STGIL12 1864. 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 i'.y thomas penny, 121, leman street. whitechapel, e. 1865. 1864—5. ANNUAL REPORT of the Medical officer of health Section I—Oil the Mortality of the Metropolis in 1864. In my last Annual Report, I had to record a mortality in the Metropolis in 1863, greater than any that had been experienced since the year 1854. That high rate of deaths has, however, been considerably exceeded in the year 1864, when it reached the extremely high point of 26.45 per thousand. Only in the influenza year, 1847, and in 1849 and 1854, the two cholera years, has the mortality of London been so high as in the period to which this Report refers. It was in the first quarter of the year that the excess of mortality was most marked. In a single week of January no less than 2427 deaths were registered, the average deaths in the corresponding weeks of ten previous years having been 1409 only. Of the 77,723 deaths that occurred in London daring the year, 22,733 were in the first quarter. The other divisions of the year had respectively—19,636 deaths, last quarter; 18,008 deaths, third quarter; and 17,346 deaths, the second quarter. The unusual cold of the early part of 1864 was in the main chargeable with the very exceptional rate of death. Thus through the whole week preceding the one in which the maximum mortality occurred, the thermometer showed a temperature steadily below the mean of former years, reaching on two nights the very low point of 6° or 7° Fahr. And in seven months of the twelve the mean temperature of the air was below, and often notably below, the average of previous years. Cold was productive of its fatal results partly through diseases of the air passages, partly indirectly through the increased activity given to certain contagious diseases when a poor population huddles into close rooms for warmth. Bronchitis, typhus, and measles especially were the diseases whose unusual prevalence in 1864 chiefly accounts for the high mortality of the year. Bronchitis caused 8666 deaths against 6049 in the previous year; typhus 3689 deaths instead of 2892; and measles 2750 instead of 1698, which was its number of deaths in 1863. The epidemic of smallpox that caused 2000 deaths in London in 1863, slowly subsided as the year 1864 advanced, but at the end the disease had scarcely declined to the standard of non.epidemic times. Scarlatina also, though much less fatal in 1864 than in the previous year, remained very prevalent and again increased in fatality in the last quarter. Diarrhoea, too, the autumn being very dry, was more fatal than usual in the town. 4 Besides bronchitis, other diseases of the breathing organs assisted in swelling the mortality beyond the common. Inflammation of the lungs and consumption (which for the present purpose may be classed with lung diseases) were fatal much above the average. The divisions of London that most contributed to the high mortality were (Appendix I.) the Central and the East. In the group of districts comprised in these divisions, the deaths have averaged 29 per thousand, being nearly 3 per thousand in excess of 1863, when they had already attained a higher mortality than in any recent year. The excess in certain ot these districts has been remarkable, reaching in some to a point a quarter beyond the mortality of 1863 and even to a third or more beyond their usual rate of death. section II.—On the Mortality of St. Giles' in 1864. From all Causes. Comparison with other Districts. What has been stated of the high mortality of London and of the Central Districts, among which St. Giles' is included, almost anticipates the statement that there has been an unusually high mortality in St. Giles'. In every season of great fatality, especially if this have resulted from causes that operate, as cold does, chiefly upon the poor, our own district habitually suffers much, and usually it has suffered out of proportion even to the increase of mortality observed elsewhere. In 1864 the deaths registered in St. Giles' amounted (after several corrections for duplicate entries in the Registrars' returns) to 1601, and 74 persons removed from St. Giles' died in hospitals situate in other districts. The registered deaths amount therefore to 29.74 per thousand of our population, and if the deaths of our parishioners in hospitals be included, the corrected death.rate* is 31.10 per thousand. There has been no such mortality as this since the health of the district has been made matter of study in these reports. It exceeds by 2 per thousand the death.rate of 1862, the year of highest previous mortality. It appears therefore that our district has to lament equally with the rest of London, the remarkable fatality of the past year, and we cannot fail to be struck by the circumstance that in front of an advance in other parts of the town, St. Giles' keeps still advancing in its mortality. But it is right to point out that our own rise in mortality, great as it is, is this year scarcely beyond what has occurred in London as a whole, and that it is a satisfactory exception to former experience that the rise should not be particularly great in St. Giles'. Further, that of the districts among which St. Giles' is situated, St. Pancras Holborn and the Strand, but especially the Strand, have all exhibited a more serious rise (though not reaching the same actual amount of mortality) in their death.rate than St. Giles', when the rate of 1864 is compared with the mean of 1862 and 1863. And, as has already been mentioned, some other districts have had a more formidable increase even than those now mentioned. A reference to the table on the opposite page and to the subjoined abstract of this and similar tables for the last eight years affords data for an accurate estimate of our mortality, both actual and by comparison with neighbouring districts, and leads to the conclusion that our district as well as * 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 seperate 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. MORTALITY IN 1864. Districts. REGISTERED MORTALITY. Column A. Column B. (see Note.*) Total Mortality in 1864 corrected for Cols. A. & B. Districts. Population, 1864. 1st Quarter, 13 Weeks. 2nd Quarter, 13 Weeks. 3rd Quarter, 13 Weeks. 4th Quarter, 13 Weeks. Whole Year, 5 2 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 208,337 1625 78.0 1239 59.5 1146 550 1416 680 5426 2605 114 Hospls. 