STPAN 22 Saint Pancras, Middlesex. TENTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, FOR THE YEAR 1865. TO THE VESTRY OF SAINT PANCRAS. Gentlemen, The time has arrived for me to present to you my Tenth Annual Report—for the year 1865. During this year the deaths numbered 5,159*; 100 deaths, which occurred in the Strand Union, being omitted, as not fairly belonging to Saint Pancras. The population in 1865 I have estimated at 217,430; my estimate has been based on the assumption, that the population has increased, since 1861, in the same ratio that it did between the censuses of 1851 and 1861. The rate of mortality during last year, if this estimate is correct, was 237.2 to every 10,000 living, or 2.372 per cent. In 1864 the rate of mortality was 2.535 per cent., which was excessively high. The following figures represent, approximately, the annual rate of mortality in St. Pancras for each year since the Metropolis Local Management Act came into operation:— In 1856 2.000 per cent. „ 1857 2.000 „ „ 1858 2.310 ,, „ 1859 2.190 „ „ I860 2.150 „ „ 1861 2.300 „ „ 1862 2.160 ,, „ 1863 2.306 „ „ 1864 2.535 „ „ 1865 2.372 „ * This number does not exactly correspond with the number on Table I., which gives the number registered in the 52 weeks, and not the actual number of deaths which occurred during the 365 days of the year. A further correction might be made by deducting 184 for those deaths in University College Hospital and the Royal Free Hospital, which were of persons not previously living in St. Pancras, and adding 132 for the deaths of St. Pancras people in tne Hospitals of adjoining districts; King's College, 8; Middlesex, 48; Charing Cross, 5; Children's, 22; Bartholomew's, 12; London Fever, 28; and Small Pox, 9. This would reduce the mortality from 5,159 to 5,107. These corrections are, however, unnecessary, because they do not much affect the death-rate, and cannot be made complete. 2 It thus appears that, in 1864, the mortality was highest; and in 1865 it was highest but one. This result is not a very encouraging one in regard to sanitary operations. Some parts of the parish are undoubtedly healthier than they were ten years ago; and if nothing had been done to improve the drainage, the paving and domestic accommodation, the parish would be incalculably more unhealthy than it is. In comparison with most of our large towns, London, during last year, had not a high mortality (24.62 per 1,000) and the mortality of Saint Pancras was a little lower than that of the whole of London, and also a little lower than that of the other northern districts of London, amongst which it is placed. Are we, therefore, to rest content? Is the mortality of Saint Pancras as low as it might be? By no means. One cause of disease and death it is most difficult to contend with, that is to say, poverty, with its attendant evils, overcrowding, unhealthy dwellings, insufficient diet and clothing. Intemperance, sexual excess, and want of cleanliness, mismanagement of children from ignorance, or other causes, imprudent marriages, and general want of providence, are other prolific causes of death, over which you, as guardians of the public health, have directly but little control. These can only be checked by education, moral, intellectual, and religious. Other causes of disease are, to a greater or less extent, under your control, such as drainage, the condition of water receptacles, noxious accumulations of decaying organic matter, in cellars, yards, or public places, the sale of diseased or putrid food, the spread of contagious disease for want of prompt isolation or disinfection, and the neglect of vaccination. Pauperism has increased in this parish, both absolutely and relatively to the population. In May, 1856, there were 1,496 paupers in the Workhouse, and 210 at Lunatic Asylums, 3 children at Tring and 2 at Margate, making in all 1,711 receiving in-door relief, and 4,805 receiving out-door relief; these two numbers give a total of 6,516 paupers. In May, 1866, there were 1,891 paupers in the "Workhouse; 363 at Lunatic Asylums; 346 children in the country, making a total of 2,600 paupers receiving in-door relief, besides 5,459 out-door paupers: which gives a total of 8,059 paupers. In ten years the number of paupers has increased in the proportion of 65 to 80, that is, about at the rate of 23 per cent. The gross estimated rental has increased between Lady-day, 1856, and Michaelmas, 1865, from £941,760 to £1,159,628, an increase of 23 per cent. The property of the parish, and the pauperism have increased in the same ratio. In the same period the population has increased only at the rate of 19 per cent. To the increase of pauperism, a part of the increased mortality may be fairly ascribed. Another cause has been in operation to a slight extent; that is, closer packing of the population. At the census of 1851 there were 898 persons to every hundred inhabited houses, whereas, in 1861 there were 907 persons to every hundred houses in Saint Pancras. In 1851, there were between 61 and 62 persons living to each acre; in 1861 there were more than 73 on each acre. The demolition of houses by Railway Companies, within the last few years, has tended seriously to aggravate overcrowding in some parts. The extent to which this has taken place, we shall have no data for estimating accurately until the next general census. 