STp AtJ 3^- St. Jfancc.as, BJiddlcscx. TVJENTY-FIFTH ANNUAL REP OR! of the MEDICAL OFFICER OF HEALTH, Being the Report for the Vear 1880. TO THE VESTRY OF ST. PANCRAS. Gentlemen, In my last report I stated that since the last Census was taken many and important changes had taken place in the parish, the full effect of which, on the population, it was impossible with certainty to estimate. The continued demolition of the area in Somers Town acquired by the Midland Railway Company has tended to reduce very considerably the number of persons who previously resided in that subregistration district, and although this reduction has to some extent been compensated for by the growth of houses iu the neighbourhood of Gospel Oak, the Census of 1881 which has just been taken proves that the population of St. Pancras has not increased at the same rate as in the previous decade. Probably 235,000 fairly represents the population in the middle of the year 1880. In the previous decade the increase of population had been at the rate of 1*1 per cent, each year, while in the present decade it has been less than half that amount. It is impossible, for want of more information, to discuss the population of our district more in detail, but it is convenient to correct' the gross population thus far for the purposes of this report. The Registrar-General's year of 1880 begins on January 4th, 1880, and ends on January 1st, 1881, thus consisting of of fifty two weeks, and I have followed the example of previous reports in including the births and deaths in this period. During this year 8,038 births and 5,286 deaths were registered in St. Pancras, but in order to ascertain more exactly the number of deaths of St. Pancras parishioners 2 during this period, it is necessary to deduct the deaths of nonparishioners which occurred in public institutions, and to 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 5,011. The birth-rate was 34.2 per 1,000 of the population. This is exactly the same birth-rate as that of last year, and is .3 below the average of the preceding ten years. The birthrate of London during 1880 was 36.2, and was therefore 2.0 per 1,000 above that of St. Pancras. So far, then, as births are concerned, St. Pancras has not kept pace with the rest of the metropolis. The death-rate was 21.32 per 1,000 of the population, and 1.06 below the average of the preceding ten years, while it was also .98 below the death-rate of the whole of London. This is, with the exception of that of 1877, the lowest death-rate since the year 1872. The excess of births over deaths, which was stated in the last report to be less marked in St. Pancras than in the whole of London, is still further reduced this year, being now less by 24 per 1,000 of the deaths than in the whole of London. St. Pancras, with the present death-rate and with the present population, gains every year about 120 persons less than she would do if she were keeping pace with the rest of the metropolis in this respect. MORTALITY AT DIFFERENT AGES. 1,286 children under one year of age died in St. Pancras in 1880, or 25.6 per cent. of the total deaths. This is 1.9 per cent. more than in the preceding year, and is .1 per cent. less than in the whole of London. 2,166 children under five years of age died in St. Pancras in 1880. This is 43.2 per cent. of the total deaths, and is 2.8 above the per centage of the previous year and 2.4 above the average of the preceding six years. It is, however, 1.0 per cent. of the total deaths less than in the whole of London during the year 1880. In St. Pancras, then, the deaths at these two ages (under one and under five years) have a smaller share of the total deaths than in the metropolis as a whole. 3 1,942 persons between the ages of five and sixty-five years and 904 above sixty-five years of age died in St. Pancras in 1880. The year has been characterised by a mean temperature very slightly in excess of the average mean temperature of the last ten years—a heavier rainfall than the average of that period, and a slight diminution of dryness of atmosphere. The proportion of deaths from pulmonary diseases (other than phthisis) and from tubercular diseases to deaths from all causes has been below the average proportion which these deaths have borne to the total deaths during the last six years. The same fact may be stated with regard to deaths from the wasting and convulsive diseases of infants. On the other hand, the deaths from the seven principal zymotic diseases thus calculated show a very slight increase upon the average of the same period. ZYMOTIC DISEASES. Before giving an account of the number of cases of infectious disease which occurred in St. Pancras during 1880, it will be well, very briefly, to refer to one of the most important arrangements which exist in the metropolis for the prevention of this cause of mortality, viz., hospital provision; and it will perhaps bo permissible, in the twenty-fifth report of your Medical Officer of Health, to notice, in passing, the efforts which have been made in past times iu St. Pancras for this purpose. The first parish to erect a hospital for infectious diseases was St. Pancras. As early as the year 1802 we find that "much good had been done by a parochial fever-house, established by the Vestry of St. Pancras." Later on the only special hospital provision for the whole of London was due to the private charity of the supporters of the London Fever and London Small-pox Hospitals. At a later stage the Guardians paid these institutions for the maintenance of paupers sent to them while suffering from infectious disease, and later still, with a view to increasing the accommodation which the Guardians found necessary for such paupers who were stricken with fever or small-pox, the Metropolitan Asylums Board was formed. The Vestries, as a rule, made no provision for those who were not paupers, although the duty of giving opportunity 4 for the isolation of infectious persons whose disease made them dangerous to others, be they paupers or not, devolve upon the Vestries as the Sanitary Authorities concerned in the prevention of the extension of disease. As a result of this neglect of the Vestries, many infectious persons of all classes sought the aid of the Relieving Officer to obtain admission into the hospitals of the Metropolitan Asylums Board, and were willing to become paupers rather than expose their families to the risk of dangerous disease. The hospitals of this Board have therefore enormously increased in number, although it was never intended that they should do more than provide accommodation for the limited number of paupers requiring hospital treatment. The Vestry of St. Pancras have, however, never lost sight of their duty to their parishioners in this respect, and have paid for the admission into the London Fever and London Small-pox Hospital of all persons who required not hospital treatment to cure them of their disease, but rather the means of passing through their illness under circumstances which should prevent them from being a source of danger to others. Moreover, when the London Small-pox Hospital has been full, and no further accommodation has existed for St. Pancras parishioners, the Vestry have not hesitated to erect a special hospital whenever the necessity has arisen. It is a source of satisfaction to me to serve, as Chief Sanitary Officer, a Vestry who were the first to erect a "parochial fever-house," and who have at the time I write, in spite of a hundred difficulties, again