235 Workh.146 Strand 4719 230.0 St. Pancras. St. Marylebone 162,876 1287 79.0 940 57.7 903 55.4 1062 65.2 4192 257.3 108 Hospital, 220 4080 250.4 St. Maryle. bone. Metropolis 2,948,963 22,733 76.2 17,346 58.2 18,008 60.3 19,636 65.7 77,723 260.4 — — 77723 260.4 Metropolis. Holborn 44,334 423 95.4 349 78.7 276 67.3 343 77.4 1391 313.8 70 Hospital, 74 1387 312.8 Holborn. Strand 42,547 348 81.8 288 67.7 266 62.5 355 83.4 1257 295.4 Workh. 146 Hosps. 49 195 Hospital, 172 1280 300.8 Strand. St. Martin's 22.104 186 83.7 149 67.1 139 62.6 151 68.0 625 281.4 25 Hospital, 81 569 275.4 St. Martin's. St. Giles's 54,034 460 85.1 333 62.6 326 60.3 483 89.4 1607 297.4 74 Hosps. 6† for errors 1675 310.0 St. Giles's. * Col. A. gives the number of the Inhabitants of each District who expired in 1863, i 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.) † The number 6 here subtracted consists of a balance of several errors, most of which have arisen by the re.entry of deaths upon which inquests where held after registration. 6 others has suffered under the influence of several consecutive seasons of unhealthiness, but that there are districts, formerly better off than St. Giles', which have not only risen in their mortality at our own rate, but have (probably from the operation of some other cause than unhealthy season) still further deteriorated in their standard of health so as now to be equal to St. Giles' in their annual rate of death. Death-rate per 10,000* in St. Giles's and neighbouring Districts. Districts. 1857. 1858. 1859. 1860. 1861. 1862. 1863. 1864. St. Pancras 197.0 224.9 221.4 208.7 228.3 215.5 225.6 247.2 St. Marylebone 217.3 224.0 225.0 227.7 242.5 237.1 245.3 250.4 Metropolis 221.0 234.4 227.0 224.1 231.8 234.1 244.4 260.4 Holborn 236.3 247.7 248.6 238.7 270.4 285.5 279.3 312.8 Strand 239.4 226.6 262.9 231.5 233.7 254.6 261.0 300.8 St. Martin 243.0 218.5 246.7 228.6 233.7 238.0 260.9 257.4 St. Giles 280.0 258.2 260.1 262.4 270.3 289.0 284.5 310.0 * Correction is here made for the longer duration of the registration years 1857 & 1863. Also for all deaths in hospitals and outlying Workhouses. Of the 1675 deaths in St. Giles', 849 were in males and 826 in females. The excess of males is somewhat smaller than is usually observed, and if the deaths in hospitals (to which males get taken more than females, from their greater liability to accident) be excluded from consideration, the deaths of each sex were as nearly as possible equal, being 800 males and 801 females. The mean duration of life in persons dying in St. Giles' in 1864, was 30 years and one month; and of those who had passed the period of infancy, and died after reaching the age of two years, the age at death averaged 42 years and nine months. Comparing these ages with those recorded in former reports, they are seen to be higher by one or two years, a fact which is accounted for by an unusual number of old people having died in 1864. One woman is stated to have died at the age of 102 years. section iii.—On the Causes of Death in St. Giles's District in 1864. The causes of death in St. Giles' have been examined side by side with the causes in London for each of the four quarters of 1864, and for the whole year. In this way the influence of special season is partly eliminated, and the results of the comparison, by showing in what respects St. Giles' differs from other parts of the metropolis, afford suggestions of practical value. One 54.6th part of the mortality of London has been taken in the following table (and in appendix IV. where the quarters are examined separately) as the quota of deaths that St. Giles' would furnish if the same rate of death prevailed in this district as in the whole town; as this is the fraction which our population constitutes of the population (calculated for the middle of 1864) of London. Some classes of disease are in excess, some are below the quota thus estimated. From the table it will again be seen how much St. Giles' district exceeds in its gross mortality the number that its population should give to the death rolls of London. In 1864, its quota of deaths was 1423.5, and its actual number was 1675. There was, therefore, an excess of 251.5 deaths, or 117 deaths occurred for every hundred that occurred in an equal population taken out of the average of London. Comparison of Mortality from various causes in London and in Saint Giles's. Whole Year, 1864. (52 weeks.) Classes. Classes and Orders of Disease. London. St. Giles's, Population 54,034. Population, 2,948,96.3 Estimated Quota.* Actual Registered Mortality. Corrected for Deaths in Hosptls. All Causes 77723 1423.5 1601 1675 Specified Causes 76872 1401.3 1593 1664 Classes. I. Zymotic Diseases 20051 366.6 346 357 II. Constitutional „ 14237 260.8 346 360 III. Local „ 31367 574.6 699 737 IV Development , 8673 158.8 163 163 V. Violent Deaths 2535 46.4 39 47 Orders. I. 1 Miasmatic Diseases 18673 341.9 316 326 2 Enthetic „ 418 7.6 13 13 3 Dietic „ 804 14.7 14 15 4 Parasitic „ 156 2.8 3 3 II. 1 Diathetic Diseases 2502 45.8 37 45 2 Tubercular Diseases 11735 217.6 309 315 III. 1 Diseases of Nervous System 7844 143.7 142 147 2 „ Organs of Circulation 3536 64.7 84 94 3 „ Respiratory Organs 15201 278.4 397 406 4 „ Digestive Organs 2964 54.3. 50 59 5 „ Urinary Organs 1086 19.9 18 22 6 „ Organs of Generation 255 4.6 4 4 7 „ Organs of Locomotion 250 4.6 4 5 8 „ Integumentary Organs 240 4.4 … … IV. 1 Dev: Dis. of Children 2179 40.0 52 52 2 „ „ Adults 323 5.9 5 5 3 „ „ Old People 2972 54.4 54 54 4 Diseases of Nutrition 3199 5S.6 52 52 V. 1 Accident or Negligence 2139 36.2 35 42 3 Homicide 126 2.3 4 4 4 Suicide 259 4.7 … … All other Violent Deaths 11 0.2 … 1 Sudden Deaths 185 3.4 … … Causes unspecified 666 12.2 8 11 Certain Special Diseases of Zymotic Class and Miasmatic Order. 1.1. Small Pox 537 9.8 12 12 Measles 2750 50.4 38 38 Scarlatina 3242 60.9 53 57 Diphtheritis 564 10.3 9 10 Croup 882 16.1 11 11 Whooping Cough 2386 43.7 34 34 Diarrhœa 2861 52.4 56 56 Typhus & other Fevers,continued, remittent and puerperal 4050 74.2 83 85 *1:-54.6th part of the entire mortality of the Town. The number of Deaths registered in the District, has here been subjected to the correction noted at foot of table on page 3. 