STGIL 18 REPORT ON THE SANITARY CONDITION OF THE ST. GILES DISTRICT, DURING THE YEAR 1871. 13 XT GKEOJEIGKE BOSS, MM)., FELLOW OF m MEDICAL SOCIETY OF LONDON, k, MEDICAL OFFICER OF HEALTH. llonbon: Printed by T. Penny & Co., 121, Leman Stkeet, WniiEcnArEL, E. 1672. 1871—72. ANNUAL REPORT of the Medical Officer of Health. Page The Census 2 The Rate of Increase in the Metropolis 2 Comparative Rates of Population to Houses in St. (riles and its Sub-districts 3 Causes of the overcrowding in St. Giles District. 3 The Birth-rate in St. Giles District 4 The Death-rate in ditto 4 Effect of Epidemics on the Death-rate 5 The Deatli-rate among Infants in St. Giles District 5 The Death-rate among Persons 60 years of age and upwards ill ditto .. 5 The Death-rate among persons at all ages in ditto 5 Small Pox 5 Summons against a Master and Medical attendant 6 Small Pox in common Lodging Houses 6 Vaccination as a preventive 6 Comparative Dcatli-ratc at home and in Hospital 7 Re-vaccination 7 Tables 8 Other Zymotic diseases, viz. Measles, Scarlet Fever, Whooping Cough and Fevers 8 Inquest cases 9 Registrations without Certificates 9 Deaths from violence 9 The Mortality in the Sub-districts of St. Giles District 9 The Mortality among Infants 10 The causes of Infant Mortality 10 Syphilis 10 Zymotic Diseases 10 Mal-nutrition 10 The evils of Artificial Feeding 11 The Composition of Cows Milk freshly drawn 11 The amount of Cream and Caseum in various samples of Cow's Milk 11 Injurious effects of dilution of Milk on the health of Infants 12 Stall feeding 13 The state of London Com Sheds 13 The small supply of Milk from St. Giles Cows 13 The Composition of various kinds of farinaceous food, viz., Dr. Ridge's food, Brown and Poison's, Colman's British Com Flour, Robinson & Belleville's Prepared Groats, Robinson and Bellevi'lc's Prepared Barley, Oatmeal, Ground Rice. Flour. 13 b2 2 Page The Mortality in the Workhouse and other Institutions.- The Workhouse 14 The Bloomsliiiry Dispensary 15 The British Lying-in Hospital 15 The Infants' Home 15 The Sanitary Work of tiie Year 15 The Disinfecting Chamber 17 The Mortuary 17 Rag and Bone Shops 17 Cow-sheds, Slaughter-houses, Bake-houses, 17 Condemned Houses 18 Sewers, and their Ventilation 19 Bad Food 19 Appendix. Tables of Births and Deaths ; of Quarterly Death-rate from all causes in St. Qiles ; and of Annual Mortality at all ages. To the Board of Works foe the St. Giles District. Gentlemen, Tiie Census. 1. Since my last Annual Report the Decennial Census of the United Kingdom has been taken, and a preliminary report has been published by the Registrar General. Comment on the importance of this census is superfluous. To the sanitary statist it is indispensable. It provides him with the facts indicating the salubrity of towns, as influenced by the births, deaths, house accommodation, acreage, and the density of the population, which are alone expressly giyen, yet these being the results of certain social conditions, reflect a light upon the operation of the more complex causes, such as the introduction of new departments of labour, the decay of local industries, and the general sanitary police of the several districts. The Rate of Increase in the Metropolis. 2. The following data enable us to form an estimate of the condition of our own district. The population of London within the Registration Division was, in 1861, 2,803,989, and in 1871, 3,254,260, having increased annually at the rate of 1.49 per cent. There is, however, between the Registration Division and the Metropolitan Police Division outside of it, a ring containing an additional population of 631,288 persons, in which the increase annually has been at the extraordinary rate of 4.19 per cent. The Rate of Decrease in St. Giles District. 3. The diminished rate of increase in the more settled parts of the metropolis, implies a stationary if not a declining condition of the numbers of the population in the older central districts. This we find to be the case; and in our own district, in particular, there has been an actual reduction of numbers to the extent of 647 persons in the ten years, or a decreasing rate of 0.12 per cent, per annum. 4. This fact of the decrease of the population in the whole district is consistent, however, with an increased density of the population in certain portions of it, as the following tabic shows:— 3 TABLE No. 1-Comparative Rates of Population to Houses in St. Giles and its Sob-Districts. District and Sub-Districts. 1861. 1871. Mean Rate of Pop. to each House Mean Rate of Pop. to each House. Actual Population. Houses. Increase Decrs. Increase Decrs. St. Giles District 11.53 11.76 647 149 St. George, Bloomsbury (Sub-district) 8.74 8.87 451 20 ...... St. Giles, South, do. 14.5 15.78 ...... 394 ...... 134 St, Giles North do. 12.67 12.47 ...... 704 ...... 35 5. Looking at the decrease in the number of houses, our population should have decreased in the proportion of 1716 instead of 647. St. Giles South is the particular sub-district in which the most strenuous efforts havo been made to abate overcrowding, yet the pressure of events has overmastered our exertions. Causes of the Overcrowding in St. Giles. 6. The causes of the overcrowding are, in the main, twofold. First, the reduction of the house accommodation in the district has tended to force the population who were deprived of their homes into the surrounding houses ; aud, secondly, the clearances in the City of London, for the purpose of erecting a new market and viaduct, and in the Strand District to form a site for the proposed Law Courts, have aggravated the evil. To effect these improvements (or chiefly so), the large number of 18,358 persons have been removed,—in the following proportions,—Strand 6,998, St. Sepulchre, City, 4,188, St. Bride, City, 4,211, Saffron Hill 2,961. 7. The larger proportion of these people were Irish poor, who would naturally crowd into the adjoining districts to the extent that accommodation could be found, and especially into those Districts where their compatriots already resided. Hence the comparative increase in portions of St. Giles. Our district has not, however, suffered alone. St. Andrew, Eastern, has increased from a rate of 11.96 to 12.83, and St. James, Clerkenwell, from 9.93 to 10.68. 8. The mean rate of population to houses in St. Giles District is, as above given, 11.78 persons per house. This is much larger than the rate for the whole metropolis, which is 7.79, whilst for England and Wales it is 5.3. 9. It must be admitted, however, that the density of the population, as thus estimated, would be a fallacious guide, if relied upon alone, in our inquiries as to the cause of the comparative liability to zymotic or developmental diseases of different districts of a great city. Houses vary much in size; and it is quite possible and likely that a small house, packed with a dozen people, would be in a worse sanitary condition than a larger house with double the number. We may form a rational conclusion upon the point from a consideration of the following facts. In St. James, Westminster, District, the rate of population to houses is 10.82; in the Strand, 10.28 ; in St. George the Martyr, 11.07 ; in Holborn, 9.94 ; in St. George in the East, 8.14; in Kensington, 7.54; and in Bethnal Green, 7.52. Here we see that the poor eastern district of Bethnal Green has the least density of population, being a little lower than Kensington, which is one of the wealthiest of the western districts. This is obviously owing to the circumstance that the eastern districts are composed of numberless streets of small two-floored houses; yet these distridts, notwithstanding the apparent sparseness of the population in relation to houses, are notoriously unhealthy. 10. It is necessary, therefore, if we would obtain a correct knowledge of the influence of overcrowding upon health, to look closer into the matter 4 than is possible from a mere review of these figures. It is indispensable to know the actual amount of cubic space enjoyed by each person at night; and upon this point I affirm that the amount generally recognised as sufficient, is much below the requirements of the animal economy. The Bieth-Raie in St. Giles District. 11. The registered Births in St. Giles District, during the year 1871, were 1689, of which number 465 are reputed to belong to St. George, Bloomsbury, 774 to St. Giles South, and 450 to St. Giles North. These numbers, however, require correction, as follows : there were 155 births in the Lying-in Hospital, which belonged to various outside districts; these, therefore, must be deducted, not only from the whole number, but especially from the number attributed to St. Giles South, against which sub-district they are registered. There were also 113 births in the Workhouse, all of which are registered against St. Giles South; but if distributed according to the previous residences of the mothers, it will be found that 7 belong to St. George, Bloomsbury, 38 to St. Giles North, and 4 to outside parishes. These deductions and re-arrangements give 472 to St. George, Bloomsbury, 488 to St. Giles North, and 570 to St. Giles South, which is a nearer approximation to the respective populations of those sub-districts-—total 1530. 