STPAN 35 St. Pancras, Midlesex. TWENTY THIRD ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, Being the Report for the Year 1878. TO THE VESTRYMEN OF ST. PANCRAS. Gentlemen, In writing my first Annual Report as your Medical Officer of Health I am under the disadvantage that I did not begin my duties until the latter part of the year 1878, to which the Report relates, I shall, therefore, deal more briefly with some points concerning the health of our Parish than I shall hope to in any subsequent Report I shall have the honour of presenting to you. During the year 1878, 8,249 births and 5,329 deaths were registered in St. Pancras. In order to ascertain the actual number of deaths of St. Pancras parishioners during the year, it is necessary to deduct the deaths of non-parishioners which occurred in Public Institutions in the Parish, and add the number of our parishioners who died in Public Institutions in other parts of the Metropolis; the corrected number of deaths then amounts to 5,068. In estimating the population of St. Pancras from the middle of the year 1878, it is assumed that the increase of population during the decade 1861-71 has been maintained at the same rate since. If this had been the case the population in 1878 would be somewhat more than 238,000, and this number has been taken for calculating the rates of mortality from different diseases, but is probably in excess of the actual population. The births during 1878 show an increase of 123 upon the births of the previous year, and the deaths were more numerous by 141 than in 1877. 2 The birth-rate was 34.6 per 1000 of the population. This was •2 in excess of the rate of the preceding year, but .1 below the average birth-rate of the previous ten years and 2.2 below the birth-rate of the whole of London for 1878. The death-rate was 21.71 per 1000 of the population, or .83 above the death-rate of the previous year, and .86 below the death-rate of the preceding ten years, and is also 1.29 below the death-rate of the whole of London for 1878. The excess of births over deaths during 1878 has been slightly more marked in St. Pancras than in the whole of London, but a comparison of the averages of the last five years shows that during this period this excess has been slightly more marked in London as a whole than in Saint Pancras. MORTALITY AT DIFFERENT AGES. 1844 children under one year of age died in St. Pancras, or 26.5 per cent. of the total deaths. In London 25.3 per cent. of the total deaths were among infants of this age. 2212 children under 5 years of age died in St. Pancras. This is 45.6 per cent of the total deaths, and is in excess of the proportion which deaths of children of this period of life bear to total deaths in London, where 43.5 per cent of the total deaths are among children under five years of age. 1968 persons between 5 and 65 years, and 888 over 65 years of age died in St. Pancras in 1878. These figures are not comparable with those of previous years, from the fact that they include not only those who died in private houses in the Parish, but also those of our parishioners who died in Public Institutions both in the Parish and other parts of the Metropolis. ZYMOTIC DISEASES. SMALL POX. 94 persons died of Small Pox in 1878. The deaths from Small Pox of St. Pancras parishioners were in the proportion of 18.5 of every 1000 deaths. In London as a whole, during the same year, the deaths were in the proportion of 16.9 of every 1000 deaths, and during this year, therefore, Small Pox was a proportionately larger element in our death rate than in the Metropolis as a whole. Of the 94 of our parishioners who died in 1878, 64 died in hospitals not situated in the Parish. 