STPAN 39 TWENTY-SEVENTH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE • Sanitary Condition of Saint Pancras, MIDDLESEX. REPORT FOR THE YEAR 1882, 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-SEVENTH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, Being the Report for the Year 1882. TO THE VESTRY OF ST. PANCRAS. Gentlemen, The publication of the first two volumes of the Census Report of 1881 enables me to add to this Report the corrected number of houses, and of population in the different subregistration districts and wards of St. Pancras on the night the Census was taken. Sub-registration Districts. Inhabited Houses. Population. Regent's Park 4878 89115 Tottenham Court Road 2420 27729 Gray's Inn Lane 2956 80247 Somers Town 8202 34369 Camden Town 1688 17811 Kentish Town 10057 87487 4 Wards. Inhabited Houses. Population. No. 1 5617 52351 ,, 2 2177 18943 „ 3 4320 34008 „ 4 2592 20314 „ 5 2311 25277 „ 6 2308 27389 „ 7 2038 23626 „ 8 3338 34350 I have estimated the population of our district during the year 1882, to be 237,800, a calculation based upon the fact that in the preceding decade the population of St. Pancras had increased annually at the rate of .66 per cent. Upon the estimated population of 237,800, the birth and death rates of 1882, will be calculated. The following is the estimated population of the different sub-registration districts. Sub-registration Districts. Population. * Exclusive of certain Public Institutions. Regent's Park 39,179 39,179 Tottenham Court Road 27,728 27,247 Gray's Inn Lane 30,300 30,150 Somers Town 84,500 34,500 Camden Town 17,405 15,631 Kentish Town 86,688 88,165 The Registrar General's year to which this Report relates, begins on January 1st, and ends on December 30th, 1882, and therefore consists of 52 weeks. During this period, 7772 births were registered in St. Pancras, being the rate of 32.6 per 1000 of population. This is the lowest birth rate since 1860, when the estimated population was 196,000, and the birth rate was 32.6, the same as in the present year. * University College Hospital, Eoyal Free Hospital, Workhouse, Cleveland Street and Highgate Sick Asylums. 5 The following table shows the birth rates since that year* those of London are added for the purposes of comparison. Year. St. Pancras. London. I860 82.6 83.6 1861 84.2 84.5 1862 88.5 84.2 1868 34.7 85.2 1864 84.6 84.7 1865 84.6 85.7 1866 88.4 85.7 1867 84.1 86.5 1868 851 86.8 1869 83.7 85.4 1870 84.6 35.4 1871 83.8 84.6 1872 85.1 85.6 1873 85.1 85.8 1874 85.0 85.6 1875 84.5 85.4 1876 85.7 85.9 1877 84.4 85.6 1878 84.6 85.5 1879 84.2 85.5 1880 84.2 85.8 1881 88.6 84.7 1882 82.6 84 8 It is deserving of remark that the birth rate of St. Pancras is in each year lower than that of London as a whole. There were 5079 deaths reported in St. Pancras, giving a death rate of 21.3. This is .1 less than the death rate of London for the same period. If the deaths of non-parishioners occuring in public institutions situated in St. Pancras be excluded, and the deaths of St. Pancras parishioners occurring in public institutions situated in other parts of the Metroplis be included, the corrected number of deaths amounts to 4780, giving a death rate of 19.89. This appears to be the lowest death rate during the 27 years that St. Pancras has had a Medical Officer of Health. The lowest death rate in London since 1841 was 21.0. The deaths of 1119 children under one year of age were registered in St. Pancras in 1882. The corrected number of 6 deaths of St. Pancras parishoners of this age was 1110, this number is 234.6 per 1000 of the corrected total deaths, and is in the proportion of 142.8 of each 1000 registered births during the same period. The proportion of deaths under one year, to total deaths in the Metropolis is 242.7 per 1000, or 8.1 above that of St. Pancras. During the preceding ten years in St. Pancras the average proportion of deaths under one year to 10C0 deaths from all causes has been 248.4, and therefore, 13.8 above that of the year 1882. During the year 1882, 1953 St. Pancras parishioners under five years of age died, being 412.8 per 1000 of the total deaths. This is practically the same as in the preceding year, when the number of deaths was 411.0 per 1000. In the whole of London the proportion of deaths at this age to total deaths was 437 3, the average in St. Pancras in the last 10 years being 402.5. Between the ages of five and sixty-five 1901, and above sixty-five years, 876 St. Pancra3 parishioners died during the year. The number of deaths in the preceding year of those from five to sixty-five years of age was greater and of those above sixty-five less than in the present year. In 1882, 1223 deaths took place in Public Institutions situated in the district, being 81 less than in the preceding year, and 868 St. Pancras parishioners died in Public Institutions, situated in St. Pancras and in other parts of the Metropolis, being 183.5 per 1000 of total deaths from all causes. At the end of this report will be found a series of Tables recommended by the Society of Medical Officers of Health. Table I shows the population, the Dumber of inhabited houses, of marriages, births and deaths during 1882, and the ten preceding years. Table II shows the annual birth-rate, death-rate, death-rate of children, and proportion of deaths in public institutions in every 1000 deaths for the same years. Table III shows the corrected number of deaths of St. Pancras parishioners at different ages and from the various causes in 1882. and is followed by another table containing a summary. 7 Table IV shows the proportion which deaths from Zymotic, Pulmonary, and Tubercular diseases, in the year 1882, bear to each 1000 of population and each 1000 of total deaths, and which the deaths of children under one year of age from Wasting and Convulsive diseases bear to each 1000 of births and each 1000 of deaths of infants under one year. Table V shows the number of deaths from the principal Zymotic Diseases in the year 1882, and the ten preceding years, and the proportion which these deaths bear to total deaths during the same period. % DEATHS FROM VARIOUS DISEASES. Pulmonary Diseases. Pulmonary Diseases other than Phthisis caused 1011 deaths, or 92 more than in the preceding year. During the previous eight years the average number of deaths from these diseases has been in the proportion of 221.1 in every 1000 deaths from 'all causes,' or 4.5 in every 1000 of population, whereas in 1882, the proportion was 213.7 in every 1000 of total deaths and 4.2 per 1000 of population. During 1882 in London the proportion has been 221.8 per 1000 of total deaths and 4.7 per 1000 of population. The following table shows the number of deaths from Pulmonary diseases other than Phthisis occuring in each subregistration district, and the proportion per 1000 of population and per 1000 of total deaths.* Sub-Registration Districts. No. of Deaths. Proportion per 1000 of Population. Proportion per 1000 of total deaths. Regent's Park 144 8.6 189.4 Tottenham Court Road 116 4.2 209.7 Gray's Inn Lane 182 4.3 207.8 Somers Town 169 4.8 212.5 Camden Town 63 4.0 194.4 Kentish Town 361 4.0 230.1 * The previous address of 26 persons dying from Pulmonary diseases in Public Institutions and 138 persons dying from "all causes" in Public Institutions could not be ascertained, and the deaths of these persona are therefore excluded from consideration. The death rates are calculated on the population of each district which does not include persona resident in hospitals and workhouses. 8 Tubercular Diseases. There were 604 deaths from the principal tubercular diseases during the year, being practically the same number as that of last year. During the preceding eight years there has been an average number of 130.2 deaths from these diseases in every 1000 deaths from 'all causes' or 2.6 in every 1000 persons living. In 1882 the proportion of deaths from these diseases has been 127.6 in every 1000 deaths from 'all causes,' or 2.5 in every 1000 of population living. In London the proportion has been 128.8 per 1000 of deaths from 'all causes,' or 2.7 in every 1000 living. The following table shows the relative mortality from this class of disease in the different sub-registration districts. Sixteen deaths from these diseases and 138 deaths from 'all causes' occurring in public institutions are excluded from considerations (vide note, page 5). Sub-registration Districts. Nr. of Deaths. Proportion per 1000 of Population. Proportion per 1000 of total deaths. Regent's Park 79 2.0 108.9 Tottenham Court Road 74 2.7 133.8 Grays Inn Lane 96 8.1 151.1 Homers Town 118 8.4 148.4 Camden Town 48 3.0 148.1 Kentish Town 178 1.9 113.4 Wasting and Convulsive Diseases of Infants. There were 241 deaths amongst children under one year of age from the Wasting Diseases of children, or 31.0 to every 1000 of births and 217.1 to every 1000 of total deaths under one year. There were also 166 deaths amongst children of the same age due to Convulsive Diseases being 21.8 per 1000 of births and 149.5 per 1000 of total deaths under one year. The following tables show the incidence of deaths at these ages from these diseases upon the different sub-registration districts, but in the first table six deaths from wasting diseases, and 17 from 'all causes' under one year could not be referred to the districts to which they belong. In the second table all the deaths from convulsive diseases could be referred, but again 17 deaths from 'all causes' under one year of age were excluded from consideration. 