12. The Birth-rate for Bloomsbury was less than last year; that for St. Giles South was precisely the same, whilst that for St. Giles North was considerably lower than the previous record. The Birth-rate for the whole district was, therefore, lower in the proportion of 28.6 for 1871 to 31.2 for 1870. TABLE No. 2.—The Birth-rate to Population in St. Giles and its Sub-disthicts. Sub-Districts Population. Births. Ratio of Births to Population. Rate per 1000. St. George Bloomsbury 17,843 472 1 in 37.8 26.4 St. Giles South 19,089 570 1 in 33.5 29.8 St.Giles North 10,497 488 1 in 33.8 29.5 Whole District 53,429 1530 1 in 34.9 28.6 Tie Death-Bate in St. Giles District. 13. The Deaths for St. Giles District, as reported in the Registrars' weeldy returns, are, for St. George, Bloomsbury, 336, St. Giles South 598, St. Giles North 321—total 1255; but these figures require considerable rectification. First, there were 132 deaths in the metropolitan hospitals belonging to our district, which must be added in the following proportions, 30 St. George, Bloomsbury; 68 St. Giles South; and 34 St. Giles North Secondly, there were 193 deaths in the workhouse (exclusive of still births), of which 15 belong to Bloomsbury, 74 to St. Giles South, and 31 to St. Giles North. Tho remainder includes 62 deaths among residents in the workhouse, not easily distributable among the sub-districts, with 5 police oases, 4 outsiders, 1 tramp, and 1 unascertained. The 15 and 31 must be added to St. George, Bloomsbury, and St. Giles North, respectively, and the remainder subtracted from St. Giles South. There were also 7 deaths in the Lying-in Hospital (not belonging to us) which must be subtracted from St. Giles South, and two belonging to the Infants' Home, which must be subtracted from Bloomsbury. There were also 4 eases that could not be satisfactorily appropriated to their proper districts : all these eases are however included in our general summary in the Appendix. After these corrections have been made, the following table gives the correct summary. 5 TABLE No. 3.—The Death-rate to Population in St. Giles and its Sub-disteicts Sub-Districts. Population. Deaths. Ratio of Deaths to Population Rate per 1000. St. George Bloomsbury 17,843 379 1 in 47.1 21.2 St.Giles South 19,089 540 1 in 35.3 28.3 St. Giles North 10,497 380 1 in 42.7 23.4 Workhouse ...... 62 ...... ...... Whole District 53,429 1,367 1 in 39.1 25.6 Effect of Epidemics on the Death-rate. 14. Notwithstanding tho large mortality from Small-pox in the year 1871, it is apparent that our death-rate (25.6), including all the deaths in hospitals, was considerably less than our death-rate (27.3) for last year. Our experience therefore confirms the opinion that is beginning to be received, that epidemics (unless under very exceptional circumstances) do not, at least, increase the general death-rate. Here, perhaps, it will be prudent to rest for a time, It will be observed, also, that there was a reduction of the birth-rate as well as of tho death-rate. The Death-rate among Infants in St. Giles. 15. The number of deaths, including those in hospitals, among infants under one year of age, in St. Giles, during the year 1871, was 319, which gives a rate of 1 death in every 4.8 births, or 20.8 per cent, of births. 16. Tho rate in respect of population is 1 in every 167 of persons living, or 5.97 per 1000. 17. Tho number of births having been smaller than last year, our deathrate in relation to births is a little higher, whilst in relation to population it is lower. The Death-rate among Persons 60 years of age and upwards. 18. The number of deaths, including those in hospitals, at 60 years and upwards, was 301, which gives a rate of 1 in every 177 of population. This is equivalent to 5.6 per 1000, which is higher than last year. The Death-rate among Persons at all ages (excluding Infants and Persons 60 years cf age and upwards.) 19. The number of deaths at these ages, including deaths in hospitals, was 747, giving a rate of 1 in every 71.5 of persons living, or equivalent to 15.5 per 1000. This rate is lower than last year, viz. 16.16 per 1000, the mortality from Small-pox not having raised it as might have been expected. The cause of this diminution of the general mortality will be referred to in subsequent notices of special diseases. Small Pox. 20. Small Pox appeared first in this District, as an epidemic, in the month of February of the year 1870; it has therefore prevailed about two years. My last Annual Report gave the details for that year; the results being 61 cases and 16 deaths, more than half the cases occurring in Bloomsbury. This Report will be confined to a statement of the cases and mortality during the year 1871. 21. The entire number of cases, public and private, for the year 1871, was 531. The sex was ascertained in every case but 5, and the proportions were 259 males and 267 females. The oldest person attacked was aged 63 years, and the youngest an infant aged 9 days. The average age of persons attacked was 15.3 years. Among the males there were 47 deaths, or a rate of 18.4 per cent. : among the females 41 deaths, or a rate of 15.3 per cent.; the excess of mortality, therefore, falling upon the males. 6 22. The actual rate of cases to population, for the whole year, was 9.9 per 1000 persons living, and the actual rate of deaths to population was 1.64 per 1000 persons living. 23. The distribution of the cases among the three sub-districts was as follows:—St. George, Bloomsbury, 160, St. Giles South 187, St. Giles North 180, besides four others who were brought into the district from outside parishes. Summonses against a Master and Medical Attendant. One of these was a journeyman baker, who had been sent from Isleworth, and had travelled by train to London. A summons was taken out, by the direction of jthe Magistrate, against his master and the surgeon who had advised his being sent, knowing him to be then suffering from Small Pox; but in consequence of the death of the man in hospital, his evidence was lost, and the defendants were acquitted. The issue of a summons against the surgeon, under " Jervis's Act," should operate as a caution to medical practitioners who give injudicious advice under such circumstances. Small Pox in Common Lodging Houses. 25. One peculiarity deserving of remark, in respect of the local prevalence of the epidemic, is the small number of cases (15) that occurred in common lodging houses. It may be remembered that, during the epidemic of relapsing fever, a very large preponderance of attacks happened in those houses ; and I attributed the fact, chiefly, to the importation of the fever by tramps and hop-pickers from country parishes. On the occasion of this epidemic, notwithstanding its highly contagious character, an opposite fact has been noticed; and I can only attribute the comparative freedom of common lodging houses from Small pox to the prompt and rigorous measures of isolation and disinfection which were carried out by the police authorities. It is fortunate that Small pox evidences itself early by eruption : on the first indisputable sign, therefore, of the malady, and before the contagium became energetic, the police inspector was able to send the cases to hospital; and by requiring the immediate clearance and disinfection of the rooms, and keeping them empty for two or three days, as might appear necessary, in no instance was the disease propagated in these overcrowded houses. The inspector of police reported to me the cases as they occurred, and received my certificate of the fitness of the rooms for occupation before they were re-occupied. The energetic conduct of these measures, by the Serjeant in charge of the duty, deserves commendation. 26. The disease spread, chiefly, among families of children, where the same decisive measures of isolation, &c., could not be carried out. The whole of one family, residing in the Model Lodging House, in Streatham Street, were attacked; three of them were sent to hospital, and two remained at home; but, owing to the facilities for isolation which this building affords, the disease did not spread from them to other families. This family had come into the Model House, from Bedfordbury, only about a fortnight before the first attack, and probably brought the seeds of tho disease with them. The father had been re-vaccinated seven days before the attack, but not a sufficient time for the constitutional changes to have been effected. The attack, however, was not severe. Vaccination as a Preventive. 27. Of the whole number of cases in which the fact could be ascertained, 451 had been previously vaccinated, and 54 had never been vaccinated. Among the vaccinated there were 56 deaths, or a rate of 12.4 per cent. ; amongj the uuvaccinated there were 29 deaths, or a rate of 53.7 per cent. The deaths icere therefore about 1 in 8 cases among the vaccinated, and more than 1 in 2 among the unvaccinated. 