STPAN 41 TWENTY-NINTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the Sanitary condition of St. Pangras, MIDDLESEX. REPORT FOR THE YEAR 1884, by SHIRLEY FORSTER MURPHY, LATE MEDICAL OFFICER OF HEALTH FOR the PARISH OF SAINT PANCRAS. St. Pancras, Middleser. TWENTY-NINTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, Being the Report for the Year 1884. TO THE VESTRY OF ST. PANCRAS. Gentlemen, I must apologise for the late appearance of this report, which should have been earlier in your hands. The delay has been due to circumstances which caused interruption to my work while in your service in the earlier part of the year, and to the claims made by other duties which have devolved upon me since I resigned the appointment of Medical Officer of Health to St. Pancras. I have estimated the population of St. Pancras to the middle of the year 1884 to be 240,000. This estimate is based somewhat upon the fact that in the preceding decade the population of the parish had increased annually at the rate of 0.66 per cent. If this increase had continued since 1881 at the same rate, we should now be dealing with a population of over 241,000 in the middle of the year. But when consideration is had for the changes which have taken place in some districts since 1881, and for the fact that during the present decade the increase of population must necessarily be less than in the previous decade, owing to the less rapid building of new houses, I believe that the estimate I have given is accurate. In more detail I have estimated the population of the various sub-registration districts to be as follows:— Sub-registration Districts. Estimated Population. Exclusive of certain Public Institutions. Regent's Park 89,850 89,830 Tottenham Court Road 27,800 26,870 Gray's Inn Lane 80,500 30,350 Somers Town 84,500 84,470 Camden Town 17,150 15,300 Kentish Town 91,200 90,900 Total 240,000 237,220 4 The year 1884 consists of 53 weeks, during which period 6,264 persons died in St. Pancras, giving a death rate of 21.6 per 1,00C were the year of ordinary length. When the number of deaths is corrected by the exclusion of the deaths of those persons in public institutions in the Parish who were not usually resident in St. Pancras, and by the inclusion of the deaths of St, Pancras parishioners in public institutions situated beyond the limits of the Parish, the corrected number of deaths amounts to 4,795, and when further correction is made in view of the fact that the year under consideration contains fifty-three weeks, the death rate amounts to 19.6 per 1000. The number of children under one year of age who died during 1884 was 1,239, but the corrected number was 1,224, or in the proportion of 154.8 of each 1,000 registered births, and 255.2 per 1,000 of the corrected total deaths during the year. In London the proportion of deaths under one year of age was 257.3 per 1,000 deaths at all ages, or 2.1 above that of St. Pancras. During the previous ten years in St. Pancras the average proportion per 1,000 total deaths has been 243.0, or 12.2 below that of 1884. The corrected number of deaths registered under five years of age, amounted during 1884 to 1,952, or 180 more than during the previous year. These are in the proportion of 407.0 per 1,000 of total deaths, or 28,2 above that of 1883. The average proportion of deaths at this age during the last ten years was 399 6 in St. Pancras, and during 1884 in the whole of London it was 433,8 per 1,000. There were 1,966 deaths of St. Pancras parishioners between the ages of five and sixty-five, and 877 deaths above sixty-five years ; these are fewer than during 1883. In public institutions within the Parish 1,482 deaths took place during 1884, being 125 more than during the previous year, and 1,066 St. Pancras parishioners died in public institutions in the Parish, and in other parts of the Metropolis, being 222,3 per 1,000 of the total deaths, and 6,2 less than last year. The number of births registered during the year was 7,905, giving a birth rate of 32,5 per 1000 of inhabitants. This is 0,3 more than in the year, 1883. At the end of this Report will be found a series of tables, recommended by the Society of Medical Officers of Health, and shewing in more detail the death rates from various diseases. DEATHS FROM VARIOUS DISEASES. PULMONARY DISEASES. The corrected number of persons who died from Pulmonary Diseases, other than Phthisis, viz.Bronchitis, Pneumonia, 5 Pleurisy, Asthma, and other Diseases of the Respiratory System, amounted to 808, or 8.8 per 1,000 of population, and 167-4 per 1,000 of total deaths, which is 70 less than during 1888. In London during the same period, the proportion from these causes was 8.9 per 1,000 of population, and 183.1 per 1,000 of total deaths. 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.* Sub-registration Districts. No. of Deaths. Proportion per l,000 of Population. Proportion per 1,000 of Total Deaths. Regent's Park 115 2.9 154.5 Tottenham Court Road 97 8.6 180.9 Gray's Inn Lane 106 3.4 171.7 Somers Town 184 8.8 184.8 Camden Town 70 4.5 201.7 Kentish Town 258 2.8 160.9 TUBERCULAR DISEASES. The principal Tubercular Diseases caused during 1884, 694 deaths, or 52 more than in 1888. The proportion of deaths from these diseases was 144.7 per 1,000 deaths from " all causes," or 2.8 per 1,000 of population. In London, during the same period, the proportion was 140.8 per 1,000 of total deaths, or 8.0 in every 1,000 persons living. The following table shows the relative mortality from these diseases in the sub-registration districts. There are 27 deaths * The previous address of 23 persons dying from Pulmonary Diseases, and 223 persons dying from "all causes" could not be ascertained, and the deaths of these persons are therefore excluded from consideration. All other deaths are referred to the district to which they belong. The death rates are, for the purpose of comparison, corrected, in view of the fact that the yoar is of fiftythree weeks' duration, and the number of residents in hospitals and workhouses is excluded from the population. 6 from Tubercular Diseases, and 228 deaths from "all causes," excluded from consideration. (Vide Note, page 5.) Sub-registration Districts, No. of Deaths. Proportion per 1,000 of Population. Proportion per 1,000 of Total Deaths. Regent's Park 121 8.0 162.6 Tottenham Court Road 84 8.1 156.7 Gray's Inn Lane 87 2.8 141.0 Somers Town 110 8.1 151.7 Camden Town 46 8.0 182.5 Kentish Town 219 2.4 186. 6 WASTING AND CONVULSIVE DISEASES OF INFANTS. There were 821 deaths during 1884 amongst children under one year of age from Wasting Diseases, or 40.6 per 1,000 of registered births, and 262.2 per 1,000 of total deaths under one year. This is in excess of the number of deaths during 1883. There were also during the same period 179 deaths amongst children under one year due to Convulsive Diseases, or 22.6 per 1,000 births, and 146.2 per 1,000 of total deaths at that age. The following tables show the incidence of disease in the different Sub-registration districts, but 2 deaths from Wasting Diseases, and 4 from Convulsive Diseases, and 13 from "all causes " under one year of age, cannot be referred to the districts to which they belong. ( Vide Note, page 5.) WASTING DISEASES. Sub-registration Districts. No. of Deaths. Proportion per 1,000 of Population. Proportion per 1,000 of Total deaths under 1 year. Regent's Park 87 0.94 218.8 Tottenham Court Road 28 1.04 222.2 Gray's Inn Lane 86 1.18 215.5 Somers Town 50 1.45 241.5 Camden Town 81 2.02 288.7 Kentish Town 187 1.50 317.8 7 CONVULSIVE DISEASES. Sub-registration Districts. No. of Deaths. Proportion per 1,000 of Population. Proportion per 1,000 of Total deaths under 1 year. Regent's Park 27 0.68 156.0 Tottenham Court Road 20 0.74 158.7 Gray's Inn Lane 30 0.98 179.6 Somers Town 28 0.81 135.2 Camden Town 15 0.98 140.1 Kentish Town 55 0.60 127.6 ZYMOTIC DISEASES. A greater number of persons have died from Zymotic Diseases than during 1883, though fewer than the average number during the previous ten years. The nine principal Zymotic Diseases have, in 1884 caused 150.9 per 1,000 deaths from "all causes," or 2.8 in every 1,000 of population, whereas in 1883, the proportions were 130.8 and 2.5 respectively, and the average proportions during 1874-83 inclusive, were 151.5 and 3.2. In London during 1884, the proportions were 161.1 and 3.5. The subjoined table shows the relative proportion of deaths from Zymotic Diseases in the sub-registration districts; 4 deaths from these diseases, and 223 deaths from "all causes," could not be referred to the districts to which they belong. ( Vide Note, page 5.) Sub-registration Districts. No. of Deaths. Proportion per 1,000 of Population. Proportion per 1,000 of Total Deaths. Regent's Park 