9 Wasting Diseases. Sub-registration Districts. No. of Deaths. Proportion per 1000 of of Population. Proportion per 1000 of Total Deaths under 1 year. Regent's Park 44 1.11 260.3 Tottenham Court Rd. 24 0.88 208.6 Gray's Inn Lane 33 1.09 227.5 Somers Town 30 0.89 154.6 Camden Town 24 1.53 307.6 Kentish Town 82 0.93 209.1 Convulsive Diseases. Regent's Park 27 0.69 159.7 Tottenham Court Rd. 21 0.77 182.6 Gray's Inn Lane 15 0.49 103.4 Somers Town 34 0.98 175.2 Camden Town 17 1.08 217.9 Kentish Town 52 0.58 132.6 Zymotic Diseases. There has been a marked decrease since the previous year in the number of deaths from diseases of the zymotic class. In 1881 the nine principal zymotic diseases caused 182.4 in every 1000 deaths from 'all causes' or 3.8 in every 1000 of population ; during 1882, these proportions have been 154.1 and 3.0 respectively. During the previous ten years the average proportions had been 155.5 and 3.4. In London during 1882, these proportions were, 163.4 and 3.4. St. Pancras has therefore during 1882 suffered proportionately to a less extent than the whole of London. The decrease in the number of deaths in 1882 upon that in 1881 will be found to have taken place in each of the nine principal Zymotic diseases but whooping cough and enteric fever, the amount of decrease will be shown when each disease is considered. The accompanying table shows the relative proportion of deaths from these diseases in the different sub-registration districts; all deaths occurring in public institutions have 10 been referred to the sub-registration district to which they belong with the exception of seven deaths from zymotic diseases, and 183 deaths from 'all causes' whose previous residences could not be ascertained (Vide Note, page 5). It will be noted that the sub-registration districts, Gray's Inn Lane and Somers Town have suffered proportionately more than the others. Sub-registration Districts. Total Deaths. Proportion per 1000 of of Population. Proportion per 1000 of Total Deaths. Regent's Park 114 2.9 150.0 Tottenham Court Road 68 2.4 122.9 Gray's Inn Lane 110 3.6 173.2 Somers Town 120 8.4 150.9 Camden Town 89 2.4 120.3 Kentish Town 271 8.0 177.7 Small Pox. It is gratifying to record a much diminished mortality from this disease. Instead of 84 deaths as in 1881, there were but 6 deaths during 1882, being in the proportion of 1.2 in each 1000 deaths from 'all causes.' The distribution of the deaths is as follows:— Regent's Park 1 Tottenham Court Road 0 Gray's Inn Lane 8 Somers Town 1 Camden Town 0 Kentish Town 1 Altogether 61 cases were reported to the Sanitary Department, 51 of which were removed to hospital. During the preceeding ten years the annual average number of deaths was 43.1 being in the proportion of 8.5 to 1000 deaths from all causes. In London as a whole this proportion was, in 1882, 5.1, being fully four times as much as in St. Pancras during the same period. 11 The facts in connection with one death are interesting, as showing the manner in which small pox is conveyed from one district to another. A woman living in Netley Street nursed a case of small pox in Wardour Street and when her patient had recovered, returned to her home.; shortly after her return she sickened with small-pox which she had evidently contracted in Wardour Street. During her illness she was nursed by her sister who in turn contracted the disease and died. If the case in Wardour Street had been known to the Sanitary Authority, and steps had been taken to secure the re-vaccination of those who came in contact with the sufferer, the last two cases would never have occurred, and one life would have been saved. Measles. Measles caused 130 deaths in 1882, being 42 less than in the previous year. The number of deaths from Measles was 27.4 in every 1000 deaths from 'all causes,' and .54 per 1000 of population. During the previous decade, Measles caused in St. Paucras an average of 22.5 in every 1000 deaths from all causes. In London, in 1882, Measles caused 28.0 in every 1000 deaths from 'all causes,' and .59 per 1000 of population being therefore slightly in excess of the St. Pancras death rate. The incidence of deaths from Measles on the different subregistration districts was as follows:— Sub-Registration Districts. No. of Deaths. Proportion per 1000 of Population. Proportion per 1000 of total Deaths. Regent's Park 19 0.49 25.0 Tottenham Court Road 4 0.14 7.2 Gray's Inn Lane 84 1.1 58.7 Somers Town 17 0.49 21.8 Camden Town 4 0.25 12.8 Kentish Town 46 0.52 80.1 Six deaths from Measles, and 188 deaths from 'all causes' occuring in public institutions could not be raferred to the sub-registration district to which they belong, and are therefore excluded from consideration. Scarlet Fever. During 1882, in St. Pancras, 66 deaths occurred from 12 Scarlet Fever, or a little more than a third of the number in 1881, and slightly more than half the annual average of the previous 10 years. Altogether 277 cases were reported to the Sanitary Department of which 92 were removed to hospital. The proportion of deaths from Scarlet Fever to 1000 deaths from 'all causes' was 13.9 in 1882, and 24.6 in the ten preceding years, and the proportion of deaths to each 1000 of population was in 1882 0.27. In London as a whole deaths from Scarlet Fever were in the proportion of 23.9 per 1000 of total deaths, and 0.51 per 1000 of population. The following table shows the relative amount of Scarlet Fever in the different sub-registration districts calculated upon each 1000 deaths from 'all causes,' and each 1000 of population. One case occurring in a public institution, and 138 deaths from all causes in public institutions could not be referred, and are therefore omitted from consideration (vide note page 5.) Sub-registration Districts. No. of Deaths. Proportion per 1000 of Population. Proportion per 1000 total Deaths. Regent's Park 8 0.24 10.5 Tottenham Court Road 4 0.14 7.2 Gray's Inn Lane 11 0.86 17.3 Somers Town 8 0.23 10.0 Camden Town 8 0.51 24.6 Kentish Town 26 0.29 17.1 An out-break of Scarlet Fever of special interest occurred in the beginning of the year. On January 28th, I received a letter from the Medical Officer of Health to St. Giles, calling my attention to an unusual prevalence of Scarlet Fever in the area, lying between Tottenham Court Road and the Gray's Inn Road. I immediately addressed a circular letter to all the medical men in practice in that locality, asking for information concerning the cases of this disease in their practice, and made an inquiry at all the houses in that district, with a view of obtaining further information on the subject. An investigation which was being conducted by the Medical Officer of Health to St. Giles, showed a special incidence of the disease upon houses supplied with milk from a particular dairy, situated in his district, and the same incidence was noticeable upon houses in St. Pancras supplied by the same milk vendor. Nearly all the parsons who 13 received their milk supply from this source, were resident in the districts of St. Giles and St. George's, Bloomsbury, while a smaller number resided in St. Pancras and in Marylebone. As soon as it became obvious that the out-break had a relation to other districts, and possibly to a milk farm, situated in Surrey, the Vestry thought it advisable to call the attention of the Local Government Board to the subject, and as a result, an Inspector of that Board was instructed to investigate it. Among the sufferers were two children of a milk carrier in the service of a dairyman, but evidence showed that these were the effect rather than the cause of the infection of the milk. Attention was then directed to a farm in Surrey from which the milk generally came. I visited this farm together with the Medical Inspector from the Local Government Board, and the Medical Officer of Health to St. Giles, but no evidence could be found of scarlet fever having existed there, nevertheless, further evidence was obtained which tended to prove the milk responsible for the disease, for another supply of this milk which was sent directly from the same farm to a district in the South of London, was accompanied by the appearance of the disease in that district amongst those drinking it. The conditions under which milk can give rise to infectious disease are not fully understood, but the present case raises the suspicion that milk may become infected with scarlet fever poison from other source than an antecedent case of the disease. The most marked characteristic of the outbreak was the large number of persons attacked with scarlet fever or throat illness within a short period of one another and the mild form of the disease. But one death occurred, that of an old lady who was suffering at the same time from a severe attack of bronchitis. During September, the rapid increase of scarlet fever in the Metropolis, for a time deprived the Vestry of the opportunity of removing to the London Fever Hospital persons suffering from scarlet fever who were