shown their determination to prevent the spread of infectious diseases by affording facilities for the removal of infectious persons from houses where the disease must otherwise have inevitably spread to others. It is very important that the relative positions of the Metropolitan Asylums Board and the Vestry as hospital providing authorities should be understood, and it is most easily shown by stating that the Metropolitan Asylums Board exist solely to maintain during their illness paupers who have fever or small-pox, while the Vestry exist to prevent persons, suffering from these diseases, endangering others. It must be recollected that for the purpose of admission into the hospitals of the Metropolitan Asylums Board it is necessary for the sufferer to seek the aid of the Relieving Officer and become a pauper, a course to which no objection can be taken when the patient goes to hospital for his own 5 benefit, but when his removal is effected for the benefit of the community, as in the case when he is sent to hospital by the Sanitary Authority, this is obviously unjust. The hospitals of the Metropolitan Asylums Board cannot with its present constitution serve the purpose of hospitals for sanitary purposes—the thought and intention of the two classes of institutions is entirely different. For the hospitals of that Board to come to serve the purpose of the Sanitary Authorities, it would be necessary for it to cease to be of Poor Law constitution. First that the hospitals may come to be freely used by all classes, a result which can never be attained, so long as the hospitals are associated with pauperism, and secondly that institutions so closely related to the health of the inhabitants of a district, may be placed under the control of those who are responsible for it. The Vestry have undoubtedly acted wisely in expressing the opinion that hospitals iutended for the prevention of the spread of disease should be under the control of a Central Board representative of the Sanitary Authorities. The number of infectious persons sent on the order of the Vestry to the London Fever and Small-pox Hospitals is increasing as people learn the enormous advantages which result. The Vestry have shown their intention not to allow a lack of accommodation in these institutions to interfere with the thorough performance of one of their most important public health functions. One of the most important subjects that has for some years come before the Metropolitan Vestries and District Boards, is that of the compulsory notification of cases of infectious disease. At the instigation of the Vestry of Kensington, a conference of Vestries and District Boards was held, at which St. Pancras was represented by the Vice-Chairman of the Sanitary Committee. The following resolutions were unanimously passed:— 1.—"That in the interests of public health, and to enable Nuisance Authorities to discharge the duty of checking and preventing the spread of infectious diseases, such as Scarlet Fever, Small Pox, etc., provision should be made, by legislative enactment, to secure the compulsory disclosure to the said authorities of all cases of such diseases immediately after their occurrence." 6 2.—"That the provisions of the 26th Section of the Sanitary Act, 1866 (Section 124 Public Health Act, 1875) are insufficient for the protection of the public health, and should be so amended as to empower any Justice to direct the removal to a hospital, within the district of a Nuisance Authority, of any person suffering from any dangerous infectious disorder, and being without proper lodging or accommodation which would enable him to be properly isolated, so as to prevent the spread of disease to other inmates of the same house, or be properly treated." 3.—"That the admission into hospitals, for the purpose of isolation of persons suffering from infectious diseases, and being without proper lodging or accommodation, is eminently desirable in the interests of the public, and should be encouraged; that payment for the assistance given in hospitals to such persons removed thereto for isolation by the Nuisance or Poor Law Authority, should not he enforced. That the giving of such assistance should not entail on the recipients the loss of any social or political status, and that the cost of hospital treatment of such infective sick persons should be made a charge on the Common Poor Fund." A deputation, representing mary of the Vestries and Local Boards, subsequently waited on the President of the Local Government Board, to request that he would be pleased to bring under the notice of the Government the desirability of taking measures for giving effect to them by legislation. In connection with this subject, it may be pointed out that several large towns have already received power of compelling the notification of infectious disease, and others are seeking it. SMALL POX. Eighteen persons died from Small Pox during the year 1880 among 89 persons suffering from this disease who became known to the Sanitary Authority. Of the 18 who died, 16 had before their death been removed to hospital, leaving two who died in houses in the parish. Seventeen cases were removed to hospital at the expense of the Sanitary Authority. 7 The 18 deaths were 3.7 per thousand of the total deaths in St. Pancras, of these eight ware unvaccinated, seven were badly vaccinated, and in three the condition of vaccination was not known. In the whole of London the deaths from this disease were 5.8 per thousand of the total deaths, and were therefore in excess of the deaths in St. Pancras. In the beginning of the year the parish was threatened with a serious outbreak of this disease. The first two cases occurred in Brunswick Grove, on January 5th and 6th. On January 9th they were reported to the Sanitary Department, and were the same day removed to hospital on the order of the District Medical Officer. They were probably infected by their cousins, who lived in an adjoining parish, and who were suffering from Small Pox during the previous December.* A house to house enquiry was immediately instituted, but no other cases in the neighbourhood could be discovered. About ten days after the first cases were removed to hospital, two other members of the same family were attacked, and were removed to hospital, the one on January 22nd and the other on January 26th. Between February 5th and February 10th, 11 other cases became known, 12 in Brunswick Grove and two in Brighton Street. They were all at once removed to hospital. On February 12th the outbreak was brought to the knowledge of the Vestry and of the Board of Guardians, as the Vaccination Authority. Facilities were at once given by the Vestry for a house to house visitation in the affected area by the appointment of three specially qualified inspectors, who did everything in their power to procure the vaccination of all persons susceptible to Small Pox. The neighbouring vaccination station was opened, and the Public Vaccinator, both at the station and at the houses of the sick, was himself engaged in protecting susceptible persons from infection of Small Pox. The outbreak soon terminated, a result which is certainly attributable to the energetic action taken by the Vestry in temporarily increasing the Sanitary Staff, and to the efforts of the Public Vaccinator, the District Medical Officer, and the Believing Officers, who at the time received the thanks of the Sanitary Committee for their prompt services. *I am indebted to Dr. Makuna, then Medical Superintendent to the Small Pox Hospital at Fulham, for important information in connection with this outbreak. 