STPAN 40 TWENTY-EIGHTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the Sanitary Condition of Saint Pancras. MIDDLESEX. REPORT FOR THE YEAR 1883, by SHIRLEY FORSTER MURPHY, MEDICAL OFFICER OF HEALTH, HON. SECRETARY TO THE EPIDEMIOLOGICAL SOCIETY, and to THE SOCIETY OF MEDICAL OFFICERS OF HEALTH. St. Pancras, Middlesex. TWENTY-EIGHTH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, Being the Report for the Year 1883. TO THE VESTRY OF ST. PANCRAS. Gentlemen, I have estimated the population of our Parish during the year 1883 to be 239,174. This estimate is based upon the fact that in the preceding decade the population of St. Pancras had increased annually at the rate of 0.66 per cent. Upon the estimated population of 239,174 the birth and death rates of 1883 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 39,297 89,297 Tottenham court road 27,401 26,920 Gray's Inn lane 30,448 80,298 Somers town 34,500 34,500 Camden town 17,185 15,411 Kentish town 90,348 89,820 The Registrar-General's year to which this Report relates begins on December 31st, 1882, and ends on December 29th, 1883, and therefore consists of 52 weeks. During this period 7,719 births were registered in St. Pancras, being at the rate of 32.2 per 1,000 of population. This is the lowest birth rate St. Pancras has had since 1860, and is 1.7 lower than that of London as a whole. *University College Hospital, Royal Free Hospital, Workhouse, Cleveland street, and St. Pancras Infirmaries. 4 There were 4,965 deaths registered during the year in St. Pancras, giving a death rate of 20.76 per 1,000 of population. This is 0.2 higher than that of London as a whole. If the deaths of non-parishioners occurring in public institutions situated in St. Pancras are excluded, and the deaths of St. Pancras parishioners occurring in public institutions situated in other parts of the Metropolis are included, the corrected number of deaths amounts to 4,677, giving a death rate of 19.55. This is 0.32 lower than last year. The number of children under one year of age who died during 1883 was, 1,107, but the corrected number was 1,100, or in the proportion of 235.1 per 1,000 of the corrected total deaths and 142.5 of each 1,000 registered births during the year. In London as a whole the proportion of deaths under one year is 241.9 per 1,000, or 6 8 above that of St. Pancras for the same period. During the preceding ten years in St. Pancras the proportion per 1,000 deaths from all causes has been 244.8, or 9.7 above that of 1883. Under five years of age the corrected number of deaths which were registered amounted to 1,772, being 378.8 per 1,000 of total deaths. This is lower than any year since 1876, when it was 375.8 per 1,000, and is 34.0 lower than last year. The average proportion at this age in St. Pancras during the last ten years is 402.8 per 1,000, and in London during 1883 it is 416.3. Between the ages of five and sixty-five 2,024, and above sixty-five years 881 deaths of St. Pancras parishioners took place during the year; these are more than during 1882. In 1883 there were 1,357 deaths in Public Institutions in the Parish, being 134 more than in the preceding year, and 1,069 St. Pancras parishioners died in Public Institutions in the Parish and in other parts of the Metropolis, being 228.5 per 1,000 of total deaths, and 45.0 per 1,000 more than last year. 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 number of inhabited houses, of marriages, births, and deaths during 1883 and the ten preceding years. 6 Table II. shows the annual birth rate, death rate, death rate of children, and proportion of deaths in Public Institutions. Table III. shows the corrected number of deaths of St. Pancras parishioners at different ages, and from various causes in 1883, and is followed by another table containing a summary. Table IV. shows the proportion which deaths from Zymotic, Pulmonary, and Tubercular diseases in the year bear to each 1,000 of population and each 1,000 of total deaths, and which the deaths of children under one year of age from Wasting and Convulsive diseases bear to each 1,000 of births and each 1,000 of deaths of infants under one year of age. Table V. shows the number of deaths from the principal Zymotic diseases in the year 1883 and the ten preceding years, and the proportion which these deaths bear to total deaths during the same period. Table VI. gives an account of the Sanitary work carried out in the year 1883. DEATHS FROM VARIOUS DISEASES PULMONARY DISEASES. Pulmonary Diseases other than Phthisis—viz., Bronchitis, Pneumonia, Pleurisy, Asthma, and other Diseases of the Respiratory System caused 873 deaths, or 3.6 per 1,000 of population, and 186.6 per 1,000 of total deaths, and were 138 less in number than the previous year. In London, during 1883, the proportion from these causes per 1,000 of total deaths was 201.6 and 41 per 1,000 of population. During the nine preceding years the proportion per 1,000 total deaths has been 221.4, or 4.5 in every 1,000 of population. The following table shows the number of deaths from Pulmonary Diseases other than Phthisis occurring in each sub-registration district, and the proportion per 1,000 of population and per 1,000 of total deaths.* *The previous address of 12 persons dying from Pulmonary Diseases in Public Institutions and 87 persons dying from "all causes" in Public Institutions could not be ascertained, and the deaths of these persons are therefore excluded from consideration. The death rates are, for the purpose of comparison, calculated on the population of each district, which does not include persons resident in Hospitals and Workhouses. 6 Sub-registration Districts. No. of Deaths. Proportion per 1,000 of Population. Proportion per 1,000 of Total Deaths. Regent's park 128 3.2 179.0 Tottenham court road 85 31 155.9 Gray's Inn road 119 3.9 207.3 Somers town 168 4.8 210.7 Camden town 77 4.9 201.0 Kentish town 284 3.1 180.0 TUBERCULAR DISEASES. There were 642 deaths from the principal Tubercular Diseases during the year, being 38 more than during the preceding twelve months. In 1883 the proportion of deaths from these diseases has been 137.2 in every 1,000 deaths from "all causes," or 2.6 in every 1,000 of population. In London the proportion has been 140.1 per 1,000 of total deaths, or 2.8 in every 1,000 living. The following table shows the relative mortality from these diseases in the different districts. Fourteen deaths from Tubercular diseases and 87 deaths from "all causes" are excluded from consideration (vide Note page 3):— No. of Proportion Sub-registration Districts. Deaths. per 1,000 of Population. Proporation per 1,000 of Total Deaths. Regent's park 83 2.1 116.2 'Tottenham court road 88 3.2 161.4 Gray's Inn road 96 3.1 167.2 Somers town 122 3.5 153.0 Camden town 44 2.8 114.8 Kentish town 195 2.1 123.6 WASTING & CONVULSIVE DISEASES OF INFANTS. There were 274 deaths amongst children under one year of age from the Wasting Diseases of children, or 35.4 to every 1,000 of births and 249.1 to every 1,000 of total deaths under one year. 7 There were also 175 deaths amongst children of that age due to Convulsive Diseases, or, 22.6 per 1000 births, and 159.1 per 1000 of total deaths under one year. The following tables show the incidence of deaths at this age from these diseases in the different sub-registration