STGIL 14 1866 THE BOARD OF WORKS FOR THE Saint Giles's District. GENERAL REPORT of the Sanitary Committee of their proceedings under the Orders of the Privy Council of the 21st July last, and the Resolution of the Board of the 24th July last, on the outbreak of the Cholera in the District. Cholera appeared in London in its epidemic form at the beginning of July. It affected the Eastern Districts first, and with greatest violence. The deaths from it registered each week in the Metropolis are given in an appended Table (I) side by side with the mortality of corresponding weeks in the two preceding epidemics. On July 15th, an Order of Council declared the Diseases Prevention Act to be in force throughout the kingdom, and on July 21st a further order gave instructions as to the measures to be adopted in places where epidemic Cholera or Diarrhoea prevailed. On July 24th, the Board of Works instructed the Sanitary Committee to consider and carry into effect the Orders of Council, and gave the Committee power to incur such expense as might be necessary in carrying out the same. Precautionary Action.— Next day the Committee met, and adopted means for detecting every case of Cholera and Diarrhoea at its earliest stages, for affording the promptest medical assistance to all 2 persons attacked, and for keeping the District in the most wholesome condition practicable. These measures were carried into effect under the daily supervision of the Committee. (Order of Council, II. 1-2.) Each morning a Return was compiled of all ascertained cases of Cholera, Choleraic Diarrhoea, and Diarrhoea occuring during the previous day. Information for this return was supplied by the Officers of the "Workhouse and Bloomsbury Dispensary, and by many private practitioners, as well as by the officers whom the Committee proceeded to appoint; and there is evidence that nearly every case of Cholera or Diarrhoea came at once to the knowledge of the Committee. (0. of C. I& II. 21.) For the purpose of house visitation, the Committee divided the District into six parts, one comprising the greater part of the Parish of Bloomsbury, while the other five parts comprised St. Giles's Parish, and contained from six to nine thousand people in each. (O. of C. II. 4.) To each subdivision a Medical Staff was assigned, consisting of one Medical Visitor and two assistants. The Medical Visitor was in all cases a highly qualified practitioner, who gave all his time to the duties assigned him. His assistants were usually Medical students who had had much Hospital experience. (0. of C. 11. 4.) The Medical Visitor was charged to visit from house to house and from room to room, by himself or his assistants (for all of which work he was held responsible), in search of cases of Cholera and Diarrhoea, to treat all such cases immediately, and to take charge of every such ease to a termination. He had to report every morning the number of houses and of families visited, the number of new cases of Cholera and Diarrhoea met with on the previous day, and the result of his treatment of eases already reported. The enormous amount of work done by this Medical Staff may be judged of by the fact that they commonly visited 1,700 houses, and 5,200 families daily, and on one day these numbers amounted to 1,898 and 5,945 respectively. (O. of C. II. 4-5.) Medicines were provided at any honr of the day or night at each of four dispensaries which were established by the Committee. Although relief was never delayed to any applicant suffering under Cholera or Diarrhoea, the Committee did not consider it sufficient merely to give medicines, but the name and address of every applicant at the dispensaries were taken and the case followed up and treated by the Medical Visitors. In this way two or three hundred Diarrhoea patients were often on the lists of the Medical Visitors in a single day, while each day added a large number of new patients (frequently nearly two hundred) suffering from the complaint. Happily the Diarrhoea proved very amenable to the skilful treatment of the Visitors, and although from first to last they had about ten thousand cases of it under treatment, their work did not accumulate to an unmanageable extent. (O. of C. 11. 7-8.) The Committee early regarded the provision of a Hospital for Cholera as one of the most important portions of the duty imposed on them by the Order of Council. A disease which demands the most skilful nursing to give a chalice of recovery, and which is known t® 3 extend itself indefinitely in the presence of dirt and carelessness, could not he managed with advantage to the patient, or with safety to his neighbours, in the close and crowded houses of the poor of Saint Giles. The Committee succeeded in substituting a well arranged Hospital for 1 lie crowded room, and the best of medical care and nursing for the chance attendance of ignorant friends. (0. of C. II. 10.) The Rector of Saint Giles kindly put at the disposal of the Committee the Shelton School rooms by St Giles's Church. The Clewer Sisters undertook the entire management, under the Medical Officers, of the Hospital thus obtained. The building having been adapted to its purpose by some few alterations, the first Cholera patient was admitted into it on August 14th. (0. of C. II. 9-10.) The steps taken by the Committee to keep the District in the most wholesome practicable condition were in some sense a continuation of those which had been taken by the Board sincft the very beginning of the year. In anticipation of cpming Cholera, the Board had made provision for maintaining the sewers in a state of special efficiency, and for flushing them with disinfectants throughout the summer; they had arranged for more frequent street cleaning and removal of manure, had shut up the dangerous surface wells, had sought to obtain from the New hiver Company a better supply of water, and had engaged the services of a second Sanitary Inspector. The Committee carried out and extended this course of action, and with the extra light that was thrown on unwholesome conditions about the district by daily reports from the Medical Visitors, they were able promptly to apply sanitary remedies to those streets and houses that stood in most need of improvement. The Inspectors, acting on the reports of the visitors, called on the owners of 375 houses to make improvements; and where delay or neglect was allowing a slate of things to exist grossly prejudicial to health, the officers of the Commntee were instructed to employ workmen to carry out needful means of demising. Moreover, a quite unparalleled amount of personal and domestic cleanliness was obtained, for a time, through the exhortations and influence of the Medical Visitors. (0 of C. II. 5.) The New Hiver Company furnished a gratuitous supply of water to eighteen stand-pipes, which were erected by the Committee in the poorer streets and courts. From these, good water could be drawn by any person on Sundays as well as week days, and over a thousand persons have been frequently supplied from them in the course of a couple of hours. (0. of C. Hi Ik) The Committee endeavoured to convey to every one information as to the way of avoiding Cholera, and of preventing tae disease from extending. They issued handbills to owners and occupiers of houses inhabited by the poor, urging on all the duty of seeing that .drains and other necessaries were acting efficiently, and that water supply was pure, insisting on the importance of attending early to all Diarrhoea; and giving information about the medical and sanilnvy arrangements. Between twenty and thirty thousand handbills and placards were distributed. (O. of C. II. 20.) 4 Appearance and Course ok Epidemic.— The measures that have been here enumerated, were taken with great promptitude, and were on a scale commensurate with the actual and prospective wants of the District. In the first week (that ending August 11th) for which the Committee have complete returns, no less than 2,700 cases of Diarrhoea were ascertained to have occurred. At this time, Cholera itself had only appeared in a few houses, and was directly traceable to communication with some infected locality. At the beginning of September, however, when ordinary summer diarrhoea was declining, the cases of Cholera became more numerous, and throughout September and the first half of October, one or two fresh outbreaks were reported almost every day, and it became iu the majority of instances impossible to trace the disease to previous infection of person or locality. After the middle of October, only two or three fresh families were attacked, and the last was on November 8th. In an appended tablo (II.), are shown the weekly number of new cases of Diarrhoea, Choleraic Diarrhoea, and Cholera with the death* each week. (O. of C. II. 19 ) From first to last, 83 persons were attacked with Cholera, reckoning those who were removed from St. Giles to the hospitals of neighbouring districts, as well as those who died within the district. Out of this number, 58 died, and 30 recovered, giving almost two deaths out of every three attacks. But there can be no doubt that in reality the disease was not quite so fatal as this, inasmuch as many of the cases returned as Choleraic Diarrhoea, hardly any of which died, were really examples of true Cholera in its earlier stages. Only one death is recorded as from Choleraic Diarrhoea out of 70 cases returned kjy medical visitors under that head. Three other cases of death from " Choleraic Diarrhoea " were also registered, of which nothing but the fatal event was known. If only half these cases were really slight cases of Cholera, and should therefore be reckoned with Cholera, the proportion of deaths from Cholera to the attacks, would be barely fifty per cent. Each case of Cholera did not represent a separate outbreak of the disease; the 83 cases having occurred in 70 families living in 69 houses. The culminating period of the epidemic was in the week ending October 6th, when 13 cases and 9 deaths were recorded. Comparing the virulence of Cholera this year with that of former epidemics in St. Giles's, the Committee observe with satisfaction a very much smaller mortality. In 1832, the deaths from Cholera exceeded 300 , in 1849 they were 285; and in 1854, they were 113.* The Committee venture to assert, that the satisfactory result * These figure represent the registered deaths of former epidemics. The reyistered deal lis from Cholera and Choleraic Diarrhoea in 1866, were 48, and this is the number which ought to be compared with those of former years. The difference between the registered and actual deaths (53), results from including in the latter, deaths of persons removed to outlying hospitals, and from other means Shut have been employed to ensure accurate and complete returns. 5 in the present year was largely brought about through the opera >n of the measures which they were charged to carry into effect. For they have evidence— 1.