STGIL 13 1865. SANITARY STATISTICS AND PROGRESS IN ST. GILES' DISTRICT, BY GEORGE BUCHANAN, M.D., MEDICAL OFFICER OF HEALTH. LONDON: Printed by T. PENNY, 121, Leman Street, Whitechapel, E. 1866, 1865-6. ANNUAL REPORT OF THE Medical Officer of Heath. § I. — On the Mortality of the Metropolis in 1865 p. 1. § II.— On the Mortality of St. Giles's in 1865. From all Causes. Comparison with other Districts P.2. § III.—On the Causes of Death in St. Giles's in 1865 p. 4. § IV.— On the Localization of Disease and Death in St. Giles's in 1865 p. 7. § V.— On the Uncertified Deaths of 1865 p. 8. § VI.— On the Diseases and Deaths in the practice of Public Medical Institutions in St. Giles's P.9. § VII.— On the Infants' Home, Great Coram Street p.11. § VIII.— On the Sanitary Work of 1865 p. 12. Section I.—On the Mortality of the Metropolis in 1865. The death-rate of London in 1865, was no less than 24½ per thousand residents, the deaths numbering 73,460, and the population, estimated to the middle of the year, being 2,993,513. This is below the extreme death-rate (26½) of 1864, but higher than that of any other of the past ten years. In the first quarter of 1865, the deaths of the metropolis were at the rate of 28 in the thousand annually; the third quarter was the least fatal, giving a rate of 22¼. In the second and fourth quarters respectively, the rate of mortality was 23 and 24½ annually per thousand. Commenting on the connexion between these rates of death and the peculiarity of the seasons in 1865, the Registrar General observes, The winter was cold, and February and March seemed insensible to the growing power of the summer. The mean temperature of each of the first three months lay between 36° and 37°. The mean night temperature of these months was below or little above the freezing point of water; bronchitis was unusually fatal; and the rate of mortality in the coldest Weeks of January and February rose a fourth above the annual average . . . . After May 20th, through June, the mean temperature was high, and it rose still higher in July, reading 66°. The temperature began to rise rapidly on the 20th of June; and the thermometer touched 88° in the air and 148° in the sun on June 23rd. The deaths from diarrhoea suddenly increased in this week to 187; in successive weeks they rose to 184, to 301 in July, and then slowly declined through August and September,"—the chief and very opportune fall being in the 33rd week of the year after a wet week of singularly depressed temperature. On the whole, the diarrhœa deaths were more numerous than in any recent year, the disease being quite as fatal as in the last cholera year 1854. "The deaths from summer cholera had not exceeded one weekly, but in the third week of June three died; and the deaths increased weekly until 23 were registered in the last week of July; then the deaths gradually fell off, and the deaths by cholera in the year were 193." 2 Of other diseases classed as zymotic by the Registrar General, smallpox caused 646 deaths—a number still in excess of the non-epidemic standard of the disease; measles, scarlatina, and whooping cough were each fatal above the average of the ten preceding years; but none of these diseases were so fatal as in 1864. Continued and infantile fevers produced during 1865 excessive numbers of deaths; the epidemic of typhus, which began in 1862, persisting until the end of the past year. The several groups of districts into which the metropolis is divided, contributed less unequally than usual to the death-rates of 1865, the districts upon which the singular mortality of 1864 especially fell, showing in 1865 their death-rates reduced to nearly their ordinary amount; whereas the districts that had no great share in producing the excess of 1864, do not show any such remarkable reduction in 1865. (Appendix table I). Section II.— On the Mortality of St. Giles's in 1865, from all Causes. Comparison with other Districts. The Central districts of London had a death-rate in 1865 of 27 in the thousand. In 1864, their rate was 29¼, and in the mean of the five years preceding, it was 26. St. Giles's district, which is one of the central group, had in 1865, a death-rate of 292/3; in 1864, of 31, and in the mean of the five former years of 28. Steadily therefore, but in 1865 rather more than usual, the mortality of the district has been in excess of those among which it is grouped. Death-rate per 10,000* in St. Giles's and neighbouring Districts. districts. 1857. 1858. 1859. 1860. 1861. 1862. 1863. 1864. 1865. St. Pancras 1970 224.9 221.4 208.7 228.3 215.5 225.6 248.1 238.2 St. Marylebone 217.3 224.0 225.0 227.7 242.5 237.1 245.3 250.4 244.7 Metropolis 221.0 234.4 227.0 224.1 231.8 234.1 244.4 260.4 245.4 Holborn 236.3 247.7 248.6 238.7 270.4 285.5 279.3 312.8 207.7 Strand 239.4 226.6 262.9 231.5 233.7 254.6 261.0 300.8 283.6 St. Martin 243.0 218.5 246.7 228.6 233.7 238.0 260.9 257.4 250.0 St. Giles 280.0 258.2 260.1 262.4 270.3 289.0 284.5 310.0 295.5 * Correction is here made for the longer duration of the registration years 1857 & 1863. Also for all deaths in hospitals and outlying Workhouses. For comparison of St. Giles's with each district surrounding it, the table on the opposite page has been constructed. It appears, from this table, that Holborn was ("after correction) a little worse than St. Giles in its death-rate, and that the Strand district was nearly as bad. From the foregoing summary the fact also appears, and should be mentioned, although there is no satisfaction in it, that of recent years there has been little to choose between St. Giles and Holborn, and not much between St. Giles and the Strand, whereas at the beginning of these reports, there was a difference of about two in the thousand against St. Giles's. Scrutiny of the table indeed, suggests that in the past year at any rate, St. Giles district did not suffer disproportionately to its neighbours from causes that are most under sanitary controul The great excess of deaths in St. Giles's occurred during the inclement winter and spring weather that has been noted, and resulted to some extent indeed from epidemic typhus, but in the main from the fatality of old bronchitis and consumption among the residents of the workhouse and common lodging houses, who are disproportionately numerous in this district. In the third quarter of the year, the season of typhoid fever and diarrhoea, (although there was much of such disease in St. Giles's), St. Pancras alone shows a smaller registered mortality than this district. MORTALITY IN 1865. Districts. Population, 1865. REGISTERED MORTALITY. Column A. Column B. (see Note.*) Total Mortality in 1865 corrected for Cols. A. & B. Districts. 1st Quarter, 13 Weeks. 2nd Quarter, 13 Weeks. 3rd Quarter, 13 Weeks. 4th Quarter, 13 Weeks. Whole Year, 52 Weeks. Actual number. per 10,000. Actual number. per 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 213,300 1540 72.2 1173 55.0 1134 53.2 1369 64.2 5216 244.6 136 Hospls. 186 Workh. 