8 I may mention incidentally that during a house to house inspection I found persons suffering from Small Pox whose disease had not been recognised at the time, and one, a child, who, with the disease upon her, had gone to a shop to make purchases for a mother and unvaccinated infant sister, both of whom subsequently died of the Small Pox. they had contracted from her prior to my visit. The Vestry are to be congratulated in adopting a method of dealing with an outbreak of Small Pox which was attended with such successful results, and it is a source of satisfaction that whatever difficulties in the future may attend the existence of Small Pox Hospitals, a course is open to the Sanitary Authority which, especially if they could ensure the immediate vaccination of all susceptible persons in the houses of those attacked with Small Pox, would render the removal of the affected to hospital a matter of much smaller moment. From the termination of the Brunswick Grove outbreak until April, a few cases of Small Pox appeared in different parts of the parish. At this time, 11 cases occurred in eight houses in "Wards I. and II., they were all removed to hospital except one, who, after he had been taken ill, but before his disease had been recognised, had left London for the country. Of the eleven cases two occurred in a common lodging house, where both were probably infected by one of the other inmates, although no cne could at the time of my visit be discovered in the lodging house who had recently suffered from Small Pox. These two cases infected two others, one who at the time of being taken ill was still residing in the same lodging house, the other in a house in Bayham Street. So far as St. Pancras is concerned, no other cases could be traced to this centre, but it is of course impossible to say how many cases elsewhere may have resulted from the man who in the first instance brought infection into the common lodging house. In May, 13 cases of Small Pox were reported, but after this month the disease slightly diminished, but I felt it my duty in December to call the attention of the Vestry to the serious increase of this disease in the eastern parts of the Metropolis, and to recommend that by the purchase of an ambulance greater facilities should be given for the removal of the sick to hospital. I am indebted to the Vaccination Officers for the accompanying tables for the twelve months ending June 30th, 1880, 9 showing the number of children born, the number of those who are vaccinated, and the number of cases included under "removal to places unknown or which cannot be reached, and cases not having been found." It will be seen that the number of children who have thus escaped vaccination amount to 7.1 per cent. of the total births. During the preceding twelve months they amounted to 6.2 per cent. DIPHTHERIA. Thirty-four deaths from Diphtheria occurred among St. Pancras parishioners, of which 32 took place in the parish and two in hospitals outside the parish, to which they had been removed during their illness. 34 deaths is an increase by nine upon the number of deaths which resulted from this disease in the previous year. The 34 deaths are in the proportion of 6.8 to every 1000 deaths from all causes. In the whole of London the deaths from Diphtheria represent the same proportion of total deaths. It is a matter of regret that a large number of the cases of this disease which occur are not reported to the Sanitary Department. As a rule, the first intimation received is that of the death of the sufferer. Diphtheria is a highly infectious and fatal affection, and it is very necessary that persons suffering from even mild attacks of it should not be allowed to associate with others. WHOOPING COUGH. This disease caused 293 deaths in 1880, being nearly double the number in the previous year. The 293 deaths are in the proportion of 58 in every 1000 deaths from all causes, while in the whole of London the deaths from Whooping Cough make only 42 in every 1000 deaths from all causes. Whooping Cough has therefore been especially fatal in St. Pancras, and has killed in the proportion of 14 for every 1000 deaths from all causes above the average for the preceding 10 years. The deaths have been distributed fairly evenly by over the whole parish, and have not been confined to any special araa. Whooping Cough has been more fatal in the Northern districts than in any other. Next to the North it has prevailed in the Southern and Central districts—the East and the West being most and equally exempt. 10 SCARLET FEVER. Scarlet Fever or Scarlatina caused 156 deaths, or 31 par 1000 of the total deaths from all causes. In the whole of London this disease caused 37 per 1000 of the total deaths and was therefore in excess of the proportion of deaths from Scarlet Fever in St. Pancras. 156 deaths are slightly in excess of the average number for the last 10 years. 866 cases were reported to the Sanitary Department during the year of which 38 were removed to hospital, 28 of these being sent at the expense of the Vestry to the London Fever Hospital. Deaths from Scarlet Fever are often due to the mistaken belief that a mild case of this disease is less dangerous to its neighbours than one more severe. During last May, in a crowded house, a child suffered from an attack of Scarlet Fever which the parents thought too slight for it to be sent to hospital; as a result the disease extended to six others. FEVER. During the year 1880 but one death was registered from Typhus, this occurred in the Somers Town sub-registration district, and was that of a boy thirteen years of ago. The case was not known to the Sanitary Department until after death occurred, and no opportunity was therefore given for it to be seen by your Medical Officer. No evidence could be found of the previous exposure of the boy to infection, his was the only case of Typhus which occurred in the house, and the disease did not extend further. Enteric Fever caused 43 deaths during 1380, being in the proportion of 8.7 in every 1000 deaths from all causes. In the whole of London Enteric Fever caused 8.4 in every 1000 deaths from all causes. In my last report I pointed out that with a proper system of drainage and drain ventilation Enteric Fever might be almost eliminated from our death returns, and I quoted the 76th section of the Metropolis Local Management Act to show that with regard to all new houses every drain shall be made in such "manner, form, and of such material and workmanship" as the Vestry shall order. 