STGIL 11 1863. SANITARY STATISTICS AND PROCEEDINGS IN ST. GILES' DISTRICT, BY GEORGE BUCHANAN, M.D., FELLOW OF UNIVERSITY COLLEGE, LONDON. PHYSICIAN TO THE LONDON FEVER HOSPITAL, &c., &c., Medical Officer of Health. LONDON PRINTED BY T. PENNY, 121, LEMAN STREET, WHITECHAPEL. 1864. 1863-4. ANNUAL REPORT OF THE Medical Officer of Health. SECTION I.—On the Mortality of the Metropolis in 1863. The year 1863 has been conspicuous among recent years for a high mortality, resulting from the prevalence of epidemics to an unusual degree. Small-pox, scarlatina, and typhus, have especially left their marks on its death-rolls. In London there were 72,346 deaths from all causes in the year 1863, a larger mortality (relatively to the increasing population) than has been observed since 1854. Allowing however for the circumstance of the registration year comprising one week more than is customary, the cxcess is considerably reduced, but the death-rate remains about one in the thousand more than that of 1862. In 1863 (corrected to a solar year) 24.52 persons died out of every thousand residents in London. The year 1863 witnessed the severest epidemic of small-pox that has been recorded since 1844. This disease is constantly present in the town, but every three or four years it assumes an epidemic form, finding its victims mainly among those whom a year or two of security has lulled into a neglect of vaccination. Two thousand deaths from small-pox were registered in London in 1863. It is not too much to say that every one of these should have been prevented. From scarlatina the number, almost unprecedented, of 5075 deaths were recorded, and there were also 724 deaths from diphtheritis. From typhus and other forms of continued fever, 2892 persons died. These diseases were considerably more fatal in the preceding year, but the epidemic of true typhus that began in 1861 continued through the whole of 1863; in the summer months experiencing a slight decrease, but again becoming more fatal in the fourth quarter of the year. Besides these important members of the zymotic class, croup and puerperal fever require mention as having contributed an undue share of deaths to the register of 1863. But measles, whooping cough and diarrhoea, three disorders that always contribute many deaths to this class were not above the average in their mortality. The year 1863 had a somewhat high average temperature, the winter months being warmer, although four of the summer months were cooler than in the average of years. Nevertheless, the two most important of the diseases that are especially affected by temperature, bronchitis and consumption in the lungs, exhibited their full contingent of deaths. Inflammation of the lungs was not so fatal as usual. 2 All the five divisions of London experienced in 1863 a rise in their mortality over that of the preceding year. But the high mortality of the Central and Eastern Districts, that was commented upon in the last of these reports, has been maintained in the midst of this general rise, and both these groups of districts now have the remarkably high death-rate of 26.64 in the thousand. No such high mortality has been observed in the Central districts (unless in seasons of cholera) for the past twenty years. Following the ordinary law of distribution, the seasons of the greatest mortality were the first and last quarters of the year 1863. The zymotic group of diseases indeed rather tended to impress a higher death-rate upon the summer months. Small-pox culminated in the second quarter of the year. Scarlatina was increasingly fatal throughout the four quarters. But the intenser prevalence of lung diseases in cold weather more than counterbalanced the tendency of the zymotic diseases. From all causes 37824 persons died in the first and last quarters, and in the two warmer quarters of the year only 34522. Detailed tables, whose chief points of interest are embodied in the foregoing statements, are placed as Nos. I and IV in the appendix to this report. SECTION II.—On the Mortality of St. Giles's in 1863. From all Causes. Comparison with other Districts. In the high mortality of London in 1863, St. Giles's District of course participated. Among the central districts, its death-rate was conspicuously high. A high rate of death is however an invariable character of St. Giles's, and is not peculiar to the year that has just expired. It is of interest to know that while London and the group of Central districts both experienced a larger mortality in 1863 than in 1862, the St. Giles's death rate did not increase between the two years. The unhealthiness of 1863 arose therefore from the assimilation of other districts to the condition of St. Giles's, and not from any further deterioration of our own district. The total number of deaths registered in the three sub-districts of St. Giles's in 53 weeks, was 1503. Ten of these however were dup icate entries, and have been deducted in the calculations of this report. Besides those persons who died at their own homes or in the workhouse, 79* persons belonging to St. Giles' and Bloomsbury died in Hospitals of adjacent districts. The corrected mortality of our parishioners was therefore 1572 in the 53 weeks, Reducing this period to a mean year the number represents a deathrate of' 28 64 in the thousand residents of St. Giles's District. Of the whole number of deaths, 801 were of males, 771 of females; the excess of males being what is usually observed in St. Giles'. Of the Hospital deaths, 52 or about two thirds were in males. This arises of course from their greater exposure to accidents and to many of those diseases which especially call for Hospital treatment. The average age at death was 28 years and three months. The expectation of life at the time of birth is shortened greatly by the accidents of infancy, and this is probably the case in St. Giles' more than in most other districts. There were 516 deaths among children under two years of age, and 155 other deaths in children between the ages of two and live. Excluding the deaths of children under two years the average age at death in 1863 was 41 years and 8 months. * Besides the 79 deaths, three persons died in the Westminster Hospital, of whom no particulars were ascertained except that they came from St. Giles. (See Appendix II.) MORTALITY IN 1883. Districts. Population, 1 863. REGISTERED MORTALITY. Column A. Column B. (see Note.*) Total Mortality in 1863 corrected for Cols A. & B. Districts. 1st Quarter, 13 Weeks. 2nd Quarter, 13 Weeks. 3rd Quarter, 13 Weeks. 4th Quarter, 14 Weeks. Whole Year, 53 Weeks. 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 number. per 10,000. St. Pancras 205,154 1276 62.0 1131 55.0 1142 56.0 1292 63.0 4841 237.0 141 Hospls Workh. Straud 156 107 4719 230.0 St. Pancras. 263 St. Marvlebone 162,477 1097 67.1 1030 63.5 938 57.4 1028 63.2 4099 251.2 132 Hospital, 167 4064 250.0 St. Marylebone. Metropolis 2,904,413 18,967 65.2 17,417 60.0 17,105 58.9 18,857 65.0 72,340 249.1 — — 72340 249.1 Metropolis. Holborn 44,510 337 75.7 279 62.7 332 74.5 308 69.1 1256 282.2 79 Hospital, 67 1268 284.7 Holborn. Strand 42,691 283 66.3 281 65.8 252 59.0 296 69.3 1112 200.5 Workh. Hosps. 107 54 Hospital, 137 1136 266.0 Strand. 161 St. Martin's 22,299 159 71.3 145 65.0 149 66.8 158 70.9 611 274.0 40 Hospital, 58 593 265.9 St. Martin's. St. Giles's 54,048 394 72.9 377 69.5 335 62.1 397 73.2 1503 277.7 79 Hosps. 10 for errors† 1572 290.8 St. Giles's. *Col. A. gives the number of the Inhabitants of each District who expired in 1863, 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 II.) † These errors have arisen by the re-entry of deaths upon which inquests were held after registration: and by the accident of deaths being recorded twice over in the sheets of successive weeks. 4 The gross mortality of St. Giles' is compared with that of the districts adjacent to it, in the table on the preceeding page. Inasmuch as some districts contain hospitals in which persors coming from other districts may die, correction has been made of the registered mortality. Upon comparison of the metropolis with St. Giles', the excessive mortality of our own district (4 in the thousand) is at once apparent. And St. Giles' is as usual the highest in its death-rate of all the districts among which it is situated. Holborn still continued (as is the two preceding years) to present a mortality almost as high as St. Giles'. The death-rate in the Strand, though it has risen steadily for the last three years, is still much less than that of St. Giles'. St. Martin and St. Marylebone show exceptionally high mortality, but remain much below St. Giles'. In the comparison there is however this satisfaction that St. Giles' has not fallen below its habitually poor standard of health, in a year when almost all its neighbours have seriously retrograded from the better position that they generally occupy. The annexed table shows the variation in the death-rate of each district from year to year since these reports were commenced. Death-rate per 10 000* in St. Giles's and neighbouring Districts. districts. 