STPAN38 TWENTY-SIXTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the Sanitary Condition of Saint Pancras MIDDLESEX. REPORT FOR THE YEAR 1881, by SHIRLEY FORSTER MURPHY, HON. SECRETARY TO THE EPIDEMIOLOGICAL SOCIETY. HON. SECRETARY TO THE SOCIETY OF MEDICAL OFFICERS OF HEALTH. MEDICAL OFFICER OF HEALTH TO THE PARISH OF ST. PANCRAS. St. Pancras, Middlesex. TWENTY-SIXTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, Being the Report for the Year. 1881. TO THE VESTRY OF ST. PANCRAS. Gentlemen, When the Census was taken on April 1st, 1881, the enumerated population of St. Pancras was found to be 236,209. There has been, therefore, an annual increase of only .66 per cent. upon the enumerated population of the previous Census of 1871, whereas the annual average increase during the previous decade was 1.1 per cent.; St. Pancras, therefore, has during the last ten years increased at about half the rate of the preceding ten years. The rate of increase has of course varied in the different districts, thus, in the Kentish Town district in which, since the last Census, 19,289 persons have been added to the population, the increase has been at the rate of 2.71 per cent. each year, while in the Gray's Inn Road and Regent's Park districts, the increase has been only .84 and .28 per cent. respectively, representing an increase of 1026 in the former, and 915 in the latter. The other districts show a decrease; Somers Town has lost as many as 4164 of its population, chiefly owing to the demolition of houses situated in the area acquired by the Midland Railway Company. If this loss of population had been distributed evenly over the ten years, it would have represented an annual decrease of 1.08 per cent. of the population. In Tottenham Court Road and Camden Town the population has been reduced by 1611, and 632 persons respectively, being equal to .55 per cent. each year in the former and .29 in the latter. The increase in the number of inhabited houses has not kept pace with the increase of the population ; thus, in 1871, there was an average of 9.l persons to each inhabited house ; in 1881 this average has increased to 9.5. In the different sub-districts there is considerable variation in the proportion of population to houses. In the Tottenham Court Road district there were, in 1881,11.4 persons to each inhabited house ; in Somers Town, 10.7 ; in Camden Town, 10.3 ; in Gray's Inn Road, 10.2; in Regent's Park, 8.9; and in Kentish Town, 5.7. 4 For the accompanying Census tables of 1881, from which these figures are extracted, I am indebted to Mr. Davis, Superintendent Registrar of the District of St. Pancras. Table I. PARISH OF ST. PANCRAS. Table showing the Population, Inhabited Houses, Births and Deaths for the year 1881 and 8 Years preceding. Gross Numbers. Population estimated, at the middle of the Year * No. of Inhabited Houses. (Estimated) Births. Deaths. ** 1881 236,600 24,655 7,943 5.211 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 8 Years ) 1873-1880 j 25,265.6 8,132.6 5,158.0 Notes. 1. Population at Census 1881, 236,209. 2. Area in acres, 2,672. 3. Average No. of Persons in each house at Census 1881, 9.5. • 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 institution 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. Table II. CENSUS, 1881, POPULATION OF SUB-REGISTRATION DISTRICTS. Sub-Districts. Number of Schedules. Houses. Papulation. Increase on 1871. Decrease on 1871. Inhabited. Uninhabited. Building. Males. Females. Total. 1. Regent's Park 9,992 4,373 180 3 18,262 20,841 39,103 903 2. Tottenham Court Road 7,073 2,418 351 22 13,091 14,637 27,728 ... 1,642 3. Gray's Inn Road 8,105 2,947 125 6 14,197 15,732 30,229 1,008 4. Somers Town 8,905 3,198 134 1 16,541 17,814 34,355 ... 4,178 5. Camden Town -1,136 1,689 37 1 8,406 8,999 17,405 ... 538 6. Kentish Town 19,895 10,030 399 85 41,641 45,747 87,388 19,190 Totals 58,106 24,655 1,226 118 112,438 123,770 236,208 21,101 6,358 Net Increase 14,743 Table III. census, 1881.-population of wards. Sub-Districts. 1. 2. 3. 4. 5. 6. 7. 8. Inhabited Houses. Population. Inhabited Houses. Population. Inhabited Houses. Population. Inhabited Houses. Population. Inhabited Houses. Population. Inhabited Houses. Population. Inhabited Houses. Population. Inhabited Houses. Population. 1. Regent's Park ... ... 474 3,986 ... ... 2,571 20,094 1,328 15,023 2. Tottenham Court Road ... ... ... ... ... ... ... ... ... ... ... ... 2,037 23,625 381 4,103 3. Gray's Inn Road ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2,947 30,229 4. Somers Town ... ... ... ... ... ... ... ... 969 10,251 2,229 24,104 5. Camden Town ... ... 134 1,109 1,472 12,924 ... ... ... ... 83 3,372 6. Kentish Town 5,596 52,282 1,595 14,097 2,839 21,009 Totals 5,596 52,282 2,203 19,192 4,311 33,933 2,571 20,094 2,297 25,274 2,312 27,476 2,037 33,625 3,328 34,332 7 Table IV. CENSUS, 1881. ST. PANCRAS, MIDDLESEX. Inhabited Houses and Population of the Ecclesiastical Districts Name of District. Inhabited Houses. Population. J. St. Pancras 1,520 16,409 2. St. Andrew, Haverstock Hill 1,350 15,103 3. Holy Trinity, Haverstock Hill 1,563 13,900 4. St. John, Fitzroy Square 1,072 13,365 5. St. James, Hampstead Road 998 11,060 6. Christ Church, Albany Street 1,145 11,017 7. St. Martin, Kentish Town 973 10,565 a. St. Stephen, Camden Town 1,158 10,524 9. St. Mark, Regent's Park 1,298 10,376 10. St. Mary, Seymour Street 816 9,826 11. Old St. Pancras 654 7,985 12. St. Peter, Regent Square 746 7,924 13. St. Matthew, Oakley Square 974 7,518 14. St. John the Baptist, Kentish Town 946 7,299 IS. St. Jude, Gray's Inn Road 725 6,373 16. St. Luke, Kentish Town 957 6,229 17. St. Thomas, Camden Town 744 5,960 18. St. Saviour, Fitzroy Square 424 5,844 19. St. Bartholomew, Gray's Inn Road 611 5,790 20. St. Silas, Kentish Town 538 5,555 21. Holy Cross 499 5,545 22. St. Paul, Camden New Town 766 5,513 23. St. Michael, Camden Town 688 5,439 24. All Saints, Gordon Square 551 5,363 25. Christ Church, Somers Town 430 5.150 26. St. Mary Magdalene, Munster Square 448 4,652 27. St. Barnabas, Kentish Town 604 4,479 28. St. Benet and All Saints, Kentish Town 530 4,059 29. St. Mary, Brookfield 430 3,385 30. St. Anno, Highgate Rise 274 2,747 31. St. Michael and All Angels, Highgate 168 1,254 Total 24,655 236,208 The mean temperature of the year 1881 was 48.78, being .78 less than the previous year or the average of the last 40 years. The rainfall during the year was 25.24 inches, being 2.3 inches less than the previous year, and 0.2 less than the average of the preceding 40 years. The first quarter of the year was colder by 2.68 than the average and had a mean temperature of 37.38, while the rainfall was 5.43 inches, and was .42 above the average. On the 18th of January a fall of snow of unusual severity took place. 8 During the second quarter the mean temperature was 52.98 being .68 above the average, and the rainfall was 4.10 inches, or 1-64 below the average. The third quarter had a mean temperature of 608 being .38 above the average, and a rainfall of 8.19 inches, or .75 above the average. The fourth quarter had a mean temperature of 44.68, which was .18 above the average, and a rainfall of 7.52, which was .38 above the average. The Registrar General's year to which this Report relates begins on January 2nd, and ends on December 31st, 1881, and therefore consists of 52 weeks. During this period 7943 births were registered in St. Pancras, being at. the rate of 83.6 per 1000 of population. This is the lowest birth-rate since 1866 when it was 33.4 per 1000. The birth-rate in the whole of London was, in 1881, lower than it has been since 1871, and notwithstanding this dimininution it is still 1.1 per 1000 of population higher than that of St. Pancras. There were 5211 deaths registered in St. Pancras, giving a death-rate of 22.05. If the deaths of non-parishioners in public institutions in St. Pancras be deducted, and the deaths of St. Pancras parishioners occurring in public institutions in other parts of the metropolis be included, the corrected number of deaths would be 5000, giving a death-rate of 21.16. The rate of mortality for the whole of London in 1881 was 21.2 per 1000 living. It will be seen that the number of persons who are not St. Pancras parishioners, who died in public institutions in our district, makes the St. Pancras death-rate somewhat in excess of that of the whole of the metropolis, but when the number of deaths comes to be corrected the St. Pancras death-rate is practically the same as that of London. The deaths of as many as 1236 children, under one year of age, were registered in St. Pancras in 1881. The corrected number of deaths of St. Pancras parishioners of this age was 1234 ; these numbers are 24.6 per cent. of the corrected total deaths, and are in the proportion of 15.5 to each 100 registered births during the same period; 24.6 per cent. is 1.0 less than in the preceding year, and is .4 less than the proportion of deaths under one year of age to total deaths in the metropolis. The average proportion of deaths under one year to total deaths in the preceding seven years is in St. Pancras 24.4, and in London 25.08 per cent. 9 Table V. 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 1881 and 10 and 7 Years preceding. Birth Rate per 1000 of 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 Number of Deaths in Public Institutions 1881 33.6 22.05 24.6 15.5 41.1 1,254 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 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 1,031 1873 35.1 22.32 1872 35.1 21.l28 1871 33.8 25.19 Average of 10 years 1871 to 1880. 34.6 22.09 Average of 7 years, 1874 to 1880. 24.4. 15.4. 41.0. 1,147.7. During 1881, 2055 St. Pancras parishioners, under five years of age died, being 41-1 percent, of the total deaths. This is 2-1 below the proportion of 1880, and nearly the same as the average of the preceding seven years. In the whole of London the proportion of ileaths under five years to total deaths in 1881 is 41-1, or the same as that of St. Pancras, while during the preceding seven years the average was 42-3 per cent., or 1-3 above the average of St. Pancras during the same period. Between the ages of five and sixty-five, 2161, and above sixty-five years, 784 St. Pancras parishioners died during 1881. 1254 deaths took place in public institutions situated in the Parish, being about the same number as in 1880, and 1047 St. Pancras parit-hioners died in public institutions Bituated in St. Pancras and in other parts of the metropolis. 