3 I am enabled through the courtesy of Mr. Bingham, Medical Superintendent to the Small Pox Hospital at Hampstead, Mr. F. W. Strugnell, Resident Surgeon to the Small Pox Hospital at Highgate, and Dr. William Gay ton, Medical Superintendent to the Small Pox Hospital at Homerton, to give the following details of the vaccination of our parishioners who died in these institutions. Under 12 years of Age. Over 12 years of AgeNot Vaccinated 19 15 Having bad ation marks 1 14 Having one or more fair marks — 8 Having one or more good marks 2 5 It is constantly urged, as an argument against Vaccination' that more vaccinated persons die of Small Pox than unvaccinated, and the number of vaccinated persons who died in St. Pancras might at first sight appear to lend some support to this view. The question really is, however, not the number of vaccinated and unvaccinated persons who die, but the proportion of the vaccinated and unvaccinated, seeing that there are not the same number in the Parish of these two classes of persons. It was found in an examination of school children in St Pancras in 1863, in an inquiry made by Drs. Seaton and Buchanan (Sixth Report of the Medical Officer of the Privy Council) that of 2568 children born between 1850 and 1860 who were examined, 2445 bore marks of Vaccination, and 94 had none while a few were doubtful. Now if we assume that vaccinated and unvaccinated persons over 12 years of age in the Parish are in this proportion, we have for every unvaccinated person 26 vaccinated. At an equal rate of death, therefore, we ought to have had 26 deaths among the vaccinated for every death among the unvaccinated, and for the 15 deaths which occurred among our unvaccinated parishioners, 390 deaths among the vaccinated instead of the 27 that occurred. It will be seen that but three children with any signs of vaccination died under 12 years of age. Proper Vaccination in infancy can be largely trusted for preventing death from Small Pox up to this age, after puberty, however, although 4 Vaccination still exercises a very considerable protective power, this power is less than before, and Re-vaccination becomes necessary. With regard to Re-vaccination it cannot be too often pointed out that no re-vaccinated attendant at any of the Small Pox Hospitals ever contracted Small Pox. It may be interesting, in passing, to show in a table the influence of Vaccination in mitigating the severity of an attack of Small Pox, and for this purpose I shall take the cases among our parishioners who were admitted during 1878 into the Hampstead Small Pox Hospital. The observations were made by the Medical Superintendent, Mr. S. A. Bingham, whom I have to thank for this information. ALL AGES. Discrete Small Pox. Semi Confluent Small Pox. Confluent Small Pox. Pustular Hoemorrhagic Small Pox. Hœmorrhagic Small Pox. In each 100 cases not Vaccinated 6.4 23.8 57.1 9.5 3.1 „ „ having bad marks 33.8 25.0 36.7 1.4 2.8 , „ having one or fair marks 540 17.5 20.2 6.7 1.3 „ ,, having one or good marks 64.2 20.4 13.1 1.0 1.0 Among the tables which accompany this Report will be found an account of the number of the infants born and the number vaccinated in St. Pancras from July to December, 1877, and from January to June 1878; for this I am indebted to the courtesy of Mr. Jones, Vaccination Officer. SCARLET FEVER, . Scarlet Fever or Scarlatina caused 138 deaths in St. Pancras in 1878, and is at the rate of 4.5 in each 1000 deaths from all causes, and is 5.8 more than the proportion Scarlatina deaths bear to deaths from all causes in the Metropolis. 5 DIPHTHERIA. 23 persons died from this disease in St. Pancras in 1878; this is at the rate of 4.5 in each 1000 deaths from all causes. The deaths in London from Diphtheria were in the proportion of 6.6 per 1000 of the total deaths and were therefore 2.1 in each 1000 in excess of our local rate. It will be rememberered that during 1878 a considerable epidemic of Diphtheria (traced by Mr. W. H. Power to contaminated milk supply) prevailed in the North of London, but did not extend to St. Pancras. WHOOPING COUGH. Whooping Cough has been more fatal in St. Pancras during 1878 than in 1877 by 112 cases, the number of deaths from this cause being in the two years 