1857. 1858. 1859. 1860. 1861. 1862. 1863. St. Pancras 197.0 224.9 221.4 208.7 228.3 215.5 225.6 St. Marylebone 217.3 224.0 225.0 227.7 242.5 237.1 245.3 Metropolis 221.0 234.4 227.0 224.1 231.8 234.1 244.4 236.3 247.7 248.6 238.7 270.4 285.5 279.3 Strand 239.4 226.6 262.9 231.5 233.7 254.6 261.0 St. Martin 243.0 218.5 246.7 228.6 233.7 238.0 260.9 St. Giles's 280.0 258.2 260.1 262.4 270.3 289.0 284.5 * Correction is here made for the longer duration of the registration years 1857 & 1803. Also for all deaths in hospitals and outlying workhouses. SECTION III.—On the Causes of Death in St. Giles's District. In the present report, as in former ones, comparison has been carefully made between the prevalence of each class of diseases in London, and of the same in St. Giles's. Thus have been ascertained what are the causes of death that are especially met with in St. Giles's, and hence, of course, may be expected suggestions for improving the health of the district. The population of St. Giles', being numerically pretty stationary, bears every year a smaller proportion to the aggregate population of London. In 1863 the metropolis is calculated to have 53.7 times as many residents as our own district. Learning from the returns of the Registrar General the gross mortality of the town, the above number furnishes the means of calculating the quota of deaths from each cause that should be furnished by our population. This has been done by detail on the opposite page, and it will there be seen that some important groups of diseases were considerably more fatal in St. Giles's than in the average of London. Zymotic Diseases, it has been said, were unusually fatal in London. At that high rate of prevalence the miasmatic group of these diseases would be computed to give 366 deaths as the quota of St. Giles'. The actual deaths * The corrected mortality comprises then for St. Giles's as for other districts, 1—those who die in the houses of the district, 2—those who die in the Workhouse belonging to the district,..and 3, those who die in hospitals having been removed from the houses of the district, on account of their fatal illness. In no instance can the attempt be made to separate persons who die in a district into a class of permanent residents and a class of chance comers. People of the latter class, being those who resort especially to the Workhouse and to common lodging houses, are probably more numerous in St. Giles's than in most of the districts with which it is compared. Comparison of Mortality from various causes in London and in Saint Giles's. Whole Year, 1863 (53 weeks.) Classes. Classes and Orders of Disease. London. St Giles's, Population 54,048. Population, 2,904,413. Estimated Quota.* Actual Registered Mortality. Corrected for Deaths in Hosptls. All Causes 72346 1347.2 1493 1572 Specified Causes 71665 1334.5 1486 1503 Classes. I. Zymotic Diseases 21005 391.1 387 402 I I. Constitutional „ 13518 251.7 298 319 iii. Local „ 26738 498.0 593 632 IV. Developmental, 7874 146.6 162 162 V. Violent Deaths 2530 47.1 46 54 Orders. I. 1 Miasmatic Diseases 19689 366.6 346 360 2 Euthetic „ 397 7.4 17 17 3 Dietic „ 767 14.3 24 25 4 Parasitic „ 152 2.8 ... ... II. 1 Diathetic Diseases 2421 45.1 38 47 2 Tubercular Diseases 11007 206.6 260 266 III. 1 Diseases of Nervous System 7406 137.9 144 149 2 „ Organs of Circulation 3116 58.0 64 75 3 „ Respiratory Organs 11499 214.1 313 322 4 „ Digestive Organs 2950 54.9 42 51 5 „ Urinary Organs 1025 19.1 24 28 6 „ Organs of Generation 254 4.7 4 4 7 „ Organs of Locomotion 230 4.3 2 3 8 „ Integumentary Organs 258 4.8 ... ... IV. 1 Dev: Dis. of Children 2054 38.2 56 56 2 „ „ Adults 350 6.5 4 4 3 „ „ Old People 2087 50.1 58 58 4 Diseases of Nutrition 2783 51.8 44 44 V 1 Accident or Negligence 2149 40.0 37 44 3 Homicide 128 2.4 5 5 4 Suicide 251 4.7 4 4 All other Violent Deaths 2 0.0 ... 1 Sudden Deaths 233 4.4 1 1 Causes unspecified 448 8.3 6 8 Certain Special Diseases of Zymotic Class and Miasmatic Order. 1.1 Small Pox 2012 37.5 52 57 Measles 1698 31.6 32 32 Scarlatina 5075 94.5 73 76 Diphtheritis 724 13.5 12 13 Croup 927 17.3 11 11 Whooping Cough 2229 41.5 42 42 Diarrhœa 2448 45.6 58 58 Typhus & other Fevers, continued and remittent 2892 53.8 46 48 * 1:- 53.7th part of the entire mortality of the Town. The number of Deaths registered in the District, has here been subjected to the correction for ten errors; see note (†) to table on page 3. 6 from these diseases were 360, and they were therefore somewhat less prevalent in St, Giles's than elsewhere in London. This is an unusual, but not an unprecedented circumstance. When it is remembered that diseases of this sort are those most controllable by public sanitary arrangements, we may venture to believe the vigilance of the district authorities has really been productive of some fruits. The most preventible disease, however, of all this group has been very unduly fatal in St. Giles's. The number of deaths that would be computed to fall on St. Giles' in the recent epidemic of small-pox is 37 or 38. The actual number of deaths was 57. It is of particular moment to enquire concerning the vaccination of these cases: There were 22 fatal cases of small-pox in which no record was furnished of the previous vaccination. Excluding these, the remaining 35 were classed as follows: Not vaccinated 22 Not vaccinated until they had caught small-pox 2 Vaccinated unsuccessfully 3 Wholly unprotected, therefore 27 Said to have been vaccinated 8 Of these eight deaths in persons alleged to have been vaccinated, some were entered as occurring after "imperfect" vaccination. In other cases the quality of the vaccination, as judged by the scars, was not stated, and even the fact of its success was not always ascertained. It is not enough to observe that more unvaccinated persons died of small-pox than vaccinated persons, unless we at the same time remember the very different numbers of the two classes of people that live among us. It may be affirmed that 90 per cent.* of our population has been subjected to vaccination of some degree of efficiency. That 90 per cent. of the population lost only 8 persons by small-pox in the year, while the 27 deaths among unvaccinated occurred in the remaining tenth of the population. A simple calculation therefore shows that for equal numbers the unvaccinated died to thirty times the extent of the vaccinated. In the last section of this report, however, it will be shown that a great deal of the vaccination upon which people rely for protection against small pox is illusory, and indeed the vaccination was ascertained to be inefficiently done in certain of the eight deaths that occurred from small-pox among those who believed themselves protected by the operation. The epidemic of small-pox began and culminated in St. Giles's at the same time as in the metropolis taken as a whole, but its subsidence appears to have been slower in our own district. Scarlatina, though extensively prevalent in St. Giles' and causing no fewer than 76 deaths, (against 70, itself a very high number, in 1862) was yet not so fatal as our population would lead us to expect. Our quota of deaths from this disease was 94 or 95. Typhus and other continued fevers also were less fatal in St. Giles's than in the average metropolis, 48 deaths from these causes being recorded instead of a quota of 54. Diarrhoea caused twelve more deaths, than the 46 which we should have computed to be furnished by our population. Measles, whooping cough, and diphtheritis, were fatal in St. Giles's to exactly the satr.e extent as in the average of London. Croup exhibited fewer deaths than its computed number, a circumstance very exceptional on our death-register. * ln the schools indeed, as will be seen by the 7th Section of this Report, less than 5 per cent. of children were found without marks of vaccination. 