STPAN 23 Saint Pancras, Middlesex. ELEVENTH ANNUAL REPORT OF THE Medical Officer of Health, Fob the Year 1866. Gentlemen, In the year 1866, the rate of mortality in St. Pancras was high, considerably higher than the average of ten preceding years; although it included an epidemic of Cholera, the mortality was not however so high as in 1864 and 1865. In 1841-50, the rate of mortality per thousand was 23, and in 1851-60, it was only 22. In 1864 it was as high as 25 per thousand; and in 1866, the year now reported on, it was 23.5 per thousand. The deaths registered as having occurred in St. Pancras during the year, numbered 5254; from this are deducted 110, the deaths in the Strand Union Workhouse, which do not belong to St. Pancras. The population has been estimated by the Registrar-General, as 219,024, which is based on the increase in the number of houses upon the rate-books, between 1861 and 1866. The rate of mortality in all London was 26.47, and of the Northern group of districts, amongst which St. Pancras is situated, it was 25.31 per thousand. The mortality in the Eastern Districts, where Cholera proved fatal, was at the rate of 33.96 per thousand; in the South Districts, where Cholera was so fatal in 1854, the rate of mortality was only 24.10, lower than in the North. In the Cholera year, 1849, London suffered from a mortality of 30.14; the North Districts, 23.68; the East, 31.76; and the South, 37.62 per thousand. In the Cholera year 1854, London suffered from a mortality of 29.43 per thousand; the Northern Districts, 24.36 per thousand; the Eastern, 29.98 ; and the Southern, 34.83 per thousand. The birth-rate in St. Pancras during 1866 was 33.4 per thousand; in London, it was 35.67 ; in thirteen large towns, including London, it was 36.85. Amongst the Zymotic diseases, the most fatal was Diarrhoea, which caused 215 deaths; this is a smaller number, however, than was due to that cause in 1865, namely, 260. 2 Next to Diarrhoea, came Hooping Cough with 211; then Cholera with 130 deaths; then Scarlatina with 121 deaths; Typhus and Typhoid 116; besides 47 Typhus and 7 Typhoid, who died in the London Fever Hospital; 101 Measles ; 43 from Small Pox, besides 16 who died at the Small Pox Hospital; then 31 from Diphtheria, and 36 from Croup. The following figures represent approximately the annual rate of mortality in this Parish since 1855:— In 1856 2.00 percent. „ 1857 2.00 „ 1858 2.31 „ 1859 2.19 „ 1860 2.15 „ 1861 2.30 „ 1862 2.16 „ 1863 2.306 „ ,,1864 2.535 „ „ 1865 2.372 „ „ 1866 2.35 These are the rates of mortality calculated by me in my various Annual Reports; they are liable to slight inaccuracy from the impossibility of accurately ascertaining the population of the Parish, except at the year of the census. The population in 1865 was estimated at 217,430, which was probably too high, so that the per centage rate of mortality above given for that year is too high. In 1866, I have adopted the Registrar General's estimate, 219,024. The actual number of deaths in St. Pancras in 1865, was 5159; and in 1866, it was 5154, in each case omitting the deaths which occurred in the Strand Union. The rate of mortality was therefore higher in 1864 than 1865, and in 1865 than in 1866. The deaths from all causes may be thus classified, using the nomenclature of the Registrar General:— I. Zymotic Diseases. 1. Miasmatic 1065 2. Enthetic 41 3. Dietic 45 4. Parasitic 25 II. Constitutional Diseases. 1. Diathetic 177 2. Tubercular and Rickety 978 III. Local Diseases. 1. Nervous System 537 2. Vascular System 261 3. Respiratory System 894 4. Digestive System 206 5. Urinary System 90 6. Generative and reproductive systems 11 7. Organs of locomotion 9 8. Skin 20 3 IV. Developmental Diseases, 1. Infantile 316 2. Middle Age 17 3. Old Age 188 V. Violent Deaths. 1. From Accident or negligence 140 2. Homicidal 37 3. Suicidal 23 VI. Causes not specified 71 The Zymotic diseases were neither so fatal as in 1864, nor as in 1863, notwithstanding the epidemic of Cholera. The class of diseases which was more fatal than usual, was the tubercular and rickety, which gave 978 deaths, nearly one-fifth or more exactly 19 per cent. of the mortality from all causes. Diarrhoea was fatal in 215 cases, whereas, in 1865, it gave 260 deaths. Cholera was fatal in 112 cases, besides 20 that died in Hospitals in this parish, having been brought into them from other districts. In 1854, Cholera was fatal to 248, and Diarrhœa to 164. Hooping Cough gave 211 deaths, Scarlatina, 121, and Measles, 101 deaths; all rather lower numbers than in 1865. Typhus and Typhoid Fevers are registered as the causes of 116 deaths, besides 47 from Typhus, and 7 from Typhoid, at the London fever Hospital, of persons sent from St. Pancras. This is in all, 170; last year the total was 162. Small Pox was more fatal than in 1865, causing 43 deaths in the Parish, and 16 at the Small Pox Hospital. This is a very high mortality from a disease, the mortality of which is almost absolutely preventible by a universal system of vaccination properly carried out. From Diphtheria, 31 died, and from Croup, 36. Vaccination.—There are still a few persons who undervalue vaccination, and even do what they can to discourage its general adoption. The number of these persons is small, and they act in opposition to evidence of the most complete and convincing character. During the four years, 1863-66, there have been admitted into the Small Pox Hospital, 5,691 cases; amongst these, the general rate of mortality was in 1863, 17 per cent.; in 1864, 12.9 per cent.; in 1865 and 1866, 13 per cent. Amongst the unvaccinated persons, the mortality was 48, 36, 38, and 35.7 per cent. in the four years respectively; whereas, amongst the vaccinated patients, the mortality was only 12.0, 8 7, 7.4, and 7.3 per cent. in the four years; in other words, the rate of mortality was more than four times greater amongst the unvaccinated than amongst the vaccinated patients. From these figures, collected by one of the most careful medical observers in England, it is clearly demonstrated that vaccination, as commonly practised, reduces the mortality of Small Pox very greatly, from 48 per cent. to 12 in one year, and from 36.7 per cent. to 7.3 in another year. Unfortunately, we cannot say so much in regard to its preventing the occurrence of the disease in a milder form. The proportion of vaccinated cases 4 to the total number of admissions to the Small Pox Hospital in 16 years, was 53 per cent.; and this proportion has been higher during the epidemic of the past four years, than it was in 1851-52, or 1854-56, or 1859-60. During the recent epidemic, the proportion has risen to 81 per cent. It might apoear from these figures at first sight, that although vaccination may render Small Pox, when it occurs, less virulent, it has entirely lost its power in preventing the occurrence of the disease. There is, however, good reason to believe that there are in London, about 95 per cent. of the community who have either been vaccinated, or had Small Pox; so that if Small Pox attacked the vaccinated, and the unvaccinated in equal proportions, there would be nineteen times, instead of four times, as many vaccinated persons, as unvaccinated, with Small Pox. Still the results above given are not so satisfactory as could be wished; and there is reason to believe, that with the best attainable arrangements for vaccination, much better results would be obtained. It is very rare to see Small Pox in persons whose arms exhibit three or four scars of normal vaccination ; the cases of Small Pox, and especially the severer cases in vaccinated persons, are seen in those whose vaccination has not taken well, and has left but one or two meagre scars. Small Pox in St. Pancras is much more common