districts, but 2 deaths from Wasting diseases, and 3 from Convulsive diseases and 12 from "all causes" under one year could not be referred to the districts to which they belong. (Vide Note, page 3.) WASTING DISEASES. Sub-registration Districts. No. of deaths. Proportion per 1000 of population. Proportion per 1000 of total deaths under one year. Regent's Park 41 1.04 262.8 Tottenham Court Road 30 1.11 263.1 Gray's Inn Road 41 1.32 278.8 Somers Town 46 1.33 247.3 Camden Town 29 1.88 252.1 Kentish Town 85 0.94 229.7 CONVULSIVE DISEASES. Sub-registration Districts. No. of deaths. Proportion per 1000 of population. Proportion per 1000 of total deaths under one year. Regent's Park 26 0.66 166.6 Tottenham Court Road 21 0.77 184.2 Gray's Inn Road 22 0.72 149.6 Somers Town 21 0.60 112.3 Camden Town 17 1.10 147.8 Kentish Town 65 0.72 175.6 ZYMOTIC DISEASES. There have been fewer deaths from Zymotic Diseases during 1883 than for some years. In 1882 the nine principal Zymotic diseases caused 154.1 in every 1000 deaths from "all causes" or 3.0 in every 1000 of population, during 1883 these proportions have been 130.8 and 2.5 respectively. During the previous ten years the average proportions were 169.9 and 3.3. In London during 1883 these proportions were 135.0 and 2.7. 8 The decrease in the number of deaths in 1883 is due to the decrease which has taken place in deaths from whooping cough and measles. The subjoined table shows the relative proportion of deaths from Zymotic diseases in the different sub-registration districts; 8 deaths from these diseases and 87 deaths from "all causes" could not be referred to the districts to which they belong. (Vide Note, page 3.) No. of deaths. Proportion per 1000 of population Population per 1000 of total deaths. Regents Park 97 2.4 135.8 Tottenham Court Road 51 1.8 93.5 Gray's Inn Road 83 2.7 144.5 Somers Town 94 2.7 117.9 Camden Town 53 3.4 138.3 Kentish Town 225 2.5 142.6 SMALL POX. In 1883 there were but three deaths from this disease, being in the proportion of 0.6 per 1000 deaths from "all causes." The distribution of the deaths is as follows:— Regent's Park 0 Tottenham Court Road 0 Gray's Inn Road 0 Somers Town 0 Camden Town 0 Kentish Town 3 Altogether 13 cases were reported to the Sanitary Department all of which were removed to hospital. During the preceding 10 years the annual average number of deaths was 37.9 being in the proportion of 7.5 to 1000 deaths from " all causes." In London during 1883 this proportion was 1.6, being nearly three times as much as in St. Pancras VACCINATION. The accompanying tables, kindly supplied by the Vaccination Officers, show the number of children vaccinated during the last six months of 1882, and the first six months of 1883. Report for the Six Months ending December, 1882. Registration Sub-Districts comprised in the Vaccination Officer's District Number of Births returned in the 'Birth List sheets' registered during the year. "Successfully Vaccinated. Insusceptible. Number of Cases "Dead." Postponement by Medical Certificate. Removal to Districts the Vaccination Officer of which has been duly apprized. Removal to Places unknown, or which cannot be reached; and Cases not having been found. Number of Cases outstanding. 1 2 3 4 5 6 7 8 9 1 Kentish Town 1488 1312 3 97 26 6 44 2 Regent's Park 571 483 1 50 9 1 27 3 Camden Town 350 324 ... 13 7 ... 6 4 Somers Town 565 469 ••• 46 11 1 38 5 Tottenham Court Road 381 816 ... 23 15 ... 27 6 Gray's Inn Road 450 359 ... 40 10 2 39 Total 3805 3263 4 269 78 10 181 Report for the Six Months ending June, 1883. Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the 'Birth List Sheets' registered during the six months ended June, 1883 "Successfully Vaccinated. Insusceptible. Number of Cases " Dead." Postponement by Medical Certificate. Removal to District's the Vaccination Officer of which has been duly apprised. Removal to Places unknown, or which cannot be reached; and Cases not having been found. Number of Cases outstanding, 1 2 3 4 5 6 7 8 9 1 Kentish Town 1533 1339 1 104 34 4 49 2 Prosecutions. 2 Regent's Park 578 496 1 46 15 ... 20 3 Camden Town 430 387 ... 29 4 ... 10 4 Somers Town 616 530 1 53 14 2 16 5 Tottenham Court Road 415 351 ... 87 10 ... 17 6 Gray's Inn Road 482 403 2 43 7 ... 26 1 out of district. Total 4054 3506 5 312 84 6 138 3 11 MEASLES. This disease caused 99 deaths in 1888, being 81 less than in the previous year. The number of deaths was 21.1 per 1000 deaths from "all causes" and 0.41 per 1000 of population. During the previous ten years measles caused an average of 24.2 in every 1000 deaths from "all causes." In London in 1883 measles caused 30.0 in every 1000 deaths from "all causes" and 0.61 per 1000 of population, the former being 8.9 in excess of the death rate in St. Pancras. The distribution of the disease was as follows:— No. of deaths. Proportion per 1000 of population. Proportion per 1000 of total deaths. Regent's Park 11 0.27 15.4 Tottenham Court Road 7 0.26 12.8 Gray's Inn Road 14 0.46 24.3 Somers Town 15 0.43 18.8 Camden Town 8 0.51 20.8 Kentish Town 89 0.43 24.7 Five deaths from measles and 87 deaths from "all causes" occurring in public institutions could not be referred to the districts to which they belong. (Vide Note, page 8). SCARLET FEVER. In St. Pancras, 61 deaths occurred from Scarlet Fever, being almost the same number as during 1882 and about half the annual average of the previous 10 years. The proportion of deaths from this disease to 1000 deaths from "all causes" was 13.0 in 1883 and 23.0 in the 10 preceding years. The proportion of deaths to every 1000 of population was, in 1883, 0.25. In London as a whole, these proportions were 24.6 per 1000 of total deaths, and 0.50 per 1000 of population. The following table shows the relative proportion of Scarlet Fever in the different sub-registration districts. All the deaths occurring in public institutions were referred to the districts, but 87 deaths from "all causes" are omitted from consideration. (Vide Note, page 3). 12 No. of Population Proportion deaths. per 1000 of per 1000 of population total deaths. Regents Park 12 0.30 16.8 Tottenham Court Road 5 0.18 9.1 Gray's Inn Road 14 0.46 24.8 Somers Town 10 0.28 12.5 Camden Town 7 0.45 18.2 Kentish Town 13 0.14 8.2 Only 174 cases were reported to the Sanitary Department, of which 64 were removed to hospital. If the number of cases be estimated from the number of deaths from this disease upon the supposition that the rate of mortality of scarlet fever is the same over the whole parish as that which is found in hospitals, there must have been fully 1000 persons in St. Pancras suffering during the year from this disease. On this estimate which is in all probability much below the correct number, not one case in six became known to the Sanitary Department. In one family five persons were attacked with scarlet fever, showing how this disease spreads when persons with insufficient means of isolation retain in their own homes persons suffering from this affection. In this family two children were first attacked; nine days afterwards, the father and another child; and twelve days later, a fourth child. Thus, of a family consisting of father, mother, and four children, all but the mother were attacked, and the father and one child lost their lives from this disease. The interval of time which