94 2.3 126.3 Tottenham Court Road 93 8.4 173.5 Gray's Inn Road 111 8.6 179.9 Somers Town 126 8.6 173.7 Camden Town 44 2.8 126.8 Kentish Town 1 252 2.7 157.2 8 SMALL-POX. This disease caused in 1884 a greater number of deaths than in any year since 1881, as many as 61 persons dying during 1884, or in the proportion of 12.7 per 1,000 deaths from "all causes." During the same period in London, this proportion was 10.9 per 1,000, or 1.8 less than in St. Pancras. The annual average number of deaths from Small-Pox in St. Pancras during the preceding ten years was 88.0, or in the proportion of 7.6 per 1,000 deaths from "all causes." The distribution of the deaths in 1884 is as follows:— Sub-registration Districts. Vaccinated . Unvaccnated. Not stated. Total. Regent's Park 4 3 1 8 Tottenham Court Road — 1 2 3 Gray's Inn Road 6 — 2 8 Somers Town 2 1 4 7 Camden Town 1 1 — 2 Kentish Town 9 15 9 33 The relative extent to which the different Parishes in London have suffered during the year 1884 is shown in the following table:— Small-Pox Death-rate per 100,000 Small-Pox Death-rate per 100,000[##] Kensington 11.8 Shoreditch 54.5 Fulham 17.4 Bethnal Green 77.1 Chelsea 28.8 Whitechapel 26.6 St. George, Hanover Square 4.7 St. George-in-the-East 95.4 Stepney 58.0 Westminster 15.0 Mile End Old Town 66.2 Marylebone 16.1 Poplar 56.8 Hampstead 55.0 St. Saviour 28.0 St. Pancras 27.0 St, Olave 23.0 Islington 82.5 Lambeth 11.8 Hackney 116.8 Wandsworth 10.4 St. Giles 44.0 Camberwell 16.0 Strand 20.8 Greenwich 26.6 Holborn 27.6 Lewishm 2.7 City 7.7 Woolwich 14.8 9 The distribution of the disease in St. Pancras is of importance in relation to the question whether the two neighbouring SmallPox Hospitals, the one at Highgate, and the other at Hampstead, have been concerned in its production. The use for Small Pox of the hospital at Hampstead during the year 1884, after having been closed for a number of years, enables a comparison to be made between the distribution of Small-Pox in St. Pancras at times when the hospital was closed, and the distribution of the disease during this particular year, when it was receiving cases of Small Pox. Now I desire to say at the beginning that I am unable to report on this important subject as fully as I could wish. The Hampstead Hospital is situated fully a quarter of a mile beyond the parish boundary of St. Pancras, and my observations are necessarily limited to those houses which are in St. Pancras. The Highgate Hospital is also situated outside the parish boundary, and here, again, 1 have only before me the behaviour of Small Pox in St. Pancras. I am, therefore, unable to discuss the influence of these hospitals on the greater part of the concentric areas which surround them. The St. Pancras houses, indeed, constitute but a small portion of those which surround the hospitals, and I hesitate to draw conclusions of too detailed or positive a character from an experience which is limited in the sense I have described. Nevertheless the facts, such as they are, deserve to be recorded; but it must be recollected that any statements made here refer only to houses situated in St. Pancras. The charts which accompany this report will sufficiently show the position of the hospitals in relation to St. Pancras houses and the distribution of Small Pox in the Parish during the successive years 1880, 1881, 1882,1883, and 1884. Each spot upon the charts represents the position of a house invaded by Small Pox, and which became known to the Sanitary Department. The shading represents the area covered by buildings. In the first instance it will be well to consider the distribution of Small Pox in relation to the Hampstead Hospital, which daring the years 1880, 1881, 1882 and 1883 received no case of Small Pox, but was opened in May of 1884 for the reception of persons suffering from this disease. If circles having respectively ,½,¾ and 1 mile radius be drawn round the Hampstead hospital as a centre, and the number of houses in each ring belonging to St. Pancras counted, it is found they were in each year invaded by Small Pox in the proportion shown in the following table:— Area near the Hampstead Small Pox Hospital. No. of houses in each ring Total No. of houses invaded. Houses invaded per cent. of total houses. 1880 Hospital closed. 18S1 Hospital closed. 1882 Hospital close!. 1883 Hospital closed. 1884 Hospital open. 1880 Hospital closed. 1881 Hospital closed. 1882 Hospital closed. 1883 Hospital closed. 1884 Hospital open. Quarter mile radius Not in St. Pancras. Half mile radius 1118 0 16 0 0 75 .00 1.4 .00 .00 6.7 Three Quarters mile radius 1791 4 36 3 0 57 .22 2.0 .16 .00 3.1 One mile radius 3007 5 37 4 2 41 .16 1.2 .13 .06 1.3 Special area of one mile round Hospital 5916 9 89 7 2 173 .15 1.5 .12 .03 2.9 Rest of Parish 18739 45 307 26 10 178 .24 1.6 .14 .05 0.9 It should be stated that the number of St. Pancras houses in each of the circles has been counted with as much care as possible, and the total number of houses in each circle in 1884 is made the basis of calculation. As a matter of fact there has been some increase of houses between the years 1880 and 1881, but this has been examined and is not found to be sufficient to disturb the results. The number of houses in the "rest of Parish" is the total number of inhabited houses in the Parish at the Census of 1881, with the numbers of St. Pancras houses in the special area deducted. The actual number of houses ia the rest of the Parish is larger than that given, but it is convenient that the error should be such as to minimize rather than exaggerate the appearance of any effects of any small pox hospital influence. 11 The lessons these figures teach are—First: That in the four years 1880, 1881, 1882 and 1883, when the Hampstead Hospital was closed, the houses in the special area surrounding the hospital were attacked less than those in the rest of the parish, but that in the year 1884, when the hospital was re-opened the special area suffered three times as much as the rest of the parish. Second : That whereas in the first four years, when the hospital was closed against Small Pox, the houses in the rings nearest to the hospital were not invaded in greater proportion than those further away, in the year 1884, when the hospital was open, there was a marked gradation of incidence, the houses in the ring nearest to the hospital suffering more than twice as much as those in the next ring and more than five times as much as those in the outer ring. It should be observed that during the year 1884, the number of patients iu the hospital has not exceeded the number recommended by the Royal Commission appointed to inquire respecting Small Pox and Fever Hospitals, the numbers admitted during and remaining at the end of each week being as follows, after the hospital was opened on May 7th:— Cases admitted during each week. Cases remaining in Hospital at end of week. Cases mitted during each week. Cases remaining in Hospital at end of week. May 10 17 16 September 6 20 19 17 24 28 13 10 13 24 19 26 20 16 20 31 17 17 27 18 20 June 7 24 22 October 4 10 12 14 26 23 11 1 19 21 41 15 18 2 20 28 14 12 25 6 12 July 5 30 24 November 1 9 12 12 13 14 8 21 18 19 7 14 15 20 21 26 20 15 22 4 11 August 2 6 9 29 10 10 9 34 23 December 6 13 10 16 8 5 13 5 7 23 8 5 20 10 10 30 11 13 27 7 7 12 Moreover, during 1884, the admirable ambulance arrangements of the Metropolitan Asylums Board came into force, and the opportunities for the dissemination of Small Pox through defects of ambulance administration were reduced to a minimum. Again very considerable precautions were taken to reduce the visiting of friends to patients in the hospital, and the spread of infection through the outgoing of nurses and hospital servants, yet, notwithstanding these precautions, the distribution of the disease has been such that it is difficult not to believe that the Small Pox Hospital at Hampstead has, in some way or other, been the cause of Small Pox in St. Pancras houses situated near to it. After careful consideration of all the circumstances connected with the outbreak of 1884, I have felt that such knowledge as I have concerning the Hampstead Hospital and the distribution of disease around it, does not warrant me in expressing any definite opinion on the question whether the disease was spread through personal communication or was aerially diffused. Before such opinion could be formed it would be necessary to study all the facts in connection with the distribution of Small Pox in the total area round the hospital, and this, as Medical Officer of Health for St. Pancras has not been possible for me to do. The next point for consideration is the distribution of Small Pox in the neighbourhood of the Highgate Small Pox Hospital. This hospital is situated in the Parish of Islington a few yards "west of the boundary of the Parish of St. Pancras. The portion of St. Pancras Parish which is nearest to the hospital is not thickly covered with houses; they are of small size, and are not, therefore, occupied by a large number of persons. Access to the hospital can be obtained by an entrance gate on the boundary of St. Pancras Parish, as well as on the other side of the hospital, in the Highgate Road, and the details of administration of this hospital differ in some respects from those of the Hampstead Hospital. The patients moreover, are, as a rule, conveyed to the hospital in private ambulances, which are not under the control of the hospital authorities. The distribution of Small Pox in the neighbourhood of the Highgate Small Pox Hospital will be understood by reference to the charts which accompany this report, and to the following table: Area near the Highgate Small Pox Hospital. No. of houses in each ring. Total No. of houses invaded. Houses invaded per cent. of total houses. 