not paupers. This period may be referred to as one which affords good evidence of the unsatisfactory position of the Metropolitan Sanitary Authorities with regard to hospital provision for cases of infectious disease. As soon as it became known that all the beds in 14 the London Fever Hospital were occupied, the Vestry acceded to the request of the Committee of that institution to lend for erection on their ground at Islington the tents stored at Finchley; by the time, however, that the tents were erected, difficulties occurred which prevented their occupation and finally they were returned to the Vestry without having been used at all. It was fortunate that during this period St. Pancras was far more free from scarlet fever than the rest of the Metropolis, otherwise there would probably have been no alternative but to have again opened the hospital at Finchley. Diphtheria. During 1882 there were 51 deaths from diphtheria, being 19 less than in 1881, and 71 cases were reported to the Sanitary Department. The number of deaths was 10.7 in every 1000 deaths from 'all causes,' and 0.21 in every 1000 of population. During the previous 10 years the average number of deaths from diphtheria had been 7 in every 1000 deaths from ' all causes.' In London the average number of deaths was 10.4 in every 1000 deaths from 'all causes,' and .22 per 1000 of population, being about the same as in St. Pancras. The following table shows the incidence of deaths from diphtheria on the different sub-registration districts. AJ1 tha deaths from diphtheria were referred to the sub-registration districts to which they belong, but 188 deaths from 'all causes,' which could not be referred are eliminated from consideration. Sub registration Districts. No. of Deaths. Proportion per 1000 of Population. Proportion per 1000 of total deaths. Regent's Park 9 0.28 11.8 Tottenham Court Road d 9 0.33 16.2 Gray's Inn Lane 2 0.06 8.1 Somers Town 8 0.08 3.7 Camden Town 2 0.12 6.2 Kentish Town 26 0.29 17.0 Whooping Cough. This disease caused 288 deaths or 66 more than in the previous year, and 98.1 more than the average of the previous ten years. The number of deaths in 1882 was 60.9 15 in every 1000 deaths from 'all causes' and 1.21 in every 1000 of population. In London these proportions were 56.0 and 1.19 respectively. Whooping cough, has therefore, been exceptionally fatal in St. Pancras. The following table shows the incidence of this disease upon the sub-registration districts of St. Pancras. All the deaths from whooping cough occurring in public institutions are referred to the districts to which they belong, but 138 deaths from 'all causes,' which could not be referred are omitted from consideration. Sub-registration Districts. No. of Deaths. Proportion per 1000 of Population. Proportion per 1000 of total deaths. Regent's Park 53 1.35 69.7 Tottenham Court Road 19 0.69 34.3 Gray's Inn Lane 29 0.96 45.6 Somers Town 56 1.62 70.5 Camden Town 14 0.89 43.2 Kentish Town 117 1.32 76.7 Typhus Fever. One death was registered after an inquest from 'apoplexy typhus fever,' this being the only case reported to the Department. The death had been previously registered as being due to pneumonia. A child of the deceased had been removed to the Homerton Fever Hospital, under the belief that it was suffering from typhus, but I was informed by the Medical Superintendent of that Institution that it did not suffer from th&t disease. An investigation into the circumstances of the case has led me to the belief that the first case was not typhus, and therefore during 1882 we may assume that St. Pancras has been free from that disease. But 52 deaths from this disease were registered in the whole of London during 1882. Enteric Fever. Enteric fever caused 69 deaths being 3 more than in the previous year, and 6.3 more than the average of the preceding 10 years. The number of deaths in 1882 is in the proportion of 14.5 per 1000 of total deaths from 'all causes,' and 0.29 per 1000 of population. In London these proportions were 11.7 16 per 1000 of total deaths, and 0.29 per 1000 of population, St. Pancras has therefore suffered more heavily from this disease than the Metropolis. Altogether 83 cases of this disease were reported to the Sanitary Department. The following table shows the incidence of this diseaso upon the various sub-registration districts. All the deaths from enteric fever were referred to the sub-registration districts to which they belong, but 138 deaths from 'all causes, could not be referred and are therefore omitted from consideration. Sub-Registration Districts. No. of Deaths. Proportion per 1000 of Population. Proportion per 1000 of Total Deaths. Regent's Park 7 0.18 9.2 Tottenham Court Road 9 0.33 16.2 Gray's Inn Lane 13 0.43 20.4 Somers Town 9 0.26 11.8 Camden Town 6 0.88 18.5 Kentish Town 25 0.28 16.3 Simple Continued Fever. No death was registered as occurring from Simple Con* tinued Fever during 1882. Diarrhœa. There were 119 deaths from Diarrhoea, being 92 less than in the previous year, and 85.4 less than the average of the preceding ten years. During 1882 the deaths from this disease in St. Pancras were 23.4 per 1000 of total deaths and 0.50 per 1000 of population; in London these proportions were 26.0 and 0.55, St. Pancras has therefore suffered proportionately slightly less from fatal diarrhoea. Of the 119 deaths, 89 occurred in children under one year of age and 15 amongst those from one to five. When all the cases of fatal diarrhœa are referred to the sub-registration districts to which they belong, their incidence is as follows. The table does not take cognizance of 138 deaths of persons from 'all causes' occurring in public institutions, the previous residence whom could not be ascertained. 17 Sub-registration Districts. No. of Deaths. Proportion per 1000 of Population. Proportion pe 1000 of Total Deaths. Regent's Park 17 0.43 22.8 Tottenham Court Road 28 0.84 41.5 Gray's Inn Lane 18 0.59 28.3 Somers Town 26 0.75 82.7 Camden Town 5 0.81 15.4 Kentish Town 80 0.84 19.1 Puerperal Fever. In 1882 this disease caused 12 deaths or 7 less than in the preceding year. The proportion which these deaths bear to 1000 deaths from 'all causes' is 2.5 in St. Pancras, and in London it is 8.4 or 0.9 in excess of St. Pancras. The distribution of the deaths in the different sub-registration districts is as follows:— Regent's Park 0 Tottenham Court Road 1 Gray's Inn Lane 3 Somers Town 1 Camden Town 0 Kentish Town 7 Violent Deaths. The deaths from violence in 1882 were 184 in number, or if corrected 121, being 33 less than in the previous year. Of these deaths, 99 occurred from accident or negligence, 7 from homicide, and 15 from suicide, the last number being 8 less than in 1881. The number of infants suffocated was 25 as against 42 in the previous year. Fractures and contusions caused 50 deaths. There were 429 inquest cases held in St. Pancras during the year, being 20 more than in 1881. Uncertified Deaths. The uncertified deaths in St. Pancras were 6 in number, or but one third as many as in the previous year. They were in the proportion of 1.2 in every 1000 deaths, while in London they were in the proportion of 11.8 in every 1000 deaths. 18 INFECTIOUS DISEASES. It is interesting to observe the proportion of cases of infectious disease which were unknown to the Sanitary Department. Taking into consideration three diseases: Small-pox, Scarlet fever, and Diphtheria alone, we find that 409 cases became known to the Department, while 123 daaths remitted from these causes. Now 123 deaths represent at the very least ten times the number of cases or 1230. At this estimate, only one case in every three which occurred became known, and a large share of these would never have been heard of, if the death register had not borne witness to the case. It is a matter for regret that more information is not given to the Sanitary Department and that greater use is not made of the opportunities afforded by the Vestry for the isolation of infectious persons and for the disinfection of their rooms, clothing, and bedding. The advantages which result from utilizing the machinery of the department cannot be learnt at once, nor will they be fully appreciated until the public have become better educated as to the manner in which diseases spread. Nevertheless, the Vestry have done good work in preventing the extension of disease from those centres which became known to them. Altogether, 85 cases of small pox and 64 cases of fever were removed to hospital by the Vestry's ambulance apart from those cases removed to the Metropolitan Asylums' Board, and other hospitals. Four hundred rooms and a large amount of bedding and clothing were disinfected. It is doubtless to these measures that St. Pancras is partly indebted for the fact, that there has not been a larger mortality from infectious diseases and it is upon their further extension that we must rely if our efforts in preventing disease are to meet with a larger success. There is, however, one of the infectious diseases for which different preventive measures are required, which can be absolutely prevented if these are properly carried out. I refer to small pox, and its prevention by properly performed vaccination and re-vaccination. At the time I write, efforts