elapsed between the attacks of the first two children and of the others which followed, makes it in the highest degree probable that had the first two been removed to hospital the others would have been saved from illness, and the father and one child from death. Again, in another house, scarlet fever was first introduced into the house by a girl, whose illness was followed by that of a younger sister and brother, and later by two other children, and finally by the mother, who died. 13 In another house it was found that the father, mother, and two living children were occupying the same room, the only one they possessed, as the corpse. Two other children of the same family had also, the previous month, died from scarlet fever. It is occurrences such as these which point to the urgent need there is for a public mortuary in St. Pancras; and until such mortuary is provided, and the public are taught to take advantage of this opportunity for removing infection from their homes, such calamities must be expected to happen. It is often urged that where a mortuary is provided it is not used as freely as those who have recommended it have expected. Undoubtedly the habit of removing infectious bodies to mortuaries can only be acquired by the slow process of education; but until proper accommodation is provided our parishioners will never be educated in this direction. As the Vestry are aware, at the present time, the Workhouse deadhouse is the only place which can be used for this purpose; it is then no matter for surprise that with only such opportunities at their disposal as this place offers, our parishioners are slow to learn the advantages which would result from the removal of the infectious dead from a room which has to be shared by the living. DIPHTHERIA. During 1883 there were 78 deaths from Diphtheria, being 27 more than in the previous year. The number of deaths was 16.6 in every 1000 deaths from "all causes," and 0.32 in every 1000 of population. During the previous 10 years the average number of deaths from diphtheria had been 7.7 in every 1000 deaths from "all causes." In London the average number of deaths was 11.7 in every 1000 deaths from "all causes," and 0.24 per 1000 of population. St. Pancras, therefore, has suffered more heavily from this disease than London as a whole. The following table shows the incidence of deaths from diphtheria on the different sub-registration districts. All the deaths from Diphtheria were referred to the sub-registration districts to which they belong, but 87 deaths from "all causes," which could not be referred, are eliminated from consideration. (Vide Note, page 3). 14 No. of Proportion Proportion Sub-Registration Districts. Deaths per 1000 of per 1000 of population. total deaths. Regent's Park 15 0.38 21.0 Tottenham Court Road 7 0.26 12.8 Gray's Inn Lane 6 0.19 10.4 Somers Town 13 0.37 16.3 Camden Town 4 0.25 10.4 Kentish Town 33 0.36 20.9 One of the deaths from this disease occurred in University College Hospital, where it had previously been removed from a house in Euston Square. The parents were, at the time, taking charge of this house, which was otherwise unoccupied. After the first child was taken ill the family removed to a house in Drummond Street, where another child became ill, which was also removed to the same hospital. A few days afterwards the father was attacked with the same disease, and removed to the Hampstead Hospital, and subsequently the mother and landlady of the last house suffered from throat illness, probably of the same character. These cases afford an instance of the way in which diphtheria may be conveyed. Altogether 88 cases of this disease were reported to the Sanitary Department, 15 of which were removed to hospital. WHOOPING COUGH. There were 72 deaths from this disease, or 216 less than last year. There has therefore been a very great decrease in the number of deaths in St. Pancras from this disease. The number of deaths in 1883 was 15.3 in every 1,000 deaths from "all causes," and 0.3 in every 1,000 of population. In London these proportions were 19.6 and 0.41 respectively. The following table shows the incidence of this disease upon the sub-registration districts. All the deaths from Whooping Cough are referred to their districts, but 87 deaths from "all causes" are omitted from consideration (vide Note, page 3). 15 No. of Proportion Proportion Sub-registration Districts. Deaths. per 1000 of per 1,000 of Total Population. Deaths. Regent's Park 8 0.20 11.2 Tottenham Court Road 9 0.33 16.5 Gray's Inn Lane 9 0.29 15.6 Somers Town 19 0.55 23.8 Camden Town 4 0.25 10.4 Kentish Town 23 0.25 14.5 There cannot be any doubt that much of this diminution— —which was shared by all the sub-registration districts of St. Pancras—is, to a great extent, attributable to the absence of excessive cold during the winter months. In London there were as many as 1,655 fewer deaths from "Whooping Cough than the average of the previous ten years. TYPHUS FEVER. Two deaths were registered from Typhus Fever. The first took place in the Homerton Hospital, in February, and was that of the wife of a printer, living in York place, Somers Town; it is not known how the deceased became infected. The other was that of a rag sorter, who was removed from the Parish of Holborn to the Royal Free Hospital, and subsequently to the Hospital at Hampstead. No other cases of this disease became known to the Sanitary Department during the year. ENTERIC FEVER. Enteric Fever caused 132 deaths, being twice as many as during 1882 and 17.5 more than the average of the preceding ten years. The number of deaths in 1883 is in the proportion of 28.2 per 1,000 of total deaths from "all causes," and 0.55 per 1,000 of population. In London these proportions were 11.6 per 1,000 of total deaths, and 0.24 of population. Altogether 544 cases of this disease were reported to the Sanitary Department. 16 The following table shows the incidence of this disease upon the various sub-registration districts. All the deaths from Enteric Fever were referred to the sub-registration districts to which they belonged, but 87 deaths from "all causes " are omitted from consideration (vide Note, page 3). No. of Proportion Proportion Sub-registration Districts. Deaths per 1,000 of per 1,000 of Total Population. Deaths . Regent's Park 34 0.86 47.6 Tottenham Court Road 9 0.33 16.5 Gray's Inn Lane 9 0.29 15.6 Somers Town 11 0.31 13.8 Camden Town 22 1.42 57.4 Kentish Town 47 0.52 29.8 The excessive mortality from this disease is due to the distribution during the month of August of an infected milk supply, which was received from a farm in Hertfordshire. This milk was mostly consumed by the inhabitants of Camden Town and Regents Park sub-registration districts who Buffered out of all proportion to the residents in other districts. From July 28th to September 8th as many as 431 persons living in 276 houses were attacked with this disease The circumstances of the outbreak will be sufficiently within the memory of the Vestry to make it unneccessary for me to enter in any detail into the subject, but I may remind the Vestry that an investigation conducted at the time showed a special incidence of the disease upon houses supplied with milk coming from a milk vendor in the Parish, and who received his milk from five sources. It was also found that there