STMART 8 ST. MARTIN-IN-THE-FIELDS, WESTMINSTER. FOURTH ANNUAL REPORT OF THE Medical Officer of Health, FOR THE YEAR 1859. LONDON: JOHN SMITH & CO., PRINTERS, LONG ACRE, W.C. 1860. MEDICAL OFFICER'S REPORT, For the Year 1859. To the Vicar, Churchwardens, and Vestrymen of the Parish of St. Martin-in-the-Fields. Gentlemen, I have the honor to present you with my Fourth Annual Report on the State of the Health of the Parish. In the four years which have elapsed since the Metropolis Management Act came into operation, the number of deaths has been as follows:—in 1856, 598: in 1857, 658: in 1858 593: in 1859, 603. The year 1856 was a very healthy year, and the whole metropolis participated in great exemption from disease; the three following years have not been so favourable to health, as will appear from the following numbers, showing the deaths in the whole metropolis for the four years. In 1856, 57,274: in 1857, 59,103: in 1858, 61,578: in 1859, 60,141. We must bear in mind, that the whole metropolis is a very increasing population, while a restricted district, like St. Martin's, must, if it increases at all, do so in a much smaller ratio. The number of births during the year 1859 has been 630; in the year 1857 we had in the parish 646 births, being less than the number of deaths by 12. The population of so central a district as St. Martin's 4 cannot be a very increasing one; indeed, the improvements in streets, the diminished number of occupants of underground dwellings, and other sanitary measures, must tend to diminish population, and for many years there has not been so great a difference in the number of births and deaths as in localities admitting of extension by new buildings. I have given a table of the births and deaths in the two districts of Charing Cross and Long Acre, which strikingly exhibits the different rate of mortality in open well-ventilated streets, and in close and overcrowded places. The number of deaths in the Charing Cross district was 312, in Long Acre district, 291; but to arrive at the death rate, we must deduct the deaths in Charing Cross hospital, 70, and half the deaths in the workhouse, 31, from 312, leaving 211 for the Charing Cross district; we must then add 20 to each district, 40 being the number of parishioners of St. Martin's who die in the various London hospitals, and giving 32 deaths in the workhouse to the Long Acre district, we have 231 deaths in Charing Cross district,* and 343 in Long Acre district,* making a death rate of 18.35 in 1000 for Charing Cross, and 28.45 in 1000 for Long Acre, or 23.40 in 1000 for the whole parish. If the death rate in the Long Acre district had been the same as that of the Charing Cross d strict, the number of deaths in the parish would have been 452, instead of 574; thus we arrive at the conclusion, that by overcrowding, bad ventilation of rooms, bad drainage of houses, and bad habits of the people, 122 human beings are prematurely killed annually in a population of 12,053. The death rate of the Charing Cross district is very little in excess of that which is laid down by the Registrar-General, as the healthy death rate, 17 in 1000. We must, however, *In my Report for 1859, the extent of these districts is shown. 5 bear in mind, that a large number of families belonging to Charing Cross district reside, for the greater part of the year, out of London. The table I have given, showing the number of deaths in the various streets and courts of the two districts, points out the localities which are especially distinguished by the great mortality of children under 5, and of those suffering from epidemic diseases. In Charing Cross, the total deaths are 171, those of children under 5 are 72, and those from epidemic diseases 29. In Long Acre, the respective numbers are 278—135—60. In Charing Cross district, giving 6 deaths in 1000 of children under 5, and 2.5 in 1000 of deaths from epidemic diseases, while in Long Acre district, we have 10 deaths in 1000 of children under 5, and 5 deaths in 1000 from epidemic diseases. There cannot be a stronger demonstration of the comparative healthiness of the two districts. In some of the worst localities of both districts, we shall find the infant mortality to be more than half of the whole. In Bedfordbury, in 16 deaths, 9 were children under 5; in Drury Lane, the numbers were 