in Kentish Town than in the southern parts of the Parish ; 30 fatal cases out of 59 in 1866, coming from Kentish Town. It is more common amongst persons who come from the country than amongst the natives of London. There is reason to believe, that a larger, proportion of unvaccinated and imperfectly vaccinated persons, is found amongst those brought up in the country, than amongst Londoners. There is no doubt that re-vaccination is advisable in all persons above the age of 14 or 16, who do not present on their arms three or more satisfactory marks of vaccination ; and if they are much exposed to the contagion, re-vaccination is a wise precaution for all adults. All the nurses engaged at the Small Pox Hospital, who have not had Small Pox, are vaccinated when they enter upon their duties ; and there has not been one case of a nurse contracting the disease since the Hospital was opened. During the year 1866, 179 cases were sent to the Small Pox Hospital from St. Pancras, of whom 16 died; ten of those who died were unvaccinated, and of the other 6, four had only one indifferent vaccine scar each; one had two small scars ; and in the other, vaccination was doubtful. Of 70 cases in the Workhouse, between February 17th and April 24th, 1867, 55 were vaccinated, none of whom died, 15 were vaccinated, and 3 of these, or 20 per cent. died. The number of deaths from the under-mentioned diseases, in St. Pancras and London respectively, were:— London St. Pancras Diarrhœa 3184 206 Cholera 5577 112 Typhus and Typhoid Fevers (including deaths in Fever Hospital) 2681 170 Scarlatina 1885 124 Small Pox (including deaths in Hospital) 1388 59 Hooping Cough 2933 211 Pulmonary diseases (including Phthisis) 22193 1615 Phthisis alone 9277 741 The estimated population of St. Pancras was to that of London, in the pro- 5 portion of 100 to 1434; if the death rates from the above mentioned diseases had been exactly the same in St. Pancras, as in London at large, we should have had from Diarrhoea, 222, instead of 206 deaths ; from Cholera, 388, instead of 112; from Scarlatina, 131, instead of 124 ; from Typhus, 186, instead of 170; from Small Pox, 96, instead of 59; from Hooping Cough, 204, instead of 211 ; from Pulmony disease, 1,547, instead of 1,615; from Phthisis, 647, instead of 741. It thus appears, that from Diarrhoea, Cholera, Scarlatina, Typhus and Small Pox, the deaths in St. Pancras were proportionally not so numerous as in all London. From Pulmonary disease and Consumption, St. Pancras suffered a considerably higher mortality than London as a whole. This corresponds with what has been observed in previous years. It has been ascertained recently, that the mortality from Consumption is much reduced by thorough drainage of the subsoil. The completion of the sewerage in this Parish in the parts not yet supplied with sewers, would, in all probability, have the effect of reducing the undue mortality from Consumption. Cholera..—The year 1866 was characterized by the occurrence of epidemic Cholera, which carried off 112 persons who lived in St. Pancras, including the cases of Choleraic Diarrhoea, which is usually only a milder term for the same disease. In the week ending July 21st, there was considerably more diarrhoea under the care of the Parish Surgeons than in previous weeks; in the week ending 14th July, the weather had become suddenly very hot. The first case of undoubted Cholera which proved fatal in this parish, was that of a boy aged 6 years, who came from a house in Mile End, where Cholera was at the time raging severely, he died on the 22nd July ; the next day, his sister, aged one year died ; on the same day, 23rd July, a solicitor died in Mecklenburgh Square, after about 36 hours' illness of genuine Asiatic Cholera. His house was badly drained; he had been to Wimbledon to a review of the Volunteers the day on which he was taken ill; he had not been, so far as I could learn, in communication with any cholera patients. On the 24th July, a woman died in Camden Town, having taken the disease from her husband, who came home ill with Cholera a few days previously from the Isle of Dogs, where he had been employed as an engineer ; he survived his wife one week. On the 25th and 26th July, a brickmaker and his son died at a small house in a newly built street (Piercefield Street) in the upper part of Kentish Town; they were both engaged at work in brickmaking at Belsize Park, and there was no other case of the disease at that time in the neighbourhood. Two other children died of the disease on the 1st and 4th August in the same house. No other case occurred in the street. It very much puzzled me to account for these cases. I could not find out that any of the patients had been in communication with infected districts. There was nothing in the locality, especially to invite the disease, except that the house was newly built, and was very damp, and with nothing to prevent the rising of moisture from the heavy clay soil into the porous and indifferent bricks of which it was built; it must, however, be admitted, that the house was not worse than many of those around it, in which no case of Cholera occurred. Another supposition occurred to my mind, that this man and boy working in the fields where there are open sewers, may have introduced into their stomach, either from their hands at their meals, or by drinking water, some sewage matter. 6 On the 27th July, the grandfather of the children who imported the diseases from Mile End, fell a victim to the malady. On the 23rd July, a woman who had been to Stepney, to visit a married daughter suffering from Cholera, and having washed linen for her, came home to Somers Town, and died in two days. In this house, in Ossulston Street, two children subsequently died on the 6th August; from them their grandmother, who waited on the children, but lived in the next street, contracted the disease, and died on the 11th August; her son, occupying the same room with her, died the next day. From that date, there were only two deaths from Cholera until the 4th September, when a vagrant pauper, of very drunken habits, died in University College Hospital, The next well marked case occurred in Eedhill Street, also in a very intemperate man, who died on the 8th September. The next day, a fatal case occurred for the first time in the Tottenham Court District, in the person of a female, living at 14, Cumberland Street, Goodge Street; on the following day, her mother died; and on the 13th, a sister; and on the 21st, a woman occupying the kitchen of the same house, fell a victim after two days' illness. From this date, until the last week of October, cases of the disease were constantly occurring, scattered over the entire parish. The fatal cases from the commencement to the end of the Epidemic, were thus distributed amongst the sub-districts, referring the deaths in Hospitals, to the place from which they came:— Eegent's Park 25 Tottenham Court 15 Grays Inn Road 8 Somers Town 33 Camden Town (or 11 excluding Workhouse and vagrant wards) 13 Kentish Town 18 Eelatively to every 10,000 of the population, the several sub-districts suffered as follows, placing them in the order of their comparative freedom from the disease:—Grays Inn Road, 2.9; Kentish Town, 2.9; *Camden Town. 5 1; Tottenham Court Eoad, 5.2; Eegent's Park, 6.6; Somers Town, 8.4. All the cases of Cholera that came to my knowledge in St. Pancras, are here referred to their several streets and districts:— Regent's Park,—25 deaths. Albany Street, one death. 32, Brook Street, 2 cases—one death. 1 and 6, Cumberland Street West, 2 cases—one death. 9, Eden Street, one death. 8 and 9, Upper Fitzroy Place—4 fatal cases at No. 8; 2 fatal cases at No. 9. 40, Henry Street, one death. 5 and 79, Hampstead Eoad, 3 cases—two deaths. 