was a still greater incidence upon houses supplied with milk coming from a particular farm. Again it was observed that the milk was infected before its arrival in London, this fact being proved by an outbreak at the railway station where the milk arrived, among the porters, who were in the habit of drinking it, a proof also that the infected milk was received from one of three farms sending milk by this line. Of these three farms it was found that the milk of one could be eliminated from suspicion owing to its having been used elsewhere without harm. 17 Finally of the remaining two, it was shown that enteric fever had occurred among those who consumed in the neighbouring town the milk from one of these farms, and that a case of enteric fever had occurred among the residents on the farm itself. The immediate cause of the infection of the milk was not obvious. No ailment could be discovered amongst the cattle which would give rise to suspicion. A cesspit in proximity to a well from which water was drawn for washing the cans was all that could be found. The circumstances under which milk becomes infected are too often involved in obscurity, but while it must be left to the future to discover the cause, it is well deserving of notice that the boiling of milk appears to deprive it of its infective properties, and that it is thus within the power of every householder to guard his household against disease communicated by milk. A further lesson may be learnt from this outbreak, and that is the need which exists for a system by which information of all cases of infectious disease should be reported to the Medical Officer of Health. In the absence of such system very considerable mischief is occasioned before the outbreak comes to be suspected, it is indeed often only when deaths have resulted, that the Medical Officer of Health is made aware of what has taken place. But for the action of one or two medical men practising in our parish in calling attention to the large number of enteric fever cases which were coming under their observation, there is no question but that a much greater calamity would have befallen our parish than that which occurred on this occasion. But although it may be a cause of satisfaction to feel that more sickness might have occurred and more deaths have resulted, it cannot be forgotten that a large proportion of nearly 500 persons, were attacked with dangerous, and in many cases, fatal illness for want of the system for which I would plead. Before leaving this subject I would, on behalf of the milk vendor, as well as the milk consumer, urge the necessity for the books of the former to be so kept that it would be possible to tell at a glance whether infectious illnesses occurring in a neighbourhood were related to milk received from one farm or another. At the present time all the milk supplies 18 of a milk vendor come under such circumstances to be regarded with suspicion, and while the difficulties of discovering the cause of the disease are increased, the interruption to the business of the milk vendor is far greater than would occur if it could be seen that the drinkers of milk from a particular farm were alone being attacked. Dairies, Cowsheds and Milkshops Order, 1879.—A point of some importance arose during the month of September. A death from scarlet fever of the child of a milk carrier was registered. The fact was then ascertained that the milk carrier had continued at work, but had kept his employer in ignorance of the nature of the disease from which the child was suffering. The Order in Council, Clause 9, states "it shall not be lawful for any person following the trade of cowkeeper, or dairyman, or purveyor of milk, or being the occupier of a milk store or shop, to allow any person suffering from a dangerous infectious disorder, or having recently been in contact with a person so suffering, to milk cows or handle vessels used for containing milk for sale, or in any way to take part or assist in the conduct of the trade or business of the cowkeeper or dairyman, purveyor of milk, or occupier of a milk store or milk shop, as far as regards the production, distribution, or storage of milk." It appears doubtful whether there is here any provision for the prosecntion of the servant under the circumstances stated above, i.e., where the employer is kept in ignorance of the illness. It may be that the clause makes the master alone responsible, as the person following the trade of cowkeeper or dairyman, or purveyor of milk, or being the occupier of a milk store or milk shop, and it is for him to make his servants comply with the clause. But it is important to know whether the milk carrier is not the actual "purveyor" of the milk. In many cases he sells the milk as a vendor rather than as an agent of a vendor. SIMPLE CONTINUED FEVER. But two deaths were registered as occurring from Simple Continued Fever during 1883. They were registered in the Kentish Town sub-registration district. In London 90 deaths were registered as due to this cause. 19 DIARRHŒA. Diarrhoea caused 162 deaths, being 43 more than in the previous year, and 3.3 less than the average of the preceding ten years. During 1883 the deaths in St. Pancras from Diarrhœa were 34.8 per 1000 of total deaths, and 0.67 per 1000 of population. In London these proportions were 32.8 and 0.69, showing that St. Pancras has suffered more severely than London as a whole. The following table shows the incidence of this disease on the sub-registration districts. Five cases of fatal diarrhœa could not be referred to their districts, and 87 deaths from "all causes" could not be referred, and are therefore omitted from consideration. Of the 162 deaths, 120 occurred in children under one year of age, and 18 amongst those from one to five years. No. of Proportion Proportion Sub-Registration Districts. Deaths per 1000 of per 1000 of population total deaths. Regent's Park 17 0.48 23.8 Tottenham Court Road 14 0.52 25.6 Gray's Inn Road 30 0.99 52.l Somers Town 25 0.72 31.3 Camden Town 8 0.51 20.8 Kentish Town 65 0.72 41.2 During the month of July one death of an infant was registered as being due to " cholera infantum." It may be well to state that the Medical man who attended this child informed me this description of the cause of death does not imply that the child died from any other disease than infantile diarrhæa. PUERPERAL FEVER. This disease in 1883 caused 14 deaths, or two more than in the preceding year. The proportion these deaths bear to 1,000 deaths "from all causes" in St. Pancras is 2.9, and in London 3.8 or 0.9 in excess of St. Pancras. 20 The distribution of the deaths in the sub-registration districts is as follows:— Regent's Park 1 Tottenham Court Road 1 Gray's Inn Lane 1 Somers Town 1 Camden Town 2 Kentish Town 8 VIOLENT DEATHS. The deaths from violence in 1883 numbered 204, or. if corrected, 162, being 41 more than in 1882. Of these deaths 126 occurred from accident or negligence, 10 from homicide, and 26 from suicide, the last number being greatly in excess of that registered during the previous year. The number of infants suffocated during the year was 42, or 17 more than in 1882. Fractures and contusions caused 53 deaths, and burns and scalds 16 deaths. There were 468 inquest cases held in St. Pancra6 during 1883, or 39 more than in the preceding year. UNCERTIFIED DEATHS. The number of uncertified deaths in St. Pancras has increased from six in 1882, to nine in 1883; they occurred in the Somers Town, Camden Town, and Kentish Town sub-registration districts only, and were in the proportion of 1.9 in every 1,000 deaths. In London as a whole they were in the proportion of 12.2 per 1,000 deaths, being slightly in excess of the proportions estimated for the previous year. SANITARY CONDITION OF 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 occurring 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 87 deaths from "all causes," including 14 from Tubercular, 12 from Pulmonary, and 8 from Zymotic diseases, which could not be referred to the districts to which they belong. 