3 We know that 10,000 persons, chiefly of the poorer classes, have been turned out of their houses, to find shelter where they could; many have been driven into the Workhouse, others have left the parish, some have gone into newly built houses, whilst many more have been squeezed into houses previously quite as full as, or fuller than they ought to be. As a partial compensation for these evils, in the general clearance, a largo amount of house property has been pulled down which was totally unfit for human occupation. If suitable provision had been made for the reception of those who were thus deprived of their dwellings, great good would have been effected. The misfortune, however, is, that nearly all of the people who have not found their way to the Workhouse, have been forced into houses, each containing from four to eight rooms, the houses being adapted only for one family, whilst they are made to receive a number of families. The result will be that these houses, tolerably well adapted for a single family, will soon become as unfit for occupation as the old ones just referred to. Stanley Buildings, recently erected in the Old Saint Pancras Eoad by the Industrial Dwellings Society, accommodate 103 families. In these buildings every family has a scullery, a water-cistern, a water-closet, and a dust-shoot lor itself. The rents vary from 5s. to 7s. 6d., according to the size, number, and position of the rooms. They are paid in advance. These rents do not meet the case of the very poorest, but the accommodation afforded is greatly superior to what can be obtained for the money in any of the houses commonly let out to the working classes. No man with a family can obtain, in London, a residence fit for him to occupy at less than 5s. per week. It is, no doubt, a very large proportion of many a man's earnings, but if, by spending 2s. 6d. a week more on his rent, his home can be made comfortable and fit for him to sit in of an evening, that sum or much more may often be saved by his avoiding the Gin Shop, and only taking what beer he needs after work at home with his family. There will, I fear, be but little improvement in the habits of the London working classes, until there is some provision for making their dwellings more attractive, or at any rate less repulsive. Immediately that the Stanley Buildings were opened, every set of rooms was let; and there are now many names entered by persons waiting for admission to them on the first vacancy. A dozen similar erections might with great advantage be provided in this parish. There is also greatly required a large number of dwellings for families, who can only afford to pay from 3s. to 4s. 6d. per week. At present, these families occupy usually a single room only, in a house of six or eight rooms, adapted only for one family. The water supply is inadequate, and at some distance from the upper rooms; there is but one privy, one dust-bin, one coal-cellar, and one wash-house for the whole. No one is responsible for the cleanly condition of the water-closet, the water-tank, the stair-case, the basement, the areas, and the yard, or for the emptying of the dust-bin. These houses require to be periodically inspected by the Sanitary Officers, and ought to be put under the same regulations as the Common Lodging Houses. The Trustees of the Peabody Fund could not, I think, find any district standing more in need of their notice and assistance than some parts of Saint Pancras. As regards those causes of disease over which you have some control, in 4 proportion as the density of population increases, the duty is more urgent to leave not a stone unturned for their removal. In reference to drainage, I expressed my opinion in a report to the Yestry in January last. I am glad to find that since that time several new sewers have been made, and that the attention of the Yestry and the Committee of Works, is still directed to this subject. I hope that you will not rest satisfied until all parts of the parish are efficiently sewered. In proportion to the size of the parish, the amount of new sewerage required is not great; in the older parts of the district, however, some of the sewers are not deep enough, and the condition of some is such, that they are liable to become sewers of deposit, enormous cesspools in fact; to what extent this is the case, you may learn from your Chief Surveyor. I am glad to hear that the Committee of Works are busily engaged on the sewers which act imperfectly, in the way of flushing them and preventing deposits. During the summer months it is their intention, I believe, to resort to disinfectants, whereever these appear necessary. It would not be safe to disturb the soil near old sewers during hot weather; but I trust that the work of renovating imperfect sewers will be resumed in the winter. The condition of water-tanks in private dwellings is a subject of great importance; it is one over which the existing state of the law gives you but imperfect control. So far as your powers extend, the Sanitary Committee will do what they can to improve them. The removal of decaying organic matter from the neighbourhood of houses is also of great moment. By means of house to house inspection, now being carried on by the four Sanitary Inspectors, and the co-operation of the Committee of Works, the dust contractors are stimulated to much greater activity. Amongst the poor there is often great indifference exhibited as to the removal of houserefuse, and amongst other persons the dustman is often allowed to pass the house several times without being hailed, even where there is an offensive accumulation in the dust-bin, because the time at which he passes is not a convenient one for the purpose. All public dust-bins should be emptied twice a week. During the summer months, I should recommend that tho streets, and especially narrow places occupied by the poor, should be scavengered more frequently than they have been during the winter; such places require, in the summer, to be swept every other day. The plan of storing vegetable and animal matter near dwellings, for several weeks, is a very objectionable one. It would be much better that all such refuse, which is not burnt, should be kept in a covered box, to be emptied by the scavenger every morning, or every second day at furthest. This change cannot be carried out at the present time. The refuse from green-grocers' shops is constantly, and that from fishmongers and others, is sometimes thrown into the streets in front of their shops, and there it is allowed to be exposed to sun and shower, until it is removed by the scavenger, who in many cases only passes once a week. This practice is very objectionable, and gives rise to offensive smells and noxious effluvia. All refuse of this kind should be kept in baskets or boxes, and removed at least three times in each week, either by the scavenger or dustman, at the expense of the shopkeeper, or by some private arrangement on his part. 5 RELATIVE