are being made in our district to prejudice our parishioners against vaccination. That they will not meet with success among the thinking portion of the community there is no doubt; as evidence that they have met with no success among our legislators may be 19 instanced, the refusal of the House of Commons by a majority of 286 to 16 to approve a resolution condemnatory of the Compulsory clauses of the Vaccination Acts. The evidence which has been accumulated in the small pox. hospitals, in the public services, and in the death registers, has placed the value of vaccination beyond a doubt in every reasonable mind. It may, however, be well to note the evidence on this subject which was forthcoming in 1882, derived from the statistics of the previous year, and we cannot do better than extract from the report of Dr. Buchanan, the Medical Officer to the Local Government Board the following paragraph:— "The population of London under 10 was 916,784 on census night, 1881. It divides, to speak in round numbers, into about 55,000 unvaccinated and 861,000 vaccinated. In 1881, the small pox deaths of London among children under ten, turn out to have been: (a) 782 deaths among the 55,000 who had not been vaccinated; (b) 125 deaths among the 861,000 who had been vaccinated. Upon equal numbers of the two classes, therefore, the mortality from small pox among the unvaccinated was about a hundredfold the mortality from small pox among the vacoinated. This degree of protection was given to children under 10 by the average current vaccination of London. If the London children under 10 who were unvaccinated had had the protection which the current vaccination gives, not 782 of them, but at the outside nine, would have died of small pox during the year. If the 861,000 vaccinated children had died at the rate the 55,000 unvaccinated, we should not now be considering 125 small pox deaths, and how they can be reduced, but we should be confronted with an additional 12,000 and more deaths from small pox, occurring during the year in the London population under ten years of age." The accompanying tables for which I am indebted to tbe Vaccination Officers, Messrs. Richards and Webb show the results obtained by proceedings under the Vaccination Acts in St. Pancras. They show that 7961 children were born during the twelve months, June, 1881 to June, 1882, that 6795 was successfully vaccinated, 10 were reported as insusceptible to vaccination, 3 had small pox, 592 died unvaccinated, in 102 cases the vaccination was postponed by medical certificate, 88 children were removed to districts known to the Vaccination Officer, 424 were removed to places unknown, and there were 2 outstanding. Return for the Period—July to December, 1881. 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, 1881, 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, 1881. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Dead Unvaccinated. Postponement by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown, which cannot be reached, and Cases not having been found. Cases Outstanding. 1 Kentish Town 1495 1293 2 ... 107 22 10 59 2 2 Regent's Park 592 492 1 ... 62 6 2 29 3 Camden Town 411 363 1 ... 27 5 4 14 4 Somers Town 601 490 2 1 53 10 1 44 5 Tottenham Court Boad 381 312 1 ... 28 1 ... 42 6 Gray's Inn Eoad 504 402 1 47 11 5 38 Total 3990 3352 7 2 324 55 22 226 2 Return for the Period- January to June, 1882. 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 80th, 1882, 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, 1882. Succesfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Dead Unvaccinated. Postponement by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown, or which cannot be reached; and Cases not having been found. Cases Outstanding. 1 Kentish Town 1512 1345 1 ... 98 17 11 40 2 Regent's Park 618 520 ... ... 47 7 ... 44 3 Camden Town 360 327 1 ... 20 5 ... 7 4 Somers Town 606 520 ... ... 48 10 ... 28 5 Tottenham Court Road 389 330 1 1 28 ... ... 29 6 Gray's Inn Road - 486 401 ... ... 27 8 ... 50 Total 3971 3443 3 1 268 47 11 198 23 The avoidance of vaccination by the removal of a child from one district into another is openly recommended with this object by those who are endeavouring to prejudice persons against vaccination, and it becomes therefore necessary to guard against this dangsr. Beyond these efforts which may be made for overcoming prejudice, the chief measure which has to be relied upon is a house to house visitation and inquiry for unvaccinated persons. This has been done very unequally in the Metropolis, and there is no doubt but that in which ever district the Guardians are most slow to adopt this method of procuring vaccination, in that district will the largest number of unvaccinated persons congregate and eventually the largest mortality from small pox take place. A house to house inquiry by the Vestry's officers during a local outbreak of small pox in 1880 showed the value of such a course and the amount of good which results from a direct personal appeal to individuals to protect themselves against small pox. It is then very desirable that when small pox is absent from our district, that unceasing efforts should be made to prevent an increase of the unvaccinated population. Those whose interest it is to save life as well as to prevent the needless expenditure of public money, will see the need for such action. REPORT OF THE HOSPITAL COMMISSION. As part of the consideration of the subject of diseases of the Zymotic class it will be fitting to make some reference to the Report of the Commissioners appointed to inquire respecting Small Pox and Fever Hospitals, before whom your Vestry Clerk and Medical Officer gave evidence. It will be unnecessary to recapitulate the opinions the Vestry have from time to time expressed upon this subject, but it is gratifying to find that they, as well as those of most of the Sanitary Authorities, are on the whole in accordance with the views of the Commissioners. The Commission, after accepting as conclusively proved that the aggregation of a large number of cases of small pox in the acute stage of the disease gives rise to the occurrence of small pox in the neighbourhood, state that "all evidence goes to show that well-conducted fever hospitals involve no appreciable risk to the neighbourhood." 24 Dealing with the administrative questions raised, they report as follows:— "We are of opinion that the provision of hospital accommodation for persons suffering from infectious disease in the metropolitan districts should be entirely disconnected from the administration of the poor law, and treated as part of the sanitary arrangement of the Metropolis. "We think that the conduct of the hospitals cannot be better placed than under the management of the Metropolitan Asylums Board, with such changes in their mode of election as shall give the Sanitary Authorities of London, that is to say, the Vestries, District Boards, and Commissioners of Sewers, at least an equal influence with the Guardians of the Poor, in the choice of the elective members of the Board. "We think that every person suflering from an infectious disease, or those in charge of him, or if these neglect their duty, the occupier of the house in which the sick person is residing, or if he is a pauper, his medical attendant should be required by law to notify the nature of the disease to the Medical Officer of Health so soon as they or any of them are aware of it, and that in the case of non-paupers, the medical attendant should, if it is inexpedient to impose any further obligation on him, be similarly required by law to furnish the sick person, or those in charge of him, with a certificate of the nature of the disease, in the form in which we have already suggested, to be by them communicated to the Medical Officer of Health. On every certificate so communicated, a small fee should be paid to the medical man who signed it. "If the Medical Officer after receiving such certificate, is. satisfied that the patient can and will be properly isolated, and requisite means for disinfection adopted, the matter will proceed no further. "If he is not so satisfied, and if the sick person is not too ill to be removed, he will notify the case to the Metropolitan Asylums Board, who will thereupon be at once and entirely charged with the patient till his complete recovery, and in particular, will be empowered to remove him at once, to one of their hospitals. So far, no distinction ihould be made between paupers and non-paupers who cannot be isolated. But within the hospital those who are desirous of being placed. 