217 and 105 respectively. In 1878 it caused 42.8 in every 1000 deaths, and in the preceding 10 years 35.9. Whooping Cough has also been more prevalent in the Metropolis as a whole in 1878. In this year it caused 53.1 in every 1000 deaths, while in the preceding 10 years 86.5 in every 1000. FEVER. Four of our parishioners died from Typhus in 1878; 59 died from Enteric or Typhoid Fever. In 1878 11.6 in every 1000 deaths were due to Enteric Fever, while in London in this year 12 in every 1000 deaths resulted from this disease. Four deaths also occurred in 1878 from Simple Continued Fever. MEASLES. Measles caused but 48 deaths in St. Pancras in 1878. In 1878 9.4 in every 1000 deaths were due to Measles in St. Pancras, while in London during the same period Measles caused 18 in every 1000 deaths. DIARRHŒA. The number of deaths due to Diarrhoea in St. Pancras in 1878 was 229, being 105 more than died from the same disease in 1877. During 1878 Diarrhoea caused 45 in every 1000 deaths both in St. Pancras and London. In the preceding ten years Diarrhoea caused in St. Pancras 45.7, and in London 50.9 in every 1000 deaths. 6 The principal Zymotic Diseases have therefore, with the exception of Small Fox and Scarlatina, caused a smaller proportion of our deaths than has been the case in the Metropolis as a whole. The Vestry, with a desire to afford every facility for the isolation of infectious diseases, instructed me to send to hospital all cases of infectious disease requiring isolation whether any part of the cost of maintenance could be defrayed by the patients friends or not, in addition to, as heretofore, those whose friends could pay some portion of this cost. The number of persons thus seeking the benefit of isolation is increasing, and doubtless will continue to increase as the advantage to be gained by such a step is more fully recognised. The question of provision of hospital accommodation for persons suffering from infectious diseases and who are not paupers, again received the consideration of the Vestry, and was referred to the Vestry Clerk and your Medical Officer for report. In this report the opinion was expressed that the present machinery should be retained in the hands of the Metropolitan Asylums Board, and the Board elected by the Sanitary Authorities, instead of the Board of Guardians. Further, that every sufferer, irrespective of his ability to pay, should he admitted to these hospitals, leaving it to the Board to arrange for payment in cases of persons able to do so, and in the cases of persons who are actually paupers they could either, as in the case of Poor children at School Board Schools, be relieved of payment, or the cost could be charged to the Board of Guardians of the Parish or Union to which they belonged. A deputation from several of the Vestries has since waited on the President of the Local Government Board with a view to obtaining the necessary powers to send non-pauper cases to the hospitals of the Metropolitan Asylums Board, the cost of such cases to be paid by the Vestries, but such an arrangement cannot be regarded as satisfactory ; for although a difficulty to be met with in any alteration of the constitution of the Metropolitan Asylums Board is found in the fact that this Board has other duties besides that of providing for infectious cases, such as the care of pauper children in certain Training Ships and of Imbeciles, duties which could not conveniently be transferred to a Board elected by Sanitary Authorities, it must not be forgotten that, beyond the objection which would exist in the mind 7 of many to the removal to hospitals which are under Poor Law Administration, the whole duties of the Board in connection with these hospitals have intimate Sanitary relations. The removal of an infectious person from his room, through the streets to the hospital; the precautions to be taken with a view to preventing infectious disease spreading, either from the patient or his friends ; and the control of the amount and character of hospital provision required, are so closely associated with the public health that hospitals intended for the reception of all classes of persons, a very small proportion of whom are actually paupers, should have the closest relations with the Authorities responsible for the health of the Metropolis. SLAUGHTER-HOUSES. There are 59 licensed Slaughter-houses in St. Pancras. No fresh applications for licenses were made in 1878. They were found on inspection to be as a rule in a satisfactory condition, and in but one case was complaint made to the Sanitary Committee of an infringement of the Bye-laws. COW HOUSES. There are 66 licensed Cow-houses in the Parish. Two fresh licenses were granted in 1878. The condition of the Cow-sheds was satisfactory and no irregularities were reported. By the Contagious Diseases (Animals) Act, 1878, the Privy Council may from time to time make such General or Special Orders as they may think fit for the following purposes.— 1.—for the registration with the Local Authorities of all persons carrying on the trade of cow-keeper, dairyman, or purveyor of milk. 2.—For the inspection of cattle in dairies, and for prescribing and regulating the lighting, ventilation, cleansing, drainage, and water supply of dairies and cow-sheds in the occupation of persons following the trade of cow-keeper or dairyman. 3.—For securing the cleanliness of milk stores, milk shops and of milk vessels used for containing milk for sale by such persons. 4.—For prescribing precautions to be taken for protecting milk against infection or contamination. 8 5.—For authorising a Local Authority to make regulations for the purposes aforesaid, or any of them, subject to such conditions, if any, as the Privy Council prescribe. The Local Authority in the Metropolis for the purposes of this Act is the Metropolitan Board of Works. BAKE-HOUSES. By the passing of the Factory and Workshops Act, 1878, the inspection of Bake-houses has passed out of the hands of the Vestry into those of Factory Inspectors. The Vestry will not have forgotten the successful efforts of my predecessor to improve the condition of Bake-houses, and will, therefore, regret the more that the supervision of these places will no longer be exercised by their Officers. By the passing of the Canal Boats Act it has become the the duty of the Vestry to cause the inspection of Canal Boats used as dwellings, the removal of infectious cases from these boats to hospital and the disinfection of the boats. Appended are the usual tables reccommended by the Society of Medical Officers of Health. A table shewing the work carried out by the Sanitary Department is also added. I have much pleasure in acknowledging the very valuable aid afforded to the Sanitary Department during the past year by the Medical and Relieving Officers of the different districts, the Officers of Public Institutions, and many private practitioners in this Parish. The early information thus given to me of the locality of infectious cases has enabled steps to be taken which have prevented the extension of disease from these centres. I have the honour to be, Gentlemen, Your obedient Servant, SHIRLEY F. MURPHY, Medical Officer of Health. 9 Table I. PARISH OF ST. PANCRAS. Table showing the Population, Inhabited Houses, Births and Deaths, for the year 1878 and 5 Years preceding. Gross Numbers. Population estimated at the middle of the Year * No. of Inhabited Houses. ( Estimated) Births. Deaths.** 1878 238,000 25,800 8,249 5,068 1877 236,000 25,580 8,126 4,927 1876 234,000 25,360 8,317 5,019 1875 231,000 25,140 8,000 5,401 1874 229,000 24,920 8,010 4,982 1873 227,000 24,700 8,095 5,392 Average of 5 Years 1873-1877 25,140 8,109 5,144 Notes. 1. Population at Census 1871, 221,465, 2. Area in acres, 2,672. 