8 Viewed as a cause of the very high mortality of St. Giles's, the Zymotic Class of diseases requires special consideration, as they are the class most amenable to public sanitary measures. It is found that this group (as a whole) has furnished even less than its estimated number of deaths. This fact is probably mainly due to some of those fluctuations from year to year, to which the zymotic class is especially liable, but it may also be supposed to be evidence that the measures of sanitary improvement that can be enforced by local authorities, have not been without their effect in our district. The same circumstance was recorded in the Report for 1863. Of diseases of this class, measles, scarlatina, croup, and whooping cough are those which have been less fatal in St. Giles' than we should calculate for its population. On the other hand, smallpox, diarrhoea, and continued fevers have been in slight excess. Referring to the table for a statistical account of the degree to which these diseases have prevailed, it will suffice to state that of fevers the one which has caused most deaths has been true typhus. The epidemic of this disease, which began in London in 1861, had not subsided in 1864. St. Giles has shared in its prevalence, and of the 85 deaths registered in 1864, from various forms of fever, 65 were from typhus. The deaths that are entered under smallpox, include one from chickenpox; of the 11 persons who lost their lives from real smallpox, not one had been vaccinated : no vaccinated person died of smallpox in the year. Tubercular Diseases, of which consumption affecting the lungs is the most important, were as usual, intensely fatal to our district. It has been said that consumption was remarkably fatal in London, but it was so much more prevalent in St. Giles, that 315 deaths occurred instead of the quota (already exceptionally high) of 217.6 which our population would be calculated to give. Nearly two.fifths of the total excess of deaths iu St. Giles are to be laid to the account of this single disease. Diseases of the Breathing Organs, another group which has been particularly fatal to the metropolis as a whole, have been also fatal far beyond their calculated degree to St. Giles. The high quota of 278.4 deaths has been exceeded by no less than 128, giving a total of 406 deaths from this order of diseases, and accounting for nearly all the remainder of the excess which has been noted in the gross mortality of St. Giles. The other classes of disease of exceptional prevalence in St. Giles in 1864, have been diseases of the heart, and the disorders incident to early periods of life. Every other important class of disease has contributed to our death registers almost exactly the due of our population at the existing rate of mortality in the town. A number of children suffocated as usual; three, if not four, infants murdered; and the fact of there being no single suicide, are the points most needing notice among the returns of violent deaths. The above are the most noteworthy facts that may be gathered from the preceding table, and from the appended tables III and IV. SECTION IV.—On the Localization of Disease and Death in St. Giles's in 1864. It is proposed, in this report, to consider the localization of fatal disease more briefly than formerly, regarding in the main the three sub.districts of the Registrar General. (Appendix V.) * * The boundaries of the three sub.districts are as follows Bloomsbury, coterminous with the Parish of St. George. St. Giles' South, all the Parish lying to the east of a line drawn along St. Andrew's Streets from St. Martin's Lane to Broad Street, where it meets the Boundary of Bloomsbury Parish. St. Giles North, all the remainder of the Parish, stuate West of the above line, and West of the Parish of Bloomsbury. 9 In Bloomsbury, the deaths of 160 males and 193 females were recorded in all 353 persons; the singular excess of female deaths resulting chiefly from the exceptional excess of women resident in this sub-district. In St. Giles South, 423 males and 392 females—total 815 died; and in St. Giles North, 217 males and 216 females, or 433 persons. These numbers do not, however, represent the true mortality of each sub. district, inasmuch as many persons are taken from the other two sub-districts and die in the workhouse in St. Giles South. Correction must be made for these, and also for parishioners of St. Giles and Bloomsbury dying in the hospitals situated outside the boundaries of our districts. Besides the 35S deaths registered in Bloomsbury, six persons had recently been taken from their homes in that parish and died in the workhouse, and seventeen persons from Bloomsbury died in hospitals. The total deaths of the parish amount therefore to 376, giving a deathrate of 21.62 per thousand. Subtracting from the registered mortality of St. Giles South all the deaths (119) among old workhouse inmates, and all those occurring in people brought from Bloomsbury (6) and St. Giles, North, (47,) we have to regard the mortality among people at their own houses 503, along with 140 who had been lately transferred from the houses of this sub-district to the workhouse infirmary, and also 35 who had been taken to hospital and died there. The corrected mortality of St. Giles South was, therefore, 678 or 137 short of the registered number of deaths. This gives a deathrate of 34.81 per thousand on the population of this sub-district. St. Giles North requires an addition to be made to its registered deaths, of 47 persons recently removed to the workhouse, and of 22 who died in hospitals. This brings the deaths to 502, and the deathrate to 29.21 per thousand residents in this sub-district. The order of mortality that has been constantly seen in former years, is again observed in the three sub-districts. Their comparative statistics through a series of years have been as follows:— Death-rate per 1000 in Sub-Districts.* Districts. 1857. 1858. 1859. 1860. 1861. 1862. 1863. 