—That the excessive mortality from Diarrhoea, which existed up to the time of their appointment, disappeared immediately that their work began.* 2.—That the Cholera affected most those localities which from their previous condition were the least amenable to precautionary measures, particularly the neighbourhood of New Compton Street, (whose sewerage the Board had not succeeded in completing before they found that Cholera was in London—they knew that typhoid fever had been particularly rife in that quarter)—suffered more from Cholera than even worse looking streets.t 8.—With the precautions that the Committee enforced, scarcely any instance occurred of a second family being attacked in the same house, and 110 instance of persons suffering in two contiguous houses. 4.—Attacks of Cholera were in the great majority of cases confined to single individuals, and did not spread even to others of the family; and the exceptional cases where whole families were attacked, occurred almost exclusively among those who would not or did not adopt the course prescribed by the Committee. Sanitary and Remedial Measur.es.—Upon the occurrence of any case of Cholera, the action of the Committee was, lstly, to procure the removal of the. patient whenever possible to the Shelton Hospital. 2ndly.—To remove his family, if they were not properly lodged, into another and detached portion of the Hospital; here they were kept under observation and in wholesome conditions until their own room could be made safe for their return. ((). of C. II. 11.) 8rdly.—To disinfect and limewash the room thoroughly, to disinfect the privy and drains, aud to clean out the waterbutt of the house. (O. of C. II. 7-12.) 4thly.—To destroy or in some cases disinfect * The following are the numbers of Registered Deaths from Diarrhoea before and after house visitation began ; it commenced iu Si. Giles North on July 30th. BE FOUR HOUSE VISITATION. AFrKK HOUSE VISITATION. Iu sub- District, Week ending. July 7. July 14. July 21. July 28 Aug. 4. Aug. 11. Aug. ;a. Aug. 25. .. 2 3 4 1 2 .. .. St. Giles South 1 S 4 3 3 4 2 •• 2 2 3 4 •• 1 1 .. Whole District 3 9 10 11 4 7 3 •• † In the Report of Saint Giles Cholera Committee for 18.H, a list is given of 18 houses which were affected by Cholera, both in that year and in 1849. It is curious that not one of these houses was affected in 1866. 6 every article of clothing and bedding that had been soiled by any discharges. (O. of C. II. 12.) The Committee are confident that in proportion as these measures were carried out early and efficiently, they succeeded in preventing the extension of Cholera. Into the Hospital, 75 persons were admitted suffering from Cholera, Choleraic Diarrhoea, or some severe form of Diarrhoea. 57 cases of unequivocal Cholera were admitted, out of the total 83 cases that occurred in the district, and of these 37 proved fatal, being at the rate of 65 per cent. That the mortality was not higher, among cases that were all severe, the Committee regard as due partly to the circumstance of the Hospital being so near the infected localities; for they observe that of six persona taken beyond the District to various General Hospitals more or less distant, every one died. And partly they regard the recovery of their patients as having been assisted in a most material degree by the unwearied devotion of the Clewer Sisters. Of the manner in which these ladies have discharged the complicated and laborious duties which they undertook the Committee would wish to speak in the warmest terms of gratitude;—without the wisdom and skill and self sacrifice, of which every hour witnessed some fresh proof, the Committee could not satisfactorily have carried out the part of their functions which they believe to have been, of all others, the most efficacious in arresting the spread of the epidemic.* Into the rooms which were set apart as a refuge and place of observation for persons belonging to infected families, 67 persons were admitted. The disinfection of rooms and privies, and the destruction of articles contaminated by discharges from the sick was regarded as a matter of primary importance, inasmuch as the infective quality of Cholera has teen shown to be developed during a certain stage of decomposition of its discharges, and to be capable of communication by the discharges to water or masses of night soil. The chemical agent used for disinfection was Chloride of Lime, a substance chosen as being the most generally useful, and in all probability the most efficient. This was given with a paper of instructions for its use to very many families attacked by Diarrhoea, and always when there was Cholera. In the Hospital and in particular instances elsewhere, Carbolic acid was employed, and Condy's fluid was used in rinsing out water butts. Where actual Cholera appeared, the needful processes of cleansing and disinfecting were not lell lo landlords and relatives, but were performed by careful competent persons in the employ of the Committee, and in no case were these processes omitted. In certain cases where the want of sufficient wholesome food appeared to be actually keeping up Diarrhoea, and in other cases during convalescence after Diarrhoea or Cholera had ceased, the Committee caused * It is witli groat regret that the Committee record the death from Cholera of Jean Measer one of the Volunteer Nurses who assisted the Sisters in their work at the hospital. 7 the necessary nourishment and comforts to be supplied. (0. of C. II. 8.) All bedding and clothing destroyed by their orders were immediately replaced, or their value paid in money. And in obedience to the order of Council, cases of destitution observed by the Medical Visitors were reported to the parochial authorities. (O. of C. II. 6.) The Committee entered into an engagement with the Necropolis Company to remove and inter the body of any poor person who had died of Cholera. Such bodies were taken within a few hours to the mortuary of the Company in the Westminster Road, and were speedily interred at the Cemetery at Woking. (0. of C. II. 15-17.) The Committee were assisted towards the end of the epidemic in closing their Dispensaries and the Hospital by the Medical Officers of the Workhouse and the Bloomsbury Dispensary. In rendering this account of the action taken under the order of Council and the instructions of the Board, the Committee are pleased to record that the poorer inhabitants of the District, upon whom the danger of the epidemic almost entirely fell, showed themselves throughout grateful for the care that was taken by the Committee. They were very accessible to the visitors, and generally attentive to their advice; in a larger proportion of cases than might have been expected they allowed the removal of their friends to the Hospital, in spite of their natural preference for attending them at home; and they offered no obstruction to the Committee in the action which it was thought right to take respecting disinfection, destruction of clothing and speedy interment of the dead. RICHARD CULL, F.S.A., Chairman. 12th February, 1867. 8 APPENDIX J. Mortality in London from Cinder a during each week of three Epidemics. No. of Week. 1849. 1851. 1866. In 1806, Week ending 21 at 5 2 May 26 22nd 9 2 2 June 2 23rd 22 1 3 June 9 2tth 42 1 3 June 16 2ith 49 1 1 June 23 26th 124 .. 6 June 30 27th 152 1 14 July 7 88th 339 5 32 July 14 29th 678 26 346 July 21 31th 783 133 904 July 28 31st 926 399 1053 Aug. 4 32nd 823 644 781 Aug. 11 33rd 1210 729 455 Aug. 18 31 th 1272 847 265 Aug. 25 35th 1663 1237 198 Sept. 1 36th 2026 2050 157 Sept. 8 37th 1652 1519 182 Sept. 15 38th 839 1281 150 Sept. 22 39th 434 754 177 Sept. 29 40th 288 411 182 Oct. 6 41st 110 249 2u7 Oct. 13 42nd 41 163 144 Oct. 20 43rd 25 66 112 Oct. 27 44th 11 31 73 Nov. 3 4.5th 6 23 67 Nov. 10 46th 8 12 32 Nov. 17 47th 2 8 8 Nov. 24 APPENDIX II. New Cases of Cholera, Choleraic Diarrhea and Diarrhoea, occurring in St. Giles's District, reported each week to the Sanitary Committee, and by them to the Privy Council; with the deaths from each form of disease. 1866. CHOLERA. CHOLERAIC DIARRHOEA. DIARRHOEA. Week Ending. New Cases. Deaths. New Cases. Deaths. New Cases. Deaths. Aug. 4 1 .. 5 .. 1629 4 11 3 3 9 1 2700 6 „ 18 2 1 10 .. 2147 4 „ 25 1 .. 13 1 1600 .. Sept. 1 8 3 14 .. 1365 1 „ 8 4 4 7 .. 982 .. „ 15 9 6 4 .. 669 2 22 7 3 3 .. 473 3 „ 29 11 8 1 1 360 2 Oct. 6 13 9 3 .. 625 2 13 10 6 3 1 879 .. „ 20 4 5 2 .. 90 .. „ 27 4 1 1 .. 91 .. Nov. 3 4 3 .. .. 67 .. „ 10 2 2 .. 43 .. „ 17 . . .. 11 35 „ 24 •• .. .. .. 30 •• Total 83 53 75 4 13,085 24 9 APPENDIX III. THE BOARD OF WORKS FOR THE ST. GILES'S DISTRICT. Account shewing the sums expended, in carrying out the Order of the Privy Council of the 21 st July last, and the Resolution of the Board of the 26th July last. £ I. d. Salaries to Medical Visitors, &c. 923 9 6 Chemists' Bills 270 0 7 Hospital Expenses 135 19 11 Furmiture 85 18 3 Incidentals 122 2 8 Interments 69 3 8 Altering and adapting the Shelton Schools for the purpose of a Hospital, erecting and maintaining Stand pi pes throughout the District, making good after the same, and restoring Schools on disusing the premises as a Hospital 370 13 0 Wages to Men watching Stand-pipes, removing patients, destroying bedding, &c. 136 15 2 Payments to Officers for extra services 178 10 0 Donation to Bloomsbury Dispensary 10 10 0 £2293 2 9 E. A. Mitohener, Printer, 110, Great Rus>ell Street, Bloomsbusy 1806. 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. 1867 1866—7. ANNUAL REPORT. OP THE Medical officer of Health. § I.— Oil the Mortality of the Metropolis in 1866 P. 1. § II.— On the Mortality of St. Giles's in 1866. Frorn all causes. Comparison with other Distrtcts p. 2. § III.— On the Causes of Death in St. Giles's in 1866 p. 4. § IV.— On the Localization of Disease and Death in St. Giles's in 1866 p. 7. § V.— On the Uncertified Deaths and Inquests of 1866 p. 9. § VI.— On the Diseases and Deaths in the practice of Public Medical Institutions in St. Giles's, and in the Infant's Home p. 9. § VII.— On the Sanitary Work of 1866-7 p. 12. VIII.— Tables Appended. Section I.