7 To recapitulate then, fevers were less prevalent, small-pox and diarrhœa more prevalent in St. Giles' than in an equal population taken indiscriminately from London at large. The balance of mortality from the group of miasmatic diseases was on the side favorable to St. Giles'. Consumptive or Tuberculous Diseases followed their invariable rule in being extraordinary fatal in St. Giles's District. The deaths from such diseases were 266 against a population-quota of 207. When one year is taken with another this is about the ordinary degree of excess that is observed in our parishes. Heart and Brain Diseases also exhibited their usual excess of mortality, Physical and mental work at high presure, with the frequent abuse of alcoholic stimulants, are the causes to which such mortality is mainly to be ascribed, and there can be no doubt that these causes operate especially upon the residents of such a district as our own. Infantile convulsions too, which are included in the class of Brain Diseases, depend upon causes that must ever be most rife in a poor and ignorant population. Diseases of the Lungs again, that large group that contributes every year a sixth part of the entire mortality of London, habitually exhibits a larger proportional mortality in St. Giles'. In 1863, our population would have given 214 deaths from these diseases at the rate of mortality prevailing in the town at large. The actual deaths were just half as many again, 322. Exposure and poverty do the work of death with particular certainty through this class of diseases, and public sanitary measures are in the main unable to afford safeguards against their attacks. Under the fourth class of the foregoing table, the excessive mortality among children from the causes reckoned by the Registrar General as developmental has been less apparent than usual in St. Giles's. Taking together premature birth, malformations, teething, and atrophy in children, 100 infants died in lieu of the population-quota of 90. The excess has generally been double to this. In the class of accidental deaths, the only point to be noted under the present division of our subject is, that homicide as well as accident unhappily adds to the mortality of St. Giles' in a distinguishing degree. SECTION IV.—On the Localization of Disease and Death in St. Giles's in 1863. A. In Sub-Districts. Referring to each sub-district those persons who were taken from it for treatment in hospitals, or in the parish infirmary, the subjoined table gives the materials for calculating the death-rate in each. [See Table top of next page.] 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, 20.3 per 1000; in St. Giles' South 33.3 per 1000; and in St. Giles' North 27.8 per 1000. Herein the workhouse with its residents is excluded. * In this computation the population for the year 1863 has been computed according to the rate of change experienced between 1851 and 1861. Thus Bloomsbury has been estimated to contain 17509 persons; St Giles's South (without the workhouse) 18695. St. Giles' North 17150. All the three death-rates, it is to be further observed, are rather too high, from the year being taken at 53 weeks, but correction for this is made in the table that follows. 8 Sub-districts of St. Giles's, Deaths in 1863. Deaths of residents in sub-district of Dying at own Homes. Dying in Hospitals. Dying in Workhouse. Total. Bloomsbury 318 18 19 355 St. Giles's South 481 38 104 623 (Workhouse Inmates, &c.) ... ... 116 116 St.. Giles's North 403 23 52 478 Whole District 1202 79 291 1572 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. 1863. St George, Bloomsbury 180 198 184 185 205 216 199 St Giles's South 357 292 349 346 291 317 327 St. Giles's North 283 277 240 247 279 282 273 Whole District 280 258 260 262 270 289 285 * Correction has been made for the extra length of the registration years 1857 & 1863. In the year 1863, the three sub-districts were in their usual order, viz: Bloomsbury healthiest, next St. Giles' North, while the largest mortality falls on St. Giles' South. None of the sub-districts differed strikingly from its average of former years, hut a slight decline in the mortality of Bloomsbury from 1862 is to be observed. In this place it is customary to give the registered Births of each year. The Registrar General comments upon the increased vigilance of local registrars throughout the metropolis, in getting information of all the births that occur. Perhaps this cause may have operated to increase the numbers in St. Giles's. But it is certain that any such vigilance is an inadequate substitute for a proper system of compulsory registration, such as exists in Scotland and Ireland and in most Continental countries. Registered Births in Sub-districts. Sub-districts. 1857. 1858. 1859. 1860. 1861. 1862. 1863. St. George Bloomsbury 398 403 411 430 416 383 467 St. Giles's South 860 717 780 786 808 772 881 St. Giles's North 592 557 538 562 532 583 550 Whole District 1850 1677 1729 1778 1756 1738 1898 9 B. In the Ten Localities. The varying character of the residents within the bounds of the same registration sub-districts renders a further sub-division desirable in considering the localization of prevalent diseases in St. Giles's. The same ten localities that have been adopted in former reports will therefore be taken in the present for the further consideration of this subject. Their boundaries have been often stated, and their population is given in the VIIth Table of the Appendix. Here it is needful to remark that however desirable it would be to make collection for the fluctuations of population in each locality from year to year, this has not been found practicable, and the population of 1861 is therefore retained as the basis for calculations of death-rate. The Mortality from all causes in 1863 was distributed in the ten localities in the manner shown on the table next following. The order of healthiness (on this standard) is not materially different from that observed in 1862, indeed the five localities at the head of this table, and the one at the bottom of the list stood in just those same positions in the former year. The fact is seen—that would be startling if we had not got used to it—that three persons die in the poorer parts of South St. Giles' for every one that dies in the richer parts of Bloomsbury. And this is after exclusion of deaths in the workhouse. Ten Sub-divisions of St. Giles's; their order of Mortality from all causes, 1863. Order of Sequence, 1863. Locality of Actual number of Deaths in 1863. Total Mortality per 10,000 In Houses. In Workh. In Hosptls. Total. Best 1st B. Russell-square 67 2 3 72 129 2nd A. Bedford-square 59 2 3 64 162 3rd L. Lincoln's Inn-fields 40 - 5 45 199 4th. I). Bloomsbury-square 108 3 8 119 226 5th. C. Coram-street 138 11 7 156 255 6th.7th.8th. E. Church- lane 109 24 8 141 301 F. Dudley-street 239 29 12 280 309 K Southern Drury-lane. 125 21 12 158 312 9th. H. Northern Drury-lane. 121 53 9 183 355 Worst 10th. G. Short's gardens 196 30 12 238 377 Workhouse Inmates, &c. — 116 — 116 — Whole District 1202 291 79 1572 291 The figures of this table tell sufficiently their own story. With the remark that the mortality of the Coram Street locality was a shade under that of 1862, we may pass to consider the ages at death and the chief causes of death in each of the ten sub-divisions. The Ten Sub-divisions—their Order of Infantile Mortality in 1853. Order of Sequence, 1862. Locality of Deaths among Children in 1863. Infantile mortality per 10,000 residents. Under 3 Months. 3 Months to 2 years. 2 years to 5 years. Total under 5 years. Best 1st. B. Russell-square 5 7 3 15 27 2nd A. Bedford square 6 12 6 24 61 3rd L. Lincoln's Inn fields 7 7 5 19 84 4th D. Bloomsbury-square 9 24 15 48 91 5th C. Coram-street 11 41 14 66 108 6th C. Coram-street 16 36 13 65 128 7th E. Church-lane 13 36 14 63 134 8th H. Northern Drury lane 19 38 26 83 160 Worst 9th.