1864. St. George, Bloomsbury 18.0 19.8 18.4 18.5 20.5 21.6 19.9 21.6 St. Giles's, South 35.7 29.2 34.9 34.6 29.1 31.7 32.7 34.8 St. Giles's, North 28.3 27.7 24.0 24.7 27.9 28.2 27.3 29.2 Whole District 28.0 25.8 26.0 26.2 27.0 28.9 28.5 31.1 * Correction has been made for the extra length of the registration years 1857 & 1863. The large excess of deaths that characterizes South St. Giles, will be readily understood after what has been said in reference to the diseases that have prevailed most during the year. Although in the foregoing computation the deaths occurring among old inmates of the workhouse have been excluded, the deaths of people recently admitted from common lodging-houses are included. In these establishments, which are by far the most numerous in South St. Giles's, and which are frequented by the poorest people, often in broken health and on the verge of starvation, an inclement season finds very numerous victims. Bronchitis and consumption were of course intensely fatal among this class of persons, and to these disorders a large part of the excessive mortality of South St. Giles was due. 10 The zymotic class of diseases were of different degrees of fatality in the three sub.districts. Of the 11 deaths from smallpox, 10 occurred in St. Giles South. Four persons died of this disease in the workhouse, two having been taken in for treatment, and the other two being infants who had been in the house since their birth, and were considered too young for vaccination. Measles was distributed among the three sub.districts almost exactly in equal proportions. Diphtheria and whooping cough too, were not specially localized in any one neighbourhood. Diarrhoea was as usual most fatal among the children of South St. Giles, and next in mortality from this disease came Bloomsbury. Scarlatina was most fatal in Bloomsbury, in which sub.district (with the smallest population of the three), it caused 23 deaths out of the 57 registered in the whole district. The disease prevailed here most in November, and found its head quarters about Everett Street, at the Northern extremity of the parish. Fevers were fatal to three persons only in Bloomsbury, to 57 in St. Giles South, and to 21 in St. Giles North; persons dying of fever in the workhouse being considered in this statement at the place from which they were brought. The great stress of epidemic typhus fell on the parts of St. Giles to the South of Holborn, and to the East of the Seven Dials. The streets leading off the top of Drury Lane were especially attacked by the fever, and many patients were taken into the workhouse from the common lodging.houses with which these streets abound. In all, there occurred in the workhouse 40 deaths from typhus out of the 85 which were registered in the whole district. Herein may be observed how much this is a disease of the destitute classes. Of the 40 deaths from typhus in the workhouse, four were among persons who caught the disease in the house, one nurse and three inmates having died of it. The distribution through our district of the disorders of infancy and childhood requires no special comment this year, beyond the observation that they have been very fatal in Bloomsbury through the recent establishment at No. 35, Great Coram Street, of a home for illegitimate infants, among whom there have been many deaths. In the last quarter of 1864, this house was occupied by a number of children, who, with others, admitted up to the end of the year, amounted to 49. In the course of three months 15 deaths were registered among them, chiefly from "exhaustion" and " diseased bowels." Probably all, or nearly all, might have been correctly entered under " want of breast milk " as the cause of death. Registered Births in Sub-Districts. Note that 1863 & 1857, were years of 53 weeks. Sub-District. 1857. 1858. 1859. 1860. 1861. 1862. 1863. 1861. St. George, Bloomsbury 398 403 411 430 416 383 467 419 St. Giles's, South 860 717 780 786 808 772 881 825 St. Giles's, North 592 557 538 562 532 583 550 485 Whole District 1850 1677 1729 1778 1756 1738 1898 1729 In a sanitary report it is always of interest to rate the number of births as well as of deaths. In the above table, the actual number of children born in each sub.district is given for several years, and in Table VI of the Appendix, detailed information for 1864 is contained. The small number of births registered in St. Giles's North last year is noticeable, but it is not worth while to speculate on the cause of this, seeing that the law has not provided, as it is most desirable it should do, for the registration of all children that are born. 11 section V.—On the Diseases and Deaths in the Practice of the Public Medical Institutions of St. Giles's in 1864. The past year was of course a busy one at the Parish Infirmary and Bloomsbury Dispensary. The statistics of each institution are given in the tables that follow. The parochial medical practice shows a high number of cases under treatment in each of its three departments. The in-patients of the pauper hospital were more numerous than in any of the years that have been examined in these reports, with one exception only. The out-patients of the parochial dispensary have also applied in greater number than in any other recent year. And of the paupers who received medical assistance at their own homes, many more new cases came under treatment than in 1862 or 1863, in both of which years their number was unusually high. The rate of death among the patients of the workhouse was of course very high, owing to the nature of the complaints treated; and it was even higher in 1861 than usual, by reason of the greater prevalence of typhus, among other serious diseases. (See Table following page.) It has been mentioned that persons suffering from fever and small.pox taken into the workhouse infirmary from houses where these diseases had originated were not treated without fatal results to some other inmates of the workhouse who had caught the diseases. In view of this circumstance the Directors of the Poor have resolved to take no more cases of small.pox and typhus into the Workhouse Infirmary, but to send them to the special Smallpox and Fever Hospitals. The Bloomsbury Dispensary has had almost as many patients in 1861 as in the three previous years, in which their numbers had been steadily above the average. The annexed table shows how many poor persons above the rank of paupers have availed themselves of this excellent charity, aud it shows also how many have been visited at their own homes and how many have died. New Cases treated at Bloomsbury Dispensary, 1864. 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. 762 203 30 210 64 … 310 1282 267 30 June 24th. 727 133 16 202 64 1 218 1147 197 17 Sept. 29th. 728 154 20 188 42 … 341 1257 196 20 Dec. 25th. 695 211 14 183 52 1 312 1190 263 15 Whole Yr. 2912 701 80 783 222 2 1181 4876 923 82 At the Lying-in Hospital in Endell Street five deaths only occurred in the year. All of these were infants, no mother having lost her life out of all who came to the Hospital to be delivered. SECTION VI.