MORTALITY OF DIFFERENT PARTS OF THE PARISH. I have stated that the rate of mortality in the whole parish was 23 72 per thousand. In the several registration sub-districts it ranged from 20.9 to 25.2 per thousand: Camden Town had the lowest, and Somers' Town the highest rate of mortality; Kentish Town stands second on the list, Regent's Park third, Grays Inn Road fourth, and Tottenham. Court fifth, having a mortality very nearly as high as Somers' Town. The figures on which these statements are based, are given in detail in Table A. They are only approximately true, from the impossibility of determining exactly the population of the several sub-districts. I believe that Camden Town appears to an undue advantage, because, probably, its population has not increased since 1861, as it did between 1851 and 1861, owing to the removal of so many dwellings in Agar Town, a great part of which were situated in the Camden Town registration district. There is another way of judging of the relative mortality of the districts, less liable to fallacy, that is, by estimating the proportion borne by the deaths under 5 years of age, to the births registered. On this plan, the several districts stand in the following order, beginning with the one with the lowest proportional infant mortality: Kentish Town, Regent's Park, Gray's Inn Road, Camden Town, Somers Town, and Tottenham Court Road. Under one year of age there have died 1,245 children, whilst 7,419 birtlia have been registered; so that between 16 and 17 per cent, of the children born, died before they reached the age of 12 months. In Kentish Town, the deaths under one year of age were only 14.3 per cent, of the births; whilst in Somers Town they were 17.3; in Tottenham Court, 17.7; and in Gray's Inn Road, 18.3 per cent. See Table C. On Table B a number of streets and places are arranged, to shew their death-rates last year, and in nine preceding years. It will be seen that the following had, as might be expected, a mortality above that of the average of the whole parish: Drapers-place, Gresse-street, Midford-place, Tottenhamplace, Eden-street, Henry-street, Mary-place, Peace-cottages, Cooper's Buildings, Derry (late James) street, Wellington-square, Cromer-street, Compton-place, Poplar-place, Riley-street, Melina-place, Ashby-street, and Thornley-place. During 1835, instead of a mortality below 24 per thousand in Drapersplane, it was nearly 35; in Eden-street and Peace-cottages nearly 48; in the Colonnade, 45; in Riley-street 49; in Ashby-street nearly 47; and in Thornleyplace 71 per thousand. When the rate of mortality has been calculated for the ten years 1856 to 1861, the results are not quite so startling, though quite sufficiently so to excite very grave enquiry as to the causes of the difference in the death-rate of the several places. Thus, Henry-street exhibits a mean annual death-rate for ten years of nearly 40 per thousand; Midtord-place about the same; Poplar-place 34 per thousand; Eden-street 30 per thousand; Ashby-street 33 per thousand; and Thornley-place, 37.7 per thousand; Peace-cottages, Colonnade, and Hampton-court, each between 32 and 33 per thousand. These numbers do not give a true notion of the insalubrity of the places, because, very many of the persons living in these streets go either to the 6 "Workhouse or some Hospital to be treated for diseases which prove fatal. This source of fallacy applies more to the poor districts than to those occupied by persons in easy circumstances. In Pancras-square, a block of buildings occupied by 110 families, erected by the Metropolitan Association for Improving the Condition of the Labouring Classes, the death-rate in 1865 was only 9.2 per thousand, the mean annual death-rate in ten years was 18 per thousand. This square is occupied by a large number of families with young children, and is consequently liable to the inroads of infectious diseases, such as scarlet fever, hooping cough, measles, and others; the mortality is likely to be higher than it is amongst a population consisting of more adults. It is satisfactory to see, that, on the average of ten years, the mortality was only 18 per thousand. It was considerably raised by an epidemic of scarlet fever and diphtheria, which carried off 12 children in the year 1863. These numbers afford a good illustration of the benefit of suitable dwellings for the working classes, even when they are compelled to live together on a very small area. Each family has its own water-supply, its own water closet, scullery, and shoot for dust. The arrangements are not perfect, but they are vastly superior to what is usually supplied to persons paying the same rents. VIOLENT DEATHS. On Table VI. are given all the deaths from violence registered in the Parish. The total number was 198; of these 166 were from accident or negligence. Twelvo were run over or injured by railway trains; fifteen were run over on the public roads ; five were from falls from vans, cabs, or carts. There were seventeen deaths from burns, two of which were ascribed to the use of crinoline. There were six children scalded to death. Three persons were accidently poisoned; one by spirits of ammonia, one by aqua fortis, and one by an overdose of laudanum. There were seven deaths from accidental drowning, of which four were in the Regent's Canal. There were 25 children suffocated in bed, and nine others from negligence of various kinds. Two children died from want of nourishment, and three from exposure to cold. There were 16 deaths by suicide; of which four were by poison, two by drowning, three by hanging, three by cutting their throats, two by stabbing, one by gunshot, and one by throwing himself from a window. The poisons used were, in two oases, oxalic acid, once prussic acid, and once oil of vitriol. There were 14 cases of infanticide, beside many others of such culpable negligence as to be properly described by that name. MORTALITY FROM ZYMOTIC DISEASES. Small Pox was fatal in 26 cases, besides 9 in the Small Pox Hospital; Measles, in 108 ; Scarlatina, in 133; Diphtheria, in 35; Hooping Cough, in 225; Diarrhoea, English Cholera, and Dysentery, in 282 cases. From Typhus and Typhoid Fevers, there were 134 deaths, besides 28 persons from St. Pancras, who died in the London Fever Hospital. 