10 DEATHS FROM VARIOUS DISEASES. Pulmonary Diseases. In the deaths from Pulmonary Diseases, other than Phthisis, there has been a slight decrease during the year 1881. During the previous seven years the average number of deaths from these diseases has been in the proportion of 226.5 in every 1000 deaths from all causes, or 4.6 in every 1000 of population living, whereas in 1881 the proportion has been 183.4 in every 1000 deaths, or 3.8 in every 1000 persons living. In London the proportion has been 4.1 in every 1000 living. .Table VI. PARISH OF ST. PANCRAS. Table shewing the Mortality from certain classes of Diseases, and proportions to Population, and to 1,000 Deaths in 1881. Total Deaths. Deaths per 1000 of Population. Proportion of Deaths to 1000 Deaths. 1. Seven Principal Zymotic Diseases 914 3.8 102.4 2. Pulmonary Diseases (other than Phthisis) 919 3.8 183.4 3. Tubercular Diseases. 607 25 121.2 4. Wasting Diseases of Infants 323 1.3 64.3 5. Convulsive Diseases of Infants 312 1.3 62.2 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. 11 The following table shows the number of deaths from Pulmonary Diseases other than Phthisis occurring in each district, exclusive of 152 who died in public institutions, and also shows the proportion per 1000 of population in each district:— Districts. Total Deaths. Proportion per 1000 of Population. Regent's Park 96 2.4 Tottenham Court Road 83 2.9 Gray's Inn Road 98 3.2 Somers Town 133 3.8 Camden Town 71 4.1 Kentish Town 286 3.2 Tubercular Diseases. The number of deaths from Tubercular Diseases agrees closely with that of last year. During the preceding seven years there has been an average number of 131.5 deaths from these diseases in every 1000 deaths from all causes, or 2.7 in every 1000 persons living. In 1881 the proportion of deaths from these diseases has been 121.2 in every 1000 deaths from all causes, or 2.5 in every 1000 of population living. In London the proportion has been 2-5 in every 1000 living. The following table shows the number of deaths from these diseases in the different sub-districts, exclusive of 166 who died in public institutions in the parish and in other parts of the Metropolis :— Districts. Total Deaths. Proportion per 1000 of Population. Regent's Park 72 1.8 Tottenham Court Road 53 1.9 Gray's Inn Road 72 2.3 Somers Town 70 2.0 Camden Town 31 1.7 Kentish Town 143 1.6 12 Wasting and Convulsive Diseases in Infants. It has been already shown that the proportion which deaths amongst infants under one year of age bear to total deaths is in 1881 slightly greater than the average proportion of the previous seven years. But the deaths from the Wasting Diseases of Infants show a diminution. During 1881 these diseases have constituted 64.8 in every 1000 deaths, or 1.8 per 1000 of population. During the past seven years on an average 69.4 deaths from these diseases in every 1000 deaths from all causes have been registered, or 1.4 deaths among every 1000 persons living. The deaths from Convulsive Diseases of Infants of the same age have also decreased, constituting in 1881, 62.2 in every 1000 deaths from all causes, whereas the average during the preceding seven years was 74.7, or calculated in proportion in every 1000 of population it was 1.3 in 1881, and 1.5 during the preceding seven years. Zymotic Diseases. The diseases of the Zymotic class caused a larger proportion of deaths during 1881 than in any previous year since 1871. Thus the seven principal Zymotic diseases caused 182.4 in every 1000 deaths from all causes, or 8.8 in every 1000 of population, as compared with an average of 156.1 in every 1000 deaths from all causes in the preceding ten years, and an average of 8.4 in every 1000 of population in the preceding seven years. This is somewhat in excess of the proportion which deaths from these diseases bear to total deaths in the whole of London ; in 1881 this proportion was 170 3 to every 1000 deaths, or 3.5 in every 1000 of population. Table VII. PARISH OF ST. PANCRAS. Table shewing the Number of Deaths from the seven principal Zymotic Diseases, in the 10 Years 1871 to 1880, and in the Year 1881. Disease. 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 Annual Average of 10 years, 1871-80. Proportion of Deaths to 1000 Deaths in 10 years, 1871-80. 1881 Proportion of Deaths to l060 Deaths in 1881. Small Pox 448 58 2 3 2 22 129 94 19 18 79.5 15.5 84 16.4 Measles 105 105 221 64 82 117 143 48 129 58 107.2 21.0 172 34.2 Scarlet Fever 95 70 17 95 220 137 89 138 144 156 116.1 22.6 180 36.0 Diphtheria 37 16 38 35 55 38 22 23 25 34 32.3 6.3 70 14.0 Whooping Cough 158 259 212 121 232 198 141 217 154 293 198.5 38.8 122 24.2 Typhus Fever 20 14 9 10 8 5 20 4 4 1 9.5 1.8 1 0.2 Enteric Fever 60 52 58 38 35 60 58 59 57 43 52.0 10.1 66 13.2 Simple Continued Fever 23 16 14 25 16 7 10 4 5 4 12.4 2.4 8 1.6 Diarrhœa 236 235 253 222 178 239 155 229 118 204 206.9 40.1 211 42.1 Total 1,181 825 824 613 828 823 767 816 655 811 814.4 158.6 914 181.9 London 19,676 12,874 11,549 11,352 13,518 12,696 12,380 14,857 12,256 13,677 13,483.5 166.3 13,811 170.3 14 The accompanying table shows the distribution of deaths from these diseases amongst the sub-districts, exclusive of 167 which occurred in public institutions :— Districts. Total Deaths. Proportion per 1000 of Population. Regent's Park 117 2.9 Tottenham Court Road 84 3.0 Gray's Inn Road 97 3.2 Somers Town 125 3.6 Camden Town 43 2.4 Kentish Town 281 3.2 Hospital Provision for Infectious Disease. In my last report I gave some account of the present arrangements in the Metropolis for the isolation of cases of infectious disease. It will be within the memory of the Vestry that they had not thought it well to take advantage of that section of the Poor Law Amendment Act of 1879, which gives power to the Metropolitan Sanitary Authorities to contract with the Metropolitan Asylums Board, for the admission into the hospitals of that Board of cases of infectious disease occurring among all classes of the community. The Vestry had felt that they could not make such an arrangement until the Metropolitan Asylums Board ceased to be of poor-law constitution. For not only would patients sent to these hospitals have been made paupers, and thus deprived of certain of the rights of citizens, but it was obvious that hospitals which are intended for the reception of persons of all classes must not, if they are to be freely used, be under the control of an authority whose chief function is to provide for the destitute. The Vestry are to be congratulated that they took this course, for the experience of the year 1881 proved clearly enough that the Vestry acted wisely in the conclusion to which they had come not to rely upon the hospitals of the Metropolitan Asylums Board. Legal proceedings on behaif of the inhabitants of the districts surrounding the small pox hospitals of the Board led to the closure of one of these institutions, and to the limitation of the use of others of them to persons living immediately in their vicinity ; and thus the Vestry would have been deprived, by circumstances over which they had no control, of accommodation which would have been absolutely necessary during the small pox epidemic of that year. The coarse which the Vestry adopted to meet the exigencies of the epidemic of 1881 is not only creditable in the highest 15 degree to the Vestry themselves, but is important in indicating the intention of a large Metropolitan Sanitary Authority to protect its parishioners by every means in its power against an epidemic of a loathsome disease. At a time when the hospitals to which we refer were closed, and the duty of providing for all classes, be they paupers or persons of higher social grade, was thrown upon the Vestry, the Small Pox Hospital at Highgate, into which the Vestry had been in the habit of sending persons suffering from small pox, whom it was necessary to remove for the sake of the public health, was filled by sick persons from other parts of the Metropolis. The Vestry were therefore left with the alternative cf leaving the sick in their own homes, or of providing other accommodation for their reception. Unfortunately no laud which was available as a site for a hospital in our parish could be used for the special disease for which the Vestry had to provide. Very considerable pains were taken to seek for an appropriate site, but without avail, and until the thoughtfulness of the Vestry Clerk suggested that a temporary site might be obtained from the Burial Board, there was every reason to believe that this means of checking the spread of small pox among our parishioners would have to be abandoned. The site which was selected at Finehley was chosen on account of its far removal from any dwelling—the nearest house being not nearer than 1700 feet from the hospital, while the distance of the institution from the nearest road, which was but little frequented, was fully 300 feet. The hospital which was there erected, and which was opened on April 29th, for the reception of persons suffering from small pox, consisted of a central kitchen, made of brick and iron, a wooden shed for laundry purposes, and canvas tents for patients and the resident staff. Each ward tent had a floor of wood raised above the level of the earth, and was heated by a hot water pipe supplied by a small furnace placed outside the tent. The walls and roof consisted of two layers of canvas separated a few inches from each other. The dimensions of each tent for patients were 30 feet long, by 16 feet wide, and 7 feet high at the sides, and contained 3800 cubic feet of space. In each of these were placed eight patients. Duriug the months when these tents were occupied the temperature of the atmosphere ranged from twenty-seven degrees to seventy-five degrees. Each tent was provided with means of ventilation in the roof, and it was found that with reasonable care during the cold weather the internal temperature of the tents could be 16 maintained at a sufficient height without the air becoming unpleasant through the number of patients placed within them ; of course, during warmer weather, when it was not necessary to keep the doors of the tents closed for the purpose of maintaining the temperature, there was no room for anxiety on the score of want of ventilation. Each tent was carefully trenched, and care taken to prevent the entrance of wet during storms, and by paying attention to keeping the two layers of canvas apart from each other, it was found not difficult even during very heavy rains to keep the iuterior thoroughly dry. The disposal of the excreta caused no difficulty, as they were readily dealt with by means of Moule's earth closets and the dry earth system, but the enormous amount of slop water from the laundry and patients' baths gave rise to much anxiety, for it will be recollected that the fall of the land naturally caused the drainage to gravitate towards a brook at the bottom of the field in which the hospital was situated, and that this brook passed through a public institution in the vicinity, the managers of