1880 1881 1882 1883 1884 1880 1881 1882 1883 1884 Quarter mile radius 246 1 23 1 3 19 .57 107 .40 1.20 7.70 Half mile radius 241 2 5 0 1 2 .83 20 .00 .41 .83 Three-quarter mile radius 762 0 12 0 0 6 .00 1.5 .00 .00 .78 One mile radius 1040 0 14 1 0 15 .00 1.3 .09 .00 1.40 Special area of one mile round hospital 2289 3 54 2 4 42 .13 2.3 .09 .17 1.8 Rest of parish 22366 51 342 31 8 309 .22 1.5 .13 .03 13 This Table has been constructed in the same manner as that relating to the Hampstead Hospital. In the first circle the number of houses has increased during the period under consideration and allowance has been made for this increase in the calculation of per centages. 14 It will be seen that in the years 1881, 1883 and 1884, the distribution of Small Pox in the special area, as related to the rest of the Parish, and also in the different rings of the special area, resembles in its incidence the distribution of Small Pox around the Hampstead Hospital during the year 1884, when it received patients, except that in the one mile ring, during the year 1884, the incidence of disease has been greater than in the three quarter mile ring, a fact that becomes especially important when the proximity of houses in the one mile ring to the Hampstead Hospital is considered, and when it is recollected that in this particular year only the Hampstead Hospital received cases of Small Pox. During the years 1880 and 1882, however, the special area suffered less than the rest of the Parish. It has apparently been thought by the Royal Commission that the number of cases in a Small Pox Hospital has some relation to the opportunity for diffusion of disease in its neighbourhood, but during the year 1883 the Highgate Hospital in this respect has not seemingly had greater opportunities for exercising such influence than in 1880 and in 1882, as is shown by the tables at the end of this section. Whether the explanation of this apparent difference is to be found in the fact that but a very limited portion of the area round the hospital has been under consideration, and that the invaded houses in St. Pancras have been too few to eliminate such error as is liable to occur in dealing with small numbers, or whether there may be some difference in the power for diffusion of epidemic disease during one time or another cannot be stated. In this connection observations of Mr. W. H. Tower concerning the influence of the Fulham Hospital at different periods of the year, during which it was occupied, must be borne in mind. Mr. Power found that while the aggregation of nine persons suffering from Small Pox in this hospital was attended under certain meteorological conditions, and a particular stage of the epidemic, by the appearance of Small Pox in houses surrounding the hospital on all sides, at other periods, during the same year, the hospital might contain a larger number of cases, and very similar meteorological conditions exist without any evidence of this diffusion being apparent. As I have already stated I have not the opportunity for entering further into the details of this subject, but before leaving it I may state that the evidence which St. Pancras affords tends to show that these Small Pox hospitals, as at present constructed and managed, are a source of disease to the neighbourhood in which they are placed. It should, in conclusion, be pointed out that as yet the recommendations of the Royal Commission have not been fully adopted by those who have the management of these 15 tions. An essential part of these recommendations was that Small Pox Hospitals should be so constructed as to permit the destruction of all air which the wards have contained. If the special incidence of disease in the hospitals' neighbourhood has been the result of air-borne infection, there is hope that the aggregation of Small-Pox cases may still be practised in institutions constructed so as to ensure this object. No. of cases admitted into the Highgate Small-Pox Hospital during each week, and remaining at end of each week. 1880. Cases Admitted during the week. Cases remaining at end of week. 1880. Cases Admitted during the week. Cases remaining at end of week. January 10 5 6 July 10 2 10 17 0 4 17 1 9 24 0 2 24 2 9 31 0 1 31 0 9 February 7 1 1 August 7 1 8 14 8 7 14 4 11 21 0 7 21 0 7 28 7 12 28 4 11 March 6 2 12 September 4 2 10 13 5 16 11 1 9 20 3 16 18 3 9 27 5 14 25 1 7 April 3 7 19 October 2 1 8 10 5 18 9 0 8 17 7 22 16 2 9 24 10 26 23 0 7 May 1 3 21 30 2 7 8 8 24 November 6 4 9 15 7 24 13 1 9 22 7 27 20 7 15 29 5 22 27 4 17 June 5 4 19 December 4 7 21 12 2 13 11 10 30 19 3 9 18 7 26 26 2 11 1881 25 7 28 July 3 3 10 January 1 6 28 1881 1881 January 8 5 24 March 5 24 56 15 5 26 12 25 60 22 11 27 19 37 74 29 7 30 26 17 74 February 5 20 37 April 2 33 87 12 16 46 9 21 77 19 15 53 16 28 85 26 8 43 23 29 95 16 1881. Cases admitted during each week. Cases remaining at end of week. 1881. Cases admitted during each week. Cases remaining at end of week. April 30 20 88 Sept. 3 14 34 May 7 21 85 10 9 36 14 23 86 17 6 28 21 20 92 24 9 26 28 20 84 October 1 6 25 June 4 28 86 8 7 28 11 19 83 15 4 24 18 21 80 22 9 22 26 17 73 29 7 23 July 2 32 85 November 5 19 36 9 11 72 12 9 37 16 13 70 19 8 36 23 15 59 26 11 41 30 6 49 December 3 0 38 August 6 10 46 10 9 31 13 6 34 17 5 29 20 8 34 24 8 34 27 10 28 31 11 36 1882 1882 January 7 7 35 July 1 3 10 14 8 32 8 2 11 21 9 32 15 3 10 28 3 30 22 0 8 February 4 3 30 29 0 4 11 2 20 August 5 2 4 18 4 17 12 2 5 25 10 22 19 1 6 March 4 11 28 26 2 7 11 5 28 September 2 1 8 18 4 27 9 1 8 25 8 27 16 2 6 April 1 7 26 23 2 6 8 13 32 30 1 4 15 3 25 October 7 4 6 22 5 20 14 7 11 29 8 21 21 0 8 May 6 4 21 28 1 7 13 2 15 November 4 0 6 20 2 13 11 0 1 27 9 19 18 1 1 June 3 1 16 25 2 2 10 4 14 December 2 1 3 17 3 11 9 3 6 24 3 8 16 1 6 23 4 8 30 2 9 17 1883. Cases Admitted during each week. Cases remaining at end of week. 1883. Coses admitted during each week. Cases remaining at end of week. January 6 1 7 July 7 0 9 13 5 10 14 1 5 20 2 8 21 1 3 27 1 8 28 2 5 February 3 3 11 August 4 2 5 10 4 13 11 1 4 17 0 9 18 0 4 24 2 10 25 3 7 March 3 3 10 September 1 1 4 10 0 6 8 0 4 17 1 6 15 1 3 24 0 3 22 2 5 31 1 3 29 1 4 April 7 0 2 October 6 4 8 14 1 3 13 4 10 21 1 3 20 2 11 28 0 3 27 1 10 May 5 1 3 November 3 0 9 12 0 2 10 1 7 19 0 0 17 1 5 26 3 3 24 3 6 June 2 2 5 December 1 1 7 9 0 5 8 3 7 16 2 7 15 0 6 23 4 9 22 3 6 30 1 9 29 3 9 1884 1884 January 5 2 8 April 5 1 13 12 4 10 12 4 17 19 2 11 19 6 17 26 0 10 26 2 15 February 2 2 5 May 3 8 20 9 2 5 10 21 36 16 1 6 17 12 41 23 1 7 24 16 52 March 1 0 5 31 21 61 8 3 7 June 7 19 70 15 2 7 14 21 84 22 3 7 21 22 90 29 8 14 28 11 83 18 1884. Cases admitted during each week. Cases remaining at end of week. 1884. Cases admitted during each week. Cases remaining at end of week. July 5 20 81 October 4 7 22 12 18 79 11 1 16 19 8 68 18 5 18 26 6 56 25 6 20 August 2 2 45 November 1 3 18 9 6 45 8 18 30 16 6 37 15 20 41 23 5 28 22 11 48 30 4 20 29 24 58 September 6 14 30 December 6 35 80 13 4 31 13 22 92 20 1 26 20 22 99 27 3 25 1885 27 14 95 January 3 15 92 VACCINATION. The increase of Small Pox during the early part of the year 1881 led me to recommend the Vestry to place themselves in communication with the Board of Guardians, with a view to a house-to-house visitation being made without loss of time, and to arrange for the issue of a memorandum, calling attention to the dangers of Small Pox, and to the protection offered by vaccination. This was accordingly done, and Mr G. W. Collins was appointed, with nine colleagues, to make a house-to-house visitation throughout the whole Parish, and to urge upon all persons, by the distribution of appropriate literature and by personal appeal, to protect themselves and their children against Small Pox. Street lists, in the order of route, with the names of householders, were prepared from the rate books, and uniform books were printed, in which to collect the information for each house separately. The whole work was accomplished in the space of twelve weeks, and in this period, 21,885 inhabited houses were visited, of which about 2,200 were let in tenements, and the condition as to vaccination of 142,788 persons was ascertained. It may be useful in the future to know the cost of these proceedings, and it may, therefore, be stated that the sum of £866. 