25 in separate wards should be allowed such accommodation, on paying for it; in case of ordinary accommodation, it appears to us a question whether payment should be claimed even from those who can make payment without difficulty. "If the sick person cannot be removed or isolated by those about him, the Medical Officer will be bound to take all necessary steps for his isolation and generally for the protection of the neighbourhood, with power to clear the house of its inmates. In all cases he will be bound to disinfect the house, and in the case of houses invaded by Small Pox, should be empowered to require the re-vaccination of all occupants who are not otherwise protected. "We are led by the concurrent evidence of several experienced witnesses, to hope that the immediate and complete isolation which ought to be secured by these means will greatly diminish the amount of Small Pox, Scarlet Fever, and Typhus in London. With regard to these, and also Typhoid, still further diminition may be anticipated if the attention of the proper authorities is directed to the removal of all local causes of disease, and to the constant employment of means of disinfection. And we feel bound to repeat our conviction that Small Pox would still further be reduced if vaccination could be made more effectual, and re-vaccination more frequent. But in what follows we take little or no account of these reductions. How far our recommendations will, from this cause, be in excess of what is eventually found necessary is a mere matter of conjecture. We hope they may prove considerably so. Meantime this uncertainty is a reason for proceeding somewhat tentatively. "Subject, therefore, to what may be expected from the above or other preventive measures, we think it would be advisable that there should be sites and buildings which could without difficulty, be made capable of receiving 3000 Fever Patients, and 2100, or by special exertion, 2700 Small Pox Patients. "Of the 3000 Fever cases, those in the earlier stage, probably about half, should be provided for in the neighbourhood of London, the other half, the convalescents, in two or three of the country hospitals. "The existing hospitals of the Metropolitan Asylums Board. 26 which in our judgment, can no longer be used, to anything like their present extent, for cases of Small Pox, should we think, become in the main Fever hospitals. And we think it probable that with the aid of another hospital, which appears to be almost indispensable for the east of London, they would fully accommodate all the cases requiring London treatment. "By these arrangements cases of fever would be adequately provided for. "Of the 2100 small pox cases, the mild, and with them the convalescent cases, being probably more than three-quarters of the whole, should be provided for in two or three more country hospitals. "The remainder, being the severe cases, during their acute stage must be provided for in or within easy reach of London. "For these 400 or 500 persons who, being too ill to take a long land journey to the country hospitals, but at the same time not too ill to be removed from their immediate neighbourhood, cannot or will not be properly isolated by those in charge of them, we think, in the first place, that administrative blocks with a few small wards attached to them might be maintained within the precincts of the fever hospitals, sufficient, in each hospital for 30 or 40 small pox patients; that the hospital authorities should divide the Metropolis into hospital districts, assigning one to each hospital; and that no hospital should receive small pox patients except from the district in which it is situated. "This qualification is required not only becanse the patients will always be such as must be sent to the nearest hospital, but also to obviate, as far as the nature of the case admits of it, the great and natural complaint of those who are in the neighbourhood of large small pox hospitals, that the infec-' tion of the rest of London is poured in upon them. "With regard to matters of detail, we have already recommended that the hospital authorities should have the entire control of the ambulances, by which all other modes of conveyance should be as far as possible superseded." 27 It is not quite obvious on what grounds it is proposed that the Guardians of the Poor should be represented on a Board which should have purely sanitary functions, but with this exception, the report may be accepted as offering a satisfactory solution to this difficult question. Experience alone can show what may be the effect of the aggregation of even so small a number as 30 or 40 cases of small pox, but it may be hoped that hospital provision for this disease will become less and less wanted as better facilities are given for securing the vaccination and re-vaccination of persons living in houses in which cases of small pox occur. The existing arrangements in London for this purpose are altogether inadequate to secure that end, indeed the only legal provision which has been made relates solely to cases in which the person attacked with small pox happens to be a pauper, and even then as a matter of practice this provision is rarely acted upon. Such difficulties will always occur so long as important sanitary measures are merely a branch of poor-law administration. It is only when the principle is accepted that the assistance offered is for the protection of the public, rather than for the relief of the individual, that considerations of the social condition of the sufferer will not be permitted to limit the benefit of aid which is necessary for the safety of the community whether the individual be a pauper or not. SANITARY CONDITION OF DIFFERENT SUB-REGISTRATION DISTRICTS. I am glad to be able in the present report to compare with greater accuracy than before the rates of mortality in the different sub-registration districts. For the purposes of comparison the following figures are taken from the tables already given. In their preparation the deaths of non-parishioners occuring in public institutions in the parish are excluded, from consideration, while the deaths of parishioners occurring in public institutions in all parts of the Metropolis are included, with the exception of 138 deaths from 'all causes,' including 16 from tubercular, 26 from pulmonary, and 7 from zymotic diseases, which could not be referred to the district to which they belong. 28 The following table thus shows the death rates from certain diseases during 1882:— Sub-Registration Districts All Diseases. Tubercular Diseases. Pulmonary Diseases other than Phthisis. Zymotic Diseases. Regent's Park 19.3 2.0 8.6 2.9 Tottenham Court Road 20.2 2.7 4.2 2.4 Gray's Inn Lane 21.0 8.1 4.3 3.6 Somers Town 23.0 8.4 4.8 8.4 Camden Town 20.5 3.0 4.0 2.4 Kentish Town 18.4 1.9 4.0 8.0 "Whether the death-rate be calculated on the deaths from 'all causes,' on tubercular diseases, on pulmonary diseases, or on zymotic diseases, the result is always the same, Somers Town and Gray's Inn Lane sub-registration districts head the list: Kentish Town has the lowest death rate in all except from pulmonary diseases, when Regent's Park is lower still. When the death-rate among infants comes to be considered we find that when calculated upon the number of registered births the following results are obtained:— Sub-Registration Districts. No. of Deaths under one. Proportion to 10 births. Regent's Park 169 142.1 Tottenham Court Road 115 162.5 Gray's Inn Lane 146 155.5 Somers Town 194 165.6 Camden Town 78 108.5 Kentish Town 892 134.4 Here again, Somers Town heads the list, and Tottenham Court Road and Gray's Inn Lane follow. The small death rate of Camden Town is probably due to the fact that deaths occurring in the Workhouse which is situated in that subregistration district are referred to the sub-registration districts to which they belong while the births are not. So again, just as we find one sub-registration district in St. Pancras, having a far higher death rate than another, we find in eaoh district the inhabitants of one locality dying at a far greater rate than in another, and wherever this may be, it is always the poor living under the worst hygienic conditions who suffer most. Let us take for example the death rates of certain special localities in the Gray's Inn Lane sub-registration district. In Cromer Street the rate of mortaliy is 25.8 per 1000; 29 in Poplar Place, 30.0 per 1000; in Prospect Terrace, 85.2 per 1000; in Derry Street 44.4 per 1000; in Wellington Square, 53.7 per 1000, all be it remembered, compared with a general death rate of the district of 21.0. As evidence that it is possible for a population to live in the Gray's Inn Lane subregistrarion district under conditions more favourable to life, may be cited the death-rate of a model lodging house, Derby Buildings, where the death-rate for 1882 was only 18.7. So again, in the Tottenham Court Road sub-registration district where the general death rate is 20.2, that of Draper's Place is 38.8, a death rate nearly twice as much as in the district as a whole. If the death rate of our parish is to be lowered, it must be by the removal of those circumstances which lead to the loss of life of which these figures give evidence. As the Vestry are aware, much has been done already by insisting upon a higher degree of cleanliness in the dwellings of the poor, by dealing with nuisances as they arise in individual houses; there are however, some conditions intimately bound up with the health of the people, which can only be altered on a much larger scale, I refer particularly to the pollution of water supplied by the Water Companies in a great proportion of dwelling houses. It is unnecessary to describe the endless opportunities which the cistern and water-butt give for the pollution of water which is used for food, but it may be accepted that in houses without number water which enters them wholesome and good, is