3. Average No. of Persons in each house at Census 1871, 9.2. * For statistical purposes the Registrar-General estimates the population to the middle of the year on the basis of the rate of increase ruling between the two preceding Census periods. The estimate of population may be cheeked by the known number of inhabited houses, and by the average number of inmates per house, as ascertained at the preceding Census. ** The deaths of non-parishioners in public institutions within the parish are deducted, but a proportion of the deaths occurring in General Hospitals, relative to the population of the parish is added to the total number of deaths in this column. 10 Table II. PARISH OF ST. PANCRAS. Table showing the Annual Birth-Rate, Rate of Mortality, Death Rates among Children, and Deaths in Public Institutions, for the Year 1878 and 10 Years preceding. Birth Rate per 1000 of the Population. Annual Rate of Mortality, per 1000 living. Deaths of Children under 1 year: percentage of total Deaths. Per cent- age of Deaths of Children under 1 year to Registered Births. Deaths of Children under 5 years: percentage of total Deaths. Total Nam ber of Deaths in Public Institution* in the Parish. 1878 34.6 21.71 26.5 16.2 45.6 1,095 1877 34.4 20.88 23.0 14.5 43.3 1,159 1876 35.7 21.54 24.8 15.5 37.9 1,119 1875 34.5 23.38 23.4 15.8 39.7 1,091 1874 35.0 21.75 24.4 15.5 37.4 1,013 1873 35.1 22.32 1872 35.1 21.28 1871 33.8 25.19 1860 34.6 24.14 1869 33.7 22.81 1868 35.2 22.50 Average of 10 years 1868 to 1877. | 34.7 22.57 CAUSE OF DEATH. AGES. 0 to 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 to 95 95 and upward Total under 5 years Total Local Diseases continued. Order 2.—Organs of Circulation. 1 Pericarditis 1 ... ... 1 1 ... ... ... 1 ... 1 ... ... 1 5 2 Aneurism 1 ... ... ... ... 3 3 1 1 ... ... ... 1 9 3 Heart Disease, &c. 4 ... 1 10 17 18 20 44 47 49 24 ... ... 5 243 Order 3—Respiratory Organs. 1 1 Laryngitis 7 3 2 1 1 1 2 1 ... 1 ... ... ... 12 19 2 Bronchitis 164 75 45 4 5 8 20 56 111 127 70 12 ... 284 97 3 Pleurisy ... ... 2 ... ... 2 3 3 1 ... ... ... ... 2 11 4 Pneumonia "62 "44 30 "11 3 13 11 IB 19 13 4 1 ... 136 229 5 Asthma 1 1 4 7 I 1 ... 21 G Lung Disease, &c. 17 "'4 "l "4 "4 6 5 4 7 5 5 ... ... "22 62 Order 4.—Digestive Organs. ... 1 Gastritis ... ... 1 ... 2 ... 1 1 ... ... 5 2 Enteritis 6 ... "3 "2 .. 1 ... ... ... ... 1 ... ... 9 13 3 Peritonitis 4 ... 1 3 2 3 3 1 ... ... ... ... 5 18 4 Ascites ... 1 ... 1 ... ... ... 1 ... 1 ... ... ... 1 4 5 Ulceration of Intestines ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Hernia 1 ... ... ... 1 1 3 .. 1 3 3 ... ... 1 13 7 Ileus ... ... ... ... .. ... •• ... ... ... ... ... ... 8 Intussusception 1 ... ... ... ... ... ... 1 ... 1 ... ... ... 1 3 9 Stricture of Intestines 1 ... .. ... 1 2 ... 1 1 1 3 ... ... 1 10 10 Fistula ... ... 1 ... ... 1 ... ... 1 1 ... ... ... 1 4 11 Stomach Disease, &c. 2 ... 1 ... .. ... 1 2 3 2 1 ... ... 3 12 12 Pancreas Disease, &c. ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... 13 Hepatitis ... ... ... ... ... 1 ... 2 ... ... 1 ... ... ... 4 14 Jaundice 5 ::: ... 1 ... ... 2 2 ... ... ... ... ... 5 10 15 Liver Disease, &c. 1 1 ... ... 1 5 16 15 11 11 6 ... ... 2 68 10 Spleen Disease, &c. ... 1 ... ... 1 ... .. ... ... ... ... 1 2 Order 5.—Urinary Organs. 1 Nephritis ... ... ... ... ... 2 1 2 1 1 1 ... ... ... 8 2 Ischuria ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 3 Bright's Disease (Nephria) ... ... ... ... 1 2 6 5 7 6 ... ... ... ... 27 4 Diabetes ... ... ... 2 2 ... ... ... 1 ... ... ... ... 5 5 Calculus (Stone) ... 1 1 ... ... ... ... 1 ... 1 ... ... ... 2 4 0 Cystitis ... ... ... 1 ... ... ... 1 4 4 ... ... ... 10 7 Kidney Disease, &c. ... ... 1 1 3 4 8 14 7 7 1 ... ... 1 46 Order 6.—Organs of Generation. 1 Ovarian Dropsy ... ... .. 1 ... ... 1 1 1 3 ... ... ... ... 7 2 Uterus Disease, &c. ... ... ... ... ... 2 4 3 2 1 ... ... ... ... 12 Order 7.—Organs of Locomotion. 1 Synovitis (Arthritis) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Joint Disease, &c. ... ... ... 4 2 1 2 2 2 ... ... ... ... ... 13 Order 8.—Integumentary System. 