9s. was expended in salaries, and a further sum of £157, 4s. 11d. expended upon printing, upon advertisements, and upon the purchase of vaccination pamphlets, making altogether a total of £523. 18s. 11d. 19 The following information, which I extract from Mr. Collins' report, was obtained as the result of the inquiry. Those who were visited being classed under the headings, "Vaccinated" (first-class), "Imperfectly Vaccinated," "Unvaccinated" "Under Vaccination," "Information refused":— By First Class Vaccination is meant "foveated" (or pitted and depressed) vaccination marks, equal in total area to ½ a square inch. Imperfect vaccination includes—1. Marks that are not foveated (or pitted). 2 Marks less than ¼ a square inch in total area. 3 Marks of doubtful origin. 4. No marks to be seen, but vaccination stated to have been performed. The unvaccinated Class includes those who deny having been vaccinated, and on whom there are no marks. Also those persons who are stated to be insusceptible to vaccination. "Under Vaccination" includes those in whom the scabs from recent vaccination had not fallen off at the time of the visit. The measurements were made by means of a graduated measure of the Local Government Board Standard. The total number of persons examined is as follows:— Under 1 year of age 3,499 1 to 10 years of age 26,537 Over 10 „ 112,752 Total 142,788 The condition of vaccination of those under one year of age was — First Class Vaccination 1,658, or 50.5 per cent. of those examined. Imperfectly Vaccinated 296, or 9.02 „ „ Unvaccinated 952, or 29.04 ,, ,, Under Vaccination 372, or 11.34 ,, ,, 3,278 Information refused 221 Total 3,499 The large number of unvaccinated children is accounted for by the majority being under 3 months of age. From 1 to 10 years of age— First Class Vaccination 20,504, or 70.11 percent. of those examined Imperfectly Vaccinated 5,127, or 19 78 ,, „ Unvaccinated 225, or .86 ,, „ Under Vaccination 61, or .23 ,, ,, 25,917 Information refused 620 Total 26,537 20 The above figures show that out of 30,036 children under 10 years of age who were inspected, 22,162, or 73.78 per cent., bear evidence of vaccination of the first class, this being undoubtedly due to the efficient way in which vaccination is performed at the Public Vaccination Stations. Now this proportion is not more than the average proportion vaccinated at the Public Vaccination Stations of St. Pancras which are invariably vaccinated in such a manner as to entitle them to have their vaccination placed in the first class; the inference is therefore that children vaccinated elsewhere than at the Public Stations receive much less protection against Small-Pox, a point to which the attention of private practitioners might with advantage be directed. Of the persons over 10 years of age there were— Vaccinated 71,213, or 63.34 per cent. of those examined. Re-vaccinated 39,836, or 35.43 ,, ,, Unvaccinated 1,377, or 1.22 ,, ,, 112,425 Information refused 327 Total 112,752 In persons over 10 years of age a different classification had to be adopted, as it would have been quite impracticable to examine their arms, and it was necessary, therefore to depend upon the information given. Nevertheless, the information thus obtained is upon the whole correct and reliable, for imich care was taken to lest by crossexamination the accuracy of the answers given, and to ascertain whether those who had suffered from Small Pox, and were stated to be vaccinated, had passed through this affection before or after their vaccination ; and again, whether the Small Pox from which they had suffered was the result of inoculation. It deserves comment that in the Regent's Park District, those revaccinated were twice as numerous as those only once vaccinated, and there were hardly any unvaccinated; whilst in the poorer districts, such as Somers Town, the proportions were reversed, showing that the value of re-vaccination is better appreciated by the educated than the uneducated portion of the community. Amongst the children under 10 years of age the number marked with Small Pox is so small that it may be disregarded, but among persons over 10 years the protective power of vaccination is very clearly shown, thus:— number examined. numbeb marked with small-pox. Re-vaccinated .. 39,835 29, or 0.8 per cent. Vaccinated . 71,213 2,013, or 2.8 ,, Unvaccinated .. 1,377 857, or 62.2 ,, 112,425 The above figures are very striking and conclusive, aud show clearly enough that but for vaccination more than hall the people in St. Pancras over 10 years of age would be disfigured by Small Pox. 21 As soon as the enquiries were instituted the Vaccination Stations were opened in the evening to give facilities for the revaccination of adults who were prevented by their occupation from attending during the day, and over fifteen hundred St. Pancras Parishioners were re-vaccinated at the public stations during the months of June, July and August. The number revaccinated by private practitioners is unknown. At the same time immediate notice was given to the Public Vaccinator, by the Sanitary Department, of every case of Small Pox which was brought to knowledge, and with as little delay as possible he proceeded to the house and offered to vaccinate or re-vaccinate all who were insufficiently protected. The ambulance of the Metropolitan Asylums Board was speedily procured owing to the telephonic communication which now exists between the Vestry Hall and the Offices of that Board; the sick were removed to hospital whenever this was permitted, and the disinfection of the house and its contents immediately followed. The arrangements for preventing the extension of disease were therefore complete with the one exception, that notification to the Sanitary Department of all cases could not be enforced. I have no hesitation in expressing the opinion that the action of the Guardians has been of great value to the Parish, that it has been and will in the future be a means of saving life, for the protection afforded to those people who have given practical effect to the recommendations which have been urged upon them is not limited to the epidemic period of 1884. Even if regarded from the lower view point of money expenditure, it will be found that the cost of five hundred pounds which have been expended will eventually make an ample return in saving money which would otherwise be lost in hospital provision for persons suffering from Small Pox, and in maintaining those who as the result of every Small Pox epidemic become a more lasting charge upon the ratepayers. The steps which have been taken in 1884 I should desire to see repeated from time to time, and especially when there is reason to believe that Small Pox is likely to assume epidemic proportions in the Metropolis. S Every year gives evidence of the dangers of Small Pox, thus Mr. Bichards, Vaccination Officer, brought to my notice the case of a woman of advanced years, living in the Maiden Road, to whom a case of Small Pox had occurred. He found it impossible to convince her that advancing years did not confer immunity from Small Pox upon the unvaccinated. Her death from this 22 disease shortly after occurred, and she was the only other inmate of the house who contracted Small Pox from the first case. Such persons are constantly exposed to risk of death from the most loathsome of diseases, and no one can protect themselves against the chances of exposure to infection. Persons suffering from Small Pox may while highly infectious have but a few pimples on their body, which escape serious attention, and thus while associating with others they may convey a fatal disease to those unprotected by vaccination. In a house situated in Somers Town, in the latter part of 1884, a woman living in one of the kitchens suffered from what I am told was regarded as "a severe cold with pimples on the face," but which subsequent events led to the conclusion was modified Small Pox. About three weeks later her husband was attacked with this disease, and was removed to the Hospital where he died; a neighbour who attended her during her illness was attacked with the same affection, and also died after giving birth to an infant which survived its birth