99 Strand 285 5077 238.2 St. Pancras. St. Marylebone 163,204 1206 73.9 974 59.7 923 56.5 964 59.1 4067 249.2 100 Hospital, 173 3994 244.7 St. Marylebone. Metropolis 2,993,513 21,018 70.2 17,367 58.0 16,682 55.7 18,393 61.5 73,460 245.4 - - 73,460 245.4 Metropolis. Holborn 44,176 374 84.7 318 72.0 280 63.3 331 74.9 1303 294.9 88 Hospital, 76 1315 297.7 Holborn. Strand 42,385 385 90.8 275 64.9 243 57.3 286 67.5 1189 280.5 Workh. 99 Hospls. 72 171 Hospital, 158 1202 283.6 Strand. St. Martin 21,880 194 88.7 142 64.9 123 56.2 136 62.2 595 272.0 29 Hospital, 77 547 250.0 St. Martin. St. Giles 54,000 545 101.0 423 78.3 295 54.6 322 59.6 1585 293.5 110 Hosps. Infant Home 95 Errors † 4 99 1596 295.5 St. Giles. *Col. A. gives the number of the Inhabitants of each District who expired in 1865. 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.) † The number 4 here subtracted consists of a balance of several errors. 4 In compiling the following tables, correction of the registered mortality has been made for each district by adding to it the deaths of all persons (so far as known) who after removal from the district died in the public institutions of neighbouring parishes, and by subtracting from the registered mortality of each district the deaths of those extra-parishioners whe died in its public institutions. Until 1860, the only correction of this kind required for St. Giles, was an addition in respect of its parishioners dying in hospitals outside the limits of the district; but in 1865, a subtraction has had to be made from the registered mortality of 95 children who, having no previous connexion whatever with the district, died within a short time of their admission into the Infants' Home, 35, Great Coram Street. To a consideration of these deaths, a special heading will be presently devoted. In the mean time, in all statements respecting cause and localization of disease, fallacy from this and every other avoidable source will be excluded. Of the 1596 persons whose deaths are reckoned in the corrected mortality of St. Giles's, 823 were males and 773 females. Of those dying in hospitals, the excess on the side of males was not so marked as usual, sixty males and fifty females from St. Giles's, having died during the year in hospitals. The average age of persons dying in St. Giles's in 1865, was (after exclusion of the Infant Home children) scarcely 29 years,—about the age noted in former years. Excluding children dying under the age of two years, the age at death averaged nearly 43 years, or slightly higher than usual. Section III.— On the Causes of Death in St. Giles's District in 1865. In accordance with the plan of former reports, an examination of the causes of death in St. Giles's in 1865 has been made, and the number of persons actually dying from each sort of disease, has been compared with the number which, at the current rate of mortality in the whole of London, would have been calculated to have died out of the St. Giles's population. On the best computation that can be made, St. Giles district, in 1865, contained one 55.45th part of the population of London within the limits of the Registrar General. Dividing the total mortality of London from each cause by 55.45, we have therefore the quota of deaths which would fall on our district if the same rate of death from each cause prevailed therein as in the town at large. But between this estimated number and the actual mortality there are many great and instructive differences. The comparison is made in the opposite table, and in table IV of the appendix, where the four quarters of 1865 are separately examined. The gross mortality of St. Giles from all causes has been shown to have been considerably above the mean of the metropolis in 1865. The table shows that the excess (after correction for hospitals) amounts to 271 deaths in the year, so that six persons died in St. Giles for every five who died out of an equal population in the average of London. In four out of the five classes of disease, the excess of mortality of St. Giles over the mean of London will be observed. In the class of developmental disease, however, which comprehends the disorders incident to function at various ages of life, there is no notable difference between our district and the average of the town. The four other classes require separate consideration. Of the zymotic disorders the most important members are examined at the foot of the table. Smallpox, measles, scarlatina, and croup were not so prevalent with us as elsewhere; but three members of the class, more important than these as regards the numerical amount of their fatality, were in notable excess in St. Giles. Whooping cough produced 75 deaths instead of its quota Comparison of Mortality from various causes in London and in Saint Giles's. Whole Year, 1865, (52 Weeks.) Classes. Classes and Orders of Disease. London. St. Giles's, Population 54,00.0. Population. 2,993,513 Estimated Quota.* Actual Registered Mortality. Corrected for Deaths in Hosptls. All Causes 73460 1325.1 1581 1596 Specified Causes 72551 1308.7 1578 1593 Classes. I. Zymotic Diseases 18058 325.7 401 392 II. Constitutional 14415 260.0 320 335 III. Local 28826 520.0 627 654 IV. Developmental 8606 155.2 195 154 V. Violent Deaths 2646 47.7 35 58 Orders. I. 1 Miasmatic 16539 298.4 369 368 2 Enthetic „ 441 7.9 8 10 3 Dietic „ 880 15.8 23 14 4 Parasitic „ 198 3.6 1 ... II. 1 Diathetic Diseases 2483 44.8 48 57 2 Tubercular Diseases 11932 215.2 272 278 III. 1 Diseases of Nervous System 7892 142.3 134 134 2 „ Organs of Circulation 3456 62.3 78 86 3 „ Riespiratory Organs 12545 226.3 350 358 4 „ Digestive Organs 3091 55.6 35 43 5 „ Urinary Organs 1088 19.7 19 22 6 „ Organs of Generation 268 4.8 4 4 7 „ Organs of Locomotion 239 4.3 3 4 8 „ Integumentary Organs 247 4.5 4 3 IV. 1 Dev: Dis. of Children 2077 37.5 41 41 2 „ „ Adult 310 5.6 7 7 3 „ „ Old People 2721 49.0 43 43 4 Diseases of Nutrition 3498 63.0 104 63 V 1 Accident or Negligence 2241 40.4 31 53 3 Homicide 132 2.4 1 1 4 Suicide 267 4.8 3 4 All other Violent Deaths 6 0.1 ... ... Sudden Death 191 3.4 ... ... Causes unspecified 718 13.0 3 3 Certain Special Diseases of Zymotic Class and Miasmatic Order. 1.1. Small Pox 646 11.6 9 9 Measles 1302 23.5 12 12 Scarlatina 2181 39.3 36 36 Diphtheritis 433 7.8 7 8 Croup 742 13.4 10 10 Whooping 2921 52.5 83 75 Diarrhœa 3557 64.2 94 79 Typhus & other Fevers,continued, remittent and puerperal 3428 62.1 89 115 * 1:- 55.4th part of the entire mortality of the Town. The number of Deaths registered in the District, has here been subjected to the correction of 4 noted at foot of table on page 3. 