21 The following table shows the death rates from certain diseases in the different districts during 1883 :— Sub.registration Districts. All Diseases. Tubercular Diseases. Pulmonary Diseases other than Phthisis. Nine Principal Zymotio Diseases. Regent's Park 18.1 2.1 8.2 2.4 TottenhamCourt Road 20.2 3.2 3.1 1.8 Gray's Inn Lane 18.9 3.1 3.9 2.7 Somers Town 23.1 3.5 4.8 2.7 Camden Town 24.8 2.8 4.9 8.4 Kentish Town 17.5 2.1 8.1 2.5 This year the Camden Town sub-registration district shows a marked increase upon the death rates of the previous year when calculated on deaths from "all causes," Pulmonary diseases, and Zymotic diseases. Gray's Inn Lane shows a marked diminution in the death rates from the same diseases. Kentish Town has the lowest death rate of all the districts in all diseases except Zymotic, in which Tottenham Court Road is still lower. Somers Town also has a lower death rate than last year. When the death-rate among infants comes to be considered, it is shown that when calculated upon the number of registered births, the following results are obtained: — No. of deaths Proportion to under one year. 1000 births. Regent's Park 156 139.1 Tottenham Court Road 114 164.4 Gray's Inn Lane1 46 164.8 Somers Town 186 160.4 Camden Town 116 142.5 Kentish Town 870 125.8 Here Somers Town heads the list, and Gray's Inn Lane follows as was the case in 1882. Kentish Town shows a much lower death rate than the preceding year, that of Camden Town has, however, increased. In my last report I referred to the high death.rates in certain localities in the Grays Inn Lane sub-registration district. These localities have shared in the general 22 tion which, it has already been stated, is to be found in the general death-rate of this district. The death-rates are, nevertheless, sufficiently high to indicate that the residents have suffered much more heavily than in the more healthy areas. Thus in Prospect Terrace, the death-rate for 1888 was 27.1 per 1000 in Wellington square, 82.6; in Colonnade, 80.0 ; in Drapers place, 28.9. Compared with these should be observed the death-ate of a model lodging house, Derby Buildings, which is 15.7. These figures show clearly enough the relation which exists between conditions of unhealthiness and death and disease, and are a strong reason for the Vestry to recognize the powers which they possess as a Sanitary Authority over the welfare of the inhabitants of this parish, and for still further efforts to be made to preserve life and health. More has been done during the year 1883, than in previous years by the Vestry with this object, but more still remains to be done. In connection with this point I would beg again to urge upon the Vestry the advantage of exercising the power which Section 35 of the Sanitary Act of 1866 confers upon them of controlling more efficiently under regulations, those tene. mented houses which are occupied by the very poor. I would beg to remind the Vestry that until proper regulations are made and enforced in St. Pancras for this class of houses, the Vestry have not exercised to their full extent the powers they possess for improving the condition of their poorer parishioners, and that the moral and physical welfare of those who are least able to help themselves, is a question which concerns the Vestry as much, if not more, than any other it is their duty to consider. The Local Government Board have now declared this Section in force in St. Pancras, and have called upon the Vestry to make the necessary regulations. During 1883 I reported to the Vestry, under the Artizans' and Labourers' Dwellings Act, as unfit for human habitation, all the houses in Cooper's buildings, seventeen houses in Colonnade, one in Dutton street, five in Melina place, and all the houses in Catel place, as well as six houses in North terrace. The need for the demolition of many of these houses and the improvement of others have been recognised by the Vestry, who have made orders for this purpose. It will be a source of much satisfaction to me when these orders are 23 carried into effect. At any moment these houses may become a danger not only to those who inhabit them, but to others who may be exposed to disease having its origin within them. As the Vestry are aware, a Royal Commission is now making enquiry into the means which may be adopted for improving the dwellings of the poorer classes. I would wish to see, as a result of this Commission, the opportunity given for proceedings being instituted against those freeholders who neglect to enforce the repairing clauses of leases. If in default of the immediate owner maintaining his houses in proper condition, he could be made to forfeit his interest in them, houses that are occupied by the very poor would not continue to be owned by those who are unwilling or unable to maintain them in a proper habitable condition. During the year the Vestry thought it well to call the attention of all householders to the opportunities which they themselves possessed for protecting their households against disease, and a card containing precautions against disease prepared by your Vestry Clerk and Medical Officer was issued to every householder. Moreover, a step was taken by the Vestry which is a cause for much congratulation at a time when there is urgent need for the preservation of purity of water supply. The opportunity which is given for the pollution of water by the method of storing it in water.butts and cisterns has been referred to in past reports. The course the Vestry have taken in addressing the Local Government Board on this subject, will eventually procure for St. Pancras a constant water service, and will remove in the future the chances of local contamination. Again, the need for preserving the sources of water supply from pollution has not been lost sight of The sources of supply to St. Pancras and other parts of the Metropolis are not under the control of the Metropolitan Sanitary Authorities, but at a Conference which was held between Dr. Buchanan, the Medical Officer to the Local Government Board, and the Metropolitan Medical Officers of Health, in reference to the means which should be taken to prevent the dissemination of cholera in London, the opportunity was given me of calling the attention of the meeting to the need for 24 ness over the reservoirs and mains of the Water Companies, and at the request of the Society of Medical Officers of Health, Dr. Buchanan promised that the subject should receive the consideration of his Board. SLAUGHTER HOUSES. There are now 40 licensed slaughter houses in St. Pancras. With few exceptions, these