but three days. Later the landlady of the house died from Small Pox doubtless contracted from the same source. That these calamities can be prevented there is no manner of doubt. I am informed by Mr. Webb, Vaccination Officer, that he has never found a single re-vaccinated person among those St. Pancras parishioners who having been attacked by Small Pox have come under his personal notice, and this experience is in no way exceptional. The provisions of the Vaccination Acts have been enforced during the year, and the accompanying tables, kindly supplied by the Vaccination Officers, give account of the results of their operations during the year ending June 30th, 1881, MEASLES. In 1884 Measles caused 89 deaths, being 10 less than during the previous year. The proportion of deaths per 1000 deaths from "all causes" was 18.5 and 0.36 per 1000 of population. During the previous ten years this disease caused an annual average of 20.8 in every 1000 deaths from "all causes." In London, in 1884, Measles caused 27.5 per 1000 deaths from "all causes," and 0.59 per 1000 of population, the former being 9.0 more than the St. Pancras rate. Report for the Six Months ending December, 1883 • Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the 'Birth List Shoots' registered during the six months ended Dec, 1883. "Successfully Vaccinated." Insusceptible. Number of csses "Dead." 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. Out of District. cutions. 1 Kentish Town 1450 1269 6 115 18 ... 40 ... 2 2 Regent's Park 547 472 ... 44 17 ... 14 ... ... 3 Camden Town 378 327 2 27 6 ... 16 ... ... 4 Somers Town 550 457 1 47 15 ... 28 1 1 5 Tottenham Court Road 324 278 ... 31 9 ... 6 ... ... 6 Gray's Inn Road 461 382 1 45 16 ... 16 1 ... Total 3710 3185 10 309 81 ... 120 2 3 Report for the Six Months ending June. 1884. 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, 1884. "Successfully Vaccinated." Insusceptible. Number of cases "Dead." 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. Out of District. Prosecutions. 1 Kentish Town 1563 1348 5 124 30 ... 56 2 Regent's Park 578 492 2 55 13 ... 16 3 Camden Town 396 334 ... 43 3 ... 16 4 Somers Town 606 512 2 63 14 ... 15 5 Tottenham Court Road 370 309 2 37 10 ... 12 6 Gray's Inn Road 481 393 1 49 25 ... 13 Total 3994 3388 12 371 95 ... 128 25. The distribution of the disease was as follows: Sub-Registration Distriots. No. of Deaths. Proportion per 1000 of Population. Proportion per 1000 of Total Deaths. Regent's Park C 0.15 8.0 Tottenham Court Road 19 0.70 35.4 Gray's Inn Road 20 0.65 32.4 Somers Town 18 0.52 24.8 Camden Town 2 0.13 5.4 Kentish Town 23 0.25 14.3 One death from Measles, and 223 from "all causes" could not be traced to the districts to which they belong. (Vide Note, page 5.) SCARLET FEVER. This disease caused 44 deaths in St. Pancras during 1884, being 17 less than during the previous year, and about onethird of the annual average of the previous ten years. The proportion of deaths to 1000 deaths from "all causes" was 9.1 in 1884, and 20.1 in the years 1874-88. The proportion of deaths to 1000 of population was 0.18 in St. Pancras. In London, as a whole, these proportions were 17.3 and 0.37 respectively. The following table shews the relative proportion of Scarlet Fever in the sub-registration districts: Sub-Registration Districts. No. of Deaths. Proportion per 1000 of Population. Proportion per 1000 of Total Deaths. Regent's Park 12 0.30 16.1 Tottenham Court Road 6 0.22 11.1 Gray's Inn Road 7 0.28 1138 Somers Town 3 0.08 4.1 Camden Town 2 0.13 5.7 Kentish Town 14 0.15 8.7 26 DIPHTHERIA. This disease caused 45 deaths during 1884, being fewer than since 1880, and 33 less than last year. The proportion per 1000 deaths from "all causes" was 9.3, and 0.18 in every 1000 of population, the annual average of deaths from diphtheria during the previous ten years had been 8.6 in every 1000 deaths from "all causes." In London the number of deaths was 11.l7 per 1000 deaths from "all causes," or M2.7 above that of St. Pancras, and 0.25 per 1000 of population. The deaths in St. Pancras were distributed as follows: Sub-registration Districts. No. of Deaths. Proportion per 1000 of Population. Proportion per 1000 of Total Deaths. Regent's Park 8 0.20 10.7 Tottenham Court Road 4 0.14 7.4 Gray's Inn Road 5 0.16 8.1 Somers Town 6 0.17 8.2 Camden Town 4 0.26 11.5 Kentish Town 18 0.19 11.2 WHOOPING COUGH. In 1884 there were 202 deaths from this disease, or 130 more than during the previous year. The proportion of deaths to 1000 deaths from "all causes" was 42.1, as compared with 15.3 in 1883, and per 1000 of population the proportion was 0.83 in 1884, as compared with 0.3 in the previous year. In London these proportions were 38.3 and 0.83 respectively The following table shows the incidence of Whooping Cough upon the different sub-registration districts:— Sub-Registration Districts. No. of Deaths. Proportion per 1000 of Population. Proportion per 1000 of Total Deaths. Regent's Park 24 0.61 32.2 Tottenham Court Road 30 1.11 55.9 Gray's Inn Road 27 0.88 43.7 Somers Town 35 1.01 48.2 Camden Town 14 0.91 40.3 Kentish Town 71 0.78 44.2 27 One death from this disease, and 223 from " all causes," could not be referred to the districts to which they belong, and are, therefore, omitted from consideration. (Vide Note, page 5.) TYPHUS FEVER. One death was registered as due to Typhus Fever, that of a woman living in the Kentish Town sub-registration district. I made enquiry into this case, with the result that I ascertained that the deceased was a widow in good circumstances, who occupied the whole of a small house, and who had not, so far as is known, been exposed to infection of typhus. I had not the opportunity of seeing this case either during life or after death. ENTERIC FEVER. There were 55 deaths from this disease during 1884, being 0.9 less than the annual average of the preceding ten years. The number of deaths in 1884 in St Pancras was in the proportion of 11.4 per 1000 deaths from "all causes," and 0.22 per 1000 of population. In London these proportions were 112 per 1000 of total deaths, and 0.24 per 1000 of population. The deaths were distributed in St. Pancras as follows :— Sub-registration Districts. No. of Deaths. Proportion per l,000 of Population. Proportion per 1,000 of Total Deaths. Regent's Park 4 0.10 5.8 Tottenham Court Road 8 0.29 14.9 Gray's Inn Road 12 0.39 19.1 Somers Town 11 0.31 15.1 Camden Town 6 0.39 17.2 Kentish Town 14 0.15 8.7 Among local outbreaks which it devolved upon me to investigate, were certain cases of this disease occurring among the drinkers of milk received from a dairy situated in an adjoining parish. The supply of milk was being received by the sufferers from a farm in Hertfordshire, which was at the same time, the cause of a serious outbreak of enteric fever in the City and neighbourhood of St. Albans. It was the same farm as that which in the previous year had supplied milk which led to the disastrous epidemic of enteric fever in St. Pancras, and which had again 28 acquired the power of disseminating disease. I investigated this outbreak in St. Albans, on behalf of the Local Government Board, and the details will be found in a report presented to that Board. The London milk vendor, on my representation determined to draw his milk supply from another source, and the injury sustained by St. Pancras was therefore very slight. SIMPLE CONTINUED FEVER. No deaths were registered from Simple Continued Fever during 1884, but a young child died from so-called remittent fever in the Kentish Town sub-registration District, DIARRHÆA. In 1884, there were 227 deaths from diarrhoea, a larger number during any year since 1878, and 65 more than in 1883. The annual average of the previous ten years was 188'7 or 44 less than that of the year under consideration. The deaths in St. Pancras from this disease were in the proportion of 47.3 per 1000 of total deaths, and 0 93 per 1000 of population. In London these proportions were 45.5 and 0.99 respectively showing that St. Pancras had suffered more severely than London as a whole. Of the 227 deaths, 6 were from simple cholera, and of these, 3 occurred in the Kentish Town, 2 in the Gray's Inn Road, and 1 in the Regent's Park sub-registration Districts. As regards the ages at which the deaths from diarrhoea took place, 159 were of children under one year of age, 195 under five years, and the remainder from five to eighty-five years of age. The distribution of the disease in the various sub-registration Districts was as follows:— Sub-registration Districts. No. of Deaths. Proportion per 1000 of population. Proportion per 1000 of Total Deaths. Regent's Park 32 0.81 43.0 Tottenham Court Road 23 0.85 42.9 Gray's Inn Road 32 1.05 51.8 Somers Town 46 1.33 63.4 