7 and 13, Mary Place, 5 cases—two deaths. Mornington Crescent, one death (a case imported from Brussels). 21, Netley Street, one death. 4, Palace Yard, one death. *In this calculation, the Workhouse is excluded. 26, Park Street, one death. 11 and 33, Redhill Street—4 cases at No. 11—three deaths; one death at No. 33. 5, Robert's Court, 2 cases—one death. Stanhope Street, one death. Single cases not fatal in Little Edward Street, Little Brook Street, Little Albany Street, North-Western Terrace, Wharf Hampstead Road, Wellington Street. Tottenham Court Road,—15 deaths. 60, Burton Crescent, one death. 30, Cumberland Street, one death. 14, Cumberland Street—4 fatal cases. 23, Drapers Place,one death. 15, Fitzroy Market, one death. 19, Market Street, one death—1 case not fatal at No. 16. 15, Princes Street, one death. 2, Stephen Street, one death—one recovery. Tottenham Court Road, one death. 21, Tottenham Place, 2 fatal cases—1 case not fatal at No. 24. 29, Warren Street, one death. Cleveland Street, 2 cases not fatal. Strand Union, one death, (not counted). Grays Inn Road,—8 deaths. 21, Brighton Street, one death. 19, 89, and 215, King's Cross Road, three deaths. Mecklenburgh Square, one death. Mecklenburgh Street, one death. 32, Marchmont Street, 3 cases—one death. Harrison Street, cases not fatal. Royal Free Hospital, 1—address unknown. Somers Town,—33 deaths. 16, Barclay Street 1, Christopher Place 34, Church Way 22 and 23, Clarendon Square 66 and 90, Drummond street 9, Exmouth Street 5, Gee Street 18, Goldington Street 3, Hampden Street 12, James Street One fatal case in each of these houses. 51, Little George Street, 3 cases—two deaths. 52, Little George Street, one death. 11, Marston Street, one death. 30, Melton Crescent, one death. 38, Ossulston Street, 3 cases fatal. 9, Seymour Row, 2 cases fatal—1 recovery. 8, Seymour Street, one death. 14 and 18, Stanmore Street, two deaths. 2, 29, and 30, Union Street, 3 cases—two deaths. 8 2 and 8, West Street, two deaths. 11, York Buildings, one death. 16, 18, and 63, "Wilstead street, 3 fatal cases. Cases not fatal in Latham's Court, Isaac's Place, and Chalton Street. Camden Town—13 deaths. 72 and 83, Bayham Street, four deaths. 33, Caroline Street, one death. 7, Greenland Place, one death. 7, King's Yard, one death. Pancras Infirmary and Casual "Ward, two deaths. 3, St. Stephen's Place, 2 fatal cases. 17 and 21, Suffolk Street, 2 fatal cases—1 recovery. Two cases not fatal in Ashby Street, one in Pancras Walk. Kentish Town,—18 deaths. 87, Carlton Street, fatal case. 40, Castle Road, fatal case. 3, Clarendon Cottages, fatal case. 5 and 12, Dale Road, 2 cases—one death. 29 and 36, Duke's Terrace, 2 cases—one death. 1, Harold Street, one death. 4, Hargrave Place, one death—two cases. 6, Haverstock Road, one death. 7, St. George's Road, one death. 15, Piercefield Street, 4 fatal cases. 8, Little Randolph Street, one death. 7, Spring Place, fatal case. 31 and 158, Weedington Road, 2 fatal cases. 2, Whitfield Street, 1 fatal case—1 case not fatal. Cases not fatal in Maiden Road, Modbury Terrace, and St. Leonard's Square. The Regent's Park sub-district, includes not only what is generally understood as Regent's Park, but a large portion of Ward 5; and it was in this part of the district that nearly all the deaths occurred. Grays Inn sub-district had the lowest mortality from the disease, the cases which died in the Free Hospital, brought from other parishes, being excluded from the calculation. One of the very early cases was in Mecklenburgh Square, which has but a very indifferent sewer. I would suggest that the Surveyor be requested to report on the condition of it. Three deaths, and several other cases not fatal, occurred in King's Cross Road, in the line of the Fleet Sewer. Of the 13 deaths in Camden Town, six were distinctly traced to importation ; of the other seven, one was from the Casual Wards, and one from the Workhouse. Of the 18 deaths in Kentish Town, two appeared to be traceable to bad drainage. One was imported from Tring, in Bedfordshire. Several were apparently induced by intemperate habits. The occupations of the persons who died from Cholera, or of their parents in the case of children, were as follows:—Banker, 1 from Brussels, where he contracted the disease; solicitor, 1; poor gentlewomen, 2; shopkeepers' class, 5 ; journeymen shoemakers and tailors, 5; servants, 6; clerks, 2; artisans, 43; nurses, 3; cabmen or wives, 5; day labourers, 39; general dealers, 4; occupation unknown, all poor, 9; paupers, 7. 9 It will be seen that the poorer classes suffered far more severely than the middle or upper classes. Amongst exciting causes, I clearly traced intemperance as a very common one; another was bad drainage; another was infection or contagion, especially in the houses of the poor, where cleanliness was not observed, and ventilation was defective. The disease appeared to spread from one room to another in the same house where there was crowding, and in the earlier cases where disinfection was not vigorously carried out. None of the nurses at University College Hospital, where 96 cases (71 of Cholera, and 25 Choleraic Diarrhoea) were treated, contracted the disease. None of the Medical visitors took the disease, although several had troublesome diarrhoea. I believe the escape of the nurses and doctors was mainly due to the observance of strict cleanliness, and great care in immediately disinfecting and removing all discharges from the sick, and attention to ventilation. Unless such precautions are observed, Cholera is undoubtedly contagious and infectious ; but with proper precautions, I believe its infection need not be feared. No cases came to my knowledge in St. Pancras where the disease was clearly propagated by drinking water; but during previous epidemics, and in other districts, this mode of its propagation has been abundantly proved. Only one case of Cholera occurred in the Workhouse itself, and one ease in the Casual wards. The one from the Workhouse was a nurse who was pregnant, and had been doctoring herself with strong aperient pills; and there seemed to be no other cause to account for this isolated case, except the use of these pills, for some time after the bowels had been acting freely. She died with all the symptoms of Asiatic Cholera. There was no Choleraic diarrhoea in the house at the time. This case certainly is opposed to the plan of treatment recommended by some recent writers, of giving purgatives to cure the premonitory diarrhoea during an epidemic of Cholera. Of one thing I was fully convinced during the epidemic, and that was of the value of disinfection in arresting the spread of the disease. The two disinfectants chiefly employed, were carbolic acid and fire. Owing to the want of a place to which infected linen and clothes could be sent to be purified and washed, it was necessary in many cases, to burn articles which might with safety have been kept for future use, if proper appliances had been available. Great difficulty was found in some cases in finding a suitable place for burning bedding and clothes. When they could not be burnt at the rear of the houses where the disease had existed, they were sent either to a yard belonging to Mr. Culverhouse, the contractor, or to some open space in the northern part of the Parish. In either case, this was attended with considerable expense. Disinfection is quite as important in dealing with Small Pox, Typhus Fever, and Scarlet Fever, as in the case of Cholera, and might be accomplished with as much certainty. The Sanitary Act, 1866, imposes this duty upon the Vestry, and the subject is one which demands your serious consideration. An establishment is required to which all infected clothing and bedding can