— On the Mortality of the Metropolis in 1866. The deaths of London in 1866 amounted to no less a number than 80,129, itself the population of a very considerable town. The rate of mortality upon the calculated population 3,037,991 was 26.47 per thousand. This is a higher death-rate than in any of the past ten years, but only a fraction above that of 1864; and the high rate is accounted for by the presence of epidemic cholera. A comparison of the mortality of London in 1866 with that of former cholera years demonstrates that sanitary work (imperfect as it is) has deprived the disease of much of its power, and encourages us to rely on the ultimate extinction of cholera if we use the means that sanitary science points out. In 1832 the death-rate from cholera in London was 3.7 per 1000. In 1849 the death-rate of the town from all causes was 30.14, and that from cholera 6.2 per 1000. In 1854 the corresponding figures were 29.43 and 4.6; and in 1866 they have been 26.47 and 1.8. Already the fatality of cholera has been reduced to such a point that the gross mortality of the epidemic year 1866 scarcely exceeds that of a year (1864) when no foreign epidemic was present, but when typhus, measles, and other indigenous complaints were swelling the number of deaths in London. The prevalent epidemic of the year caused the mortality of the several quarters to differ a good deal from the usual relative amount. Generally the highest mortality of London is in the first quarter; but in 1866 the third quarter was in excess, having had 22,353 deaths, while the first quarter had 20,029, the second 19,291, and the last quarter 18,456. In fact, if cholera had not occurred, the year would have been one of somewhat high, but not remarkable mortality. With this distribution of mortality through the four quarters, and with the circumstance that the mortality of the first three months was distinctly lower than usual, it readily occurs to connect the fact that the mean temperature of the year was slightly above the average, and that the winter temperature was higher while the summer temperature was lower than the average. A somewhat excessive rainfall along with the low summer temperature is to be gratefully recognized as contributing to keep down the extension of cholera. Other members of the symotic group of diseases that were in excess of their usual amount in London in 1866 were small-pox, which, from its outbreak in 1863, has never declined to its usual standard, and which, towards 2 the end of last year, became again unmistakeably epidemic; measles, which was slightly in excess of its average mortality; typhus and other fevers, which, however, were much less prevalent in 1866 than in any of the four preceding years; and diarrhcea, a disease that is to be expected to prevail largely when cholera is epidemic. Of zymotic diseases less prevalent than usual, scarlatina and diphtheria are the chief. Among other groups of diseases, those of the respiratory organs, consumption, heart and brain disorders, have been fatal to an average, or a little above an average, degree. The divisions of London habitually contribute unequally to the death. registers. In 1866 however, the difference between them was more marked than usual, the brunt of the cholera epidemic having been borne by the Eastern districts. The appended table (I.) will show that the East suffered a mortality half as large again as the "West of London. The central districts, among which St. Giles' is placed, had a high mortality, but scarcely greater than that of the five previous years taken together. Section II.— On the Mortality of St. Giles's in 1866, from all Causes. Comparison with other Districts. The mortality of the central districts of London in 1866 was 26.75 per thousand; that of St. Giles' was 29.05. This is about the same excess of mortality of our district over that of its neighbours, that we have habitually to observe. In 1866 the deaths registered in St. Giles' numbered 1492, after correction for several deaths recorded twice over. The further correction required by the circumstance that St. Giles' has no hospital within it, and that its parishioners, when not paupers, largely seek medical aid from the charities of neighbouring districts, adds to the registered number a further 114 deaths. But as 36 of the registered deaths occurred among children in the Infants' Home, who had no previous connexion with the district, but died there soon after admission, that number has been deducted, and the mortality of St. Giles' with Bloomsbury as finally corrected becomes 1570. Similar corrections having been made for the districts immediately adjacent to St. Giles's, comparison of their mortality shows that our district has a fractionally higher death.rate than Holborn, and an appreciably higher rate than any other of our neighbours. St. Pancras and Marylebone are below, and the Strand and St. Martins, as well as Holborn, are above, the mean death.rate of the metropolis for the year. These facts are shown on the table of the opposite page, and a* summary of them for a series of years is given below. Death.rate per 10,000* in St. Giles's and neighbouring Districts. [DISTRICTS. 1807. 1858. 1859. 1860. 1861. 1862. 1863. 1864. 1865. 1866. St. Pancras 197.0 224.9 221.4 208.7 228.3 215.5 225.6 248.1 238.2 236.9 St. Marylebone 217.3 224 0 225 0 227.7 242.5 237 1 245.3 250.4 244.7 246.7 Metropolis 2210 234 4 227.0 224 1 231.8 234.1 244.4 260.4 240.4 204.7 Holborn 236.3 247.7 248.6 238.7 270.4 285.5 270.3 312.8 297.7 285.9 Strand 239.4 226 6 262 9 231.5 233.7 254.6 201.0 300.8 283 6 205.4 St. Martin 243.0 218.5 246.7 228.6 233.7 238.0 2G0.9 257.4 250 0 252.2 St. Giles 280.0 258.2 260.1 262.4 270.3 289.0 284.5 3100 295 5 290.5 * Correction is here made for the longer duration of the registration years 1857 & 1863. Also for all deaths in hospitals and outlying Workhouses. The sex of persons dying in St. Giles' in 1866 was, males 817, females 753. Of the males, 68 died in various hospitals; of the females 48; the excess of males being as usual great among such persons, inasmuch as accidents, to which men are mere exposed, constitute a frequent reason for their being taken to hospital. MORTALITY IN 1866. Districts. Estimated population, 1866. registered mortality. Column A. Column B. Total Mortality in 1 866 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. (see Note.*) 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 215,300 — — — — — — — — 5248 2438 151 Hospls. 187 5101 236.9 St. Pancras. Strand 111 Workh. 298 St. Marylebone 163,504 — — — — — — - — 4129 252.5 102 Hospital, 198 4033 246.7 St. Marylebone. Metropolis 3,037,991 20,029 66.2 19,291 63.7 22,353 73.9 18,456 60.9 80,129 264.7 — — 80129 264.7 Metropolis. Holborn 44,100 — — — — — — — — 1253 2841 75 Hospital, 67 1261 285 9 Holborn. Strand 42,205 — — — — — — — 1126 266.8 Workh. 111 Hospital, 170 1120 265.4 Strand. Hospls. 53 164 St. Martin 21,650 — — — — — — — - 565 261.0 36 Hospital, 55 546 252.2 St. Martin. St. Giles 54,000 385 71.3 377 69.5 382 70.9 352 65.2 1496 277.0 114 Infant Home 36 1570 290.5 St. Giles. Errors † 4 40 * Col. A. gives the number of the Inhabitants of each District who died in 1866, 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 i here subtracted comes of duplicate entry. 4 Section III.— On the Causes of Death in St. Giles's District in 1866. Instructive statistics have been obtained for 1866 as for other years by a comparison of the rate of mortality from various causes in London as a whole with that existing at the same time in St. Giles's. The influence of the particular season being the same, this mode of comparison gives several valid results of very practical importance. The quota of deaths from all causes which the population of St. Giles' should furnish to the general mortality of London, if the mean death-rate of the metropolis prevailed in the district, is one 56.25th part of the mortality in the metropolis, that being the fraction which St. Giles' population is of the entire population of London. In the opposite table, this fraction of the mortality of London is shown for each group of diseases and for some of the more important particular diseases : and in parallel columns are placed the figures representing the actual mortality from those diseases in the district. The quota of deaths from all causes was 1425 : the actual number was 1570. For every hundred deaths therefore, that would have occurred if the mean death-rate of London had prevailed iu St. Giles', the District did actually suffer the loss of 110. Diseases unnamed in the registers or of a kind that cannot be classified were of too frequent occurrcnce in St. Giles's, but this consideration is not of magnitude enough to affect the deductions concerning named diseases. The zymotic class of diseases has, as usual, great interest for us. It has been shown that small-pox, measles, continued fevers, and diarrhcea, were more prevalent than usual in London. In the excess of small-pox and fevers St. Giles' participated to about the same extent as the average of the town; in the case of measles and diarrhcea the excess was disproportionably large in our own district. The death-rate of St. Giles' from scarlatina was about the mean of London; that from whooping-cough notably below the mean. Referring to the table for the figures relating to each of these diseases, particular mention is only needed of two. Of the 22 persons to whom small pox was fatal, 14 were not protected by vaccination, 4 appeared to have been vaccinated, and of the 4 others the vaccination is not recorded. If small-pox among unvaccinated was fatal 14 times to 4 times that it was fatal in vaccinated, then—since at least 90 per cent, of our population is vaccinated—it follows that unvaccinated persons in St. Giles' died from small-pox last year at least thirty times more numerously than the vaccinated. And there is a strong presumption given by the Registrar's notes that in certain of the eases of fatal small-pox after vaccination the operation had been imperfectly done in infancy, and its protective power had not been again sought (as in such cases especially it should be) about the age of puberty.—The other disorder of which further mention is required is "fever." Of the 48 deaths grouped together as having occurred from such cause, "typhus" is credited with the fatal event in 24 instances, while the other 24 are set down either to "typhoid" or simply to "fever" or "continued fever." In 1865, 75 deaths were ascribed to typhus, 18 to typhoid, and 10 to undescribed forms of fever. In 1864, the number of deaths from typhus was 65; from fevers otherwise registered, 20. The typhus epidemic in St. Giles' which increased rapidly up to last year has now decreased with even greater rapidity, a fact which it is impossible not to connect with the adoption in 1865 of the plan of removing all fever patients at once, when practicable, to hospital, and so ridding the district of many centres of contagion. Comparison of Mortality from various causes in London and in Saint Giles's. Whole Year, 1866, (52 Weeks.) Classes. Classes and Orders of Disease. London. St. Giles's, Population 54,000. Population, 3,037,991 Estimated Quota.. Actual Registered Mortality. Corrected for Deaths in Hosptls. All Causes 80129 1425 0 1492 1570 Specified Causes 79446 1412.7 1478 1552 Classes. I Zymotic Diseases 23680 421.1 383 409 II Constitutional „ 14804 204.3 324 334 III. Local „ 29755 529.1 583 608 IV Developmental „ 8G04 1530 153 152 V. Violent Deaths „ 2543 45.2 35 49 Orders. I. 1. Miasmatic Diseases 22203 391.8 342 364 2 Enthetic „ 457 8.1 16 17 3 Dietic „ 836 14.9 24 27 4 Parasitic „ 184 3 3 1 1 II. 1 Diathetic Diseases 2466 43.8 35 39 2 Tubercular Diseases 12398 220.5 283 295 III. 1 Diseases of Nervous System 8272 1471 136 131 2 ,, Organs of Circulation 3496 62 2 81 85 3 „ Respiratory Organs 13230 235.3 289 300 Digestive Organs 2916 1131 51'8 20.1 46 15 50 23 6 ,, Organs of Generation 260 4.6 3 4 7 ,, Organs of Locomotion 241 4.3 12 14 8 „ Integumentary Organs 209 3.7 1 1 IV. 1 Dev: Dis. of Children 2207 39.2 40 39 2 „ „ Adults 328 5.8 8 11 3 „ „ Old People 2574 45.8 43 43 4 Diseases of Nutrition 3495 62.2 62 59 V. 1 Accident or Negligence 2137 380 28 42 3 Homicide 138 2.5 3 3 4 Suicide 258 4.6 4 4 All other Violent Deaths 10 0.2 ... ... Sudden Deaths 131 2.4 ... ... Causes unspecified 552 10.0 14 18 Certain Special Diseases of Zymotic Class and Miasmatic Order. 