Camden Town 14 0.91 40.3 Kentish Town 78 0.85 48.6 29 Two deaths from diarrhoea and 223 from " all causes " could not be referred to the districts to which they belong, and are therefore omitted from consideration. (Vide Note, page 5.) PUERPERAL FEVER. There were 14 deaths during 1884 in St. Pancras from this disease, or the same number as in the preceding year. The proportion in St. Pancras per 1000 deaths from "all causes" was 2.9, and in Londou 3.9 or 1.0 more than in St. Pancras. The distribution of the deaths were as follows:— Sub-registration Districts. No. of deaths. Regent's Park 2 Tottenham Court Road 0 Gray's Inn Road 2 Somer's Town 3 Camden Town 1 Kentish Town 6 VIOLENT DEATHS. During 1884, the deaths from violence numbered 235, or, if corrected, 143, being 19 less than in 1883. Of these deaths, 111 occurred from accident or negligence, 10 from homicide, and 22 from suicide, or 4 less than during the previous year. The number of infants suffocated was 38 or 4 less than in 1883. Fractures and contusions caused 44 deaths, and burns and scalds 6 deaths. There were 478 inquests held in St. Pancras during the year, being 10 more than in the preceding twelve months. UNCERTIFIED DEATHS. The number of uncertified deaths in 1884 was 9, the same as in 1883 ; the deaths occurred in the Camden Town and Kentish Town sub-registration districts, and were in the proportion of 1-8 per 1000 of deaths from "all causes." In London uncertified deaths were in the proportion of l.26 per 1000 total deaths, which is 0.4 in excess of the proportion in the previous year. 30 BAKEHOUSES. The inspection and improvement of Bakehouses under the Act which had been passed in the previous year, 1883, more seriously engaged the attention of the Sanitary Department. The following Regulations indicating the requirements of the Vestry were forwarded to every occupier of a bakehouse, and each bakehouse was visited by one of the Sanitary Inspectors, and a notice sent pointing out in detail any alteration which was needed. Later I visited all the premises personally, and found that of two hundred and eleven bakehouses, forty-nine were more or less dirty, a few of them so dirty that I felt it my duty to recommend the Vestry to institute proceedings against the occupier. To some extent this uncleanliness was fostered by insufficient light within the bakehouse, for others there was not even this excuse. It is often the custom of persons employed in bakehouses either only to sweep the floors at long intervals, or to brush such matter as falls upon them beneath the troughs, where, in many cases, it is allowed to lie tor an indefinite time. The statement is usually made that it is removed from its temporary resting place once a week, but even if this be done, it is insufficient, the requirements of cleanliness demand that the sweepings of the bakehouse should be daily removed and placed in sacks or other suitable receptacles. In three instances I found the bakehouse used as a coal cellar, and in one fowls were kept within it; in two instances materials used in the preparation of bread and pastry were stored in adjoining premises, which decency should forbid being used for such a purpose. In two bakehouses I fouud that the flour room was used for sleeping purposes. In seventy-eight bakehouses there was need for some structural alterations, such as the improvement of water supply, the better trapping of the drainage, or the abolition of a water-closet either within or ventilating into the bakehouse. As a result of my inspection, the occupier of one bakehouse was summoned before the Magistrate, and fined for neglecting to maintain the bakehouse in a cleanly condition. Other occupiers then complied with the Vestry's requirements. At the end of the year there was but one bakehouse which required the immediate attention of the Sanitary Department. 81 REGULATIONS FOR BAKEHOUSES. Factory and Workshops Act, 1878 and 1883. 1.—Every bakehouse shall be kept in a cleanly state, and free from effluvia, arising from any drain, privy, water-closet, or other nuisance. 2.—All the inside walls of the rooms of the bakehouse, and! all the ceilings or tops of such rooms (whether such walls, ceilings, or tops of such rooms be plastered or not),, and all the passages and staircases of the bakehouse shall either be painted with oil or varnished, or be limewashed, or be partly painted or varnished, and partly lime-washed ; where painted with oil or varnished there shall be three coats of paint or varnish, and the paint or varnish shall be renewed once at least in every seven years, and shall be washed with hot water and soap once at least in every six months ; where lime-washed the lime-washing shall be renewed once at least in every six months. 8.—A place on the same level as the bakehouse and forming part of the same building, shall not be used as a sleeping place. (a) Unless it is effectually separated from the house by a partition extending from the floor to the ceiling. (b) Unless there be an external glazed window of at least 9 superficial feet of area, of which at the least 4½ superficial feet are made to open for ventilation. 4.—No water-closet or dust-bin shall be within, or communicate directly with the bake-house. 5.—Any cistern for supplying water to the bakehouse shall be separate and distinct from any cistern for supplying water to a water-closet. 6.—No drain or pipe for carrying off fæcal matter shall have an opening within the bakehouse. 7.—Every bakehouse shall be ventilated so as to render harmless all gases, vapours, dust, or other impurities ; and it shall not be over-crowded while work is carried on therein. 82 8.—Any bakehouse in such a state as to be on sanitary grounds unfit for use or occupation as a bakehouse, may be closed upon the order of a Court of Summary Jurisdiction, or the Court may order improvements, and the occupier in either case will be, in addition, liable to fines. PUBLIC MORTUARY. The determination of the Vestry to provide for the Parish a Public Mortuary will undoubtedly confer a great boon upon their parishioners. The subject has been so often discussed that I have little to add to what I have already said, but inasmuch as my own opportunity for advising the Vestry in this matter is now at an end, I would desire to re-iterate here the recommendations which were embodied in a report I addressed, under instructions, to the joint Committee of the Parliamentary and General Purposes and Sanitary Committees. " I would wish, in the first instance, to point out that the Vestry propose to erect on the site which has been selected, buildings which are to serve two distinct purposes : one set being for the reception of the dead, and the other for the holding of Inquests. These two purposes, although of a different character, have certain relations to each other, and it is necessary that the buildings required for one should be in convenient proximity to those required for the other. It is very necessary that every effort should be made to ensure that the buildings intended for Mortuary purposes should be of a character which should sufficiently indicate their object as a temporary resting place for the dead. I think this is necessary for two reasons. First, because unless the friends of the deceased are assured that due respect will be paid to the remains, they will be unwilling to use the Mortuary to the extent which for health reasons it is desirable they should use it; and secondly, because it is most important to encourage among all classes a proper sense of the sanctity of the dead. The buildings should therefore be architecturally of an ecclesiastical character, and should, I think, be sufficiently separated from the buildings devoted to other purposes. They should consist of two separate Mortuaries, one for persons who have died of infectious diseases, the other for persons who have died from non-infectious maladies. Each Mortuary should have an impervious floor and the inner wall should be built with tiled bricks; and each should be furnished 33 with slate slabs on which the bodies could rest and should also be supplied with water and a hose. The room for infectious cases should be provided with a glass screen so that jurymen and other persons who are compelled to view the bodies should not be exposed to infection, and it should preferably be ventilated through the roof The Mortuaries might, I think, with advantage, be placed on the northern portion of the site where they would be removed from persous seeking entrance to the gardens. They should not extend to the boundary of the site, and the Mortuary for infectious bodies should especially be set back. There is some difficulty in deciding upon the amount of accommodation which should be provided by a parish containing