which had threatened to apply for an injunction should any of the slop water enter the brook. This difficulty was overcome by emptying the water in the first instance into Field's flushing tanks, from which drain pipes carried it away to a part of the ground where they ended in a number of other radiating pipes around the terminal ends of which the ground was freely broken up. Even with these precautions it became necessary to dig deep trenches to receive any overflow that would otherwise have taken place into the brook owing to the non-absorbent nature of the ground, but these proved sufficient to overcome the difficulty, and there was no interruption to the usefulness of the institution. The greatest care had to be taken in the management of the institution, to prevent it being a source of danger to the district in which it was placed; the attendants were provided with a special dress which could not therefore be taken out of the hospital; the patients were removed in the Vestry's ambulance, and the friends who accompanied them were brought back in it to their homes, and it was not permitted to stop anywhere on either journey to or from the hospital; visiting to patients was restricted to those who were seriously ill, and the visitors were taken to and from the hospital in the Vestry's conveyance. It is satisfactory to be able to report that there is not the least evidence that the hospital gave rise to a 17 single case of small pox in Finehley. The staff, who were all re-vaccinated before entering on their duties, escaped without exception, while a number of workpeople, who were engaged in erecting the kitchen in close proximity to the touts, after the latter were occupied by patients, also escaped ; a result doubtless due to the fact that the opportunity for re-vaccination was freely offered to and accepted by them. I have every reason to be satisfied with the results obtained by treating cases of small pox under canvas during the months the hospital was occupied. As many as 134 patients were treated in it with a mortality of but nine ; many of the cases were very severe, and it is worthy of especial notice that not a single case of erysipelas occurred while pulmonary complications were infrequent. The hospital has been of very material use to the parish, and is ready at any moment it may be required. It would be a matter for regret if any step were taken to remove it until there is a thorough solution of the difficulties which now surround the whole question of hospital accommodation for infectious diseases in the metropolis, or until the ground is required for its original purpose as a cemetery. The institution has already cost the parish a large sum of money, for though the hospital itself and its furniture were of the simplest and most inexpensive character, much money was necessarily expended in the preparation of the site, and in the layiug on of a water supply from the distance. Seeing that the hospital is absolutely doing no injury to the surrounding neighbourhood, that the land is not yet required for burial purposes, and that the cost of its maintenance in its present condition is but trifling, it would be a misfortue if any step were taken which might in the future impose upon the Vestry the necessity of incurring a further expenditure should another outbreak of disease take place. How soon the Vestry will be relieved of the difficult position in which it is now placed as a hospital providing authority, it is not possible at the present moment to state. It will be recollected that at the end of last year a Koyal Commission was appointed to collect evidence, and to report upon the following points :— 1. The nature, extent, and sufficiency of the hospital accommodation for small pox and fever patients provided by the Managers of the Metropolitan Asylum Board, and the several Vestries and District Boards in the Metropolis, including the Commissioners of Sewers for the City of London. 2. The relative advantages and disadvantages to patients 18 and the public of providing for small pox and fever cases, whether amongst persons of the pauper class, or persons of the non-pauper class without proper means of isolation, or both, by a limited number of hospitals for the whole Metropolis under one authority, such as the Managers of the Metropolitan Asylum District, or by parochial and district hospitals, under Vestries and District Boards. 8. The expediency of continuing the several existing small pox and fever hospitals now under the Managers of the Metropolitan Asylum District; or, if it be considered desirable that any should be closed, the accommodation for small pox and fever cases which should be substituted. 4. The expediency of the Managers of the Metropolitan Asylum District establishing additional hospitals and of making special provision for convalescent cases. 5. The conditions and limitations under which the hospitals provided by the Managers should be continued, and the general conditions aud limitations which should be observed in the case of the establishment of new hospitals, whether by the Managers or any other authority, so as to insure as far as practicable, the recovery of the patients and the protection of the public against contagion. 6. The operation of the Acts relating to the establishment of hospitals for small pox and fever patients in the Metropolis, and the provisions, if any required for the acquisition of sites for such hospitals, whether by agreement or otherwise ; and for the protection of the authorities providing small pox aud fever hospitals, subject to the same being conducted with reasonable care, and according to prescribed regulations, from liability to legal proceedings, so as to secure the public against the loss of the benefits arising from such institutions ; and to make such suggestions as the Commission may deem expedient in connection with all or any of the matters aforesaid. The Commission have since that time examined a number of witneeses, aud their report may be shortly expected. Ambulance Provision for Infectious Diseases. An important step taken by the Vestry during 1881 in the performance of its duties in relation to infectious disease was the purchase of an ambulance for the removal of infectious cases to hospital. The arrangement which had existed for this purpose up to that time was unsatisfactory, and delay sometimes resulted. The ambulance was first used on May 17th, and since that date to the end of the year removed as many as 223 cases to hospital, thus giving complete evidence of the necessity of such a conveyance. 19 Notification of Infectious Diseases. In my last report I referred to the question of the compulsory notification of infectious diseases ; during the year public attention has been much directed towards this matter, and public opinion has undoubtedly grown in favour of such a coarse. It is from time to time necessary for the purpose of discovering the cause of an outbreak of disease to obtain information on certain points with regard to every case of the disease in a district; where, however, the intention of -obtaining knowledge of the existence of cases is limited to ensuring the proper isolation of infectious persons, it may be assumed that the action of the Sanitary Authority will be chiefly needed where the sick person is dwelling in a house occupied by many persons, or which is let out in lodgings. Under these circumstances if the extension of disease is to be limited, I believe it to be a matter of the greatest importance that early notice of the existence of the case should be given to the Sanitary Authority, seeing the difficulties which so frequently stand in the way of the proper isolation of infectious persons in these houses. Now the Yestry under Section 47 of the Sanitary Laws Amendment Act of 1874 already possess powers to compel the notification to the Sanitary Authority of all cases of dangerous infectious disease occurring in houses let in lodgings. The provisions of this clause cannot be put in force without making other regulations under the 35th Section of the Sanitary Act, 1866, concerning the condition of these houses. There is, of course, less necessity for the Yestry to make these regulations apply equally in our district to some houses let in lodgings as to others, but it would be well if they were in force for the poorest class of house which is let out in unfurfurnished tenements, and is occupicd by many families. I do not think the Vestry could do better than begin by exercising the powers they already possess, aud compel notice of cases of infectious disease occurring under these conditions to be given to the Sanitary Authority. If, in the future as seems probable, an Act were to come into existence making the notification of cases in houses of all classes compulsory, the Yestry would be far better able to undertake its new duties, and would know how it could best apply its increased powers, to the advantage of the community. It is in the poorest and most crowded houses that the first cases of an outbreak of infectious disease often occur, and therefore by a knowlege of those cases the amount of prevalence of this class of disease in the whole district would be much under control. 