-10th. F. Dudley-street 41 83 32 156 172 G. Short's-gardens 28 59 25 112 178 Workhouse Inmates, &c. 7 10 2 19 — Whole District 162 353 155 670 124 10 Here will be seen to what a great degree the variations in the total mortality are produced by the deaths of infants. While Russell Square district lost only 15 children under 5 years, or 27 per 10,000 of its residents; the parts about Dudley Street and Short's Gardens experienced deaths among children to the extent of 172 and 178 per 10,000 of their population respectively. Doubtless there are fewer infants among the people of comfortably established position in the one neighbourhood, than swarm in the poor courts and alleys of the other district. But this consideration explains but a very small part of the prodigious disproportion between the localities at the top and at the bottom of this list. The Ten Localities—their Order of Mortality from Zymotic Diseases, (Miasmatic Order) 1863. Order of Sequence, 1863. Locality of Deaths from Miasmatic Diseases in 1863* Miasmatic mortality per 10,000. All miasmatic diseases. Small-pox. Measles. Scarlet Fever. Diphtheritis. Whooping Cough. Continued fevers, of which ( ) registered as "typhus." Diarrhœa. Other miasmatic ( diseases. Best 1st. B. Russell-square 10 1 1 3 1 - 1 (-) - 3 18 2nd. A. Bedford-square 17 1 1 3 2 4 3 (1) 2 1 43 3-4 L. Lincoln's Inn-fields 12 2 — 3 4 — 1 (-) 1 1 53 K. Southern Drury-la. 28 4 2 5 — 5 6 (1) 5 1 55 5th E. Church-lane 30 3 5 5 1 4 4 (3) 7 1 64 6-7 D. Bloomsbury-square 37 1 3 15 — 5 2 (-) 5 6 70 F. Dudley-street 63 14 3 12 1 10 11 (4) 11 1 70 8 th. C. Coram-street 48 7 6 11 1 3 6 (3) 5 9 78 Worst 9-10 H. Northern Drury-la. 48 14 6 10 2 3 5 (2) 8 — 93 G. Short's-gardens 59 10 5 10 1 7 11 (5) 13 2 94 Workhouse Inmates 8 - — 1 — 1 2 (2) 2 2 - Whole District 360 57 32 78 13 42 52 (21) 59 27 66 * The totals may not always be found to correspond exactly with those in Table III. of the Appendix. This would arise from the different ways in which a complicated disease may be recorded on two occasions. In the column of "fevers," puerperal fever is here included. With scarlatina, quinsy. Here again Russell Square district stands in the highest position, having about a fifth part of the zymotic mortality for its population that is observed in the worst parts of St. Giles'. But it is not necessary to leave the Parish of Bloomsbury for a contrast with the Russell Square district. The Coram Street locality continued in 1863 the very high rate of death from these diseases that it had in 1862: every important disorder of the zymotic group giving several deaths in that unfortunate district, and scarcely any being unrepresented on its death-rolls. It will be seen that small-pox found its largest number of victims in those districts whose general zymotic mortality was greatest, a circumstance that would seem to show that vaccination is not much more neglected in one part of St. Giles' than in another. Fevers obtained their maximum prevalence in Dudley Street and Short's Gardens district, where the most deaths from typhus proper were also recorded. Bloomsbury Square district holds a bad position by reason of the many deaths from scarlatina that occurred there. 11 The Ten Localities—1 heir order of Mortality from Tubercular Diseases, 1863. Order of Sequence, 1863. Locality of Deaths from Tubercular Diseases. Tubercular Mortality per 10.000. From Consumption, Tabes and Serofula. From Water-on-the Brain. Total. Best 1st B. Russell-square 3 - 3 5 2.-3.-4.-5th L. Lincoln's Inn-fields 6 — 6 27 A. Bedford-square 9 2 11 28 D. Bloomsbury-square 12 3 15 29 C. Coram-street 16 2 18 30 6th K Southern Drury-lane 23 5 28 56 7th F. Dudley-street 43 11 54 60 8th H. Northern Drury-lane 28 5 33 64 Worst 9.-10th G. Short's-gardens 37 7 44 70 1 E. Church-lane 30 4 34 73 Workhouse Inmates 21 — 21 - Whole District 228 39 267 49 Tuberculous diseases constitute the next class of causes in which St. Giles' district is conspicuously fatal beyond the average of London. The ten localities appear to suffer from these complaints very much in the order of their poverty, and this is to be expected from the conditions of privation and exposure under which consumptive diseases chiefly arise. But the three districts lowest on the list have an especial reason for high tubercular mortality in the large number of common lodging houses they contain. These establishments often constitute the last alternative with the workhouse for persons suffering from incurable maladies, and consumption is one of the diseases that always prevails to an extreme extent in the districts where such houses abound. Diseases of the lungs have been fatal in the ten localities in the proportions below specified. After what has been said concerning the influence of exposure with insufficient food and clothing upon the production of these diseases, there is no remark of importance to be made upon the order of this table. The Ten Localities-their order of Mortality from Diseases of the Lungs, 1863 Order of Sequence, 1863. Locality of Deaths from Lung Diseases. Mortality per 10,000. Acute Bronchitis, Inflammation of Lungs and Pleura. Chronic Bronchitis and Asthma. Total. From acute lung diseases. From all lung diseases Best 1st B. Russell-square 3 7 10 5 18 2nd A. Bedford-square 7 2 9 18 23 3rd L. Lincoln's Inn-fields 4 2 6 18 27 4 th D. Bloomsbury-square 9 10 19 17 36 5th C. Coram-street 19 8 27 31 44 6th F. Dudley-street 33 18 51 38 57 7th E. Church-lane 17 13 30 37 64 8 th H. Northern Drury-lane 21 16 37 41 72 9th G. Short's-gardens 34 17 51 54 81 Worst 10th K. Southern Drury-lane 28 17 45 55 89 Workhouse Inmates 3 34 37 — - Whole District 178 144 322 33 60 12 Deaths from Violence and Intemperance numbered 69 in the whole district, and were distributed as follows: In locality A, 4; In B & C, each 6; In D and E, each 3; In F and G, each 11; In H, 7; In K. 10; In L, 2; while six deaths from such causes were among inmates of the workhouse. The general conclusion to be drawn from this chapter appears to be that we are achieving a little better position for those districts which habitually had the most of zymotic deaths, but that one district at least is deteriorating steadily in this respect. Both the fact and the exception appear to point to the influence of sanitary work over this class of disease. But in respect of deaths among infants from other than zymotic causes, in respect of consumption and lung disease, and probably also in respect of other disorders not here investigated, the poorer districts manifest little disposition to rise to the standard of the wealthier neighbourhoods. And it is not so certain that with these classes of disorders, the sanitary powers entrusted to the Board of Works are able to contend. SECTION V.—On the Diseases and Deaths in the Practice of the Public Medical Institutions of St. Giles's in 1863. A summary of the practice of the Parochial Medical Officers is given on the opposite page. A comparison of this table with the corresponding one of 1862 shows an increase in those branches of the workhouse practice which from their nature most admit of variation from year to year. Within the Workhouse Infirmary the number of cases received and the mortality are both somewhat below the standard of 1862, yet are higher than have been observed in other years. In the out-patient department, the numbers for 1863 are exceptionally high, both among people whose smaller ailments allow of their attending at the dispensary and among those who are visited at their own homes. Applicants at the parochial dispensary appear to have been more numerous than in 1862 through the greater prevalence of diarrhoea and of slight feverish disorders, and also through the much greater number of sufferers from bronchitis and other lung diseases. Those who were visited at home would be almost the same in number in the two years but for the prevalence of smallpox, 210 cases of which disease required treatment at their homes in 1863 against 3 cases only in 1862. Small-pox cases, in so far as they have been removed from their own homes, have been received into the parish infirmary, where they have been distributed among other patients whose vaccination was well ascertained. Even with this precaution, there was some risk in the admixture of this disease, but fortunately no serious ill results have followed. The admissions for small-pox were 95, of whom 5 only died. They were unvaccinated persons. Typhus fever sent 141 cases to the infirmary for treatment, against 359 in 1862, and the deaths in the 141 cases amounted to 10 only. The high mortality that is observable from certain classes of disease in the practice of the infirmary results from two circumstances in the main: the incurable nature of many of those complaints which drive their victims to the workhouse as a last refuge; and the late period of their course at which the diseases come under treatment. The influence of these conditions has been very conclusively shown in some tables recently compiled by Mr. Bennett. The practice of the Bloomsbury Dispensary in 1863, is shown in summary on the table on page 14. While the total number of cases coming under treatment was a little under that of the two previous years, the cases that have been severe enough to require treatment at their own homes have been Cases of Disease and Deaths, occurring in the Practice of the Workhouse in 1863, 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. In 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 320 93 351 56 346 49 384 89 1401 287 1142 1269 1682 1343 5436 668 52 660 59 819 45 671 58 2618 214 Small-pox 22 ... 