7 Erysipelas and Puerperal Fever were fatal in 61 cases. To every 100,000 persons, the death-rates from the undermentioned diseases, in St. Paneras and London respectively, were:— St. Paneras. London. Pulmonary affections (including Phthisis) 717 604 Diarrhoea, Dysentery, Cholera 129 103 Typhus and Typhoid Fevers (including deaths in Fever Hospital) 73 108 The estimated population of St. Paneras bore to that of London in 1865, the proportion of 1 to 13.76; there were from Small Pox, in London, 646, which gives as the quota for St. Paneras, 47, instead of 36, the actual number; from Measles in London, 1302, which gives as the quota for St. Paneras, 94, instead of 108; from Scarlatina in London, 2181 deaths, which gives as the quota for St. Paneras, 158, instead of 133; from Diphtheria in London, 433, which gives as the share for St. Paneras, 31.5, instead of 35; from Hooping Cough in London, 2921, which gives as the share of St. Paneras, 212, instead of 225. It thus appears that the following diseases were proportionally more fatal in St. Paneras than in the rest of London: Pulmonary diseases generally, Diarrhoea, and allied diseases; Diphtheria, and Hooping Cough. Whilst the following were less fatal in St. Paneras than in the rest of London: Typhus and Typhoid Fevers, Small Pox, Measles, and Scarlatina. There were more deaths from Diarrhoea, Dysentery, and English Cholera, last year, than in any year since the last Cholera epidemic, in 1854. The numbers in 1854 were Cholera, 248, and Diarrhœa, 164; in 1855, from Diarrhoea, 120; in 1856, 141; in 1857, from Cholera, Dysentery, and Diarrhoea, 173; in 1858 only 65; in 1859, 116; in 1860,101; in 1861, 161; in 1862, 103; in 1863, 153; in 1864, 189; and in 1865, 282 deaths. This high mortality from Diarrhoea and allied diseases, together with the presence of Cholera on the shores of the Mediterranean, and, towards the end of the summer in Paris and at Southampton and Epping, made us apprehensivo that Cholera was likely again to visit our Metropolis. The disease is still prevalent in many parts of the Continent; there have been a few cases at Swansea, Bristol, and a serious outbreak of it amongst the German emigrants in Liverpool. It has not at present manifested itself in a distinct form in London, but it is impossible not to look forward with some anxiety to the next two or three months. We have had quite enough warning to call for great activity in all sanitary precautions; while there is also ground for hope that we may escape a severe outbreak of this dire malady. PAUPER SICKNESS. During the year 1865, there were 16,418 orders issued by the Directors of the Poor, for out-door medical relief. This was nearly 10 per cent, more than in 1864. The cases were distributed amongst the several districts as follows:— ( Mr Knaggs 2453 I Mr. Barley 1389 North North-West Mr. Claremont 2944 Central Mr. Sutherin 3464 East District Dr. Thompson 3517 South District Dr. Saul 2651 8 In 1855 the number of orders issued for medical relief was 10,729, so that in ten years, the number of persons in receipt of out-door medical relief, had increased 59 per cent. There were sent, during the year 1865, to the Fever Hospital, from Saint Pancras, at the expense of the Directors of the Poor, 193 cases, of whom 28 died; and to the Small Pox Hospital, 106 cases, of whom 9 died. In 1864 the number sent to the two Hospitals were 179 and 45 respectively. VACCINATION. During the year which ended 29th September, 1865, there were successfully vaccinated, by the Parochial District Vaccinators, 2,934 persons, of whom 2,580 were under twelve months of age. In the same period there were registered 7,349 births. Besides the number vaccinated, at the expense of the parish, there are many children vaccinated at the two national vaccine stations in Saint Pancras, and many by private medical praotitioners; moreover, of the children born, a number die before they reach the age at which vaccination should be performed. But even when all these points are considered, there is reason to fear that a considerable number of children are not vaccinated. In the present state of the law, there is no practicable method of ascertaining to what extent vaccination is neglected, and the law for enforcing its performance is nearly a dead letter. There is a Bill now before Parliament, which, if it pass into law, will be a slight improvement, though it will be far from ensuring anything like universal vaccination. It attempts to provide for the registration of vaccination, when this operation is performed by the Public Vaccinator, in the district where the birth was registered, by imposing a penalty on him if he fails to transmit the certificate of successful vaccination to the Registrar; and where vaccination is performed by other medical practioners, the duty of transmitting the certificate of vaccination is thrown upon the parent or guardian. It imposes a penalty upon the parent who neglects to have a child vaccinated, or to take the child to the Yaccinator for inspection after vaccination. It empowers any Registrar, or any officer appointed by the Guardians, to take proceedings under the Act, against any person who has a child under thirteen years of age, who, there is reason to believe, is not vaccinated, and the parent or guardian with the child, may be summoned before a Justice, and fined 20s., unless he can show that the child has been vaccinated, or is unfit for or insusceptible of vaccination. The onus of proof is thrown upon the defendant, and not, as before, on the prosecutor. In England, compulsion, in the strict sense of the term, will never be enforced, in respect to vaccination; but the infliction of a penalty upon those who neglect it from mere indifference, and not from conviction, is perfectly justifiable. It would be well if evidence of vaccination were made an essential for admission to all public schools, to employment in the public service, and were required by all employers of labour. Many of the prejudices against vaccination arise from imperfections in the operation itself. The Government, whilst requiring every person to be vaccinated, should make provision for the efficiency of vaccination throughout the kingdom. The attention of the Privy Council has been directed to this subject, but there is still need for furtherimprovement in this direction. 