28. It is thus evident that the mortality was at least four times greater among the unvaccinated than among the vaccinated ; and we must presume 7 that in those instances among tho unvaccinated in which death did not occur the ravages of the system, the impairment of vital power, the damage of internal organs, and the facial disfigurement were far greater than in the vaccinated cases. In the latter the disease was usually mild. 29. It must be remembered, also, that in many of the so-called vaccinated cases, there is a decided probability that the operation had been imperfectly performed, inasmuch as the average age of the persons attacked having been 15 years, the majority of them had been vaccinated before the present laws were in force for ensuring satisfactory vaccination. Comparative Death-rate at home and in Hospital. 30. The Death-rate in all the cases was 16.6 per cent. It should be observed that the rate per cent, of those cases treated in hospital was 13.8, whilst of those treated at home it was 20.7 (Table No. 7)—a very considerable difference in favor of hospital management. Another striking result, worthy of remembrance, is gathered from our records. During the first part of the epidemic, up to the end of August, the mortality among those cases treated at home, in the charge of private practitioners, was only 12 per cent.; but so soon as complaints were made of the management of the Hampstead Hospital, the people became alarmed, and refused to allow their sick friends to, be removed : they were thus left in their dirty and wretched homes, to run deeper into the malady, and to poison their families; then the disease increased in fury, especially in the Little Coram Street section, the victims became alarmingly numerous, and the mortality mounted to 49 per cent., or 22 deaths in 45 cases treated by private practitioners. These facts ought not to be forgotten in relation to the question of isolation for the prevention and treatment of contagious diseases. Re-vaccination. 31. In some instances the patient was attacked after re-vciccinatlon; one case of the kind I have already adverted to. In another case, at 16, Phoenix Street, a boy 12 years of age had been vaccinated six months before the attack ; and it is reported that the re-vaccination took well. In another, at 46, Museum Street, a boy aitat 1C had been re-vaccinated, expressly to avert an attack: the operation was successful, (nevertheless he suffered from Small pox. Two others in this family were ill; they were treated at home. Two female servants, residing at 36, Alfred Place, had been re-vaccinated; they were subsequently attacked, and sent to hospital: one died. I could not ascertain the degree of success that had attended these re-vaccinations. A boy getat 7, at 29, Brownlow Street, had been re-vaccinated a clay before his attack. 32. I have thought it right to enumerate these instances of attack after re-vaccination, without intending to lay much stress upon them as matters of evidence. It is clear that, in the case of the boy at 29, Brownlow Street, the re-vaccination could not have exerted any prophylactic effect, on account of the recency of the operation. It would not be surprising, however, if attacks of Small pox occasionally followed re-vaccination, as they follow primary vaccination, and even Small pox itself. For example, a boy ffitat 16, at 29, Brownlow Street, and a boy aatat 6, at 180, Ilolbom, had each had Small pox when about one year old. A woman 25 years of age, residing at 10, Brownlow Street, had been vaccinated, and had also suffered from Small pox; yet she caught it a second time. A young man, who lived at 14, Southampton Row, had been vaccinated and re-vaccinated, and had had an attack of Small pox, yet he was subjected to a second attack during this epidemic. 33. These are undoubtedly exceptional cases, serving to show that there are certain constitutions which are peculiarly susceptible of organic poisoning, and which nothing will entirely protect. 8 34. The following Tables give a synopsis of the various facts :— TABLE No. 4. Shewing the Number or CASES and or DEATHS feom SMALL POX in St. GILES DISTRICT, in each Month of the Yeas 1871 MONTHS. GASES. PRIVATE CASES. DEATHS. Public. Private. Total. Sent to Hospitl. Treated at home Total. In Hospitl. At home Wrkhs. Total. January 31 2 33 1 1 2 4 1 1 6 February 40 13 53 5 8 13 5 3 — 8 March 37 24 61 3 21 24 6 1 — 7 April 30 16 46 5 11 16 4 2 — 6 May 42 32 74 8 24 32 5 5 — 10 June 48 7 55 1 6 7 5 2 — 7 July 28 33 61 1 7 26 33 7 5 — 12 August 12 5 17 2 3 5 3 — — 3 September 5 7 12 — 7 7 1 2 — 3 October 35 16 50 1 15 16 — 12 — 12 November 19 14 33 1 13 14 5 5 — 10 December 22 14 36 4 10 14 1 3 — 4 Total 349 183 531 38 145 183 46 41 1 88 TABLE No. 5, op Cases, Sex, Age and Mortality. Number of Cases. Sex. Average Age of Persons attacked Deaths. Average Age at Death m. f. m. f. Botb Sexes m. Rate per cent to Cases. f. Rate per cent, to Cases. Mean Rate BothSexcs m. f. Both Sexes. 531* 259 267 16.5 14.4 15.3 47 18.4 41 15.3 16 7G 12.3 15/2 13.7 * There were five cases in which the age was not stated. TABLE No. 6. Ratio op Cases and Deaths to Population in Sub-Districts. sub-districts. Population. Cases. Rate per 1000 of Population Deaths. Rate per 1000 of Population St. George, Bloomsbury 17.843 160 8.9 31 1.73 St. Giles South 19.0S9 187 9.79 28 1.46 St. Giles North 16.497 180 10.9 29 1.75 Whole District 53.429 *527 9.86 88 1.64 Four cases came from outside Parishes. TABLE No. 7, Showing the Rate per Cent, op Deaths to Cases treated in Hospital and at Home respectively. Treated in Hospital. Deaths. llate per cent Treated at Home. Deaths. Rate per cent. Mean rate per cent, of all cases. 333 46 13.8 198 41 20.7 16.6 TABLE No. 8, Showing the Mortality among the (ascertained) Vaccinated and Unvaccinated Cases. Vaccinated. Deaths. Rate per cent. Unvaccinated. Deaths. Rate per cent. 451 56 12.4 54 29 53.7 Other Zymotic Diseases. 35. The mortality from these diseases lias been much less than in previous years. Measles. From this affection we have suffered only 15 deaths ; in the preceding year there were 29. 9 Scarlatina. Tlio mortality from this disease was only 20, which is very low in comparison with that for 1870, viz. 102 ; or with that for 1869, viz. 48. Whooping Cough was more fatal than in the preceding] year, viz. 38 against 16. In the year 1869, the deaths from this affection were 83. Fevers gave us a death-number of 26, against 31 in 1870, and 37 in 18G9. Diarrhoea produced 62 deaths; our mortality from this cause having been 83 in 1870, and 94 in 1869. 36. These, with Small pox, constitute the chief miasmatic diseases; and this brief comparison gives a better notion of their virulence and extension than a more lengthened statement. The prevalence of one form of miasmatic disease is usually accompanied by a diminished energy in other forms of this order ; whether owing to a subtle conversion of morbid force from one form to another, or to the simple probability that any active poison selects for its victims those persons most liable to attack, and who, if not assailed by the prevalent epidemic, would otherwise have succumbed to another form of disease—whether, then, owing to one cause or the other, may be a matter of dispute; but the fact is commonly observed, and explains the data in this year's Registers. Inquest Cases. 37. Eighty Inquests were held during the year, of which 21 were in the first quarter, 20 in the second, 13 in the third, and 26 in the fourth. Bloomsbury gave 27, St. Giles South 35 (of which 9 are returned for the Workhouse), and St. Giles North 18. There were three cases of poisoning, viz. one with cyanide of potassium, one with carbolic acid, and one with opium—all in Bloomsbury. Four inquests were held on deaths from Small pox. The verdict in 9 other inquests was " suffocated in bed "—a form of death that requires close scrutiny. One child was found dead in the arms of a woman carrying it in the street, the mother being- an unmarried woman. In 3 cases the infants (newly born) had been found dead in the squares (2 in Bedford Square, 1 in Brunswick Square) and verdicts of " wilful murder" returned. Other infants were also found dead, but the causes of death in those instances were returned as "Pneumonia," "Atalectasis," &c. One child, 15 months old, was suffocated by a piece of almond in the larynx. In the large majority of the other cases, the verdicts returned were either " apoplexy," or " disease of the heart," the ordinary causes of sudden death. Registrations without Certificate. 38. The cause of death was registered, without a Certificate, in 14 cases. In 4 of these, the cause assigned was " premature birth "—obviously, therefore, no medical practitioner attended at the accouchement, and there is no guarantee of a truthful statement. In 3 cases the bodies had been brought dead to hospitals. The cause of death was certified as "unknown," in 6 cases,—5 of which occurred in the Workhouse. The omission of an examination was not perhaps of much importance, except in a scientific point of view, in the latter cases, as the public would have the needful assurance that the persons, while living, had been duly cared for. Deaths from Violence. 39. Our mortality (31) from the causes ranged under this head has been loss than in the previous year (38). Fractures were the cause of 11 deaths ; suffocation, as already stated, of 9. The Mortality in the sub-districts of St. Giles. 