1 Phlegmon 3 ... ... ... ... ... ... 1 ... ... ... • • ... 3 4 2 Ulcer ... ... ... ... ... ... ... ... 4 3 ... ... ... ... 7 3 Skin Disease, &c. 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Class IV.—Developmental Diseases. Order 1 .—Diseases of Children. 1 Premature Birth 86 ... ... ... ... ... ... ... ... ... ... ... ... 86 86 2 Cyanosis 3 ... ... ... ... ... ... ... ... ... ... ... ... 3 3 3 Spina Bifida 11 ... 1 ... ... ... ... ... ... ... ... ... ... 12 12 4 Other Malformations 13 ... 1 1 ... ... ... ... ... ... ... ... ... 11 15 0 Teething 34 42 4 ... ... ... ... ... ... ... ... ... ... 80 80 Order 2.—Adults. 1 Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Childbirth (see Puerperal Fever) ... ... ... ... 3 7 2 ... ... ... ... ... ... ... 12 Order 3.— Old People. 1 Old Age ... ... ... ... ... ... 12 84 122 42 5 ... 265 Order 4.—Nutrition. 1 Atrophy and Debility 229 18 8 1 2 ... 1 1 3 2 ... ... ... 255 265 Class 4.—Violent Deaths. Order 1.—Accident or Negligence. 1 Fractures and Contusions 3 2 1 4 5 5 4 5 4 4 ... ... ... 6 37 2 Wounds Gunshot ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... 3 Burns and Scalds ... ... 5 1 1 ... ... ... ... ... 1 ...... ...... 5 8 4 Poison 1 ... ... ... ...... ... 1 1 1 2 ... ...... ...... 1 6 5 Drowning ... ... 1 "2 ... 1 ... ... ... ... ... ... ... 1 4 G Suffocation 36 1 1 1 ... ... 1 2 ... 1 ... ... ... 38 43 7 Otherwise 8 1 1 ... ... ... ... 1 1 ... ... ... 10 12 Oreler 3.—Homicide 7 ... ... ... ... ... ... ... 1 ... ... ... ... 7 8 Order 4.— Suicide .. ... ... ... 1 1 5 6 1 ... ... ... ... 14 Causes not specified or ill defined 6 ... ... ... ... 1 ... ... 1 1 ... 1 ... 6 10 PARISH OF SAINT PANCRAS. Deaths Registered at several groups of Ages from different causes during the Year 1878. Note. The Death, of non-Parishioners in Public Institution are exluded, and deaths of st. pancras parishioners in Public Institutions in other parts of the Metropolis are included. parts of the Metropolis are included. AGES CAUSE OF DEATH. 0 to 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 to 95 95 and upwards Total under 5 years Total CLASSES. I. Zymotic Diseases 330 105 165 1OO 45 44 44 35 22 25 4 1 1 686 1007 II. Constitutional Diseases 136 87 72 58 73 166 164 123 89 47 17 - - 295 1032 III. Local Diseases 415 176 116 58 55 93 146 526 310 321 183 23 - 707 2149 IV. Developmental Diseases 376 60 14 2 5 7 7 3 1 15 122 42 5 450 738 V. Violent Deaths 55 4 9 8 7 7 11 14 8 8 1 - - 63 132 Not specified or ill defined 6 0 0 0 0 1 - - 1 1 - 1 - 6 10 Totals 1844 439 376 226 185 318 368 426 448 488 327 67 6 2212 5068 Class I —Zymotic Diseases. Order 1.—Miasmatic. 1 Smallpox 5 4 11 17 18 17 12 7 3 ... ... ... ... 20 94 2 Measles 15 19 11 3 ... ... ... ... ... ... ... ... ... 45 48 3 Scarlet Fever (Scarlatina) 10 28 61 38 3 1 2 ... ... ... ... ... 94 138 4 Diphtheria ... 2 9 11 ... ... ... 1 1 ... ... ... 11 23 5 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... 1 6 Croup 6 7 11 3 ... ... ... ... ... ... ... ... 24 27 7 Whooping Cough 84 82 44 6 1 ... ... ... ... ... ... 210 217 8 Typhus Fever ... ... ... ... 1 2 1 5 1 ... ... ... ... 4 Enteric or Typhoid F. 1 ... 7 15 14 10 5 ... ... ... ... ... 8 50 Simple Continued F ... 1 ... 2 ... ... 1 1 4 ... ... ... 1 4 9 Erysipelas 6 ... 1 1 .. 2 ... ... ... ... ... ... 7 17 10 Puerperal Fever (Metria) ... ... ... ... 2 1 2 3 1 ... ... ...... ... ... 5 11 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 12 Influenza ... ... ... ... ... 1 ... ... 1 ... ... ... 1 13 Dysentery ... 1 ... ... ... ... ... 4 2 8 3 1 1 1 2 14 Diarrhœa 178 21 5 1 1 ... 4 ... ... ... ... ... ... 201 229 15 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Aguo ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Remittent Fever ... ... 2 2 ... ... ... 6 ... ... ... ... ... 2 4 18 Rheumatism ... 1 1 ... 3 2 4 ... 4 10 ... ... ... 2 31 19 Other Zymotic Diseases 2 2 1 ... 1 1 1 ... 1 1 1 ... ... 5 11 Order 2.—Enthetic. 1 Syphilis 25 2 ... ... ... ... 