17 and 10; in Rose Street, 10 and 6; in York Place, 6 and 4; in Princes Court, 2 and 2. Wherever we find the infant mortality above the average, there we also find want of cleanliness, bad drainage, and bad ventilation. Next year, by means of the census, we shall be able to ascertain the exact population of each street and court, which will make all these points more clear and distinct. In the year 1859 the deaths exceeded those of 1858 by 10. The deaths from epidemic diseases exceeded those of 1858 by 31, the numbers being in 1858, 81: in 1859, 102; from small-pox there was 1 death in each year; from measles, 10 in 1858, 8 in 1859; from scarlatina 15 in 1858, 11 in 1859; from hooping cough, 14 6 and 25; from diarrhoea, 18 and 30; from fever, 18 and 19; from croup and diphtheria, 4 and 8. From pulmonary diseases, the numbers in the two years was 188 and 183: this includes 72 cases of consumption in 1858, and 88 in 1859; of diseases of the brain there were 89 deaths in each year; from diseases of the heart the numbers were 41 and 34; from diseases of the intestines the numbers were the same in both years, 23; from old age there were 42 deaths in 1858; and 39 in 1859; of deaths from violence, or accident, 31 occurred in 1858, 23 in 1859; 4 suicides occurred in 1858, 3 in 1859. The infant mortality was in larger proportion in 1859, the numbers being 191 in 1858, 213 in 1859; of deaths under the age of 5 years, hooping cough and diarrhoea were the diseases causing the excess, there being 11 more deaths from the former, and 16 more from the latter. The visitations of epidemics, or zymotic diseases, are among the mysteries in the laws of the universe which we have not yet fathomed; that they are bred before our eyes by bad ventilation, sewer emanations, or the concentration of other known causes of bad health, must not be considered the explanation, although asserted by a lady,* whose benevolence and authority on all that relates to the management of the sick may be studied with advantage by the whole world. How to deal with epidemic diseases, when they occur, of this problem, we may assume to have obtained considerable knowledge; but why they occur, and the laws by which they select some localities, avoiding others, and in subsequent outbreaks selecting the letter, and avoiding the former; *I have seen with my eyes, and smelt with my nose, small-pox growing up in first specimens, either in close rooms, or in overcrowded wards, where it could not by any possibility have been caught, but must have begun.—Miss Nightingale's Notes on Nursing. 7 of these, and other circumstances connected with the appearance and disappearance of epidemic diseases, we must admit our ignorance. There have been four epidemics in the past year—scarlatina, diarrhœa, fever, and small-pox. Scarlatina more than doubled the average number of deaths from that disease. Diarrhœa occurred in the hot weather, but almost limited its ravages to the young. In our own parish the total deaths from diarrhoea were 47, in children under 5, 34. Typhus fever made its appearance in the autumn, and was very threatening atone time. In the month of September, Mr. Leonard had an unusual number of new cases of this disease, but whether from natural causes, or from the good effect of our sanitary provisions, the outbreak came to a more speedy close than it is usual. Although we cannot trace the outbreaks of epidemics to neglect of the Laws of Health alone, yet we can speak confidently as to the fact, that where sanitary measures have been adopted in a locality, the influence of epidemics is limited, and we have neither so large a percentage of attacks, nor any thing like so many deaths as when these laws were neglected. By attention to the Laws of Health, we make ourselves less liable to the attacks of disease, and when attacked our constitutions are in a condition more readily to resist and conquer the morbid influence. The outbreak of small pox at one time threatened to be very virulent, but the extension of vaccination, and its immediate employment in cases where it had been neglected, arrested the contagion or mitigated its virulence. In 111/5 children whose arms I examined at our schools, 67 were unvaccinated altogether, and 87 were doubtfully protected; by vaccinating all these, we may fairly conclude much mischief was prevented. We had three deaths from small pox, but these occurred during the present year, and are not included in my Returns. 