11 This cause of mortality is therefore greatly under the control of the Vestry and deserves their serious attention. MEASLES. Measles caused 58 deaths in St. Pancras during 1880, being about half the number in 1879, and in the proportion of 11.5 in every 1000 deaths from all causes. This is but half the average of the preceding ten years, and is about 6 per 1000 less than in the whole of London. DIARRHŒA. During 1880, 204 persons died of Diarrhœa, of whom 159 were under one year; the deaths from this disease were in the proportion of 46.1 of every 1000 deaths from all causes, and were 6 in every 1000 deaths above the average of the last ten years. The proportion of deaths from Diarrhæa to total deaths is the same in the whole of London as in St. Pancras; our parish has not therefore suffered more heavily from this disease than the metropolis as a whole. TRADE AND HOUSE REFUSE. The disposal of house and trade refuse in London has recently excited the serious attention of many engaged in the performance of sanitary duties. In our own parish the difficulties with regard to the collection and disposal of house refuse have been prominently before the Vestry, and no better evidence can be found of the Vestry's disapproval of existing arrangements than the fact that they thought it well to send into the north of England a deputation to consider the various methods which obtained in that part of the country. The habit in London of storing the refuse of the house in close proximity to the habitation, where it only requires the opportunity so readily afforded by the contract system to become not only offensive to the nose and eye, but absolutely injurious to health, has been sufficiently condemned by the Vestry. At the present time, however, no steps have been taken to remedy what all are agreed ought no longer to be tolerated. 12 The Vestry exercise the power of preventing householders from disposing of this refuse themselves, and upon them, therefore, devolves the duty of insuring its removal at times and in a manner which shall insure that no nuisance shall be created. Whatever course the Yestry may in the future adopt as to the mode of dealing with house refuse after its removal from the house, the removal is a duty which should be retained in their own hands. Moreover, the removal should take place at frequent and regular intervals, and ought not to depend upon the chance of the dustman's cry being heard, but every house should be called at in turn. No system can be worse than the present one, which tempts the contractor to make the removal of house refuse depend upon its commercial value. Whatever the opportunities for its eventual utilization may be, its removal should be independent of such considerations. That under the present system this cannot be the case—there has of late years been abundant evidence before the Vestry. I would beg to call the attention of the Yestry to a report on this and kindred subjects recently issued by the Society of Medical Officers of Health. The other subjects to which I refer are those of trade, stable, and cow-shed refuse. The Vestry are at the present time liable to be called upon by any tradesman to collect trade refuse, animal and vegetable, and remove it from the premises; they ought equally to have it in their power to take possession of such refuse without being called upon, should the owner be unable or unwilling to dispose of it before it is likely to become a nuisance, and they should be entitled to charge a small fee for doing so. It is, however, especially to the third point, the collection of stable and cow-shed manure, I would desire to call the attention of the Vestry. The difficulties of enforcing the regular removal of this material is gradually increasing, and complaints are constantly made to the Sanitary Department on the one hand by people who are offended by the close proximity of unemptied dung-pits to their houses, and on the other hand by the 13 owners of the manure, who are unable to secure its removal at sufficiently frequent intervals to prevent it becoming offensive. I cannot but believe that were the Vestry themselves to undertake the duty of thus removing the manure, and were to charge a small fee for doing so, they would not by this action increase the rates, but would confer a considerable boon upon the parish. The report to which I refer appears to me of sufficient importance to warrant me in asking your leave to append it to my report:— 1. With respect to trade refuse.—The Metropolis Local Management Act (18 & 19 Vict. cap. 120, sect. 128) entitles the owner or occupier of any house or land to require the "scavenger" to remove the refuse of any trade, manufacture, business, &c., on payment of a reasonable sum by way of compensation; but the Nuisance Authority, which by its own staff or by its "contractor" is the "scavenger," has at present no power to remove trade refuse, whatever its nature or condition, excepting on the requisition of the owner or occupier as aforesaid. The Committee, however, are of opinion that as the refuse of slaughter-houses and the refuse of the trades of fishmonger, poulterer, greengrocer, &c., being of animal or vegetable origin and liable to decomposition, would, if not speedily removed from the premises, become a "nuisance and injurious to health," the Nuisance Authority should have power as well as obligation to collect, remove, and dispose of such refuse, and should receive reasonable compensation for so doing. In the City of London the Nuisance Authority (Commissioners of Sewers), as a matter of fact, collect trade refuse—animal and vegetable —receiving payment; and the Committee are informed by the Medical Officer of Health that the Commissioners have under consideration a scheme for its profitable utilization —a scheme which is the more likely to succeed, as the Commissioners will have to deal with large and regular supplies. It is open to question whether the Nuisance Authority in a district not having public 14 markets could profitably utilize limited quantities of animal refuse directly; but possibly a scheme might be arranged for this purpose through the agency of establishments where "offensive trades" are carried on under the provisions of the Slaughterhouses Metropolis Act, 1874. In any case the refuse should be collected daily in the early morning hours, and conveyed in properly constructed covered receptacles, or in vehicles expressly adapted for the prevention of effluvium nuisance. Failing an arrangement for utilization, each district should provide the means of destroying animal refuse. It appears doubtful whether vegetable refuse could be profitably utilized in London by the process of "carbonisation." The mere destruction of such refuse by fire could be effected without difficulty or nuisance. 2. With respect to the collection and disposal of house refuse.— It is almost superfluous to observe that the Committee cannot approve of the refuse being deposited in large heaps or "tips"in or near towns or inhabited dwellings: its use for levelling land for building purposes is now very properly forbidden by the bye-laws regulating the foundations of buildings,* and its destruction in the open air, creating an intolerable nuisance, is impracticable. The refuse, moreover, is not without value—the "breeze, for instance, being almost indispensable to the brick maker. The value, however, has decreased of late years, for the growth of London has led to the production of the refuse in larger amount, while the increased distance to the brickfields has greatly increased the cost of carriage. Formerly contractors were willing to pay large sums for the privilege of removing the contents of dust-bins. Now they invariably receive payment. The expense to the Nuisance Authority, however, is not so great as it would be were not the refuse capable of * Vide Bye-laws made on Oct. 3rd, 1879, by the Metropolitan Board of Works, under the provisions of the Metropolis Management and Buildings Act, 1878, sec. 16. 