ... 2 4 1 3 10 31 9 V. Violent Deaths 19 15 34 17 4 ... 1 2 2 4 2 1 ... 1 ... I. (Orders.) I Miasmatic Diseases 168 159 327 105 104 24 14 6 16 23 14 16 3 2 ... 2 Enthetic „ 10 5 15 15 ... ... ... ... ... ... ... ... ... ... 3 Dietic „ 9 3 12 3 ... ... ... ... 1 4 3 1 ... ... ... 4 Parasitic „ 1 2 3 2 ... 1 ... ... ... ... ... ... ... ... ... II. 1 Diathetic ,, 18 27 45 1 2 ... 1 ... 1 6 10 10 11 3 ... 2. Tubercula ,, 153 144 297 55 27 13 19 25 63 51 30 12 2 ... ... III. 1 Diseases of Nervous System 76 70 146 43 10 5 1 4 5 12 24 16 19 6 1 2 „ of Organs of Circulation 36 31 67 ... ... ... 1 1 4 16 18 13 5 9 ... 3 „ of Respiratory Organs 208 138 346 108 32 8 4 2 8 17 31 54 66 14 2 4 „ of Digestive Organs 18 30 48 9 3 1 2 2 3 4 8 6 6 4 ... 5 „ of Urinary Organs 8 7 15 ... 2 1 ... ... ... 2 3 2 3 2 ... 6 ,, of Organs of Generation ... 4 4 ... ... ... ... ... 1 1 1 1 ... ... ... 7 „ of Organs of Locomotion 1 2 3 ... ... ... 1 ... ... ... 1 1 ... ... ... 8 „ of Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV 1 Dev. Diseases of Children 29 33 62 60 2 ... ... ... ... ... ... ... ... ... ... „ of Adults ... 6 6 ... ... ... ... ... 2 4 ... ... ... ... ... „ of Old People 18 36 54 ... ... ... ... ... ... ... 1 3 10 31 9 4 Diseases of Nutrition 31 24 55 49 5 1 ... ... ... ... ... ... ... ... ... V. 1 Accident or Negligence 17 14 31 16 4 ... ... 2 2 4 1 1 ... 1 ... 3. Homicide ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 4 Suicide 2 ... 2 ... ... ... 1 ... ... ... 1 ... ... ... ... 5. Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths not classed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Deaths, cause unascertained ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified or ill- definde 11 13 24 9 ... 1 ... 1 2 1 4 5 1 ... ... TABLE III—(continued.) Diseases in Orders. Class. Causes of Death. At all Ages. Under 2 years. 2 and under 5. 5 and nnder 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 and upwards. Males. Females. Total. I. Order 1. 1 Small pox 2 2 4 3 ... ... ... ... ... 1 ... ... ... ... ... 2 Measles 17 20 37 22 15 ... ... ... ... ... ... ... ... ... ... 3 Scarlatina 34 36 70 18 35 12 3 ... 1 ... 1 ... ... ... ... 4 Diphtheritis 4 5 9 3 3 1 ... ... 1 ... ... 1 ... ... ... 5 Quinsy 2 ... 2 1 1 ... ... ... ... ... ... ... ... ... ... 6 Croup 15 11 26 6 19 1 ... ... ... ... ... ... ... ... ... 7 Whooping Cough 20 22 42 25 13 4 ... ... ... ... ... ... ... ... ... 8 Continued Fevers, Ty- phus, &c. 49 41 90 2 14 6 10 5 10 18 10 13 2 ... ... 9 Erysipelas 5 1 6 3 ... ... ... ... 1 ... ... 2 ... ... ... 10 Metria ... 6 6 ... ... ... 1 1 2 2 ... ... ... ... ... 11 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Influenza 1 1 2 ... ... ... ... ... ... ... 1 ... ... 1 ... 13 Dysentery ... 2 2 ... ...1 ... ... ... ... ... 1 ... ... ... ... 14 Diarrhœa 14 11 25 20 1 ... ... ... 1 1 ... ... 1 1 ... 15 Cholera 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 16 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Remittent Fever 2 1 3 1 2 ... ... ... ... ... ... ... ... ... ... 18 Rheumatism 2 ... 2 ... ... ... ... ... ... 1 1 ... ... ... ... Order 2. 1 Syphilis 10 5 15 15 ... ... ... ... ... ... ... ... ... ... ... 2 Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 3. 1 Privation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Want of Breast Milk 2 1 3 3 ... ... ... ... ... .. ... ... ... ... ... 3 Puerpura and Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Alcholism.— a Delirum Tremens 7 ... 7 ... ... ... ... ... 1 3 3 ... ... ... ... 4 Intemperance ... 2 2 ... ... ... ... ... ... 1 ... 1 ... ... ... Order 4. 1 Thrush 1 1 2 2 ... ... ... ... ... ... ... ... ... ... ... 2 Worms ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... II. Order 1. 1 Gout 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 2 Dropsy 6 1 7 ... ... ... ... ... ... 1 1 2 1 2 ... 3 Cancer 8 24 32 ... ... ... ... ... 1 5 9 8 8 1 ... 4 Noma 2 1 3 1 1 ... ... ... 1 ... ... ... ... ... ... 5 Mortification 1 1 2 ... ... ... 1 ... ... ... ... 