20 Small Pox. In my last report I referred to the increasing prevalence of small pox in the eastern districts of London ; at this time the disease could hardly be said to have invaded St. Paucras, as but three cases of small pox became known to the Sanitary Department during December, 1880, but in the following month of January, 1881, this number was increased to' sixteen, two of the infeeted persons dying in their own homes in the parish. In February, 1881, 23 cases were reported, and on the 16th of that month, I pointed out to the Vestry that the Small Pox Hospital at Highgate was the only institution in the Metropolis to which the Vestry could send cases of small pox occurring among persons who were not paupers, that the few beds in this hospital were not solely at the disposal of the Vestry, but were used by persons coming from all parts of the Metropolis, and that, although the Vestry had formerly been able to rely upon the Metropolitan Asylums Board for providing hospital accommodation for the very poor, this Board's action was so crippled by past and threateued legal proceedings that it would not be safe to assume that they would be able to receive into their hospitals as many patients as in the previous epidemic; and I therefore recommended the Vestry upon whom under these circumstances might fall the necessity of providing for all classes of the community, that inasmuch as arrangements for hospital accommodation for infectious diseases cannot be made in a few days, they should take measures for facilitating the provision of such accommodation as might be found to be necessary. At the same time letters were read to the Committee from the Metropolitan Asylums Board, pointing out the position in which that Board was placed, and from the Local Government Board urging the Vestry to make the provision necessary for the epidemic. The course of the epidemic can be seen by Table VIII. During March the number of cases further increased to 47 ; in April 101 fresh cases, occurring in all parts of the district, were reported; during this month the Small Pox Hospital at Highgate, as well as the Metropolitan Asylum Board Hospitals were unable to receive any cases, and for a short period cases of small pox were compelled for want of accommodation to remain in their own homes. However, on April 29th, the Vestry's hospital at Finchley was opened, and received nine cases the same day. In the month of May 106 new cases were reported, after which date the epidemic declined, and in 23 September but 17 fresh cases were heard of, while during the last three months of the year the number of cases reported was 23, 28, and 26 respectively. Of the 547 cases reported to the Sanitary Department during the year, 376 were removed to hospital. That the removal of these cases from their own homes was the means of limiting the further extension of the epidemic there cannot be the least doubt. As evidence of what might have happened in many houses if the infectious sick had not been early removed, may be cited the case of a house in Whitfield Street, in which a person suffering from small pox was compelled to remain during the short period when there was no hospital accommodation for our parishioners ; in this house eight other persons were subsequently attacked, one of whom died. There were 84 deaths from small pox during 1881, 58 of those who died were removed to hospital before their death, leaving 26, who died in their own homes. The 84 deaths were 16.7 per 1000 of the total deaths in St. Pancras. In the whole of London the deaths from this disease were 29.2 per 1000 of the total deaths, or 12.5 above those in our parish. St. Pancras has not suffered in proportion to population as heavily as the Metropolis ; thus, in London, as a whole, there were 618 deaths per million of population, in the northern districts 536 deaths per million, and in St. Pancras 355 deaths per million. When we recollect the thickly populated districts which are situated in St. Pancras, where there is so much opportunity for infectious diseases to spread, we can have very little doubt that much of the immunity enjoyed by the parish during the epidemic of 1881 is due to the action of the Vestry, in providing ample accommodation for the isolation of persons suffering from this disease. And St. Pancras suffered at the same rate as the rest of the Metropolis, instead of having to chronicle 84 deaths from small pox, we should have lost 145 parishioners, nor would the loss of life have been the only misfortune which would have resulted, for each death we may assume fully five persons would have passed through a loathsome disease, would have been deprived of the opportunity of continuing their occupations, and some, besides bringing their families into poverty, would have perhaps been permanently disabled by the loss of eyesight, which is one of the accompaniments of this terrible disease. 24 I have arranged the accompanying Table with a view to showing the number of deaths from small pox in the different sub-districts, and their proportion to population, and it will be seen that the district of Kentish Town had a larger number of deaths from small pox in proportion to population than either Somers Town or Tottenham Court Road, and these again than the remaining sub-districts. Total Deaths. 0,000 of Population. Regent's Park 10 2.5 Tottenham Court Road 9 8.2 Gray's Inn Road 7 2.8 Somers Town 14 4.0 Camden Town 5 2.8 Kentish Town 38 4.8 It is not my intention to enter into a discussion of the question whether a Small Pox Hospital is a source of danger to the neighbourhood in which it is placed. The Royal Commission on Hospital Provision for Infectious Diseases will shortly present a Report on this subject; but I would point out that Table VIII., which shows the number of cases of small pox reported to the Sanitary Department, must not be altogether trusted as giving accurate evidence of the distribution of cases of this disease. It shows that the Kentish Town Sub-District, on the borders of which the Highgate Small Pox Hospital is situated had less small pox than two other Sub-Districts. The death register, which is more reliable, places Kentish Town first, on the list in this respect. But it would not do to assume that the Hospital is responsible in any degree for this prevalence without further evidence. Vaccination. I am indebted to the Vaccination Officers for the accompanying tables (ix. & x.) for the twelve months ending June, 1881, which show the number of children born, the number of those who are vaccinated, and the number of cases included under the headings— "Removed 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 amounts to 6.1 per cent. of the total births, this is an improvement on the previous year when the number was 7.1 per cent. TABLE VIII. CASES OF SMALL-POX REPORTED TO THE SANITARY DEPARTMENT DURING 1881. Week Janunary 8 ,, 15 ,, 22 „ 29 February 5 „ 12 „ 19 „ 26 March 5 „ 12 ,, 19 „ 26 April 2 ,,9 „ 16 ,,23 ,, 30 May 7 ,, 14 ,,21 „ 28 June 4 „ 11 „ 18 „ 25 July 2 9 „ 16 „ 23 ,, 30 August 6 „ 13 ,, 20 „ 27 September 3 „ 10 „ 17 „ 24 October 1 8 „ 15 „ 22 „ 29 November 5 ,,12 ,, 19 ,, 26 December 3 „ 10 „ 17 „ 21 „ 31 Total. Per 1000 Population. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 31 35 36 37 33 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Gray's Inn Road ... ... ... 1 ... 2 ... 1 3 1 ... ... 1 ... 2 4 2 2 4 6 3 1 3 3 2 1 1 1 1 ... ... 1 ... ... 1 ... ... ... ... 1 ... 1 ... 1 ... ... 1 ... ... ... ... 1 51 1.6 Tottenham Court Road 1 1 1 ... ... 2 ... ... ... ... ... 1 ... 3 2 2 3 1 7 4 6 1 4 4 1 3 ... 6 2 ... ... ... ... 1 1 ... ... 1 2 3 ... 2 3 2 5 1 1 1 ... 2 ... ... 80 2.8 Regent's Park ... ... 1 ... 1 1 3 1 ... 1 ... ... 2 3 ... 2 ... ... 2 1 1 2 ... 1 1 1 8 11 3 3 2 ... ... ... ... 1 ... 2 1 1 ... ... 1 2 1 1 ... ... 7 ... ... 4 71 1.8 Somers Town ... ... 2 ... ... 1 ... ... 4 3 1 ... 4 ... 6 2 8 5 7 4 3 1 5 3 3 7 2 3 3 4 ... 8 3 2 ... ... 1 ... ... ... 3 ... 1 ... 1 ... ... ... 1 1 1 103 2.9 Camden Town ... ... 1 ... ... ... 1 ... ... 1 ... 1 1 1 ... 2 1 2 ... 1 1 1 ... 1 1 1 ... 1 ... 2 ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... 1 ... 25 1.4 Kentish Town 2 1 3 1 2 2 ... 2 4 3 4 7 25 9 12 5 13 12 11 10 5 6 8 7 5 2 4 7 ... ... 6 2 4 2 2 2 1 2 2 ... 1 1 3 3 1 3 4 1 3 1 1 ... 217 2.4 Total 3 2 8 2 3 8 4 4 11 9 5 9 33 16 22 17 27 22 31 26 19 12 19 19 10 11 20 23 9 8 12 4 12 6 6 3 1 6 5 7 1 7 7 9 7 6 6 2 11 4 3 6 547 2.2 Table IX. Return for the Period—July to December, 1880. RETURN made by Messrs. Richards and Webb, Vaccination Officers of the Six Districts of St. Pancras Parish, respecting the Vaccination of Children whose Births were Registered in their Districts, from 1st July, to 31st December, 1880, inclusive. 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, 1880. Number of these Births duly entered by 31st July, 1881, in Columns 10,11, and 13 of the Vaccination Register (Birth List Sheets, viz.: Number of these Births which on the 31st July, 1881, remained unentered in the Vaccination Register on Account (as shown by Report Book.) Number of these Births remaining on 31st July, 1881, 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. II. 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 Unvaccinated. 1 Kentish Town 1469 1255 1 1 98 17 10 83 4 2 Regent's Park 619 518 3 ... 51 2 1 41 3 3 Camden Town 403 361 ... ... 23 ... 2 16 1 4 Somers Town. 599 484 ... ... 70 3 ... 37 5 5 Tottenham Court Road . 421 319 1 ... 48 2 ... 43 8 6 Gray's Inn Road . . 461 353 2 ... 51 5 2 45 3 Total 3972 3290 7 1 341 29 15 265 24 Table X. Return for the Period—January to June, 1881. Return made by Messrs. Richards and Webb, Vaccination Officers of the Six Sub-Districts of St. Pancras Parish, respecting the Vaccination of Children whose Births were Registered in their Districts from 1st January, to June 30th, 1881, 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, 1881. Number of these Births duly entered by 31st January, 1882, in Columns 10, 11 and 13 of the Vaccination Register (Birth List Sheets) viz.: Number of these Births which on 31st January, 1882, remained unentered in the Vaccination Register on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1882, 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. Succesfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Dead Unvaccinated. 1 Kentish Town 1490 1297 7 ... 101 18 20 45 2 prosecuted 2 Regent's Park 584 477 3 ... 45 7 4 48 3 Camden Town 398 351 ... 25 6 1 15 4 Somers Town 585 500 1 ... 38 2 3 40 1 5 Tottenham Court Read 394 326 2 ... 27 3 1 30 5 6 Gray's Inn Road 526 410 1 ... 57 8 4 44 2 Total 3977 3361 14 ... 293 44 33 222 10 27 The following table, showing the condition of Vaccination of those persons suffering from small pox, who were admitted into the Vestry's hospital at Finchley, will be of interest. Discrete. Semi-Confluent. Confluent. Haemorrhagic. Total Unvaccinated 4 8 2 1 10 Alleged to be Vaccinated but without marks 1 1 4 1 7 Vaccination bad 28 16 6 — 50 Vaccination good 44 4 2 — 60 Vaccination not stated 2 2 — — 4 Total 79 26 14 2 121 The point particularly worthy of notice is that of 50 persons having good vaccination marks who were attacked, 44 of them had the mildest form of small pox; of those badly vaccinated but a little more than half suffered from this mild form, while of those who were without evidence of vaccination less than one-third suffered from modified small pox. With regard to the fact that out of 110 persons whose condition of vaccination was accurately known 100 were vaccinated, these figures might at first sight appear to favour the belief that vaccination had rendered them specially susceptible to small pox, and this conclusion would perhaps be justifiable did the community consist of vaccinated and unvaccinated persons in equal proportions, but as I pointed out in my Report for the year 1878, as long ago as 1863 an inquiry into the condition of vaccination in St. Pancras showed the proportion of vaccinated children to unvaccinated to be as 25 to 1. At the present time, owing to the Compulsory Vaccination Act, the proportion of vaccinated persons to unvaccinated is enormously increased, but if for the sake of argument we assume that only the same proportion still exists as in 1863, for every one unvaccinated person who is attacked, providing vaccination did not protect against an attack, we should have 25 vaccinated persons attacked, and for the 10 unvaccinated people received into the hospital at Finchley there would have been 250 who were vaccinated instead of only 100. 