be sent, either to be destroyed, or to be purified. Several distinct apparatuses are required,—a furnace for burning articles not fit to be purified, a hot chamber for disinfecting things which will be damaged by boiling water, and the ordinary appliances for boiling, washing, and drying linen. A properly constructed truck or other vehicle, would be required to remove infected articles. In Liverpool, two establishments of this kind are in operation. If such arrangements were made and properly carried out, they would be of very great value in arresting the 10 spread of infectious diseases. I am frequently applied to for advice, what should be done with bedding and clothes used by patients with fevers or small pox? I can only tell these persons who apply to me, that such things as can be washed should be purified by boiling and washing, that feathers may be purified at bedding makers, and that other things must be burnt. This is very unsatisfactory, because infected articles are conveyed through the streets, without any precaution, and then mixed at the laundries and bedding makers with noninfected articles, and many valuable things are burnt which might be saved if a hot chamber were provided. The Commissioners of Baths and Washhouses would do well to provide a second establishment, in which there might be laundries of the ordinary kind, as well as a distinct department for the purification of infected linen, such as I have alluded to; it would be but a small additional cost to provide such a department in an establishment where all the appliances for a washhouse already exist. The continuance of Small Pox in the Parish, as well as the frequent occurrence of Typhus and Scarlet Fever, render such a plan as I have recommended very advisable, even in an economical point of view. The cost of Typhus Fever last year in St. Pancras, it is difficult to estimate. As one item, there was a payment to the Fever Hospital of more than £300 for the patients sent there; then there were 59 deaths of adults, between 20 and 60 years of age, leaving, in a great many cases, families destitute and dependent on parochial relief; besides those who died, a large number who recovered were left so weak, as to be unable for many weeks to earn their livelihood. The additional burden thrown on the rates by these cases is a most serious item. The same remarks apply to Small Pox; more than £150 was paid for the cases sent to the Small Pox Hospital, besides the cost of the cases treated in the Workhouse, which numbered 63, between September 1st and December, 1866, and 141 between 1st January and 25th April of this year. Then there died during 1866, besides children and old people, 17 adults between the ages of 20 and 60 years, many of them leaving families dependent on the rates. At the present time, every fresh case of Small Pox costs the Parish four guineas for Hospital accommodation alone. I have no hesitation in saying that a considerable number of cases could have been prevented by the adoption of such precautionary measures as it is within your province now to institute. The history of this last epidemic of Cholera,'affords ample proof of the value of sanitary measures; at the East end of London where the main drainage was incomplete, and the water supply was contaminated, the disease raged with an intensity which has never been surpassed in this country; in the Southern districts, where in previous epidemics it had been most virulent, but in which the drainage and water supply had been greatly improved, the disease prevailed with far less severity; in St. Pancras, and other districts similarly situated, it was less severe than in 1854 and 1849, and its attacks were most severe in places where sanitary measures had been incompletely carried out. In 1849, the deaths from Cholera in St. Pancras, numbered 360; in 1854, they were 238; and in 1866, 112. The rate of mortality to every 10,000 of the inhabitants, was in 1849, 22; in 1854, 13; and in 1866, it was only 5.3. In London at large, the rate of mortality was 60 in 1849; 45 in 1854; and 18.4 in 1866. 11 St. Pancras suffered from Cholera in this last epidemic more than St. Marylebone or Islington, less than Hackney, Clerkenwell, St. Giles, or the Strand, and about in the same proportion as Holborn. The annexed table will show the relative position of St. Pancras, as regards mortality from Cholera and all causes, population, the annual value of property, and various other matters. It is taken from the Registrar General's report, except so far as relates to St. Pancras, the mortality of which, I am able from local enquiries, to give with a little more accuracy than he could. See pages xviii. and xix. of the Registrar General's Summary of Weekly Returns of Births and Deaths, during the year 1866. Table shewing the Water Companies supplying each of the Parishes and Districts constituted under the Provisions of the Metropolitan Management Act, number of Vestrymen and of Health Officers, Area in Statute Acres, Annual Value of Property assessed in 1866, Estimated Population in 1866, Deaths, and the Rate of Mortality to 10,000 Population from all causes and from Cholera and Diarrhoea, density of Population, Elevation, and Annual Value of Property per Head of Population. Water Company furnishing chief Supply. Pabishes and Distbicts constituted under the Provisions of the Metropolis Management Act, 18 & 19 Vict., cap. 120. Number of Members of Board or Vestry. Number of Health Officers. Area in Statute Acres. Annual Value of Property assessed in 1866. Estimated Population in 1866. Deaths in 1866 from Rate op Mortality per 10,000 in 1866. Persons to an Acre in 1866. Elevation in Feet above Trinity High water Mark of the Thames. Annual value of Property per Head of Population. All Causes. Cholera. Diarrhoea. Cholera and Diarrhoea. All Causes.* Cholera.† Diarrhoea. Cholera and Diarrhœa. LONDON 2,611 47 77,997 £ 15,261,999 3,037,991 80,129 5,577 3,184 8,761 264.7 18.4 10.5 289 39.0 39 £ 5.006 West Distbicts. J.W.M. Paddington 72 1 1,245 758,344 93,365 1,720 26 80 106 174.4 2.8 8.6 11*4 75.0 78 8.122 WMc. Kensington 84 1 1,942 501,132 85,171 1,962 18 106 124 229.6 2.1 12.4 14 5 43.9 23 5.884 WM. J.C. Fulham 39 1 4,155i0 171,876 48,657 1,153 41 65 106 249.2 8.4 13.4 218 11.7 7 3.532 J.W.M.C. Kensington Registration District 195 3 7,342ic 1,431,352 227,193 4,835 85 251 336 211.1 3.7 11.0 147 30.9 40 6.300 C. Chelsea 60 1 865ic 299,868 65,957 1,704 22 48 70 269.4 33 7.3 106 76.3 12 4.546 J. C. St. George, Hanover-square 108 2 1,161m; 1,076,272 94,315 1,907 18 50 68 181.0 1.7 5.3 70 81.2 34 11.411 C. Westminster 57 1 917 to 341,116 68,268 1,884 42 69 111 266.9 6.2 10.1 163 74.4 3 4.997 N. C. St. Mai tin-in-the-Fields . 