11. Small Pox 1388 24.7 22 22 Measles 2259 40.2 47 47 Scarlatina 1885 335 30 32 Diphteritis 431 7.7 7 9 Croup 716 127 15 16 Whooping Cough 2933 52.1 32 32 Typhus & other continued Fevers 2681 47.7 35 48 Diarrhoea 3184 56.6 82 82 Cholera 5577 99.2 47 49 * 1÷56¼th 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 toot or table on page 3. And the numbers in the last column have had deduction made tor deaths in the Infant's Home, as well as addition for deaths in outlying hospitals. Enquiry was not made this year at the Small Fox Hospital. 6 In regard of cholera, it will bo observed from the foregoing table that the mortality of St. Giles' was very closely half that which occurrcd on an equal population taken from the average of London. The subjoined tabular statement shows however, that after excluding the Eastern districts, where the main outbreak of cholera occurred, a somewhat excessive mortality from this disease fell on our district of St. Giles's. And it is further shown that the diarrhoea mortality was considerably above the average of the districts with which St. Giles' is naturally grouped. Mortality* (1866) From Cholera and Diarrhoea per 10,000 inhabitants (From the Registrar General's Annual Summary.) Cholera. Diarrhoea. London 18.4 10.5 West Districts 4.1 9.9 North Districts 6.7 10.4 Central Districts 8.7 11.2 East Districts 68.8 16.2 South Districts 92 9.5 St. Pancras 6 0 9.7 St. Marylebone 30 11.3 Holborn 52 16.9 Strand 6.6 7.1 St. Martin's 4.2 11.7 St. Giles's 9.2 16.1 * The district Mortality is here partially corrected for the disturbing influence of Hospitals. Tubercular diseases were again in 1866 greatly more fatal to St. Giles's District than would be reckoned for its population on the rate of death prevailing from such diseases elsewhere in London. Our district habitually stands among the highest of all the London districts in its death-rate from consumption, indeed it is scarcely exceeded by any except those whose rate is artificially raised by the presence in them of large hospitals. Last year the excessive death-rate from consumption was quite as great as usual. But as a large proportion of deaths from this cause are returned from the moveable class of people who frequent common lodging houses; and, as this sort of houses is disproportionately numerous in St. Giles's, it is impossible to say to what extent an undue amount of consumption may be generated in our district. The diseases of various organs and systems of the body, grouped by the Registrar General under the name of Local diseases, also furnish a disproportional number of deaths to our registers as compared with those of an equal population from the average of London. The excess was in 1866 chargeable to three kinds of these local diseases. The great groups of heart and lung 7 diseases were both excessively fatal, the circumstances of a poor, exposed, ill clothed, and ill housed labouring population obviously conducing to a high mortality of such complaints among them. The other set of local diseases was the little one of diseases of the bones and joints which yielded the unusual number of 14 deaths against a quota of four. In the Developmental class of diseases of the Registra General, the numbers for St. Giles' agree so closely with those that would be calculated for its share that no special notice of them is required. But it is found that, besides three deaths from puerperal fever, there were 11 deaths of women in childbed against a quota of 6 ; an excess which is only partly accounted for by the presence of the Lying-in Hospital in St. Giles's. Violent deaths were in some excess in our District; 42 persons lost their lives by accident or negligence, including 14 babies who were suffocated. Three murders and four suicides show no more disposition to undervalue life on the part of our parishioners than among those who live elsewhere in London. Section IY.— On the Localization of Disease and Death in St. Giles's in 1866. Our District of St. Giles' is divided into three sub-districts for registration purposes, and these three parts exhibit for 1866 as for other years very remarkable differences between themselves in the amount and nature of their mortality. (Appendix—Table TV.) St. George Bloomsbury, our most wealthy and best constructed subdistrict, had 333 deaths registered in it. From this number a deduction of 36 has been made for children dying after a short residence at 35, Great Coram Street, who had no previous connexion with the parish. But an addition has been made of 37 persons taken from Bloomsbury into various hospitals and dying there, 11 for residents dying in the "Workhouse within a short period of their admission from Bloomsbury, and 3 for persons from this subdistrict who died in the Shelton Hospital. These various corrections bring the true number of deaths among residents of the St. George's sub-district to 348, being at the rate of 20.0 per thousand residents, estimated according to the census of 1861. St. Giles' South, our poorest and most crowded district, had 694 deaths registered in it. But this number includes 226 persons who died in the "Workhouse having previously resided in various parts of the three subdistricts, and of these 226 only 85 had recently been resident in the houses of the sub-district, the remaining 141 deaths being among persons brought from other sub-districts or among old residents in the Workhouse, with a few tramps. Excluding these 141 but adding 47 deaths in persons taken from. St. Giles' South and dying in various hospitals of other districts as well as 16 persons from this sub-district dying in the Shelton Hospital, the mortality for the houses of South St. Giles' as finally corrected is 616, or 32.8 per 1000 of the residents in St. Giles' South. St. Giles' North comprises one portion which has almost the advantages of Bloomsbury, and another which has all the defects and poverty of South St. Giles's. Hence it holds habitually an intermediate position between those two sub-districts in its rate of mortality. In 1866 its registered deaths were 465, but of this number 37 occurred in the Shelton Cholera Hospital, out of whom 18 only belonged to North St. Giles's. Deducting the remaining 19 therefore, and adding 23 deaths of persons in Hospital and 44 deaths in the "Workhouse among persons shortly before resident in the sub-district, the corrected mortality of North St. Giles' becomes 513, and its death-rate 29'8 per thousand. 8 The subjoined table shows that the three sub-districts have held in 1866 the same position with regard to each other that is habitual to them, and it will be observed that while the death-rate of Bloomsbury is that of the healthiest London districts, that of South St. Giles' has, as usual, reached to nearly the highest rate that is anywhere to be found in the Metropolis. Death-rate 'per 1000 in Sub-Districts.* DISTRICTS. 1857. 1858. 1859. 1860. 1861. 1862. 1863. 1864. 1865. 1866. St, George, Blooms. 18.0 19.8 18.4 18.5 20.5 21.6 19.9 21.6 21.1 20.0 bury St. Giles's, South 35.7 29.2 34. 34.6 291 31.7 32.7 84.8 34.6 32.8 St. Giles's, North 28.3 27'7 240 24.7 27.9 28.2 27.3 29.2 266 29.8 Whole District 280 25.8 28.3 262 27.0 28.9 28.5 311 29 6 29'0 *Correction has been made for the extra length of the registration years 1857 & 1863. Reference may here be made to the Table V. of the Appendix, which shows for the three sub-districts the births of each quarter and of the whole year. The total number of births will be found to be about the average, and the highest rate to have been, as usual, in South St. Giles's. This consideration suggests one among the many causes that habitually determines a disproportionately high rate of mortality in that sub-district. Particular diseases of the zymotic class have prevailed to different degrees in the three sub-districts. Subjoined are the numbers of deaths from each of eight principal causes of this kind. An excess of diphtheria in Bloomsbury, of small-pox and fevers in South St. Giles's, and of measles and diarrhoeal complaints in St. Giles' North will be observed. Measles and whooping-cough were epidemic in the Workhouse, and several persons died from typhus fever contracted there. Certain zymotic deaths in 1866, in Sub-districts. Districts, &c. Population 1861, DEATHS IN SUB-DISTRICT FROM Small-pox. Measles. Scarlatina, Diphtheria. Whooping Cough. Various Fevers. Diarrhoea. Cholera. Bloomsbury 17392 ... 12 8 5 5 11 18 6 St. Giles's South 18788 13 12 13 2 10 22 33 21 St. Giles North 17201 9 18 11 2 9 9 31 22 Workhouse Inmates & 695 ... 5* ... ... 8 6 ... ... Tramps . Who also had pertussis. 9 Section Y.— On the Uncertified Deaths and Inquests of 1866. The deaths in St. Giles's District reported to the Registrar without any medical certificate of their cause used to number 40 to 50 yearly Four years ago attention was directed in the annual report to the misfortune of this state of things, and an improvement in the amount of certification has since been steadily taking place. In 1863 the number of uncertified deaths fell to 26, next year to 15, and in 1865 only 12 deaths were registered without medical evidence of their cause. It is satisfactory to note that the improvement has gone farther, and that in 1866 only five deaths were so registered. Four of these five were cases of premature birth, and the fifth was that of a child 15 hours old, who died from unknown cause without medical attendance. The amendment of practice last year has plainly resulted from the Registrars of Bloomsbury and South St. Giles's having been (as suggested to them in the last of these reports) more stringent in their requirement of certificates. There can be little question as to the possibility of procuring medical evidence in every case, and there is no question whatever as to the extreme desirability of such a rule being enforced by law. In 1866, inquests were held upon the large number of 99 persons, of whom no less than 32 were under one year old. No other age is comparable with this for its numbers of obscure or accidental deaths. Next most frequent were inquests on people between 40 and 60 years of age, a period of life when several accidents and a few suicides swelled the number of violent deaths. Section VI.