—On the Uncertified Deaths, and on the Inquests of 1864. When attention was first drawn in these reports to the practice of registering deaths without medical certificate, upon the mere statement of friends and neighbours as to the cause of death, there were each year between 40 and 50 of such instances. In 1863 this number was reduced to 26, and in 1864 certificates of the cause of death have been produced to the registrars in all but 15 cases out of the 1601 registered by them. This improvement in practice is strong evidence that there would be no difficulty in enforcing the production of a medical certificate in all cases if the law chose to require it. Cases of Disease and Deaths, occurring in the Practice of the Workhouse in 1864, 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 496 111 313 65 264 50 387 92 1490 318 1347 1419 1758 1202 5726 785 68 628 54 322 53 883 74 2918 249 Small Pox 8 4 2 1 1 … 2 … 13 5 1 ... 1 … 2 10 1 3 … 1 … 10 2 24 3 Measles … ... 2 … 3 … 15 1 20 1 4 10 16 36 66 2 … 32 2 41 3 178 6 253 11 Scarlet Fever … … 5 … … … 1 1 6 1 2 4 22 5 33 3 … 17 3 61 2 37 3 118 8 Whooping Cough 10 1 5 … … … … … 15 1 17 11 19 12 59 14 2 4 2 5 1 16 7 39 12 Diarrhœa 1 … 6 … 3 … 1 … 10 … 90 195 547 97 929 16 1 29 2 38 4 14 1 97 8 "Fever and Febricula" 11 … 16 … 33 … 21 … 81 ... 130 157 176 180 643 55 … 51 … 73 … 101 … 280 … " Typhus Fever " 123 14 72 10 41 6 110 12 146 42 … 1 … 2 3 52 4 40 2 41 7 90 1 223 14 Ague ... … … … ... … 1 ... 1 ... … .. … 1 1 … … 1 … … ... 1 … 2 ... Bronchitis (acute and chronic) 70 30 40 16 25 11 52 13 187 70 487 299 193 329 1308 178 19 57 5 33 4 109 10 377 38 Inflammation of the Lungs & Pleura 5 4 3 3 3 2 7 3 18 12 21 18 15 12 66 60 8 50 8 24 5 56 13 190 34 Consumptive Diseases 32 22 21 15 20 12 26 21 99 70 21 15 15 11 62 34 6 31 8 20 4 45 17 130 35 Ophtalmia 2 ... 4 … 3 ... 1 … 10 ... 14 13 15 3 45 3 ... 4 ... 1 ... … … 8 ... 13 The nature of the deaths that are registered without medical certificate gives this year fresh proof of the necessity for an amendment of the registration laws in this respect. In two infants of the 15 cases the cause of death is acknowledged to be "unknown"; in five other instances, without any medical evidence, the cause of death is entered as "premature birth"; in another infant " convulsions "; in another " malformation." It is clear that the practice of accepting such statements of the cause of death deprives society of an important safeguard against crime. Again, deaths have been registered without medical certificate as occurring from "disease of the liver," from "phthisis," from "inflammation of the lungs," and from " bronchitis." No reliance whatever can be placed on these alleged causes, and statistics of great importance are pro tanto damaged by the reception of such uncertified entries. Their untrustworthiness is constantly illustrated in the cases where inquests are held after registration (cases not included in the fifteen above noted) where the cause of death certified by the coroner has often turned out to be something very different from what had been stated to the registrar. Another evil result of the existing system is that some medical practitioners knowing that it is optional whether a certificate of cause of death be produced or not, are less disposed to be accurate in granting such certificates, and occasionally do so in a very unsatisfactory manner. It is difficult to estimate the importance of this consideration upon the correctness of the death registers. Inquests where held in 1864 on not fewer than 99 persons, the proportion of inquests to population being larger in St. Giles's parish than in any other parish of the district assigned to the Coroner for Central Middlesex. Three of these inquests were on newly born children who had been murdered. Forty of the inquests were on children under five years of age, most of them only a few days or months old. The coroner's court throws great protection over helpless children, whose parents are too apt to neglect them, sometimes it may be feared even wilfully. An instance of the negligence through which children come by their deaths is found in the fact that 18 infants suffocated in bed became the subject of the Coroner's enquiry, and this negligence becomes suspicious in its character when it appears that close upon half of these children were illegitimate. Most of the inquests on persons over the age of infancy were on cases of sudden death and accident—often brought about by intoxication. section vii.—On the Sanitary Work of 1864. The amount of sanitary inspection carried out by the Inspector under the supervision of the Medical Officer of Health does not differ materially from that of previous years. Each month some four hundred or more visits are paid to houses in the poor quarters of the district, especially in streets where epidemic disease is prevalent, and the services of the Inspector are also extended to any better class houses that appear to be in need of them. Amendment of sanitary defects thus discovered has been procured in the vast majority of instances upon the service of notice or as the result of warnings conveved by the Medical Officer. Few persons have thought proper to neglect altogether these notices, though there is still too much delay in complying with their requirements. It has been needful to take proceedings before a magistrate in five cases only. The following is an abstract of the sanitary work done, showing in several important respects an advance upon the work of other years. 14 House Improvements in St. Giles's, effected under the superintendence of Inspector Webb between March 25th, 1864, and March 25tli, 1865. Number of houses improved 530 Improvements in Drainage. Drains constructed or repaired 188 traps fixed 180 Cesspools abolished 53 Stabled drained and horse-pools abolished 99 In Water Closets. Pan, trap, and water provided 20 Water and appparatus 150 Cleaned or repaired 134 Newly constructed or Build 11 In Dust Bins. Newly constructed 10 Repaired or covered 44 Paving. Re-laid 68 In General Water Supply. Receptacles provided 28 Receptacles repaired 59 In Cleanliness and Repair. General Repaired 27 Cleansed and lime-whited 320 Various accumulations removed from cellars, &c. 68 In Ventilation, &c. Ventilation improved 180 Overcrowding Reduced 14 Kitchens disused, or made legally habitable 35 Proceedings taken. First notices 301 Second notices, letters &c. 60 Summoned 5 Reported to police or District Surveyor 36 Total Improvements 1688 A valuable improvement has been made in 1864 