36 1 305IP 265,336 21,370 565 9 25 34 245.4 4.2 11.7 159 70.1 38 12.416 J. N. St. James, Westminster 48 1 164 462,032 34,155 797 12 15 27 248.0 3.5 4-.4 79 208.3 58 13.527 Nobth Distbicts. WM, ???. Marylebone 120 1 1,509 1,053,748 159,871 4,129 54 181 235 255.6 3.0 11.3 143 105.9 87 6.591 N. WM. Hampstead 24 1 2,252 147,624 23,557 395 2 15 17 178.2 .8 6.4 7-2 10.5 350 6.267 N.H.WM. Pancras 117 1 2,716 925,872 219,024 5,248 112 205 327 209.6 5.1 9.3 14-4 80.6 73 4.371 N. Islington 117 1 3,127 777,632 193,648 5,135 120 167 287 225.9 4.3 8.6 129 61.9 94 4.016 N. E. Hackney 57 1 3,929 370,616 97,120 2,394 103 74 177 250.3 10.6 7.6 18.2 24.7 53 3.816 Central Distbicts. N. St. Giles 48 1 245 277,412 52,226 1,502 48 84 132 305.7 9.2 16.1 25 3 213.2 68 5.312 N. Strand 49 1 172 w 299,808 40,883 1,126 29 29 58 258.2 6.6 7.1 137 237.7 50 7.333 N. Holborn 49 1 196 231,875 42,556 1,253 22 72 94 3130 5.2 16.9 221 217.1 53 5.419 N. Clerkenwell 72 1 380 242,524 63,957 1,661 45 93 138 276.1 7.0 14.5 215 168-3 65 3.792 N. St. Luke 48 1 220 186,452 56,710 1,487 46 75 121 313.3 8.1 13.2 21-3 257.8 51 3.288 N. E. East London ‡ 26 Aldermen 206 Common Councilmen 1 153 2,137,791 37,661 773 59 29 88 248.4 15.7 7.7 234 246.2 40 20.778 N. West London 138w 25,470 1,116 60 28 88 276.5 11.8 11.0 22-8 184.6 29 N. London City 434w 39,756 659 20 15 35 222.3 5.0 3.8 8-8 91.6 31 East Districts. N. R. Shoreditch 120 1 646 386,014 136,836 3,411 135 145 280 250.3 10.7 10.6 21-3 211.8 48 2.821 E. Bethnal Green 48 1 760 192,116 110,289 3,824 614 181 795 368.6 60.4 16.4 76'8 145.1 38 1.742 E. N. Whitechapel 68 1 406 w 277,748 76,386 3,499 900 123 1,023 387.0 84.0 16.1 100.1 188.1 32 3.636 E. St. George-in-the-East 36 1 243 196,745 47,779 1,877 387 82 469 417.6 87.9 17.2 105-1 196.6 21 4.118 E. Stepney (Limehouse) 36 1 576 w 234,804 56,198 1,849 557 111 668 375.1 107.6 19.8 127.4 97.6 11 4.178 E. Mile End Old Town 84 1 681 191,056 80,695 2,427 503 98 601 318.7 67.7 12.1 79.8 118.5 30 2.368 E. Poplar 48 2 2,918 w 344,320 99,762 3,687 835 187 1,022 362.1 90.8 18.7 109.5 34.2 8 3.451 South Districts. S. L. St. Saviour, Southwark 39 1 250w 161,000 36,422 910 32 38 70 253.8 7.4 10.7 18.1 145.7 3 4.503 S. St. Olave, Southwark 28 1 169w 110,700 18,914 947 20 19 39 260.1 8.5 10.0 18.5 111.9 4 5.853 S. Rotherhithe 21 1 186w 83,500 28 767 600 25 17 42 221.7 8.7 5 .9 11.6 32.5 0 2.903 S. L. Bermondsey 36 1 688w 150,000 64,310 1,623 34 82 116 268.3 5.3 12.8 181 93.5 0 2.332 S. L. St. George, Southwark 48 1 282 146,000 57,198 1,551 38 47 85 286.7 6.6 8.2 14.8 203.9 0 2.539 L. S. Newington 72 1 624 240,000 92,680 2,240 26 53 79 235.7 2.8 5.7 8.5 148.5 —1 2.590 L.. S. Lambeth 116 1 4,015w 637,000 174,904 4,173 114 180 294 253.6 6.5 10.3 16.8 43.6 3 3.612 S. L. Wandsworth 57 5 11,695 361,400 82,979 2,075 40 67 107 265.8 4.8 8.1 12.9 7.1 21 4.355 S. L. Camberwell 82 1 4,312 250,000 81,818 2,050 46 68 114 266.3 5.6 8.3 13.9 18.8 4 3.056 K. S. Greenwich 57 1 3,771w 274,976 97,473 2,481 202 74 276 259.3 20.7 7.6 28.3 25.8 9 2.821 K. Woolwich 21 None 1,596w 83,000 47,363 915 80 73 123 205.4 16.9 9.1 26.0 29.7 ? 1.752 K.S. Greenwich Registration District 78 1 5,367w 357,976 141,836 33,96 282 117 399 211.7 19.5 8.1 27.6 27.0 8 2.472 K. Plumstead and Charlton. 37 4 11,806w 183,850 67,047 933 44 35 79 147.9 6.6 5.2 11.8 5.7 ? 2.748§ L. Lewisham 27 1 5,118 227,410 23,373 487 11 9 20 221.5 4.7 3.9 8.6 4.3 89 6663 K. L. Lewisham Registration District 64 5 17,224w 411,260 90,120 1,420 55 44 99 166.9 6.1 4.9 11.0 5.2 28 4.548 The areas marked thus (to) include water. The several water companies are designated by letters ; thus, the New River Company by N., the Grand Junction by J., Chelsea by C., West Middlesex by W M,, East London by E., Hampstead by H., Southwark by S , Lambeth by L., and Kent by K. In cases where a district is supplied by more than one company, the initial of the company supplying the greater part is placed first. Where a company supplies only a small part of the district it is indicated by a small initial letter. That part of Hackney District served by the East London Company is, it is believed, supplied from Lea Bridge after filtration; the East Districts are supplied principally from the reservoirs at Old Ford. *In deducing the mortality from all causes in the several districts, the population and the deaths in the following Hospitals wore subtracted from the population and deaths of t.he respective districts in which the Hospitals wore situated, viz., St. Mary's, Paddington, inmates 191, deaths 191; Consumption, inmates, 218, deaths, 127; West London inmates, 23, deaths 13 ; St. George's, inmates 376, deaths 343; Westminster, inmates 171, deaths, 17.4; Charing Cross, inmates 102, deaths 71; Middlesex, inmates, 320, deaths 292 ; University College, inmates 151, deaths 211; Royal Free, inmates 129, deaths 129; Small-pox, inmates 35, deaths 260; London Fever, inmates 44, deaths 668; King's College, inmates 161, deaths 231; St, Bartholomew's, inmates 788, deaths 565; London, inmates 405, deaths 733; Guy's inmates, 675, deaths 511; St. Thomas's, inmates 539, deaths 197; and the Dreadnought, inmates 202. deaths 108. The numbers of inmates returned are those enumerated at the census of 1861, but the accuracy of the results are not materially affected by adopting those numbers. The Hospital population and deaths were then distributed proportionally over all the districts of the metropolis. The workhouse of the district of St. Luke's is in Shoreditch, the workhouse of the Strand is in St. Pancras, the workhouses of the City of London District are in Mile End Old Town and Poplar Districts, and so on for other outlying workhouses. In calculating the mortality of the respective districts from all causes, the deaths and population of these outlying workhouses were taken from those districts in which they happen to be situated, and placed to the districts to which the inmates belong. †The following corrections have been made in calculating the Cholera mortality of certain districts wherein Hospitals are situate; the deaths in the London and Cholera Hospitals at Whitechapel of persons belonging to other districts have been distributed proportionately over each of the East London Districts; the Cholera mortality of the districts of St. George, Hanover Square, Marylebonc, St. Saviour and St. Olave, Southwark, Sirand, Islington, West London, and St. Pancras, has been calculated on the deaths from Cholera exclusive of the deaths in the Hospitals of persons brought from other districts. ‡The Commissioners of Sewers are the Board for the City of London, and number about 80; the members of the Corporation, including the Aldermen, 232. §The annual value of property per head of population in Plumstead District is exclusive of Mottingham Hamlet. Under the provisions of the Metropolis Management Act, Mottingham is excluded from Plumstead, but for registration purposes it is included. //The annual value of property per head of population in Lewisham District is inclusive of Penge Hamlet. Under the provisions of the Metropolis Management Act, Penge is ncluded in Lewisham, but for registration purposes it is excluded. 14 The ages at which the deaths from Cholera in this Parish occurred were as follows:—Under 1 year, ten; from 1 to 2 years, seven; from 2 to 3, two; from 3 to 4 years, one; from 4 to 5, four; from 5 to 10 years, fourteen; from 10 to 15, five; from 20 to 25 years, six; from 25 to 35, seventeen; from 35 to 45, eighteen; from 45 to 55 years, twenty; from 55 to 65, fifteen; from 65 to 75 years, eight; and over 75, three. On Tables A, B, C, the several sub-districts of the Parish are compared as to their rates of mortality per thousand; they stand in the following order, commencing with the one whose death-rate is lowest, Camden Town, Kentish Town, Tottenham Court Road, Regent's Park, Grays Inn Road, Somers Town. Comparing the births with deaths under 5 years of age, they stand in the following order, beginning with the most healthy:—Grays Inn Road, Camden Town, Regent's Park, Tottenham Court Road, Kentish Town, Somers Town. On Table D, the death-rates of several streets in 1866, and in preceding years are given, as specimens of the much higher mortality which prevails amongst those where there is overcrowding, poverty, and waut of sanitary arrangements than in the Parish as a whole. In Eden Street, for instance, the death-rate was 43.3; and in Henry Street, 33.3 per thousand last year; and on an average of 11 years, Henry Street had a death-rate of 38 2, and Midford Place, 36 9. [ Table A. ] Shewing the estimated population of the Sub-districts, and the Death-rate per thousand in 1866. Estimated population. Estimated Mortality. Deathrate per Thousand. Regent's Park 37447 875 23.3 Tottenham Court 28649 659 23.0 Grays Inn 27707 672 24.3 Somers Town 39099 1061 27.1 Camden Town 21466 461 21.5 Kentish Town 62033 1413 22.8 Strand Union 568 University College Hospital 154 St. Pancras Workhouse 1800 Royal Free Hospital 101 Total 219024 5254 23.5 15 [Table B.] Shewing the rates of Births to Deaths in the several Sub-districts. Name of Sub-District. BIRTHS. Registered Deaths. Estimated Mortality. Rates of Births to Deaths. Regent's Park 1220 712 875 1000:717 Tottenham Court 833* 535 659 1000:791 Grays Inn 954 546 672 1000:704 Somers Town 1332 884 1061 1000:796 Camden Town 631† 385 461 1000:730 Kentish Town 2069 1138 1413 1000:683 University College Hospital .. .. 