15 utilization for various trade purposes. Of these the manufacture of bricks is the most important; and it is, perhaps, not too much to say that the diligence of the contractor in carrying out his contract is governed to no inconsiderable extent by the season of the year and by the demands of the brickmaker, so that the dust-bins are apt to be neglected when their contents are not in requisition in the brickfield. The Committee consider, however, that the removal of house refuse ought not to depend upon its pecuniary value, but should be regarded from the sanitary rather than the commercial point of view, and they are of opinion that the time is at hand when the Nuisance Authority will have to adopt the process of refuse-destruction by fire, in specially constructed apparatus, such for instance as is in operation at many great provincial centres of population, as Birmingham, Leeds, Manchester, Warrington, &c., &c. The mere reduction in bulk resulting from this process (some 70 to 80 per cent.) is in itself a great gain, so that in the event of no practicable means of utilizing the products of combustion—slag and dust—being found, the quantity of perfectly innocuous matter to be disposed of would be relatively small. This is a very important factor in the case, having regard to the limited facilities for water carriage, and to the exorbitant, not to say prohibitory, cost of railway carriage. The slag, however, is useful for making up roads, and ground into powder and mixed with lime it makes a valuable mortar, which in the provincial towns finds a ready sale at a remunerative price. The combustion apparatus might be made available for the destruction of vegetable refuse and of infected articles; and probably it would suffice for the destruction of small quantities of animal refuse, failing any scheme for its utilization." The Committee, in concluding this section of their report, desire to place on record their disapproval of the present system of storing house refuse in "dustbins" in close proximity to dwelling-houses, a system unjustifiable on Sanitary principles, and productive of nuisance at every stage. 16 Legal provision should be made for the daily removal of the refuse in covered carts, and to facilitate collection the refuse should be deposited in suitable receptacles, which should be placed every morning on the pavement in front of the house. 3. With respect to stable and cow-slied refuse. —The Nuisance Authority has power under the 53rd section of the Sanitary Act, 1866 (50th section of the Public Health Act, 1875) to make regulations for the "periodical removal" by the owner, of manure, &c., and an ample penalty, twenty shillings per day, is provided for default. Nevertheless, where regulations exist they are rarely carried out strictly, for this reason among others, that it is found difficult to get Justices to inflict the penalties for neglect or default Of late years the difficulty of procuring the removal of the refuse has considerably increased, owing to the growth of London and the greater distances to the fields and market gardens. Formerly stable manure was in request by market gardeners, who paid a good price for it. Now, horse owners generally have to pay for its removal, or at best to give it away. It is often difficult, moreover, to get it removed on any terms, for as a rule it is conveyed in vehicles returning from the markets ; and at certain seasons of the year, e.g., hay-making and harvest-time, it is practically impossible to get the farmers to send their carts so regularly as is necessary for compliance with the regulations. "With the permission of the owner" the Nuisance Authority may collect the refuse: but the Committee are of opinion that the Nuisance Authority should have the same right everywhere as in the City of London* to collect it when the owner is in default, and to charge him with the cost of so doing. There is good ground for believing that many horse owners would be glad to be relieved of the difficulty and responsibility of their position under the " regulations," and would be willing to pay a reasonable compensation to the Nuisance Authority to cover the cost of the removal of the refuse. The * City of London Sewers Act, 1851, 14 & [5 Vic., cap. 91, sec. 8. 17 penalties for default of compliance with the regulations should be rigorously enforced against persons who fail to come to an arrangement with the Nuisance Authority. Less difficulty is experienced in enforcing the removal of cow-shed refuse, this being further provided for by regulations framed under the "Dairies, Cow-sheds, and Milk-shops Order, 1879;" the Nuisance Authority, moreover, being able to bring pressure to bear on offenders on the occasion of the annual application for the renewal of the cow-shed licence. The cow-keeper being thus compelled to incur the expense of removing his shed refuse regularly, would probably welcome any scheme whereby, without increased outlay, this duty would be taken off his hands by the Nuisance Authority. The refuse of cow-sheds should be removed within specified hours in the early morning, in vehicles specially constructed so as to prevent slopping and effluvium nuisance. It would be found difficult in some districts to remove stable refuse within the same hours, and the necessity for so doing would be less, provided it were found practicable to abolish sunken dung-pits, in which manure rapidly ferments and decomposes, giving rise to intolerable nuisance when the receptacle is emptied, and also in the passage of the cart through the streets. Were the plan universal of employing properly paved and drained receptacles enclosed within iron racks above the surface of the ground, so as to dry the refuse by air currents, its removal might be effected at any period of the day without offence, provided it had not been kept too long in the stable or in the receptacle itself, so as to become rotten and offensive. The Committee having in the second and third sections dealt with the "collection" of house and stable refuse, have now only to express their conviction that legislation will be found necessary to solve the difficulty attending the ultimate "disposal" of such refuse, viz., by imposing on canal and railway companies the obligation of conveying it from towns in boats and vans, expressly contrived for the avoidance of nuisance and at a rate for carriage 18 which, while fairly remunerative, shall not beoppressive to the ratepayers—power to settle the rate, in case of dispute, to be vested in the railway commissioners or some similar tribunal having an equitable jurisdiction. INSPECTION OF HOUSES. As much attention as possible has been devoted to the inspection of houses. For the class of houses which more particularly require the attention of the Sanitary Authority a constant supervision is required. A house may be inspected, and notices served and enforced for its proper lime-whiting, cleansing and repairing, but from the fact of its being occupied by a large number of people, and especially by those whose habits are often uncleanly, it does not long remain in a sanitary condition. It again and again requires inspection if any effort is to be made to keep it in a cleanly and wholesome state, until the poorer classes become accustomed and learn to acquire those habits of cleanliness which are necessary to health. The Vestry are aware of the good which has resulted from the regulations which the police authority enforce with regard to common lodging houses. If the poorest class of houses in our parish were submitted to regulations made under the 85th section of the Sanitary Act there would be a reasonable probability that these houses would be maintained in a better condition than at present. This clause gives the Vestry power to compel the registration of such houses, and to draw up regulations for fixing the number of persons who may occupy them, for keeping them in a cleanly condition, for enforcing the provision of privy accommodation, and other appliances and means of cleanliness, and for cleansing and lime-whiting the premises at stated times. If regulations could be made that even did not go beyond compelling the mere cleansing and repairing of the premises at stated times, and the notification of infectious diseases occurring as they do in these houses, under circumstances which are so especially favourable to their extension, much of the disease and misery of the present time could be prevented. 