have been maintained in a satisfactory condition during the year. COWSHEDS. There are 60 licensed cowsheds in St. Pancras. The regulations of the Vestry have, on the whole, been complied with. BAKEHOUSES. The Bill which, in 1883, was brought in for the improvement of bakehouses has become law While this Act does not include all the provisions which the Bill, as originally drawn, contained, the transference of the duty of inspection of bakehouses from a central to a local authority promises to lead to their improvement. Nevertheless, I cannot but express the opinion that until bakehouses are registered and licensed in the same manner as cowsheds and slaughter houses, there will be much difficulty in ensuring these places being maintained in a proper condition. It is a matter for regret that there is no provision for preventing the future construction of under.ground bakehouses. In the large majority of cases, under.ground cellars and kitchens are used which cannot either be properly ventilated or properly lighted. In many, a stranger has much difficuly in finding his way into the bakehouse until the gas is lighted; so dark are the places in which the business of baking is conducted. Without light, proper cleanliness cannot be maintained; without proper ventilation the bread makers are obliged to work under conditions which are not conducive to their own health, and which for obvious reasons must interfere with the food which is prepared. It is almost needless to add that I am not satisfied with the condition of many bakehouses in St. Pancras. The Vestry have, however, supplied to every occupier of a bakehouse a copy of regulations prepared by your Vestry Clerk and Medical Officer, and indicating the requirements the Sanitary Authority can insist upon. In the event of infringement of these regulations the Vestry will, I trust, authorize suoh proceedings being taken as the new Act permits. 25 LEGISLATION. Diseases Prevention (Metropolis) Act, 1888.—This Act was passed with the object of conferring increased powers on the Metropolitan Local Authorities, for the purpose of dealing with cholera, should it invade the metropolis. The Metropolitan Asylums Board are constituted a Local authority and are enabled to contract with the managers of any existing hospital for the purpose of utilizing such hospital accommodation as may be placed at their disposal. They may also utilize the hospitals under their own control, and subject to the consent of the Local Government Board, they may contract for the use of accommodation in Asylums under the Metropolitan Poor Act of 1867 or any Workhouse. The duty is also put upon the Managers of the Metropolitan Asylums District to provide wharves upon the Thames for the purpose of facilitating the removal to hospitals of persons suffering from infectious disease. This Act also provides that the admission of a person suffering from infectious disease into any hospital or hospital ship provided by the Managers, or the maintenance of any such person therein, shall not be considered parochial relief, alms, or charitable allowance to any person, or to the parent of any person, and no such person or his parent, shall, by reason thereof be deprived of any right or privilege, or be subject to any disability or disqualification. It is also provided that " nothing in this Act shall be deemed or construed to exempt any local authority in the metropolis from the performance of any duties or liabilities assigned to them by regulations of the Local Government Board under the Diseases Prevention Act, 1855." Factory and Workshop Act, 1888.— This Act requires that no white lead factory shall be carried on after December 31st of the present year, unless the occupier shall have received from an Inspector of Factories a certificate stating that certain conditions have been complied with. These conditions relate to the ventilation of stacks and stoves, opportunities for cleanliness, opportunities for taking meals in a room where no work is carried on, and the provision for every person working at any tank of an overall suit with head covering, for every person working at any white.bed a respirator 26 for the mouth and nostrils and head covering, and for every person working at any dry stove or rollers an overall suit with head covering and respirator. Work people are also to have a sufficient supply of acidulated drink. Not later than three months after the passing of the Act each occupier of a white lead factory shall frame and transmit to the Chief Inspector for approval by a Secretary of State special rules for such factory ; these rules, when established, shall be observed in and about the factory as if they were enacted by the Act. The same Act, as already stated, replaces in the hand, of the Vestries not only the powers they formerly possessed under the Bakehouse Regulation Act, but certain increased powers concerning bakehouses not let or occupied before the first day of June, 1883. With regard to the latter: 1.—No water.closet, earth.closet, privy, or ashpit, shall be within or communicate directly with the bakehouse. 2.—Any cistern for supplying water to the bakehouse shall be separate and distinct from any cistern for supplying water to a water.closet. 3. No drain or pipe for carrying off faecal or sewage matter shall have an opening within the bakehouse. The penalty for any infringement of the above is a fine not exceeding forty shillings and a further fine not exceeding five shillings for every day the offence is continued after conviction. Again, where any place used as a bakehouse (whether the same was or was not so used before the passing of this Act), is in such a state as to be on sanitary grounds unfit for use or occupation as a bakehouse, the occupier shall be liable on summary conviction to a fine not exceeding forty shillings, and on subsequent conviction not exceeding five pounds. The court of summary jurisdiction in addition to, or instead of inflicting such fine may order means to be adopted by the occupier for the purpose of removing the grounds of complaint. The Medical Officer of Health has all powers of entry, inspection, taking legal proceedings, and otherwise. 27 This Act, as the Vestry will see, necessarily adds to the duties and responsibilities of the Sanitary Department. REMOVAL OF DUST. The improved system of removal of dust, by which householders are able to have their houte refuse removed weekly, should they desire it, deserves record here. It is to be hoped that they will, in increasing numbers, take advantage of this opportunity, and that the old fixed dustbin which is now constructed to hold large quantities of house refuse will gradually be replaced by small movable receptacles. 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 1883 and 10 years preceding. Cross Numbers. The Year.* Estimated Population. Estimated No. of Inhabited Houses. Marriages. Registered Births. Corrected Number of Deaths. Deaths in Public Institutions. Total all Ages. Under One Tear. Under Five Years. 