in the method of procedure with owners of houses that are habitually kept dirty. Much of the poor house property in the district is owned by some few landlords who wanted incessant looking after, and had come to regard the lenient measures or warning adopted by the Board as a cheap way of keeping them informed about the state of their premises. The Board has now resolved that in the case of persons habitually offending against the sanitary laws, proceedings before a magistrate shall be taken immediately if a simple notice be neglected The public sewerage works done by the Board during 1864 comprise an important sewer in Tavistock Mews, one in New Yard Great Queen Street, and a sewer that has been of much service to the inhabitants in Bloomsbury Market. The Surveyor's report gives particulars as to the extent of these works. The streets in which new sewers are most urgently required are Dudley Street and New Compton Street. In the presence of the epidemic of typhus that has continued through 1864, continued attention has been given to the ventilation of houses and to preventing overcrowding of rooms. The proceedings noted on the table do not represent the whole of the care that has been taken to provide for the health of the poor in these respects, for handbills (in the form now long 15 adopted by the Board) have been circulated with every notice that has been issued, warning landlords against permitting the practice of overcrowding. The decision of the Magistrates that was obtained by the Board has been adopted by other Magistrates in London and has been taken as a precedent when proceedings for overcrowding have been taken in other parts of England. In our own district we may probably trace the result of our precautions in the circumstance that in 1864 our mortality from contagious disorders has not exceeded, as it formerally has habitually done, the average of the metropolis. A more favourable result than this we are not likely to obtain. In the past session of Parliament, the railway bill was passed of which mention was made in the last of these reports, and in the course of a short time we may expect that its provisions will be put in force and a large number of houses in the poorest part of North St. Giles's will be demolished. The evidence given before Committees of the two Houses went to show that these houses were crowded with poor people among whom a high mortality prevailed, especially from the contagious class of complaints. By removing these houses, therefore, the formation of a new street from Tottenham Court Road to St. Martin's Lane would be productive of much sanitary advantage. But it was impressed on the Committees and assented to by the promoters of tbe railway bill that there was another very important sanitary aspect of the case: that provision must be made for the lodgment of the poor who were displaced, or else they would only migrate from their unhealthy homes into other houses adjacent, which they would soon overcrowd to a worse degree and make more unwholesome than ever. It is understood that facilities will be given by the Railway Company for the cheap transit of labourers along their line, and an inducement will thus be held out to the poor to seek, and to capitalists to provide, in the suburbs better house accommodation than could possibly be procured at the same rate in St. Giles's. It remains to help the working classes to understand the advantage that they may thus gain for themselves and their families in economy of health and in accession of bodily and mental strength. The three trades which are placed by law under the inspection of the Board of Works, have been supervised as usual during the past year. The butchers' slaughter.houses have been found, on the whole, in good condition; but at the Michaelmas licensing day, one in Kingsgate Street that was formerly licensed, had its license refused, and has since been altogether disused. The cow.houses have created less nuisance of late, and last year the license to none of them was opposed. The bakeries have been frequently looked after, and no infringement of the regulations found that required proceedings. No complaint of nuisances arising from other trades have been made during the year, and it is not the custom of the sanitary officers to interfere with trades, even if offensive, unless they are made the subject of formal complaint. Upon inspection of the Infants' Home, in Coram Street, advice was given to the managers which it may be hoped will tend in the future to save the lives of some of the infants Particularly it was insisted, if children were to be taken from their mother's breasts for the advantage of the mothers, that for the children's sake the utmost skill in nursing, with ceaseless medical supervision, should at least be secured. The sanitary operations of the past year have therefore been numerous and incessant, but uneventful for record in a report. There are but narrow limits within which the law gives powers to enforce sanitary requirements, and within these limits there has been no want of action. 16 But it is much to be desired that Local Boards should have power of dealing effectually with many sorts of sanitary defect against which the law does not at present properly provide. Collectively the Medical Officers of Health have experience of many such shortcomings in the law, and they have recently drawn up a memorandum on the subject for the use of Government in framing future legislation. GEORGE BUCHANAN, M.D. 63, Hahlky Street. June, 1865. APPENDIX. TABLE I.—Mortality per Thousand in London, in the Divisions of London, and in St. Giles's in 1864, and in preceding Years. Death-rate in London, in groups of Districts, and in St. Giles. Mean of Ten year 1847-1865 Mean of Five years 1855-1859. Death-rate of last Seven years, each corrected to 365¼ days. 1857. 1858. 1859. 1860. 1861. 1862. 1863. 1865. London 27.02 23.08 22.41 23.90 28.69 22.49 23.18 23.56 24.47 26.45 West Districts.— (Kensington, Chelsea, St. George, Hanover. square, Westminster, St. Martin, St. James.) 23.27 21.80 21.19 22.37 21.44 22.17 22.42 22.30 23.24 24.85 North Districts.— (Marylebone, Hamp. stead, Pancras, Islington, Hackney) 22.67 22.08 21.50 22.88 21.67 21.17 22.33 22.00 23.77 25.32 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 26.51 29.01 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 28.48 28.93 South Districts.