40. The following Table shows the death-rate in the several sub-districts for the past year, in comparison with the ten previous years. It is apparent that the death-rate in St. Giles South and St. Giles North was considerably lower last year than in any year of the previous ten; St. 10 George, Bloomsbury, having been slightly in excess. The death-rate for the whole district was consequently less, by 2.8 per 1000, than the average of the ten years, and lower than for any year of which I have a record; the year 1858 approaching it the nearest, when the death-rate was 25.8. This is the more remarkable in the presence of a severe epidemic of Small pox. TABLE 9.—Death-bate per 1000 in Sub-districts * districts. 1861. 1862. 1863. 1864. 1865. 1866. 1867. 1868. 1869. 1870. A verage Dcatli-rate of 10 years. 1871. St. George Bloomsbry. 20.5 21.6 19.9 21.6 21.1 20.0 19.0 21.0 21.16 22.1 20.9 21 2 St. Giles South 29.1 31.7 32.7 34.8 34.6 32.8 31.6 31.1 33.20 341 32.1 28.3 St. Giles North 27.9 28.2 27.3 29.2 26.6 29.8 26.6 25.3 29.47 27.5 27.8 23.4 Whole District 27.0 28.9 28.5 31.1 29.6 29.0 26.9 26.8 27.94 28.19 28.4 25.6 * Correction has been made for the extra length of the registration years 1863 & 1868, and for the proportion of deaths due to each sub-district among the deaths in the Workhouse and in Hospitals outside the respective sub-districts. The Mortality among Infants. 41. The reiteration of the fact, year after year, of the excessive mortality among infants in this district, fulfils but imperfectly the duties of a Medical Officer of Health, and almost forces upon him the consideration of the causes of that mortality. These are various; but the chief of them may be ranged under four heads. Causes of Infant Mortality. 42. First—Degeneracy of constitution at birth, arising either from natural parental defects, or from syphilis. 2nd— Zymotic diseases. 3rd—Mal-nutrition, from " want of breast-milk," or from insufficient or improper food. 4th—Neglect or violence. 5th— Pulmonary affections. 43. The first, second and third causes come immediately within the sphere of duty of the Medical Officer of Health, who is empowered to advise your Board concerning them, and to deal with them under various Acts of Parliament. The fourth cause is less subject to his intervention, and the events are usually registered, as " suffocated in bed," " suffocated in the mother's arms," " convulsions or they become the subject of legal inquiry Syphilis. 44. With reference to the first cause, and, more particularly, syphilitic poisoning, it is certain that a large amount of infantine mortality is caused by it, notwithstanding the fact that only a small comparative number of deaths (7) among children is registered this year under that head. One reason of this is that medical practitioners do not like to write such a designation on the face of a certificate that is put into the hands of parents for transmission to the Registrar. This disinclination operates in other cases, as well as in syphilis, and should be obviated under a good system of registration. Zymotic Diseases. 45. Secondly—Zymotic diseases carried off 94 children under one year of age. Each form of these diseases having been already adverted to, specially, in another part of this Report, the only one that requires notice now is diarrhoea; this affection having caused a large number of the infant deaths. As nearly the whole of these deaths occurred in the months of July, August, and September, it is obvious that the temperature, and other associated atmospheric conditions, had an important influence in producing them. This high temperature, however, operates less prejudicially in the open air than in the close and vitiated atmosphere of the dwelling-houses. 11 Mal-nutrition. 46. Thirdly—Mal-nutrition, from "want of breastmilk," and from improper artificial feeding, is undoubtedly another cause of infant mortality. The " want of breast-milk" indicates a fault in the mother, either of structure, health, or secretory function, or possibly of neglect and its consequence,—inadequate nourishment. These matters come more particularly under the care and direction of the personal medical attendant The Evils of Artificial Feeding. 47. The evils of artificial or hand-feeding, however, demand the consideration of the Medical Officer of Health. I therefore deem it desirable to make a few remarks upon this subject. 48. I propose to give the results of some inquiries into the qualities of the cows' milk sold in this neighbourhood, as well as of the various kinds of farinaceous food in most common use. The composition of the various specimens of cows' milk, cited in the Table No. 11, was determined in the usual way, by the help of the lactometer and the specific gravity bottle. The quantity being the same in each instance, the weight of each sample was determined at first, and again after the skimming of the cream, and after the removal of the caseum. The caseum likewise was filtered, dried, and weighed. Only the more important facts, in relation to the cheese and the butter, are noticed in the Tables. The Composition of Cow's Millc freshly drawn, 49. The constituents of three samples of genuine Cow's Milk, drawn direct from the udder, were in the following proportions:— TABLE No. 10. No. 1. No. 2. No. 3. Mean. Water 861 861 858 860 Cream 28 32 45 35 Casein 59 57 47 54.3 50. Having thus obtained a standard for comparison, I examined 17 specimens of milk, as sold by retail, in the shops of the district. The following Table shows the results, represented in the more common way, as ascei-tained by the specific gravity bottle and lactometer. TABLE No. 11.—The Amount of Cream and Caseum in various Specimens of Cow's Milk. No. Specific Gravities. Amount of Cream by Lactometer. Weight of Casein. Milk. Skim. Whey. Mean of the 3 samples 1 1031.7° 1034° 1030.3° 9° 54.3 gr. 2 1025 ...... 1015 7° ...... 3 1030 1035 1029 13° 50 ,, 4 1032 1035 1031 9° 28 „ 5 1030 1030 1024 4° ...... 6 1026 1028 1025 8° 26 ,, 7 1025 1026 1023 5° 22 ,, 8 1028 1029 1025 7° ...... 9 1025 1025.5 1023.5 5° 22 „ 10 1030 1031 1028 7° 25,, 11 1031 1031 1030 7° 25 ,, 12 1030 1035 1029 5° 45.4 „ 13 1032 1035 1031 6° 37 ,, 14 1029 ...... 1025 4.5° 25 „ 15 1027 ...... 1024 7° 28 ,, 16 1025 1025 1023 5° 25 ,, 17 1023 1023 1022 5° 18 ,, 18 1035 1037 1033.5 12° 36 ,, 12 51. In explanation of the foregoing Table, I should state that the amount of cream largely varies in different samples of natural milk, according to the functional activity of the animals, the period of lactation, the quality of food, and other causes, It cannot, therefore, be exclusively relied 011 as a test of richness or nutritive value. A milk rich in cream may be skimmed, and remain rich in azotized or flesh-forming principles ; or it may be diluted with half its quantity of water, and it might still appear moderately rich in cream, although deprived of half its nutritive value. These facts must be borne in mind in estimating the probable degree of adulteration ; but they will not prevent the formation of a reasonable judgment in most cases. 52. In order to avoid this source of error, I have preferred to take as my guide the proportion of casein found in the milk. This is an ingredient that cannot either be added or taken away without destroying the milk for sale. It may be diluted with water; but then its deficiency becomes a test of the adulteration. 53. Supposing, therefore, that the amount of casein in genuine milk is 54.3, it is clear that some of the specimens of milk in the Table were diluted with at least an equal portion of water, The brackets, embracing series of figures, denote that the specimens of milk represented by the figures were bought at the same shop. No. 3 was supplied by the same dealer (a cowkeeper), as Nos. 2 and 4. No. 3 was a rich, unadulterated milk. No. 4 was fairly rich in cream, but poor in casein, and was probably diluted in a moderate degree. No. 2 was rich in cream, like No. 3 originally, but had been considerably reduced with water. Nos. 5, G and 7 had all been skimmed, and watered very considerably. This seller had been supplied by a wholesale dealer, who obtained his milk from the country. No. 8 was probably one-third water, and No. 9 one-half. Nos. 10 and 11 had been skimmed and watered. The second specimen had been bought at an interval of four days from the first, yet the two specimens were almost identical in composition. The lactometer and specific gravity bottle had evidently been used to regulate the quality. The retailer had been supplied by a wholesale dealer. Nos. 12 and 13 had been skimmed, and the latter watered. Nos. 14, 15 and 16 were of very inferior quality, and the adulteration had been systematically regulated; but No. 17 was perhaps the worst specimen of the lot. It was obtained from a shop in one of the lowest streets of the district. This shop was kept by a man, who had a cow house in an adjoining- district, and his agents were simply cheating, very grossly, the poor people whom they supplied. No. 18 was rich in cream, though deficient of casein. The specific gravity of the whey having been extraordinarily high, I allowed it to stand until a considerable deposit was formed, and on subjecting the deposit to a microscopic examination, I detected starch granules; the only instance in which any other adulterating ingredient than water was discovered. I am willing to believe that in this case it might have been accidental. Injurious Effects of the dilution of Milk on the Health of Infants. 