43 3 18 ... 12 2 95 5 5 23 13 5 46 40 7 94 13 44 5 32 6 210 31 Measles 1 ... 8 ... 1 ... 2 ... 12 ... 10 26 10 0 46 25 ... 72 5 14 1 6 ... 117 6 Scarlet Fever 2 ... 4 1 3 ... ... ... 9 1 ... 9 6 9 24 9 2 11 1 28 5 30 5 78 13 Whooping Cough ... ... 1 ... 1 1 19 1 21 2 5 21 19 15 60 1 ... 9 1 ... ... 9 1 19 2 Diarrhœa ... ... 3 1 5 1 ... ... 8 2 111 152 526 117 906 16 1 25 1 83 ... 15 ... 139 2 "Fever and Febricula" 7 ... 8 ... 2 ... 9 ... 26 ... 99 175 162 139 575 55 3 56 ... 52 ... 36 1 199 4 "Typhus Fever" 25 3 13 ... 24 3 79 4 141 10 ... ... ... ... ... 26 1 30 ... 25 1 37 2 118 4 Ague ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... Bronchitis (acute and chronic) 66 26 47 17 31 8 50 20 194 71 358 265 231 381 1235 108 12 49 8 27 1 91 7 275 28 Inflammation of the Lungs & Pleura 5 1 5 2 2 1 9 2 21 6 15 20 20 18 73 26 1 39 4 32 6 47 11 144 22 Consumptive Diseases 30 28 14 9 21 16 34 19 99 72 3 3 8 10 24 30 8 26 13 31 12 37 11 124 44 Ophthalmia 2 ... 4 ... 2 ... 1 ... 9 ... 5 11 18 11 45 2 ... ... ... ... ... 3 ... 5 ... 14 steadily increasing in number. These cases are a chief test of the usefulness of a dispensary. The class of poor persons above the rank of paupers, who require gratuitous medical assistance are largely indebted to the out-patient departments of hospitals, but the dispensary alone is the charity to which they can look when their illness is of a sort to be made worse by going out of doors. But for the Bloomsbury Dispensary a great proportion of these thousand persons who receive assistance at their own homes must have been driven to seek medical relief from the parish. New Cases treated at Bloomsbury Dispensary, 1863. 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. 763 183 30 266 70 3 239 1268 253 33 June 24th. 741 171 20 253 52 2 236 1230 223 22 Sept. 29th. 793 200 24 181 41 1 198 1172 241 25 Dec. 25th. 672 188 15 190 59 2 206 1068 247 17 Whole Yr. 2969 742 89 890 222 8 879 4738 964 97 The mortality among the Dispensary patients, in proportion to the number of severe cases, was slightly less in 1863 than in the preceding year. At the British Lying-in Hospital in Endell Street four deaths only occurred, three of them were of children, and the remaining one was of a mother who died from puerperal peritonitis. SECTION VI.—On the Deaths in St. Giles', where there was no Certificate of the Cause from a Medical Practitioner or Coroner. These deaths in 1863 numbered twenty-six. In nine of these cases there was no medical attendant in the fatal illness, and in none was the cause of death certified by a medical practitioner. In none of these cases was any enquiry made as to the real cause of death; but in all, the death was registered, a certificate for interment was therefrom obtained, and in every case the body was buried without further question. The registration laws do not appear, indeed, to have been enacted primarily to provide information as to the cause of death, but as they have long been administered, these laws have provided a most valuable check upon the manner in which persons have come by their death. In at least 97 cases out of a hundred, certificates of the cause of death are made by medical practitioners in set form and with a fair amount of accuracy. But the law has not provided for this practice, but has permitted registration of death without any other evidence of its cause than the statement of some person present. It has repeatedly been contended in these reports that the practice which is so nearly universal, should, in the interests of society, be made a matter of law. That any certificates of the cause of death are given depends under present arrangements upon the administration of an office, and upon the voluntary services of medical practitioners. Even if one should make the blunder of looking on statistics as an end in themselves, instead of a means for advancing the department of knowledge to which they are applied, it would be desirable to get our figures freed from 3 per cent. of wholly unreliale data. But the subject matter of these statistics is the life and death of 15 the population. By ensuring that the cause of death shall be well ascertained in every case—we obtain more certain knowledge to apply to the prevention and alleviation of disease. We also exercise a most important influence in restraining and detecting death from unfair means. A very little alteration of the registration laws would suffice to extend the present practice of registering causes of death to every instance where certificates are now deficient. Such an amendment cannot be deemed impossible when actual practice has advanced already to the desired point in 97 per cent. of deaths. In some districts indeed, what is here contended for is actually observed as a rule; civil registrations being refused in any case where the cause of death is obscure, until the coroner has been communicated with. Although this practice appears of doubtful legality, no inconveniences are known to be produced by its operation. Since this subject was first brought under notice in these reports, the Metropolitan Association of Medical Officers of Health has given careful attention to it, and have pressed the views that are here advocated upon the attention of the Registrar General. Similar opinions have been published recently by the Coroner for Central Middlesex, whose experience shows that facility to crime is undoubtedly afforded by the present system of interring bodies without sufficient evidence of the way in which death was produced. Memorials to the Home Secretary have been presented by most of the District Boards of London, and first by that of St. Giles's, advocating an improvement of the laws in this respect. And public attention is being called by the public press to the need of further provision for the safety of life. SECTION VII.—On the Sanitary Work of 1863. By the following tabular statement it appears that the usual amount of house inspection was performed in St Giles's in 1863. The poorer streets of the district, and those where zymotic disease was most prevalent, have been the objects of special care. In the presence of epidemic typhus much attention has been given to promote cleanliness and ventilation, and to reduce overcrowding in the Southern parts of St. Giles. The table does not indeed show the full amount of work that has been done in the last direction. With every notice for the abatement of other unwholesome conditions, aud upon every available opportunity, warning has been given to the owners of house property of the determination of the Board to prevent overcrowding. The five instances notedin the table refer only to cases where further proceedings were commenced for the protection of the public health in this respect. In the case of one overcrowded house, the owner was summoned, and the decision of the Magistrate at Bow Street upheld the view of the Board that 400 cubic feet of air were essential to the health of every adult inmate. It is probably to care upon this point that the reduction of the zymotic mortality of St. Giles's is mainly to be ascribed. The precautions as to space which the legislature has provided in Common Lodging Houses require especially to be extended to poor houses occupied by a family in every room, (and which do not fall under the technical definition of Common Lodging Houses) at a time when London is subjected to "improvements" whose tendency is to overcrowd the working population more seriously than ever. Experience has shown that the demolition of poor neighbourhoods by new streets produces no corresponding reduction in the number of inhabitants; for the displaced population is partly provided for in houses previously occupied by single families; partly it is received into houses which already contain as many inmates as they can healthfully accommodate. A larger rent can be obtained for the same room if it is overcrowded by a large family than if it be hired for only as many inmates as it can properly receive. Hence the interests of landlords are constantly on the one side, the health of the poor on the other. This 16 cnism would evidently increase year by year, as the accommodation for the poor in the centre of London becomes less and less adequate to their increasing numbers. But the premium on unwholesome crowding is much increased by the progress of those metropolitan works, which, however admirable in themselves, destroy whole