28 When we come to deal with deaths we find that vaccination has had a most marked influence, thus of the nine deaths which took place in the Finchley Hospital all were either unvaccinated or without any evidence of vaccination, while in the Highgate Small Pox Hospital, where 18 of our parishioners died, in only two was any evidence of vaccination found, and in both of these the vaccination is stated to be "inferior." Scarlet Fever. During 1881, in St. Pancras, 180 deaths occurred from Scarlet Fever, or 3.0 per 1000 of total deaths, a slight increase on that of last year. Of these 39 were removed to hospital before their death, and 141 died in their own homes. The proportion of deaths from Scarlet Fever to 1000 deaths from all causes in the preceding ten years was 22.6 or 18.8 less than in St. Pancras during 1881. St. Pancras has suffered, proportionately, more severely than the whole of London from this disease, the proportion of deaths from Scarlet Fever per 1000 of total deaths from all causes being 26 in London as compared with 86 in our own parish. The different sub-registration districts have not suffered equally from this disease. The following table shows the number of deaths belonging to each district, when the deaths occurring in hospitals outside the parish are referred back to the districts from which thev came:— Total Deaths. Per 10,000 of Population. Eegent's Park 88 9.0 Tottenham Court Road 17 6.0 Gray's Inn Road 25 8.0 Somers Town 28 6.0 Camden Town 22 12.0 Kentish Town 55 6.0 The total number of cases reported to the Sanitary Authority was 435, and of these 164 were sent to hospital, or 38 per cent; 136 cases being sent to the London Fever Hospital at the expense of the Vestry. There are certainly, at the very least, ten cases of Scarlet Fever to every death, and at this estimate there were 1800 cases of this disease in the parish during last year; more than three quarters, therefore, of the total number of cases never became known to the department. Although a certain proportion of these cases may have occurred in houses where there was ample opportunity for isolation, there cannot be any doubt but that many of them must have been so 29 situated that they could not remain in their own homes without infecting other people. It is therefore desirable that every publicity should be given to the opportunities afforded by the Vestry for the removal of such cases to hospital and for the disinfection of their rooms and clothing. If all cases were immediately reported, the Vestry would not necessarily have to concern itself with the removal of a much larger number to hospital, for by the early removal of cases occurring in houses where the sufferers cannot be properly isolated, the spread of Scarlet Fever would be limited. Diphtheria. Diptheria caused 70 deaths during last year, being twice as many as occurred in 1880. The 70 deaths are in the proportion of 14 to every 1000 deaths from all causes, while the proportion to 1000 deaths during the previous ten years was but 6.1. In London the proportion was only 8.0 or 6.0 less than in St. Pancras during the same period. Reckoned upon population there were l.7 deaths per 10,000 from this disease in the whole of London, and in St. Pancras 2.9 deaths. The relative number of deaths in the different sub-districts is shown in the following table:— Total Deaths. Per 10,000 of Population. Regent's Park 18 3.3 Tottenham Court Road 18 4.6 Gray's Inn Road 7 2.8 Somers Town 18 8.7 Camden Town 6 8.4 Kentish Town 18 2.0 But few of these cases came to the knowledge of the Sanitary Department from any other source than the death registers. The infectiousness of this disease is so little understood that but few persons sought the aid of the Vestry for the purpose of isolating their sick or disinfecting their clothes and rooms, and only about 19 of the 70 deaths took place in hospitals to which the sufferers had been removed. The Vestry will recollect that this disease was made the subject of a special inquiry during the year. A circular letter was, by order of the Sanitary Committee, addressed to every Metropolitan Medical Officer of Health, with a view to ascertaining how far it was felt desirable in the Metropolis, that the Sanitary Authorities should give opportunity for the isolation of persons suffering from Diphtheria, by removing the sick to hospital. An offer had been made by the authorities of University College Hospital to remove to the London Fever Hospital, at 80 the expense of the Vestry, cases of Diphtheria which had been brought to the hospital instead of returning them to their own homes. This course had been for a long time adopted with regard to the other dangerous infectious diseases, and had been found to be of considerable service to the parish. The question was raised in the Vestry whether general hospitals might not be expected to receive into their wards persons suffering from diphtheria, and the circular letter sent was intended to elicit an opinion how far this was desirable, but of twenty-three replies from the Medical Officers of Health on this point, twenty-one condemned the practice of placing cases of diphtheria in a ward devoted to persons suffering from general diseases. Although the Vestry did not immediately agree to the proposal made to them, they have since approved of cases of diphtheria being sent to the London Fever Hospital. That they have acted wisely in this respect there is no doubt, for diphtheria is not only infectious, but is a very fatal malady, and connot with safety be treated in houses occupied by many people. As evidence of the infectiousness of diphtheria, I may refer to the behaviour of this disease in a house in Harmood Street, Kentish Town, in November, where owing to the retention in the house of one person suffering from this disease, it spread to seven others, and caused the death of three. Typhus. But one death occurred from this disease in 1881, and this took place in the London Fever Hospital, the person who died being a woman aged 28 from the Somers Town sub-district. During the year a serious outbreak of this disease occurred in the adjoining Parish of Marylebone, but fortunately did not extend to our own. Enteric. Enteric fever caused 66 deaths during the year, being in the proportion of 13.2 per 1000 of total deaths from all causes, or 3.1 deaths per 1000 deaths above the average of the preceding ten years. In London Enteric fever caused 12 in every 1000 deaths from all causes, this being an excess upon the average of the preceding ten years. Reckoned upon population there were 2.7 deaths in St. Pancras for every 10,000 persons living. 31 The following table shows the proportion of deaths from this cause in the different sub-districts, when the deaths occurring in hospitals have been referred to the sub-district from which the sick persons were removed no addresses could be found. For two of these no addresses could be found. Total Deaths. Per 10,000 of Population. Regent's Park 10 2.5 Tottenham Court Road 6 2.1 Gray's Inn Road 12 3.9 Somers Town 13 3.7 Camden Town 2 1.1 Kentish Town 21 2.4 Usually this disease is not equally prevalent throughout the year, by far the greater number of cases occurring during the autumn months. This autumnal increase was especially marked in London last year, thus in St. Pancras in the six weeks beginning September 18th, and ending October 29th, sixteen deaths occurred of the 56 which were registered during the year in St. Pancras.. Simple Continued Fever. Eight deaths were registered as occurring from Simple Continued Fever during 1881, being twice the number during the preceding year. Measles. There were 172 deaths from measles in 1881; 34.2 in every 1000 deaths from all causes were due from this disease. The average proportion of deaths from measles to 1000 deaths from all causes during the last ten years was 20 5. Calculated upon the population, the death-rate from Measles was in 1881, 7.2 per 10,000 living. In London measles caused 32.4 of every 1000 deaths, and 6.6 for every 10,000 of population living. When the deaths occurring in hospitals are referred back to the districts to which they belonged they occurred in these districts in the proportion shown in the following table. No address could be found for four who died in the Workhouse, and these are therefore excluded:— Total Deaths. Per 10,000 of Population. Eegent's Park 20 5.1 Tottenham Court Road 20 7.2 Gray's Inn Road 23 7.5 Somers Town 37 10.7 Camden Town 14 8.0 Kentish Town 54 6.1 82 Whooping Cough. This disease was not so prevalent either in London or in St. Pancras as in past years. The Registrar General states in his Annual Summary that "the death-rate from Whooping cough was the lowest on record in London." The number of deaths, 122, recorded for St. Pancras is the lowest since 1874, and is 76.5 less than the average of the preceding ten years. In 1881 whooping cough caused in St. Pancras 24.2 deaths per 1000 deaths from all causes, and in London 24.1. Both in St. Pancras and London there were 5.1 deaths to every 10,000 of population living. The following table shows the relative proportion of deaths from this disease in the different sub-districts when the deaths occurring in institutions are referred back to the districts to which they belong. For two deaths occurring in the Workhouse no address could be found, and they are therefore excluded. Total Deaths. Per 10,000 of Population. Regent's Park 15 8.8 Tottenham Court Road 17 6.1 Gray's Inn Road 24 7.9 Somers Town 17 4.9 Camden Town 4 2.8 Kentish Town 48 4.9 Diarhœa. During 1881 there were 211 deaths from diarrhoea, of these 195 were of children under one year of age. When compared with the death-rate from this disease in London, whether reckoned as a proportion of total deaths from all causes upon the population, St. Pancras suffered more heavily from this disease than London during 1881, for the former method of calculation gives 421 for St. Pancras, and 86.9 for London, and the latter method 8.8 for St. Pancras, and 7.8 for London. The following Table shows the proportion of deaths in the various sub-districts when the deaths in institutions are referred back to the sub-districts to which they belong:— Total Deaths. Per 10,000 of Population. Regent's Park 29 7.4 Tottenham Court Road 22 7.9 Gray's Inn Road 18 5.9 Scmers Town 40 11.6 Camden Town 18 7.1 Kentish Town 89 10.1 83 The Somers Town and Kentish Town sub districts suffered far more heavily from diarrhoea than the other sub-districts. How far any proportion of this excess may be due to a proportionately larger infantile