8 I am happy in being able to report considerable improvements in several places; the most marked are Crown Court, Duke's Court, and Cross Court. This part of the parish is on the Bedford estate, and every thing has been done to carry out the objects of the Metropolis Management Act. I may mention Shelton Court, Turner's Court, as being much cleaner than they have been, but all such places, without continued vigilance, are apt to fall back. Davey's Buildings, which was formerly a pattern of cleanliness, has latterly lost its credit. Its landlord has been changed, and such changes always operate for or against sanitary improvements, although if landlords knew their own interests, they would devise means of keeping their premises clean and wholesome, as by such management they will improve the class of tenants. Turner's Court was the very worst in the parish, and has become decent by arrangements which bring a better class of lodgers. The owners of such property would find it to their interest to appoint, from among their lodgers, one who should be responsible for the cleanliness and good order of the premises, and who should have power to get rid of dirty and refractory people. Wherever the houses let out in rooms or tenements are under good supervision, the character of the occupants improves, and as a consequence, the rent, because it becomes the interest of people to retain their holdings. Upon the whole, I can speak favourably of a general improvement in the condition of the habitations of the working classes in the parish of St. Martin. Princes Court, Pipemaker's Alley, and York Place, are among the worst, and although not so bad as they were, there is much room for improvement. In York Place and Pipemaker Alley, many of the houses are so old that any thing less than re-building could hardly effect a sufficiently salutary change. 9 The three principal sources of bad health arc bad ventilation, bad drainage, and bad food; the two first may be reduced to one, because the organs influenced are the same, the lungs, their action being to separate from the air we breathe a health-giving principle contained in all atmospheric air not contaminated by the impurities caused by many breathing the same air, or breathing that which is mixed with the poisonous gases arising from drains and sewers. So that, in point of fact, there are only two great sources of disease and impaired health—bad air, and bad food; but there is this essential difference in the two, we cannot breathe air in excess; the larger quantity of pure air we take into our lungs the better, but not so in regard to food. We may err as much in regard to quantity as quality, so that bad health can only be caused in relation to the air we breathe as to one point—its quality; while two principles are involved in the bad health produced by food—its quantity as well as its quality. No one can have good health who violates the laws by which the blood is rendered fit to give to the body health and strength; food gives to the blood the necessary fluid and solid matter, but it is the air we breathe which gives to this matter its power of producing warmth, health, and strength; food may be entirely wasted if the air we breathe has been poisoned with other gases than those of which nature has made our surrounding atmosphere. Every body is acquainted with the smell of coal gas, and it is a great good that it does smell, for being very injurious to health to breathe much of it, we at once take steps to stop the leakage. We must bear in mind that other smells arise from gases equally unfit for breathing, and we should be equally energetic in stopping the leakage, or production of them. The organ of smell is closely connected with the organ of taste, and you will see all animals smelling their food before eating it. 10 Whatever has a bad smell is, more or less, injurious to health, and, therefore, we should get rid of had smells at any expense. The principal causes of bad smells are too many people breathing the atmosphere of a badly ventilated room, stagnant, or ill-trapped drainage under a house. Many people may remain in the same room for hours and the air becomes so foul as to make a new comer start back, finding