— St. Saviour, St. Olave, Bermondsey, St.George Southwark, Newing. ton, Lambeth, Wandsworth, Camberwell, Rotherhithe, Greenwich, Lewisham.) 26.81 22.90 21.49 23.96 22.60 22.14 22.79 22.68 23.33 25.30 St. Giles.— Registered mortality 26.89 25.49 26.60 24.84 24.82 24.97 25.81 27.49 27.34 29.84 Corrected for Hospitals — 26.61 28.20 25.91 26.13 26.33 27.12 23.99 28.64 31.10 TABLE II.—Deaths in Hospitals among Patients brought from St. Giles's and neighbouring Districts, 1864. 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). St. Mary's Hospital (Paddington). Deaths in Hospital out of the district. St.Pancras 204 17 53 0 77 8 13 13 23 — 114 St. Marylebone 188 7 80 5 23 3 2 2 33 53* 108 Metropolis 4540 215 300 101 216 84 628 109 639 200 — Holborn 80 17 4 3 2 10 30 6 8 — 70 Strand 92 43 14 10 1 7 3 1 7 — 49 St. Martin's 45 12 3 20 0 1 3 0 6 — 25 St. Giles's 74 21 22 6 5 8 7 5 0 — 74 The figures in the above table were obtained by personal inspection of the books of the several Hospitals, but some are estimated for 1863. That marked with a Star was furnished me by Or. Sanderson, the Officer of Health for Paddington. TABLE III.–Causes of Death in St. Giles's in 1864, 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. 45 and under 55. 55 and under 65. 65 and under 75. 75 and under 85. 85 and upwards. Males. Females. Total. All causes 849 826 1675 502 164 61 45 33 105 150 175 206 142 72 20 Specified Causes 843 821 1664 496 163 61 44 33 104 150 174 205 142 72 20 (Classes.) I. Zymotic Diseases 186 171 357 132 79 27 13 4 21 22 28 19 10 2 … II Constitutional „ 191 169 360 75 25 10 20 18 46 72 49 29 10 5 1 III. Local „ 367 370 737 160 54 21 11 8 35 53 94 149 115 35 2 IV. Developmental „ 71 92 163 102 2 … … 2 1 2 … 3 5 29 17 V. Violent Deaths 28 19 47 27 3 3 … 1 1 1 3 5 2 1 … (Orders.) I. 1 Miasmatic Diseases 170 156 326 116 76 27 13 4 19 19 22 18 10 2 … 2 Enthetic „ 4 9 13 10 1 … ... ... 1 ... 1 … … … … 3 Dietic „ 11 4 15 4 1 ... … ... 1 3 5 1 ... … … 4 Parasitic 1 2 3 2 1 … … … ... ... … ... … … ... II. 1 Diathetic „ 12 33 45 … … … … 1 4 4 12 14 5 4 1 2 Tubercular „ 179 136 315 75 25 10 20 17 42 68 37 15 5 1 ... III. 1 Diseases of Nervous System 80 67 147 39 13 6 2 1 6 8 14 30 22 6 … 2 „ of Organs of Circulation 51 43 94 2 2 3 1 … 10 9 20 24 18 5 … 3 „ of Respiratory Organs 197 209 460 115 37 7 3 4 9 23 43 76 65 22 2 4 „ of Digestive Organs 27 32 59 4 … 2 1 2 8 6 14 14 7 1 … 5 „ of Urinary Organs 11 11 22 … 1 1 3 … 2 6 1 5 2 1 … 6 „ of Organs of Generation … 4 4 … … … … 1 … 1 2 … … ... … 7 „ of Organs of Locomotion 1 4 5 … 1 2 1 … … … … … 1 … … 8 „ of Integumentary System … ... … ... ... … … … … … … … ... … ... IV. 1 Dev. Diseases of Children 32 20 52 52 … ... … ... ... … … … … ... ... 2 „ of Adults ... 5 5 … … … … 2 1 2 … ... … … ... 3 „ of Old People 14 40 54 … … … … … … … … 3 5 29 17 4 Diseases of Nutrition 25 27 52 50 2 … ... ... ... ... ... ... … … ... V. 1 Accident or Negligence 24 18 42 23 3 2 … 1 1 1 3 5 2 1 … 3 Homicide 3 1 4 4 … … … ... … ... … ... … … ... 4 Suicide … ... ... … … ... ... ... … ... ... … ... ... ... … ... … … … … … … … … … … ... … … Violent Deaths not classed 1 … 1 ... … 1 … … ... ... ... … ... ... ... Sudden Deaths, cause unascertained … … … ... … … … … … ... ... … … … … Causes not specified or defined 6 5 … 6 1 ... 1 ... 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 5 7 12 5 4 1 1 … ... 1 … … … ... ... Measles 18 20 38 21 15 2 ... … ... … … ... … ... ... 3 Scarlatina 34 23 57 12 30 7 7 1 … … … ... … … ... 4 Diphtheritis 6 4 10 4 3 1 ... … 1 1 … ... ... … … 5 Quinsy … ... … ... ... … ... … … ... … … … … … 6 Croup 7 4 11 6 4 1 … … ... ... … ... … ... … 7 Whooping Cough 20 14 34 16 16 2 ... … … … … … … … … 8 Continued Fevers, phus, &c. 44 38 82 1 1 11 2 1 13 15 19 13 … … … 9. Erysipelas 6 4 10 3 … … 1 … 1 1 … 1 2 1 … 10 Metria … 8 3 … … … 1 2 … … … … … … … 11 Carbuncle … … … … ... … … … … ... ... ... … … … 12 Influenza 1 … 1 1 … … … … … … … … … … … 13 Dysentery 1 … 1 … … … 1 … … … … … … … … 14 Diarrhœa 24 32 56 47 2 1 ... … ... 1 1 1 2 1 … 15 Cholera … ... … … ... ... … ... ... … … … … ... … Ague … ... … … … … … … … … … … … … … 17 Remittent Fever … ... … … … … ... … … … … … … … … 18 Rheumatism 4 7 11 … 1 1 1 1 2 … 2 3 … … ... 19 Other Miasmatic Dis ... … … ... … … ... ... … … … ... … ... ... Order 2. 1 Syphilis 4 … 13 10 1 … ... … 1 … 1 ... … … … 2 Stricture of Urethra … … … … … … ... … ... ... ... … … … … Order 3. 1 Privation … 1 1 … … ... ... … … … 1 ... … ... … 2 Want of Breast Milk 2 2 4 4 ... … … ... … … … … … … … 3 Purpura 1 … 1 … 1 … … … … … ... … ... ... … 4 Alcoholism. a Delirium Tremens 2 … 2 … ... ... … … 1 … 1 … … ... … b Intemperance 6 1 7 … ... … … … ... 3 1 ... … … … Order 4. 1 Thrush 1 2 3 2 1 … … … … … … … ... … … 2. Worms … ... … … … … … ... … ... … ... ... ... … Order 1. II. 1 Gout 2 1 3 … … ... … … ... … 1 1 … ... 1 2 Dropsy 2 3 5 … … ... … 1 … … 1 … 2 1 … 3 Cancer 7 26 32 … … … … … 4 3 10 11 2 2 … 4 Noma … … … … … … … … … … … … … … … 5 Mortification 1 4 5 ... ... ... ... ... ... 1 … 2 1 1 … Order 2. 1 Scrofula 6 4 10 5 … 2 1 … 1 1 ... ... ... … … 2 Tabes Mesenterica 22 20 42 31 8 2 1 ... … … ... … … … … 3 Phthisis 131 99 230 15 9 6 17 17 41 67 37 15 5 1 … 4 Hydrocephalus 20 13 33 24 8 … 1 … ... … ... … … … … Order 1. III. Cephalitis 8 6 14 3 5 4 … 1 ... 1 … … ... … … 2 Apoplexy 16 17 33 … … … … … 3 3 5 14 5 3 … 3 Paralysis 13 9 22 … … … … … ... … 4 8 9 1 … 4 Insanity 2 ... 2 … … … … … ... ... … … 1 ... … 5 Chorea … … … … … … … … … … … … ... ... … 6 Epilepsy 5 7 12 … … … 1 … … 3 2 4 2 ... … 7 Convulsions 22 15 37 30 6 1 ... … … … … … … … … 8 Other Brain Diseases 14 13 27 6 2 … 1 … 3 1 3 4 6 2 … Order 2. 1 Pericarditis 2 ... 2 … … 1 ... … 1 … … … … … … 2 Aneurism 3 2 5 … … … … … 1 … 1 3 … … … 3 Heart Disease, &c 46 41 87 2 2 2 1 ... 8 9 19 21 18 5 … Order 3. 1 Laryngitis 5 5 10 3 3 … … 1 1 … … 1 1 ... … 2 Bronchitis 105 141 246 50 15 2 2 1 2 14 22 58 57 21 1 3 Pleurisy 5 2 7 1 … 1 ... … … 1 3 1 … … ... 4 Pneumonia 78 54 132 60 19 4 1 2 6 6 16 12 5 1 … 5 Asthma 2 7 9 … … … … ... … 2 2 3 2 … … 6 Other Lung Diseases 2 … 2 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 1 1 2 … ... ... ... … 1 … 1 … … … ... 2 Enteritis 6 3 9 2 1 1 ... … … … 1 … 2 1 … 3 Peritonitis 2 1 3 … … … … … 2 … … … 1 ... … 4 Ascitcs 2 1 3 ... … … … … 1 … 1 1 … … … 5 Ulcer. Intest, 2 ... 2 … ... … 1 … … … 1 … … … … 6 Hernia 1 3 4 … ... … … … … … 2 2 … … … 7 Ileus 2 2 4 ... ... 1 … … … … 1 2 ... … ... 8 Intussusception … … … … … … … … ... … … … … … ... 9 Strict. Intest 1 ... 1 … … … … … 1 … … … … ... 