streets of poor houses without making any provision for those who are displaced. House Improvements in St. Giles's, effected under the superintendence of Inspector Webb between March 25th, 1863, and March, 25th, 1864. Number of houses improved 510 Improvements in Drainage. Drains constructed 102 Improved or repaired 102 Traps fixed 199 Cesspools abolished 25 Stables drained and horse-pools abolished 48 In Water Closets. Pan, trap, and water provided 27 Water and apparatus only provided 180 Cleaned or repaired 144 Newly constructed 10 In Dust Bins. Newly constructed or re-built 23 Repaired or covered 41 Paying. Re-laid 61 In General Water Supply. Receptacles provided 20 Receptacles repaired 70 Water provided where none in house before 3 In Cleanliness and Repair. Generally repaired 27 Cleansed and lime-whited 301 Various accumulations removed from cellars, &c. 73 In Ventilation, &c. Ventilation improved 150 Overcrowding reduced 5 Kitchens disused, or made legally habitable 20 Other rooms disused 2 Proceedings taken. First notices 329 Second notices, letters, &c. 38 Summoned 2 Reported to Police or District Surveyor 7 Total Improvements 1633 At the present moment, a bill is before parliament for making a new railway through the poorest parts of St. Giles's. The simultaneous formation of a handsome new street, that will involve the removal of some 200 dwelling houses, of a kind now occupied by the very poorest people, is likely to be insisted on by Parliament as one of the conditions for conceding this bill. At the lowest computation 2500 persons will be displaced by this scheme. Unless provision be simultaneously made for accommodating, either in large central lodging houses or in the suburbs with access by railway, the people who are thus removed, the spectacle will be repeated in St. Giles's that has lately been seen in the East of London of a number of families wandering about some Saturday night, with their scanty worldly goods on their backs, without any resting place but the workhouse. Even at an advanced rent, the people who are displaced will hardly be able to get an accommodation so good as the meagre one they have left, and they are generally of a class ignorant enough to be content with worse conditions of lodgement, such as will certainly 17 be injurious to their moral welfare, and will conduce more than anything else to the shortening of theirlives. In such a scheme as that now under consideration, it is therefore, of the last importance that the sanitary aspects of the case should not be overlooked. A useful measure has been adopted to prevent overcrowding in Lincoln Court. On the inside of every room door a paper has been affixed, stating the number of inhabitants that can be allowed to reside in that room, in conformity with the scale of cubic space settled by the Board of Works. The owner deserves to have the credit of assenting to this plan. A special report was made in 1863 upon one of the worst spits in our district, Church Lane and its vicinity. As this report is in print, it is only needful here to mention the conclusion which it arrived at; that unceasing care was demanded of the owners of the houses to prevent the incessant recurrence of dangerous nuisances among the miserable population. But that the very construction of the courts, and especially the way in which every spot of groundin the rear of the lane was covered by thickly tenanted hovels, was an obstacle to effectual sanitary improvement; that the absence of any notion of decency among the residents tended to perpetuate nuisances, and that conversely the filthy conditions under which they lived, were injurious to all notions of decency. The courts about Coram Place, which were stated in the last of these reports to be deteriorating from year to year in their sanitary state, have been shown in the present report to have experienced a still higher rate of mortality from those diseases that are most produced by the operation of bad hygienic circumstances. What could be done in these courts by the action of the Sanitary Inspector has been done throughout the year, but the original arrangement of many of these courts, in hollows below the street level, where the air is stagnant and the drainage bad, constitutes an unhealthy condition with which the Inspector has no power to deal, but which appears to be making its influence more felt as each year passes by. Representations to this effect have been made in 1863 to the Committee of the Foundling Hospital, upon whose estate most of these courts are situated. This Committee state that they have no power to undertake a thorough reconstruction of these courts until the expiration of the existing leases. They have given instructions to their Surveyor, however, to see that the covenants of the leases are strictly enforced as to the proper maintenance of the property. The Slaughter-houses of the district that were formerly licensed have had their licenses renewed. Applications for new licenses were made by owners of slaughter-houses in Drury Lane and New Yard, and were opposed, as the places in question were not in conformity with the requirements of the Building Act of 1848. Their licenses were consequently refused. The New Yard premises had previously been employed as a slaughter-house without a license, and for this infringement of the law the owner would have been summoned if he had not immediately ceased to employ them for that purpose. All the licensed slaughter-houses have been repeatedly inspected, and are in satisfactory order. The Cow-houses of the district received considerable improvement from their proprietors before the time came for a renewal of their licenses at Michaelmas. Several of them however remained in an especially defective state, and their owners received their licenses with a warning to keep them better. The regulations of the Board for the management of these establishments have been pretty well observed in the majority of instances, so that it is to be hoped that the injury to health which cow-houses are demonstrated to produce in St. Giles's may be somewhat lessened in the future. 18 In the session 1862-63, an Act of Parliament was passed for the Better Regulation of Bakehouses, providing for cleanliness and ventilation, and prohibiting the employment by night of boys under eighteen years of age, and forbidding any place on the bakehouse level to be used as a sleeping place unless properly separated from the bakehouse itself. An' inspection of 56 bakehouses of St. Giles's under the powers of the Act was made with the following results: Bakeries—Forty eight. Persons under eighteen years of age employed by night 0 „ „ employed by day (legally) 11 Sleeping room on bakehouse level complying with the law 1 „ „ not so complying 2 Bakehouse on level of street 6 „ underground 40 „ half underground 2 Bakehouse clean 28 „ requiring limewhiting 16 „ „ and otherwise dirty 4 Bakehouses well ventilated 39 „ capable of being ventilated but habitually kept too close 6 Bakehouses badly ventilated 3 „ smelling of drains, &c. 4 Bakehouses lighted sufficiently from without 36 „ capable of being so lighted but habitually darkened 5 „ admitting little or no external light 7 Confectionaries—with no night nor early morning work—Eight. Clean 4 Requiring limewhiting 4 Ventilation good 7 „ bad 1 On street level 4 Underground 4 In respect of every condition that infringed the law, notices have been served upon the proprietors of the bakehouses, and numerous improvements have been made in consequence. Another enquiry whose results it is here of interest to put on record was made in the summer of 1863, while small-pox was extensively prevalent in London. 