—On the Diseases and Deaths in the Practice of the Public Medical Institutions of St. Giles's in 1866. Among public medical institutions in St. Giles's in 1866, mention must be made not only of the permanent institutions for the relief of the sick poor, but of the Board of Works itself, acting under the Diseases Prevention Act. And the operations of the Infants' Home may be considered under the same head. The "Workhouse practice last year is reported in summary on the following page. Unusually large aggregate numbers have received mcdical relief from the parish. Partly this has arisen from the singular prevalence of diarrhoea, partly from the large number of persons coming under treatment for bronchitis and other lung affections. The prevalence of measles and the reduction of scarlet and typhus fevers, which were noticed upon the death registers, are again observable in the table of Workhouse practice. Many cases of measles and whooping-cough occurred among children resident in the Workhouse, but inasmuch as most of the deaths from these diseases occurred among children suffering from preexisting maladies, they have been mostly returned in the reports of the Workhouse under the heads of such maladies and not of the contagious complaints. Cases of typhus fever occurred in far less numbers than in any of the last few years, not only because of the diminished prevalence of the disease, but also from the custom of sending fever patients to the Islington Hospital being maintained. In the year 1866, 59 cases of typhus, 16 of typhoid, and 3 of scarlet fever, besides other diseases, were sent into the London Fever Hospital from St. Giles's, and nine of the cases of typhus (five of them inmates of the Workhouse), three of typhoid, and nine of the other diseases were fatal. Cases of Disease and Death, occurring in the Practice of the Workhouse in 1866, 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 Th rd. 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 480 76 370 65 427 37 429 47 1706 225 1141 1088 2982 1089 6300 997 88 585 63 723 83 474 73 2779 307 Small Pox 1 .. ... ... 7 1 1 ... 9 1 ... ... 2 ... 2 8 1 7 ... 60 9 24 2 99 12 Measles 32 ... 8 ... 10 ... 14 ... 64 ... 10 10 18 34 72 90 8 59 3 21 ... 91 3 261 14 Scarlet Fever 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 3 ... 19 3 46 ... 68 3 Whooping Cough 37 1 11 4 2 ... ... ... 50 5 5 33 1 12 51 13 1 13 3 4 ... 2 1 32 5 Diarrhoea 4 1 3 ... 48 1 11 ... 66 2 88 114 2303 165 2670 3 ... 23 1 184 7 20 1 230 9 “Fever and Febricula” 22 ... 21 ... 15 ... 9 ... 67 ... 73 63 60 71 267 90 5 63 3 109 6 95 2 357 16 “Typhus Fever” 1 ... ... ... 1 1 ... ... 2 1 ... ... ... ... ... ... ... ... ... 24 2 ... ... 24 2 Cholera ... ... ... ... 3 2 ... ... 3 2 ... ... ... ... ... ... ... ... ... 4 1 ... ... 4 1 Bronchitis (acute and chronic) 64 11 47 9 24 4 66 7 201 31 359 173 180 247 959 107 26 39 8 46 12 90 5 282 51 Consumptive Diseases 6 4 9 6 3 2 8 3 26 15 2 34 11 22 69 35 1 33 2 21 2 21 9 110 14 Consumptive Diseases 45 24 28 18 18 7 30 15 121 64 6 11 8 12 7 41 11 25 11 18 13 29 18 113 53 Ophthalmia 4 ... 6 ... 7 ... 1 ... 18 ... 6 3 1 ... 10 ... ... ... ... ... ... 1 ... 1 ... 11 At the Lying-in Hospital in Endell Street, the high mortality of 1865 was exceeded in 1866. There were no less than four deaths of mothers and 21 of children in the first three quarters of the year. Prom the middle of June to the middle of September, erysipelas occurred to a serious extent in the wards ; six children died from this disease and one mother from puerperal fever. The Hospital was then closed for cleansing and repairs, and only one other death occurred between its reopening and the end of the year. A subjoined table shows in summary the work of the Bloomsbury Dispensary in 1866. For the same reasons that caused the numbers at the Workhouse to be so high, the amount of medical assistance given to the poor by the Dispensary was vastly greater than its usual amount. If the total number of new admissions to its benefits be taken as the measure, it is found that the usefulness of the charity has been very closely double that of any recent year. New Cases Treated at Bloomsbury Dispensary, 18CG. Quarter ending. Physician's Cases. Surgeon's cases. Casualties, Total. Admitd. Visited at home. Died. Admitd. Visited at home. Died. Admitd. Visited at homo. Died. Mar. 25th. 866 288 31 245 53 1 372 1483 341 32 June 24th. 811 193 28 231 21 2 268 1310 214 30 Sept. 29th. 688 163 19 284 47 3 800* 1772 210 22 Dec. 25th. 598 142 21 225 23 3 482† 1305 170 24 Whole Yr. 2963 786 99 985 149 9 1922 5870 935 108 *Including 488 cases of Diarrhoea, some of which were of a choleraic nature, and one or two cases of collapsed Cholera, f Including 260 cases of Diarrhoea and choleraic Diarrhoea. During the epidemic of cholera and diarrhoea of last autumn, the Board of Works, acting under an Order of Council applying the Diseases Prevention Act, provided medical advice and medicines to all poor persons suffering under cholera and diarrhoea, and had under treatment, between the end of July and the end of November, about 70 cases of cholera and 9000 of diarrhoea. The Shelton School building was fitted up as a temporary hospital for cholera, and into it 57 cases of cholera were admitted, of which 37 proved fatal. Eighteen other persons were admitted suffering from choleraic or some other severe form of diarrhoea and 67 persons were taken into rooms set apart as a refuge and place of observation. The Infants' Home, 35, Great Coram Street, has been pursuing its course through the year. Ninety illegitimate infants were received here in 1866, forty-six of them being accompanied by their mothers, while forty-four of them were admitted without their mothers. The deaths among the children in the Home were no fewer than 36, and two others died in St. Bartholomew's Hospital. It is hoped that the adoption of a rule more stringently requiring the nursing of each child by its own mother, and of some system of educating the women to perform the duties of motherhood, may, in the future, operate to reduce the excessive mortality among these unhappy children. At present it is impossible to avoid a conviction that the relief of the mothers from the burthen of their offspring is obtained at an unwarrantable cost of life among the infants. 12 Section VII.—On the Sanitary Work of 1866. The year 1866 has been exceptionally fruitful in sanitary labour. In the last of these reports, mention was made of the precautionary action that was being taken against cholera. In April a second sanitary inspector was engaged to assist in the work of house inspection and removal of nuisances. Certain imperfect sewers were replaced by new and efficient ones; means of disinfecting the sewage were employed; and the public pumps which yielded impure and dangerous water were locked up. The hope was expressed that, in the event of cholera attacking the Metropolis, these measures would cause the epidemic to fall lightly on the District; and it was confidently stated that in any case, these precautions would bear fruit in an improvement in the conveniences and general health of the parishioners. House Improvements in St. Giles's District, effected under the superintendence of the Sanitary Inspectors between Lady Day, 1866, and Lady Day, 1867. Inspector Webb. Inspector Dixon. Improvements in drainage Number of houses improved 617 723 Brains constructed or repaired 237 75 Traps fixed 254 325 Cesspools abolished 28 25 Stables drained and horse-pools abolished 15 5 Water Closots. Pan, trap, and water provided 25 16 Water and apparatus only provided 134 325 Cleaned or repaired 173 120 Newly constructed or re-built 9 41 In Dust Bins. Newly constructed 18 30 Repaired or covered 95 260 Paviug. Re-laid 43 31 In General Water Supply. Receptacles provided 12 50 Receptacles repaired 67 193 In Cleanliness and Repair. Cleansed and lime-whited 497 570 Various accumulations removed from cellars, &c 45 240 in Ventilation, &c.' Ventilation improved 127 35 Overcrowding reduced 48 165 Kitchens disused, or made legally habitable 37 5 Proceedings taken. First notices 425 455 Second notices, letters, &c 70 113 Summoned and Fined 1 9 Reported to Police or District Surveyor 5 3 Total Improvements 1864 2511 As regards the inspection and amendment of houses, the appointment of Inspector Dixon allowed of remarkable extension being given to this most important department of sanitary work. In previous years, the utmost number of houses that could be kept under inspection was from five to six hundred. In 1866, the two inspectors have caused improvements to be made in no less than 1340 houses; and this is exclusive of the improvement that was obtained, almost universally in the poor houses, by the exhortations of the medical visitors during the cholera time. The number of improvements of all kinds that were procured in these 1340 houses amounted to 4375, and 13 Comprise, among other important measures, the reduction of overcrowding in the large number of 213 instances, the ventilation of 162 rooms, the improvement of water supply to 322 houses, the amendment (exclusive of mere trapping) of 312 house drains, and the clcansing of 1067 houses or parts of houses. This amount of work has been procured by 880 notices, which were almost all obeyed, though in 183 cases so tardily that second notices or letters of reminder were required. Only ten owners were summonsed before magistrates, and in all these cases a penalty was inflicted. These figures give evidence at once of the diligence of the inspectors, and of the forbearance of the Board in using any harsh measures where owners can be made to keep their property in decent order by other means. But it is also plain how much need there is for inspection to be very extended, very systematic and very frequently repeated. Last year, after commenting on some similar facts, the following was written:—"Unless alaw, much more stringent than any at present in force, should be enancted to fine 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 1866 a most important amendment of the sanitary laws was made by the " Sanitary Act," of which § 35 gives precisely the powers which, not last year only, but every year since the constitution of the Board, the Medical Officer has demanded for the efficient discharge of his functions in respect of houses inhabited by the poorer classes. That section has given to the local authority the power of making bye laws for the regulation of sublet houses and of enforcing the observance of it rules by penalties. In St. Giles' District it is this class of houses almost exclusively which need the supervision of the sanitary authorities, and which become, without that supervision, nests of filth and disease. Accordingly, soon after the passing of the Sanitary Act, bye-laws were prepared, adopted by the Board and sanctioned by the Secretary of State for the regulation of sublet houses. It will now not be the fault of the law if St. Giles' does not make rapid strides towards decency in its worst quarters, and towards a lower rate of mortality than it has yet had.