by the time it comes to be consumed often absolutely injurious to health. Nor can a system, which is open to this accusation, be defended on the score of expense, for those who own house property have had too much experience of the constant expenditure incurred in attempting to maintain in proper condition cisterns and water-butts. The time has certainly come when all classes of the population should be able to receive their water free from impurity, and the first step towards this is the provision of a constant service. I have in former reports pointed out the improved position the Vestry might occupy towards houses inhabited by the very poor if regulations were made under the 35th Section of the Sanitary Act, for dealing with tenemented houses. Objection has been made to this course, based upon the belief that it it would be necessary under this clause to treat alike all houses let in lodgings. There is however, no necessity to bring under the control of the regulations other houses than those which are let out in tenements to the very poor, but 30 much good would result if houses of this class were registered and were made to comply with certain requirements. If regulations were made under this clause the owners of houses would be at once liable to penalty if these regulations were disobeyed. Under present arrangements it becomes necessary for a notice to be served, for the owner to be summoned, and for an order to carry out the work to be made by the Magistrate, the owner only becoming liable to penalty when the Magistrate's order is disobeyed. The time must come however, when property of the worst sort will have to be dealt with under other Acts. Since my last Report, I have reported to the Vestry the houses in Mary Place, Stanhope Street, in Poplar Place and a number of houses in Compton Place, under the Artizans Dwellings Act, of 1876. "With regard to Mary Place, the Vestry have postponed making an order under the Act, with a view to giving the owners the opportunity of endeavouring to put these houses into habitable condition. Concerning the houses in Poplar and Compton Place, they will again be before the Vestry on the Eeport of the Chief Surveyor. Before leaving the subject of unhealthy dwellings, it is my duty to refer to the insufficiency of the regulations made by the Metropolitan Board of Works to ensure the proper construction of new houses. A number of houses have been erected in the Kentish Town sub-district to which the attention of the Metropolitan Board of Works was directed by the Vestry on the recommendation of the Sanitary Committee. The materials of which these houses consist were condemned by many members of the Committee who had a practical knowledge of building; the regulation of the Metropolitan Board which admits the use of 'grit' opens the door to the use also of much worthless material. The regulation which requires a damp-course to be inserted into the walls, does not prevent this from consisting of nothing but a few bits of zinc placed between the bricks at intervals, and from being placed at a higher level than the floor which it is intended to prevent from receiving moisture from the earth. The result of the erection of such houses is only too clear, the inmates will suffer from ill-health, the houses will shortly become dilapidated, and a few years will probably require the Vestry to be at the trouble and expense of dealing with these houses under the Artizans' Dwellings Acts. 31 LEGISLATION DURING THE YEAR. Artizans' Duellings Act, 1892.—This Act amends the Artizans' and Labourers Dwellings Improvement Acts, 1875 and 1879 in certain important particulars. Under the 1875 Act, it is ordered that an improvement scheme of a Local Authority shall provide for the accommodation of at the least as many persons of the working class as may be displaced in the area with respect to which the scheme is proposed, in suitablo dwellings which, unless there are special reasons to the contrary shall be situated within the limits of the same area, or in its vicinity. Under the 1879 Act it is permitted that the accommodation may be provided at some other place than within the area or its immediate vicinity, while under the Act of 1882, the Confirming Authority is permitted to dispense with the obligation of the Local Authority to provide accommodation for one half of the persons of the working class thus displaced. The same Act provides that where the Officer of Health finds any building, although not in itself unfit for human habitation, is so situated that by reason of its promixity to or contact with any other buildings, it stops ventilation or otherwise conduces to make or makes such other buildings in a condition unfit for human habitation, or it prevents proper measures from being carried into effect for remedying the evils complained of in respect of such other buildings, he shall report the case to the local authority who shall have the same powers for its removal as if it were itself unfit for human habitation. Metropolis Management and Building Acts (Amendment) Act, 1982.—This Act among other matters provides that every new building begun to be erected upon a site not previously occupied, in whole or in part, by a building after the passing of this Act, intended to be used wholly or in part as a dwelling house, shall, unless the Metropolitan Board of "Works otherwise permit, have directly attached to it, and in its rear, an open space exclusively belonging to it of the following extent:— "Where the building has a frontage not exceeding 15 feet, the extent of the open space shall be at least 150 square feet. "Where the frontage is not less than 15 feet and not more than 20 feet, an open space not less than 200 square 32 feet. Where the frontage is over 20, and not more than 30 feet, an open space of not less than 300 square feet. Where the frontage exceeds 30 feet, an open space of not leas than 450 square feet. A part of the same clause, however, permits the erection over this so-called open space of a building which is not higher than the level of the ceiling of the ground floor storey. Another clause of the same Act gives power to the same Board to make complaint to a Magistrate where any building is ruiuous, or so far dilapidated as to have become unfit for use or occupation, or is in a structural condition prejudicial to the property in, or the inhabitants of, the neighbourhood. The justice may order the building to be demolished or repaired, and if this order is not obeyed, the Board may execute the order. Minute of the Education Department of the Privy Council.— A minute of the 6th March, 1882, establishing a new code of regulations, orders that "the Managers of School Board Schools must comply with any notice of the Sanitary Authority requiring them for a specified time with a view to preventing the spread of disease either to close the School, or to exclude any Scholar from attendance subject to an appeal to the Department if the Managers consider the notice to be unreasonable." This minute throws a responsibility on the Vestry, for it is to be expected that the School Board will seek the advice and assistance of the Sanitary Authority in all cases in which infectious diseases appear among children attending a School. It need not be anticipated that the power to close a School will frequently be exercised, but it is probable that the exclusion of a Scholar from attendance will be a much more frequent event, for speaking generally, no child ought to be permitted to attend School if any member of his family resident in the same house with him should be suffering from an infectious disease. SLAUGHTER-HOUSES. There are now 50 licensed slaughter-houses in St. Pancras. These have, with few exceptions, been kept in a cleanly condition during the year. In one case, after repeated warnings, the licensee was summoned, by the Vestry, and a penalty of £5 inflicted by the Magistrate for infringement of the Vestry's regulations. 