19 In dealing with house property it is well to bear in mind that the Metropolis Local Management Act gives opportunity to the Vestry to enforce far better sanitary arrangements for houses than they at present have. The Sanitary Committee have during the year wisely visited many of the poorest localities of the parish, and have ascertained for themselves the filthy condition to which the houses in these districts would soon be reduced, did they not receive the constant attention of the Sanitary Officers. The condition of some of the water closets at the time of their visit will be within the memory of many of the Committee and it will also be recollected that the flushing of these closets was dependent solely on the willingness of the inhabitants ta carry water from the back to the front of the house in a pail, a duty which it is needless to say was left by one to another until it was not performed at all. The question of water supply to water closets has often been under consideration, and I therefore desire to bring to the notice of the VeStry the fact that the Water Companies are at the present time compelling all house owners to provide such water closets as are supplied with water, with water waste-preventers, limiting the amount which can flush the closet at any one time to two gallons. While the Water Companies' regulations prevent the use of mitre than two gallons at one time, it is very desirable that the Vestry should on the other hand limit the amount to not less than two gallons. Indeed, the opinion is held by competent authorities that two gallons is not, under all conditions, sufficient to properly flush the pan and soil pipe. It is a matter of great importance that the height of the waste-preventer above the water closet pan and the size of the supply pipe to the pan should be noted. The West Middlesex Company limit the internal diameter of the supply pipe to the pan to not less than ??? inches, but the regulations of the New River Company place no such limit, and the probability is that unless the Vestry exercise some control in the matter of water supply, apparatus will be placed in the houses which will be altogether inadequate, and which there will be great difficulty in altering. One of the regulations of the Water Companies is very beneficial, viz., that which prevents any waste pipe from a cistern being in direct communication with a drain. While 20 this communication exists, opportunity is afforded for the fouling of water from the cistern by the passage into it of air from the drain. During the year the West Middlesex Company laid on a constant service of water to one district in our parish, bounded on the north by and including Cumberland Market, Cumberland Street East and West, and Edward Street, Hampstead Road; on the south by, but not including, the Euston Road; on the west by, but not including, Albany Street; and on the east by, but not including, the Hampstead Road. COW-HOUSES AND SLAUGHTER-HOUSES. There are 57 licensed cow-houses and 50 licensed slaughterhouses in St. Pancras. These, with very few exceptions, were found, on inspection, to be in a satisfactory condition. With a view to better defining the requirements of the Vestry, the following regulations were drawn up with regard to cow-sheds:— 1.—That the cow-house be properly cleansed, lighted, and ventilated. 2.—That it be provided with properly-constructed drainage, communicating with the main sewer, and that the inlet to the drain be properly trapped and covered with a fixed grating. 3.—That the cow-house and adjoining yards be properly paved, with a fall to a drain, and the yards be well drained and kept cleansed. 4.—That there be a sufficient supply of water, with the necessary apparatus, and that each stall be provided with a trough of impervious material supplied by a pipe with water from a cistern, the bottom of which shall not be less than 6 feet above the level of the floor of the shed. 5.—That there be a properly-constructed receptacle for manure, garbage, and other refuse from the sheds; that such receptacle be not placed inside or directly communicating with the shed, that it be drained by a pipe with an outlet to sewer, and be made of or be lined with impervious material, and that the manure 21 be removed as frequently as the Sanitary Committee' and the Medical Officer of Health may from time to time deem necessary. 6.—That the grain-bins and receptacles for wash be kept in repair, clean, and well-covered; that they be made of or be lined with impervious material and placed outside the shed, and that the grain-bin be drained by a drain disconnected from the sewer. 7.—That the cubical area be sufficient to allow of a breathing space of not less than 800 cubic feet for each cow, and the height of the cow-house in excess of 18 feet shall not be taken into account in estimating the air space. 8.—that the inner walls of every cow-house in front of the cows be covered with hard, smooth, and impervious material to a height of at least 5 feet from the floor of each cow-shed. 9.—That a greater number of cows be not kept in any cow-house than the number for which such cow-house is licensed. 10.—That there be no dwelling room over the cow house and that in all cases there be an intervening space between the cow-house and the dwelling-house adjoining. 11.—No water-closet, privy, cesspool, or urinal shall be within, communicate directly with, or ventilate into the cow-house. 12.—That the premises be lime-whited throughout the interior at least once in every three months. 13.—That no milk shall be stored in the cow-house or in any room or place directly communicating with it. UNCERTIFIED DEATHS. The Vestry will recollect that they had recently brought to their notice a memorial from the Wandsworth Board of Works to the Home Secretary, urging the necessity for an enquiry by a skilled officer in cases in which the cause of death of a person has not been certified to by a registered medical practitioner, and concerning which no inquest has. been held before the death is registered and the body buried. 22 The uncertified deaths in St. Pancras have been in 1876, 26 ; 1877, 20 ; 1878, 28; 1879, 11; and in 1880, 11. The Vestry wisely supported the memorial, and it may be hoped that an early alteration in the law will give a better protection to life than the existing law affords, and will ensure proper enquiry by a skilled person into all deaths concerning which such certificate cannot be produced. OPEN SPACES. The Kyrle Society have recently brought before the Vestry a scheme for laying ont as a garden the disused burial grounds of St. George-the-Martyr and St. George, Bloomsbury, situated at the back of the Foundling Hospital. The Vestry have already expressed their approval of this plan, and it only remains for me, as their Medical Officer, to hope that nothing will interfere with its thorough fulfilment. There are few better means of improving the health of the inhabitants of the crowded neighbourhood in which these grounds are placed than that of opening them for the recreation of the people. I am, Gentlemen, Your obedient Servant, SHIRLEY F. MURPHY. To the Vestry of St. Pancras. 