* Nor is § 35 the only clause of the Sanitary Act, of which the enforcement is calculated greatly to benefit St. Giles' District. Other clauses confer on the Board powers to order disinfection of houses where there has been contagious disease; to provide carriages for the conveyance of infected persons; to remove to hospital persons suffering from contagious diseases when they are not properly lodged, and to provide, when necessary, hospital accommodation for such persons; to provide places for the reception of dead bodies, and direct the removal of bodies thereto. The Board is also charged with the duty of inspecting the district to ascertain what nuisances call for abatement, additional authority is given to them for this purpose, and the Secretary of State may be appealed to if the powers given by the Act are not exercised. Under previous Statutes very great progress has been made in the sanitary state of St. Giles's, but as each of these new powers comes to be put in force, further advantages to the condition of the people and the health of the district will unquestionably arise. *A reference in this connexion to the tables of mortality in the earlier parts of this report is full of encouragement and promise. In the last quarter of 1866 the District had been, through the exertions of the medical visitors as well as of the inspectors, put into a condition of quite unparalleled cleanliness. In that quarter the remarkably small number of 364 deaths occurred, tlic mean number for the same quarter in the five previous years having been 413. To a very slight degree only can this low mortality be ascribed to the circumstance of cholera having carried off sickly people in the previous quarter, inasmuch as the victims of cholera were mainly people in perfect health. 14 Besides the work of house to house visitation and removal of nuisances, the inspectors were much occupied during the autumn in duties relating to the cholera epidemic. Passing by these as being of a special nature that have elsewhere been reported on, mention must be made of a class of proceedings that have never before been so efficiently taken as in 1866, when the prevalence of bowel complaints caused unwholesome articles of food to be more than commonly dangerous. Three parcels of bad meat, eight of bad fish, and nineteen of decaying fruit were seized, and eleven persons were summond and fined for exposing such things for sale. To Inspector Dixon belongs the chief credit of these proceedings. Referring for particulars of construction to the Report of the Surveyor, a record may be here made of very important new sewers built in the past year in Dudley Street and New Compton Street. These works may be relied on to improve the convenience and health of the localities—which especially have much needed improvement—in which they have been carried out. The charcoal boxes which were fitted to certain sewers experimentally a year ago, have answered their purpose satisfactorily; at least so far as can be judged from the very limited scale on which they were applied. As to the trades that are placed by law under the supervision of the sanitary authorities: 1. Slaughter-houses have been repeatedly inspected and are found habitually in a fair condition. Two of these establishments, those in Kingsgate Street and Little Turnstile, have ceased to be licensed, and no new one has come on the list. 2. Cowhouses have been disused, to the great advantage of that neighbourhood, in Lloyd's Court and Stacey Street. The other cow-houses of the district have had their licenses renewed and have been kept in decidedly better condition than usual. In all, 88 cows are now kept in the district, in the sheds of six licensed cow-keepers. There has been no cattle plague in the sheds since the end of 1865. 3. Bakeries have been frequently inspected. Though in many of these places a good deal of improvement has been made and greater attention than formerly is habitually paid to cleanliness and ventilation, there are others which are often in a filthy condition and require constant looking after. It will probably be necessary to take some more stringent action in the ensuing year, if the regulations of the Board be not better obeyed in these bakeries. In the last of these reports mention was made of legislative action which had for its object the provision of healthy tenements for the poor. The powers which have been conferred on local authorities by various Acts, of which that of 1865 was the last, have not yet been put into action in St. Giles's. But private action in this direction has been taken by several societies, and recently by the Central London Dwellings Improvement Company. In 1863, three houses in Parker Street, and in 1866 seventeen houses in Star Court and Cross Lane have been purchased by this Company, and are kept in a much better condition by them than by their former owners; while the property is so managed as to pay a small dividend on the outlay. It may be hoped that the success of the endeavours of this and other societies may be such as to encourage similar endeavours on a larger scale by public authorities. In concluding this report, in which frequent reference has been made to the cholera epidemic of 1866, and to the measures that were adopted in respect thereof, attention must be drawn to the special report that was made by the Sanitary Committee of their action under the Diseases Prevention Act. It is not needful to repeat what that action was, but, for a complete understanding of the sanitary operations of the year, it is essential that that report be read in connexion with the present. GEORGE BUCHANAN, M.D. APPENDIX, TABLE I.—Mortality per Thousand in London, in the Divisions of London, and in St. Giles's; in 1866, 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 Ten years, each corrected to 365i days. 1857. 1858. 1859. 1800. 1861. 1862. 1863. 1864. 1865. London 2502 23.08 24 05 22.41 93.90 22.69 22.49 23.18 23.56 24.47 26.53 24.56 26.47 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 22.96 22.95 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 24.53 25 .31 Central Districts—(St.Giles, Strand, Holborn, Clerk. enwell, 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 26.79 26.75 East Districts —(Shoreditch, Betlinal Green, White. chapel, St. George East, Stepney, Poplar) 26.43 24.63 25.92 24.63 25.78 23.95 2408 2402 25.98 23.48 29.03 26.40 33.96 South Districts.— St. Saviour, St. 01ave,Bermondsey, St. George Southwark, Newington, Lambeth, Wandsworth, Camberwell, Rotherhithe, Greenwich, Lewis. ham.) 26.81 22.90 23.26 21.49 23.96 22 60 22.14 22.79 22.68 23.33 25.36 23.16 24.10 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 27.74 Corrected for Hospitals - 26.01 28.44 28.20 25.91 26.13 26.33 27.12 28.99 28.64 31.10 29 66 29.15 TABLE II.—Deaths in Hospitals among Patients brought from. St. Giles's and neighbouring Districts, 1866. Districts. Total ascertained Deaths in London Hospitals. Kings College Hospital, (Strand). Middlesex Hospital (Marylebone). Charing Cross Hospital (St. Martins University College Hospital (St. Pancras, 1 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 304 11 54 2 113 9 6 40 69 ? ? - 151 St. Marylebone 196 4 94 1 18 1 8 4 16 ? 48 2 102 Metropolis 4980 234 292 74 211 71 565 129 668 36 191 174 - Holborn 79 14 - 2 1 4 24 25 9 ? ? - 75 Strand 117 64 17 16 1 3 3 2 11 ? ? - 53 St. Martin's 55 26 1 19 1 1 - - 7 ? 1 - 36 St. Giles's 114 27 20 9 11 13 8 4 21 0 ? 1 114 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 for Marylebone patients in St. Mary's Hospital is an estimate. TABLE III.-Causes of Death in St. Giles's in 1866, 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 tinder 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 cnuscs 817 753 1570 542 159 61 57 40 101 149 131 148 114 59 9 Specified causes 805 747 1552 530 159 61 57 39 101 147 130 146 114 59 9 I. (Classes.) Zymotic Diseases 216 193 409 183 75 28 16 7 16 29 19 26 9 1 ... II Constitutional „ 171 163 334 54 29 12 20 19 52 64 45 28 10 1 ... III. Local 319 289 608 176 52 18 15 10 28 46 64 88 77 31 3 IV Developmental„ 72 80 152 96 2 ... 2 2 4 3 ... ... 14 23 0 V. Violent Deaths 27 22 49 21 1 3 4 1 1 5 2 4 4 3 ... I. (Orders.) I Miasmatic Diseases 188 176 364 157 73 28 15 7 15 23 15 22 8 1 ... 2 Enthetic „ 11 6 17 11 1 ... ... ... 1 3 ... 1 ... ... ... 3 Dietic „ 17 10 27 14 1 ... 1 ... ... 3 4 3 1 ... ... 4 Parasitic ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... II. 1 Diathetic „ 10 23 39 1 3 3 ... ... 1 7 8 10 5 1 ... 2 Tubercular „ 155 140 295 53 26 9 20 19 51 57 37 18 5 ... ... III. 1 Diseases of Nervous System 67 64 131 47 16 3 3 ... 4 6 8 19 16 8 1 2 „ of Organs of Circulation 40 45 85 ... ... ... 3 3 8 13 20 17 12 8 1 3 „ of Respiratory Organs 170 130 300 114 32 10 1 4 7 12 25 35 35 14 1 4 „ of Digestive Organs 24 26 50 3 4 ... 3 2 8 7 5 9 9 ... ... 5 „ of Urinary Organs 13 10 23 ... ... 1 2 ... 1 6 4 5 3 1 ... 6 „ of Organs of Generation ... 4 4 ... ... ... ... ... ... 1 1 1 1 ... ... 7 „ of Organs of Locomotion 4 10 14 1 ... 4 3 1 ... 1 1 2 1 ... ... 8 „ of Integumentary System 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... IV 1 Dev. Diseases of Children 21 18 39 39 ... ... ... ... ... ... ... ... ... ... ... 2 „ of Adults ... 11 11 ... ... ... 2 2 4 3 ... ... ... ... ... 3 „ of Old People 15 28 43 ... ... ... ... ... ... ... ... ... 14 23 6 4 Diseases of Nutrition 36 23 59 57 2 ... ... ... ... ... ... ... ... ... ... V. I Accident or Negligence 22 20 42 19 1 2 4 ... 1 4 2 3 3 3 ... 3 Homicide 2 1 3 2 ... 1 ... ... ... ... ... ... ... ... ... 4 Suicide 3 1 4 ... ... ... ... 1 ... 1 ... 1 1 ... ... 5 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths not classed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Deaths, cause unascertained ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified or illdefined 12 6 18 12 ... ... ... 1 ... 2 1 2 ... ... ... 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 14 8 22 8 7 2 1 ... 2 2 ... ... ... ... ... 2 Measles 25 22 47 33 10 3 ... ... 1 ... ... ... ... ... ... 3 Scarlatina 15 17 32 7 15 8 2 ... ... ... ... ... ... ... ... 4 Diphtheritis 8 1 9 4 4 ... 1 ... ... ... ... ... ... ... ... 5 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Croup 8 8 10 8 8 ... ... ... ... ... ... ... ... ... ... 7 Whooping Cough 14 18 32 21 11 ... ... ... ... ... ... ... ... ... ... 8 Continued Fevers, Typhus, &c. 23 25 43 ... 8 5 5 4 4 6 8 7 ... 1 ... 9 Erysipelas 7 8 15 9 ... ... 1 1 ... ... 1 1 2 ... ... 10 Metria ... 3 3 ... ... ... ... 1 1 1 ... ... ... ... ... 11 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Dysentery 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 14 Diarrhœa 47 35 82 63 0 1 ... ... ... 1 1 5 5 ... ... 15 Cholera 22 27 49 3 4 9 5 1 5 9 4 8 1 ... ... 16 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Rheumatism 4 4 8 ... ... ... ... ... 2 4 1 1 ... ... ... 19 Other Miasmatic Dis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order2. 1 Syphilis 8 6 14 11 1 ... ... ... 