1 ... ... Order 2. 1 Scrofula 11 10 21 9 9 2 ... ... ... 1 ... ... ... ... ... 2 Tabes Mesenterica 16 9 24 19 4 1 ... ... ... ... ... ... ... ... ... 3 Phthisis 105 117 222 9 5 9 17 25 63 50 30 12 2 ... ... 4 Hydrocephalus 22 8 30 18 9 1 2 ... ... ... ... ... ... ... III. Order 1. 1 Cephalitis 2 6 8 2 2 3 ... ... ... 1 ... ... ... ... 2 Apoplexy 11 12 23 ... ... ... ... 1 2 2 9 3 4 1 1 3 Paralysis 14 20 34 ... ... ... ... ... 2 3 5 10 10 4 ... 4 Insanity ... ... ... ... ... ... ... ... ... ... ... ... 5 Dhorea ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Epilepsy 9 5 14 ... 1 ... ... 2 ... 1 7 1 1 1 ... 7 Convulsions 26 20 46 39 7 ... ... ... ... ... ... ... ... ... 8 Other Brain Diseases 10 11 21 2 ... 2 1 1 1 5 3 2 4 ... ... Order 2. 1 Pericarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Aneurism 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 3 Heart Disease, &c. 35 31 66 ... ... ... 1 1 4 16 17 13 5 9 ... Order 3. 1 Laryngitis 2 1 3 3 ... ... ... ... ... ... ... ... ... 2 Bronchitis 132 91 223 47 15 4 1 1 3 7 25 47 61 11 1 3 Pleurisy 4 2 6 1 ... ... ... ... 1 ... 2 1 ... ... 1 4 Pneumonia 61 39 100 57 17 4 3 1 3 6 3 3 2 1 ... 5 Asthma 7 3 10 ... ... ... ... ... 1 1 1 3 2 2 ... 6 Other Lung Diseases 2 2 4 ... ... ... ... ... ... 3 ... ... 1 ... ... TABLE III. 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 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 and upwards. Males. Females. Total. Order 4. 1 Gastritis ... 4 4 2 1 ... ... ... ... ... 1 ... ... ... ... 2 Enteritis 3 5 8 2 1 ... ... 1 ... 1 2 ... 1 ... ... 3 Peritonitis 1 3 4 1 ... 1 ... ... ... ... ... 1 1 ... ... 4 Ascites 1 1 2 ... ... ... ... ... 1 ... ... 1 ... ... ... 5 Ulcer. Intest 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 6 Hernia 2 2 4 ... ... ... ... ... ... ... ... 2 1 1 ... 7 Ileus 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 8 Intussusception 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 9 Strict. Intest 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 10 Fistula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Stomach Disease, &c 2 4 6 ... ... ... ... 1 ... ... 1 2 1 1 ... 12 Pancreas Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Hepatitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 6 3 1 ... ... ... ... ... 1 ... 1 ... ... 15 Liver Dis. &c 2 7 9 1 ... ... 1 ... 1 1 3 ... ... 2 ... 16 Spleen Disease, &c ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... Order 5. 1 Nephritis 1 2 3 ... 2 1 ... ... ... ... ... ... ... ... ... 2 Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Nephria 3 1 4 ... ... ... ... ... ... ... 3 1 ... ... ... 4 Diabetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Stone ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Cystitis 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 7 Kidney Disease, &c 3 4 7 ... ... ... ... ... ... 2 ... 1 3 1 ... Order 6. 1 Ovarian Dropsy ... 3 3 ... ... ... ... ... ... 1 ... 1 ... ... ... 2 Uterine Disease, &c ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... Order 7. 1 Arthritis ... 2 2 ... ... ... ... ... ... ... 1 ... ... ... ... 2 Joint Disease, &c 1 ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... Order 8. 1 Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Skin Disease. &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV. Order 1. 1 Premature Birth 14 19 33 33 ... ... ... ... ... ... ... ... ... ... ... 2 Cyanosis 1 1 2 2 ... ... ... ... ... ... ... ... ... ... ... 3 Spina Bifida 1 1 2 2 ... ... ... ... ... ... ... ... ... ... ... 4 Other Malformations ... 3 3 3 ... ... ... ... ... ... ... ... ... ... ... 5 Teething 13 9 22 20 2 ... ... ... ... ... ... ... ... ... ... Order 2 1 Paramenia ... 2 2 ... ... ... ... ... ... 2 ... ... ... ... ... 2 Childbirth (see Metria) ... 4 4 ... ... ... ... ... 2 2 ... ... ... ... ... Order 3. 1 Old Age 18 36 54 ... ... ... ... ... ... ... l 3 10 31 9 V. Order 4 1 Atrophy and Debility 31 24 55 49 5 1 ... ... ... ... ... ... ... ... ... Order 1. (Accident or Negligence.) 