6 of 52 or 53; diarrhoea 79 deaths (and this is after exclusion of all the infants who died from this cause in the Great Coram Street Home) instead of its quota of 64. Typhus and other fevers caused 115 deaths instead of their quota of 62. Important considerations arise from these facts. Of whooping cough, indeed, we can say little as to connexion with unwholesome conditions; except that density of lodgment encourages the spread of this disease in a popnlation. But diarrhoea and fevers are commonly held to be indicative of other insalubrious conditions that are more readily under the controul of sanitary authorities. Diarrhœa, it has been already said, was more prevalent in London in 1865 than in any recent year; in St. Giles it was distinctly more prevalent than in London as a whole, though perhaps not more prevalent than in the districts immediately surrounding our own. Continued fevers are grouped together by the Registrar General, and as a whole, have been in serious excess of their prevalence in average parts of London. The registered names of the various fevers do not afford conclusive evidence as to their nature; but it appears that the registered number of 112 deaths from continued fever, (disregarding 3 puerperal) is made up of 75 typhus, 18 typhoid, and 19 of "fever" unnamed or undescribed. The separation, so far as it is reliable, is of much practical moment. Doubtless, real typhus has been greatly more prevalent in St. Giles than elsewhere in London; in the first quarter (Appendix IV) it was even three times more fatal than in the average of the town. But typhoid has probably not been excessively, though it has been largely prevalent in our district. Now typhus fever, a very contcgious disease, is spread by overcrowding and dirtiness, personal and domestic, and is scarcely affected by other unwholesome conditions about houses; whereas typhoid fever, a far less contagious disorder, appears usually to require for its dissemination contamination of air or water by sewage, and is far less affected by the personal habits of the community among whom it prevails. Hence arises the conclusion that the mortality of St. Giles from fever in 1865, being mainly from typhus, shows the special deficiency in the lodgment of the poor, and that deficient drainage and bad water supply (though doubtless these causes have been in lamentable frequent operation) are not even in the main chargeable with the excess in the St. Giles's fever rate above that of London. The class of constitutional diseases in 1865, shows the same high deathrate that has been recorded from them in all previous reports. Cancerous, and the still more important group of tuberculous diseases, were both more fatal in St. Gdes than in the average of London. It is probable that an excessive amount of consumption actually originates in our district, but as long as St. Giles contains a disproportionate share of the common lodging-houses of the town, it is pretty sure (whether consumption be generated or not specially in our district) always to give an excessive mortality from this cause to the death registers. Local diseases, which form the third class of the Registrar General, were in the greatest excess of all in St. Giles in 1865; but all organs and systems whose diseases are included under this title, did not contribute equally to the excess. Diseases of the nervous system, of the digestive and generative organs, of the bones and of the skin, did not cause so many deaths in our district as the calculated quota for its population. But diseases of the circulating and urinary organs, and above all, diseases of the organs of respiration—which are just those that suffer most from the effects of physical work and exposure— each of these produced an undue degree of mortality in St. Giles. Bronchitis alone, in the inclement season of 1865, caused more deaths in St. Giles than all lung diseases put together would be estimated to produce in the population, and yet lung diseases were much more fatal in London than usual. Taking with bronchitis, inflammation and other disorders of the lungs, the deaths from this group of diseases were nearly 60 per cent. in excess of those of an equal population elsewhere in London, 7 Violent Deaths were, in some degree, more frequent in St. Giles's than in other parts. The excess was entirely caused by "accident or negligence," under which head are included the deaths of 18 infants from suffocation. Section IV.—On the Localization of Disease and Death in St. Giles's in 1865. The distribution of our mortality through the three sub-divisions of the district, has followed the ordinary rule. Bloomsbury has had the smallest, St. Giles South the highest, and St. Giles North an intermediate deathrate. This conclusion is arrived at after correction for deaths in the workhouse and in hospitals as follows:— The deaths recorded by the Registrar of Bloomsbury numbered 431—216 males and 215 females. To these must be added the deaths of 10 Bloomsbury parishioners, who died in St. Giles's workhouse, and those of 22 persons taken from Bloomsbury and dying in the hospitals of various other districts. But 95 infants dying in the Great Coram Street Home, who had lately been brought from Marylebone and other parishes, have to be subtracted. The corrected deaths of the sub-district amount therefore to 368, or (on the population of 1861) 21.1 per thousand residents. The registered deaths of St. Giles, South, were 768, but of these 284 occurred in the workhouse, of whom only 114 had recently been resident in the houses of St. Giles, South; the other deaths being either among inmates of the house, or among persons brought from the other sub-districts. Excluding these, therefore, but adding 58 deaths of persons recently taken from South St. Giles into neighbouring hospitals, the mortality of the sub-district (corrected, that is, to what it would be, if every death occurred in the person's own residence, and if the workhouse were away) amounted to 656, or 34.6 per thousand residents. St. Giles North had 382 registered deaths, to which must be added those of 50 persons taken from the sub-district to the workhouse, and 23 taken to various hospitals with their fatal illnesses upon them. The total of 455 deaths represents a rate of 26.6 per thousand residents. The subjoined statistics show that the relative mortality of the three subdistricts in 18(55 was not materially different from that of former years. Death-rate per 1000 in Sub-Districts.* DISTRICTS. 1857. 1858. 1859. 1860. 186l. 1862. 1863. 1864. 1865. St. George, Bloomsbury 18.0 19.8 18.4 18.5 20.5 21.6 19.9 21.6 21.1 St. Giles's, South 35.7 29.2 34.9 34.6 29.1 31.7 32.7 34.8 34.6 St. Giles's, North 28.3 27.7 24.0 24.7 27.9 28.2 27.3 29.2 26.6 Whole District 28.0 25.8 26.0 26.2 27.0 28.9 28.5 31.1 29.6 * Correction has been made for the extra length of the registration years 1857 & 1863. The following table of deaths represent the relative prevalence in subdistricts of the more important members of the zymotic class of diseases. Deaths in hospitals are here included, so far as the place is known from whence the patients were brought, and deaths in the Infants' Home are excluded. 