1 1 ... ... ... ... ... 2 Stricture of Urethra 3 ... 3 ... ... ... ... ... ... 2 ... 1 ... ... ... Order 3. 1 Privation 2 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... 2 Want of Breast Milk 5 7 12 12 ... ... ... ... ... ... ... ... ... ... ... 3 Purnura 3 1 4 ... 1 ... 1 ... ... 1 ... 1 ... ... ... 4 Alcoholism.— a Delirium Tremens 2 ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... b Intemperance 5 7 ... ... ... ... ... ... ... 2 2 1 ... ... Order 4. 1 Thrush ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 2 Worms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 1. 1 Gout 2 ... 2 ... ... ... ... ... ... ... ... 1 1 ... ... 2 Dropsy 4 5 9 1 1 3 ... ... ... ... 1 2 1 ... ... 3 Cancer 8 17 25 ... ... ... ... ... 1 7 7 7 2 1 ... 4 Noma 1 1 2 ... 2 ... ... ... ... ... ... ... ... ... ... 5 Mortification 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... Order 2. 1 Scrofula 2 1 3 ... ... 1 2 ... ... ... ... ... ... ... ... 2 Tabes Mesenterica 17 17 34 26 7 ... 1 ... ... ... ... ... ... ... ... 3 Phthisis 117 109 226 8 10 6 15 19 51 57 37 18 5 ... ... 4 Hydrocephalus 19 13 32 19 9 2 2 ... ... ... ... ... ... ... ... Order 1. III 1 Cephalitis 7 7 14 4 6 1 2 ... ... ... ... 1 ... ... ... 2 Apoplexy 5 6 11 ... ... ... ... ... ... 2 2 2 1 3 1 3 Paralysis 17 18 35 ... ... ... ... ... 2 2 1 15 12 3 ... 4 Insanity ... 2 2 ... ... ... ... ... ... 1 1 ... ... ... ... 5 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Epilepsy 3 2 5 1 1 1 ... ... 1 1 ... ... ... ... ... 7 Convulsions 22 24 40 38 8 ... ... ... ... ... ... ... ... ... ... 8 Other Brain Diseases 13 6 18 4 1 1 1 1 ... 4 1 3 2 ... Order 2. 1 Pericarditis 2 2 4 ... ... ... ... ... 1 1 ... 2 ... ... ... 2 Aneurism 1 2 3 ... ... ... ... 1 ... 1 ... ... ... 1 ... 3 Heart Disease, &c 37 41 78 ... ... ... 3 2 7 11 20 15 12 7 1 Order 3. 1 Laryngitis 8 2 10 4 3 3 ... ... ... ... ... ... ... ... ... 2 Bronchitis 107 04 901 85 23 3 1 ... 2 5 14 23 31 14 1 3 Pleurisy 3 4 7 1 ... ... ... ... 1 ... 1 4 ... ... ... 4 Pneumonia 46 99. 68 34 7 4 ... 2 1 6 6 6 2 ... ... 5 Asthma 1 6 7 ... ... ... ... 2 ... ... 2 2 1 ... ... 6 Other Lung Diseases 5 2 7 ... ... ... ... ... 3 1 2 ... 1 ... ... TABLE III.—Diseases in Orders—(continued ) Class. Causes of Death. At all Ages. Under 2 years 2 anil 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. 1 Total. Order 4. — - 1 Gastritis 2 3 5 1 1 ... ... ... 1 ... ... ... 2 ... ... 2 Enteritis 3 3 6 ... 2 ... ... 1 1 ... ... 2 ... ... ... 3 Peritonitis 2 3 5 ... ... ... 1 1 2 1 ... ... ... ... ... 4 Ascites ... 2 2 ... ... ... 1 ... ... ... ... 1 ... ... ... 5 Ulcer. Intest 2 ... 2 ... ... ... 1 ... ... ... 1 ... ... ... ... 6 Hernia 1 2 3 ... ... ... ... ... ... ... ... 2 ... ... ... 7 Ileus 1 ... 1 ... ... ... ... ... ... ... ... 1 2 ... ... 8 Intussusception 1 ... 1 ... 1 ... ... ... l ... ... ... ... ... ... 9 Strict. Intest ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Fistula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Stomach Disease, &c 1 1 2 ... ... ... ... ... 1 ... ... ... 1 ... ... 12 Pancreas Disease ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 13 Hepatitis ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 14 Jaundice l l 2 1 ... ... ... ... ... ... ... ... 1 ... ... 15 Liver Dis. &c 8 10 18 ... ... ... ... ... 2 6 3 5 2 ... ... 16 Spleen Disease, &c 2 ... 2 1 ... ... 1 ... ... ... ... ... ... ... ... Order 5. 1 ... ... ... ... 1 Nephritis 3 ... 3 ... ... ... 1 ... ... ... ... 1 1 ... ... 2 Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Nephria 2 3 5 ... ... ... 1 ... ... 1 1 2 ... ... ... 4 Diabetes 2 1 3 ... ... ... ... ... 1 1 ... ... ... ... ... 5 Stone 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... 6 Cystitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Kidney Disease, &c. 5 6 11 ... ... ... ... ... ... 4 3 2 2 ... ... Order 6. 1 Ovarian Dropsy ... 4 4 ... ... ... ... ... ... 1 1 1 1 ... ... 2 Uterine Disease, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 7. 1 Arthritis ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... 2 Bone Disease, &c 4 9 13 1 ... 4 3 1 ... 1 1 1 1 ... ... Order 8. 1 Phlegmon ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... 2 Ulcer 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 3. Skin Disease, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 1. IV. 1 Premature Birth 18 15 33 33 ... ... ... ... ... ... ... ... ... ... ... 2 Cyanosis ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 3 Spina Bifida ... 2 2 2 ... ... ... ... ... ... ... ... ... ... ... 4 Other Malformations 2 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... 5 Teething 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... Order 2 i ... j 1 Paramenia ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 Childbirth (see Metria) ... 10 10 ... ... ... 1 2 4 3 ... ... ... ... ... Order 3. 1 Old Age 15 28 43 ... ... ... ... ... ... ... ... ... 14 23 6 Order 4. d 1 Atrophy and Debility 36 23 59 57 2 ... ... ... ... ... ... ... ... ... ... Order 1. v. 'Accident or Negligence.) 1 Fractures, &c 11 8 19 3 ... 1 2 ... ... 3 2 3 3 2 ... 2-3 Wounds 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 4 Burns, &c 2 3 5 1 1 ... 1 ... ... 1 ... ... ... 2 ... 5 Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Suffocation 6 9 15 14 ... ... 1 ... ... ... ... ... ... ... ... 8 Otherwise 2 ... 2 1 ... 1 ... ... ... ... ... ... ... ... ... Order 3. ... j Homicide 2 1 3 2 ... 1 ... ... ... ... ... ... ... ... ... Order 4. (Suicide) " ! ... 1 Wounds—Gunshot 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 2 „ Cut, Stab 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 3 Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Hanging 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 6 Otherwise ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... TABLE IV.—Registered Deaths in 52 Weeks of 1866. Sub-Districts of St. Giles's.. After correction for four duplicate entries. Deaths in Sub-Districts. [Population 3861,] First Quarter. 13 weeks. Second Quarter. 13 weeks. Third Quarter. 13 weeks. Fourth Quarter. 13 weeks. Whole Year, 1866. 52 weeks. M. F. M. F. M. F. M. F. M. F Both Sexes. St. George, Bloomsbury. [17392 ] 46 39 45 39 42 34 35 53 168 165 333 St. Giles's. South. [19483.] 104 85 98 84 85 87 73 78 360 334 694 St. Giles's, North. [17201.] 53 58 52 59 73 60 59 51 237 228 465 Whole District. [54076.] 203 182 195 182 200 181 167 182 765 727 1492 TABLE Y.—Registered Births in 52 Weeks of I860. 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, 1866. 52 weeks. M. F. M. F. M. F. M. F. M. F. Total Children St. George, Bloomsbury 63 60 61 58 97 56 56 ? ? 451 St. Giles's, South 122 123 105 113 198 88 95 ? ? 844 St. Giles's, North 67 53 59 68 110 66 57 ? ? 480 Whole District 252 236 225 239 405 210 208 ? ? 1775 The printed returns of the Registrar General, which alone were available for some weeks in the Autumn, did not distinguish the sexes of children born. [1] THE BOARD OF WORKS FOR THE Saint Giles’s District. Regulations under" Sanitary Act, 1866," as to LODGING- HOUSES situate within the above District. 1.—No person shall let any house, or part of a house in lodgings, or to be occupied in lodgings, by members of more than one family, and in which more than two persons shall sleep in one room, until such house, and the person proposing to let the same, is registered at the Office of the Board of Works. The person so registered shall be responsible for the observance of the following Regulations until he shall give notice in writing to the said Board at their office that he has ceased to be tenant of the said house, or part of a house. No person shall be entitled to be so registered unless he shall satisfy the said Board that he is the bona fide Owner or Tenant 2 of the house or part of a house so to he registered, and that the said house or part of a house is furnished with all the conveniences required by the following Regulations. 2.—No person who shall let a house or any part of a house in lodgings, or to be occupied by members of more than one family, shall permit the same to be occupied by a greater number of persons than shall be fixed by the Board of Works for the Saint Giles District, as is hereinafter mentioned. 3.—A Ticket, according to the form A in the Schedule to these Regulations, under the Common Seal of the said Board, stating the entire number of persons allowed to sleep in each such house, and which number such house is registered to accommodate, will be supplied to the person letting such house, and he is to produce such ticket whenever required by any officer appointed for inspecting such houses by the said Board The Board will in no case sanction an accommodation less than 400 cubic feet of space for each person. 4.—The person letting such house, shall put up in a conspicuous place in each room a ticket signed by the Clerk of the said Board, stating the number of persons allowed to sleep in such room, which will be supplied to the person letting such house, and he shall keep such ticket at all times visible and legible, which ticket shall be according to the form contained in the Schedule to these Regulations marked B. 5.—Two Children under ten years of age may be counted as one lodger. 3 6.—The person letting such house or part of a house shall reduce the number of persons permitted to inhabit the same, or any part thereof, upon receiving notice to that effect from the said Board; such notice stating the special cause of the same being given, and the period during which it shall continue in force. 7.—The person letting such house or part of a house shall keep the same in repair, and cause the walls and ceilings of every room, and of the staircases and passages, and . yards of such house to be thoroughly cleaned, and well and sufficiently limewashed four times (at least) in every year, at such periods as may be directed by the said Board, and shall cause the floors of all the rooms, passages and stairs of such house, or part of a house, to be kept at all times clean and washed, and swept at least twice a week, and also shall cleanse and wash every private court, back yard and area belonging to such house or part of a house, daily. The cellars of such house shall be cleaned out once a week, and shall also be limewashed as often as need shall require by the person letting the said house, or any part thereof. 8.—The person letting such house or part of a house, shall cause every room to be ventilated from the outside and otherwise, and the passages and staircases in such house or part of a house, to be lighted and ventilated at their highest part, and elsewhere, to the satisfaction of the Medical Officer of Health. 9.—The person letting such house, or part of a house, shall provide such accommodation for washing, and such a supply of water for the use of the lodgers, with proper covered cisterns and apparatus above ground, as shall be 4 satisfactory to the Medical Officer of Health. The cisterns shall be of such size as to give at least fifteen gallons a day to each inmate of such house. 