54. It is pertinent to observe, that an effort has been made to prevent the Legislature attaching penalties tq what has been called innocent or nonpoisonous adulteration, of which the reduction of the strength of milk with water is the most conspicuous example. The fallacy of the position assumed by the supporters of this movement will be found obvious by this consideration,—that supposing a given supply of milk to an infant be reduced to one-half of its genuine strength by the milkman, and that the nurse further reduce it one-third, by medical advice or otherwise, to bring it down to the standard of mother's milk, acting upon the rule that mother's milk is one-third less rich than ordinary cow's milk, it would happen that the poor infant, defrauded of its nourishment, would gradually pine and die. 13 Nothing could save it. Death from starvation would be its doom. This would be the result with the quicker certainty if, acting in ignorance, or pressed by penury, an insufficient quantity, say one pint a day, should be given. Poisonous adulteration might act more promptly, but not more certainly, than this fraudulent and unsuspected withdrawal of the means of life. A child might struggle on with one pint of good milk a day, until it was old enough to take farinaceous or other food; but no child could be nourished on half-a-pint a day. The addition of water to cows' milk has the further disadvantage of hardening the casein, and making it more indigestible. 55. This question, therefore, is of immense importance to the poor, and even to the more respectable classes, who may nourish their infants by the spoon or bottle, or who may be compelled to practise economy in providing food for their offspring. I have hardly ever known a child in a poor family supplied with the quantity of milk which experience has shown to be necessary for its due nourishment and growth. Stall-Feeding. 56. With reference to the practice of stall-feeding of cows, and the assumption that it deteriorates the milk, my observation does not sanction this opinion, unless the cow-keeper feeds his cows with improper food. Freshly-drawn milk is undoubtedly often acid, as I showed in my Eeport last year, when tho cow from which it has been taken has been long in the shed. Sour, unwholesome grains, would be likely to produce the same result. A rich and nutritive milk, however, can be obtained as well from the diet used in the shed as from grass; the cow being treated as a mere machine, to produce a certain amount of good milk. Further, the milk of grass-fed animals alone would fail to provide for the wants of our vast population; the supply of such milk, both as to quality and quantity, being inconstant for a constant demand. The state of London Cow-Sheds. 57. On the other hand, the dilapidated and unwholesome state of our cow-houses, the impossibility of keeping such ruinous places clean, the liability to febrile, inflammatory, and tuberculousjdiseases among the animals, arising from the enforced inhalation of the foul effluvia steaming up from the filth around their feet, the probability that certain epidemic diseases are but modifications of epizootics, and that the deteriorated milk of diseased cows may infect injuriously the health of human beings who use it: all these arc considerations pointing to thejirgent need of the abolition of cow-sheds in the centre of populous cities. The evil of intra-mural cowkeeping seems to me so obvious, that I am astonished it should be permitted by our laws. The small supply of Milk from St. Giles Cows. 58. The utility of the practice to our. population is so trifling, that tho closure of every cowshed in the district would not produce any perceptible inconvenience, for I find that the daily yield of milk from all the cows kept iu the district does not suffice to provide more than two tea-spoonfuls of milk per diem for each person resident therein. Composition of various Fabinaceous Foods. 59. Following up this subject, I have thought it right to report upon the composition of the various kinds of farinaceous foods sold for children. The subjoined articles I have submitted to microscopical examination : Dr. Ridge's Food contains wheat starch granules, with small portion of cellulose. It is said to be partially cooked before sale, but the wheat granules are not perceptibly injured. Brown Poison's is composed of Indian Maize starch granules, with some cellulose. Colma-t's British Corn Flour is composed of rice starch. There was no " British Corn " of any sort in the specimen I examined. I have noticed 14 h at in some advertisements tho manufacturer states that it is made from rice; hut it is not so stated on the wrappers, and the public are consequentlylikely to be deceived. The article is however very carcfully prepared. Robinson Belleville's Prepared Groats contain oat-starch, both large and small, (the large ones like wheat, but not apparently compound,) cellulose, and portions of inner lining of husk. Robinson Sf Belleville's Prepared Barley contains barley starch, with cellulose in good proportion. Oatmeal—(one pennyworth, bought at a retail shop)—adulterated with about one-fifth of barley-meal rubble; it also contained cellulose, with inner and outer husk ; in fact, it was simply the oatmeal ground and adulterated. Ground Rice contained rice-starch and cellulose, but more cellulose than rice-starch. Several specimens of wheat-flour were examined : all were found genuine. 60. Farina or starch is the chief ingredient of these various descriptions of food ; all should therefore be mixed with milk. The nitrogenous elements, as well as the potash salts in which the wheat flour is deficient, would thus be provided. Colman's " British Corn Flour " could not support life without milk. The Oatmeal, (bought at a shop, and such as is ordinarily made into gruel by poor persons to feed their infants) containing, as it does, a large proportion of coarse husk, would be sure to irritate the bowels, and cause diarrhoea. Yet it is supposed to be " soothing " in suck cases. The Barley, which is commonly used to adulterate oatmeal, is less digestible and nutritious than oatmeal. It contains less oil and protein, about half the quantity of lime, less phosphoric acid, potash and soda, and about ten times the quantity of silica. It is therefore less calculated to make bone and tissue, and is more irritating to the digestive organs, particularly those of an infant, I do not, however, intend to enter upon these minute and yet most important points, as to the suitability of food for infants. I have said enough to indicate how it is possible to heap up heavy Bills of Mortality through an improper and insufficient dietary. The Mortality in the Workhouse and other Local Institutions.—The Workhouse. 61. The number of deaths in the Workhouse in 1871, was 193, to be distributed among the sub-districts, as already stated (§ 13). There were five other still-births in the lying-in department; these, however, are not registered. I regret that the mode in which the sick returns are now entered do not offer facilities for a satisfactory analysis. 62. The general mortality in the Workhouse was equally favorable with that for the district at large, having been about 25 per cent, lower than last year. Owing to the excellent arrangements of the officers, and the promptitude with which persons who were attacked with Small pox were removed to hospital, it is satisfactory to know that this fell disease did not spread in the Workhouse. 63. I feel it incumbent on me to acknowledge the valuable services which the Board of Guardians rendered to your Board, by permitting the use of the ambulance for the removal to hospital of Small pox patients who were not paupers, and for the readiness with which the suggestions of your Board, for the sanitary well-being of the district, so far as they appertained to the duties of Guardians, were carried out. I must also express my obligation to Mr. Bennett, the Medical Officer, and the officers generally, for the assistance they, on all occasions, rendered to me personally in discharging the trying duties of my office in connexion with the epidemic. 15 The Bloomsbury Dispensary. 64. The usefulness of this charity has never been better exemplified than it has been this year, in contending with the severe epidemic of Small pox. It happened that this fatal disease spread with most intensity in the sub-district of Bloomsbury, and thus caused the heaviest demands upon the services of the physicians of this charity. The late house physician was accustomed to Jgive me daily information of the occurrence of cases, and co-operated with me with much energy in the removal of the patients, and the disinfection of the premises. Tho following is tho tabular statement of the sickness and mortality for the year. TABLE No. 12.—New oases treated at the Bloomsbury Dispensary, 1871. Quarter ending— Physician's Cases. Surgeons' Cases. Casualties about Total. Admitd. Visited at home Died. Admitd. Visited at home Died. Admitd Visited at homo Died. Mar. 25tli 790 283 29 331 38 1 270 1121 321 30 June 24th 737 254 35 314 19 0 260 1051 273 35 Sept. 29th 672 163 20 325 17 0 300 997 180 20 Dec. 25th 739 289 33 279 22 0 290 1018 311 33 Whole Yr. 2938 989 117 1249 96 1 1120 4187 1085 118 The British Lying-in Hospital. 