1986 children in the National and other elementary schools of St. Giles's and Bloomsbury, and in the workhouse, were examined as to their vaccination. These may be classified as follows:— 1868 with vaccine marks, 1 of whom was scarred by small-pox. 97 without vaccine marks, 34 of whom was scarred by small-pox. 21 with doubtful vaccine marks. More than a third of unvaccinated persons, therefore, even at the age of school schildren, had already been disfigured by small-pox, while of those who had been vaccinated less than oue in a thousand had any marks of small-pox. 19 The quality of the vaccine scars was noted in 1876 of the children. The subjoined figures show the number of children that bore scars of the number and kind indicated: Vaccine Marks. Good. Tolerable. Bad. Four or mora 395 104 63 Three 355 89 53 Two 287 89 49 One 185 59 36 Proof has been repeatedly given, of the most extended and indisputable kind, that the protective value of vaccination is greater according as the scars left by the operation are numerous and well marked. Not half the vaccinated children examined in the St. Giles's schools can be considered to have received all the protection against small-pox that vaccination is capable of affording. This is an important fact to which public attention should be directed. Parents should know that the kind of vaccination that produces no constitutional and hardly any local effect is very likely to leave their children susceptible to an attack of small-pox. At the time of inspection, those children whose vaccine scars were very imperfect were urged to have the operation repeated. Hand bills were circulated through the district, with the authority of the Board of Works, giving information about the outbreak of small-pox, and urging revaccination as well as primary vaccination for those who required it. GEORGE BUCHANAN, M.D. 75, Gower Street. June, 1864. APPENDIX. TABLE I.—Mortality per Thousand in London, in the Divisions of London, and in St. Giles's in 1863, and in preceding Years. Note.—The Death-rate of each year has been computed afresh by the Registrar General, from corrected Data. The figures of this fable differ therefore from those of former reports, and should be substituted for them. Death-rate in London, in groups of Districts, and in St. Giles. Mean of Ten years 1847-1856. Mean of Five years 1855-1859. Death-rate of last Seven years, each corrected to 356¼ days. 1857. 1858. 1859. 1860. 1861. 1862. 1863. London 27.02 23.08 22.41 23.90 22.69 22.49 23.18 23.56 24.52 West Districts.— (Kensington, Chelsea, St. George, Hanoversquare, Westminster, St. Martin, St. James.) 23.27 21.89 21.19 22.37 21.44 22.17 22.42 22.30 23.24 North Districts.— (Marylebone, Hampstead, Pancras, Islington, Hackney) 22.67 22.08 21.50 22.88 21.67 21.17 22.33 22.00 23.81 Central Districts— (St. Giles, Strand, Holborn, Clerkenwell, St. Luke, East London, West London, London City) 25.10 24.10 23.77 24.46 24.14 23.34 25.03 25.83 26.64 East Districts.— (Shoreditch, Bethnal Green, Whitechapel, St. George East, Stepney, Poplar) 26.43 24.63 24.63 25.78 23.95 24.08 24.02 25.98 26.65 South Districts.— St. Saviour, St. Olave, Bermondsey, St. George Southwark, Newington, Lambeth, Wandsworth, Camberwell, Rotherhithe, Greenwich, Lewisham.) 26.81 22.90 21.49 23.96 22.60 22.14 22.79 22.68 23.37 St. Giles.— Registered mortality 26.89 25.49 26.60 24.84 24.82 24.97 25.81 27.49 27.34 Corrected for Hospitals — 26.61 28.20 25.91 26.13 26.33 27.12 28.99 28.64 TABLE II.—Deaths in Hospitals among Patients brought from St. Giles's and neighbouring Districts, 1863. 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). Small Pox Hospital (Islington.) Westminster Hospital (Westminster). St. Mary's Hospital (Paddington). Deaths in Hospital out of the district. St. Pancras 231 17 53 0 77 8 13 13 23 27 — — 141 St. Marylebone 212 7 80 5 23 3 2 2 33 16 — 47* 132 Metropolis 4105 180 247 78 169 77 577 77 335 290 147 189 — Holborn 89 17 4 3 2 10 30 6 8 9 — — 79 Strand 97 43 14 16 1 7 3 1 7 5 — — 54 St. Martin's 60 12 3 20 0 1 3 0 6 4 11* — 40 St. Giles's 82 21 22 6 5 8 7 5 0 5 3* — 82 The figures in the above table were obtained by personal inspection of the boohs of the several Hospitals, with the exception of those marked with a star, and for these I have to thank Dr. Sanderson, and Mr Beale, the Officers of Health of Paddington and St. Martin. No particulars have been ascertained, respecting the three Deaths of St. Giles's parishioners in the Westminster Hospital, and they are nowhere taken into consideration in the statements of the Report. TABLE III.- Causes of Death in St. Giles's in 1863, with the Ages at Death. (Deaths in Hospitals are here included.) 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. 4 5 and under 55. 55 and under 65. 65 and under 75. 75 and under 85. 85 and upwards. Males. Females. Total. All causes 801 771 1572 516 155 70 58 27 93 109 158 147 152 65 22 Specified causes 799 764 1563 511 155 70 58 27 92 109 157 146 151 65 22 (Classes.) I. Zymotic Diseases 219 183 402 178 89 37 20 12 20 16 12 11 4 3 ... II. Constitutional „ 150 163 313 49 26 14 28 9 41 44 51 37 13 1 ... III. Local „ 332 300 632 154 35 16 9 6 23 48 89 95 119 34 4 IV. Developmental „ 69 93 162 93 5 1 ... ... 4 ... 2 1 13 25 18 V. Violent Deaths 29 25 54 37 ... 2 1 ... 4 1 3 2 2 2 ... (Orders.) I. 1 Miasmatic Diseases 196 164 360 147 89 37 18 11 20 12 9 11 3 3 ... 2 Enthetic „ 6 11 17 14 ... ... 2 ... ... 1 1 ... ... ... ... 3 Dietic „ 17 8 25 17 ... ... ... 1 ... 3 3 ... 1 ... ... 4 Parasitic „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... II. 1 Diathetic „ 13 34 47 ... ... ... 2 ... 3 6 14 12 9 1 ... 2 Tubercular „ 137 129 226 49 26 14 26 9 38 38 37 25 4 ... ... III. 1 Diseases of Nervous System 74 7.5 149 49 7 4 2 2 5 11 18 18 21 12 ... 2 „ of Organs of Circulation 40 35 75 ... ... 2 2 1 11 10 13 14 16 4 2 3 „ of Respiratory Organs 171 151 322 99 25 9 2 1 3 15 38 47 69 13 1 4 „ of Digestive Organs 29 22 51 6 2 ... 1 ... 2 8 14 12 5 ... 1 5 „ of Urinary Organs 18 10 28 ... 1 ... 2 2 1 4 4 3 7 4 ... 6 „ of Organs of Generation ... 4 4 ... ... ... ... ... 1 ... 1 ... 1 1 ... 7 „ of Organs of Locomotion ... 3 3 ... ... 1 ... ... ... ... 1 1 ... ... ... 8 „ of Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV 1 Dev. Diseases of Children 29 27 56 53 3 ... ... ... ... ... ... ... ... ... ... 2 „ of Adults ... 4 4 ... ... ... ... ... 4 ... ... ... ... ... ... 3 „ of Old ple 20 38 58 ... ... ... ... ... ... ... 1 1 13 25 18 4 Diseases of Nutrition 20 24 44 40 2 1 1 ... ... ... 1 ... ... ... ... V. 1 Accident or Negligence 22 22 44 33 ... 1 1 ... 2 1 1 2 1 2 ... 3 Homicide 3 2 5 4 ... ... ... ... 1 ... ... ... ... ... ... 4 Suicide 3 1 4 ... ... ... ... ... 1 ... 2 ... 1 ... ... 5 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths not classed 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... Sudden Deaths, cause certained ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... Causes not specified or defined 2 6 8 5 ... ... ... ... 1 ... 1 1 ... ... ... TABLE III—(continued.) Diseases in Orders. Class. Causes of Death. At all Ages. Under 2 years. 2 and under 5. 5 and under 10. 10 and under 20. 20 and under 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 29 28 57 16 14 11 3 1 9 1 1 1 ... ... ... 2 Measles 19 13 32 17 14 ... 1 ... ... ... ... ... ... ... ... 3 Scarlatina 43 33 76 20 33 15 5 2 ... ... ... 1 ... ... ... 4 Diphtheritis 8 5 13 2 8 1 1 ... ... ... ... 1 ... ... ... 5 Quinsy ... 3 3 1 1 1 ... ... ... ... ... ... ... ... ... 6 Croup 8 3 11 7 2 2 ... ... ... ... ... ... ... ... ... 7 Whooping Cough 21 21 42 28 12 2 ... ... ... ... ... ... ... ... ... 8 Continued Fevers, Typhus, &c. 24 24 48 2 4 4 5 5 7 9 7 4 1 ... ... 9 Erysipelas 6 4 10 2 ... ... ... 1 1 1 1 2 2 ... ... 10 Metria ... 3 3 ... ... ... 1 1 1 ... ... ... ... ... ... 11 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Diarrhœa 31 27 58 51 ... ... 1 ... ... 1 ... 2 ... 3 ... 15 Cholera 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 16 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Remittent Fever 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 18 Rheumatism 3 ... 3 ... ... ... ... 1 2 ... ... ... ... ... ... 19 Other Miasmatic Dis. 2 ... 2 1 ... ... 1 ... ... ... ... ... ... ... ... Order 2. 1 Syphilis 6 11 17 14 ... ... 2 ... ... 1 ... ... ... ... ... 2 Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 3. 1 Privation 4 4 8 7 ... ... ... ... ... ... 1 ... ... ... ... 2 Want of Breast Milk 2 1 3 3 ... ... ... ... ... .. ... ... ... ... ... 3 Rickets. &c 5 2 7 7 ... ... ... ... ... ... ... ... ... ... ... 4 Alcoholism.— a Delirium Tremens 4 ... 4 ... ... ... ... 1 ... 1 2 ... ... ... ... b Intemperance 2 1 3 ... ... ... ... ... ... 2 ... ... 1 ... ... Order 4. 1 Thrush ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Worms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 1. II. 1 Gout 2 1 3 ... ... ... ... ... 1 ... 1 ... 1 ... ... 2 Dropsy ... 7 7 ... ... ... 1 ... ... 2 2 ... 2 ... ... 3 Cancer 9 25 34 ... ... ... 1 ... 2 4 11 12 3 1 ... 4 Noma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Mortification 2 1 3 ... ... ... ... ... ... ... ... ... 3 ... ... Order 2. 1 Scrofula 2 3 5 2 1 1 ... ... ... 1 ... ... ... ... ... 2 Tabes Mesenterica 12 9 21 14 5 1 1 ... ... ... ... ... ... ... ... 3 Phthisis 106 95 201 13 6 11 21 9 38 37 37 25 4 ... ... 4 Hydrocephalus 17 22 39 20 14 1 4 ... ... ... ... ... ... ... ... Order 1. III. 1 Cephalitis 9 4 13 8 2 2 1 ... ... ... ... ... ... ... ... 