population in these two districts cannot be seen until the full Census Report is published, and the numbers of people at different ages in each district known. It will be observed that until the twenty-seventh week in the year, but comparatively few deaths were registered from this disease; but from this date to the thirty-third week inclusive, the mortality from diarrhoea was considerable. During this interval a very large majority of the persons who died were infants under one year of age. The diarrhoea which occurs at other periods of the year does not show as special an incidence upon infants as does the diarrhoea of the period to which I have referred. There is something therefore about the diarrhoea of this period which tends to indicate that it has a cause different from that which produces the diarrhoea of the rest of the year; whatever this cause may be, it is more powerful in its action in towns than in rural districts, and in some towns than in others. The cause has been said to be the artificial feeding of children, the poisoning of houses from imperfect sewers, the use of impure water, associated with certain meteorological conditions. That high temperature is intimately associated with the existence of this disease there can be no doubt, but I have failed in St. Pancras to find any evidence that would lead me to conclude that children brought up by hand suffer more than children wholly breast-fed. "With regard to the statement that any local condition of a sewer is a cause of atumnal diarrhoea, I have arranged the streets in which deaths from diarrhoea have taken place in three years in St. Pancras, so as to show whether any particular streets are liable to this disease. In eighty-six streets, in which two or more deaths from diarrhoea took place during three successive years, this event happened in each of these years but once, and occurred a second time in the same street but twelve times. Whatever cause may produce this heavy mortality among children, there is much probability that it is in some way or other associated with the putrefactive changes whieh take place in hot weather, and the necessity, therefore, for cleansing of roads, the frequent removal of house dust, and for enforcing general cleanliness in streets and habitations is clearly marked. 34 Violent Deaths. The deaths from violence in 1881 were 200 in number, or if corrected, 154. There were 23 capes of suicide and 5 of homicide, the latter number being but half as many as in the previous year. The number of infants suffocated had also decreased, being only 42 as against 61 in 1880. Fractures and contusions caused 45 deaths, a slight increase on those of the preceding year. 409 inquests were held in St. Pancras during the year, being 65 less than in 1880. Uncertified Deaths. The uncertified deaths in St. Pancras were 18 in number in 1881, being in the proportion of .3 in every 100 deaths. This is in excess of the previous year, when but 11 such deaths were registered. In London the uncertified deaths were in the proportion of 1.2 in every 100 deaths. During the previous year the Vestry had joined in a Memorial to the Home Secretary, urging the necessity for an inquiry by a skilled officer in all cases in which the cause of death had not been certified, and concerning which no inquest would be held. That such an inquiry is much needed with a view to preventing crime is obvious enough. Before leaving this part of my report I would desire to acknowledge the valuable services rendered to the Sanitary Department during the year by the District Medical Officers and the Believing Officers of the Parish. The aid they have afforded the Department by the promt reporting of cases of infectious diseases which came to their knowledge, and by the speedy removal of infectious paupers to the hospitals of the Metropolitan Asylums Board have been a great assistance in dealing with cases of this class of disease. SANITARY CONDITION OF DIFFERENT DISTRICTS. It is a source of great regret to me that I am not able to deal as thoroughly with this subject as I could wish. I have been desirous of obtaining information Of the death-rates in different parts of our Parish for the purposes of comparison, but am met with this difficulty, that in the very poorest localities the sick and dying are frequently removed to Hospitals, to the Workhouse, or to the Sick Asylums at Cleveland Street and Highgate, and thus the deaths come to be registered in districts different from those in which the last illnesses were contracted. 85 In all institutions, but those of the Workhouse and the Central Sick Asylum Board I have been able to ascertain the locality from which the sick person was removed, but although I have had the cordial co-operation of the Medical Officers of these institutions, and of the Relieving Officers of St. Pancras I have been unable to refer back to the districts to which they belong a very considerable proportion of the deaths of St. Pancras parishioners occurring in these institutions. The difficulties are caused solely by the system of book-keeping adopted, and I would recommend the Vestry to urge upon the Local Government Board, who control the form of books kept, the urgent necessity of adopting a form which will enable the Vestry to obtain information of the utmost importance to them as a Sanitary Authority. If the deaths of all persons in public instituions were excluded and only those deaths included which occurred in private houses, the following table would then show the rate of mortality for every 1000 of the population in the different districts:— All Diseases. Tubercular Diseases. Pulmonary Diseases other than Phthisis. Zymotic Diseases.* Regent's Park 15.7 1.8 2.4 2.9 Tottenham Court Rd. 15.7 1.9 2.9 8.0 Gray's Inn Road 18.4 2.8 3.2 8.2 Somers Town 19.2 2.0 3.8 3.6 Camden Town 16.0 1.7 4.1 2.4 Kentish Town 16.0 1.6 3.2 8.2 So far as these Tables may be trusted, Somers Town and Gray's Inn Road have suffered more heavily from all classes of disease except the pulmonary, and with the exception of the Camden Town district both the Somers Town and Gray's Inn Road districts have a higher rate of mortality from this class of disease than any of the other districts. It must be borne in mind that these figures are (with the exception of the column of Zymotis diseases) only of use for the purposes of the comparison of one sub-district with * In this column the deaths from the seven principal Zymotic Diseases occurring in Public Institutions, have been referred back to the Districts to which they belong. 36 another, and inasmuch as they only represent death-rates calculated from a portion of the total deaths, must not be compared with those of the whole of the parish which are of course calculated upon all the deaths. I am desirous of calling the attention of the Vestry to certain small areas in the parish which are exercising an injurious effect upon the health of those resident within them. The recent demolitions which have taken place in our own parish as well as in neighbouring parts of the Metropolis have made me feel that up to the present it has been advisable not to displace, by further demolition, more of the inhabitants of the poorest class of houses in our parish, and I have, therefore, until now recommended the Vestry to actively put in force the Sanitary Acts for the improvement of these houses instead of reporting any of them under the Artizans and Labourers' Dwellings Acts. But there are in certain localities houses so built and arranged that they must inevitably within a short period be differently dealt with. The Sanitary Committee have from time to time visited these unhealthy areas, and are conversant with the condition of the property. Proceedings have been taken under the Sanitary and Metropolis Local Management Acts for improving them as far as possible, but these Acts do not give the Vestry the power to compel under all circumstances the maintenance of dwelling houses in a habitable condition. Poplar and Compton Place in Gray's Inn Road district especially call for notice. The houses are for the most part placed back to back, so that proper ventilation is practically an impossibility. From the absence of back windows, the opportunity for light to enter is limited, while from the proximity of the two rows of houses in Poplar Place, between which there is only an interval of about twelve feet, this defect is increased. The water closets, which until recently have been without any supply of water, are mostly situated in a dark corner behind the stairs, while the only means of external ventilation of many of them is through a very small shaft carried upwards. The opportunity for air to circulate round these houses is limited by the fact that almost on all sides the courts end in a cul de sac, and their only entrances are through archways situated in Hunter Street and Compton Street. It is a matter of surprise that, in spite of the difficulties of tracing out all the deaths during 1881, which belong to the 87 houses in Poplar and Compton Place there should still be sufficient deaths found to show that the residents in these houses died at nearly twice the rate that they did either in St. Pancras or in London as a whole. Another place deserving the attention of the Vestry is Cooper's Buildings, situated near Cromer Street, in the Gray's Inn Road sub-district. Here are eleven houses in two rows placed but seven or eight feet from each other. These houses are in a dilapidated condition, have no backs to them, for the houses in Riley Street and Dutton Street on either side abut on to them, and are themselves provided with but the smallest of back yards. Two water closets placed on the ground floor of one of the houses serve for all the court, while one tap of water has also to do duty for all the houses. At the Cromer Street end the court is blocked up, while at the northern end a factory at the rear of Manchester Street stands within ten feet of the entrance. Thus surrounded the circulation of air round Cooper's Buildings is further prevented by the court being sunk some four to eight feet below the level of the land immediately adjoining it. In other areas where the houses are back to back, the death-rate is also heavy; thus, in the block of houses composed of Prospect Terrace on the one side, aud Derry Street, and certain houses in Wellington Square on the other, notwithstanding the difficulty of referring back to their own district, the deaths of persons occurring in public institutions, there is evidence to show that people in this block died at a rate one-and-a-half times as large as that of St. Pancras or London as a whole. Draper's Place is especially one that has received the attention of the Officers of the Sanitary Department. The houses have frequently