a quarter of a million of persons It must be at once aocepted that if all bodies which ought to be removed to a mortuary were sent to this site, it would not accommodate anything like the number. The Mortuary, therefore, must be looked upon as making a beginning. If, in the future, more accommodation be required, it would be better to erect it in the immediate neighbourhood whence the demand comes. St. Pancras, indeed, is large enough to have several rather than one Mortuary. The beginning, I would propose is that a Mortuary should be built for about eighteen non infectious bodies and for about twelve infectious bodies. This would probably be sufficient for some time to come. In connection with the Mortuary there should be a room for the examination of bodies, provided with a suitable table, sink, lavatory, &c., and it would be a very great convenience and one much calculated to further the ends of justice if a small additional room could be given for the more minute examination of anything which required such scrutiny. These rooms should have ample light for such operations. A small room would be very useful for mourners to meet in. These per ons often walk to the Mortuary whence they follow the body, and a room is required for them during the time of waiting. A coffin room is also required for the purpose of storing shells. A coach-house should be provided, which should accommodate a hearse. The hearse I regard as an absolute necessity, for unless the means are afforded for the removal of the dead to the Mortuary, I believe the latter would be much less used thin the Committee would wish. A stable for a horse is also desirable. I do not know whether I am going beyond my province in suggesting that some ground might be saved Dy the re-arrungement of the present Workhouse Mortuary and coach-houses. If the coachhouse for the hearse and ambulance could be placed ou this part 34 of the ground it would leave the rest free for the other buildings. This opportunity might well be taken for the improvement of the present means for disinfecting infectious articles, which to say the least, are certainly not all that can be desired. The entrance for admission to the Mortuary premises should be separate from that leading to the Coroner's Court, or. at any rate, should be so placed that it is impossible for those visiting the Coroner's Court alone to pass anywhere near the Mortnary. I do not propose to dwell at any length upon the buildings required for the purposes of the Coroner. There is, of course, need for a public court, waiting rooms, lavatories, water closets, urinals, a room for the Coroner, and a room to which the Jury could retire for consultation. I do not think all these rooms need be on the ground floor, but some of the smaller rooms, with those of the caretaker, might conveniently be placed on the upper storey. I should wish to see the architecture of the buildings for the Coroner's purposes harmonize with that of the Mortuary building, but still sufficiently different to indicate the difference in their purpose. SANITARY CONDITION OF DIFFERENT DISTRICTS. As in past years, I should wish to devote a portion of the report to the subject of comparative death rates in the different sub-registration districts. During the year 1884, each 1,000 of the inhabitants of Somers Town and Tottenham Court Road lost by deaths from Tubercular Diseases 8.1 persons, while the other districts lost in Regent's Park and Camden Town 3.0, Gray's Inn Lane 2.8, and Kentish Town 2.4 in every 1,000. The deaths from Pulmonary Diseases occurred in the following proportions : Camden Town 4.5, Somers Town 3.8, Tottenham Court Road 8.6, Gray's Inn Lane 3.4, Regent's Park 2.9, and Kentish Town 2'8, in each 1,000 of inhabitants. From the nine Zymotic Diseases, Somers Town and Gray's Inn Lane lost 8.6 in each 1,000, Tottenham Court Road 8.4, Camden Town 8.4, Kentish Town 2.7, and Regent's Park 2.3. The higher death rates in the southern part of the Parish have been discussed in previous reports, and it has been shown how much of these are due to the insanitary condition of certain localities to which the especial attention of the Vestry has been directed. It is with much satisfaction I am able to record that the continued existence of such localities as Poplar and Compton Places 35 are nearly at an end. These houses were reported early in 1883 to the Vestry as unfit for habitation under the Artizans and Labourers' Dwellings Act, and were ordered by the Vestry to be demolished. Finally the Local Government Board appointed an arbitrator, who in making his award, " regarded not only the value of the leasehold interest of the said owners in the said premises, but the fair market value, as estimated at the time of the valuation," and took "into consideration the nature and condition of the said premises, and also the probable duration of the buildings in their existing state, and the state of repair thereof and all circumstances affecting such value, and without any additional allowance in respect of a compulsory purchase." The sum to be paid by the Vestry under these circumstances is but comparatively trifling, and tbey may be congratulated on removing from their Parish dwellings which have year by year shortened the lives of many of their parishioners. Other changes are going on at the same time which tend to remove from the Parish other unhealthy areas. Wellington Square, whose inhabitants have in 1884 lost per 1000 seven more than the average of the rest of the Parish, has passed into the hands of the London School Board, and will soon be replaced by the buildings this Board will erect. Twenty years ago the death. rnte of this locality was still higher, and the fact that it has fallen is, I believe, due to the action of the Vestry as a Sanitary Authority. But all past reports of the Medical Officer of Health, which discuss this subject, tell the same tale, and no effectual remedy is to be found except that which is afforded by the action of the School Board. The healthiness of a district is much dependent upon the planning and arrangement of streets, and newly built parts of St. Pancras, in which houses have been erected since recent legislation, are less open to objection on this score than some parts which were covered by houses long time since. Still much can be done to improve a locality if in building houses on sites previously occupied by those which have been demolished due regard is had to their position in relation to others. I have, during the year 1884, further examined the Subregistration district of Somers Town, and have seen with regret the erection of some houses in certain situations without sufficient regard to this consideration. The need for a re-arrangement of many of the houses in this district is obvious, and it is unfortunate that the closing of 36 narrow streets should be perpetuated, and the provision for a free current of air through them not made. Among other changes, in Johnson Street, Somers Town, additions have been built which will cartaialy deprive those houses of the ventilation which Health Officers would desire in the future to see preserved in any alterations which take place. These matters are not immediately under the control of the Vestry, but they deserve attention in a report which is devoted to considerations relating to the health of the community. The whole subject of the housing of the Working Classes has during the year received the attention of a Royal Commission before which your Medical Officer of Health gave evidence. The extreme difficulty of satisfactorily dealing with this subject has been obvious. Nevertheless, it may be expected that the outcome of the inquiry will be useful, for the evidence and the report have amply shown that while there is no one single remedy which can be found, there are many which may be applied with more or less advantage to the same end. Upon the Metropolitan Sanitary Authorities rests a great responsibility, for it is absolutely within their power to insist upon all dwelling houses being maintained in condition fit for human habitation, and they may, within limits, prevent over-crowding, which is no less disastrous to health than to morality. I have repeatedly recommended the Vestry to adopt regulations for houses let in lodgings, and have pointed out the power they would then possess for ensuring tencmented houses being maintained in proper sanitary condition. I would desire, in my last report, to urge upon them the further consideration of this subject. GENERAL SANITARY WORK. It is with much satisfaction that I look back upon the work of the Sanitary Department during the year 1884, of which account will be found in Table VI. The condition of the Parish improved in a marked degree, as the result