8  Population 1861. DEATHS IN SUB-DISTRICT FROM Small-pox. Measles. Scarlatina Diphtheria. Whooping Cough. Various Fevers. Diarrhœa. Bloomsbury 17392 2 3 9 5 24 9 17 St. Giles' South 18788 4 3 14 1 27 49 38 St. Giles' North 17201 3 5 11 1 24 31 22 Workhouse Inmates & Tramps 695 0 0 0 0 0 14 3 Further detail as to the localization of epidemics appears to be requisite only in the case of fever. Dividing the district into the ten localities that have usually been employed in these reports when accurate consideration of locality was needed, and distinguishing fevers, so far as may be done, into typhus, typhoid, and undescribed fevers, the following figures are obtained:— Locality of Death. Population, 1861. From "typhus." "Typhoid." Undescribed Fevers. A About Bedford Square 3948 - - 1 B „ Russell Square 5551 1 - 2 C „ Coram Street 6104 2 1 2 D „ Bloomsburv Square 5251 1 2 - E „ Church Lane 4674 5 - 3 F „ Dudley Street 9017 11 6 3 G „ Short's Gardens 6306 11 2 - H „ Nothern Drury Lane 5155 16 4 1 K „ Southern „ 5057 10 2 2 L „ Lincoln's Inn Fields 2261 - - 1 Workhouse Inmates and tramps 695 12 1 1 Unknown - 6 - - Herein it will he observed that typhus has prevailed most in the crowded parts of the district to the south of Holborn. Cases came in considerable numbers from the common lodging houses of Charles Street and other streets in this neighbourhood. Typhoid appears to have prevailed most in the Dudley Street locality, and next in the streets at the north of Drury Lane. Section V.—On the Uncertified Deaths of 1865. The deaths which, in 1865, were registered without certificates of their cause from a medical practitioner or coroner, numbered twelve only. The attention that has been drawn in these reports, and elsewhere, to the abuses likely to spring from the want of proper medical certificates of cause in every case of death, appears to have had effect. When first pointed out, 40 or 50 deaths yearly were registered without certificate of their cause. In the past three years, the uncertified deaths have numbered 26, 15, and 12 respectively, showing a considerable and progressive improvement of practice. Of the twelve uncertified deaths, six were in Bloomsbury sub-district, five in St. Giles Scuth, and only one in St Giles North. It is worthy the consideration of the Registrars of the two former sub-districts, whether they cannot get in practice the small degree of omission that is found in the practice of their colleague in St. Giles North. Half of the twelve deaths were in children under one year of age. 9 Section VI.— On the Diseases and Deaths in the Practice of the Public Medical Institutions of St. Giles's in 1865. In the year 1865, there appears from the records of the public medical institutions, to have been an average amount of sickness in the district of St. Giles. These records give information respecting sickness that cannot be derived from the death registers, and have therefore an importance of their own. On the following page are given the numbers of persons under treatment in each department of the workhouse practice. In all, there were fewer cases than in 1864, and the mortality was not only actually less, but less in proportion to the numbers under treatment. In the last of these reports, it was mentioned that the Directors of the Poor had resolved to send their fever patients to the Fever Hospital, instead of treating them along with other patients in the wards of the workhouse. This resolution appears to have been come to from an observation of the danger to which other persons were exposed through the proximity to them of this contagious disease. As justifying the action of the Directors, it is well to quote figures that show for Hospital and Workhouse the relative risk of fatal typhus being contracted by nurses or other inmates from those admitted for this complaint. Total number of typhus cases under treatment in 3 years, 1863-4-5 Total deaths from typhus, or in proportion to attacks Of the total deaths from typhus, the proportion of those catching the disease in the Institution to those admitted with the disease from outside, was Hospital. 5777 Hospital. 1040 18 per cent. Hospital. 16:1024 or 1:64 Workhouse. 631 Workhouse. 86 or 13½ per cent. Workhouse. 16 : 70 or 1:4¼ It is seen that the Hospital has a greater apparent rate of mortality in its cases, but without other information, and especially without the means of comparing the ages of the patients under treatment in the two institutions, no deductions can be drawn from this circumstance.* But the very important fact is also seen that for every four or five deaths from typhus admitted into the workhouse, one person, who was resident in the workhouse for some other reason, loses his life from the contagion: whereas in the hospital, the proportion of deaths in those admitted, to deaths of inmates, was only 64 to 1. This proportion indicates the degree of usefulness as against the degree of risk. There is always risk to others in treating this very contagious disease, and at the hospital it is reduced to a minimum. At the Lying-in Hospital in Endell-street, the year 1865 has witnessed a higher mortality than usual. This hospital has about 200 cases of labour yearly. Last year it lost five mothers and ten children. The deaths of the children were mainly, after a very few days of life, from congenital weakness. The deaths of the mothers were from, diseased heart, causing exhaustion after labour, 1 haemorrhage after labour, 1; puerperal hysteritis, 1; acute uterine phlebitis, 1; pneumonia, 1. At the Bloomsbury Dispensary, a large number of patients, mostly from the parishes of St. Giles's district, have received relief. The following (p. 11) gives an abstract of the work of this most useful charity. * In 1865 the death-rate from typhus was rather smaller in the Hospital than it was iu the Workhouse, while typhus was treated there. Cases of Disease and Death, occurring in the Practice of the Workhouse in 1865, 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 383 98 294 62 353 48 424 63 1454 271 908 1262 1298 611 4079 783 51 500 45 521 34 564 46 2368 176 Small Pox 4 1 ... ... ... ... ... ... 4 1 4 1 ... ... 5 15 2 5 ... 2 ... 4 ... 26 2 Measles 1 ... ... ... ... ... ... ... 1 ... 7 2 4 4 17 9 ... 5 ... 6 ... 49 4 69 4 Scarlet Fever 7 ... 2 1 1 ... ... ... 10 1 1 1 10 2 14 4 1 8 ... 37 5 30 7 79 13 Whooping Cough ... ... ... ... 2 ... 12 ... 14 ... 52 28 8 41 129 43 6 9 ... 3 ... 11 ... 66 6 Diarrhœa 3 ... 3 ... 14 3 5 ... 25 3 42 221 413 66 742 3 ... 41 ... 80 3 15 2 139 5 " Fever and Febricula" 18 11 ... 10 ... 20 1 59 1 110 107 107 28 352 178 3 49 ... 58 77 2 362 5 "Typlius Fever" 137 28 9 6 1 ... ... ... 147 34 ... ... ... ... ... 61 9 33 2 3 1 14 3 111 15 Ague ... ... 1 ... ... ... ... ... 1 ... 1 ... ... 1 2 1 ... ... ... ... ... 1 ... 1 ... Bronchitis (acute and chronic) 86 25 17 11 23 6 52 7 178 49 329 266 115 44 754 153 22 45 5 25 4 51 4 274 35 Inflammation of the Lungs & Pleura 3 2 5 3 2 1 19 4 29 10 3 13 7 3 26 23 9 15 5 13 2 18 5 69 21 Consumptive Diseases 18 18 21 7 26 12 35 19 100 56 9 18 19 5 51 14 4 27 8 28 6 26 7 95 25 Ophthalmia ... ... 3 ... 4 ... 10 ... 17 ... ... 15 5 6 26 ... ... ... ... ... ... 2 ... 2 ... 11 New Cases Treated at Bloomslury Dispensary, 1865. 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. 791 177 31 166 60 4 379 957 237 35 June 24th. 634 171 18 205 38 2 257 839 209 20 Sept. 29th. 525 138 12 176 27 0 251 701 165 12 Dec. 25th. 443 197 14 160 45 1 302 603 242 15 Whole Yr. 2393 683 75 707 170 7 1189 3100 853 82 The officers of the Dispensary have, on many occasions, been good enough to assist the sanitary work of the district, by pointing out unwholesome conditions that came under notice at the homes of the patients. Section VII.