it impossible to enter, while the inmates, from the gradual destruction of the air, do not perceive the change, but it may be looked upon as an imperative law, that when several persons are breathing the air of a room, that the air soon becomes loaded with poisonous gases, and that unless such persons will occasionally open door and window, they will lose their health. Many schemes for ventilation have been tried, and failed, but doors and windows are in all rooms, and the horror of draughts should not prevent us from using them, for, for one person who suffers from open windows, there are thousands who suffer from stifling rooms; it is easy to get out of a draught, but it is impossible to escape the poisonous effects of impure air, which operates, by so deteriorating our blood, and filling it with impurities, that the first exciting cause of disease, an ordinary cold, or the visitation of an epidemic, finds our constitution in an unfit state to resist fever, or the inflammation of some important organ, which if not fatal, leaves some chronic disease, or consumption, or paralysis, as our companion for what remains of life. All our care in regard to ventilation and drainage will, however, be null and void, unless we are equally careful in eating and drinking; similar debasement of the blood, and similar susceptibility to disease, is caused by overfeeding, or over-drinking, and, in fact, excess or intemperance of any kin;1 The relations between health and the public welfare is a subject by no means sufficiently understood and 11 appreciated. The importance of health to individuals is assented to by every person to whom the question could be put; many would even assent to the proposition that every sacrifice should be made to establish health, and yet how few we meet with who sacrifice what they think a personal gratification, even if told that it will impair health. It is not known, or not believed, that health depends on the individual management of each for himself, that no one can be really healthy who does not know enough of his own structure, and who has not watched the daily actions of his own organism, to know where it is seriously going wrong. So much of the happiness of life depends on health, that it will some day be a branch of education in which all will be initiated. Not only is it to the welfare of the individual in question, but the welfare of children of future generations, and clearly the prosperity of the whole state. Whether our children shall be healthy, or the reverse, depends on our own management, and on our knowledge of the Laws of Health. Every attack of illness is not a special interference of Providence, as is supposed by too many, but the result of our own ignorance, or our disregard of those sanitary principles so much talked about, but so little acted on. The ventilation and drainage of our houses are among the most important of these laws, but perfect ventilation and perfect drainage will not insure health without attention to food, exercise of mind and body, with a sufficient general knowledge of our structure, as to enable us to judge when we are doing a thing likely to be injurious to health. A very little genuine reflection on these subjects must lead to the conclusion that the general welfare can never be materially advanced but by making the structure and functions of our minds and bodies a part of general education. This point is becoming more and more obvious year by year; it must be right that the principles on 12 which depend the real prosperity of ourselves and our families should be among the subjects of our education, for how can we properly guard the organs on which so much depends if we know nothing about them. We may call in the advice of a man skilled in these subjects when any thing is wrong, but to prevent the first germs of disease, we must all know something of physiology. I shall quote a passage from the address of Sir B. Brodie on his election as President of the Royal Society, in corroboration of these views. "Is there any one in any situation in life to whom it would not be a benefit to know something of animal physiology, of the functions of his own body, and of the influence which his bodily condition exercises over those moral and intellectual faculties, by which he is distinguished from the rest of the animal creation ? If it did not teach him how to cure disease, it might be useful for him to know how far disease may cure itself, and what are the limits of nature in this respect. To man, looking at him as an individual, there is no art so important as understanding and managing himself—an art so simply and well-expressed by the two significant words which were inscribed over the heathen oracle of Delphi. To correct bad habits when once acquired, is no easy task. A strong sense and a strong will, such as only a limited number of persons possess, are necessary for the purpose. But it would go far towards preventing the acquirements of such habits, if young persons during the acquirement of their education were made to understand the ill consequences to which they must inevitably lead, and how eventually the body must suffer, and the mind be stupified and degraded, not by the reasonable indulgence, but by the abuse of the animal instincts." The year 1859 will be distinguished for the great sanitary measure of removing all the coffins from under 13 the Church into the catacombs, so that we may boast of what few parishes can, that no human remains are below the Church, all the vaults having been swept away, and the crypt of the Church laid open. Many of the coffins were perished, and in some of the vaults the exhalations were very offensive; happily the removal of all the bodies was effected without any thing untoward, the men employed having suffered little or no disturbance in their health. The removal of the coffins from the vaults was made interesting from the discovery of the remains of that eminent surgeon and anatomist, John Hunter, the founder of the Museum of the College of Surgeons, whose body was subsequently reburied in Westminster Abbey. This very important work of removing 2600 coffins, and their contents, was arranged and managed by Messrs. Latchford and Petter, Churchwardens, and their Sidesmen, Messrs. Goodchild, Marshall, Soames, ana Ogden, one or more of whom were always present during the whole operation, which lasted about 10 weeks, and the whole was ably carried out by our Surveyor, Mr. Burstall. The friends of the deceased, many of whom visited the vaults on the occasion, having expressed perfect satisfaction with the disposition of the remains of their departed relatives. All sanitary reformers must pray for the successful issue of the movement in regard to the Embankment of the River. We shall all rejoice if we are able to record of the year 1860 that a work, important not only to the health of a district, but of the whole metropolis, not only to the physical welfare of the inhabitants of London, but to the prosperity of the whole empire; for this, and more than this, may be said for the Embankment of the River, and carrying the lower level main drainage along the banks of the Thames instead of below our houses. Nobody can contemplate the danger 14 of excavating a great tunnel under such houses as those of the Strand and Fleet Street without serious alarm. I would advise all who are interested in this question, to go down into the basements and cellars of the many old houses in this line of street; he will see all sorts of expedients for maintaining the integrity of the superstructure : evidences of great age and decay, to which the digging of a great sewer appears likely to be as perilous as an earthquake. The expense of the Embankment is of course the difficulty, but it would truly be a disgrace to us if means cannot be found to accomplish a work that would redound to the honour of the present generation, that would be to future generations the greatest gift for health and prosperity, and could be pointed out to admiring strangers as one of the noblest monuments of any age or country, and the most glorious evidence of our progressive civilization. I have the honor to be, Gentlemen, Your obedient Servant, LIONEL J. BEALE, Medical Officer of Health. June, 1860. 15 BIRTHS AND DEATHS IN THE charing cross and long acre districts In the Year 1859. Districts Population Births Rate per 1000 Deaths Rate per 1000 Death Rate of whole Parish Charing Cross 12,587 251 19.14 312 18.35 23.40 Long Acre 12,053 379 31.43 291 28.45 To arrive at the deaths of each District, it is necessary to deduct the deaths in Charing Cross Hospital, 70, and half of those in the Workhouse, 31, from the total of Charing Cross District, then adding 20 to each District, being the number of St. Martin's parishioners dying in the various Metropolitan Hospitals, the real numbers for each District will be, Charing Cross, 231, Long Acre, 343. 