1883 239,000 25,000 2,199 7,719 4,677 1,100 1,772 1,069 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 1,231 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 1,159 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 1,754 1,013 1873 227,000 24,700 2,238 8,095 5,149 1,305 2,115 1,039 Average of 12 Years, 1873.9 234,440 25,167 2,226 4 8,077 6 5,047.6 1,2163 2,032.0 1,097 0 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 CensuB periods. The estimate of population may be checked by the known number of inhabited houses, and by the average number of inmates per house, ascertaineat the preceding Cenuse. TABLE II. Showing the Annual Birth Rate, Death Rate, Death Rates of Children, and Proportion of Deaths in Public Institutions in a Thousand Deaths for the year 1883, and 10 years preceding. In Tear. Birth Rate per 100) 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. 1883 32.2 19.55 142.5 235 1 378.8 228.5 1882 32.6 19.89 142.8 234.6 412.8 183.5 1881 33.6 21.16 155.3 246.8 4110 209.4 1880 34.2 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 2160 1877 34.4 20.88 143.8 237.2 3951 235.2 1876 35.7 21.54 151.3 250.8 398 6 222 9 1875 34.5 23.38 1590 235.5 375.3 201.9 1874 35.0 21.75 145.9 231.4 352 0 203.3 1873 351 22.32 161.2 253.4 410.7 201.7 Average of 10 years 1873—1882. 343 21.55 1531 244. 402.8 2171 Note.—All the Death Rates are calculated on the corrected number of Death . Table No. III. PARISH OF SAINT PANCRAS. Deaths Registered at several groups of Ages from different causes during the Year 1883. 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 to5 85 and upwards Total under 5 years Total CLASSES. 1. Zymotic Diseases 217 238 79 88 47 30 10 12 11 l0 2 488 720 2. Parasitic Diseases 6 1 1 — — 1 — — — — — 7 0 3. Dietic Diseases 8 — — 2 2 l0 0 1 2 — 8 28 4. Constitutional Diseases 137 124 41 71 180 188 124 106 45 14 1 261 974 8. Developmental Diseases 130 2 — — . . 1 54 13 36 132 358 0. Local Diseases 383 273 74 60 128 165 240 324 331 163 26 656 2173 7. Deaths from Violence 49 20 13 3 10 22 13 7 9 8 2 69 162 8. Ill defined 173 14 8 2 8 3 4 9 19 11 2 187 283 Total 1100 672 216 202 387 380 403 460 471 341 69 1772 4677 Class I.—Zymotic Diseases. Order 1.—Miasmatic. 1 Small pox. Vaccinated ... ... ... 2 1 ... ... ... ... ... ... ... 3 2 Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... 3 No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Measles 25 66 8 ... ... ... ... ... ... ... ... 91 99 5 Scarlet Fever 1 35 20 1 4 ... ... ... ... ... ... 36 61 6 Tvphns ... ... ... 1 ... ... 1 ... ... ... ... 2 7 Whooping Cough 25 43 4 ... ... ... ... ... ... ... ... 68 72 8 Diphtheria 4 55 13 3 1 2 ... ... ... ... ... 59 78 9 Simple Continued Fever ... 2 ... ... ... ... ... ... ... ... ... 2 2 10 Enteric or Typhoid Fever ... 9 31 39 23 17 6 4 2 ... 1 9 132 11 Other Miasmatic Diseases 1 2 ... ... ... ... ... ... ... ... ... 3 3 Order 2.—Diarrhœal. 1 Simple Cholera ... ... ... 1 ... ... ... ... ... ... ... ... 1 2 Diarrhœa, Dysentery 120 18 2 3 2 1 3 4 4 6 ... 138 163 Order 3.—Malarial. 1 Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... Order 4.—Zoogenous, 1 Cowpox and Vacoination ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Other Diseases (eg., Hydrophobia, Glanders) ... ... ... ... ... ... ... ... ... ... ... ... ... Order 5.—Venereal. 1 Syphilis 26 5 ... ... 1 2 1 ... ... ... ... 31 35 2 Gonorrhœa, Stricture ... ... ... ... ... ... ... ... ... ... ... ... ... Order 6.—Septic. 1 Erysipelas 13 1 ... ... ... 1 2 3 5 4 1 14 30 2 Pyaemia, Septicaemia 2 2 1 4 7 5 3 1 ... ... ... 4 25 3 Puerperal Fever ... ... ... 4 8 2 ... ... ... ... ... ... 14 Class II.—Parasitic Diseases. 1 Thrush, and other Vegetable Parasitic Diseases 6 1 1 ... ... 1 ... ... ... ... ... 7 9 2 Worms, Hydatids, and other Animal Parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ClassIII..Dietic Diseases. 1 Want of Breast Milk, Starvation 5 ... ... ... ... ... ... ... ... ... ... 5 5 2 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Chronic Alcoholism ... ... ... 2 1 6 5 1 2 ... ... ... 17 4 Delirium Tremors ... ... ... ... 1 4 1 ... ... ... ... ... 6 Class IV.—Constitutional Diseases. 1 Rheumatio Fever, Rheumatism of the Heart ... ... 1 1 4 2 2 1 ... ... ... ... 11 2 Rheumatism ... 1 ... 1 1 3 1 1 4 1 ... 1 13 3 Gout ... ... ... ... ... ... 1 4 5 1 ... ... 11 4 Rickets 4 .6 ... ... ... ... ... ... ... ... ... 10 10 5 Cancer, Malignant Disease ... ... ... ... 2 25 38 45 24 10 1 ... 145 6 Tabes Mesenterica 44 19 4 1 ... ... ... ... ... ... ... 63 68 7 Tubercular Meningitis, Hydrocephalus 49 59 14 1 1 ... ... ... ... ... ... 108 124 8 Phthisis 6 7 20 67 141 122 78 49 8 2 ... 13 500 9 Other forms of Tuberculosis, Scrofula 32 '29 1 ... ... 1 1 ... ... ... ... 61 64 10 Purpura. Hemorrhagic Diathesis 1 2 ... ... 1 ... ... ... ... ... ... 3 4 11 Anætnia, Chlorosis, Leucocythaemia 1 1 1 ... 2 1 1 1 1 ... ... 2 9 12 Diabetes ... ... ... ... 4 1 2 5 3 ... ... ... 15 13 Other C onstitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... CLAbs V.—Developmental Diseases. 1 Premature Birth 101 ... ... ... ... ... ... ... ... ... ... 101 101 2 Atelectasis 14 ... ... ... ... ... ... ... ... ... ... 14 14 3 Congenital M alformations 15 2 ... ... ... ... ... ... ... ... ... 17 17 4 Old Age ... ... ... ... ... ... ... 1 54 135 36 ... 226 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 Class VI—Local Diseases. 1 1 1. Nervous System. 1 1 Inflammation of Brain or Membranes 19 13 3 6 3 2 6 ... 2 ... ... 32 54 2 Apoplexy, Softening of Brain, plegia, Brain Paralysis 1 1 1 2 10 16 23 59 73 46 2 2 234 3 Insanity, General Paralysis of the Insane ... ... ... ... 3 3 6 3 12 6 5 ... 38 4 j Epilepsy ... ... 2 3 6 6 5 4 4 1 ... ... 31 5 Convulsions 85 26 ... ... ... ... ... ... ... ... ... 111 111 6 Laryneismus Stridulus (Spasm of 21 Glottis) 11 10 1 ... ... ... ... ... ... ... ... 22 7 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... 1 ... 1 6 5 7 5 3 1 ... 29 8 Other Diseases of Nervous System ... ... 1 ... ... ... ... ... ... ... ... ... 1 2. Organs of Special Sense. 2 2 ... ... ... ... ... ... ... ... ... 4 4 3. Circulatory System. 1 Pericarditis ... 1 7 4 7 1 4 2 1 ... ... 1 27 2 Acute Endocarditis ... 1 4 2 1 1 1 ... ... ... ... 1 10 3 Valvular Diseases of Heart 1 ... 4 ... 3 7 3 7 9 3 ... 1 37 4 Other Diseases of Heart 2 1 4 11 11 21 39 41 40 10 2 3 182 5 Aneurism ... ... ... ... ... 1 6 1 4 1 ... ... 13 6 Embolism, Thrombosis ... ... ... ... ... ... ... ... 2 ... ... ... 2 7 Other Disease of Blood Vessels ... ... ... ... ... ... ... 1 1 1 ... ... 3 4. Respiratory System. 6 1 Laryngitis 2 4 3 1 ... 2 ... 1 1 ... ... 14 2 Croup 3 16 6 ... ... ... ... ... ... ... ... 19 25 3 Emphysema, Asthma ... ... ... ... 3 6 8 10 9 "2 ... ... 38 4 Bronchitis 166 124 8 4 9 12 42 88 94 58 12 290 617 5 Pneumonia 30 37 12 6 23 14 15 14 8 5 1 67 165 6 Pleurisy 1 1 1 3 4 4 2 4 3 1 1 2 25 7 Other Diseases of Respiratory System 5. Digestive System. 5 5 1 2 1 3 2 3 4 1 1 10 28 1 Dentition 22 22 ... ... ... ... ... ... ... ... ... 44 44 2 Sore Throat, Quinsey ... 2 ... ... ... ... 1 ... ... ... ... 2 3 3 Diseases of Stomach 2 ... ... 1 ... 2 3 ... 5 2 ... 2 15 4 Enteritis 12 2 1 ... ... 1 3 ... 1 ... ... 14 20 5 Obstructive Diseases of Intestine 4 ... 1 1 3 6 4 7 6 2 ... 4 34 6 Peritonitis 3 1 4 7 6 4 3 5 1 1 ... 4 35 7 Ascites ... ... ... ... 1 1 1 3 3 2 ... ... 11 8 CirrhosiB of Live ... ... ... ... 2 16 21 9 8 1 ... ... 57 9 Jaundice and other Diseases of Liver 5 ... 1 ... 1 4 9 8 9 2 ... 5 39 10 Other Diseases of Digestive System 6. Lymphatic System. 1 ... ... ... 1 ... 1 2 ... 1 1 1 7 1 Disease of Lymphatics and Spleen 7. Bronchocele and Addison's Disease ... ... ... ... ... ... ... 