33 COW-SHEDS. There are 49 licensed cow-sheds in St. Pancras. These also have with very few exceptions been kept in a cleanly condition, and the regulations of the Vestry have been complied with. BAKE-HOUSES. In June, 1882, I reported to the Vestry on this subject, and urged the necessity of an improved method of inspection, and regulation of bake-houses. The action which the Vestry took on that occasion in communicating with the various Vestries and District Boards elicited an almost unanimous opinion in favour of the views embodied in the report. The Vestry did not deem it desirable to proceed further in the matter, but there can be no doubt that to their timely action is very largely due the fact that the Government have brought in a Bill for the improvement of these places, an improvement which, while benefitting the public as well as those employed in bake-houses, will not prejudice the owners of existing bake-houses which cannot comply with all that will be required of those of more recent date. CANAL BOATS. Canal Boats have been inspected during the year, and no case of infectious disease in any such boat was reported to the department. There was no prosecution for using an unregistered canal boat as a dwelling. SANITARY WORK DURING THE YEAR. During the year 4259 houses and premises have been inspected, and 2600 notices served for their amendment. Table VI shows that 1628 water-closets have been improved, 886 dust bins, and 134 cisterns, and a large amount of other work performed. The following is a list of houses disinfected, and of articles of clothing, bedding, &c., disinfected in the Vestry's apparatus in Cambridge Street. Houses 296 Quilts 7 Rooms 400 Counterpanes 18 Beds 89 Carpets 6 Pillows 133 Rugs 5 Sheets 21 Mats 7 Blankets 91 Articles of wearing apparel 43 34 CONCLUSION. In conclusion of the Report for the year, 1882,1 may point out that this year is again one which bears witness to the good results of the continued efforts of the Vestry to prevent disease, efforts which have year by year borne fruit in adding to the health and happiness of the inhabitants of one of the largest districts in London. There is however, still much work before the Vestry, as a Sanitary Authority, to which their attention must be devoted. Efforts must be continually made to limit the spread of infectious disease wherever it should appear. The houses inhabited by the poorest members of the community must be unceasingly inspected if they are to be maintained in a proper sanitary condition; nor must the dwellings of their more wealthy neighbours be forgotten, seeing how frequently sickness occurs among them, due to ignorance or neglect. So again as increased knowledge teaches more fully the manner in which disease is caused, this knowledge must guide the Vestry in their labours to benefit those who are dependent upon them. I am, Gentlemen, Your obedient Servant, SHIRLEY F. MURPHY, Medical Officer of Health. Table I. Showing the Population, Inhabited Houses, Marriages, Births, and Deaths for the year 1882 and 10 years preceding. Gross Numbers. The Year.* Estimated Population. No. of Inhabited Houses. Marriages. Registered Births. Corrected Number of Deaths. s in Public Institutions. Total all Ages. Under One Year. Under Five Years. 1882 237,800 24,850 2,394 7,772 4,730 1,110 1,953 868 1881 236,600 24,701 2,212 7,943 5,000 1,234 2,055 1,047 1880 235,000 24,605 2,083 8,038 5,011 1,286 2,166 1,244 1879 240,000 26,020 2,154 8,226 5,189 1,231 2,100 1,295 1878 238,000 25,800 2,168 8,249 5,068 1,344 2,212 1,095 1877 236,000 25,580 2,235 8,126 4,927 1,169 1,947 1,169 1876 234,000 25,360 2,310 8,317 5,019 1,259 2,001 1,119 1875 231,000 25,140 2,289 8,000 5,401 1,272 2,017 1,091 1874 229,000 24,920 2,181 8,010 4,982 1,153 1,764 1,013 1873 227,000 24,700 2,238 8,095 5,149 1,305 2,116 1,039 1872 224,000 24,400 2,278 7,830 4,767 1,291 1,956 795 Average of 10 Years, 1872-81 233,060 25,122 2,194.8 8,083.4 5,051.3 1,254.4 2,032.3 1,089.7 Notes. 1. Population at Census 1881, 236,209. 2. Average No. of Persons in each house at Census 1881, 9.5. 3. Area of District in acres, 2,672. * 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 home, as ascertained at tbe preceding Censu . TABLE II. Showing the Annual Birth Rate, Death Bate, Death Rates of Children, and Proportion of Deaths in Public Institutions in a Thousand Deaths for the year 1882, and 10 years preceding. n Tear. Birth Bate per 1000 of the Population. Corrected Death Rate per 1000 of the Population. Deaths of Children under 1 year; per 1000 of Registered Births. Deaths of Children under 1 year; per 1000 of Total Deaths. Deaths of Children under 5 years; per 1000 of Total Deaths. Deaths in Public institutions; per 1000 of Total Deaths. 1882 32.6 19.89 142.8 234.6 412.8 183.5 1881 33.6 21.16 155.3 246.8 411.0 209.4 1880 342 21.32 159.9 256.6 432.2 248.2 1879 34.2 21.62 149.6 237.2 404.7 249.5 1878 34.6 21.71 162.9 265.1 436.0 216.0 1877 34.4 20.88 143.8 237.2 395.1 235.2 1876 35.7 21.54 151.3 250.8 398.6 222.9 1875 34.5 23.38 1S9.0 235.5 375.3 201.9 1674 35.0 21.75 145.9 231.4 352.0 203.3 1873 35.1 22.32 161.2 253.4 410.7 201.7 1872 35.1 21.28 163.6 270.8 410.3 164.9 Average of 19 years 1872—1881. 34.6 21.69 155.0 248.4 402.5 215.3 Note.—All the Death Kates are calculated on the corrected number of Deaths. Table III. Showing Deaths registered from all causes during the year 1882. Note—The Deaths of Non-Residents occurring in Public Institutions situated in the district are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the district are included. CAUSE OF DEATH. AGES. 0 to 1 1 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 and upwards Total under 5 years Total Specific FebrileorZymotic Diseases 283 355 70 34 31 19 13 8 7 4 — 638 824 Parasitic Diseases 15 1 — — — — — — — — — 16 16 Dietic Diseases 11 — — — 3 7 10 2 1 — — 11 34 Constitutional Diseases 100 121 50 76 144 155 116 82 44 8 2 221 898 Developmental Diseases 123 1 — — — — — 3 72 131 57 124 387 Local Diseases 405 325 76 54 132 177 230 305 340 148 23 730 2215 Deaths from Violence 31 15 8 7 16 17 12 4 6 3 2 46 121 Death from ill defined & not specified causes 142 25 3 4 7 3 9 14 16 10 2 167 235 Totals 1110 843 207 175 333 378 390 418 486 304 86 1953 4730 Class I —Zymotic Diseases. Order 1.—Miasmatic. Smallpox Vaccinated ... ... 2 ... ... ... 1 ... ... ... ... ... 3 Unvaccinated ... 1 ... ... ... ... ... ... ... ... ... 1 1 No Statement ... ... 1 ... ... 1 ... ... ... ... ... ... 2 Measles 36 83 6 ... ... ... ... ... ... ... ... 124 130 Scarlet Fever (Scarlatina) 5 41 18 2 ... ... ... ... ... ... ... 46 66 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 108 167 13 ... ... ... ... ... ... ...... ... 275 288 Diphtheria 4 33 14 ... ... ... ... ... ... ... ... 37 51 Simple Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... 5 14 22 12 10 5 ... 1 ... ... 5 69 Other Miasmatic Diseases 1 1 ... ... ... ... ... ... ... ... ... 2 2 Order 2 —Diarrhœal. Simple Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, Dysentery 89 15 1 1 2 2 1 2 4 2 ... 104 119 Order 8.—Malarial. Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... Order 4.—Zoogenous. Cowpox and Vaccination 1 ... ... ... ... ... ... ... ... ... ... 1 1 Other Diseases (e.g., Hydrophobia, Glanders) ... ... ... ... ... ... ... 1 ... ... ... ... 1 Order 5.—Venereal. Syphilis 31 2 ... ... 1 ... ... ... ... ... ... 33 34 Gonorrhœa, Stricture ... ... ... ... ... ... 1 ... ... ... ... ... 1 Order 6.—Septic. Erysipelas 6 2 ... ... 5 1 3 4 1 1 ... 8 23 Pyæmia. Septicæmia 2 ... 1 4 5 4 2 1 1 1 ... 2 21 Puerperal Fever (Metria) ... ... ... 5 6 1 ... ... ... ... ... ... 12 Class II.—Parasitic Diseases. Thrush and other Vegetable Parasitic Diseases 15 ... ... ... ... ... ... ... ... ... ... 15 15 Worms, Hydatids, and other Animal Parasites ... 1 ... ... ... ... ... ... ... ... ... 1 1 Class 111.— Diitic Diseases. Want of Breast Milk, Starvation 11 ... ... ... ... ... ... ... 1 ... ... 11 12 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 2 6 7 2 ... ... ... ... 17 Delirium Tremens ... ... ... ... 1 1 3 ... ... ... ... ... 5 Class IV.—Constitutional Diseases. Rheumatic Fever, Rheumatism of the Heart ... ... 3 3 1 2 ... ... ... ... ... ... 9 Rheumatism 1 1 2 1 2 1 ... 4 2 3 ... 2 17 Gout ... ... ... ... 1 ... 3 2 3 2 ... ... 11 Rickets 4 5 ... ... ... ... ... ... ... ... ... 9 9 Cancer, M alignant Disease ... ... ... ... 5 21 34 45 30 2 1 ... 138 Tabes Mesenterica 39 24 8 ... ... ... ... ... ... ... ... 63 71 Tubercular Meningitis, Hydrocephalus 25 63 13 2 1 ... 1 ... 1 ... ... 88 106 Phthisis 9 12 22 68 133 129 78 27 7 1 ... 21 486 Other forms of Tuberculosis, Scrofula 22 14 1 ... 1 ... ... ... ... ... ... 36 38 Purpura, Hæmorrhagic Diathesis ... 2 ... ... ... ... ... ... ... ... ... 2 2 Anæmia, Chlorosis, Leucocythæmia.. ... ... 1 ... ... 2 ... 1 ... ... ... ... 4 Diabetes ... ... ... 2 ... ... ... 3 1 ... 1 ... 7 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... Class V.—Developmental Diseases. Premature Birth 96 ... ... ... ... ... ... ... ... ... ... 96 96 Atelectasis 6 1 ... ... ... ... ... ... ... ... ... 7 7 Congenital Malformations 21 ... ... ... ... ... ... ... ... ... ... 21 21 Old Age ... ... ... ... ... ... ... 3 72 131 57 ... 263 Class VI.—Local Diseases. Order 1.—Nervous System. Inflammation of Brain or Membranes 29 19 11 4 4 4 2 ... ... ... ... 48 73 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 1 1 ... ... 8 16 38 56 53 35 4 2 212 Insanity, General Paralysis of the Insane ... ... 1 1 1 2 3 4 12 10 3 ... 37 Epilepsy ... 1 ... ... 1 3 4 1 ... 1 ... 1 11 Convulsions 85 28 2 ... ... ... ... ... ... ... ... 113 115 Laryngismus Stridulus (Spasm of Glottis) 9 4 ... 2 ... 1 ... ... ... ... ... 13 16 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... 1 2 4 6 10 12 8 ... ... 43 Other Diseases of Nervous System ... ... ... ... ... ... ... ... ... ... ... ... ... CAUSE OF DEATH. AGES. 0 to 1 1 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 and upwards Total under 5 years Total Local Diseases continued. 1 Order 2.—Organs of Special Sense ... 1 ... ... ... ... ... ... 1 ... ... 1 2 Order 3—Circulatory System. Pericarditis ... 2 5 4 6 3 ... ... ... 1 ... 2 21 Acute Endocarditis ... ... ... 2 ... ... ... 1 ... ... ... ... 3 Valvular Diseases of the Heart ... ... 4 2 6 11 12 6 9 3 ... ... 53 Other Diseases of Heart 1 1 3 ... 9 18 33 30 33 11 ... 2 139 Aneurism ... ... ... ... 1 ... ... 4 2 ... ... ... 7 Embolism, Thrombosis ... ... 1 1 1 2 1 ... 5 ... 1 ... 12 Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... 2 1 ... ... 