— On the "Infants' Home," 35, Great Coram Street. Mention has been repeatedly made of the Infants' Home at 35, Great Coram Street. It has hitherto been considered only as a disturbing element of the death-rate. But some more particular statement respecting it must be made. In the last quarter of 1864, this house was occupied by a number of illegitimate infants, 49 of whom were admitted before the end of the year, and 15 of them had died This circumstance of course attracted the special attention of the Officer of Health, and was reported in the annual statement of 1864. All the infants admitted into this "Home" are illegitimate, mostly the children of domestic servants, and their mothers have mostly resided before their birth in Marylebone or Paddington. The rules of the Home allowed of their being taken in at all ages, and their mothers were allowed to obtain occupation for themselves, making a small payment for the maintenance or funeral of the child left in the Home. In 1865, besides the 34 children who were in the Home on January 1st, 137 other infants have been admitted, and of the 171 the mortality has been no less than 97. In the first quarter, there were 40 deaths; in the second, 43 ; in the third, 10; and in the fourth quarter, 4 only. The reason for the difference between the quarters will presently appear. The causes of death were as follows:—From tubercular and scrofulous diseases and abscess, 6; from bronchitis and lung disease, 4; from whooping cough, with and without other complaints, 8; from sequelæ of vaccination, 2; from diseases presumably produced by the artificial feeding of children who ought to be at the breast, or by other kinds of improper feeding, 77; this last number, including "marasmus," "ablactation," " thrush," "convulsions," and "diarrhoea." In view of the frightful mortality among these infants, the Home was carefully inspected by the Medical Officer of Health, accompanied by the medical adviser of the Institution, and advice was given respecting the number that should be allowed in the Home at one time, respecting the feeding, nursing, and management of the children; and particularly it was urged that the attendance of its own mother upon each child ought to be secured during the early months of its life. However well calculated to relieve mothers of the burthen of their illegitimate offspring, the system was felt to be intolerable which 12 resulted in the consignment of more than half the children to their graves within a few months of their separation, and generally as the demonstrable effect of their separation, from their mothers. This advice has been in the main followed, and few children have been admitted in the latter half of 1865, without their mothers being kept to nurse them. Such a curtailment of the operations of the Infants' Home appears to have been absolutely necessary, if the institution is not to do far more harm than good. Section VIIIl.— On the Sanitary Work of 1865. The following summary shows the great amount of work that has been done by a single Inspector in the course of the year. The figures show a general increase in the amount of work over that of former years, and this increase is mostly attributable to the resolution of the Board, which permitted proceedings being immediately taken against owners of property who habitually kept their houses in a dirty condition. It is to be observed that this resolution has not operated at all harshly, and that in pursuance of the large discretion which the Board has given to its officers, only one person has been summoned, and yet more work has been done. House Improvements in St. Giles's effected under the superintendence of Inspector Webb between March 25th, 1865, and March 25th, 1866. Number of houses improved 582 Improvements in Drainage. Drains constructed or repaired 188 Traps fixed 208 Cesspools abolished 34 Stables drained and horse-pools abolished 41 In Water Closets. Pan, trap, and water provided 25 Water and apparatus only provided 186 Cleaned or repaired 145 Newly constructed or re-built 15 In Dust Bins. Newly constructed 17 Repaired or covered 123 Paving. Re-laid 57 In General Water Supply. Receptacles provided 13 Receptacles repaired 73 In Cleanliness and Repair. Generally repaired 47 Cleansed and lime-whited 435 Various accumulations removed from cellars, &c. 39 In Ventilation, &c. Ventilation improved 135 Overcrowding 52 Kitchens disused, or made legally habitable 47 proceedings taken. First notice 325 Second notice, letters, &c. 81 Summoned 1 Reported to Police or District Surveyor 25 Total Improvements 1880 13 Unless a law, much more stringent than any at present in force, should be enacted to line any owner whose premises are found in a filthy state, it does not appear that more rapid action can be taken by an Inspector to prevent nuisances than has been taken in the past year. But some such law really is wanted, for there are numerous streets where, as soon as the Inspector's back is turned nuisances reaccumulate in every house as a matter of course, until he again comes that way.* In the course of 1865-6, new brick sewers have been constructed where sewers were deficient or ill-acting, in Lincoln-court, in George-street, Newstreet, and Streatham-street, in Little Queen-street, and in the Vinegar-yard and Lascelles-place. New pipe sewers have been constructed in Hampshire Hog-yard, in Church-passage, and lately in Russell and Coram-places. Many sewers have been repaired and improved. Particulars respecting these works will be found in the Surveyor's report. Slaughter-houses, bakeries, and cowhouses have been as usual under supervision. No change in the licensing arrangements has to be reported, nor have any legal proceedings been had recourse to in respect of such places. In regard of the cow-houses in 1865, special interest attaches from the prevalence in them of contagious cattle plague. The first case of this disease known to have occurred in England, was on June 21th, in a cow-shed of Lambeth, and three days later cases occurred in a shed at Islington. On July 3rd, 40 cows had been attacked in various parts of the metropolis, and half of them were dead, and in spite of measures adopted by the Government for arresting the disease, 7238 cattle are known to have been attacked before the end of the year in the metropolis alone. In St. Giles's district the first shed attacked was that of Mr. Rowe, in Great Coram-street, the smallest, apparently the most isolated and one of the best conducted sheds of the district. For some weeks no other cow-house was attacked, but soon the disease appeared in the numerous sheds of South Sr. Giles's, and many owners suffered severe losses, while others disposed of their whole stock to avoid the risk of their cows being carried off by the plague. At the end of the year there were only 20 or 30 cows in all the sheds of the district, instead of the usual number of 157. It is matter for thankfulness that, although the milk and flesh of the diseased animals must