10 Fistula ... … … ... … ... ... … … … … … … … … 11 Stomach Disease, &c 1 3 4 … … … … … 1 1 1 ... 1 … … 12 Pancreas Disease … ... … … … … … … … ... … … … … ... 13 Hepatitis 1 1 2 … ... ... … … 1 … 1 … … … ... 14 Jaundice 1 5 6 2 ... … ... … 1 … 1 2 … ... … 15 Liver Dis. &c 7 12 19 … ... … … … 1 4 4 7 3 … … 16 Spleen Disease, &c … … … … ... … … … … … ... … … ... ... Obder 5. 1 Nephritis 1 ... 1 … … … … … ... … … 1 … ... … 2 Ischuria ... … ... ... ... … … … … … … … … ... … 3 Nephria l 4 5 ... ... … ... … 1 3 … 1 … … … 4 Diabetes 1 … 1 ... ... ... ... … … 1 … … … … … 5 Stone 2 ... 2 ... 1 ... ... … … … … … … 1 … 6 Cystitis ... … … ... … … … … … … … … … … … 7 Kidney Disease, &c. 6 7 13 … ... 1 3 … 1 2 1 3 2 ... … Obder 6. 1 Ovarian Dropsy … … ... ... … … ... … … … … ... … ... … 2 Uterine Disease, &c … 4 4 … … … ... 1 … 1 2 … ... … … Order 7. 1 Arthritis … 1 1 … … … … … … … … … 1 … … 2 Joint Disease, &c. 1 3 4 … 1 2 1 … … … … ... … … … Order 8. 1 Phlegmon … … … ... … … … … … ... … … ... … … 2 Ulcer … … ... … … ... … … … … … … … … ... 3. Skin Disease, &c ... ... … … ... … ... … … … … … … … … Order 1. IV. 1 Premature Birth 22 15 37 37 ... … … … ... … … … … … ... 2 Cyanosis 1 1 2 2 ... … … ... … … … … … … … 3 Spina Bifida 1 1 2 2 … ... … … … … … … … … … 4 Other Malformations 2 … 2 2 … … … … … … … ... ... ... ... 5 Teething 6 3 9 9 ... … … ... … ... … … … … … Order 2 … … … … … … … … … … … … … … … 1 Paramenia … … … ... ... ... … … … ... … … … … … 2 Childbirth (see Metria) ... 5 5 ... … … ... 2 1 2 … … … … … Order 3. 1 Old Age 14 40 54 ... ... … ... ... ... ... … 3 5 29 17 Order 4. 1 Atrophy and Debility 25 27 25 50 2 ... ... ... ... ... ... … … … … Order 1. V. (Accident or Negligence.) 1 Fractures, &c 9 7 16 2 ... 2 ... ... l 1 2 5 2 1 … 2-3 Wounds ... ... ... ... ... … ... ... … … ... ... … … 4 Burns, &c. 2 1 3 2 1 … ... … … … … ... … … ... 5 Poison … … ... … … … ... ... … … ... … … ... … 6 Drowning … 1 1 1 … … … … … … … … … … … 7 Suffocation 13 8 21 17 2 ... … 1 … … 1 … … … … 8 Otherwise … 1 1 1 ... … … … … … … … … … … Order 3. Homicide 3 1 4 4 ... ... .. ... … … ... … ... … ... Order 4. (Suicide) 1 Wounds—Gunshot ... … … ... ... ... ... … … … … … … … ... „ Cut, Stab ... ... … … ... ... ... ... ... ... ... … ... ... … 2 Poison ... … … … ... ... ... ... ... ... … … ... ... ... 3 Drowning ... … … … … ... ... ... ... ... … … ... … ... 4 Hanging … … … ... … … ... ... … ... ... … ... ... … 5 Otherwise … … … … 1 … … … … … … … … … … TABLE IV.—Comparison of Mortality from various causes in London, and in St. Giles's. Four Quarters, 1864. Class. Classes and Orders of Disease. First Quarter. 13 weeks. Second Quarter. 13 weeks. Third Quarter. 13 weeks. Fourth Quarter. 13 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 22733 416.3 485 17345 317.8 342 18008 329.7 337 19636 359.7 511 Specified Causes 22499 412.1 480 17094 313.2 340 17843 320 7 536 19436 3561 508 (Classes.) Zymotic Diseases 4458 81.6 72 4325 79.2 69 6421 117.6 96 4847 88.8 120 i. Constitutional „ 3951 72.3 97 3573 654 79 3389 62.1 82 3324 60.9 102 ii. Local „ 10932 200.2 250 6608 1211 152 5301 97.1 104 8535 156.3 231 in. Developmental ,, 2528 46 3 50 1972 361 28 2105 38.5 44 2068 37.9 41 iV. VioleDt Deaths 630 11.5 11 616 11.3 1.2 627 11.5 10 662 121 14 V. (Orders.) I. 1. Miasmatic Diseases 4111 75.3 64 8988 74.7 59 6059 1110 90 4515 82.7 113 2. Enthetic ,, 119 2.2 3 123 2.2 6 88 1.6 2 88 1.6 2 3. Dietic ., 194 3.5 4 175 3.2 7 222 4.7 3 213 3.9 4 4. Parasitic „ 34 .6 1 39 .7 … 52 .9 1 31 .6 1 II. I. Diathetic ,, 678 12.4 14 588 10.8 12 622 11.5 11 614 11.3 8 2. Tubercular „ 3273 600 83 2985 54.7 67 2767 50.7 71 2710 49.7 94 Ill 1. Dis. of Nervous Syst. 2385 43.7 42 1848 33 9 32 1734 31.8 30 1927 35.3 43 2. „ Organs of Circulation 1100 20.2 34 806 14.7 19 683 12.5 14 947 173 27 3. ,, Respiratory Organs 6237 114.2 151 2798 51.2 85 1699 31.1 41 4467 … 129 4. „ Digestive ditto 765 140 17 695 12 7 12 760 13.9 10 744 13 6 20 5. ,. Urinary ditto 306 5.6 5 253 4.6 4 273 5.0 6 254 4 6 7 6. „ Organs of Gene. ration 51 .9 … 76 1.4 … 60 1.1 … 68 1.2 4 7. „ Locomotion 74 1.3 1 62 1.1 … 50 .9 3 64 1.2 1 8. „ Integumentary System 64 1.2 ... 70 1.3 ... 42 .8 … 64 1.2 … IV 1. Dev. Dis. of Children 620 11.5 19 560 10.2 5 471 8 6 17 528 9.7 11 2. „ „ Adults 91 1.7 3 71 1.3 ... 72 1.3 2 89 1.6 … 3. „ „ Old People 1075 196 19 633 11.6 14 562 10.3 9 702 12.9 12 4. Diseases of Nutrition 742 13.6 9 708 13.0 9 1000 18.3 16 749 13.7 18 V 1. Accdt. or Negligence 530 9.7 … 510 9.3 10 527 96 10 572 10.5 14 Homicide 36 .6 2 30 .5 2 35 .6 … 25 .4 … 2. Suicide 57 1.0 … 75 1.3 … 63 1.2 … 64 1.2 … All other Violent Dths. 7 .1 1 1 … … 2 .1 … 1 … ... Sudden Deaths 54 .9 ... 60 1.1 … 38 .7 … 33 .6 … Cause unspecified 180 3.3 5 192 3.5 2 127 2.3 1 167 30 3 I. Certain Special Diseases. Small Pox 161 2.9 6 116 2.1 2 140 2.5 … 120 2.2 4 Measles 413 7.6 2 844 15.5 8 855 15.6 10 638 11.7 18 Scarlatina 749 13.7 3 593 10.8 9 805 14.7 13 1095 20.0 32 Diphtheritis 135 2.4 2 143 2.6 3 145 2.6 3 141 2.6 2 Croup 255 4.7 5 198 36 3 195 3.6 1 234 4.3 2 Whooping Cough 913 16.7 14 639 11.7 4 396 7.2 2 438 11.7 14 Diarrhœa 172 31 2 321 5.9 8 2080 38 0 39 288 5.3 7 Typhus and other Fevers,continued,remittent & puerperal. 953 17.5 22 876 16.1 20 1049 19.2 18 1172 21.4 25 Deaths in Hospitals here included. Population of St. Giles, 1÷54.6 part of the Population of London in 18613. TABLE V—Registered Deaths in 52 Weeks of 1864 Sub-Districts of St. Giles's. After correction for duplicate entries, &c. Deaths in Sub-Districts. [Population 1861,] First Quarter. 13 weeks. Second Quarter. 13 weeks. 1 hird Quarter 13 weeks. Fourth Quarter. 13 weeks. Whole Year, 1864. 52 weeks. M. F. M. F. M. F. M. F. M. F Both Sexes. St. George, Bloomsbury. [17392] 33 54 35 44 27 40 65 55 160 193 353 St. Giles's. South. [19474.] 131 129 86 69 89 84 117 110 423 392 815 St. Giles's, North. [17183.] 61 51 55 44 40 44 61 77 217 216 433 Whole District. [54049.] 225 234 176 157 156 168 243 242 800 801 1601 TABLE VI.—Registered Births in 52 Weeks of 1864 Sub-Districts of St. Giles's. Births in Sub-Districts. First Quarter. 13 weeks Second Quarter. 13 weeks. Third Quarter. 13 weeks. Fourth Quarter. 13 weeks. Whole Year, 1864. 52 weeks. M. F. M. F. M. F. M. F. M. F. Total Children. St. George, Bloomsbury 55 60 45 40 61 48 46 64 207 212 419 St. Giles's, South 91 118 105 98 104 105 107 97 407 418 825 St. Giles's, North 72 60 71 54 67 55 208 58 48 209 268 217 485 Whole District 218 238 221 192 232 211 882 847 1729