1 Fractures, &c. 7 4 11 1 ... ... ... 2 2 4 1 ... ... 1 ... 2 Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Burns, &c. 1 3 4 ... 4 ... ... ... ... ... ... ... ... ... ... 4 Poison 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 5 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Suffocation 8 6 14 14 ... ... ... ... ... ... ... ... ... ... ... 7 Otherwise ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... Order 3. Homicide ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... Order 4. (Suicide) 1 Wounds—Gunshot ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... „ Cut. Stab 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Hanging 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 5 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cause not specified 11 13 24 9 ... 1 ... 1 2 1 4 5 1 ... ... TABLE V.—Registered Deaths in 52 Weeks of 1862. Sub-Districts Of St Giles's. (Corrected, but see note to page 3†) Deaths in Sub-Districts. [Population 1861, corrected.] First Quarter. Second Quarter. Third Quarter Fourth Quarter. Whole Year, 1862. M. F. M. F M. F. M. F. M. F. Both Sexes. St. George, Bloomsbury [17392 ] 39 46 55 44 43 50 43 22 180 162 342 St. Giles's. South. [19474.] 125 95 91 76 76 85 80 109 372 365 737 St Giles's, North. [17183.] 48 59 40 41 58 40 62 56 208 196 404 Whole District. [54049 ] 212 200 186 161 177 175 185 187 760 723 1483 TABLE VI —Registered Births in 52 Weeks of 1862. Sub-Districts of St. Giles's. Births in Sub-Districts. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year, 1862. M. F. M F. M. F. M. F. M. F. Total Children St. George, Bloomsbury 45 46 57 51 48 42 50 44 200 183 383 St. Giles's, South 115 86 83 87 99 92 110 100 407 365 772 St. Giles's, North 91 99 65 64 63 48 79 74 298 285 583 Whole District 251 231 205 202 210 182 239 218 905 833 1738 TABLE VII.- Houses and Population of the Ten Sub-divisions of St. Giles's. From the Census of 1861. 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 308 2261 Workhouse 1 695 Total 4675 54,049 Here Eve Terrace, Old St. Pancras Road (thirteen houses and eighty-eight residents) Is, for brevity's sake, included in locality A. The enumerators' returns, on which this Table is based, were kindly furnished by the Registrar-General. APPENDIX VIII. Regulations adopted by the Board for the future Management of Cow-houses in St. Giles's District. 1. Every Cow-house shall be en the ground level. Cow-houses under inhabited rooms, or in immediate proximity to sleeping-rooms, cannot be permitted. 2. Every Cow-house shall give to each cow a space 12 X 6 superficial feet, exclusive of gangway and channel. The cubic space for each cow shall in no case be less than 1300 cubic feet. 3. Every Cow-house shall be well lighted, and well ventilated, both in summer and winter. 4. The paving must be uniform, and the channels behind (he cows must be of Yorkshire stone or of sound brick-work in cement, of the width of 2 feet 6 inches, at the least, sloping towards the entrance of the drain. 5. Dung pits shall be constructed of York stone sides and bottoms, set and jointed in cement, and shall be provided with proper drains. Dung shall be removed from the premises, where there are upwards of 10 cows, daily ; where there are less than 10 cows, every second day ; and always before 8 o'clock in the morning. 6. The Sheds shall be swept and thoroughly cleansed at least twice a day, and the yard once a day. Every part of the cow-houses and yard shall be lime-whited twice in the year. 7. Every Cow-house and yard shall be provided with underground pipe drains to the public sewer, furnished with efficient traps at their entrances. 8. Every Cow-house shall be supplied with water at the highest part of the channel in each shed. 9. There shall be two covered pits or receptacles, properly drained, for the stowage of grains ; or if there be one pit, it shall be divided by a partition, and each part shall be properly drained. Grains and other food shall not be kept so as to become offensive.