in many cases have been consumed as human food, there is no evidence of any disease being produced in man by the prevalence of the cattle plague. During the year 1865-6, important Bills for improving the sanitary condition of the population have been introduced into Parliament, both by Government and by private members. A Public Health Bill, amending the Nuisances Removal and other Acts, and a Vaccination Bill were brought in by Government. A Bill to facilitate the provision of healthy tenements for the poor has actually passed the legislature, and another Bill intending to * Referring to the efforts that have been made for some years in this district to lessen the disastrous results of overcrowding, it is gratifying to quote the following acknowledgement from an independent authority of the character of results obtained:- "A regular system of visitation and regulation has long been instituted in St. Giles, and is now begun in the Strand and elsewhere. The police, who administer the Common Lodgings Act in the Metropolis, and had abundant means of knowing, said St. Giles's was the only district in which they felt the action of the local authorities in the matter. This St. Giles's administration was in fact a very unusually energetic enforcement of the twenty-ninth section. Single-room tenements were measured and registered, and a few ticketed with the numbers which the authorities and the landlord agreed to permit to live in each room, Prosecutions were instituted wherever any gross violations of the regulations of the rooms were detected. The justices to whom recourse w as made had from the first determined on the principle that each adult person required 400 cubic feet of air. The credit of the essential and responsible step belongs to the late Mr. Jardine."—Dr. Hunter's Report to the Med. Of. of the Privy Council—8th Report of Med. Off., 1866. 14 promote the same objects and to supply a machinery tor the demolition of notoriously unhealthy dwellings has been introduced into the House of Commons by Mr. Torrens, the Member for the Borough in which St. Giles's is situated. The principle of these Bills has been welcomed by all who have sanitary progress at heart. In the latter half of 1865, cholera prevailed epidemically in several cities of the Continent, and notably Paris, (which is more than any other foreign city in communication with England), suffered seriously from the disease. In our own country a few cases happened at Southampton, aud others nearer to London at Epping. These occurrences, together with the high mortality of the Metropolis from diarrhoea in the autumn, produced in the mind of those who had watched the progress of former epidemics, considerable anxiety for the autumn of 1866. It was felt, however, that before the time when it was likely that cholera would prevail in London, there was a period in which measures might be adopted for removing conditions that had demonstrably assisted in the extension of cholera on former occasions. It is in presence of impure air and foul water that cholera, following the direction of human intercourse, assumes the proportion of an epidemic. To advise that all such conditions should be remedied wherever existing in the Metropolis, and to point out the best means of remedying them in their several districts, appeared to the Officers of Health to be their plain duty. In St. Giles's district at the first meeting of the Sanitary Committee in 1866 the need of extraordinary vigilance and of special means of sewerage, disinfection, cleanliness, water supply improvement aud inspection was brought under consideration. In consequence of these representations the Board obtained from their Surveyor a report as to the state of the sewers and have already at the date of this report nearly completed the construction of two important new sewers in Dudley Street and New Compton Street in lieu of old imperfect sewers. This will put in a better state of defence one of our poorest districts which (it has been shown in this report) had last year the highest mortality from diarrhoea. The construction of another large sewer in Southampton Row was resolved on, but has been postponed for a time at the wish of the residents there. Russell and Coram Places have been supplied with pipe sewers. Means of disinfecting the sewage of the district throughout the summer months have been adopted. A few charcoal ventilators have been fixed experimentally to certain sewers. The arrangements for scavenging and dust removal have been frequently considered with a view to obtaining special effectiveness through the coming hot weather. And a second Sanitary inspector has been engaged to assist in the work of house inspection and to procure the removal of nuisances. The public pumps of the district whose water is very impure and in seasons of epidemic cholera especially dangerous have been locked up and employed only for street watering. And an application of the Board for a supply of water on Sundays throughout certain poor districts of St. Giles' has been assented to by the New River Company. In the event of cholera attacking the Metropolis, it may be hoped that these precautionary measures, with others that will be taken by the Board, may cause the epidemic to fall lightly on our district. If happily we should not have cholera, the precautions against it that have been taken will bear their fruits in an improvement in the conveniences and general health of the parishioners. GEORGE BUCHANAN, M.D. June, 1866. APPENDIX. TABLE I.—Mortality per Thousand in London, in the Divisions of London, and in St. Giles's; in 1865, and in preceding Years. Death-rate in London, in groups of Districts, and in St. Giles. Mean of Ten years 1847-1856. Mean of Five years 1855-1859. Mean of Five years 1860-64. Death-rate of last Nine years, each corrected to 365¼ days. 1857. 1858. 1859. 1860. 1861. 1862. 1863. 1864. 1865. London 25.02 23.08 24.05 22.41 23.90 22.69 22.49 23.18 23.56 24.47 26.53 24.62 West Districts.—(Kensington, Chelsea, St. George, Hanover-square, Westminster, St. Martin, St. James.) 23.27 21.89 23.00 21.19 22.37 21.44 22.17 22.42 22.30 23.24 24.89 23.01 North Districts.—(Marylebone, Hampstead, Pancras, Islington, Hackney) 22.67 22.08 22.93 21.50 22.88 21.67 21.17 22.33 22.00 23.77 25.37 24.54 Central Districts—(St. Giles, Strand, Holborn, Clerkenwell, St. Luke, East London, West London, London City) 25.10 24.10 25.99 23.77 24.46 24.14 23.34 25.03 25.83 26.51 29.26 26.97 East Districts.—(Shoreditch, Bethnal Green, Whitechapel, St. George East, Stepney, Poplar) 26.43 24.63 25.92 24.63 25.78 23.95 24.08 24.02 25.98 26.48 29.03 26.44 South Districts.—St. Saviour, St. Olave, Bermondsey, St. George South wark, Newington, Lambeth, Wandsworth, Camberwell, Rotherhithe, Greenwich, Lewisham.) 26-81 22-90 23-26 21-49 23-96 22-60 2214 22-79 22-68 2333 25.36 23.23 St. Giles.—Registered mortality 26.89 25.49 27.09 26.60 24.84 24.82 24.97 25.81 27.49 27.34 29.84 29-45 Corrected for Hospitals - 26.61 28.44 28.20 25.91 26.13 26.33 27.12 28.99 28.64 31.10 29.66 TABLE II.—Deaths in Hospitals among Patients brought from St. Giles and neighbouring District, 1865. 