23 Table I. PARISH OF ST. PANCRAS. Table showing the Population, Inhabited Houses, Births and Deaths for the year 1880 and 7 Years preceding. Gross Numbers. Population estimated at the middle of the Year * No. of Inhabited Houses. (Estimated) Births. Deaths. ** 1880 235,000 24,605 8.038 5,286 1879 240,000 26,020 8,226 5,189 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 7 Years 1873-1879 25,360 8,146.1 5,139.7 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 checked 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 should be deducted, but a proportion of the deaths occurring in General Hospitals, relative to the population of the parish or district, should be added to the total number of deaths in this column. 24 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 1880 and 10 and 6 Years preceding. Birth Bate per 1000 of the Population. Annual Rate of Mortality, per 1000 living. Deaths of Children under 1 year: per centage of total Deaths. Per cent- age of Deaths of Children under 1 year to Registered Births. Deaths of Children under 5 years : per centage of total Deaths. Total Number of Deaths in Public Institutions 1880 34.2 21.32 25.6 15.9 43 2 1,244 1879 34.2 21.62 23 7 14.9 40.4 1,295 1878 34.6 21.71 26.5 16.2 45.6 1,095 1877 34.4 20.88 230 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 1870 34.6 24.14 Average of 10 years 1870 to 1879. 34.7 22.38 Average of 6 years, 1874 to 1879. 24.3. 15.6. 40.8. 1,128.6. Table III. PARISH OP ST. PANCRAS. Deaths Registered at several groups of Ages from different causes during the Year 1880. 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 55 55 to 65 65 to 75 75 to 85 85 to 05 95 and upwards Total under 5 years Total CLASSES. I. Zymotic Diseases 301 180 220 90 30 48 28 20 20 21 10 1 — 761 1032 II. Constitutional Diseases 118 80 56 44 90 155 188 107 97 42 17 1 — 233 946 III Local Diseases 400 156 141 09 63 110 148 238 321 371 147 24 2 697 2190 IV. Developmental Diseases 335 48 0 2 2 7 8 1 7 76 129 47 4 386 669 V. Violent Deaths 72 10 7 10 12 18 14 10 8 7 8 — — 89 167 Not specified or ill defined — — — 2 1 1 1 2 — — — 7 Totals 1286 450 430 217 203 333 384 384 480 517 308 6 6 2166 5011 Class I—Zymotic Diseases. Order 1.—Miasmatic. 1 Smallpox 2 ... 1 1 6 6 1 1 ... ... ... ... 3 18 2 Measles 14 17 21 5 1 ... ... ... ... ... ... ... 52 53 3 Sc arlet Fever (Scarlatina) 6 18 82 44. 4 2 ... ... ... ... ... ... 106 156 4 Diphtheria ... 6 13 11 3 1 ... ... ... ... ... ... 19 34 5 ! Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Croup 7 7 20 2 ... ... ... ... ... ... ... ... 34 d6 7 Whooping Cough 104 105 72 11 1 ... ... ... ... ... ... ... 281 293 8 Typhus Fever Enteric or Typhoid F. . Simple Continued F. ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 3 9 ... 10 7 5 .. 2 ... ... 4 43 ... ... ... ... ... ... ... 2 ... ... 2 ... ... 4 9 Erysipelas 4 ... ... ... ... 2 2 4 3 3 4 ... 4 22 10 Puerperal Fever (Motria) ... ... ... ... ... 9 3 ... ... ... ... ... ... 14 11 Carbuncle ... ... ... ... ... ... ... 1 ... ... ... ... 1 12 Influenza ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 13 Dysentery 1 ... ... ... ... 1 1 1 ... 1 3 14 Diarrhoea 159 22 "4 ... ... 2 6 4 5 ... ... 185 204 15 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Aguo ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Kemittent Fever ... ... ... ... ... ... ... ... ... ... ... ... 18 Rheumatism ... ... 2 5 3 0 2 2 1 3 ... ... 3 25 19 Other Zymotic Diseases 1... ... 2 1 2 4 1 2 ... ... ... ... ... 2 12 Order 2.—Enthetic. 1 Syphilis 0 3 ... ... 1 1 ... ... ... ... .. ... ... 23 23 2 Strioture of Urethra ... ... ... ... ... ... ... 1 3 1 1 ... ... ... 6 3 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 3.—Dietic. 1 Privation 3 ... ... ... ... ... 1 ... 3 2 ... ... ... 3 9 2 Want of Breast Milk 23 ... ... ... ... ... ... ... ... ... ... ... ... 23 23 3 Purpura and Scurvy ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 2 4 Alchoholism (a Del. Tremens) ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 „ (b Intemperance) ... ... ... ... ... 3 9 3 6 2 1 ... ... ... 24 Order 4.—Parasitic. 1 Thrush 18 ... ... ... ... ... ... ... ... ... ... ... ... 18 18 2 Worms, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Class ii.—Constitutional Diseases. Order 1 ——Diathetic 1 Gout ... ... ... ... ... ... 2 5 5 4 1 ... ... ... 17 2 Dropsy ... ... 1 3 ... 1 1 3 6 5 4 ... ... 1 24 3 Cancer ... ... ... 1 ... 5 34 35 48 18 9 ...1 ... ... 150 0 4 Cancrum Oris (Noma) ... 1 1 ... ... ... ... ... ... ... .... 1 ... 2 a 19 5 Mortification l ... ... ... ... ... ... 1 3 6 ... ... ... 1 Order 2.—Tubercular. 1 Scrofula 7 4 5 2 ... ... ... ... ... ... ... ... 16 18 2 Tabes Mesenterica E5 22 10 4 ... ... ... ... ... ... ... ... ... 87 91 2 3 Phthisis 14 15 17 21 13 148 118 63 35 8 2 ... ... 46 80 134 4 Hydrocephalus 41 17 22 13 1 1 ... ... ... ... ... ... 95 Class III —Local Diseases. Order 1-.Nervous System. 1 Cephalitis 24 16 16 4 2 2 1 2 3 94. ... ... ... ... 56 4 70 132 2 Apoplexy 2 1 1 ... 1 1 6 9 21 17 47 32 12 8 ... 1 80 3 Paralysis ... ... ... 1 3 4 5 5 11 17 ... ... ... 25 4 Insanity ... ... ... ... ... 1 1 ... ... 1 5 1 1 ... 1 5 Chorea ... ... ... ... ... ... ... ... 4 5 ... ... 1 ... ... 19 6 Epilepsy ... ... ... 1 1 3 2 3 ... ... ... ... ... 147 151 7 Convulsions 114 23 10 4 ... ... ... ... 11 12 1 3 ... ... 11 65 8 5 1 5 5 8 5 3 6 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 upwards ' Tota under 5 year Total s Local Diseases continued. , Order 2.—Oraans of Circulation. 1 2 Pericarditis 2 ... ... 2 3 2 3 1 2 2 ... ... ... 2 17 q Aneurism ... ... ... ... 1 4 4 4 2 1 1 ... ... ... 17 3 Heart Disease, &c 4 1 2 10 9 15 27 54 58 59 19 2 ... 7 17 260 Order 3—Resviratorv Oraans. 1 Laryngitis 3 3 6 3 ... ... 2 ... ... 1 ... ... 12 18 2 Bronchitis 154 81 70 7 5 17 23 63 113 133 67 10 1 305 738 3 Pleurisy ... 1 1 2 ... ... 5 2 1 1 i ... ... 2 14 4 Pneumonia 32 22 16 10 5 7 19 16 8 8 2 1 ... 70 146 5 Asthma 1 ... ... 1 ... ... 1 4 7 8 3 1 ... 1 26 6 Lung Disease, &c. 18 3 7 2 2 ... 4 4 6 3 2 ... ... 28 51 Order 4—Digestive Organs. 1 Gastritis 2 ... 2 1 1 ... 1 1 ... ... ... ... ... 4 8 2 Enteritis 11 1 ... 4 3 1 1 1 1 2 ... ... ... 12 25 3 Peritonitis ... ... 1 4 3 5 5 2 1 2 1 ... ... 1 14 4 Ascites ... ... ... ... ... ... 2 3 2 2 2 ... ... ... 11 5 Ulceration of Intestines 2 ... 1 ... ... ... ... ... ... ... ... ... ... 3 3 6 Hernia 1 ... ... ... ... ... ... ... 1 6 1 ... ... 1 9 7 Ileus ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 8 Intussusception 3 ... ... ... ... ... ... ... ... 1 ... ... ... 1 4 9 Stricture of Intestines 3 ... ... ... 1 3 ... 1 8 4 ... ... ... 3 4 10 Fistula ... ... ... ... ... 1 ... ... ... 1 2 ... ... 3 22 11 Stomach Disease, &c. 2 ... ... ... ... 3 ... 1 1 2 ... ... ... ... 1 12 Pancreas Disease, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... 2 9 13 Hepatitis 1 ... ... ... ... 1 1 4 ... 1 1 ... ... ... 21 14 Jaundice 8 ... ... 1 1 3 1 3 1 2 1 ... ... 1 9 15 Liver Disease, &c. 2 ... 1 2 2 7 8 13 9 11 ... ... ... 8 3 21 55 16 Spleen Disease, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 5.—Urinary Organs. 1 Nephritis ... ... 1 ... 1 2 ... 2 3 1 ... ... ... 1 10 2 Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Bright's Disease (Nephria) ... ... ... ... 4 7 10 10 10 3 2 ... ... ... 