1 ... ... ... ... 1 8. Urinary System. ... ... ... ... ... 2 ... ... ... ... ... ... 2 1 Nephritis ... ... 3 2 5 1 1 9 2 1 ... ... 24 2 Bright's Disease, Albuminuria ... ... 1 7 9 7 22 21 12 5 ... ... 84 3 Disease of Bladder or of Prostate ... ... ... ... ... ... ... 6 1 5 ... ... 12 4 Other Diseases of the Urinary System 9. Reproductive System. A—Of Organs of Generation. ... ... ... ... ... ... 2 1 3 ... ... ... 6 1 Male Organs 1 ... ... ... ... ... ... 1 ... 1 ... 1 3 2 Female Organs B—Of Parturition. ... ... ... ... 1 2 2 3 2 1 ... ... 11 3 Abortion, Miscarriage ... ... ... ... 3 2 ... ... ... ... ... ... 5 4 Puerperal Convulsions ... ... ... 1 ... 1 ... ... ... ... ... ... 2 5 Placenta prævia, Flooding ... ... ... 1 1 5 ... ... ... ... ... ... 7 6 Other Accidents of Child Birth 10. Bones and Joints. ... ... ... 1 3 4 ... ... ... ... ... ... 8 1 Caries, Necrosis ... ... 1 ... 2 2 ... 2 2 ... ... ... 9 2 Arthritis, Ostitis. Periostitis ... 1 ... ... ... ... ... 1 1 ... ... 1 3 3 Other Diseases of Bones and Joints 11. Integumentary System. 2 3 3 1 2 ... ... ... 3 1 ... 5 15 1 Carbuncle. Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Other Diseases of Integumentary 6 System 3 ... ... ... 3 ... ... ... ... ... ... 3 Class VII—Violence. 1. Accident or Negligence. 1 Fractures and Contusions ... 10 7 1 4 5 5 5 7 7 2 10 53 2 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Burn, Scald 1 6 2 1 2 1 1 1 1 ... ... 7 16 5 Poison ... ... ... ... 1 1 ... ... ... ... ... ... 2 6 Drowning 2 ... 3 ... 1 1 ... ... 1 ... ... 2 8 7 Suffocation 39 3 1 ... ... ... ... ... ... 1 ... 42 44 8 Otherwise 1 ... ... ... 1 1 ... ... ... ... ... 1 3 2. Homicide. 3 1 Manslaughter ... 1 ... ... ... 2 ... ... ... ... ... 1 2 Murder 3. Suicide. 6 ... ... ... 1 ... ... ... ... ... ... 6 7 1 Gunshot Wounds ... ... ... ... 1 1 ... ... ... ... ... ... 2 2 Cut, Stab ... ... ... ... ... 1 2 ... ... ... ... ... 3 3 Poison ... ... ... 1 3 4 1 ... ... ... ... ... 9 4 Drowning ... ... ... ... 1 ... 1 ... ... ... ... ... 2 5 Hanging ... ... ... ... 1 5 3 ... ... ... ... ... 9 6 Otherwise ... ... ... ... ... ... ... 1 ... ... ... ... 1 Class VIII.—Ill.defined Causes. 20 1 Dropsy ... ... 1 ... 5 2 2 2 6 2 ... ... 2 Debility, Atrophy, Inanition 168 13 ... ... ... ... ... ... 3 1 2 181 187 3 Mortification 1 ... ... ... ... ... 1 1 4 6 ... 1 14 4 Tumour ... 1 2 ... 1 ... ... 1 ... ... ... 1 5 5 Abscess 2 ... 5 ... ... ... ... 1 1 ... ... 2 9 6 Hsemorrhage ... ... ... 1 ... ... ... ... ... ... ... ... 1 7 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... 3 3 2 ... ... 8 8 Causes not Specified or Ill.defined 2 ... ... ... 2 1 1 1 2 ... ... 2 9 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 & up ward Total under 5Years Total I.—Specific, Febrile, or Zymotic Diseases 217 238 79 58 47 30 16 12 11 10 1 455 720 1. Miasmatic Diseases 56 212 76 46 29 19 7 4 2 .. I 268 45 2 2. Diarrhœal „ 120 18 2 4 2 1 3 4 4 6 .. 138 164 3. Malarial „ .. .. .. .. .. .. .. .. .. .. .. .. .. 4. Zoogenous „ .. .. .. .. .. .. .. .. .. .. .. .. .. 5. Veneral „ 26 5 .. .. 1 2 1 .. .. .. .. 31 35 6. Septic 15 3 1 8 15 8 5 4 5 4 1 18 69 II. Parasitic Diseases 6 1 1 .. .. 1 .. .. .. .. .. 7 9 III..Dietic Dieseas 5 .. .. 2 2 10 6 1 2 .. .. 5 28 IV. Constitutional Diseases 137 124 41 71 156 155 124 106 45 14 1 261 974 V. Developmental Diseases 130 2 .. .. .. .. .. 1 54 135 36 132 358 VI..Local Diseases 383 273 74 66 128 165 240 324 331 163 26 656 2173 1. Diseases of Nervous System 116 50 9 11 23 33 45 73 96 56 8 166 520 2. „ Organs of Special Sense 2 2 .. .. .. .. .. .. .. .. .. 4 4 3. „ Circulatory System 3 3 19 17 22 31 53 52 57 15 2 6 274 4. „ Respiratory System 207 187 31 16 40 41 69 110 119 77 15 394 912 5. „ Digestive System 49 27 7 9 14 34 46 34 33 11 1 76 265 6. „ Lymphatic System .. .. .. .. .. .. .. 1 .. .. .. .. I 7. „ Glandlike Organs of uncertain use .. .. .. .. .. 2 .. .. .. .. .. .. 2 8. ,, Urinary System .. .. 4 9 14 8 25 37 18 11 .. .. 126 9. „ ReproductiveSystem 1 .. .. 3 8 14 2 4 2 2 •• 1 36 (a) Diseases of Organs of tion 1 .. .. .. 1 2 2 4 2 2 .. 1 14 (6) Diseases of Parturition • • .. .. 3 7 12 .. .. .. .. •• .. 22 10. ,, Diseases of Bones andJoints 2 4 4 1 4 2 .. 3 6 1 .. 6 27 11. „ of Integumentary System 3 .. .. .. 3 .. .. .. .. .. .. 3 6 VII..Violence 49 20 13 3 16 22 13 7 9 8 2 69 162 1. Accident or Negligence 43 19 13 2 9 9 6 6 9 8 2 62 126 2. Homicide 6 1 .. .. 1 2 .. .. .. .. .. 7 10 3. Sucide .. .. .. 1 6 11 7 1 .. .. .. .. 26 4. Execution • • .. .. .. .. .. .. .. .. .. .. .. .. VIII.—Ill.Defined and not Specified Causes 173 14 8 2 8 3 4 9 19 11 2 187 253 Total 1100 672 216 202 357 386 403 460 471 341 69 1772 4677 48 Table IV. PARISH OF ST. PANCRAS. Showing the number of deaths at all ages in 1688 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. Death per 1000 of Total Deaths at all ages. 1. Principal Zymotic Diseases 611 2.5 130.6 2. Pulmonary Diseases 873 3.6 186.6 8. Principal Tubercular Diseases 642 2.6 187.2 Division II. Infants under One Yoar. Total Deaths. Deaths per 1000 of Births. Deaths per 1000 of Total Deaths under one year. 4. Wasting Diseases 274 85.4 249.1 5. Convulsive Diseases 175 22.6 159.1 Notes. 1. Includes Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Typhus, Enteric (or Typhoid), and Simple Continued Fevers, and Diarrhoea. Fifty.four of the Doaths ocourred in Hospitals situated beyond the limits of the District. 3. Includes Phthisis, Sorofula, Tuberculosis, Rickets, and Tabes. 4. Includes Marasmus, Atrophy, Debility, Want of Breast Milk, and Premature Birth. 5. Inoludes Hydrocephalus, Infantile Meningitis, Convulsions, and Teething. Table V. Shewing the Number of Deaths from the principal Zymotic Diseases, in the 10 years 1873 to 188., and in the year 1883. Disease. 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 Annual Average of 10 years, 1873.82 Proportion of Deaths to 1000 Deaths in 10 years, 1873.82. Total Deaths in 1883. Proportion of Deaths to 1000 Deaths in 1883. Small Pox 2 3 2 22 129 94 19 18 84 6 37.9 7.5 3 0 6 Measles 281 64 82 117 143 48 129 58 172 130 122.4 24.2 99 21.1 Scarlet Fever 17 95 240 137 89 138 144 156 180 65 126.2 23.0 61 130 Diphtheria 38 35 55 38 22 23 25 34 70 51 39.1 7.7 78 16.6 Whooping Cough 212 121 232 198 141 217 154 293 122 288 197.8 391 72 15.3 Typhus Fever 9 10 8 5 20 4 4 1 1 .. 6.2 1.2 2 0.4 Enteric Fever 58 38 35 60 58 59 57 43 66 69 54.3 10.7 132 28.2 Simple Continued Fever 14 25 16 7 10 4 5 4 8 .. 9.3 18.4 2 0.4 Diarrhoea 253 222 178 239 155 229 118 204 211 119 192.8 38.1 162 34.8 Totals 884 613 848 823 767 816 655 811 914 729 786.0 169.9 611 130.4 Totals—London 11.226 11,327 13,340 12,536 12,232 14,619 12,010 13,735 13,553 13,553 12,838.9 147.6 1,884 135.0 Table VI. Inspectors Report of the Sanitary Work carried out in the year 1883. No. of Complaints received during the year. No. of Houses, Premises, Ac., inspeoted. 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, Ac., Cleansed, Repaired, Whitewashed, Ac. Houses Disinfected after illness of an Infectious Character. Repaired, Cleansed, Trapped, Ac. New provided. Repaired, Ac. Supplied with Water. New provided. Repaired, Covered, Ac. 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. Lioensed Cowsheds. Licensed Slaughter.houses. Totals 506 10218 4840 425 341 376 19 250 1607 256 237 23 254 7 35 5 50 40 60 75 6 165