65. The number of births in this institution was 177, of which 99 were males and 78 females. There were 7 still-births,—3 males and 4 females. There were also 7 deaths,—4 of mothers and 3 of children: one of tho mothers died from pleurisy, two from peritonitis after flooding, and one from flooding. In the last caso, the patient was brought in nearly exanimate, and was delivered with instruments. Eighteen of the women belonged to St. Giles' parish and 4 to St. George, Bloomsbury. The Infants' Home. 66. One hundred and eleven infants were provided for by this institution during the year: 70 were received into the house in Great Coram-street, in the first instance, and afterwards put out to be nursed; 41 were sent out to be nursed without passing through the home. We maytherefore consider that this has become, practically, an institution for " farming out," as it is termed, young children. It will be therefore interesting to watch the effects of the new system in comparison with the former practice. Only two are reported to have died in this district. Dr. Pakamore, the medical attendant, has obligingly informed me that the entire number of deaths was 13, and that the causos of death were as follow, vix., 2 (twins) of hereditary syphilis, 2 of bronchitis, 1 of pneumonia, 4 of tabes mesenterica, 2 of diarrhcea, 2 of debility from birth. This gives a mortality of 12.6 per cent.,—a rate that is much lower than the death-rate among infants in St. Giles District, which may be taken at 20 per cent. It is much lower also than the infantile death-rate to children born in the whole of England. Further experience is required to determine the real value of this most interesting experiment. The Sanitary W nrk of the Year. 67. The duties of the Inspectors have been more than usually onerous this year, in consequence of the prevalence of Small pox. During tho earlier part of the year this epidemic ra ed principally in tho Par isli of St. Giles; but about the month of Se tember it broke out with exceeding severity in the Little Coram Street section of the Parish of St. George, Bloomsbury, necessitating the most active efforts on thepart of 16 the Inspector. The physical infirmity of Inspector Webb, who had charge of this sub-district, incapacitated him for the efficient performance of his duty ; he was therefore superseded by Inspector Dixon, who worked with great energy in carrying out the requirements of your Board. Mr. Handsley was appointed temporarily, to discharge Inspector Dixon's duties in the southern division of the district, but he was unfortunately attacked with Small pox after he had been about three weeks in the work. Up to that time he had fulfilled his duties with much care and intelligence. It however became necessary to appoint another temporary Inspector, in the person of Serj. Stoey. At the expiration of the period of Serj. Stoey's appointment, an election took place for the office of Sanitary Inspector, when the present Inspector, Serj. Harnack, received the appointment. This brief recital is sufficient to show the labors and perils which a Sanitary Inspector must undergo in the discharge of his duties. The private practitioners of this district cooperated in the most frank and liberal manner with your Board, in giving information to the Inspectors, and in transmitting, weekly, replies to the circular letters which were forwarded to them; and I feel bound to express to them my acknowledgments, on my own behalf, for their prompt and useful assistance, without which my Tables could not have been compiled with their present fulness of detail. G8. Tho following Table sets forth the sanitary improvements that have been carried out during the year. TABLE 13. House Improvements in St. Giles District effected under the Superintendence of the Sanitary Inspectors between Lady-day, 1871, and Lady-day, 1872. [nspcctor WEBB. Inspector Dixon. Number of liouscs improved 724 920 Improvements in Drainage, Drains constructed or repaired 97 190 Traps fixed 306 480 Cesspools abolished 17 42 Stables drained and horse-pools abolished 1 6 In Water Closots Pan, trap, and water provied 64 80 Water and apparatus only provided 205 360 Cleansed or repaired 279 309 Newly constructed or re-built 7 14 In Dust Bins. Newly constructed 4 13 repaired or covered 125 187 Paving. Re-laid or repaired 136 213 In General Water Supply. Receptacles provided 66 40 Receptacles repaired 56 62 In Cleanliness and Repair. Cleansed and lime-whited 723 882 Various accumulations removed from cellars, &c. 69 72 In Ventilation, &c. Ventilation improved 16 22 Overcrowding reduced 30 25 Kitchens disused, or made legally habitable 25 67 Proceedings takon. First notices 0 0 Second notices, letters, &c 0 0 Summoned and Fined 0 0 Reported to Police or District Surveyor 0 4 Total number of Improvements 2207 3068 Total Number of Visit during the year 5883 7023 17 The Disinfecting Chamber. 69. Wc have found this chamber most useful in disinfecting tho bedding and clothing of persons attacked with Small pox and other miasmatic diseases. It has been in constant employment during the year; but the extent of its usefulness can only be appreciated by a perusal of the following Table, showing the large number of articles that have been disinfected. It must be gratifying to the Board to know, that they were the first District Board in the Metropolis to erect such a useful sanitary appliance. TABLE No. 14. List of Articles Disinfected in tiie Hot-Air Chamber since its Erection to the end of the Year 1871. Inspector webb. Inspector DIXON. Beds 187 365 Blankets 232 346 Pillow 279 461 Quilts 155 360 Mattresses 160 178 Carpets 131 64 Curtains 23 32 Sheets 170 451 Bolsters 123 218 Rugs 46 53 Sundries 304 571 1810 3099 - 1810 Total 4909 70. In addition to the foregoing, the chamber was used for the disinfection of 62 sets of bedding, Ac., sent to us by the Strand District Board, under an arrangement made with your Board for tho purpose. I am happy to state that, owing to arrangements made with Dr. Conway Evans, the Medical Officer of Health of the Strand District, we were able to give the required accommodation to a neighbouring district at a critical juncture, without unduly impeding our own necessary work. 71. The time required for each disinfection, including the carriage of articles to and from the chamber, occupies on an average 2½ hours, and the cost of each disinfection is about live shillings. The Mortuary. 72. Twenty-six bodies have been removed to the Mortuary during the year, viz., 24 of persons dead from small pox, 1 from fever, and 1 in a state of dangerous decomposition. Hag and Bone Shops. 73. The Inspectors have been diligent in carrying out the regulations of your Board in respect of these shops, and they report that the premises have been, generally, kept in good condition ; and that the owners have shown much willingness to comply with the Board's instructions. Mr. Levy's shop, No. 14, Drury-lane, is always kept in good order, and is a pattern of cleanliness to the trade. Cow Sheds. 74. Serious objections have been made during tho year to the state of Mr. Gibson's cow shed in Drury-lane. On one occasion I visited it with Dr. Bobarts, and we found that the improvements and alterations ordered by your Board had not been complied with. The water supply in particular was out of order, the place was dirty, and there was one cow more than the number. This cow shed is, by its situation, in the rear of a dwelling-house, and by being without the possibility of proper ventilation, quite unfit for its purpose. The other cow-sheds have been kept as fairly clean as such premises, unsuitable and ruinous as most 18 of them are, can be expected to be. The number of cows now kept in the several sheds is as follows:— I Little Wild Street 12 Cows Goldsmith's Alley 20 „ 15 Drury Lane 7 „ 1 Coal Yard 12 ,, 54 Great Coram Street 6 ,, Tavistock Mews 5 „ Total 68 Slaughter Houses. 75. There is less slaughtering now done in tho district than formerly. Tho slaughter-house in Duke-street, which has been a constant subject of complaint, has been at length closed. The number of cattle killed annually in the various slaughter-houses, is 359, and of sheep 7436. Bake-houses, 76. These have been kept in a clean and wholesome state. Condemned Houses. 77. Owing to a communication from the Local Government Board, your Board desired me to report on the condition of Church-lane and the adjacent courts. After a careful inspection of the whole of the houses, I certified to your Board, in pursuance of the 5tli section of the " Artizans' and Labourers' Dwellings' Act, 1868," that they were unfit for human habitation. The subject is now under the consideration of the Surveyor. 