212 Royal Free Hospital .. .. 134 St. Pancras Workhouse .. .. 595 Strand Union Workhouse .. .. 110 [Table C. ] Shewing Rales of Births to Deaths under 5 years of age. Regent's Park 1220 : 344 = 1000 : 280 Tottenham Court Road 833 : 247 = 1000 : 284 Grays Inn Road 954 : 252 = 1000 : 263 Somers Town 1332 : 461 = 1000 : 346 Camden Town 631 : 174 = 1000 : 276 Kentish Town 2069 : 607 = 1000 : 293 The whole Parish 7239 : 2230 = 1000 : 308 *In this Sub-district, 50 has been subtracted from the number of births, to allow for the Strand Union. †In this Sub-district, 200 births have been omitted to allow for the Workhouse. §In this column, the deaths in Strand Union are left out. and the deaths in Hospitals and the Workhouse have been distributed through the sub-districts, in proportion to their populations. 16 [ Table D. ] Shewing the rate of mortality in a few Streets and Places occupied by the poorer classes. Names of Streets, &c. Number of Houses. Estimated Population Number of Deaths in 18G6. Death-rate per 1000 in 1866. Average number of Deaths in years 1856—66. Mean Death-rate per 1000 in 11 years. Eden Street 13 230 10 43.3 7.3 31.7 Henry Street 50 900 30(a) 33.3 34.4 38.2 Mary Place 19 300 9 (b) 30.0 8.6 28.7 Drapers Place 32 663 14 21.1 18 27.1 Gresse Street 36 676 20 29.5 18 26.6 Midford Place 8 203 4 20.0 7.5 36.9 Stephen Street •• 585 15(c) 25.6 Ashby Street 24 329 8 24.3 Average of 5 years. 9.6 29.1 Stanley Buildings 93 448 10 22.2 Suffolk Street 50 516 15(a) 29.0 Pancras Square 110 650 9 13.8 Average of 11 years. 11.45 17.6 Little George Street 56 725 18 (e) 24.8 16.4 22.6 (a) Three of these deaths occurred in University College Hospital. (b) Two of these deaths occurred in University College, and two in the London Fever Hospital. (c) One death was from Cholera in the Middlesex Hospital. (d) One of these from Cholera in University College Hospital. (e) Three deaths from Cholera in University College Hospital. 17 METEOROLOGY. The mean temperature of the whole year was 49.°8, which is half a degree above the mean of 25 years. The winter and autumn, however, were not so cold, and the spring and summer were not so warm, as usual. January, February, April, June, October, November, and December, had a higher mean temperature than the mean of preceding years. Rain fell to a depth of 30.5 inches, which is 1 inch above the average of 15 years. There was more than usual horizontal movement of the air. The meteorological conditions were not at all those which have usually attended Cholera in this country.* There is every reason to believe, that had the summer and autumn been hotter and dryer, the pestilence would have raged with even greater violence than it did. SANITARY WORK. In January of last year I called the attention of the Vestry to the probability that an epidemic of Cholera was impending, and urged the necessity of increased energy in carrying out sanitary precautions. This report was at the time considered to be too strong, and was the occasion of my being called an alarmist without sufficient cause. I was asked for a second report to justify the statements made in my first. In this second report I entered into further details, and after its consideration the Yestry were, I believe, convinced that there was some need for the adoption of additional precautions. The events of the year amply proved that my warning was necessary. Two additional Inspectors were appointed to make house-to-house visitations, and they were actively engaged for three months before the Cholera made its appearance amongst us. They entered upon their duties on the 2nd April. The results of their inspections were such as to convince all who investigated them, that houseto-house visitation was much needed. During the first week of their inspections 144 houses were examined, which were occupied by 1729 persons. Of these, 86 houses were filthily dirty, 64 were generally out of repair, so as to render them unfit for occupation, 31 had no receptacle for ashes and house-refuse, the drains of 12 water-closets were stopped up, in 3 there were open cesspools, in 74 there were offensive accumulations of house refuse. In the next four weeks, 537 houses were examined, in which 3433 persons lived. Of these, 322 were filthily dirty, in 71 there were open privies or cesspools, in 80 the drains were untrapped, in 282 the closets were without water laid on to them, in 332 the ashpits or dust-bins were either wanting or so delapidated as to be useless. These house-to-house inspections were carried on with corresponding results until the house-to-house visitations ordered by the Privy Council were carried out by the Medical Visitors and their assistants, and by means of these visitations an immense number of nuisances and sanitary defects were brought to light. The rooms occupied by 7000 separate families were visited by the six District Medical Officers and the seven Medical Assistants. The nuisances which they detected were followed up by the four Sanitary Inspectors, and occupied the whole of their time in taking measures for their abatement. In 856 houses a flusher was sent in to cleanse and disinfect the closets from time to time during the Cholera season, and whitewashes were also employed by the 18 Special Committee, to cleanse 40 infected dwellings, whose owners were poor, or for some reason could not be made at once to carry out the necessary works of purification. The two temporary Inspectors continued in office until Christmas; at the time at which their services were discontinued, there was a large amount of arrears of work arising from inspections and notices served by them which had not been complied with. Since that time the two permanent Inspectors have been engaged in working up the arrears as fast as the other routine work of the department would allow. Messrs. Boreham and Ilouch, the temporary officers, inspected between three and four thousand houses; they served 2029 notices, and took out 117 summonses for the abatement of nuisances. At the time of their giving up sanitary work, there were 1054 places in which notices had been served by them, calling for works of improvement, which works had either been neglected in part, or wholly, or else no re-inspections had been made to ascertain whether the required works had been carried out. There were, moreover, 25 places in which summonses had been issued, and magistrates' orders obtained, where the orders had not been complied with. Owing to the large amount of sanitary work done last year, and the want of a clerk to tabulate and record it, I am not in a position to report in detail what was the nature of the sanitary works effected under notices served by the temporary inspectors. The character of the work effected, may be estimated with tolerable accuracy, by the following statement of the work carried out under the inspection of Messrs. Curtis and Hartley, the permanent Inspectors, because the nature of the works executed was very much the same in the one case as in the other. They served 1885 notices; of which, 314 were final, the others being primary. They took out 95 summonses. All notices sent out by the Inspectors are previously examined and countersigned by myself. Under their inspection the following works were carried out:— New drains were laid down in ninety-seven houses. New traps were supplied to eleven hundred drains. The drains of two hundred and thirteen houses were repaired. Cesspools were emptied in 55 houses; and 70 cesspools were abolished. New pans, traps, and water were supplied to five hundred and fifty privies. Thirteen new water-closets were erected. Water supply was laid on to 84 closets. One hundred and eighty-six dust-bins were erected. Two hundred and twenty-nine dust-bins were repaired. In two hundred and forty-one houses the paving of the cellars or yards was repaved. The walls and passages of 526 houses were cleansed and lime-whited or white-washed. Over-crowding was abated in 116 cases. Nine sties of pigs were removed. 