10.—Every such house shall be furnished with a covered dust bin of sufficient size to contain the dust, ashes, &c., that accumulate in the intervals of its being cleared away, which shall not exceed one week; such dust bin to be in the best practicable situation. 11.—A water closet shall be provided in the yard of every such house, or where a water closet cannot be so provided, then outside the house, in the best practicable situation. If it is desired that one water closet should serve in common for two or more small houses, the sanction of the Board must be previously obtained thereto. For every twenty persons to be accommodated a separate closet shall be provided. 12.—Every house shall be properly drained into the public sewer, and every drain shall be provided with efficient immoveable traps at each entrance to the drain. 13.—Every water closet shall be provided with pan, trap, and properly acting water apparatus, to be affixed within the cistern supplying such water, and the floor and walls thereof shall be kept free from filth, and clean in all other respects. 14.—The yards, areas, and cellars of every such house shall be properly paved with flag paving, sloping towards the sink in the said yard or area. All private courts adjoining such houses to be similarly paved. 15.—When the Board shall require, every person 5 registered, not resident in or near to any registered house shall be obliged to appoint as his agent some person resident in or near to the house, to see that the aforegoing regulations are strictly carried out in such house, and to reinstate any defects that from time to time may occur therein. But the person registered shall be responsible for any act or default of his agent in the execution of these regulations. 16.—Every registered house, and every room thereof, shall be open to the Medical Officer of Health, and any other Officer of the Board appointed for the inspection thereof, between the hours of Eight o'Clock a m. and Ten o'Clock p.m. When there is reason to believe that the regulations respecting the number of persons to be accommodated in such house or room are infringed, then it shall be lawful for any two such Officers acting together to visit any house or room between the hours of Ten p.m. and Eight a.m. 17.—Any person registered to let, or who shall let any house or part of a house in lodgings, or to be occupied by members of more than one family, who shall violate or fail to carry out any of the above regulations, shall be liable to a penalty not exceeding Forty Shillings, for any one offence, with an additional penalty not exceeding Twenty Shillings for every day during which a default in obeying such regulations shall continue. The penalties from time to time inflicted under the above Regulations shall go to the Nuisance Authority, and shall be accounted for by them as receipts under the Act of Parliament. SCHEDULE-FORM A. Ticket, No. House let in lodgings, or occupied by members of more than one family. Street or Place Registered to accommodate persons, as specified below. In Room No. 1. In Room No. 2. In Room No. 3. In Room No. 4. In Room No. 5. TOTAL. In Room No. 6. In Room No. 7. In Room No. 8. In Room No. 9. In Room No. 10. In Room No. 11. In Room No. 12. In Room No. 13. In Room No. 14. In Room No. 15. Inspector. Day of 18 Clerk to the Board of Works for the St. Gilet's District. SCHEDULE-FORM B. House let in lodgings or occupied by members of more than one family. Street or Place. Room, No. Number of persons authorized to be received in this room Inspector. Day of 18 Clerk to the Board of Works for the St. Giles's District By order, ROBERT FINNIS, 199, Holborn. Clerk. 27th November, 1866. Confirmed. (Signed) S. H. WALPOLE. Home Office, Whitehall. 29th November, 1866. Printed by Edward A. Mitchener, 116, Great Russell Street. [2] THE BOARD OF WORKS FOR THE Saint Files Distort. Regulations under “Sanitary Act, 1866," as to Ordinary LODGING HOUSES situate within the above District. 1.—No person shall let a house, or any part of a house in lodgings, to be occupied by members of more than one family, and in which more than two persons shall sleep in one room, until such house, and the person proposing to let the same, have been registered at the Office of the Board of Works. No person shall be entitled to be so registered unless he shall satisfy the said Board that he is the bona fide Owner or Tenant of the house or part of a house so to be registered, and that the said house or part of a house is furnished with all the conveniences required by the 2 Regulations. And such person so registered shall be responsible for the observance of the following Regulations until he shall give notice in writing to the said Board at their office that he has ceased to be tenant of the said house, or part of a house. 2.—No person who shall let a house or any part of a house in lodgings, or to be occupied by members of more than one family, shall permit the same to be occupied by a greater number of persons than shall be fixed by the Board of Works as hereinafter mentioned. 3.—A Registration Memorandum according to the form in the Schedule to these Regulations, under the Common Seal of the said Board, stating the entire number of persons allowed to sleep in each such house, and which number such house is registered to accommodate, will be supplied to the person letting such house, and he is to produce such memorandum whenever required by any officer appointed for inspecting such houses by the said Board. The Board will in no case sanction a provision of less than 400 cubic feet of space for each person. 4.—The person letting such house, or part of a house, shall put up in a conspicuous place in each room a notice of the number of such room, and of the number of persons allowed to sleep therein. 3 5.—Two Children under ten years of age may be counted as one lodger. 6.—The person letting such house or part of a house shall reduce the number of persons allowed to inhabit the same, or any part thereof, upon receiving notice from the said Board; such notice shall state the special cause of the same being given, and the period during which it shall continue in force. 7.—The person letting such house or part of a house shall keep the same in repair, and cause the walls and ceilings of every room, and of the staircases, passages, and yards of such houses, to be thoroughly cleaned, and well and sufficiently limewashed whenever the Board shall direct, and shall cause the floors of all the rooms, passages and stairs of such house, or part of a house, and every private court, back yard and area belonging to such house or part of a house, to be kept at all times cleaned and washed. The cellars of such house shall be cleaned out once a week, and shall also be limewashed as often as need shall require by the person letting the said house, or any part thereof, provided that the Board may in particular instances, where the walls of rooms are otherwise covered than by limewashing, specify the times at which such covering shall be removed and renewed. 8.—The person letting such house or part of a 4 house, shall cause every room to be ventilated from the outside and otherwise, and the passages and staircases in such house or part of a house, to be lighted and ventilated at their highest part, and elsewhere, to the satisfaction of the Medical Officer of Health. 9.—The person letting such house, or part of a house, shall provide such accommodation for washing, and such a supply of water for the use of the lodgers, with proper covered cisterns and apparatus above ground, as shall be satisfactory to the Medical Officer of Health. The cisterns shall be of such size as to give at least fifteen gallons a day to each inmate of such house. 10.—Every such house shall be furnished with a covered dust bin of sufficient size to contain the dust, ashes, &c., that may accumulate in the intervals of clearing away, which shall not exceed one week; such dust bin to be in the best situation practicable. 11.—A water closet shall be provided in the yard of every such house, or where a water closet cannot be so provided, then outside the house, in the best situation practicable. If it is desired that one water closet should serve in common for two or more small houses, the sanction of the Board must be previously obtained thereto. For every twenty persons to be accommodated a separate closet shall be provided. 5 12.—Every house shall be properly drained into the public sewer, and every drain shall be provided with efficient immoveable traps at each entrance to the drain. 13.—Every water closet shall be provided with pan, trap, and properly acting water apparatus, to be affixed within the cistern supplying such water, and the floor and walls thereof shall be kept free from filth, and clean in all other respects. 14 —The yards, areas, and cellars of every such house shall be properly paved with flag paving, sloping towards the sink in the said yard or area. All private courts adjoining such houses to be similarly paved. 15.—Every registered house, and every room thereof, shall be open to the Medical Officer of Health, and any other Officer of the Board appointed for the inspection thereof. 16.—Any person registered to let, or who shall let any house or part of a house in lodgings to be occupied by members of more than one family, who shall neglect to carry out, or fail to comply with, any of the above Regulations, shall be liable to a penalty not exceeding Forty Shillings, with an additional penalty not exceeding Twenty Shillings for every day during which such neglect may continue. 6 17.—When the Board shall require, each registered person, not resident in or near to his own registered house, shall appoint as his agent some person resident in or near the same, to see that the Regulations are strictly carried out, and to remedy any defects that from time to time may occur. But the person registered shall be responsible for any act or default of his agent in the execution of these Regulations. The penalties from time to time inflicted under the above Regulations shall go to the Nuisance Authority, and shall be accounted for by them as receipts under the Act of Parliament. SCHEDULE FORM. Registration Memorandum, No. House let in lodgings, or occupied by members of more than one family. Street or Place Registered to accommodate persons, as specified below. In Room No. 1. In Room No. 2. In Room No. 3. In Room No. 4. In Room No. 5. TOTAL. In Room No. 6. In Room No. 7. In Room No. 8. In Room No. 9. In Room No. 10. In Room No. 11. In Room No. 12. In Room No. 13. In Room No. 14. In Room No. 15. Inspector. Day of 186 Clerk to the Board of Works for the St. Giles' District. By order, ROBERT FINNIS, 199, HOLBORN. Clerk. 12th November, 1867. Home Office, Whitehall. 18th Nov., 1867. Confirmed. (Signed) GATHORNE HARDY. Printed by Edwara A. Mitchener, 116, Great Russell