78. A similar inspection was made of Coram-place and Russell-place, adjacent to Little Coram-street, and finding that the whole of these houses were built in a pit, eight feet below the surface of the roadway of Little Coram-street, that several of the houses were in a ruinous state, that the ground floors of all the houses were below the surface of the soil of the yard on which they stood, that several of them had no room for necessary domestic accommodations, that the ventilation was bad, partly and primarily owing to the site, and partly to faults of construction, that the drainage was inadequate, and that, finally, the general mortality was 50 per cent, greater than that of the parish, whilst that of cholera was four times greater, I certified that these two courts were unfit for human habitation ; and your Board is now engaged with the necessary measures for carrying out the Act. I may observe that the District Surveyor has, since my Report, condemned several of the houses, and they are either closed or are in course of demolition. 79. I have also reported, during the year, on the condition of the Parochial Alms-houses, in Smart's-buildings; of Barley-court; and of King's Arms-yard. The parochial authorities are, I am informed, considering the subject of the alms-houses, and the District Surveyor has condemned Barley-court, the. whole of the houses in which are now demolished. Princes Court, Drury Lane. 80. This court was also certified by me to be unfit for human habitation, and has since been demolished by the District Surveyor. 81. It is very much to be desired that the law gave more stringent powers to local authorities, to prevent the re-erection of buildings upon the old sites, so that the new buildings might not become as unfavorable to health as the old ones. Houses built back to back, for example, like those in Princes-court, or with very small yards, are insusceptible of thorough ventilation; their staircases are always dark ; and as their domestic accommodations, water-closets, dust-bins, &c., are almost of necessity in the basement, the air in them is always impure and noxious. Such a perpetuation of mischief ought not to be permitted; and the rights of landlords 19 should be subordinated to the public good. The Building Act, which requires that all houses, recently built, shall have a hundred square feet in the rear or at the side, does not provide sufficient security for health. Sewers. 82. New Sewers have been constructed during the year in the following streets and courts:—lied Lion-yard, Denmark-place, Wild-court, Stacey-street, Lumber-court, and Lloyd's-court. 83. I beg to suggest with reference to new Sewers (and the suggestion applies equally to old Sewers) that a much larger number of ventilators should be made in them, down the centres of the streets, than is customary, The bad smells and noxious effluvia emanating from Sewers are best corrected by free dilution with air. It is the stagnation of the gases in Sewers that causes their offensiveness. If the gases could be freely diluted, and their escape facilitated as soon as they were formed, the injury they are likely to cause would be very much reduced. No plan, however costly, that I have yet heard or read of, is calculated to be successful unless this free dilution be provided for. 81. At the same time all the gully-holes at the edge of the pavement, for receiving the surface-drainage, should be trapped, and be provided with a disinfecting apparatus, so that there could be no escape through them of offensive gases. A chief cause of annoyance and injury would thus bo prevented. All sewers and drains should be egg-shaped, with the narrowest end at the base, to facilitate the flow of the sewage. Further—if all the gas-lamps received their supply of air from the sewers, there can be little doubt that the drains and sewers would be well ventilated, and a great good would be obtained at the least expense. Bad Food. 85. During the year there have been seized 18 parcels of fruit, 18 of fish, 7 of potted head, 3 of German sausages, 7 of cooked meat, &c., and 2 crates of cauliflowers; altogether, 55 parcels. The importance of the duties performed by your Sanitary Officers is made obvious by this detail of works accomplished. How much suffering has been prevented, and how many lives saved, by the prompt application of sanitary regulations, cannot be readily expressed in figures, like the diseases and deaths that occur in spite of our efforts; but we may be assured of this, that a large amount of mortality is produced by the noxious causes we arc engaged in removing ; and although our successes in this warfare with deadly influences, may not be calculable, they are not less real. Further experience may enable us to speak with more precision, even as to these negative facts, and then we shall be able to see some return for our labours. I have the honour to be, Gentlemen, Tour obedient Servant, GEORGE ROSS, M. D., Medical Officer of Health, St. Giles District. 20 TABLE I.—Registered, Deaths in 52 Weeks of 1871. Sub-districts of St. Giles. Deaths in Sub-Districts. [Population 1861] First Quarter. 13 weeks. Second Quarter. 13 weeks. Third Quarter 13 weeks. Fourth Quarter. 13 weeks. Whole Year, 1871. 52 weeks. M. F. M. F. M. F. M. F. M. F Both Sexes. St. George, Bloomsbury. [17813.] 44 53 38 36 31 38 49 47 162 174 336 St. Giles. South. [19089.] 75 78 61 77 78 69 79 81 293 305 598 St. Giles, North. [16497.] 39 50 38 32 41 40 41 40 159 162 321 Whole District. 53429 .] 158 181 137 145 150 147 169 168 614 641 1255 TABLE II.—Registered Births in 52 Weeks of 1871. 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, 1871. 53 weeks. M. F. M. F. M. F. M. F. M. F. Total Children St. George, Bloomsbury 68 61 60 61 50 42 62 55 246 219 465 St. Giles, South 120 109 108 101 91 79 73 93 392 382 774 St. Giles, North 50 52 70 50 44 51 68 65 232 218 450 Whole District 238 222 238 212 191 172 203 213 870 819 1089 TABLE No. III. Shewing the Mortality in each Quarter and in each Sub-District (including the Deaths in Hospitals). Class CAUSES OF DEATH. 1st Quarter. 2nd Quarter 3rd Quarter 4th Quarter In Hospitals St. George, Bloomsbury St. Giles South St. Giles North St. George, Bloomsbury St. Giles South St. Giles North St. George, Bloomsbury St. Giles South St. Giles North St. George, Bloomsbury St. Giles South St. Giles North St. George, Bloomsbury St. Giles South St. Giles North 1 Order 1. Small Pox 1 4 1 3 3 3 ... 2 5 16 1 3 11 18 17 Measles 1 ... 1 ... 1 1 2 ... 1 2 4 1 ... 1 ... Scarlet Fever 1 5 2 1 5 ... ... ... 1 3 ... ... ... ... 2 Diphtheria ... ... ... ... 1 ... 1 ... ... ... ... ... 6 Quinsy ... ... ... ... ... ... ... ... ... ... 3 Croup 1 ... ... ... 1 ... 2 ... ... ... 1 Whooping Cough 2 1 ... 5 3 3 2 2 9 2 3 5 Fever 3 1 2 ... ... 1 1 5 2 2 1 ... 1 6 1 Erysipelas 2 2 ... ... 1 1 1 2 1 2 2 ... ... ... 1 Metria ... 1 Dysentery 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Diarrhœa ... 2 ... 1 ... ... 16 18 15 2 4 2 ... ... 2 Rheumatism 1 1 ... ... ... ... ... ... 1 1 4 ... ... 1 Other Miasmatic Diseases 1 ... ... ... ... ... ... ... ... ... ... ... 1 Order 2. Syphilis ... 1 1 1 1 1 1 ... ... 1 ... ... 1 1 Stricture Urethra ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Order 3. Want of Breast Milk ... ... ... ... ... ... 1 Purpura ... ... ... 1 Delirium Tremens 1 ... ... ... ... ... ... 1 ... ... 1 Order 4. Thrush ... ... 1 ... ... ... ... ... 1 2 Order 1. Gout ... ... ... ... 1 Dropsy ... 1 3 ... ... ... ... 1 ... 1 ... 1 Cancer 2 1 ... 2 1 ... 1 2 1 1 2 1 3 4 Mortification ... ... 1 ... ... ... ... ... ... 2 Order 2. Tabes 2 3 3 1 4 1 4 3 4 ... 8 6 Phthisis 8 23 13 12 24 16 5 16 13 8 11 12 2 9 2 Hydrocephalus 4 6 2 1 7 3 1 3 6 ... 1 1 ... 1 3 Order 1. Cephalitis 1 Apoplexy 3 4 4 3 3 1 3 1 2 5 5 ... ... Paralysis ... 7 ... 1 3 1 3 3 ... 1 5 2 Epilepsy ... 3 ... 1 ... ... ... 1 ... ... 1 1 Convulsions 4 3 2 3 10 3 4 5 1 5 4 ... ... 2 Other Brain Diseases ... ... ... 1 1 ... ... ... 1 ... ... 2 ... ... 1 Order 2. Pericarditis 1 ... ... ... ... ... ... 1 ... ... 1 Other Heart Disease 5 7 3 7 8 1 4 6 ... 2 10 4 1 4 1 Order 3. Laryngitis ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 Bronchitis 25 41 18 9 21 4 6 16 5 16 51 14 ... 4 1 Pleurisy ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 1 Pneumonia 6 8 4 ... 8 7 2 6 1 7 12 5 ... 2 2 Asthma 2 ... 3 1 ... ... ... ... ... 1 ... ... Other Lung Diseases 3 2 ... 1 ... 1 2 ... ... 3 1 2 ... 1 Order 4. Gastritis ... ... ... ... ... ... 1 ... 1 Enteritis ... ... ... ... ... ... 1 2 ... ... 1 1 ... Peritonitis 1 3 ... ... 1 1 ... 4 1 1 2 ... ... 1 Ascitis ... ... ... ... ... 1 ... ... ... ... 1 ... Ulcer Intestines ... 1 ... ... ... 1 1 ... ... Hernia 1 ... ... Intussusception ... ... ... ... ... 1 ... ... ... ... ... ... ... Stricture Intestines ... 1 ... Stomach Disease ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Hepatitis ... ... ... ... ... ... 1 2 ... ... ... ... ... ... Liver Disease 3 1 1 5 ... 2 5 1 1 2 1 1 1 1 1 Order 5. Nephritis ... ... ... ... ... ... ... ... 1 Ischuria ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Nephria ... ... 1 2 1 ... ... ... ... ... ... ... ... 2 ... Diabetes ... ... ... ... ... ... ... ... 1 Stone ... ... ... 1 Cystisis ... ... ... 1 2 ... ... ... ... ... ... 1 ... Kidney Disease ... ... ... ... ... ... ... 2 ... ... ... ... ... Order 6. Urerine Disease ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... Order 7. Bone Disease ... 1 ... ... 1 ... ... 1 ... ... ... ... 1 3 Order 8. Phlegmn ... 2 ... ... 1 ... 1 ... ... 1 ... 1 Ulcer ... ... ... ... 1 ... •.. ... 