9 Vaccination can be most efficiently performed by those who have on every occasion on which they propose to vaccinate, a large number of cases from which to choose their lymph, and who have also large experience in the performance of the operation. The multiplication of vaccinators is, therefore, undesirable. I believe that vaccination would be more efficiently performed if it were assigned to special officers,—a great part of whose time should be thus employed. A Bill now before the House of Commons, to Amend the Law relating to the Public Health, contains a number of provisions which would be found very useful in the parish, for the abatement of nuisances, and removal of sources of disease. The definition attached to the word nuisances is extended, so as to include any house, or part of a house, so overcrowded as to be dangerous or prejudicial to the health of the inmates, any workshop not kept in a cleanly state or not well ventilated, and any fire-place or furnace which does not consume its own smoke, and is used for working engines by steam, or in any manufactory. It gives power to enforce the cleansing, limewhiting, or otherwise disinfecting any house or part thereof, upon the certificate of any legally qualified medical practitioner, that such cleansing would tend to check the spread of infectious disease. It gives power to the local authority to provide proper places for the reception of dead bodies; and when such places are provided, that if any dead body of one who has died of any infectious disease is retained in a room in which persons live or sleep, or is in such a state as to endanger the health of the inmates of the house, any Justice may, on the certificate of a medical man, order the body to be removed to such place of reception. On application to one of Her Majesty's principal Secretaries of State, the Secretary of State may empower the local authority to make regulations for the following matters; that is to say,— 1. For fixing the number of lodgings which may be separately let in any house, and for fixing the number of persons who may occupy any such lodging. 2. For the registration of houses thus let in lodgings. 3. For the inspection of such houses, and the keeping the same in a cleanly and wholesome state. 4. For enforcing therein the provisions of privy accommodation and other appliances and means of cleanliness, in proportion to the number of lodgings and occupiers, and the cleansing and ventilation of the common passages and staircases. 5. For the cleansing and limewhiting, at stated times, of such premises. A penalty, not exceeding £5, is imposed for exposure in any public place, or public conveyance, of any person suffering from a dangerous infectious disorder, without proper precaution against spreading it; and there is a like penalty on the owner or driver of a public conveyance, who does not, immediately provide for its disinfection, after it has, with his knowledge, conveyed any such sufferer. There are other provisions in the Bill which do not much affect this Parish; several of those I have enumerated, appear calculated to be of use in the promotion of public health. 10 WORKHOUSE. There were 559 deaths in this establishment; of these, 101 were children under five years of age, and 227 persons over sixty years of age. The average number of deaths in the four preceding years was 477. Epidemic diseases were fatal in the following number of cases:—Measles in 7; Scarlatina, 3; Hooping Cough, 4; Diarrhœa, 7; Typhus Fever, 4; Puerperal Fever and Erysipelas in 11. There were 79 deaths from Pulmonary consumption, and 122 from other affections of the lungs and air passages. The number of inmates was larger than in any former year. It ranged, in the fiftytwo weeks from 1581 in July to 1929 in Docember; the mean of all the weeks was 1742. The present buildings are not large enough for the increasing pauperism of the parish. METEOROLOGY. The mean temperature of the year was higher than usual by 1.9°. Every month after March, except August, was warmer than the average of twenty-four years; in the two weeks ending 16th September, the mean of the highest daily air temperatures was 80.5°. No rain fell in these two weeks. The temperature of the first, or winter quarter, was lower than usual; in the other quarters it was higher than usual. The rain-fall of the year was above the average, namely, 29.0 inches at Greenwich; of this 5.2 inches fell in three weeks of October. The mean daily range of temperature was 16.9° which was 1.1° more than the average of twenty-four years. The degree of moisture was 80°, which was 2° below the mean of twenty-four years. SANITARY WORKS. The usual amount of inspections were made in 1865, in slaughter-houses, cow-houses, bake-houses, markets, sausage shops, mews, and wharfs. The following works were carried out under the orders of the Sanitary Committee, upon my recommendation, under the inspection of the Sanitary Inspectors:— New drains were provided in 72 houses. New traps furnished to 471 drains. The drains were repaired in 150 houses. Cesspools were emptied in 64 cases, and filled up in 60 places. New pang, traps, and water were supplied to 75 closets. Fourteen new water-closets were erected. Water supply was furnished to 64 closets. Forty-four new dust-bins were erected. Twenty-five dust-bins were repaired. In 136 houses the paving of the cellars or yards was repaved. 