3 Order 4—Respiratory System. Laryngitis 3 10 4 ... 1 ... ... ... 1 ... ... 13 19 Croup 2 24 5 ... ... ... ... ... ... ... ... 26 31 Emphysema, Asthma ... ... ... ... 3 6 5 20 15 1 ... ... 50 Bronchitis 192 141 15 3 9 21 50 84 125 54 ... 336 711 Pneumonia 29 46 8 9 21 16 12 18 11 1 14. 75 172 Pleurisy ... ... 1 1 3 4 5 3 2 2 1 ... 21 Other Diseases of Respiratory System 1 4 ... ... 1 ... ... 1 ... ... ... 5 7 Order 5.—Digestive System. Dentition 27 23 ... ... ... ... ... ... ... ... ... 50 50 Sore Throat, Quinsey ... 2 1 ... 1 1 ... ... ... ... ... 2 5 Diseases of Stomach ... ... 1 2 3 3 3 4 4 3 ... ... 23 Enteritis 11 2 4 1 1 1 ... 1 4 ... ... 13 25 Obstructive Diseases of Intestine 1 1 2 1 2 4 3 6 9 3 ... 2 32 Peritonitis 2 2 3 6 8 10 2 2 2 2 ... 4 39 Ascites ... 1 ... ... ... 1 1 4 4 1 ... 1 12 Cirrhosis of Liver ... ... ... ... 7 8 8 15 3 ... ... ... 41 Jaundice and other Diseases of Liver 7 2 ... 1 5 10 12 12 5 1 ... 9 55 Other Diseases of Digestive System ... ... ... ... ... ... ... 1 1 ... ... ... 2 Order 6.—Lymphatic System. Diseases of Lymphatics and Spleen ... ... ... 1 2 ... ... ... ... ... ... ... 3 Order 7.—Glandlike Organs of uncertain use. Bronchocele and Addison's Disease ... ... ... ... 1 ... 1 ... ... ... ... ... 2 Order 8.—Urinary System. Nephritis ... 1 ... ... 4 3 2 2 ... 2 ... 1 14 Briglit's Disease, Albuminuria ... 1 1 3 6 8 16 9 13 1 ... 1 53 Disease of Bladder or of Prostate ... ... ... ... 1 ... 1 6 5 5 ... ... 18 Other Diseases of the Urinary System ... ... ... ... ... 1 3 ... 3 ... ... ... 7 Order 9.—Reproductive System. A. Of Organs of Generation Male Organs 1 ... ... ... ... ... ... ... ... ... ... 1 1 Female Organs ... ... ... 2 1 3 3 3 1 2 ... ... 15 B. Of Parturition. Abortion, Miscarriage ... ... ... ... 2 ... ... ... ... ... ... ... 2 Puerperal Convulsions ... ... ... ... ... 2 ... ... ... ... ... ... 2 Placenta prævia, Flooding ... ... ... 1 5 4 ... ... ... ... ... ... 10 Other Accidents of Child Birth ... ... ... ... 3 3 ... ... ... ... ... ... 6 Order 10.—Bones and Joints. Caries, Necrosis ... 2 3 4 1 2 2 ... 1 ... ... 2 15 Arthritis, Ostitis, Periostitis ... 1 ... 1 ... 1 ... ... 1 ... ... 1 4 Other Diseases of Bones and Joints 1 2 1 1 2 1 1 1 1 ... ... 3 11 Order 11 .—Integumentary System. Carbuncle, Phlegmon 1 ... ... ... ... ... ... 1 ... ... ... 1 2 Other Diseases of Integumentary System 2 ... ... ... ... ... 1 ... ... ... ... 2 3 Class VII.—Violence. Order 1.—Accident or Negligence. Fractures and Contusions ... 5 7 6 7 7 6 2 5 3 2 5 50 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 6 1 ... 1 ... 1 1 ... ... ... 6 10 Poison ... ... ... ... ... 2 2 1 ... ... ... ... 5 Drowning 1 ... ... ... 1 ... 1 ... ... ... ... 1 3 Suffocation 25 2 ... ... ... ... 1 ... ... ... ... 27 28 Otherwise 1 ... ... ... 1 1 ... ... ... ... ... 1 3 Order 2.—Homicide. Manslaughtor ... ... ... ... ... ... ... ... ... ... ... ... ... Murder 4 2 ... ... 1 ... ... ... ... ... ... 6 7 Order 3.—Suicide. Gunshot Wounds ... ... ... ... 1 2 ... ... ... ... ... ... 3 Cut, Stab ... ... ... ... 1 1 ... ... 1 ... ... ... 3 Poison ... ... ... 1 1 1 ... ... ... ... ... ... 3 Drowning ... ... ... ... 1 3 1 ... ... ... ... ... 5 Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... Otherwise ... ... ... ... 1 ... ... ... ... ... ... ... 1 Class VIII.—Ill-defined Causes. Dropsy ... 2 ... ... 2 ... 3 1 3 3 ... 2 14 Debility, Atrophy, Inanition 134 22 ... ... 1 ... ... 5 8 3 1 156 174 Mortification 1 ... ... ... ... ... ... 1 1 ... 1 1 4 Tumour ... ... ... 2 2 2 3 ... ... ... ... ... 9 Abscess ... 1 1 1 1 ... 2 1 1 ... 1 8 Hæmorrhage 1 ... 1 ... 1 ... ... ... ... ... ... 1 3 Suddon Death (Cause not ascertained) ... ... ... ... ... ... ... ... 1 1 ... ... 2 Causes not Specified or Ill-defined 6 ... 1 1 ... 1 1 6 2 3 ... 6 21 Inquest Case—No Age ... ... ... ... ... ... ... ... ... ... ... ... 1 SUMMARY OF TABLE III. CAUSE OF DEATH. AGES. 0 to 1 1 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 & upwards Total under 5 Years Total I.—Specific Febrile, or Zymotic Diseases 283 355 70 34 31 19 13 8 7 4 .. 638 824 1. Miasmatic Diseases 154 356 68 24 12 11 6 .. 1 .. .. 490 612 2. Diarrhœal „ 85 15 1 1 2 2 1 2 4 2 .. 101 119 3. Malarial „ • • .. .. • • • • .. • • .. • • • • .. • • •• 4. Zoogenous „ 1 .. .. • • • • • • • • 1 • • • • .. 1 2 5. Venereal „ 31 2 .. • • 1 .. 1 .. • • • • .. 33 35 6. Septic „ 8 2 1 9 16 6 5 5 2 2 .. 10 56 II.—Parasitic Diseasbs 15 1 .. • • .. .. .. .. • • • • .. 16 16 III.—Dietic Diseases 11 .. .. .. 3 7 10 2 1 • • .. 11 34 IV.—Constitutional Diseases 100 121 50 76 144 155 116 82 44 8 2 221 898 V.—Developmental Diseases 123 1 .. .. .. .. .. 3 72 131 57 124 387 VI.—Local Diseases 405 325 76 54 132 177 230 305 340 148 23 730 2215 1. Diseases of Nervous System 124 53 14 8 16 30 53 71 77 54 7 177 5°7 2. „ Organs of Special Sense .. 1 .. .. .. .. .. .. 1 .. .. 1 2 3. „ Circulatory System 1 3 13 9 23 34 46 41 51 16 1 4 238 4. „ Respiratory System 227 228 33 13 38 47 72 126 154 58 15 455 1011 5. ,, Digestive System.. 48 33 11 11 27 38 29 45 32 10 .. 81 284 6. „ Lymphatic System .. .. .. 1 2 .. .. .. .. .. .. .. 3 7. ,, Glandlike Organs of uncertain use .. .. .. .. 1 .. 1 .. .. .. .. .. 2 8. „ Urinary System .. 2 1 3 11 12 22 17 21 8 .. 2 97 9. ,, ReproductiveSystem 1 .. .. 3 11 12 3 3 1 2 .. 1 36 (a) Diseases of Organs of Generation 1 .. .. 2 1 3 3 3 1 2 .. 1 16 (b) Diseases of Parturition .. .. .. 1 10 9 .. .. .. .. .. .. 20 10. ,, Diseases of Bones and joints 1 5 4 6 3 4 3 1 3 .. .. 6 30 11. ,, of Integumentary System 3 .. .. .. .. .. 1 1 .. .. .. 3 5 VII.—Violence 31 15 8 7 16 17 12 4 6 3 2 46 121 1. Accident or Negligence 27 13 8 6 10 10 11 4 5 3 2 40 99 2. Homicide 4 2 .. .. 1 .. .. .. .. .. .. 6 7 3. Suicide .. • • .. 1 5 7 1 .. 1 .. .. .. 15 4. Execution .. .. .. .. .. .. .. .. .. .. .. .. .. VIII.—Ill-Defined and not Specified Causes 142 25 3 4 7 3 9 14 16 10 2 167 235 Total 1110 843 207 175 333 378 390 418 486 304 86 1953 4730 48 Table IV. Showing the number of deaths at all ages in 1882 from certain groups of diseases, and proportions to 1000 of population, and to 1000 deaths from all causes; also the number of deaths of infants under one year of age from other groups of diseases, and proportions to 1000 births and to 1000 deaths from all causes under one year. Division I. Total Deaths. Deaths per 1000 of Population, of all ages. Deaths per 1000 of Total Deaths, at all ages. 1. Principal Zymotic Diseases 729 3.0 1541 2. Pulmonary Diseases 1011 4.2 213.7 3, Principal Tubercular Diseases 604 2.5 127.6 Division 11. (Infants under One Yaar. Total Deaths. Deaths per 1000 of Births. Deaths per 1000 of Total Deaths under One Year. 4. Wasting Diseases 241 31.0 217.1 5, Convulsive Diseases 166 21.3 149.5 Notes. 1. Includes Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Typhus, Enteric (or Typhoid), and Simple Continued Fevers, and Diarrhoea. Forty-one of the Deaths occurred in Hospitals situated beyond the limits of the District. 3. Includes Phthisis, Scrofula, Tnberoulosis, Rickets, and Tabes. 4. Includes Marasmus, Atrophy, Debility, Want of Breast Milk, &nd Premature Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Convulsions, and Teething. Table V. Shewing the Number of Deaths from the principal Zymotic Diseases, in the 10 years 1872 to 1881, and in the year 1882. Disease. 1872 1873 1874 1875 1876 1877 1878 1879 1880 1881 Annual Average of 10 years, 1872-81 . Proportion of 1 Deaths to 1000 Deaths in 10 years, 1872-81. Total Deaths in 1882. Proportion of Deaths to 1000 Deaths in 1882. Small Pox 58 2 3 2 22 129 94 19 18 84 43.1 8.5 6 1.2 Measles 105 281 64 82 117 143 48 129 58 172 113.9 22.5 130 27.4 Scarlet Fever 70 17 95 240 137 89 138 144 156 180 124.6 24.6 66 13.9 Diphtheria 16 38 35 55 38 22 23 25 34 70 35.6 7.0 51 10.7 Whooping Cough 259 212 121 232 198 141 217 154 293 122 194.9 38.5 288 60.9 Typhus Fever 14 9 10 8 5 20 4 4 1 1 7.6 1.5 .. .. Enteric Fever 52 58 38 35 60 58 59 57 43 66 52.6 10.4 69 14.5 Simple Continued Fever 16 14 25 16 7 10 4 5 4 8 10.9 2.1 .. .. Diarrhœa 235 253 222 178 239 155 229 118 204 211 204.4 40.4 119 23.4 Totals 825 824 613 828 823 767 816 655 811 914 787.6 155.5 729 152.0 Totals—London 12,722 11,226 11,327 13,340 12,536 12,232 14,619 12,010 13,735 13,811 12,755.8 161.2 13,553 163.4 Table VI. Inspectors' Report of the Sanitary Work completed in the year 1882. No. of Complaints received during the year. No of Houses, Promises, &c., inspected. Results of Inspection. House Drains. Privies and W.C.'s. Dust Bins. Water Supply. Miscellaneous. Orders issued for Sanitary Amendments of Houses and Premises. Houses, Premises, &c., Cleansed, Repaired, Whitewashed, &c. Houses Disinfected after illness of an Infectious Character. Repaired, Cleansed, Trapped, &c. New provided. Repaired, &c. Supplied with Water. New provided. New provided. Repaired, Covered, &c. Cisterns (new) erected. Cisterns Cleansed, Repaired and Covered. Cesspools abolished. Removal of Accumulations of Dung, Stagnant Water, Animal and other Refuse. Animals Removed, being improperly kept. Regularly Inspected. Legal Proceedings, i.e., Summonses. Cases of Over-crowding. Smoke Nuisances. Paving Defects.[/##] Licensed Cowsheds. Licensed Slaughter-houses. Totals 513 4259 2600 578 296 373 10 151 1474 1 105 281 11 123 3 24 2 49 50 81 37 24 29