1 Skin Disease ... ... ... ... ... ... ... ... 1 ... ... ... 4 Order 1. Premature Birth 1 3 3 ... 4 ... ... 3 2 ... 1 1 Teething 1 3 3 1 2 ... ... 2 4 Other Malformations ... 1 ... 1 ... ... 1 1 ... Order 2. Childbirth ... ... 2 ... 3 1 ... ... ... ... ... 1 ... 1 Order 3. Old Age 5 2 2 ... 7 3 5 3 3 1 3 1 Order 4. Atrophy and Debility 3 5 3 5 5 6 7 12 5 5 6 3 5 Order 1. Fractures ... 1 ... 1 1 1 ... 1 ... 1 1 1 1 2 Wounds ... 1 ... Burns and Scalds ... ... ... 1 ... ... 1 Poison 1 ... ... 2 ... ... X Suffocation 1 2 3 ... 1 ... ... 1 1 Order 3. Homicide ... ... ... ... ... ... ... ... ... 2 ... 1 Order 4. Wounds ... ... ... ... 1 1 ... ... ... ... ... ... ... TABLE IV.—Causes of Death in the St. Giles District in 1871, with the Ages at Death. (Correction is here made for deaths in Hospitals.) Class. Causes of Death. At all Ages. Under 1 year. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Sub-Districts. Males. Females. Total. St. Geo. Blmsby. St. Giles South. St. Giles North. All causes 681 711 1392 ... 220 ... ... 260 264 ... ... ... ... Specified causes 676 708 1384 319 219 103 182 257 260 41 384 642 354 (Classes.) I. Zymotic Diseases 156 158 314 94 93 56 36 24 10 1 105 116 89 II Constitutional „ 150 129 279 31 42 25 82 76 22 1 59 131 89 III. Local „ 286 328 614 114 73 22 54 146 190 15 173 315 126 IV. Developmental „ 66 80 146 73 7 ... 8 1 34 23 36 67 43 V. Violent Deaths 18 13 31 7 4 ... 2 10 4 1 1J 13 / (Orders.) I. 1 Miasmatic Diseases 146 149 295 85 92 56 32 19 10 1 98 109 86 2 Enthetic „ 6 6 12 7 ... ... 2 3 ... ... 4 5 3 3 Dietic „ 3 2 5 1 ... ... 2 2 ... ... 3 2 ... 4 Parasitic ,, 1 1 2 1 1 ... ... ... ... ... ... ... 2 II. 1 Diathetic „ 13 18 31 ... ... ... 5 14 11 1 11 13 7 2 Tubercular „ 137 111 248 31 42 25 77 62 11 ... 48 118 82 III. 1 Diseases of Nervous System 60 60 120 36 13 1 8 24 33 5 33 62 25 2 „ of Organs of Circulation 27 39 66 ... 1 3 13 19 28 2 20 37 9 3 „ of Respiratory Organs 147 182 329 70 55 8 17 71 101 7 84 175 70 4 „ of Digestive Organs 34 29 63 5 1 5 12 24 16 ... 26 22 15 5 „ of Urinary Organs 8 9 17 ... 1 ... 2 5 8 1 6 7 4 6 „ of Organs of Generation ... 3 3 ... ... ... ... 2 1 ... 1 1 1 7 „ of Organs of Locomotion 5 2 7 ... 1 3 2 1 ... 1 6 ... 8 „ of Integumentary System 5 4 9 3 1 2 ... ... 3 ... 2 5 2 IV. 1 Dev. Diseases of Children 18 20 38 32 6 ... ... ... ... ... 5 20 13 2 „ of Adults ... 8 8 ... ... ... 8 ... ... ... ... 4 4 3 „ of Old People 13 22 35 ... ... ... ... ... 16 19 11 15 9 4 Diseases of Nutrition 35 30 65 41 1 ... ... 1 18 4 20 28 17 V. 1 Accident or Negligence 17 10 27 7 4 ... 2 9 4 1 9 12 6 3 Homicide ... 3 3 3 ... ... ... ... ... ... 2 ... 1 4 Suicide 1 ... 1 ... ... ... ... I ... ... ... 1 ... 5 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths not classed ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Deaths, cause certained ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified or ill- defined 5 3 8 ... 1 ... ... 3 4 ... ... ... ... Note.—The Sub-District was not ascertained in four instances. TABLE IV.—Di.sease in Orders—(Continued.) Class. Causes of Death. At all Ages. Under 1 year. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Sub-Districts. Males. Females. Total. St. Geo Blmsbry. St. Giles South. St. Giles North. I. Order 1. 1 Small Pox 47 41 88 10 21 33 20 4 ... ... 31 28 29 2 Measles 7 8 15 1 11 2 ... 1 ... ... 5 6 4 3 Scarlatina 9 11 20 1 13 5 1 ... ... 6 10 5 4 Diphtheritis 2 5 7 ... 4 2 ... 1 ... ... 6 1 ... 5 Quinsy 1 2 3 ... 2 1 ... ... ... ... ... 3 ... 6 Croup 3 13 6 1 5 ... ... ... ... ... 4 2 ... 7 Whooping Cough 22 16 38 18 20 ... ... ... ... ... 11 10 17 8 Continued Fevers, Ty- phus, &c. 17 9 20 1 1 9 5 6 4 7 12 7 9 Erysipelas 11 5 16 6 ... ... 1 3 o 1 ... 1 3 10 Metria ... 1 1 ... ... 1 ... ... ... ... ... ... ... 11 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Dysentery 1 1 2 ... 1 ... 1 ... ... ... 1 ... 1 14 Diarrhœa 30 32 62 47 14 1 ... ... ... ... 19 23 19 15 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Rhenmatism 5 4 9 ... ... 2 3 3 1 ... 2 6 1 19 Other Miasmatic Dis. 1 1 2 ... ... ... 1 1 ... ... 2 ... ... Order 2. 1 Syphilis 4 5 9 7 ... ... ... 2 ... ... 4 3 2 2 Stricture of Urethra 1 1 2 ... ... ... 1 1 ... ... ... 1 1 4 Glanders 1 ... 1 ... ... ... 1 ... ... ... ... 1 ... Order 3. 1 Privation ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Want of Breast Milk 1 ... 1 1 ... ... ... ... ... ... 1 ... ... 3 Purpura ... 1 1 ... ... ... ... 1 ... ... 1 ... ... 4 Alcoholism.— a Delirium Tremens 2 1 3 ... ... ... 2 1 ... ... 1 2 ... b Intemperance ... ... ... ... ... ... ... ... ... ... ... ... ... Order 4. 1 Thrusn 1 1 2 1 1 ... ... ... ... ... ... ... 2 2 Worms ... ... ... ... ... ... ... ... ... ... ... ... ... II. Order 1. 1 Gout 1 ... 1 ... ... ... ... ... 1 ... ... 1 ... 2 Dropsy 4 3 7 ... ... ... 1 4 2 ... 1 2 4 3 Cancer 7 13 20 ... ... ... 4 9 7 ... 8 10 2 4 Noma ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Mortification 1 2 3 ... ... ... ... 1 1 1 2 ... 1 Order 2. 1 Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Tabes Mesenterica 20 19 39 16 18 4 1 ... ... ... 7 18 14 3 Phthisis 95 79 174 1 6 18 76 62 11 ... 35 83 56 4 Hydrocephalus 22 13 35 14 18 3 ... ... ... ... 6 17 12 III. Order 1 1 Cephalitis ... 1 1 ... ... 1 ... ... ... ... 1 ... ... 2 Apoplexy 14 20 34 2 ... ... 4 11 15 2 14 13 7 3 Paralysis 11 15 26 ... ... ... ... 10 13 3 5 18 3 4 Insanity ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Epilepsy 5 2 7 ... 1 ... 2 2 2 ... 1 5 1 7 Convulsions & Laryngismus 26 20 46 34 11 ... ... 1 ... ... 11 25 10 8 Other Brain Diseases 4 2 6 ... 1 ... 2 ... 3 ... 1 1 4 Order 2. 1 Pericarditis 2 1 3 ... ... 1 2 ... ... ... 1 2 ... 2 Aneurism ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Heart Disease, &c. 25 38 63 ... 1 2 11 19 28 2 19 35 9 Order 3. 1 Laryngitis 3 ... 3 ... 2 ... 1 ... ... ... ... 1 2 2 Bronchitis 98 132 230 38 34 3 6 56 87 6 56 132 42 3 Pleurisy 1 2 3 ... 1 ... 2 ... ... ... ... 2 1 4 Pneumonia 36 34 70 27 17 5 6 9 6 ... 15 36 19 5 Asthma 3 4 7 ... ... ... ... 4 3 ... 4 ... 3 6 Other Lung Diseases 6 10 16 5 1 ... 2 2 5 1 9 4 3 TABLE IV.—Diseases in Orders—(Continued.) Class. Causes of Death. At all Ages. Under 1 year. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Sub-Districts. St. Geo. Blmsbry St. Giles South. St. Giles North. Males. Females. Total. Order 4. 1 Gastritis 2 ... 2 1 ... ... ... 1 ... ... 1 ... 1 2 Enteritis 3 3 6 ... ... 2 2 1 1 ... 1 3 2 3 Peritonitis 7 7 14 3 1 ... 3 5 2 ... 2 10 2 4 Ascites 1 1 2 ... ... ... ... 1 1 ... ... 1 1 5 Ulcer. Intest. 2 1 3 ... ... ... ... 2 1 ... 1 1 1 6 Hernia ... 1 1 ... ... ... ... 1 ... ... 1 ... ... 7 Ileus ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Intussusception ... 1 1 ... ... ... ... ... 1 ... ... ... 1 9 Strict. Intest. 1 ... 1 ... ... ... ... 1 ... ... ... 1 10 Fistula ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Stomach Disease, &c. 1 1 2 1 ... ... 1 ... ... ... 1 1 ... 12 Pancreas Disease ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Hepatitis 1 2 3 ... ... 1 2 ... ... ... 1 1 1 14 Jaundice 1 1 2 ... ... ... ... 1 1 ... 2 ... ... 15 Liver Dis. &c. 15 11 26 ... ... 2 4 11 9 ... 16 4 6 16 Spleen Disease, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... Order 5. 1 Nephritis 1 ... 1 ... ... ... ... 1 ... ... ... ... 1 2 Ischuria 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... 3 Nephria 4 3 7 ... 1 ... 2 2 2 ... 2 3 2 4 Diabetes ... 1 1 ... ... ... ... 1 ... ... 1 ... ... 5 Stone 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... 6 Cystitis ... 4 4 ... ... ... ... 1 2 1 1 2 1 7 Kidney Disease, &c. 1 1 2 ... ... ... ... ... 2 ... ... 2 ... Order 6. 1 Ovarian Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Uterine Disease, &c. ... 3 3 ... ... ... ... 2 1 ... 1 1 1 Order 7. 1 Arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Bone Disease, &c. 5 2 7 ... 1 3 2 1 ... ... 1 6 ... Order 8. 1 Phlegmon 4 2 6 2 ... 2 ... ... 2 ... 2 3 1 2 Ulcer ... 1 1 ... ... ... ... ... 1 ... ... 1 ... 3. Skin Disease, &c. 1 1 2 1 1 ... ... ... ... ... ... 1 1 Order 1. IV. 1 Premature Birth 7 11 18 18 ... ... ... ... ... ... 1 11 6 2 Cyanosis ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Spina Bifida ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Other Malformations 1 3 4 3 1 ... ... ... ... ... 2 2 ... 5 Teething 10 6 16 11 5 ... ... ... ... ... 2 7 7 Order 2 1 Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Childbirth (see Metria) ... ... 8 8 ... ... ... 8 ... ... ... ... 4 4 Order 3. 1 Old Age 13 22 35 ... ... ... ... ... 16 19 11 15 9 Order 4. 1 Atrophy and Debility 35 30 65 41 1 ... ... 1 18 4 20 28 17 Order 1. V. (Accident or Negligence.) 1 Fractures, &c. 7 4 11 ... 1 ... 1 6 2 1 3 6 2 2-3 Wounds 1 ... 1 ... ... ... ... 1 ... ... ... 1 ... 4 Bruns, &c. 1 1 2 ... 2 ... ... ... ... ... 2 ... ... 5 Poison 1 2 3 ... ... ... 1 1 1 ... 3 ... ... 6 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Suffocation 6 3 9 7 1 ... ... ... 1 ... 1 4 4 8 Otherwise 1 ... 1 ... ... ... ... 1 ... ... ... 1 ... Order 3. Homicide ... 3 3 3 ... ... ... ... ... ... 2 ... 1 Order 4. (Suicide) 1 Wounds—Gunshot ... ... ... ... ... ... ... ... ... ... ... ... ... 2 „ Cut, Stab 1 ... 1 ... ... ... ... 1 ... ... ... 1 ... 3 Poison ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ...