STLU 2 REPORT on the SANITARY CONDITION, VITAL STATISTICS, &C„ of the Parish of St. Luke, Middlesex, FOR THE YEAR 1894, by G. E. YARROW, M. D., Barrister-at-Law, DIPLOMATE IN PUBLIC HEALTH, ROYAL COLLEGE OF PHYSICIANS AND SURGEONS, LONDON. PRESIDENT OF THE METROPOLITAN BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. FELLOW OF THE BRITISH INSTITUTE OF PUBLIC HEALTH, OBSTETRICAL GYNECOLOGICAL AND HUNTERIAN SOCIETIES, MEMBER OF THE HONOURABLE SOCIETY OF GRAY'S INN, ETC. MEDICAL OFFICER OF HEALTH FOR THE PARISH. LONDON: Thomas Bean & Son, Phoenix Works, Golden Lane, E.C. 1895 REPORT on the SANITARY CONDITION, VITAL STATISTICS, &C., of the Parish of St. Luke, JVIiddleseX, FOR THE YEAR 1894, by G. E. YARROW, M.D., Barrister-at-Law, DIPLOMATE IN PUBLIC HEALTH, ROYAL COLLEGE OF PHYSICIANS AND SURGEONS, LONDON. PRESIDENT OF THE METROPOLITAN BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. FELLOW OF THE BRITISH INSTITUTE OF PUBLIC HEALTH, OBSTETRICAL, GYNECOLOGICAL AND HUNTERIAN SOCIETIES, MEMBER OF THE HONOURABLE SOCIETY OF GRAY'S INN, ETC. MEDICAL OFFICER OF HEALTH FOR THE PARISH. LONDON: Thomas Bean & Son, Phcenix Works, Golden Lane, E.C. 1895 400—20/4/95. TO THE VESTRY OF THE PARISH OF ST. LUKE, MIDDLESEX. Gentlemen, In presenting this, my tenth Annual Report on the Health, Sanitary condition, and Vital Statistics of the Parish, permit me again to advert to the continued decrease in the population in its Southern Districts, by reason of the demolition of dwelling houses and erection of Warehouses and Factories, and while the same observation applies to some extent to the Northern Districts, it is more than compensated for by the recent erection of Guinness' Trust Buildings, and the crowding together of the poorest of the population in the houses vacated by well-to-do Artizans. Added to which an increase in the number of Births and a considerable decrease in the Deaths, afford some explanation of what might otherwise appear questionable, and together form the basis of my estimate of the population, upon which the following statistics are formed:— The statistics of Marriages, Births, and Deaths, contained herein, relate to the fifty-two weeks ending December 29th, 1894, and are calculated upon a population, estimated to the middle of the year, of 42,941, and divided between the three Sub-Registration Districts, as follows :— Estiimated Population at Midsummer, 1894. Corrected Census Return, 1891. City Road 30,605 29,177 Whitecross Street 7,843 8,278 Finsbury 4,493 4,985 Total 42,941 42,440 The number of Marriages celebrated in St. Luke during the year were 222, the number of persons Married being in proportion to 10.3 per 1000 of the population, being a decrease on the year 1893 of 0.9 per 1,000. The Metropolitan Marriage Rate was 17.4 per 1,000, 4 Births. The Births registered in the Parish during the year 1894 numbered 1876, of these 487 children were born in the City of London Lying-in Hospital, but as only 43 of the mothers were permanent residents of the Parish of St. Luke, a deduction of 444 has to be made from the total number, leaving 1432 as the actual number of Births to be credited to the Parish, and after allotting 43 to the several districts of the Parish in which the parents resided, the Births of the respective sub-districts were as follows :— In the City Road Sub-Registration District there were 1077. In the Whitecross Street Sub-Registration District there were 258, and in the Finsbury Sub-Registration District there were 97. In relation to the estimated popidation the figures stand as under :— Births per 1000 Inhabitants. For the whole Parish 33.34 City Eoad Sub-Begistration District 35.19 Whitecross Street32-89 Finsbury „ „ 21.58 By comparing the above figures with those which relate to the three preceding years it will be seen that the number of Births, which had been gradually decreasing, last year showed a slight increase, due no doubt to the circumstance that the Artizans' Dwellings, now so numerous in the Parish, are occupied by persons at the period of life when the families are on the increase. In support of this view I may refer to the Report of the Trustees of the Peabody Donation Fund for the year 1894, in which it is stated that the Birth Rate in their Dwellings for the year reached 36.3 per 1,000, being 6.3 per 1,000 above that of London for the same period, while the death rate, including those who died in Hospitals, was 15.7 per 1,000, or 2.0 below the average of London. (A list of the Artizans' Dwellings with their estimated population will be found at Pages 24 and 25). The number of Births belonging to the Parish for the past four years and rate per 1,000 of the population. Births Rate per 1000 1891 1533 36.14 1892 1478 34.89 1893 1420 33.18 1894 1432 33.34 5 The increased number of births over deaths during the year 1894 amounted to 481, a knowledge of which fact assists in forming an estimate of the population, as already indicated. Deaths. The deaths from all causes registered during the year, belonging to St. Luke, numbered 951, and includes 397 parishioners who died in Institutions outside the Parish, but is exclusive of 71 non-parishioners who died within our parochial boundary. This, with the exception of the year 1889, is the smallest number of deaths that have been recorded for the nine years during which the deaths of persons dying in out-lying Institutions have been included in our Returns. Of the 951 parishioners, 534 were males and 417 were females, and yield upon the estimated population a death rate equal to 22.14 per 1000 persons living, being a decrease upon our last year's death rate of 7.70 per 1000, as shown by the following figures:— Deaths Rate per 1000 1892 1074 25.57 1893 1277 29.84 1894 951 22.14 Infant Mortality :—Of the 951 deaths 376 or 39.5 per cent. occurred to infants under 5 years of age. Mortality over 65 years of age :—205 parishioners were over 65 at the time of death, being at the rate of 21.5 per cent, of the total deaths recorded. The 71 deaths of non-parishioners occurred at the following Hospitals and other places in the Parish. Eoyal Hospital for Diseases of the Chest 41 City of London Lying-in Hospital 12 St. Luke's Hospital for Lunatics 15 Suicide by Drowning in Regent's Canal 1 „ Poisoning at an Hotel in Finsbury 1 Injuries by Machinery at a Warehouse in City Road 1 71 Hospitals, Asylums, Infirmaries, Workhouses and other Institutions situated outside the Parish at which Parishioners died during the year:— 6 Asylum for Imbeciles, Banstead 3 ,, „ Caterham 1 ,, „ Darenth 2 ,, „ Leavesden 1 Cattle Market, Islington 1 Cancer Hospital, Fulham 1 Central Sick Asylum, Cleveland Street 1 City of London Hospital for Consumption 1 City of London Infirmary, Bow 2 City Prison, Holloway 1 Colney Hatch Asylum 3 " Freidheim," St. John's Wood 2 German Hospital, Dalston 1 Guy's Hospital 2 Hackney Union Infirmary 1 Holborn Union Infirmary, Archway Eoad 90 Holborn Union Workhouses, Shepherdess Walk, Gray's Inn Boad and Mitcham 160 Hospital for Consumption, Brompton 3 Hospital for Sick Children, Great Ormond Street 6 Islington Workhouse Infirmary 1 Ilford Asylum 1 King's College Hospital 1 London Hospital 4 Metropolitan Asylums Board Hospitals and Ships 19 Middlesex Hospital 2 North London Hospital for Consumption 1 Royal Free Hospital 2 St. Bartholomew's Hospital. 72 Shoreditch Workhouse Infirmary 1 St. Luke's House, Osnaburgh Street 1 St. Mary's Hospital 1 St. Peter's Hospital 1 St. Saviour's Infirmary 2 St. Thomas's Hospital 1 University College Hospital 2 394 Inquests. Ninety Inquests were held on the bodies of Parishioners during the year, being at the rate of 9.4 per cent. of the total deaths. Seventy-one inquiries (three being into the cause of death of non-Parishioners) took place at the Coroner's Court belonging to this Parish, and the cause of death was ascertained by Post-mortem examination in 37 instances. 7 The remaining 22 inquiries were held at Hospitals and Institutions outside our Parochial area. Of the total Inquests the results were recorded as follows:— Deaths due to natural causes 51 Accidental— Deaths due to injuries, the result of blows, falls, &c 14 ,, ,, from burns 2 „ ,, „ being run over 2 „ „ „ machinery 1 „ Poison 2 ,, suffocation while in bed with Parents ... 6 „ ,, at a fire 1 ,, ,, abscess in throat ... ... 1 „ ,, while in a fit 1 „ „ while drunk 1 Infants still-born 3 Suicide— Poisoning by Carbolic Acid 1 ,, some Narcotic 1 By exploding gunpowder in the mouth 1 „ lumping from a window 1 „ Hanging 1 ,, Drowning 2 ,, Cut Throat 1 93 Return of Sickness and Mortality. At the end of this Report the following tables will be found : No 1., giving the population, births, and cases of infectious disease which have come to my knowledge during the year 1894. No. II., the deaths which have been registered in the Parish, including also the deaths of parishioners in hospitals and other institutions outside the sanitary district, classified according to diseases, ages and localities. These tables are prepared in accordance with the requirements of the Local Government Board, in order to insure greater uniformity in the reports of Medical Officers of Health than has hitherto existed. Table No. III. is of a more comprehensive character, and shows the deaths registered from all causes, inclusive of the deaths of parishioners at hospitals and public institutions outside the district, but exclusive of the deaths of non-parishioners at public institutions within the Parish. 8 Table IV. is a return prepared by Mr. Neighbour, the Vaccination Officer, setting forth the number of cases of successful vaccination, so far as relates to children whose births were registered during the year ending June 30th, 1894. The figures show that those not yet found in consequence of removals, etc., number 180 out of a total of 1857, being 9.6 per cent., a deficiency greater than in former years, and may fairly be ascribed to the following reasons—First, a growing opposition to the operation of vaccination, encouraged by the delay in the Report of the Royal Commission, and a vague belief that the said Report will be condemnatory of the practice. Sickness and Deaths due to the principal Zymotic or Communicable Diseases. Small-pox.—Only one death was certified as due to this cause during the year. The patient in question was a girl six years old. At the time of attack she was attending a Board School. She was removed to the hospital ship Atlas, and died after 9 days' illness. She was unprotected by vaccination. The deaths registered in London from small-pox numbered 93, against 206 for the previous year. The total number of cases of sickness notified as Small-pox, belonging to the Parish, during the year was 16, and the result of enquiries into the particulars of each case was as follows :—Three cases were ascertained not to be Small-pox. The source of infection in three instances was a child who was suffering fron a rash which at the time was erroneously thought to be chicken pox, and no precautions were therefore taken to prevent the spread of the disease. One case was that of a casual visitor to a house where a servant was ill with what ultimately turned out to be Small-pox. The servant in question returned to her parents home in in adjoining parish and the nature of her illness was not discovered until several other persons had become infected. The ages of the 16 cases notified varied from 13 to 40 years, and with the exception of the one fatal case above-mentioned, all had been vaccinated in infancy, thus furnishing another proof, if such were needed, of the protection to life which is afforded by vaccination, and while dealing with this subject, 1 should like to refer to a statement frequently used by the antivaccinators, that the decrease in small pox is due not to vaccination but to the better sanitary arrangements which now exist than was formerly the case. Now if this view were correct, why, it may be asked, has Small-pox yielded so marvellously to Hygiene, while it still allows Scarlet Fever, Diphtheria and Measles to continue their periodical ravages. 9 Scarlet Fever.—This disease, which during 1892 and 1893 had assumed an epidemic form throughout the Metropolis, showed considerable signs of abatement during last year, when 964 deaths were registered due to it, against 1596 for the preceding year. In our own district nine deaths were certified, as against 26 for the previous year. The cases of sickness from the same cause numbered 124 against 341 for the year 1893. Diphtheria caused 15 deaths to Parishioners. The returns of the Registrar General show that although the number of deaths ascribed to Diphtheria in London amounted to 2,473 during the year, the fatality was much less than in the preceding year, when the number reached was 3,265, this being also the greatest number ever recorded under this heading. On reference to table I. it will be seen that the number of cases of sickness from Diphtheria was 59, and Membranous Croup, eight. I have taken these diseases together, as they are regarded by many observers as identical, the term Diphtheria being however more frequently employed. The incidence of Diphtheria in London is such an important subject that no one will be surprised at it having occupied considerable attention of the great central Boards of the Metropolis. A "Preliminary Memorandum upon the increase of Diphtheria in London," prepared by the Medical Officer of Health of the London County Council, was forwarded to the several Sanitary Authorities in October last. In this document a large amount of evidence is adduced in support of the view that the spread of the disease is largely due to school influence, and that there has been a great increase in the mortality from it in children between three and ten years of age since the Education Act came into operation in 1870, and the co-operation of Metropolitan Medical Officers of Health is solicited to supply the London County Council with any definite knowledge on the subject. The School Board for London have lately passed a resolution requesting their Medical Officer to report generally on the prevalence of Diphtheria in London, and its alleged connection with Elementary Schools. This latter gentleman also has asked the Medical Officers of Health to supply him with any direct evidence bearing upon the suggestion. It has been the practice in your Public Health Department for many years past to 10 forward intimation to School Authorities of any case of Infections Disease occurring in the person of a scholar or even in a house from which children are attending school, and further to certify when infection ceased to exist in each case. I do not know what more can be done to facilitate the proposed enquiry, hut I am certain that any suggestion having this object in view will be gladly adopted by Sanitary Authorities and their Officers. Reference to this subject would not be complete unless mention were made to what is known as the anti-toxin treatment of the disease, the success of which in France and Germany has induced the Managers of the Metropolitan Asylums Board to give this treatment a trial in the hospitals under their control. That the lymph exerts a marvellous influence upon the disease is beyond dispute, but the amount of its curative properties can only be ascertained by experience, and better opportunities for obtaining which can hardly be conceived than that possessed by the Metropolitan Asylums Board. Arrangements have also been made between the Managers and the Royal College of Physicians and Surgeons for Bacteriological investigations to be made into the cases under the care of the Managers, with a view to the early recognition of the disease and its differentiation from other throat affections. Fever.—Under this head four deaths were registered, all of them being ascribed to enteric or typhoid fever. Three of the patients died in institutions outside the Parish and one in the City Road Sub-registration District. This is the smallest number of deaths from fever it has been my duty to record since 1888, in which year the number and nature of the disease were identical with this year's return. The table of Infectious Sickness shows an equally favourable account, there having been only 17 cases of fever notified, and all being described as enteric. In the Metropolitan area there were 653 deaths from fever, against 719 for the year 1893. Whooping Cough was the cause of 18 deaths, being a marked decrease upon the previous year, when 40 deaths were certified to this cause. The number of deaths registered in London from whooping cough was 2094, and although the disease showed a considerable increase during each quarter of the year, yet the total result showed that the death rate was considerably below the average of the preceding ten years. 11 This not being among the notifiable diseases, I am unable to record the amount of sickness which existed from it during the year. Measles.—This disease was credited with having caused 13 deaths, against 51 for the preceding year, the degree of prevalence of this malady, like the last, can only be judged of by the number of deaths ascribed to it, because it also is not notifiable under the Public Health Act. Measles was very prevalent in London during the year, almost double the number of deaths occurred to those of the previous year, namely 3292 against 1661, the number being—788 during the first quarter, it rose to 1745 during the second quarter, and then gradually fell to 300 during the fourth quarter. Diarrhœa caused 17 deaths, 16 of which occurred to children under five years of age. The number of deaths in London during the year was much below the average. During the second quarter only 140 deaths were certified from this cause, and although during the third quarter as many as 1215 deaths were registered ; for the whole year the number reached was 1780, against 3446 for the year 1893, thus showing a saving of 1666 lives under this heading. In the Parish of St. Luke during the year 1893, 40 deaths were certified as due to Diarrhcea, 35 being children under five years of age. Cholera.—The precautions against the incursions of this disease recommended by the Local Government Board during the years 1892 and 1893 were revived during the past summer and autumn, with the additional opportunity afforded of having the valuable assistance of Professor Klein, of St. Bartholomew's Hospital, to enquire into any suspected case of cholera, or even rapidly fatal diarrhcea, simulating cholera, and in any case in which it was thought desirable of having material bacterially examined. Fortunately, as far as this parish is concerned, no such opportunity occurred. In this connection I have visited a large number of addresses furnished by the various Port Sanitary Authorities, being the reported destination of passengers arriving from various parts of the Continent, and have interviewed the said persons as to their state of health in cases in which the addresses were correctly furnished. 12 13 TABLE I. TABLE I. Table of Population, Births, and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1894, in the Metropolitan Sanitary District of St. Luke, Middlesex ; Classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics ; Public Institutions being shown as separate localities. Population at all Ages. Registered Births. Aged under 5 and over 5. New Cases of Sickness in knowledge of the each Locality, coming to the medical officer of health. Number of such Case* Removed from their Homes in the several Localities for Treatment in Isolation Hospital. 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11 12 13 Census 1891. Estimated to middle of 1894. Small-Pox. Scarlatina. Diphtheria. Membranous Croup Fevers Fevers. Cholera. Erysipelas. Small-Pox. Scarlatina. Diphtheria. Membranous Croup Typhus. Fevers. Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c ) (d ) (e ) City Road Sub-Registration District 29177 30605 1043 Under 5 ... 36 19 6 ... I ... ... ... ... 6 ... ... ... 31 6 ... ... ... ... ... ... ... ... ... ... 5 upwds 10 53 25 1 ... II ... ... ... ... 62 ... ... 10 48 18 ... ... 3 ... ... ... ... ... ... ... Whitecross Street Sub Registration District 8278 7843 250 | Under 5 ... 10 4 1 ... ... ... ... ... ... 4 ... ... ... 9 3 1 ... ... ... ... ... ... ... ... ... 5 upwds 1 17 5 ... ... 3 ... ... ... ... 11 ... ... 1 15 3 ... ... 3 ... ... ... ... ... ... ... Finsbury Sub-Registration District 4985 4493 96 Under 5 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 5 upwds 2 4 5 ... ... 2 ... ... ... ... 9 ... ... 2 4 3 ... ... 1 ... ... ... ... ... ... ... St. Luke's Hospital for Lunatics ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... City of London Lying-in Hospital ... ... 487 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Hospital for Diseases of the Chest ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... St. Mark's Hospital for Fistula, &c. ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 42440 42941 1876 Under 5 ... 47 24 7 ... 1 ... ... ... ... 10 ... ... ... 41 10 1 ... ... ... ... ... ... ... ... ... 5 upwds 13 77 35 1 ... 16 ... ... ... ... 82 ... ... 13 70 24 ... ... 7 ... ... ... ... ... ... ... 14 15 TABLE II. TABLE II. Table of Deaths, during the Year 1894, in the Metropolitan Sanitary District of St. Luke, Middlesex, Classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. (a) Mortality from all Causes, at subjoined ages. (i) Mortality from subjoined Causes, distinguishing Deaths of Children under five Years of Age. At all Ages. (b) Under 1 Tear. (c) 1 and under 5 (d) 5 and under 15 (e) 15 and under25 (f) 25 and under 65 (g) 65 and upward. (h) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Small-Pox. Scarl atina. Diphtheria. Membranous Croup Typhus. Fevers. Puerperal. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, and Pleuriav. Heart Disease. Injuries. All other Diseases. Total. Enteric or Typhoid. Continued. Relapsing. City Road Sub-Registration District 403 157 75 5 7 109 50 Under 5 ... 1 ... ... ... ... ... ... ... ... 2 9 11 11 ... ... 1 67 4 0 117 232 5 upwds ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 29 51 17 8 64 171 Whitecross Street SubRegistration District 94 30 21 1 2 28 12 Under 5 ... ... 1 ... ... ... ... ... ... ... ... 3 2 3 ... ... 1 21 ... 2 18 51 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 7 6 3 13 43 Finsbury Sub-Registration District 54 14 8 ... 2 21 9 Under 5 ... ... ... ... ... ... ... ... ... ... ... 1 3 ... ... ... ... 4 1 ... 13 22 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 8 ... 4 11 32 St. Luke's Hospital for Lunatics 17 ... ... ... ... 12 5 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 1 ... 12 17 City of London Lying-in Hospital 14 13 ... ... 1 ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Royal Hospital for Diseases of the Chest 46 1 1 2 10 32 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 2 11 ... 5 44 St. Mark's Hospital for Fistula, &c ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 628 215 105 8 22 202 76 Under 5 ... 1 1 ... ... ... ... ... ... ... 2 13 16 14 ... ... 2 94 5 11 161 320 5 upwds ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 81 69 35 15 106 308 The subjoined numbers have also to be taken into account in judging of the above records of Mortality. Deaths occurring outside the District among persons belonging thereto 394 32 37 17 20 154 134 Under 5 ... 4 14 ... ... ... ... ... ... ... ... ... 2 2 ... ... ... 14 2 3 28 69 5 upwds 1 4 ... ... ... 3 ... ... ... 3 ... ... 1 ... ... 47 71 38 10 147 325 Deaths occurring within the District among persons not belonging thereto 71 12 1 2 12 39 5 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 11 13 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 3 11 3 16 58 TABLE III. Deaths registered from all Causes, inclusive of the Deaths of Parishioners at Hospitals and Public Institutions outside the District, but exclusive of the Deaths of Non-Parishioners at Public Institutions within the Parish. causes of death. ages. Total under 5 years of age. Grand Total all Ages. 0 to 1. 1 to 5. 5 to 15. 15 to 35. 25 to 65. 65 and upwards. CLASSES. I. Specific Febrile or Zymotic Diseases 23 48 7 2 9 2 71 91 II. Parasitic Diseases ... ... ... ... ... ... ... ... III. Dietic Diseases 7 ... ... ... 4 ... 7 11 IV. Constitutional Diseases 23 22 4 15 107 11 45 182 V. Developmental Diseases 36 ... ... ... ... 48 36 84 VI. Local Diseases 99 6l 11 10 184 135 160 500 VII. Deaths from Violence 9 5 1 3 10 7 14 35 VIII. Deaths from ill-defined and not specified Causes 38 5 ... ... 3 2 43 48 235 141 23 30 317 205 376 951 I. Specific Febrile or Zymotic Diseases. 1. Miasmatic Diseases. Small Pox, Vaccinated ... ... ... ... ... ... ... ... „ Unvaccinated ... ... 1 ... ... ... ... 1 „ No Statement ... ... ... ... ... ... ... ... Measles 1 12 ... ... ... ... 13 13 Scarlet Fever ... 4 4 ... ... ... 4 8 Typhus ... ... ... ... ... ... ... ... Whooping Cough 2 16 ... ... ... ... 18 18 Diphtheria 1 ... ... ... ... ... 15 15 Simple Continued or Ill-defined Fever ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... 1 1 2 ... ... 4 Other Miasmatic Diseases ... ... ... ... ... ... ... ... 16 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of age. Grand Total all Ages. 0 to 1. 1 to 5. 5 to 15. 15 to 35. 25 to 65. 65 and upwards. Specific Febrile or Zymotic Diseases—continued. 2. Diarrheal Diseases. Simple Cholera ... ... ... ... ... ... ... ... Diarrhoea, Dysentery 15 2 1 ... 1 ... 17 19 3. Malarial Diseases. Remittent Fever ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... 4. Zoogenous Diseases. Cow-pox and effects of Vaccination ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... 5. Venereal Diseases. Syphilis 2 ... ... ... ... ... 2 2 Gonorrhoea, Stricture of the Urethra ... ... ... ... ... ... ... ... 6. Septic Diseases. Erysipelas 1 ... ... ... 2 2 1 5 Pyaemia, Septicaemia 1 ... ... ... 2 ... 1 3 Puerperal Fever ... ... ... ... 1 ... ... 1 Influenza ... ... ... 1 1 ... ... 2 23 48 7 2 9 2 71 91 II. Parasitic Diseases. Thrush and other Vegetable Parasitic Diseases ... ... ... ... ... ... ... ... Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... 17 TABLE III.—continued. causes of death. AGES. Total under 5 years of age. Grand Total all Ages. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. III. Dietic Diseases. Want of Breast Milk, Starvation 7 ... ... ... ... ... 7 7 Scurvy ... ... ... ... 2 ... ... 2 Chronic Alcoholism ... ... ... ... 2 ... ... 2 Delirium Tremens ... ... ... ... ... ... ... ... 7 ... ... ... 4 ... 7 11 IV. Constitutional Diseases. Rheumatic Fever, Rheumatism of the Heart ... ... ... ... ... ... ... ... Rheumatism ... ... ... ... 2 2 ... 4 Gout ... ... ... ... ... 1 ... 1 Rickets 4 2 ... ... ... ... 6 6 Cancer, Malignant Disease ... ... ... 1 10 6 ... 17 Tabes Mesenterica 5 5 ... ... ... ... 10 10 Tubercular Meningitis, Hydrocephalus 4 10 2 1 ... ... 14 17 Phthisis 1 2 ... 12 91 2 3 108 Other Forms of Tuberculosis, Scrofula 9 3 2 ... 2 ... 12 16 Purpura, Hasmorrhagic Diathesis ... ... ... ... ... ... ... ... Anaemia, Chlorosis, Leucocythaemia ... ... ... ... 1 ... ... 1 Glycosuria, Diabetes Mellitus ... ... ... 1 ... ... ... 1 Other Constitutional Diseases ... ... ... ... 1 ... ... 1 23 22 4 15 107 11 45 182 18 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of 'age. Grand Total all Ages. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. V. Developmental Diseases. Premature Birth 31 ... ... ... ... ... 31 31 Atelectasis 1 ... ... ... ... ... 1 1 Congenital Malformation 4 ... ... ... ... ... 4 4 Old Age ... ... ... ... ... 48 ... 48 36 ... ... ... ... 48 36 84 VI. Local Diseases. 1. Diseases of Nervous System. Inflammation of Brain or Membranes 5 3 ... ... 1 ... 8 9 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ... ... ... 20 32 ... 52 Insanity, General Paralysis of the Insane ... ... ... 1 3 4 ... 8 Epilepsy ... ... 1 ... 9 ... ... 10 Convulsions 23 2 ... ... ... ... 25 25 Laryngismus Stridulus (Spasm of Glottis) ... ... ... ... ... ... ... ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... 1 ... ... ... ... 2 Other Diseases of Nervous System 1 ... ... ... ... ... 1 1 2. Diseases of Organs of Special Sense. Diseases of Organs of Special Sense, e.g., of Ear, Eye, Nose ... 1 2 ... ... ... 1 3 3. Diseases of Circulatory System. Pericarditis 1 ... ... ... ... ... 1 1 Acute Endocarditis ... ... ... ... ... ... ... ... Valvular Diseases of Heart ... 1 ... 2 5 4 1 12 Other Diseases of Heart 1 2 3 2 28 15 3 51 Aneurism ... ... ... ... ... ... ... ... Embolism, Thrombosis ... ... ... ... ... ... ... 1 Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... 19 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of age. Grand Total all Ages. 0 to 1. 1 to 5. 5Uo 15. 15 to 25. 25 to 65. 65 and upwards. Local Diseases—continued. 4. Diseases of Respiratory System. Laryngitis ... ... ... ... 1 ... ... 1 Croup ... ... ... ... ... ... ... ... Emphysema, Asthma ... ... ... ... 3 9 ... 12 Bronchitis 39 27 ... 1 46 47 66 160 Pneumonia 19 19 ... 1 26 9 38 76 Pleurisy ... ... ... ... 2 ... ... 2 Other Diseases of Respiratory System ... ... ... ... ... ... ... ... 5. Diseases of Digestive Organs. Dentition 1 2 ... ... ... ... 3 3 Sore Throat, Quinsey .1. ... ... ... ... 1 ... 1 Diseases of Stomach ... ... ... ... 2 6 ... 8 Enteritis 5 2 ... ... 1 ... 7 8 Obstructive Diseases of Intestines 2 ... ... ... 3 ... 2 5 Peritonitis ... ... ... ... ... ... ... Ascites ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... 5 ... ... 5 Jaundice and other Diseases of Liver ... ... ... ... ... 1 ... 1 Other Diseases of Digestive System ... ... ... ... ... ... ... ... 6. Diseases of Lymphatic System. e.g., of Lymphatics and of Spleen ... ... ... 1 1 1 ... 3 7. Diseases of Glandlike Organs of Uncertain Use. e.g., Bronchocele, Addison's Disease ... ... 1 ... 1 ... ... 2 8. Diseases of Urinary System. Nephritis ... 2 ... ... 10 1 2 13 Bright's Disease, Albuminuria ... ... ... ... 9 ... ... 9 Disease of Bladder or of Prostate ... ... ... ... ... 2 ... 2 Other Diseases of the Urinary System 1 ... ... ... ... ... 1 1 20 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of age. Grand Total all Ages. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Local Diseases—continued. 9. Diseases of Reproductive System. Male Organs ... ... ... ... 1 ... ... 1 Female Organs ... ... ... ... ... ... ... ... Abortion, Miscarriage ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... ... ... ... Placenta Praevia, Flooding ... ... ... 1 1 ... ... 2 Other Accidents at Childbirth ... ... ... ... ... ... ... 10. Diseases of Bones and Joints. Caries, Necrosis ... ... 1 1 3 ... ... 5 Arthritis, Ostitis, Periostitis 1 ... ... ... 1 ... 1 2 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... 11. Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... 2 ... 2 Other Diseases of Integumentary System ... ... ... ... ... 1 ... 1 99 61 11 10 184 135 160 500 VII. Deaths from Violence. 1. Accident or Negligence. Fractions and Contusions 1 4 1 2 2 3 5 13 Gunshot Wounds ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... 1 ... ... 1 Burn, Scald ... 1 ... ... ... 1 1 2 Poison ... ... ... ... ... ... ... ... Drowning ... ... ... ... 1 ... ... 1 Suffocation 7 ... ... ... 2 1 7 10 Otherwise 1 ... ... ... ... 1 1 2 21 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of age. Grand Total all Ages. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 nnd upwards. Deaths from Violence—continued. 2. Homicide. Manslaughter ... ... ... ... ... ... ... ... Murder ... ... ... ... ... ... ... ... 3. Suicide. Gunshot Wounds ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... Poison ... ... ... ... 1 ... ... 2 Drowning ... ... ... ... 1 ... ... 1 Hanging ... ... ... ... 1 ... ... 1 Otherwise ... ... ... ... 1 1 ... 2 4. Execution. Hanging ... ... ... ... ... ... ... 9 5 1 3 10 7 14 35 VIII. Deaths from Ill-defined and notspecifiedCauses Dropsy ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 36 4 ... ... ... ... 40 40 Mortification ... ... ... ... 1 1 ... 2 Tumour ... ... ... ... ... ... ... ... Abscess 2 1 ... ... ... 1 3 4 Hasmorrhage ... ... ... ... ... ... ... 2 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined ... ... ... ... ... ... ... ... 38 5 ... ... 3 2 43 48 22 TABLE IV. Return respecting the Vaccination of Children whose Births were Registered between July 1st, 1893, and June 30th, 1894, in the Parish of St. Luke, Middlesex. REGISTRATION SUB-DISTRICTS. Registered. Vaccinated. Certified as Insusceptible. Had ' Small-Pox. Died unVaccinated. Postponed by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprized. Removal to Places Unknown and Cases not yet Found. Outstanding Cases. City Road 1514 1012 4 119 19 199 149 12 Whitecross Street 240 19O — — 22 4 — 22 2 Finsbury 103 84 — — 7 2 — 9 I Totals I857 1286 4 — 148 25 199 180 15 '"These are Children born in the Lying-in Hospital the Parents of whom belong to other Districts, the Officers of which have been furnished with the necessary information for enforcement of the Law 23 24 ACCOMMODATION AFFORDED BY THE VARIOUS INDUSTRIAL DWELLINGS IN THE PARISH OF ST. LUKE. Peabody's Buildings, Whitecross Street, consists of 33 Blocks of Buildings, containing the following separate lettings :— 144 Single Rooms at 2s. 6d. to 3s. 6d. per week rent. 369 Two ,, 4s. 3d. to 5s. 3d. ,, „ 325 Three ,, 5s. 9d. to 6s. 6d. ,, ,, 5 Four ,, 7s. 3d. to 7s. 6d. „ „ No. of lettings 843 Bartholomew Buildings, Seward Street, consist of 8 Blocks, containing :— 48 Single Rooms at 3s. 6d. to 4s. 9d. per week rent. 153 Two „ 5s. Od. to 6s. Od. „ ,, 44 Three „ 6s. 9d. to 7s. 3d. „ ,, 24 Four „ 8s. 6d. to 9s. Od. ,, „ No. of lettings 269 Peerless Buildings, Peerless Street, consists of 6 Blocks, containing :— 24 Three Room lettings at 6s. 9d. to 7s. 9d. per week. 48 Four „ ,, 7s. 3d. to 7s. 6d. „ No. of lettings 72 Palmerston Buildings, City Garden Row, consists of 3 Blocks, containing :— 36 Three Room lettings at 5s. 6d. to 6s. 3d. per week. 36 Four „ „ 7s. 3d. to 8s. ,, No. of lettings 72 St. Clement's Buildings, Lever Street, consists of 2 Blocks, containing :— 6 Two Room lettings at 4s. to 4s. 6d. per week. 54 Three ,, ,, 5s. to 7s. ,, No. of lettings60 Costermongers' Dwellings, Bunhill Row, consists of 2 Blocks, and contains :— 25 29 One Room lettings at 3s. 6d. per week. 23 Two „ ,, 5s. 6d. „ 4 Three „ „ 7s. „ No. of lettings 56 Eagle Dwellings, City Road, consists of 2 Blocks, and contains :— 18 Two Eoom lettings at 5s. to 6s. 6d. per week. 12 Three ,, „ 8s. to 9s. 6d. „ 4 Pour „ „ 10s. No. of lettings 34 Chapel Buildings, Blyth's Yard, contains :— 8 Three Room lettings at 9s. to 10s. per week. No. of lettings 8 Lever Buildings, Lever Street, contains :— 6 Four Room lettings at 9s. to lis. per week. No. of lettings 6 Guinness' Trust Buildings, Lever Street, consists of 14 Blocks, and contains :— 57 One Room lettings at 2s. to 3s. per week. 175 Two „ ,, 4s. to 5s. 6d. per week. 94 Three „ ,, 5s. to 6s. ,, 6 Four „ „ 6s. 3d. „ No. of lettings 332 Making a grand total of 1752 families occupying Artizans' Dwellings, and estimating 4½ persons to each family gives a total accommodation of 7884 persons. PUBLIC HEALTH (LONDON) ACT, and WORK OF THE SANITARY DEPARTMENT. Notification of Infectious Disease. The following Table give the number and nature of the cases notified under Sections 55 and 56 of the Public Health Act during the 52 weeks ended December 30th, 1894, and indicates also where the same received treatment:— 26  Total Number of Certificates from each cause. Treated at the Metropolitan Asylums Board Hospital. Treated at General Hospital and Infirmaries. Treated at their own Homes. Small-Pox 13 13 - - Scarlet Fever 124 111 - 13 Diphtheria 59 34 11 14 Typhus Fever - - - - Enteric Fever 17 7 7 3 Continued Fever - - - - Membranous Croup 8 1 4 3 Puerperal Fever - - - - Erysipelas 92 - 23 69 Total number from all causes 313 166 45 102 The amount paid to the Medical Practitioners for furnishing the above Certificates amounted to £30 15s. For the year 1893 the sum of £58 9s. 6d. was paid. The Vestry is recouped for this expenditure by the Metropolitan Asylums Board (out of the Metropolitan Common Poor Fund), to which Board a copy of each certificate is sent within 12 hours of the receipt of the same. During the year I have visited and reported upon five Slaughterhouses, two Cowsheds, and 35 Bakehouses, situated in the Parish, the result being that notices to cleanse, whitewash, and remedy other Sanitary defects were served upon the owners of one Slaughterhouse, one Cowshed, and 18 Bakehouses. Although the condition of some of our Bakehouses cannot be regarded as wholly satisfactory, some improvement has taken place since my last report, two have been entirely closed in consequence of the action taken by your Vestry. The number drawing water direct from the main instead of through objectionably situated cisterns has increased from three to 16, still, out of a total of 35, 19 are situated underground, and are for the most part badly lighted and ventilated. 27 The subject of the improvement and regulation of Bakehouses has formed a topic of consideration and discussion by most of the Metropolitan Vestries, the result being that in October last a Conference was convened by the Vestry of St. George-theMartyr, Southwark, which was attended by Delegates from 25 Sanitary Authorities, and after a very full debate the following resolutions were declared carried:— 1. That the present state of the Law relating to Bakehouses requires amendment, by the addition of the following clauses to the Public Health (London) Act, 1891 (а) That uniform Metropolitan Bye-laws regulating Bakehouses be made by the London County Council, and be confirmed by the Local Government Board, and that the duty of enforcing these Bye-laws shall devolve upon the various Local Sanitary Authorities. (b) That the portions of the Bye-laws regulating the structure of Bakehouses do not apply to existing Bakeries. (c) That the London County Council be empowered to frame Bye-laws for the construction of underground Bakehouses, and that all Bakehouses erected after the passing of such Bye-laws shall conform thereto. Disinfection of Infected Articles. I have on several occasions called the attention of your Public Health Committee to the view generally entertained that disinfection by dry heat, as performed by the apparatus belonging to your Vestry, is much less satisfactory than disinfection by steam, and I have lately received a circular prepared by the Medical Officer of the London County Council upon the subject of disinfection, in which a like opinion is strongly expressed. The circular further points out that out of thirty Authorities who possess disinfecting apparatus of their own only eight rely upon the old system of disinfection by dry heat, and in nine other districts not possessing apparatus of their own, but depending upon the services of a Contractor, disinfection is affected by steam in eight, and dry heat only in one case. The matter is under the consideration of your Public Health Committee, and I trust your Vestry will be convinced of the desirability of replacing your present inefficient oven with one of the more effectual apparatus now in more general use. The destructor used for consuming old, dirty and infected articles answers its purpose admirably, 27 of such have been destroyed during the year, being in too bad a condition to be returned to the owners, who were provided with new ones in lieu thereof. 28 The Memorandum of the Medical Officer of the London County Council, above referred to, deals also with the subject of accommodation for temporary shelter, as required by Section 60 of the Public Health Act; I may remind your Vestry that an arrangement was made with the Vestry of Clerkenwell to share the use of the house provided by them for the purpose, but after a trial of six months the arrangement was determined in consequence of the accommodation not being available at night, and the difficulty in getting people to go so far from those portions of the Parish where the want of such a place is most often felt. Besides fulfilling the requirements of the law, there can be no doubt that the provision of such a place is a real necessity in a community in which are a number of families occupying single rooms, for when disease of an infectious character breaks out among such, the only alternatives the healthy occupants have while their apartment is being fumigated (an operation taking six or eight hours to accomplish) is to go amongst their friends, and incur the risk of carrying infection into other homes, or to walk the streets until they can have access to their own abodes. It is therefore satisfactory to learn that your Vestry proposes to furnish the necessary accommodation amongst its other provisions on the new premises situated in Wharf Road. During the past year it has been my duty to make numerous reports on the various matters which have occupied the attention of your Public Health Committee, among which I may mention The London Streets and Buildings Bill. The Report of the Cholera Superintendent of the Metropolitan Asylums Board. The Report of the Ambulance Committee of the Metropolitan Asylums Board. Bye-laws for regulating the use of the Mortuary and Post-Mortem Room. Bye-laws with respect to houses let in lodgings (the two latter are now under the consideration of the Local Government Board). I have visited a large number of dwelling-houses, factories and workshops, of which complaints have been received, and in every instance in which the Vestry's notice has not been complied with. In those cases in which summonses have been granted, I have attended the Police Court in support of the same, and with the hope that the work of the Public Health Department has been on the whole satisfactory to your Vestry. I have the honour to be, Gentlemen, Your obedient Servant, G. E. YARROW, M.D., D.P.H., &c. Vestry Hall, City Road. March 5 th, 1895. 29 Public Health Department. The works carried out by the order of the Public Health Committee, between the 1st January and 31st December, 1894, in the Parish, are as follows: — Houses Inspected 2156 Houses cleansed, whitewashed and repaired 365 Dust-bins provided and repaired 136 Yards to houses paved or amended 343 Traps provided to yards and house drains 358 Water receptacles cleansed and provided with covers 45 Drains amended and obstructions removed 175 Houses provided with new pipe drains 136 Rain-water pipes disconnected from drains 189 Waste pipes of sinks ,, „ 175 Water-closets reconstructed 216 „ „ ventilation improved 56 „ ,, water supply reinstated 105 ,, pans cleansed 148 ,, additional provided 29 Overcrowding in rooms abated 61 Underground rooms illegally occupied as dwellings 30 Roofs of houses repaired 31 Nuisances arising from accumulations of manure and refuse, etc. 127 Ventilation of houses improved 8 Cesspools emptied and abolished 2 Miscellaneous nuisances abated 230 Rooms fumigated 323 Lots of bedding disinfected 227 No. of articles of bedding, clothing, &c., destroyed 27 List of Streets, Courts, and other places inspected under systematic house-to-house visitation during the year:— 30 Baltic Court Baltic Place Bath Buildings Beckford Square Belward Avenue Charles Court Church Row Clarence Place Dean's Court Elizabeth Place French Alley Garden Court Gastigny Place Gt. Arthur Street Hull's Place James Street Macclesfield Place Mason's Place Osman's Place Red Lion Market Eichard's Place Roby Street Three King Court Wither's Court Willow Row Notices served for enforcing Sanitary Works, etc.:— Written Imitations 1086 Statutory Notices 508 Thirty-six bakehouses were visited, and the necessary notices to cleanse, limewash, and trap the drains on the premises were served, and the work done. Five slaughter-houses were inspected and found to be in good sanitary condition. Two cow-sheds were also visited and found to be in a good sanitary condition. Inspection of Food, etc. The Meat, Fish, Fruit, etc., exposed for sale in Whitecross Street and other parts of the Parish, have been kept under observation, and the following were seized and destroyed:— 14 boxes of oranges ¾ cwt. pork 1¾ cwt. beef ¾ cwt. mutton 1 cwt. rabbits 3¼ cwt. fish 6¼ cwt. fruit 1½ cwt. onions 6 bushels greens Sale of Food and Drugs Act. The Fines and Costs imposed by the Magistrates under this Act amounted to £23 15s. 6d., which has been recovered and paid into the Vestry's Account. 31 Metropolis Local Management Act, 1855, and Public Health (London) Act, 1891. Two summonses were taken out under the above Acts, with the following results:— In one case the Magistrate ordered a new drain to premises as required, and fined the defendant 40s. and costs. In the second case the summons was dismissed, the defendant proving to the Magistrate's satisfaction that the goods condemned did not belong to him. The Mortuary and Coroner's Court. During the twelve months under consideration, 225 bodies were, on sanitary grounds, received into the Mortuary. Seventyone Inquests were held during the same period, and the sum of £17 10s. paid to the Vestry for the accommodation afforded by the Coroner's Court. Thirty-seven Post-mortem examinations were held in the Post-mortem Room adjoining the Coroner's Court. A large quantity of Disinfecting Powder and Carbolic Acid has been given away to Parishioners. JOHN E. RUGG, FRED. A. BARTH, Sanitary Inspectors. Vestry Hall, City Road, E.C.