11 The walls and passages of 249 houses were cleansed and limewhited or whitewashed. Overcrowding was abated in 48 houses. Accumulations of manure were removed, in consequence of notices or summonses, in 275 cases. Fifteen sties of pigs were removed. Other nuisances, to the number of 192, were abated. For the accomplishment of these works, 790 primary notices, and 74 final notices were issued. Forty-four summonses were heard before the Police Courts, in consequence of neglect of notices. In the Appendix is given a list of the sewers constructed by the Vestry during the year. There have been seized, as unfit for human food, the following articles, which were exposed for sale:— 18 pads of plaice, 4 barrels of fresh herrings, 5 boxes of kippered herrings, 58 pads of mackeral, 6 pads of soles, 3 kits of crabs, 28 craw-fish, 7 lots of sprats, 35 rabbits, 1 buttock of beef, 33 bushels of pears, and a large quantity of rotten oranges, plums, and other fruit. There are 93 licensed slaughter-houses and 87 licensed cow-houses in the parish. These are periodically visited by the Inspectors, as also are the bake-houses. No prosecutions have been necessary during the year, for infringement of the Bake-houses' Regulation Act. A few cautionary notices have been necessary, calling attention to the need of whitewashing, but these have been complied with in every case at once. The Cattle Plague made its appearance in one or two sheds in this parish during the month of July last. Several weeks elapsed before its true nature was understood. It subsequently spread to more than two-thirds of the sheds in the parish. It is impossible to estimate the degree to which its ravages extended. In the earlier periods of the epidemic, large numbers of cattle, immediately on their being attacked, were disposed of to butchers, and killed for human food; many others were sent away lest they should contract the disease, many died from the disease, and many were slaughtered by order of the Government Inspector. No facts have come to my knowledge which indicate that any one suffered in health from eating the meat of the diseased animals. It has been chiefly of importance to the health of the poor, by raising the price of meat and milk, and thus preventing their obtaining sufficient nourishment for themselves and their children. The Cow-keepers themselves have been very heavy losers, and in many cases have been made bankrupt. The number of cows now in the parish is not more than half what it was last year. Since October last, the Privy Council has appointed an Inspector, under the Cattle Disease Prevention Act; the matter has in this way been taken out of the hands of your Sanitary Inspectors, so that I am not in possession of many statistics of the disease in the parish. The disease has not prevailed to any great extent in St. Pancras since the beginning of the present year, 1866. There were nine cases in December, none in January, two in February, six in March, and two in the first week of April; since the 7th of April no cases have been reported by the Government Inspector. The result of this disease has been to compel dairymen to obtain their supply of milk much more largely from the country. This, though at first 12 attended with loss and inconvenience, has its advantages. It is a great advantage to have cows, with their fodder and manure, removed from the midst of crowded districts, as it removes one very serious source of contamination from the air and the sewerage. In the summer months there will be some difficulty in obtaining the milk sweet, in consequence of the delay in transmission from the country, and the occasional exposure to the sun. Special trains for the bringing of milk to London at the required hours are needed, and dairy farms in the country should be within a short distance from the railway station. These things will be arranged in time. Milk, which has travelled far on the railway, becomes shaken, so that the cream does not rise on it so readily. Its nutritive properties are not at all impaired by this means, though to the Dairyman it is an inconvenience that he has no cream to sell to his richer customers, if they want it. I have no doubt that after a time carriages for the conveyance of milk will be so constructed as to prevent the shaking, which thus interferes with its commercial value. In conclusion, Gentlemen, let me quote the words of one who has written and done much for the promotion of public health:— "In the great objects which sanitary science proposes to itself—in the immense amelioration which it proffers to the physical, to the social, and indirectly to the moral condition of an immense majority of our fellow creatures —it transcends the importance of all other sciences; and in its beneficial operation, seems most nearly to embody the spirit, and to fulfil the intentions of practical Christianity. "Ignorant men may sneer at its pretensions; weak and timorous man may hesitate to commit themselves to its principles, so large in their application; selfish men may shrink from the labour of change which its recognition must entail; wicked men may turn indifferently from considering that which concerns the health and happiness of millions of their fellow-creatures—to such men an appeal would be useless."* But to men, earnest, strong-minded, and praotical, having much consideration for their fellow men, an appeal may successfully be made; and to such amongst you, I, as your Officer of Health, appeal, to give serious attention to sanitary precautions, and to consider the efforts of your Sanitary Committee and their staff as of paramount importance, and worthy of your constant support. I have the honour to remain, Gentlemen, Your obedient Servant, THOMAS HILLIER. * First Annual Report on the Sanitary Condition of the City of London, by John Smith, F.R.S. [Table 1.] TOTALS OF THE FOUR QUARTERS, 1865. Register of Births and Deaths in the Sub-Districts and Public Institutions, for the Fifty-two Weeks ending the 30th December, 1865. Area in Acres. Population in 1861. LOCALITIES. BIRTHS. DEATHS From all causes. From all causes under 5 years of age. From all causes over 60 years of age. From Small Pox. From Measles. From Scarlatina. From Diphtheria. From Hooping Cough From Diarrhoea, Cholera, and Dysentery. From Typhus, Typhoid, and Relapsing Fevers. From Puerperal Fever. From Erysipelas and Pyoemia. From Phthisis. From Bronchitis, Pneumonia, and Asthma. 427 34927 Regent's Park 1165 699 328 141 3 25 20 10 23 43 13 8 81 89 145 28348 Tottenham Court 897 607 284 104 .. 9 18 2 43 34 14 4 86 115 University College Hospital 209 11 26 .. .. 1 5 1 .. 4 9 30 37 Strand Union 99 10 59 .. .. .. .. .. 