1 ... ... ... ... ... ... 27 28 2 Stricture of Urethra ... ... ... ... ... v ... ... ... ... ... ... ... ... ... 3 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Glanders ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... Order 3.—Dietic. 1 Privation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Want of Breast Milk 9 ... ... ... ... ... ... ... ... ... ... ... ... 9 9 3 Purpura and Scurvy 1 ... 1 1 ... ... ... 1 ... 1 ... ... ... 2 6 4 Alchoholism (a. Del. Tremens) ... ... ... ... 1 2 2 2 ... ... ... ... ... ... 7 „ (6 Intemperance) ... ... ... ... ... 4 9 3 4 2 ... ... ... 22 Order 4.—Parasitic. 1 Thrush 14 ... ... •• •• •• •• •• •• •• •• •• ... 14 14 2 Worms, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Class II.—Constitutional Diseases. Order I.—Diathetic 1 Gout .. .. .. ... .. ... .. 2 3 1 .. .. ... ... 6 2 Dropsy ... ... ... 1 2 2 3 2 2 6 4 .. ... ... 22 3. Cancer ... ... ... 3 1 7 21 36 32 24 8 ... 132 4 Cancrum Oris (Noma) 3 ... ... 3 3 5 Mortification 2 .. ... ... ... ... ... ... 1 1 2 ... ... 2 6 Order 2.—Tubercular. 1 Scrofula 7 9 4 4 1 2 1 ... 1 ... ... ... ... 20 29 2 Tabes Mesenterica 56 17 12 7 ... 1 1 ... ... 1 ... ... ... 85 95 :: Phthisis 16 16 23 21 66 152 136 83 50 14 3 ... ... 55 580 4 Hydrocephalus 52 45 33 22 3 2 2 ... ... ... ... ... ... 130 159 Class III.—Local Diseases. Order 1.—Nervous System. 1 Cephalitis ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Apoplexy ... .. ... ... ... 2 10 31 24 33 25 6 ... .. 131 3 Paralysis ... ... ... 1 ... 2 5 16 27 26 24 2 ... ... 103 4 Insanity ... ... 2 ... ... ... 1 ... 1 ... ... ... ... 2 4 Chorea ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 6 Epilepsy ... ... ... 1 4 2 1 2 3 ... ... ... ... 13 7 Convulsions 112 34 14 3 2 1 ... 1 ... 1 ... 1 ... 160 169 8 Brain Disease, &c 22 12 10 7 7 9 7 15 19 6 7 1 ... 44 123 15 Table IV. PARISH OF ST. PANCRAS. Table shewing the Mortality from certain classes of Diseases, and proportions to Population, and to 1,000 Deaths in 1878. Total Deaths. Deaths per 1000 of Population . Proportion of Deaths to 1000 Deaths. 1. Seven Principal Zymotic Diseases 796 3.34 157.0 '2. Pulmonary Diseases (other than Phthisis) 1039 4.40 205.0 3. Tubercular Diseases. 704 2.95 138.3 4. Wasting Diseases of Infants 341 1.43 67.2 5. Convulsive Diseases of Infants 414 1.73 81.7 Notes. 1. Includes Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Fever, and Diarrhoea. 3. Includes Phthisis, Scrofula, Rickets, and Tabes. 4. Includes Marasmus, Atrophy, Debility, want of Breast Milk, and Premature Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Convulsions, and Teething. Table V. PARISH OF ST. PANCRAS. Table shewing the Number of Deaths from the seven principal Zymotic Diseases, in the 10 Years 1868 to 1877. and in the Year 1878. Disease. 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 Annual Average of 10 years, 1868-77. Proportion of Deaths to 1000 Deaths in 3 years, 1875-77. 1878 Proportion of Deaths to 1000 Deaths in 1878. Small Pox 12 1 21 448 58 2 3 2 22 129 6.98 14.1 94 18.5 Measles 102 68 87 105 105 221 64 82 117 143 109.5 22.2 48 9.4 Scarlet Fever 237 239 477 95 70 17 95 220 137 89 167. 6 34.0 138 27.2 Diphtheria 50 20 35 37 16 38 35 55 38 22 34.6 7.0 23 4.5 Whooping Cough 128 221 99 158 259 212 121 232 198 141 176.9 35.9 217 42.8 Fever 122 126 158 112 78 78 67 58 84 76 9.59 19.4 67 13.2 Diarrhœa 286 219 227 236 235 253 222 178 239 155 225.0 45.7 229 45.1 Total 937 891 1104 1191 821 824 607 827 835 755 879.5 178.7 816 161.0 London 15246 17630 16891 19676 12874 11549 11352 13518 12696 12380 143811 186.6 14857 177.5 17 Table VI. PARISH OF ST. PANCRAS. Report of the Sanitary Work, &c., completed in the year ending December 31st, 1878. No. of Complaints received during year from the Sanitary Inspectors and the Public - - 1717 No. of Houses, Premises, &c., inspected - - 3641 Results of Inspection. Orders issued for Sanitary Amendments of Houses and Premises- - - - 1346 Houses and