been cleansed, the water closets have been reconstructed, and a water supply laid on to them : that no effort should be neglected by the Vestry to prevent sickness and death in these houses is best made evident by stating that the death-rate was during 1881 not less than 36.2 per 1000. Mary Place, in the Regent's Park sub-district, has for a long time been recognized as an area needing constant attention from the Sanitary Department. It is entered through an archway situated in Stanhope Street, and consists of two rows of houses, the other end being closed by a warehouse. The ground floor level of most of these houses is situated 88 below the level of the ground either in front or behind, and their condition is becoming more and more dilapidated, 80 that it will shortly be necessary to declare them as unfit for human habitation. As evidence of the unhealthiness of this area, may be stated the fact that so many deaths belonging to these houses occurred during 1881 that the death-rate was for that year 57.1 per 1000, or more than two-and-a-half times as great as that of St. Pancras or London as a whole. Other areas must not be forgotten; Melina Place is especially one that will have to be kept under observation. It is approached from Riley Street, and the entrance to the court is down a series of steps, so that the level of the court is nearly seven feet below the level of the adjoining roadway. A narrow passage of but six feet eight inches in width runs in front of the houses, and is bounded on the opposite side by a high wall. None of the houses have backs, and thus every condition combines to prevent the circulation of air round and through them. The houses are five in number, and two water closets placed at the end of the court have to do duty for every house. Reference may also be made to that portion of Colonnade Mews which is situated in St. Pancras. Here again the position of these houses is such that they are below the level of the street, and their condition is anything but satisfactory. In them the death-rate for 1881 was 36 3 per 1000 living, or half as large again as St. Pancras or London as a whole. I have arranged the accompanying plans to show the relation of the houses in Poplar and Compton Place, in Cooper's Buildings and Melina Place, to each other and to surrounding Buildings. It will be seen by them how impossible it is to properly ventilate houses thus situated. St. Pancras especially needs accommodation for the working classes. Within the last few years, large areas occupied by the poor have been cleared of houses, and no adequate provision has been made for those who have been thus displaced. With so many railways running through the parish, it would be a great assistance if opportunity were given to the poor to live outside the more crowded parts, and to use the railways for the purpose of going daily to their work, but this would not meet the necessities of all, and properly constructed houses ought, therefore, to he provided wherever the opportunity presents itself. 41 At the present time it ia not encouraging to attempt to improve the dwellings of the poor by dealing with unhealthy areas under the Acts for this purpose, which are known by the name of Sir Richard Cross, nor would it perhaps be advisable to think of this Act in relation to some of the areas I have just described, but it should be stated that the Royal Commission, which are now considering the working of these and the Acts of Mr. Torrens, have presented an interim report, recommending that " with a view to putting in force, where practicable, the provisions of the Acts known as Mr. Torrens' Acts, immediate attention should be given by the Vestries and District Boards to any area which the Medical Officer has reported as unsanitary, but which the local authority, under the Act of 1875, has not included in any scheme on the ground of the smallness of the area." For small areas such as these, Torrens' Act are far more applicable, and they will enable the Vestry to remove from their district dwellings which are not only doing injury to those who inhabit them, but which may be the means of disease extending into other parts of the parsh. DUSTING AND SLOPPING. An important step taken by the Vestry during the year 1881 was that of sending into the North of Engiand a deputation, accompanied by the Vestry Clerk, the Chief Surveyor, and the Medical Officer of Health, with a view to ascertaining the best mode of dealing with house and street refuse. In my last Report I referred to this subject and to the Vestry's condemnation of a system that had failed and still fails to ensure the frequent and periodic removal of house refuse. I would beg to urge upon the Vestry the further consideration of a matter so closely related to the health of their parishioners. SLAUGHTERHOUSES. There are now 51 Licensed Slaughterhouses in St. Pancras. These have, with few exceptions, been kept in a cleanly condition during the year, and the Bye-laws of the Vestry complied with. Nevertheless the system of slaughtering animals in private slaughterhouses immediately at the rear of the butchers' shops, is one which public opinion will not permanently approve. If public abattoirs existed, not only would the method of slaughtering be itself under better control, but opportunity would be given for the thorough inspection of meat before it comes to be offered for sale. There are now such abattoirs in many towns, and while they are not found prejudicial to the interests of the butchers, are a great boon to the public. 42 COWSHEDS. There are 57 Licensed Cowsheds in St. Pancras. The Licensees have also, with very few exceptions complied with the Bye-laws of the Vestry, and the sheds have been maintained in a cleanly condition. BAKEHOUSES. The Yestry will recollect that in my Report for the year 1878,1 expressed regret that the inspection of bakehouses as such had passed out of the hands of the Yestry. The Vestry still have the right to inspect for the purpose of enforcing the cleanliness of the house when it is dirty, but they have ceased to have power to compel the periodical cleansing of the bakehouse, except for the abatement of nuisance, and to insist that the bakehouse shall be ventilated to the extent mentioned in the late Bakehouse Regulation Act, as well as other matters over which they formerly had control. As the result of an inquiry I have recently made, I find that since the passing of the Factory and Workshops Act, in 1878, very much more than half the bakehouses in St. Pancras have never been inspected by those upon whom the duty now devolves. On March 17th, 1881, I brought this subject before the Society of Medical Officers of Health, and from the observations made by the Medical Officers to other Parishes on that occasion, I gather that St. Pancras is not exceptional in this respect. The Vestry will readily understand that under these circumstances the bakehouses, instead of continuing to improve, will become more than ever unfit for the purposes for which they are intended, and I cannot but express my regret that a matter so intimately related to the public health as the condition of premises in which the chief article of food is manufactured, should have passed out of the hands of those who are responsible for the health of those who consume it. The best means of assuring that bakehouses shall be kept in proper condition is for the Vestry to have the power of making regulations for their control, and for all bakehouses to be registered in the same manner as cowsheds and slaughterhouses. This will best prevent the use of premises which are often altegether unfitted for the purpose to which they are put. 43 COMMON LODGING HOUSES. There are 33 common Lodging Houses in St. Pancras, providing accommodation for 557 persons. These, as the Vestry are aware, are under the supervision of the Police. No case of infectious disease has, during the year, been reported to the Sanitary Department, as occurring in any of these houses. CANAL BOATS. The action which the Vestry have taken in prosecuting all Owners of Canal Boats used as dwellings, which were not registered, has resulted in the registration of such boats. During 1881 no case of infectious disease occurring in any canal boat has been reported to the Department. OPEN SPACES. During the year 1881, the Vestry have, together with the Kyrle Society, been engaged in making arrangements for the acquisition of the Burial Grounds of St. George's, Bloomsbury, and St. George-the-Martyr, for the purpose of laying them out as a Recreation Ground. Although certain delays have as yet prevented the completion of these arrangements, it is to be hoped that all difficulties will shortly be overcome. In no part of the Parish is there more need for opportunities for improving health, than the district in which the Burial Grounds are situated. PUBLIC MORTUARY. That St. Pancras is still without a suitable place for the temporary reception of the dead, is a matter for regret. Wherever Public Mortuaries have been erected, they have come to be more and more used, and in a large and thickly populated Parish like our own, there is no doubt that one would prove of great service to the community. This is a matter that deserves the serious attention of the Sanitary Authority. SANITARY WORK DURING THE YEAR. The year 1881 has been one which has more heavily taxed the resources of the Sanitary Department, and the amount of work carried out has been larger than in previous years. The necessity for more constant inspection of the dwellings of the poor with a view to improving the conditions under which they live, had been for some time recognised by the Sanitary Committee, and with this object a redistribution of the duties of the Sanitary Inspectors was made in the middle of the year. 44 am able to speak with much satisfaction of the results which have followed from the more frequent inspection of tenemented houses. From the year 1874 up to the present time a record has been kept of the number of houses inspected, and of the orders made for their improvement. The average number of houses inspected during the years 1874 to 1880 inclusive is 2546, while 1184 notices have on the average been served for the abatement of nuisances. During 1881 the number of houses inspected amounted to 6687, and the number of notices served was 2469, being more than twice as many as in past years. Table xi. shows the defects which have been remedied: thus, 1556 houses have been cleansed, and 2992 defects relating to drainage or water supply have been amended. In addition to this the Vestry have removed nearly 850 cases of infectious diseases to hospital, and have disinfected 872 houses in which infectious disease had occurred. Cowsheds and slaughter-houses have been regularly inspected, and a considerable amount of work done in relation to nuisances of a miscellaneous kind. It is by constant inspection that the Vestry can best do its duty in preserving the lives and the health of its parishioners. For by teaching the poor the advantages of cleanliness and decency they will learn to regard these as necessaries of life, and in time become able to take care of their own interest in this respect. Nor are life and health only affected by the action of the Sanitary Authority, for nothing is more calculated to raise the moral tone of a people than an inprovement of the habitations in which they dwell. Efforts and increased efforts should still be made by the Sanitary Authority to carry out in the best way the very responsible duties which devolve upon them, and as guardians of the public health and the public purse they may feel sure that the best economy is that which preserves the inhabitants of their district from sickness and death. I have the honour to be, Gentlemen, Your obedient Servant, SHIRLEY F. MURPHY, Medical Officer of Health. 