1 .. .. 18 25 155 27807 Gray's Inn Road 895 575 275 88 2 10 20 4 45 39 22 2 62 125 Royal Free Hospital 105 4 8 .. .. .. .. .. 5 4 8 3 184 39096 Somers Town 1491 864 471 145 7 19 19 2 57 71 20 9 109 163 171 23406 Camden Town 976 455 244 72 2 12 16 3 16 19 15 5 52 72 Saint Pancras Workhouse 559 101 227 .. 7 3 .. 4 7 4 11 79 122 1634 44298 Kentish Town 1995 1048 490 202 12 26 36 9 36 68 37 9 134 149 2716 198784 Totals 7419 5220 2218 1072 26 108 133 35 225 282 134 61 659 900 Estimated Population, 1865: 217,430. [Table II.] FIRST QUARTER, 186 5. Register of Births and Deaths in the Sub-Districts and Public Institutions, for the Thirteen Weeks ending the 1st April, 1865. Area in Acres. Population in 1861. LOCALITIES. BIRTHS. DEATHS From all causes. From all causes under 5 years of age. From all causes over 60 years of ages. From Small Pox. From Measles. From Scarlatina. From Diphtheria. From Hooping Cough From Diarrhoea, Cholera and Dysentery. From Typhus, Typhoid, and Relapsing Fevers. From Puerperal Fever. From Erysipelas and Pyoemia. From Phthisis. From Bronchitis, Pneumonia, and Asthma. 427 34927 Regent's Park 303 184 63 54 2 2 3 2 4 .. 3 3 18 33 145 28348 Tottenham Court 232 172 82 36 .. 1 3 .. 25 4 4 3 16 39 University College Hospital 58 4 7 .. .. .. 3 .. .. 2 3 7 11 Strand Union 47 5 22 .. .. .. .. .. .. .. .. 9 16 155 27807 Gray's Inn Road 224 187 79 40 1 4 5 2 22 2 4 1 18 61 Royal Free Hospital 23 1 2 .. .. .. .. .. .. .. .. 4 3 184 39096 Somers Town 372 259 127 52 3 5 6 1 26 4 3 5 30 68 171 23406 Camden Town 2691 118 58 23 .. 1 5 .. 4 .. 8 3 11 26 Saint Pancras Workhouse 170 29 70 .. 2 .. .. .. .. 1 6 19 47 1634 44298 Kentish Town 508 314 130 74 4 2 8 4 16 4 7 3 30 63 2716 198784 Totals 1908 1532 578 380 10 17 30 12 97 14 32 27 162 367 [ Table III. ] SECOND QUARTER, 186 5. Register of Births and Deaths in the Sub-Districts and Public Institutions, for the Thirteen Weeks ending 1st July, 1865. Area in Acres. Population in 1861. LOCALITIES. BIRTHS. DEATHS. From all causes. From all causes under 5 years of age. From all causes over GO years of age. From Small Pox. From Measles. From Scarlatina. From Diphtheria. From Hooping Cough From Diarrhoea, Cholera, and Dysentery. From Typhus, Typhoid, and Relapsing Fevers. From Puerperal Fever. From Erysipelas and Pyoemia. From Phthisis. From Bronchitis, Pneumonia, and Asthma. 427 34927 Regent's Park 277 159 78 31 .. 1 3 4 12 13 2 1 21 15 145 28348 Tottenham Court 214 150 78 23 .. i 7 .. 11 7 2 i 26 33 University College Hospital 48 4 3 .. .. 1 1 1 .. .. 4 7 6 Strand Union 18 2 12 .. .. .. .. .. .. .. .. 2 2 155 27807 Gray's Inn Road 199 132 73 15 1 .. 3 15 8 5 .. 10 20 Royal Free Hospital 25 1 3 .. .. .. .. .. .. 1 .. 1 .. 184 39096 Somers Town 387 192 111 30 1 .. 2 1 15 12 4 1 25 32 171 23406 Camden Town 222 117 61 13 1 1 2 2 5 4 2 .. 18 16 Saint Pancras Workhouse 124 14 56 .. .. .. .. .. .. .. 4 18 32 1634 44298 Kentish Town 513 211 87 47 4 3 3 2 8 14 7 4 41 25 2716 198784 Totals 1812 1176 509 233 7 6 21 10 67 58 23 15 169 181 [TABLE IV.] THIRD QUARTER, 186 5. Registrar of Births and Deaths in the Sub-Districts and Public Institutions, for the thirteen weeks ending 30th September, 1865. Area in Acres. Population in 1861. LOCALITIES. BIRTHS. DEATHS From all causes. From all causes under 5 years of age. From all causes under 60 years of age. From Small Pox. From Measles. From Scarlatina. From Diphtheria. From Hooping Cough From Diarrhoea, Cholera, and Dysentery. From Typhus, Typhoid, and Relapsing Fevers. From Puerperal Fever. From Erysipelas and Pyœmia. From Phthisis. From Bronchitis, Pneumonia, and Asthma. 427 34927 Regent's Park 295 153 81 22 1 6 6 1 6 25 2 4 15 8 145 28348 Tottenham Court 217 134 65 12 .. .. 2 1 3 20 2 •• 20 13 University College Hospital 47 3 5 .. .. .. .. .. .. 1 2 5 3 Strand Union 10 .. 7 .. .. .. .. .. 1 . •• •• 1 1 155 27807 Gray's Inn Road 2531 126 69 11 .. 4 6 .. 4 22 9 .. 13 7 Royal Free Hospital 35 .. .. .. .. .. .. .. .. 3 3 2 .. 184 39096 Somers Town 352 177 109 24 1 .. 4 .. 3 43 3 1 24 13 171 23406 Camden Town 230 106 61 23 .. 6 1 • • 5 13 2 1 13 8 Saint Pancras Workhouse 120 24 41 .. .. .. .. 2 3 1 1 26 15 1634 44298 Kentish Town 460 235 126 35 3 8 11 .. 3 43 11 1 24 10 2716 198784 Totals 1807 1143 538 180 5 24 30 2 26 170 34 13 141 78 [Table Y.] FOURTH QUARTER, 186 5. Register of Births and Deaths in the Sub-Districts and Public Institutions, for the Thirteen Weeks ending the 30th December, 1865. Area in Acres. Population in 1861. LOCALITIES. BIRTHS. DEATHS From all causes. From all causes under 5 years of age. From all causes over 60 years of ages. From Small Pox. From Measles. From Scarlatina. From Diphtheria. From Croup. From Hooping Cough From Diarrhoea, Cholera and Dysentery. From Typhus, Typhoid, and Relapsing Fevers. From Puerperal Fever. From Erysipelas and Pyoemia. From Phthisis. From Bronchitis, Pneumonia, and Asthma. 427 34927 Regent's Park 290 203 106 34 .. 16 8 3 3 1 5 6 .. 27 33 145 28348 Tottenham Court 234 151 59 33 .. 7 6 1 1 4 3 6 .. 24 30 University College Hospital 56 .. 11 .. .. .. 1 .. .. .. 1 .. 11 17 Strand Union 24 3 18 .. .. .. .. .. .. .. .. .. 6 6 155 27807 Gray's Inn Road 219 130 51 22 .. 2 6 2 1 4 7 4 1 21 37 Royal Free Hospital 22 2 3 .. .. .. .. .. .. .. 1 1 1 .. 184 39096 Somers Town 380 236 124 39 2 14 7 .. 2 13 12 10 2 30 50 171 23406 Camden Town 255 114 64 13 1 4 8 1 1 2 2 3 1 10 22 Saint Pancras Workhouse 145 34 60 .. 5 3 .. .. 2 4 2 .. 16 28 1634 41298 Kentish Town 514 288 147 46 1 13 14 3 6 9 7 12 1 39 51 2716 198784 Totals 1892 1369 593 279 4 61 52 11 14 35 40 43 6 185 274 [TABLE VI.] VIOLENT DEATHS, 1865. Causes of Death. AGES AT DEATH. Total OBSERVATIONS. under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 to 85 Unknown ACCIDENTAL— Fractures and Contusions 3 4 8 11 32 23 10 .. 91 Run over and injured by Railway Trains, 12; fall from Railway Bridge, 1; run over by Omnibuses, Vans, Waggon, and Carts, 15; fall from Horse, 2; catching Horse, 1; kick from Horse, 1; falls from Vans, Cabs, and Carts, 5 ; on Corn Bin, 1; down Stairs, 2; from tree, 1; from Wall, 1; from Scaffold and Ladders, 7 ; in Building, 1; from Windows, 2; from Roof, 1; into Machinery, 2; from Bed, 3; from Step, 1; in Street, 3; when drunk, 2; falls (not described), 8; from running Nail in Great Toe, 1; Pitchfork passing into Brain, 1; Barrel of Cement falling on 1; upsetting Fire Escape, 1; blow in a light, 1; blow on head, 1; wound ol hand, 1; wound of head, 1; causes of Fractures not stated, 11. Bums and Scalds .. 