2 Apoplexy 18 17 35 ... 1 ... 1 ... 1 5 7 7 9 4 ... 3 Paralysis 7 13 20 ... 1 ... ... ... ... 1 2 1 11 4 ... 4 Insanity 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 5 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Epilepsy 5 9 14 ... ... ... ... 2 1 2 6 3 ... ... ... 7 Convulsions 18 17 35 34 1 ... ... ... ... ... ... ... ... ... ... 8 Other Brain Diseases 16 15 31 7 2 2 ... ... 3 3 3 7 1 3 ... Order 2. 1 Pericarditis 2 3 5 ... ... 1 ... ... 1 2 1 ... ... ... ... 2 Aneurism ... 2 2 ... ... ... ... ... 1 ... 1 ... ... ... ... 3 Heart Disease, &c. 38 30 68 ... ... 1 2 1 9 8 11 14 16 4 2 Order 3. 1 Laryngitis ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... 2 Bronchitis 101 91 192 37 8 3 ... ... 1 5 22 37 66 12 1 3 Pleurisy 4 2 6 1 ... ... ... ... ... 2 2 1 ... ... ... 4 Pneumonia 63 52 115 61 17 6 1 1 1 8 11 7 1 1 ... 5 Asthma 2 5 7 ... ... ... ... ... ... ... 3 2 2 ... ... 6 Other Lung Diseases 1 ... 1 ... ... ... ... ... 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 1 5 3 1 ... ... ... ... ... 1 ... ... ... ... 2 Enteritis 2 1 3 2 ... ... 1 ... ... ... ... ... ... ... ... 3 Peritonitis 2 5 7 1 .. ... ... ... 1 1 2 1 1 ... ... 4 Ascites 2 ... 2 ... ... ... ... ... ... ... 1 1 ... ... ... 5 Ulcer. Intest. 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 6 Hernia 3 3 6 ... ... ... ... ... ... ... 4 1 1 ... ... 7 Ileus 1 1 2 ... ... ... ... ... ... ... ... 2 ... ... ... 8 Intussusception ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Strict. Intest. 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 10 Fistula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Stomach Disease, &c 4 2 6 ... ... ... ... ... 1 1 1 3 ... ... ... 12 Pancreas Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Hepatitis 1 1 2 ... ... ... ... ... ... 1 ... 1 ... ... ... 14 Jaundice ... 3 3 ... 1 ... ... ... ... ... 1 ... 1 ... ... 15 Liver Dis. &c 8 5 13 ... ... ... ... ... ... 3 4 3 2 ... 1 16 Spleen Disease, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 5. 1 Nephritis 2 ... 2 ... ... ... ... ... ... ... 1 1 ... ... ... 2 Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Nephria 3 1 4 ... ... ... ... 1 ... 1 ... ... 2 ... ... 4 Diabetes ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... 5 Stone 2 ... 2 ... 1 ... ... ... ... ... ... ... 1 ... ... 6 Cystitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Kidney Disease, &c. 11 8 19 ... ... ... 2 1 1 3 3 2 3 4 ... Order 6. 1 Ovarian Dropsy ... 2 2 ... ... ... ... ... ... ... 1 ... 1 ... ... 2 Uterine Disease, &c. ... 2 2 ... ... ... ... ... 1 ... ... ... ... 1 ... Order 7. 1 Arthritis ... 2 2 ... ... ... ... ... ... ... 1 1 ... ... ... 2 Joint Disease, &c. ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... Order 8. 1 Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Ulcer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Skin Disease, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 1. IV. 1 Premature Birth 20 19 39 39 ... ... ... ... ... ... ... ... ... ... ... 2 Cyanosis 1 2 3 3 ... ... ... ... ... ... ... ... ... ... ... 3 Spina Bifida 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 4 Other Malformations 1 1 2 2 ... ... ... ... ... ... ... ... ... ... ... 5 Teething 6 5 11 8 3 ... ... ... ... ... ... ... ... ... ... Order 2 1 Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Childbirth (see Metria) ... 4 4 ... ... ... ... ... 4 ... ... ... ... ... ... Order 3. 1 Old Age 20 38 58 ... ... ... ... ... ... ... 1 1 13 25 18 Order 4. 1 Atrophy and Debility 20 24 44 40 2 1 ... ... ... ... 1 ... ... ... ... Order 1. V. (Accident or Negligence.) 1 Fractrures, &c. 8 1 9 ... ... 1 1 ... 2 1 1 1 1 1 ... 2-3 Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Burns, &c. 1 1 2 1 ... ... ... ... ... ... ... ... ... 1 ... 5 Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Suffocation 12 17 29 29 ... ... ... ... ... ... ... ... ... ... ... 8 Otherwise 1 3 4 3 ... ... .... ... ... ... ... 1 ... ... ... Order 3. Homicide 3 2 5 4 ... ... ... ... 1 ... ... ... ... ... ... Order 4. (Suicide) 1 Wounds—Gunshot 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... „ Cut, Stab 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 2 Poison ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... 3 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Hanging 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 5 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE IV.—Comparison of Mortality from various causes in London, and in St. Giles's. Four Quarters, 1863. Class. Classes and Orders of Disease. First Quarter. 13 weeks. Second Quarter. 13 weeks. Third Quarter. 13 weeks. Fourth Quarter. 14 weeks. 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 18967 353.2 418 17417 324.4 386 17105 318.5 344 18857 351.2 424 Specified Causes 18763 349.3 415 17229 320.8 384 16918 315.0 342 18775 349.3 422 (Classes.) Zymotic Diseases 4691 87.3 69 5003 93.1 93 6295 117.3 130 5016 93.4 110 I. Constitutional 3485 46.9 96 3425 63.8 68 3149 58.6 71 3459 64.4 78 II. Local 7848 146.1 186 6365 118.5 175 4886 91.0 88 7639 142.1 183 III. Developmental 2096 39.0 51 1826 34.0 38 1966 36.6 36 1986 36.9 37 IV. Violent Deaths 643 12.0 13 610 11.4 10 622 11.5 17 655 12.2 14 V. (Orders) 1. Miasmatic Diseases 4416 82.2 59 4681 87.2 78 5926 110.3 123 4666 86.9 100 I. 2. Enthetic „ 93 1.7 5 98 1.8 3 88 1.6 5 118 2.2 4 3. Dietic „ 150 2.8 5 189 3.5 12 227 4.3 2 201 3.7 6 4. Parasitic „ 32 .6 ... 35 .6 ... 54 1.0 ... 31 .6 ... 1. Diathetic „ 624 11.6 1.2 593 11.6 10 565 10.5 11 639 12.0 14 II. 2. Tubercular „ 2861 53.3 84 2832 52.7 58 2584 48.1 60 2820 52.4 64 1. Dis. of Nervous Syst. 1972 36.7 39 1850 34.5 44 1578 29.4 25 2003 37.3 41 III. 2. „ Organs of Circulation 822 15.3 22 707 13.2 21 701 13.0 10 886 16.5 22 3. „ Respiratory Organs 3897 72.5 105 2651 49.4 97 1481 27.6 33 3470 64.6 87 4. „ Digestive ditto 708 13.2 9 721 13.4 11 713 13.3 10 808 15.0 21 5. „ Urinary ditto 260 4.8 7 249 4.6 2 241 4.5 8 275 5.2 11 6. „ Organs ofGeneration 63 1.2 3 66 1.2 ... 64 1.2 1 61 1.1 ... 7. „ „ Locomotion 58 1.1 1 62 1.2 ... 53 10 1 57 1.0 1 8. „ Integumentary System 68 1.3 ... 59 1.1 ... 55 1.0 ... 76 1.4 ... 1. Dev. Dis. of Children 599 11.2 20 487 9.1 10 439 8.2 14 529 9.8 12 IV. 2. „ „ Adults 86 1.6 2 91 1.7 2 77 1.4 ... 96 1.8 ... 3. „ „ Old People 751 13.9 18 664 12.2 16 589 10.9 11 683 12.7 13 4. Diseases of Nutrition 660 12.3 11 584 10.9 10 861 16.1 11 678 12.6 12 I. Accdt. or Negligence 548 10.3 9 501 9.3 6 537 10.0 15 563 10.5 14 V. Homicide 29 .5 2 36 .7 2 29 .5 1 34 .6 ... 2. Suicide 66 1.2 1 71 1.3 2 56 1.0 1 58 1.1 ... All other Violent Dths. ... ... 1 2 ... ... ... ... ... ... ... ... Sudden. Deaths 83 1.6 ... 53 1.0 ... 53 .9 1 44 .8 ... Cause unspecified 121 2.3 ... 135 2.5 2 134 2.5 1 58 1.1 2 Certain Special Diseases. I. Small Pox 422 7.9 9 788 14.7 24 512 9.5 12 290 5.4 12 Measles 576 10.7 7 606 11.3 12 221 4.1 5 295 5.5 8 Scarlatina 880 16.4 15 1055 19.6 7 1519 28.3 20 1621 30.2 34 Diphtheritis 178 3.3 2 175 3.3 1 192 3.5 6 179 3.3 4 Croup 258 4.8 3 243 4.5 5 215 4.0 2 211 4.0 1 Whooping Cough 795 14.8 6 647 12.0 12 358 6.6 13 429 8.0 11 Diarrhœa 161 3.0 2 225 5.0 4 1799 35.5 51 263 3.0 1 Typhus and other Fevers, continued, remittent & puerperal. 824 15.3 10 695 12.9 9 714 13.4 13 971 18.1 20 Deaths in Hospitals here included. Population of St. Giles, 1÷ 53.7 part of the Population of London in 1863. TABLE V.—Registered Deaths in 53 Weeks of 1863. Sub-Districts of St. Giles's. After correction for duplicate entries Deaths in Sub-Districts. [Population 1861,] First Quarter. 13 weeks. Second Quarter. 13 weeks. Third Quarter. 13 weeks Fourth Quarter. 14 weeks. Whole Year, 1863. 53 weeks. M. F. M. F. M. F. M. F. M. F. Both Sexes. St. George, Bloomsbury. [17392 ] 40 42 37 41 33 35 46 44 156 162 318 St. Giles's. South. [19474.] 112 105 82 89 95 74 105 110 394 378 772 St. Giles's, North. [17183.] 37 56 75 52 48 44 39 52 199 204 403 Whole District. [54049.] 189 203 194 182 176 153 190 206 749 744 1493 TABLE VI-—Registered Births in 53 Weeks of 1863. Sub-Districts of St. Giles's. Births in Sub-Districts. First Quarter. 13 weeks Second Quarter. 13 weeks. Third Quarter. 13 weeks. Fourth Quarter. 14 weeks. Whole Year, 1863. 53 weeks. M. F. M. F. M. F. M. F. M. F. Total Children St. George, Bloomsbury 59 61 75 58 63 48 60 43 257 210 467 St. Giles's, South 113 94 117 123 106 101 126 101 462 419 881 St. Giles's, North 71 81 63 59 61 61 74 80 269 281 550 Whole District 243 236 255 240 230 210 260 224 988 910 1898 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.