45 Table XI. PARISH OF ST. PANCRAS. Report of the Sanitary Work, &c., completed in the year ending December 31st. 1881. No. of Complaints received during year from the Sanitary Inspectors and the Public 2965 No. of Houses, Premises, &c., inspected 6687 Results of Inspection. Orders issued for Sanitary Amendments of Houses and Premises 2469 Houses and Premises cleansed, &c. 1656 Houses Disinfected after Infectious Diseases 872 House Drains. New provided 19 Trapped 439 Repaired and Cleansed 299 Privies and Water Closets. Repaired, Cleansed, &c. 506 Supplied with Water 1138 New provided 4 Dust Bins. New provided 72 Repaired and Covered 254 Water Supply. Cisterns (new) erected 22 Cisterns cleansed, repaired, and covered 235 Miscellaneous. Cesspools abolished 4 Overcrowding rooms for which notices were served 20 Removal of accumulations of Refuse, &c. 114 Removal of Animals improrerly kept 16 Licensed Slaughterhouses Licensed Cowhouses Inspected 58 45 Smoke Nuisances 23 Other Proceedings, e.g. Legal Proceedings 63 Disinfection. Houses 872 Rooms 1227 Beds 540 Pillows 889 Sheets 572 Blankets 675 Quilts 317 Articles of Clothing 343 Tents, Bedding, and Clothing of persons in Small-pox Hospital, Finchley. PARISH OP ST- PANCRAS. Table XII. Deaths Registered at several groups of Ages from different causes during the Year 1881. The Deaths in Public Institutions of Non-Eesidents are excluded, but the Deaths of St. Pancras Parishioners in Public Institutions in other parts of the Metropolis are included. 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 Total under 5 years Total CLASSES. i. Zymotic Diseases 301 173 218 148 64 69 50 36 28 17 11 – – 752 1172 ii. Constitutional Diseases 107 47 68 27 63 147 168 109 105 43 11 1 – 219 898 iii. Local Diseases 362 138 120 76 60 98 180 232 348 338 136 20 1 620 2109 iv. Developmental Diseases 381 33 8 – 8 10 5 6 44 72 84 36 — 392 654 v. Violent Deaths 48 4 14 7 4 13 27 10 14 3 6 — — 66 184 Not specified or ill defined 5 – 1 1 1 1 1 1 2 3 — — — 6 16 Totals 1284 395 426 286 199 340 431 394 541 478 248 57 1 2055 8000 Class I.—Zymotic Diseases. Order 1.—Miasmatic. 1 Smallpox 7 2 3 19 15 20 10 6 1 ... 1 ... ... 12 84 2 A!easles 34 77 51 8 ... 1 ... 1 ... ... ... ... ... 162 172 3 Scarlet Fever (Scarlatina) 5 24 65 74 10 1 1 ... ... ... ... ... ... 94 180 4 Diphtheria 5 8 33 17 4 1 ... ... 1 1 ... ... ... 46 70 5 Quinsy 2 ... 1 1 1 ... ... ... ... ... ... ... ... 3 5 6 Croup 9 10 19 7 ... ... ... ... ... ... ... ... ... 38 45 7 Whooping Cough 52 36 32 1 ... ... ... ... 1 ... ... ... ... 120 122 8 Typhus Fever ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Enteric or Typhoid F. ... ... 3 11 20 15 10 5 1 1 ... ... ... 3 66 Simple Continued F. 1 ... 1 ... 4 ... 1 ... ... 1 ... ... ... 2 8 9 Erysipelas 6 ... ... ... 1 3 3 4 5 5 2 ... ... 6 29 10 Puerperal Fever (Metria) ... ... ... ... 5 10 4 ... ... ... ... ... ... ... 19 11 Carbuncle ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 12 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Dysentery ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... 4 14 Diarrhœa 173 14 8 3 ... 1 2 3 1 ... 6 ... ... 195 211 15 Cholera ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 2 16 Ague ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 17 Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Rheumatisin 1 ... ... 4 2 5 5 4 2 2 ... ... ... 1 25 19 Other Zymotic Diseases 2 ... ... ... 1 2 2 ... 5 1 ... ... ... 2 13 Order 2.—Enthetic. 1 Syphilis 26 2 1 ... ... 1 ... 1 ... ... .. ... ... 29 31 2 Stricture of Urethra ... ... ... ... ... ... 2 2 1 ... ... ... ... ... 5 3 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Anthrax ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 5 Tetanus ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Order 3.—Dietic. 1 Privation 3 ... ... ... ... ... ... ... 2 1 ... ... ... 3 6 2 Want of Breast Milk 18 ... ... ... ... ... ... ... ... ... ... ... ... 18 18 3 Purpura and Scurvy ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 4 Alchoholism (a Del. Tremens) ... ... ... ... ... ... 4 2 1 ... ... ... ... ... 10 „ (6 Intemperance) ... ... ... ... ... 5 5 7 4 2 ... ... ... ... 23 Order 4.—Parasitic. 1 Thrush 17 ... ... ... ... ... ... ... ... ... ... ... ... 17 17 2 Worms, &c. ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Class II.—Constitutional Diseases. Order 1.—Diathetic 1 Gout ... ... ... ... ... ... 1 3 3 5 1 ... ... ... 13 2 Dropsy ... ... ... ... ... ... ... 1 6 2 2 ... ... ... 12 3 Cancer ... ... ... ... ... 6 24 30 48 24 4 ... ... ... 137 4 Cancrum Oris (Noma) 1 1 ... ... ... ... ... ... ... ... ... ... ... 2 2 5 Mortification ... ... 3 ... 1 1 ... ... 2 4 1 1 ... 3 13 Order 2.—Tubercular. 1 Scrofula 3 2 1 2 3 ... ... ... ... ... ... ... ... 6 11 2 Tabes Mesenterica 43 11 11 3 ... ... ... ... ... ... ... ... ... 65 68 3 Phthisis 23 9 8 17 61 139 142 74 46 8 2 ... ... 40 529 4 Hydrocephalus 37 24 42 3 ... 1 1 1 ... ... 1 ... ... 103 110 Class III—Local Diseases. Order 1.—Nervous System. 1 Cephalitis 13 11 5 11 ... ... 1 ... ... ... ... ... ... 29 41 2 Apoplexy 1 1 ... 1 1 2 13 32 34 32 21 2 ... 2 140 3 Paralysis ... ... ... ... 1 ... 9 8 20 26 12 2 ... ... 78 4 Insanity ... ... ... 1 1 ... 1 ... 6 5 6 1 ... ... 21 5 Chorea ... ... ... ... 1 ... ... ... ... ••• ... ... ... ... 1 6 Epilepsy ... ... ... 1 3 2 4 1 1 2 2 ... ... ... 16 7 Convulsions 99 21 10 3 ... ... ... ... ... ... ... ... ... 130 133 8 Brain Disease, &c. 5 4 2 6 5 6 5 3 9 16 7 ... ... 11 68 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 Total under 5 years Total Local Diseases continued. Order 2.—Organs of Circulation. 1 Pericarditis ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... 4 2 Aneurism ... ... ... ... ... ... 7 1 6 1 ... ... ... ... 15 3 Heart Disease, &c. 2 ... 3 10 16 16 27 42 59 53 17 1 ... 5 246 Order 3—Respiratory Organs. 1 Laryngitis 7 5 16 2 ... 1 ... ... 1 1 1 ... ... 28 34 2 Bronchitis 146 72 48 16 2 15 23 52 111 126 42 10 1 266 664 3 Pleurisy ... ... 2 ... ... 5 2 5 5 1 2 ... ... 2 22 4 Pneumonia 31 12 15 7 8 10 15 15 11 10 3 ... ... 58 137 5 Asthma ... ... ... ... ... ... ... 5 4 8 ... ... ... ... 17 6 Lung Disease, &c. 14 3 2 ... 3 3 7 3 3 3 3 ... ... 19 45 Order 4.—Digestive Organs. 1 Gastritis 4 ... 1 ... ... 2 1 ... ... 3 4 ... ... 5 15 2 Enteritis 5 4 1 ... ... 1 2 3 3 1 1 ... ... 10 22 3 Peritonitis 3 1 2 0 5 5 6 ... 4 1 1 ... ... 6 30 4 Ascites ... ... ... ... ... 1 4 1 ... 1 ... .. ... ... 7 5 Ulceration of Intestines 3 ... ... 1 2 ... ... ... 6 2 1 ... ... 3 15 6 Hernia 2 ... ... ... 1 1 1 ... 1 5 1 ... ... 2 12 7 Ileus ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Intussusception 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 9 Stricture of Intestines 2 ... ... 1 1 2 2 7 4 6 ... ... ... 2 25 10 Fistula ... ... ... ... ... l 1 ... ... ... ... ... ... ... 2 11 Stomach Disease, &c. 5 ... ... ... .. ... 1 ... 6 1 1 ... ... 5 14 ... 12 Pancreas Disease, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Hepatitis ... ... ... ... ... 1 5 1 3 3 2 ... ... ... 15 14 Jaundice 5 ... ... ... ... 1 2 2 1 ... 2 ... ... 5 13 15 Liver Disease, &c. 5 1 1 1 1 4 16 15 16 8 2 1 ... 7 71 16 Spleen Disease, &c. ... ... ... ... ... ... 1 3 ... ... ... ... ... ... 4 Order 5.—Urinary Organs. 1 Nephritis 1 ... ... 6 1 1 3 2 ... ... 1 ... ... 1 15 2 Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Bright's Disease (Nephria) ... ... ... ... ... 6 ... 9 8 8 ... ... ... ... 32 4 Diabetes ... ... ... ... ... 2 2 3 6 1 ... ... ... ... 14 5 Calculus (Stone) ... ... 1 ... ... ... ... 1 3 1 ... 1 ... 1 7 6 Cystitis ... ... ... ... 2 2 1 1 1 4 3 ... ... ... 14 7 Kidney Disease, &c. ... ... 1 1 .. 2 5 10 9 5 ... 1 ... 1 34 Order 6.—Organs of Generation. 1 Ovarian Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Uterus Disease, &c. ... ... ... ... 1 2 7 2 1 1 ... ... ... ... 14 Order 7.—Organs of Locomotion. 1 Synovitis (Arthritis) ... 1 1 ... ... ... ... ... 1 1 ... ... ... 2 4 Joint Disease, &c. ... 1 6 3 2 2 4 2 2 2 ... ... ... 7 24 Order 8.—Integumentary System. 1 Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Ulcer and Abscess 6 1 3 1 2 1 ... 2 1 3 ... ... ... ... 10 20 3 Skin Disease, &c. 2 ... ... ... ... ... 1 ... ... ... ... ... 2 3 Class IV.—Developmental Diseases. Order 1.—Diseases of Children. 1 Premature Birth 95 ... ... ... ... ... ... ... ... ... ... ... ... 95 95 2 Cyanosis 6 ... ... ... ... ... ... ... ... ... ... .. ... 6 6 3 Spina Bifida 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 5 4 Other Malformations 11 ... 1 ... ... ... ... ... ... ... ... ... ... 12 12 5 Teething 38 18 4 ... ... ... ... ... ... ... ... ... ... 60 60 6 Atalectasis 4 ... ... ... ... ... ... ... ... ... ... ... ... 4 4 Order 2.—Adults. 1 Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Childbirth (sec Puerperal Fever) ... ... ... ... 4 10 5 ... ... ... ... ... ... ... 19 Order 3.—Old People. 1 Old Age ... ... ... ... ... ... ... 2 38 71 84 36 ... ... 231 Order 4.—Nutrition. 1 Atrophy and Debility 192 15 3 ... 1 ... ... 4 6 1 ... ... ... 210 222 Class 4.—Violent Deaths. Order 1.—Accident or Negligence. 1 Fractures and Contusions ... 3 4 1 2 7 14 4 5 2 3 ... ... 7 45 2 Wounds Gunshot ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Burns and Scalds ... ... 8 1 1 ... ... 2 1 ... 2 ... ... 8 16 4 Poison 1 ... ... ... ... 1 6 ... ... ... ... ... ... 1 8 5 Drowning 2 ... ... 3 ... 1 2 ... ... ... ... ... ... 2 8 6 Suffocation 40 1 1 2 ... ... ... ... ... ... ... ... ... 42 47 7 Otherwise 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 2 Order 3.—Homicide 4 ... 1 ... ... ... ... ... ... ... ... ... ... 5 5 Order 4.— Suicide ... ... ... ... 1 6 5 3 6 1 1 ... ... ... 23 Causes not specified or ill defined 5 ... 1 1 1 1 1 1 2 3 ... ... ... 6 16