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). Infants' Home, Bloomsbury. St. Mary's Hospital (Paddington). Westminster Hospital (Westminster.) Deaths in Hospital out of the district. St. Pancras 266 8 48 5 92 22 12 38 30 9 - 2 136 St. Marylebone 163 5 63 5 14 7 4 3 19 30 43 2 100 Metropolis 4356 207 236 89 208 82 584 108 631 97 178 182 - Holborn 94 16 1 3 1 6 29 10 26 2 - - 88 Strand 121 49 17 12 3 4 4 0 28 2 - 2 72 St. Martin's 41 13 1 12 1 0 2 0 10 - - 2 29 St. Giles's 112 32 16 11 15 5 5 5 21 2 - - 110 The figures in the above table were obtained by personal inspection of the books of the several Hospitals, but the line for the Metropolis is from the Report of the Registrar General. The figure marked with a Star was furnished me by Dr. Sanderson, the Officer of Health for Paddington. TABLE III.—Causes of Death in the St. Giles's in 1865, with the Ages at Death. (Correction is here made for deaths in Hospitals and in the Infants' Home. 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 823 773 1596 529 116 50 61 54 112 122 162 169 132 69 20 Specified causes 822 771 1593 528 116 50 61 54 111 122 161 169 132 69 20 (Classes.) I. Zymotic Diseases 214 178 392 173 48 21 20 13 27 29 25 20 11 4 1 II Constitutional „ 178 157 335 58 25 11 15 25 52 44 54 29 18 4 ... III. Local „ 337 317 654 176 33 12 21 13 25 42 78 117 95 39 2 IV Developmental „ 62 92 154 98 5 1 1 5 1 ... 2 5 21 15 V. Violent Deaths 31 27 58 23 5 5 4 2 2 6 4 1 3 1 2 (Orders.) I. 1 Miasmatic Diseases 199 169 368 160 48 21 20 13 23 27 22 18 11 4 1 2 Enthetic „ 4 6 10 8 ... ... ... ... ... 1 1 ... ... ... ... 3 Dietic „ 11 3 14 5 ... ... ... ... 4 1 2 2 ... ... ... 4 Parasitic „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... II. 1 Diathetic „ 23 34 57 1 ... ... ... ... 2 5 21 14 10 4 ... 2 Tubercular „ 155 123 278 57 25 11 15 25 50 39 33 15 8 ... ... III. 1 Diseases of Nervous System 78 56 134 40 5 4 7 2 3 12 16 18 18 9 ... 2 „ of Organs of Circulation 42 44 86 ... ... 2 4 ... 11 4 19 27 13 6 ... 3 „ of Respiratory Organs 177 181 358 129 25 5 5 9 5 20 27 59 55 17 2 4 „ of Digestive Organs 22 21 43 5 2 1 1 2 3 5 7 8 6 3 ... 5 „ of Urinary Organs 13 9 22 ... ... ... 3 ... 2 1 6 5 1 4 ... 6 „ of Organs of Generation ... 4 4 ... ... ... ... ... 1 ... 3 ... ... ... ... 7 „ of Organs of Locomotion 3 1 4 1 1 ... 2 ... ... ... ... ... ... ... ... 8 „ of Integumentary System 2 1 3 1 ... ... ... ... ... ... ... ... 2 ... ... IV. 1 Dev. Diseases of Children 19 22 41 39 2 ... ... ... ... ... ... ... ... ... ... 2 „ of Adults ... 7 7 ... ... ... ... 1 5 1 ... ... ... ... ... 3 „ of Old People 19 24 43 ... ... ... ... ... ... ... ... 2 5 21 15 4 Diseases of Nutrition 24 39 63 59 3 1 ... ... ... ... ... ... ... ... ... V. 1 Accident or Negligence 26 27 53 22 5 5 4 2 1 5 3 1 2 1 2 3 Homicide j 1 1 ... ... ... ... ... ... ... ... ... ... ... 4 Suicide 4 ... 4 ... ... ... ... ... 1 1 1 ... 1 ... ... 5 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths not classed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Deaths, cause unascertained ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified or illdefined 1 2 3 1 ... ... ... ... 1 ... l ... ... ... ... 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. I. Order 1. 1 Small Pox 5 4 9 4 1 2 2 ... ... ... ... ... ... ... ... 2 Meals 5 7 12 8 3 1 ... ... ... ... ... ... ... ... ... 3 Scarlatina 21 15 36 10 18 7 1 ... ... ... ... ... ... ... ... 4 Diphtheritis 3 5 8 3 1 2 1 1 ... ... ... ... ... ... ... 5 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Cronp 7 3 10 8 1 1 ... ... ... ... ... ... ... ... ... 7 Whooping 34 41 75 50 21 4 ... ... ... ... ... ... ... ... ... 8 Continued Fevers, Typhus, &c. 67 45 112 3 2 3 14 10 15 22 20 15 7 1 ... 9 Erysipelas 5 2 7 3 ... ... ... ... 1 1 ... 1 ... ... 1 10 Metria ... 3 3 ... ... ... ... 1 1 1 ... ... ... ... ... 11 Carbuncle ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... 12 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Dysentery 3 ... 3 1 ... ... ... 1 ... 1 ... ... ... ... ... 14 Diarrhœa 41 38 79 68 1 1 ... ... 1 ... 1 1 4 2 ... 15 Cholera l 1 2 2 ... ... ... ... ... ... ... ... ... ... ... 16 ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Remittent ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Rhenmatism 7 4 11 ... ... ... 2 ... 5 2 1 1 ... ... ... 19 Other Miasmatic Dis. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 2. 1 Syphilis 4 6 10 8 ... ... ... ... ... 1 1 ... ... ... ... 2 Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 3. 1 Privation 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 2 Want of Breast Milk 3 ... 3 3 ... ... ... ... ... ... ... ... ... ... ... 3 Purpura 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 4 Alcoholism.— a Delirium Tremens 5 2 7 ... ... ... ... ... 4 1 1 1 ... ... ... b Intemperance 1 1 2 ... ... ... ... ... ... ... 1 1 ... ... ... Order 4. 1 Thrush ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Worms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 1. II. 1 Gout 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 2 Dropsy 5 6 11 1 ... ... ... ... 1 ... 2 2 4 1 ... 3 Cancer 15 26 41 ... ... ... ... ... 1 4 19 11 4 2 ... 4 Noma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Mortification 2 2 4 ... ... ... ... ... ...... 1 ... ... 2 1 ... Order 2. 1 Scrofula 4 1 5 1 ... 1 3 ... ... ... ... ... ... ... ... 2 Tabes Mesenterica 15 14 29 19 8 1 ... ... 1 ... ... ... ... ... ... 3 Phthisis 115 91 206 10 8 7 12 26 49 39 33 15 8 ... ... 4 Hydrocephalus 21 17 38 27 9 2 ... ... ... ... ... ... ... ... ... Order 1. III 1 Cephalitis 9 7 16 3 4 2 1 ... ... 3 1 2 ... ... ... 2 Apoplexy 12 15 27 1 ... ... ... 2 1 4 8 5 5 1 ... 3 Paralysis 14 15 29 ... ... 1 ... ... ... 3 3 5 9 8 ... 4 Insanity ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... 5 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Epilepsy 5 4 9 ... ... ... ... ... 1 ... 1 2 ... ... ... 7 Convulsions 22 11 33 32 ... 1 ... ... ... ... ... ... ... ... ... 8 Other Brain Diseases 16 3 19 4 1 ... ... ... 1 2 3 4 4 ... ... Order 2. 1 Pericarditis 3 1 4 ... ... ... ... ... 2 ... 1 1 ... ... ... 2 Aneurism 5 2 7 ... ... ... ... ... 1 ... 3 2 1 ... ... 3 Heart Disease, &c. 34 41 75 ... ... 2 4 ... 8 4 15 24 12 6 ... Order 3. 1 Laryngitis 1 1 2 2 ... ... ... ... ... ... ... ... ... ... ... 2 Bronchitis 101 124 225 62 10 3 2 3 2 9 19 51 47 16 1 3 Plenrisy 3 1 4 ... ... ... ... 1 ... 1 1 1 ... ... ... 4 Pneumonia 67 59 119 65 15 2 3 ,5 3 8 7 5 5 ... 1 5 Asthma 2 3 5 ... ... ... ... ... ... 1 ... 2 1 1 ... 6 Other Lung Diseases 3 l... 3 ... ... ... ... ... ... 1 ... ... 2 ... ... TABLE III.—Diseases in Orders—(continued ) Class. Causes op Death. At all Ages. Under 2 years 2 and under 5. 5 and under 10. 10 and under 20. 20 and under 25. 25 and under 35. 35 and under 45. 4 5 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 2 3 2 1 ... ... ... ... ... ... ... ... ... ... 2 Enteritis ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... 3 Peritonitis 1 4 5 ... ... 1 ... 1 ... 1 2 ... ... ... ... 4 Ascites 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 5 Ulcer. Intest 2 ... 