Premises, &c., Cleansed, Repaired, and Whitewashed- - - - 768 Houses Disinfected after Infectious Diseases 423 House Drains. Repaired, Cleansed, &c. - - - - 208 Trapped or Ventilated - - - - 289 Privies and Water Closets. Repaired, Cleansed, &c. - - - - 234 Supplied with Water - - - - 160 New provided - - - - - 1 Dust Bins. New provided - 42 Repaired, Covered, &c. - - - - 131 Water Supply. Cisterns (new) erected - - - - 9 Cisterns Cleansed, Repaired, and Covered 141 Miscellaneous. Overcrowding - - - - - 35 Removal of accumulations of Dung, Stagnant Water, and other Refuse - - - - - 58 Removal of Animals improperly kept 24 Bakehouses ' Regularly inspected - j 196 Licensed Cowhouses 66 Licensed Slaughterhouses 59 Other Proceedings, e.g. Legal Proceedings - Return for the Period—July to December, 1877. RETURN made by Mr. W. T. Jones, Vaccination Officer of the Sub-Districts of St. Pancras Parish, respecting the Vaccination of Children whose Births were Registered in his District, from 1st July, to 31st December, 1877. Registration Sub-Districts comprised in the Vaccination Officers' District. Number of Births returned in the Birth List Sheets as Registered from ]st July, to 31st December, 1877. Number of these Births duly entered by 31st July, 1877, in Columns 10,11, and 13 of the Vaccination Begister (Birth List Sheets, viz.: Number of these Births which on the 31st July, 1877, remained unentered in the Vaccination Register on Account (as shown by Beport Book.) Number of these Births remaining on 31st July, 1877, neither duly entered in the Vaccination Register (columns 3,4,5 and 6 of this Return) nor temporarily accounted for in the Report Book, Cols. 8, 9, and 10 of this Return. Col. 10. Successfully Vaccinated. Col. 11. Col. 13. Dead Unvaccinated. Postponement by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown, which cannot be reached, and Cases not having been found. Insusceptible of Vaccination. Had Small Pox. 1. 2. 3. 4. 5. 6. 7. -8. 9. 10. 11. 1 Kentish Town 1548 1348 3 1 95 3 13 75 10 2 Regent's Park 608 509 1 ... 49 7 2 35 5 3 Camden Town 363 307 ... ... 30 6 19 1 4 Somers Town . 66G 516 1 1 56 5 6 46 7 5 Tottenham Court Road . 413 329 1 ... 30 3 6 39 5 6 Gray's Inn Road . 500 415 ... ... 30 3 5 44 3 Total 4098 3454 6 2 288 21 38 258 * 31 * These Cases have been entered in the Report Book, and the Certificates promised. Return for the Period—January to June, 1878. Return made by Mr. W. T. Jones, Vaccination Officer of the Six Sub-Districts of St. Pancras Parish, respecting the Vaccination of Children whose Births were Registered in his District from 1st January, to June 30th, 1878, inclusive. Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the Mirth List Sheets as registered from 1 st January to 30th June, 1878. N umber of these Births duly entered by 31st January, 1877, in Columns 10,11 and 13 of the Vaccintion Begister (Birth List Sheets) viz : Number of these Births which on 31st January, 1878, remained unentered in the Vaccination Register on account (as shown by Report Book) of Number of tbese Births remaining 011 31st January, 1879, neither duly entere'd in the Vaccination Register " (Columns 3, 4,5 & 6 of this Ruturn, nor temporarily accounted for in the Report Book," (Columns 3, 9 & 10 of this Return). Col. 10. Successfully Vaccinated. Column 11. Col. 13. Dead Unvaccinated. Postponement by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown, or which cannot be reached j and Cases not having been found. Insusceptible of Vaccination. Had Small Pox. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 1 Kentish Town 1483 1279 4 ... 103 11 2 81 13 2 Regent's Park 64] 523 3 ... 51 2 6 45 11 3 Camden Town 409 357 1 ... 28 3 2 16 2 4 Somers Town 657 541 2 2 56 3 2 46 5 5 Tottenham Court Read - 440 346 ... ... 41 4 43 6 C Gray's Inn Eoad - 523 398 ... ... 41 2 14 61 7 Total - 4163 3444 10 2 320 21 30 292 * 44 * These cases have been duly entered in the Report Book, and the certificates produced.