19 Other nuisances to the number of two hundred and eighty-seven were abated. They have seized as unfit for food the following; 43 pads and 2 barrels of plaice, 26 pads and 3 boxes of mackerel, 1 box of herrings, 30 pounds of eels, a barrel of sprats, 2 barrels of gurnets, 1 pad of mixed fish, 1 bushel of periwinkles, 652 rabbits, 1000 pounds of American beef, and a large quantity of rotten oranges, plums, and other fruit. In addition to these works, there have been the monthly inspections of 90 licensed slaughter-houses, and 75 licensed cow-houses, and the six-monthly inspections of all the bakehouses in the Parish, also of the various mews, wharves, sausage and tripe shops, cats' meat shops, and the several street-markets from week to week. In the Appendix is given an account of the new sewers constructed during the year 1866. A great deal more has been done than in any previous year. Of sewers, 3 feet 9 inches by 2 feet six inches, 2688 feet have been constructed, and of pipe drainage, 3079 feet have been laid down. In 13 streets or other places, the sewers were repaired. Besides these works done by the Vestry contractor, 1545 feet of sewerage have been provided by private builders. If a similar amount of drainage were constructed every year, in a very short time the main drainage of St. Pancras would be completed. Whilst I have been engaged in writing this Report, the Vestry have decided on appointing a Clerk for the Sanitary Department, and a third Sanitary Inspector. I trust that this measure may be regarded as a good omen, and as an indication that you, Gentlemen, are resolved in future, to regard Sanitary improvements with more seriousness, and to prosecute them with greater energy than you have ever yet done. Every year the importance of the prevention of disease is becoming more fully recognised, and the maxim that "prevention is better than cure" is receiving greater practical attention. Parliament passed last year an important Act (the Sanitary Act, 1866), which imposes several fresh duties upon all local boards of health or nuisance authorities. In St. Pancras, the Vestry is the nuisance authority. One of the most important clauses in that Act is the 35th Section, which empowers you, under the sanction of the Secretary of State, to make regulations for houses let out in lodgings to a number of distinct families. The provisions of the Nuisance Removal Acts, the Metropolis Local Management Acts, and the Common Lodging-Houses Act, fail to ensure the carrying out of many things which are necessary, to prevent some of these houses from becoming hot-beds of disease. By adoption of this Section, which the Secretary of State will at once permit, on your making application to him, you will be enabled to frame regulations for the registration of such lodging-houses as you think right, for the limitation of overcrowding in these houses, for enforcing a proper water supply and privy accommodation, a periodical cleansing of the houses and passages, and suitable drainage and ventilation. By previous Acts of Parliament, nearly all these things could be enforced by a roundabout process; the object of this section is to fix the responsibility for the wholesome condition of lodging houses on 20 the proper party, and to simplify and shorten the processes for enforcing the same. "When regulations are made, the neglect of which entails penalties on the responsible parties, there will be less delay in enforcing sanitary measures than at present, when it is necessary in every case to ascertain that a nuisance exists which requires removal, to serve a notice for the abatement of the same, then to take out a summons in case of the notice being neglected, to serve an order from the magistrate for the performance of the necessary works; if this order is disobeyed, another summons has to be taken out and a penalty is inflicted; if the penalty is not paid, another summons has to be issued; if the party do not appear a warrant may be necessary. Whilst all these measures are in progress, occupying at the least a month or five weeks, the nuisance may exist and be on the increase, and disease may have been raging which might have been arrested. The Vestry will, I trust, lose no time in making application to the Secretary of State for power to avail themselves of this section. "When his sanction is obtained, regulations may be framed so as to include only the houses which urgently require it, in which overcrowding is excessive, and infectious disease is almost constantly present. As guardians of the public health, it is obviously your duty to avail yourselves of the new powers placed within your reach, for the improvement of that class of property which is occupied by the very poor in which infectious fevers and cholera find a congenial soil. Section 24 of the Sanitary Act, empowers the Vestry to provide a vehicle for the removal of patients suffering from fever or other infectious disease to Hospitals. The Cab which was purchased last year for the removal of Cholera patients, is now the property of the Vestry; some provision is required for horsing and attending it when needed. A more commodious conveyance, with better springs is required, in which persons could be placed in a recumbent position. I should recommend that a Hospital carriage be purchased similar to those furnished by the Hospital Carriage Fund for the removal of fever patients; the cab might be retained for Small Pox patients. Another matter of great importance is, that a mortuary building should be provided for the reception of dead bodies previous to interment, as provided in the 27th and 28th sections. Where families occupy only one or two rooms, it is in the highest degree objectionable, both in a sanitary and a moral aspect, that the corpse should be kept amongst the living, until it can be buried. The funeral is delayed from a variety of causes, sometimes to allow of friends being present who live at a distance, sometimes to admit of the necessary funds being raised, sometimes to await a coroner's inquest; in such cases the living are liable to be poisoned by the dead. When a body is found dead and no relatives are forthcoming, there is no public mortuary to which it can be taken except the deadhouse connected with the parish workhouse, and this is not at all larger than is necessary for those that die in that establishment. When a post-mortem examination is necessary, the evil is greater and the need of a public mortuary is more urgent. These two sections of the Sanitary Act (Nos. 27 and 28) require your serious consideration. Although Cholera has disappeared from our midst during the past winter, we must not too confidently conclude that we shall escape from its further ravages during the ensuing summer. 