2 ... ... ... ... ... ... 1 1 ... ... ... ... 6 Hernia 1 2 3 ... ... ... 1 ... ... ... ... 1 ... 1 ... 7 Ileus 2 ... 2 ... ... ... ... ... ... ... ... 2 ... ... ... 8 Intussusception 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 9 Strict. Intest. 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 10 Fistula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Stomach Disease, &c. 2 3 5 1 1 ... ... ... ... ... 1 1 1 ... ... 12 Pancreas Disease ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 13 Hepatitis 1 1 2 ... ... ... ... ... 1 ... ... ... ... ... ... 14 Jaundice 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 15 Liver Dis. &c 7 8 15 ... ... ... ... 1 2 1 3 3 4 1 ... 16 Spleen Disease, &c. 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... Order 5. 1 Nephritis 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 2 Ischuria 2 ... 2 ... ... ... ... ... 1 ... ... 1 ... ... ... 3 Nephria 5 1 6 ... ... ... 1 ... 1 1 2 ... 1 ... ... 4 Diabetes 2 1 3 ... ... ... 2 ... ... ... 1 ... ... ... ... 5 Stone ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Cystitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 7 Kidney Disease, &c. 3 6 9 ... ... ... ... ... ... ... 3 3 ... 3 ... Order 6. 1 Ovarian Dropsy ... 2 2 ... ... ... ... ... ... ... 2 ... ... ... ... 2 Uterine Disease, &c. ... 2 2 ... ... ... ... ... 1 ... 1 ... ... ... ... Order 7. 1 Arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Bone Disease, &c. 3 1 4 1 1 ... 2 ... ... ... ... ... ... ... ... Order 8. 1 Phlegmon ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... 2 Ulcer 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 3. Skin Disease. &c. 1 ... 1 l ... ... ... ... ... ... ... ... ... ... ... IV. Order 1. 1 Premature Birth 7 15 22 22 ... ... ... ... ... ... ... ... ... ... ... 2 Cyanosis 2 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... 3 Spina Bifida ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Other Malformations 2 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... 5 Teething 9 7 15 13 2 ... ... ... ... ... ... ... ... ... ... Order 2 1 Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Childbirth (see Metria) ... 7 7 ... ... ... ... 1 5 1 ... ... ... ... ... Order 3. 1 Old Age 19 24 43 ... ... ... ... ... ... ... ... 2 5 21 15 Order 4. I Atrophy and Debility 24 39 63 59 3 1 ... ... ... ... ... ... ... ... ... Order 1. V. (Accident or Negligence.) 1 Fractures, &c. 9 7 16 ... 2 3 3 1 ... 3 2 ... 1 ... 1 2-3 Wounds 1 ... 1 ... ... ... ... 1 ... ... ... ... .... ... ... 4 Burns, &c. 4 6 10 ... 3 2 1 ... ... 1 ... ... ... ... 1 5 Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Suffocation 7 11 18 18 ... ... ... ... ... ... ... ... ... ... ... 8 Otherwise 5 3 8 2 ... ... ... ... 1 1 1 1 1 1 ... Order 3. Homicide ... 1 1 ... ... ... ... ... ... ... ... ... ... ... Order 4. (Suicide) 1 Wounds—Gunshot ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 „ Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Poison 2 ... 2 ... ... ... ... ... ... 1 ... ... 1 ... ... 4 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Hanging 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 6 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE IV.—Comparison of Mortality from various causes in London, and St. Giles's. Four Quarters, 1865. 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 21018 379.1 523 17367 313.3 406 16682 300.9 316 18393 331.8 351 Specified Causes 20712 373.6 522 17189 310.1 404 16395 295.7 316 18255 329.3 351 (Classes.) I. Zymotic Diseases 4349 78.5 120 3931 71.0 94 5283 95.1 103 4495 81.1 69 II. Constitutional „ 3653 65.9 95 3782 68.2 100 3388 61.1 68 3592 64.7 72 III Local „ 9681 174.6 232 6756 121.7 163 4929 88.9 104 7460 134.7 155 IV Developmental „ 2332 42.0 52 2094 37.8 32 2145 38.7 34 2035 36.6 36 V. Violent Deaths 697 12.5 17 626 11.3 15 650 11.7 7 673 12.1 19 (Orders.) I. 1. Miasmatic Diseases 3995 72.1 121 3588 64.8 85 4851 87.3 96 4105 74.1 66 2. Enthetic „ 114 2.0 1 103 1.9 4 105 1.9 2 119 2.1 3 3. Dietic „ 202 3.6 4 200 3.6 5 257 4.6 5 221 4.0 ... 4. Parasitic „ 38 0.7 ... 40 .7 ... 70 1.3 ... 50 0.9 ... II. 1. Diathetic „ 647 11.6 11 635 11.4 22 582 10.5 13 619 11.1 11 '2. Tubercular „ 3006 54.2 84 3147 56.7 78 2806 50.6 55 2973 53.5 61 III. 1. Dis. of Nervous Syst. 2270 41.0 38 2028 36.6 39 1653 29.8 22 1941 35.0 35 2. „ Organs of Circulation 1070 19.4 14 804 14.5 27 708 12.7 20 868 15.6 25 3. „ Respiratory Organs 5073 91.4 162 2733 49.2 76 1326 24.0 42 3413 61.7 78 4. Digestive orgns. 767 13.8 11 755 13.6 12 819 14.7 9 750 13.5 11 5. „ Urinary organs 303 5.5 5 241 4.3 7 254 4.6 7 290 5.2 3 6. „ Organs of Generation 56 1.0 1 63 1.1 .1 70 1.3 1 79 1.4 1 7. „ „ Locomotion 72 1.3 1 73 1.3 .1 40 0.7 1 54 1.0 1 8. „ Integumentary System 64 1.1 ... 59 1.1 ... 59 1.1 2 65 1.2 1 IV. 1. Dev. Dis. of Children 574 10.3 18 537 9.6 7 517 9.3 7 449 8.1 9 2. „ „ Adults 77 1.4 3 81 1.5 1 83 1.5 1 69 1.2 2 3. „ „ Old People 904 16.2 19 635 11.4 12 510 9.3 2 666 12.0 10 4. Diseases of Nutrition 777 14.0 12 841 15.2 12 1029 18.6 24 851 15.3 15 V. 1. Accdt. or Negligence 595 10.7 17 529 9.5 11 539 9.7 6 578 10.4 19 2. Homicide 40 0.7 ... 29 .5 1 35 0.6 ... 28 0.5 ... 3. Suicide 62 1.1 ... 63 1.1 3 75 1.3 1 67 1.2 ... All other Violent Dths. ... ... ... 5 0.1 ... 1 ... ... ... ... Sudden Deaths 53 1.0 ... 30 0.5 ... 61 1.1 ... 47 0.8 ... Cause unspecified 253 4.5 1 148 2.7 2 226 4.1 ... 91 1.6 ... I. Certain Special Diseases. Small Pox 194 3.5 5 149 2.7 3 147 2.7 ... 156 2.8 1 Measles 338 6.2 2 208 3.8 3 253 4.5 2 503 9.1 5 Scarlatina 566 10.2 8 385 6.9 5 516 9.3 14 714 12.9 9 Diphtheritis 129 2.3 3 93 1.7 ... 90 1.6 1 121 2.2 4 Croup 227 4.1 2 180 3.2 2 144 2.6 4 191 3.5 2 Whooping Cough 1013 18.2 37 842 15.2 28 443 8.0 5 623 11.2 5 Diarrhoea 103 2.9 2 700 12.7 18 2186 39.5 46 502 9.1 13 Typhus and other Fevers,continued,remittent & puerperal. 1010 18.2 53 744 13.4 23 722 12.8 20 982 17.7 20 Correction is here made for deaths in Hospitals and the Infant Home. Population of St. Giles, 1 ÷ 55.45ths part of the Population of London in 1805. TABLE V.—Registered Deaths in 52 Weeks of 1865. Sub-Districts of St. Giles's. After correction for duplicate and omitted entries. 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, 1865. 52 weeks. M. F. M. F M. F. M. F. M. F Both Sexes. St. George, Bloomsbury. [*17392] 63 84 75 54 37 34 41 43 216 215 431 St. Giles's. South. [19483.] 144 121 101 94 72 72 89 75 406 362 768 St. Giles's, North. [17201.] 61 67 50 47 48 33 35 41 194 188 382 Whole District. [54076.] 268 272 226 195 157 139 165 159 816 765 1581 TABLE VI.—Registered Births in 52 Weeks of 1865. Sub-Districts of St. Giles. Births in Sub-Districts. First Quarter. 13 weeks Second Quarter. 13 weeks. Third Quarter. 13 weeks. Fourth. Quarter. 13 weeks Whole Year, 1865. 52 weeks. M. F. M. F. M. F. M. F. if. F. Total Children St. George, Bloomsbury 60 69 57 50 60 53 53 59 230 231 461 St. Giles's, South 113 131 93 105 107 122 102 118 415 476 891 St. Giles's, North 60 68 71 73 56 68 70 72 257 281 538 Whole District 233 268 221 228 223 243 225 249 902 988 1890