46 4 Diabetes ... ... ... 2 1 2 1 1 4 ... 1 ... ... ... 12 5 Calculus (Stone) ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 6 Cystitis ... ... ... ... 2 ... ... ... 2 4 6 ... ... ... 14 7 Kidney Disease, &c. ... ... 1 ... 2 4 6 5 7 4 3 ... ... 1 32 Order 6.—Oraans of Generation. 1 2 Ovarian Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Uterus Disease, &c. ... ... ... ... ... 3 1 3 2 ... ... ... ... ... Order 7.—Organs of Locomotion. 1 2 Synovitis (Arthritis) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Joint Disease, &c. ... 1 ... 3 4 2 2 1 ... ... ... ... ... 1 12 Order 8.—Integumentary System. 1 2 Phlegmon 1 1 ... ... ... ... ... ... ... ... 1 ... ... 2 2 3 Ulcer and Abscess 1 ... ... ... ... 2 1 2 7 1 ... ... ... 1 14 skin Discases 3 ... ... ... ... ... ...... ... 1 ... ... 3 3 ClassIV. Developmental. Diseases. Order 1-.Diseases of Children. 1 2 Premature Birth 101 ... ... ... ... ... ... ... ... ... ... ... ... 101 101 3 Cyanosis 9 ... ... ... ... ... ... ... ... ... ... ... ... 9 5) 4 Spina Bifida 2 _ ... ... ... ... ... ... ... ... ... ... ... ... 2 2 5 Other Malformations 15 ... ... ... ... ... ... ... ... ... ... ... ... 15 15 Teething 37 30 4 ... ... ... ... ... ... ... ... ... ... 71 71 Order 2.—Adults 1 2 Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Childbirth (see Purperal Fever) ... ... ... ... 2 7 4 ... ... ... ... ... ... ... 13 Order 3.—Old People. 1 Old age ... ... ... ... ... ... ... ... 3 65 127 46 4 ... 245 1 Order 4.—Nutrition. Atrophy and Debility 171 15 2 2 ... 1 4 1 4 11 2 1 ... 188 214 Class 4.—Violent Deaths. Order 1,—Accident, or Negligence 1 Fractures and Contusions 1 1 3 4 5 7 6 5 1 3 3 ... ... 5 39 2 Wounds) Gunshot ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Cut,Stab ... ... "i ... ... 1 ... 1 ... ... 3 4 Burn and Scalds ... ... "4 "2 2 "i ... ... ... ... 1 ... ... 10 16 5 Poison ... 1 "i ... ... ... ... 2 6 Drowning. "2 ... ... "i "2 X 1 1 ... ... ... ... 2 8 7 Suffocation £8 3 ... 1 1 ... 1 ... 2 ... ... ... ... ... , 61 65 Otherwise ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 Order .-3Homecide 10 ... ... 1 ... 1 ... ... ... ... ... ... ! io 11 Order 4.— Suicide ... ... ... ... "i 5 6 1 4 3 "l ... ... 21 Causes not specified or ill defined ... ... ... "2 1 1 1 2 ... ... ... ... ... ... 7 29 Table IV. PARISH OF ST. PANCHAS. Table shewing the Mortality from certain classes of Diseases, and proportions to Population, and to 1,000 Deaths in 1880. Total Deaths. Deaths per 1000 of Population. Proportion of Deaths to 1000 Deaths. 1. Seven Principal Zymotic Diseases .. 811 3.4 153.4 2. Pulmonary Diseases (other than Phthisis) 993 4.2 187.8 3. Tubercular Diseases. 643 2.7 121.6 4. Wasting Diseases of Infants 312 1.3 590 5. Convulsive Diseases of' Infants 354 1.5 66.9 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 1870 to 1879, and in the Year 1880. Disease. 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 Annual Average of 10 years, 1870-79. Proportion of Death b to 1000 Deaths in 10 years, 1870-79. 1880 Proportion of Deaths to 1060 Deaths in 1880. Small Pox 21 448 58 2 3 2 22 129 94 19 79.8 15.2 18 3.7 Measles 87 105 105 221 64 82 117 143 48 129 110.1 21.0 58 11.5 Scarlet Fever 477 95 70 17 95 220 137 89 138 144 148.2 28.2 156 31.1 Diphtheria 35 37 16 38 35 55 38 22 23 25 32.4 6.1 34 6.9 Whooping Cough 99 158 259 212 121 232 198 141 217 154 179.1 341 293 58.4 Fever 158 112 78 78 67 58 84 76 67 66 84.4 16.1 48 9.7 Diarrhoea 227 236 235 253 222 178 239 155 229 118 209.2 39.9 204 46.1 Total 1104 1191 821 821 607 827 835 755 816 655 843.2 160.9 811 161.8 London: 16891 19676 12874 11549 11352 13518 12696 12380 14857 12256 13804.9 164.4 13677 168.5 Table VI. PARISH OF ST. PANCRAS. Report of the Sanitary Work, &c., completed in the year ending December 31st. 1880. No. of Complaints received during year from the Sanitary Inspectors and the Public 1411 No. of Houses, Premises, &c., inspected 8485 Results of Inspection. Orders issued for Sanitary Amendments of Houses and Premises 888 Houses and Premises, &c., Cleansed, Repaired, and Whitewashed 603 Houses Disinfected after Infectious Diseases 270 House Drains. Repaired, Cleansed, &c. 161 Trapped or Ventilated 182 Privies and Water Closets. Repaired, Cleansed, &c. 422 Supplied with Water 207 New provided 4 Dust Bins. New provided 25 Repaired, Covered, &c. 101 Water Supply. Cisterns (new) erected 9 Cisterns Cleansed, Repaired, and Covered 95 Miscellaneous. Cesspools abolished 9 Overcrowding rooms for which notices were served 13 Removal of accumulations of Dung, Stagnant Water, and other Refuse 45 Removal of Animals improperly kept 1 Licensed Slaughterhouses Regularly inspected - j 225 Licensed Cowhouses 57 Bakehouses 50 Clay Burning Smoke Nuisances 16 Other Proceedings, e.g. Legal Proceedings 27 Return for the Period—July to December, 1879. RETURN made by Mr. W. T. Jones, Vaccination Officer of tlie Sub-Districts of St. Pancras Parish, respecting the Vaccination of Children whose Births were Registered in his District, from 1st July, to 31st December, 1879. Registration Sub-Districts comprised in the Vaccination Officers' District. Number of Births returned in the Birth List Sheets as Registered from 1st July, to 31st December, 1879. Number of these Births duly entered by 31st July, 1878, in Columns 10,11, and 13 of the Vaccination Register (Birth List Sheets, viz.: Number of these Births which on the 31st July, 1878, remained unentered in the Vaccination Register on Account (as shown by Keport Book.) Number of these Births remaining on 31st July, 1878, 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. Col. 11. Col. 13. 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. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Dead Un vaccinated. 1 Kentish Town . 1491 1267 1 ... 103 25 1 82 12 2 Regent's Park 629 516 1 ... 41 21 3 38 9 3 Camden Town 406 354 ... ... 30 6 1 13 2 4 Somers Town. 619 5C9 ... ... 64 8 1 33 4 5 Tottenham Court Road . 402 281 1 ... 50 8 6 38 15 6 Gray's Inn Road . 505 367 ... ... 56 11 5 33 13 Total 4052 3317 3 ... 344 79 17 237 *55 * These Cases have been entered in the Report Book, and the Certificates promised. Return for the Period—January to June, 1880. 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 30tli. 1880, inclusive. Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the Birth List Sheets as registered from 1st January to 30th June, 1880. Number of these Births duly entered by 31st January, 1878, in Columns 10, 11 and 13 of the Vaccination Register (Birth List Sheets) viz: Numbor of these Births which on 31st January, 1878, remained unentered in the Vaccination Register on account (as shown by Report Book) of Number of these Births remaining on 31sfJanuary, 1879, neither duly entered in the Vaccination Register " (Columns 3, 4, 5 & 6 of this Return, nor temporarily accounted for in the Report Book," (Columns 8, 9 & 10 of this Return). Col. 10. Column 11. Col. 13. 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; and Cases not having been found. SuccessfullyVaccinated. Insusceptible of Vaccination. Had Small Pox. Dead Unvaccinated. 1 Kentish Town 1595 1292 2 ... 122 29 3 95 52 2 Regent's Park 598 480 2 ... 46 9 5 44 12 3 Camden Town 395 353 1 ... 18 2 ... 19 2 4 Somers Town 633 514 1 ... 47 6 1 48 16 5 Tottenham Court Read 413 328 1 ... 29 3 1 43 8 6 Gray's Inn Road 504 389 ... ... 46 3 8 S3 5 Total 4138 3356 7 ... 308 52 18 302 * 95 # These cases have been duly entered in the Report Book, and the certificates produced.