12 2 .. 6 1 2 .. 23 Burns from Crinoline, 2; Clothes taking fire, 15; Scalding, 6. Poison .. .. .. .. .. 2 1 .. 3 By Spirits of Ammonia, 1; Overdose Laudanum, 1; Inhaling Aqua fortis, 1. Drowning .. 1 1 .. 1 1 1 2 7 In Regents Canal, 3; in King's Cross Basin, 1; in Highgate Ponds, 1; in water butt, at "Bull and Gate," Kentish Town, 1; in Binn's Yard, Munster Street, 1. Suffocation 30 4 .. .. .. .. .. .. 34 For want of fresh air in bed, 25; whilst sucking at breast, 1; by falling on face in bed, 1; by food gotting in Windpipe, 3; by food passing from Stomach to Lungs, 1; by brother lying on 1; born in W.C., 1; by Mother's Discharges, 1. Neglect 3 1 1 1 .. 1 1 .. 8 Exposure to Cold, 3; want of nourishment, 2; Neglect of Mother, 1; Neglect at birth, 2. Total 36 22 12 12 39 28 15 2 166 [ TABLE VI.—continued. ] Causes of Death. AGES AT DEATH. Total OBSERVATIONS. under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 to 85 Unknown SUICIDE— Drowning ... ... ... ... 1 1 ... ... 2 In Regent's Canal. Hanging ... ... ... ... ... 3 ... ... 3 Throwing self out of Window ... ... ... ... ... 1 ... ... 1 Stabbing ... ... ... 1 1 ... ... ... 2 By Stabbing himself in abdomen, 1; by wounds on throat and head, self-inflicted, 1. Cutting Throat ... ... ... ... 2 1 ... ... 3 Poison ... ... ... 2 1 ... 1 ... 4 By Hydrocyanic Acid, 1; by Sulphuric Acid, 1; Oxalic Acid, 2. Gun Shot ... ... ... 1 ... ... ... ... 1 Total 4 5 6 1 16 MURDER— Infanticide 16 ... ... ... ... ... ... ... 16 Found in Regent's Canal, 3; in Gardens, 4; at Railway Station, 1; at Pancras Workhouse, 1; in Squares 6; on Door Step, 1. 20 [ Table A. ] Showing the Death-rate per Thousand, and the proportion of Births to Deaths under 5 years of age in each Sub-District. Names of Sub-Districts. Registered Deaths in 1865. Estimated Mortality in 1805.* Estimated population in 1865. Rate of Mortality per 1000. Proportion of Births to Deaths under 5 yrs. of age. Regent's Park 699 842 36,201 23.2 1000: 281 Tottenham Court 607 722 28,689 25.1 ‡1000: 335 Gray's Inn Road 575 686 28,343 24.2 1000: 307 Somers Town 864 1,027 40,670 25.2 §1000:316 Camden Town 455 570 28,975 20.9† 1000: 314 Kentish Town 1,048 1,274 57,202 22.3 1000: 245 University College Hospital 209 Royal Free Hospital 105 St. Pancras Workhouse 559 Strand Union 99 The whole Parish 5,220 5,121 220,080** or 217,430 *This column is calculated by excluding the deaths which occurred in the Strand Union, and distributing the deaths in University College Hospital, Royal Free Hospital, and St. Pancras Workhouse amongst the Sub-Districts in the proportion of their populations. † The number 1800 has been subtracted from the population on account of the Workhouse. ‡ The number 50 deducted from Births for Strand Union. § The number 200 deducted from Births for Pancras Workhouse. ** One of these numbers is obtained by adding together the estimated populations of the several sub-districts; the other is obtained by a separate calculation with the gross population of the Parish. 21 [ Table B. ] Names of Streets, &c. Number of Houses. Estimated Population Number of Deaths in 1865. Death-rate per 1000 in 1865. Average number of Deaths in years 1856—65. Mean Death-rate per 1000 in 10 years. Tottenham. Drapers Place 32 663 23* 34.7 18.4 27.7 Gresse Street 36 676 16† 23 7 17.7 26.2 Mid ford Place 8 203 5 25.0 7.8 38.4 Tottenham Place 33 751 17 21.9 20.0 26.5 Stephen Street 585 5 8 5 Regent's Park. Eden Street 13 230 11 47.8 7.0 30.4 Henry Street 50 900 23 25 5 34.8 38.7 Mary Place 19 300 9 30.0 8.5 28.3 Grays Inn Lane. Peace Cottages 24 146 7 47.9 4.8 in 4 yrs. 32.8 Coopers Buildings 12 59 2 33.9 1.1 18.6 Colonnade 27 310 14 45.0 10 in 4 yrs. 32.2 Derry (late James) Street 18 294 12 40.9 6.7 22.8 Wellington Sqre 18 260 5 19.0 7.6 29.2 Cromer Street 115 1540 29 18.8 39.5 25.6 Compton Place 19 296 2 6.8 7.6 25.7 Poplar Place 11 125 2 16.0 4.3 34.4 Wilson Place 13 181 2 11.5 4.3 23.8 Riley Street 8 122 6 49.1 2.2 in 4 yrs. 18.8 Melina Place 5 20 1 50.0 Somers Town Pancras Square 110 650 6 9.2 11.7 18 0 Little George St. 56 725 16 22.1 16.2 22.3 Drummond Crest. 954 15 15.7 18.3 19.2 Hampton Court 12 153 3 19.6 5.0 32.7 Camden Town. Ashby Street 23 300 14¶ 46.6 Average of 4 yrs. 10.0 33.3 Thornley Place 17 98 7 71.5 3.7 37.7 (now pulled down) * Of these, 15 were under the age of 5 years; 12 from Zymotic disease, and 2 occurred in the London Fever Hospital. † Of these, 9 were under the age of 5 years, and 5 from Zymotic disease. ¶ Of these, 1 was in the London Fever Hospital. 22 [Table C.] Shewing the number of Births, and the number of Deaths, under 1 year of age: and the per centage of Deaths under 1 year to Births in each Sub-District. Names of Districts. BIRTHS. DEATHS under 1 year of age. Per centage of Deaths under 1 to Births. Regent's Park 1,165 181 15.5 Tottenham Court 870 897 154 159 17.7 Strand Union 21 5 Gray's Inn Lane 895 164 18.3 Somers Town 1,491 258 17.3 Camden Town 776 976 136 198 17.5 Pancras Workhouse 200 62 Kentish Town 1,995 285 14.3 The whole Parish 7,419 1,245 16.7 [ Table D. ] 1865—SEWERS CONSTRUCTED IN ST. PANCRAS BY THE VESTRY. DATE. LOCALITIES. DESCRIPTION—NUMBER OF FEET REMARKS 3'9" x 2'6" PIPE. Brick barrel. 1865 March Pond Square, Highgate 196 new Holbrok Court 34 .. ,, The Grove, Highgate 118 .. ,, June Oakfield Crescent 336 .. .. ,, ,, Drapers Place 450 .. reconstructed ,, Ash by Street 382 .. new July Gillies Street 25 . .. ,, Sept. Junction Road 300 .. ,, ,, Albert Mews 34 .. ,, ,, Kings Road (by Goodall) 410 .. ,, Dec. Busby Place 56 50 ,, 361 1980 50 OTHER SEWERS CONSTRUCTED BY BUILDERS—1865. DATE. LOCALITIES. DESCRIPTION—NUMBER OF FEET. REMARKS. 3'9" x 2'6" PIPE. Brick barrel May Berkeley Road, by Tott. and Hamp. June. Rail. 237 320 July Passage by Fitzroy Road .. 170 Oct. Damarel Street 610 ,, Queens Road, Langford Road, &c. 1940 3107 170