16 TABLE OF THE CAUSES OF DEATH In the Parish of St. Martin-in-the-Fields,for the Year 1859. Under 5 Years From 5 to 20 From 20 to 40 From 40 to 60 From 60 to 80 80 and upwards Total Deaths at all ages Small Pox — — 1 — — — 1 Measles 7 1 — — — — 8 Scarlatina 9 1 1 — — — 11 Hooping Cough 25 — — — — — 25 Diarrhœa 24 1 1 4 — — 30 Fever 2 5 6 5 1 — 19 Croup 6 — — — — — 6 Diphtheria 2 — — — — — 2 Erysicelas 1 — — — 1 — 2 Rheumatic Fever — — — 1 — — 1 Delirium Tremens — — 1 — 1 — 2 Mesenteric Disease 10 — — — — — 10 Cancer — — 3 4 3 — 10 Dropsy — — 2 3 3 — 8 Consumption 3 9 41 27 8 — 88 Water on the Brain 17 1 — — — — 18 Mortification — — — — 2 — 2 Apoplexy — 1 3 10 8 — 22 Paralysis — — 1 1 8 — 10 Disease of Brain — 4 — 6 — — 10 Convulsions 23 — — — — — 23 Epilepsy — 1 2 — — — 3 Aneurism — — — 1 — — 1 Varicose Veins — — — 1 — — 1 Disease of Heart — 2 6 14 9 1 32 Bronchitis 15 1 10 23 9 2 60 Pneumonia 19 1 5 3 5 — 33 Asthæa — — — — 1 — 1 Laryngitis — 1 — — — — 1 Disease of Intestines — 1 2 6 2 1 12 Hernia 1 — — 1 — — 2 Fistula — — — 1 — — 1 Disease of Liver — — — 5 3 — 8 Ditto Kidney — — 3 4 4 1 12 Ditto Bones,&c. — 2 — 1 — — 3 Ditto Uterus — — 3 1 — — 4 Debility at Birth 19 — — — — — 19 Teething 15 — — — — — 15 Atrophy 14 1 — — — — 15 Old Age — — — — 24 15 39 Fractures — 1 2 4 6 — 13 Burns 1 1 — — — — 2 Poison — — — 2 2 — 4 Suicide — 1 3 — — — 4 Total 213 35 97 128 100 20 593 17 DEATHS IN THE CHARING CROSS DISTRICT In the Year 1859.—Population, 12,587. Total Deaths in 1859 Deaths of Children under 5 years, 1859. Deaths from Epidemic Diseases, 1859 Adelphi cottages and wharf 1 — — Adelphi terrace 1 — — Adelaide street 2 — — Agar street 3 — — Arundel place 3 1 — Bedford street 1 — — Blue Cross street 3 1 — Bullin court 2 — 1 Carlton house terrace 1 — — Cecil street 2 1 — Cockspur street 3 — — Craven street 4 1 — Charing Cross 5 — — Charles court 2 1 — Dorset place 3 — — Durham street 1 — — Eagle court 1 1 — Exeter street 3 3 — Fairfax court 1 — — George court 3 2 2 Harvey's buildings 4 2 1 Haymarket 1 1 1 Heathcock court 2 1 — Hnngerford street and market 5 4 1 James street, Adelphi 1 — 1 John street, Adelphi 3 1 — King William street 2 — — Leicester square 3 2 1 Long's court 2 1 — Lumley court 5 3 2 Monmouth court 6 4 1 New Exchange court 2 2 1 Northumberland court 3 2 1 Northumberland street 3 2 1 Oxendon street 5 2 — Pall Mall, East 3 2 2 Panton street 3 1 1 Princes court 2 2 — Princes street 3 — — Salisbury street 4 2 — Scotland yard 2 — — St James's Palace 6 — — St. Martin's mews 3 2 — St. Martin's street 15 8 3 Strand 6 1 2 strand buildings 4 2 1 Spring garden terrace 1 — — Spur street 2 — — Suffolk place and street 2 1 — Trafalgar square 2 — — Villiers street 7 4 — Whitehall and place 2 1 — Whitcomb street and court 5 3 3 York buildings 1 1 1 York place 6 4 2 171 72 29 18 DEATHS IN THE LONG ACRE DISTRICT In the Year 1859.—Population 12,053. Total Deaths in 1859 Deaths in Children under 5 years, 1859 Deaths from Epidemic Diseases, 1859 Bear street 1 1 — Bedfordbury 16 9 3 Bow street 1 l — Brewer's court 3 l — Broad court 7 2 1 Castle street, Leicester square 14 3 3 Castle street, Long acre 6 4 2 Cecil court 10 5 3 Chandos street 3 2 1 Chapel court 2 2 — Charles street, Long acre 1 1 — Charles court 2 1 — Chymister's alley 1 — 1 Conduit court 4 1 — Cranbourn street 2 2 — Crown court 4 1 — Cross court 4 2 1 Drury lane 17 10 5 Duke's court 12 6 3 Goodwin's court 3 2 1 Green street 9 4 2 Hanover court 2 — — Hanover street 5 — — Hemming's row 2 1 — Hop gardens 8 5 4 Hunt's court — — — James street, Long acre 3 1 1 Kings street 1 — — Langley court 3 2 1 Long acre 16 8 2 Martlet court 8 6 4 Marquis court 5 3 1 May's buildings, Great 9 3 1 Mercer street 4 2 1 New street, St. Martin's lane 5 2 3 Pipemakers' alley (no death since 1856) 3 — — Rose street 10 6 2 Russell court 15 8 3 Russell street, Little 6 — — Shelton court 4 3 2 St. Martin's court 4 2 — St. Ma tin's lane 12 6 2 St. Martin's lane (Upper) 4 1 — Taylor's buildings 4 3 3 Turner,s court 2 1 — Vinegar yard 1 — — White hart street 10 6 3 White hart court 7 4 — Wilson street 3 2 — 278 135 60