21 In all previous epidemics, Cholera has attacked London for two years in succession; and from this circumstance many persons believe that a second outbreak may be anticipated during the coming Autumn. I do not wish to give any opinion on this point, nor is it necessary that we should know what is coming, in order to determine what is our duty. It is clearly imperative that all sanitary precautions should be maintained, especially that the sewers should be well flushed and deodorized, and that the dustmen and scavengers should be kept well up to their duty. In the departments which I superintend, the houses of the poor must be inspected actively, and all offensive accumulations must be removed, the drains kept clear, and the water tanks cleansed. The sale of unsound meat, fish, and fruit must, as far as possible, be prevented. The immediate appointment of a third Inspector, with a Clerk and Messenger, will, I hope, enable us to carry out many of the necessary measures of precaution. I am sorry that we have not had them in operation during the whole winter. There are many works of a structural character which cannot safely be carried on in hot weather, and which must now be postponed until next winter. I have the honour to remain, Gentlemen, Your obedient Servant, THOMAS HILLIER. 22 Sewer Works executed in St. Pancras during year 1866. Date, 1866. Locality. Description. Number of Feet. Bernarks. 3'.9"x2'.6" Pipe. Brick Barrel The following home been laid by General Works Contractor. March Seymour Bow ... ... 263 Bo-construction. „ King Street & College Street W. 290 540 May Warren Street by High Street 230 „ William Street and Mary Street 250 45 July Piercefield Street 265 „ York Rise 29 „ Ditto 200 „ Camden Crescent ... ... 46 „ Ditch rear of Maiden Road ... ... 156 The Sewers in the following Places were repaired during the year, viz.:— August Dartmouth Park 406 1456 Oct. Junction of Bartholomew and Dartmouth Estates 25 Tottenham Street. Edmund Street. Munster Street. Little Brook Street. Little Charles Street. Northampton Street. Argyle Place. Bush's Buildings. Highgate Boad. Stephen Street. Gresse Street. Hampshire Grovoi Union Street. „ Ditch opposite the " Duke of St. Alban's," Highgate Bise ... ... 248 Nov Ditto ... ... 175 „ Highgate Bise ... ... 195 Dec Mansfield Place 930 2688 3079 45 The following have been undertaken by Private Parties. Jan North Villas 350 „ St. Augustine's Road 220 April Fitzroy Road 475 May York Road 500 July Cambridge Street ... ... 28 1545 28 TOTALS OF THE FOUR QUARTERS, 1866. Register of Births and Deaths in the Sub-Districts and Public Institutions, for the Fifty-two Weeks ending the 29th December, 1866. Estimated Population in Middle of 1866. 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. - From Typhus, Typhoid, and Relapsing Fevers. From Puerperal Fever. From Erysipelas and Pyoemia. From Cholera. Children Adults. 37447 427 34927 Regent's Park 1220 712 344 133 6 12 16 3 8 38 36 3 16 2 3 10 29371 145 29371 Tottenham Court 883 535 247 104 1 13 9 4 2 25 20 1 8 ... 3 1 University College Hospital 212 20 22 .. .. 1 4 .. .. .. ... 4 ... 2 36* Strand Union 110 7 46 1 .. .. .. 1 .. .. ... ... 1 27808 155 27808 Gray's Inn Road 954 546 252 115 2 14 12 2 10 17 28 4 16 3 1 7 Royal Free Hospital 134 5 16 .. .. • • .. .. .. .. .. 3 2 1 26† 39099 184 39099 Somers Town 1332 884 461 129 5 25 45 8 5 46 41 4 22 ... 4 25 23266 171 23266 Camden Town 831 385 174 56 6 6 13 4 1 24 15 5 6 1 .. 7 Saint Pancras Workhouse 595 113 259 2 2 .. 1 1 .. 1 5 1 ... 7 62033 1634 44317 Kentish Town 2069 1138 607 199 20 29 25 5 8 61 47 5 40 4 1 11 219024 2716 198788 Totals 7289 5251 2230 1079 43 101 121 31 36 211 188 27 116 12 22 130 *One of these was from Islington, †Seventeen of these were from other Parishes. [Table I.] FIRST QUARTER, 1866. Register of Births and Deaths in the Sub-Districts and Public Institutions, for the Thirteen Weeks ending 31st March, 1866. 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 Croup. From Hooping Cough From Diarrhoea. - From Typhus, Typhoid, and Relapsing Fevers. From Puerperal Fever. From Erysipelas and Pyoemia. 427 34927 Regent's Park 308 168 74 33 .. 7 4 .. 2 8 Children Adults 3 .. 1 • • .. 145 28348 Tottenham Court 215 139 63 31 .. 2 3 .. .. 7 2 1 3 .. 2 University College Hospital 45 3 4 .. .. .. .. .. .. .. .. 1 Strand Union 31 3 18 155 27807 Gray's Inn Road 264 143 68 28 .. 10 4 2 1 4 .. .. 1 Royal Free Hospital 31 1 5 .. .. .. .. .. .. .. .. 1 184 39096 Somers Town 379 242 115 40 1 10 13 .. • • 17 4 2 12 .. 1 171 23406 Camden Town 227 89 40 14 1 1 2 1 .. 3 1 1 2 Saint Paneras Workhouse 192 46 77 .. 2 • • .. .. .. • • 2 1 .. 1 1634 44298 Kentish Town 542 315 164 59 1 6 4 1 3 17 1 •• 15 2 2716 198784 Totals 1935 1395 577 309 3 38 30 4 6 56 8 6 39 2 5 [ TABLE II. ] SECOND QUARTER, 1866. Register of Births and Deaths in the Sub-Districts and Public Institutions, for the thirteen weeks ending 30th June, 1866. 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 Croup. From Hooping Cough From Diarrhoea, Cholera, and Dysentery. From Typhus, Typhoid, and Relapsing Fevers. From Puerperal Fever. From Erysipelas and Pyæmia. 427 34927 Regent's Park 315 190 92 28 3 1 2 1 3 20 Children Adults 6 1 1 5 .. 145 28348 Tottenham Court 240 159 68 31 • • 2 2 1 1 13 1 .. 4 ... 1 University College Hospital 47 2 6 .. .. .. .. .. .. .. • • .. ... 1 Strand Union 19 2 7 155 27807 Gray's Inn Road 243 141 61 35 2 3 4 .. 4 9 1 .. 3 1 Royal Free Hospital 24 .. 5 • • .. .. .. .. .. .. .. .. ... 1 184 39096 Somers Town 290 193 98 30 1 5 10 1 3 14 4 1 7 ... 2 171 23406 Camden Town 217 96 40 17 .. 3 4 1 1 10 1 1 2 1 Saint Pancras Workhouse 146 25 71 1 .. .. .. .. .. .. 2 .. ... 4 1634 44298 Kentish Town 506 292 156 58 7 13 5 2 1 25 3 .. 10 1 1 2716 198784 Totals 1811 1307 544 288 14 27 27 6 13 91 15 4 32 4 11 [Table III. ] THIRD QUARTER, 186 6. Register of Births and Deaths in the Sub-Districts and Public Institutions, for the Thirteen Weeks ending the 29th September. 1868. 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 Croup. From Hooping Cough. From Diarrhoea, From Typhus, Typhoid, and Relapsing Fevers. From Erysipelas and Pyoemia. From Cholera. 427 34927 Regent's Park 302 196 100 34 2 2 6 2 1 8 Children Adults 5 ... 4 24 3 145 28348 Tottenham Court 199 104 54 8 .. .. 1 1 1 2 17 ... 1 ... 3 University College Hospital 66 4 5 .. • • .. 2 .. .. .. ... 2 ... 22 Strand Union 29 1 10 .. .. .. .. 1 .. ... ... ... ... 1 155 27807 Gray's Inn Road 235 132 67 20 .. 1 1 .. 4 1 22 3 5 1 2 Royal Free Hospital 29 2 2 .. .. .. .. .. .. .. ... ... 2 8 184 39096 Somers Town 306 216 134 25 1 5 9 3 1 6 31 ... 1 ... 9 171 23406 Camden Town 190 97 51 13 .. 1 5 1 .. 4 13 3 1 ... 6 Saint Pancras Workhouse 111 18 35 5 .. .. 1 1 .. 1 1 1634 44298 Kentish Town 489 275 149 41 7 3 11 1 .. 6 41 5 7 1 10 2716 198784 Totals 1721 1255 580 193 15 12 33 11 9 27 149 15 22 4 63 [Table IV.] FOURTH QUARTER, 1 8 6 6. Register of Births and Deaths in the Sub-Districts and Public Institutions, for the Thirteen Weeks ending the 29th December, 1866 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, Dysentery. From Typhus, Typhoid, and Relapsing Fevers. From Puerperal Fever. From Erysipelas and Pyœmia. FromCholera. 427 34927 Regent's Park 295 158 78 38 1 2 3 .. 2 2 Children Adults. 2 1 1 6 7 .. 145 28348 Tottenham Court 229 133 62 34 1 9 3 2 .. 3 .. .. ... ... .. 4 University College Hospital 54 11 7 .. .. 1 2 .. .. .. ... 1 ... 1 14 Strand Union 31 1 21 1 155 27807 Gray's Inn Road 212 130 56 32 .. .. 3 .. 1 3 6 1 7 1 1 5 Royal Free Hospital 50 2 4 .. .. .. .. .. .. .. • • 2 ... .. 18 184 39096 Somers Town 357 233 114 34 2 5 13 4 1 9 2 1 2 ... 1 15 171 23406 Camden Town 197 103 43 12 .. 1 2 1 .. 7 .. ... 1 ... .. 1 Saint Pancras Workhouse 146 24 66 1 .. .. .. .. .. .. ... ... ... 2 1634 44298 Kentish Town 532 256 138 41 5 7 5 1 4 13 2 ... 8 ... •• 1 2716 198784 Totals 1822 1294 529 289 11 24 31 10 8 37 16 2 23 2 6 64