of the steps which were taken with that object. As many as ft,241 houses and premises were inspected by the Sanitary Inspectors, and 4,557 notices served for their improvement. The work of providing water-closets with water was proceeded with, and at last, with the exception of those which from time to time required repair, it may be said generally that every water-closet in St. Pancras had its water supply. The difference in the condition of water-closets in tenement houses 87 from that when so-called pail flushing, or, in other words, no regular flushing was depended upou, equals all reasonable expectations which have been formed, and doubtless has its influence upon the habits of the poor, as well as upon their health, in accustoming them to a higher standard of cleanliness. As many as 1560 water-closets were thus supplied during 1884, on the order of the Vestry, 250 water-closets were repaired, and 1107 houses cleansed, of which 690 were disinfected after occupation by persons suffering from infectious disease. The disconnection of waste pipes of cisterns from drains has been practically completed, aud many of the waste pipes of sinks have been also disconnected. The work of providing a constant water supply for the Parish steadily progressed, and in those districts where it was introduced, it was followed by an improved condition of cleanliness. Previously, the use of water for one purpose or another, for the washing of costermongers' barrows and their contents, and for allied purposes, left many of the houses during the early part othe day without any further supply, without the means for flushf ing water-closets, and without the means for ensuring proper cleanliness of dwelling-houses. But this is not all. The system of storage in cisterns and water-butts, where roof droppings, and often filth, are deposited, led to contamination of drinking water, which must undoubtedly have b,een prejudicial to health. The full effect of the change which is brought about cannot be seen yet, but it will assuredly be seen in the future, in the prevention of sickness, and the saving of life among all classes, but especially among those which are most dependent upon the efforts of the Sanitary Authority. Forty-six houses were reported to the Vestry as unfit for human habitation, and orders were made for the demolition or repairs of these premises, or their continued occupation was forbidden. It may be worth while to repeat what has often been said before, that structural repairs cannot be enforced under the Nuisance Removal Acts, which only enable the Vestry to insist upon the abatement of nuisances ; the difference between these conditions is very distinct, and should be clearly understood. That it has not been understood I have but too much reason for thinking. In the large Parish of bt. Pancras, with over twenty-four thousand houses, there are many which are gradually becoming unfit for human habitation, and the Vestry possess no effectual remedy but to resort to the Artizans and Labourers' Dwellings Act, for the prevention of the ill-health which results from the occupation of houses in this condition. 38 I have felt it my duty to report such houses to the Vestry. The duty is placed upon the Health Officer by Act of Parliament, and I felt that I should be unworthy of my office were I to fail in this respect. The closing of illegally occupied underground dwellings was systematically enforced during the year, and orders were issued for preventing the occupation of 884 of these places, or they were altered to meet the requirement of the Act. Doubtless this has not been well understood by many who had for years derived rental from their occupation, but the time had fully come for the Vestry to exercise all the powers they pcseess for the improvement. of the health of their parishioners. During the year I have, as already said, carefully inspected the bake-houses of St. Pancras, of which there are over two hundred, and the Vestry have made orders for the improvement of those which were found to require alteration. These orders have been complied with, and the bake-houses of St. Pancras will now bear favourable comparison with those of other parts of the Metropolis. Cow-sheds and slaughter-houses have also been duly visited by the Inspectors and by myself, and the requirements of the Vestry have been enforced. The determination of the Vestry to provide the Parish with a Public Mortuary is a matter for sincere congratulation. The retention of the dead, often of the infectious dead, in rooms with the living, is a practice which has been permitted too long. "When the poor have no alternative other than the workhouse mortuary, or the undertaker's premises, it is no matter for surprise that the dead have often been kept in rooms which are occupied by day and by night by living persons. The Vestry must not be disappointed if there is not immediately a large demand for the use of the mortuary they are about to erect; this can only come about as the result of the process of education, but the lesson will gradually be learnt that the dead can, pending burial, be placed in the mortuary without irreverance, and without injury to the better feelings which belong to human nature, while, at the same time, the safeguarding of the health of the living is ensured. The improved opportunities for the removal of the infectious sick is a further gain, and the admirable ambulance arrangements of the Metropolitan Asylums Board deserve special recognition here. The removal of the sick has 39 been followed by the cleansing of their houses, and by the disinfecting of their clothing and bedding in the Vestry's apparatus, as many as 4,695 articles being thus disinfected during the year. I may here also refer to the beginning of a system of notification of infectious diseases, which, while only a beginning, nevertheless deserves record in this report. I am indebted to the Vice-Chairman of the Metropolitan Asylums Board for making arrangements for a weekly list to be sent to your Medical Officer of all cases of infectious disease in the Metropolis which come to. the knowledge of that Board. This list enables the growth of an epidemic to be seen before our own district is invaded, and without waiting during the time which must elapse before the death returns give evidence of its occurrence. In the future it will probably serve in indicating any spread of disease through an infected milk supply which is perhaps being distributed in various parts of the Metropolis, and will enable the cause of the illness to be detected earlier than heretofore, and loss of life and health prevented. This system is now extended to the whole Metropolis. The increased amount of work carried out by the Sanitary Department, could not have been accomplished without a material addition to the small staff which the Vestry possess, had not the duties of the inspectors been re-arranged, to make their work more effective than heretofore. The gradual increase in the thoroughness of the work of the Sanitary Department during the last few years, of which the accompanying table bears witness, has been of the greatest service to the Parish in ensuring its better sanitary condition. Of this evidence is to be found not only in diminished death-rates, but during the last few years, the Vestry have increasingly taken the initiative in remedying unhealthy conditions, and have not waited until their parishioners brought them to their notice after a longer interval, during which health must have suffered as a result of delay. I believe this to be the proper position of an efficient Sanitary Authority. That these results could not be obtained without interfering with certain interests is obvious to all who have any knowledge of the effects of Sanitary work. I am, however, fully convinced they will make ample return by conferring greater freedom from disease, and prolongation of life upon the inhabitants of the Parish, and I have felt that, as Medical Officer of Health, I incurred a serious responsibility when I undertook the duties 40 of an office which is concerned in the welfare of nearly a quarter of a million of persons, and that I could only acquit myself of this responsibility by the free discharge of my duties. With this record my report must close, and, in conclusion, I need not say that I have not abandoned my seven years' work in St. Pancras without sincere regret, I do not intend to discuss further the circumstances which brought about my retirement, they are sufficiently known to the Vestry, but, in writing my last 1 report, I would desire to thank the Chairman and Vice-Chairman of the Sanitary Committee, and those other Members of the Vestry who have supported me in the performance of my duties, and to express the pleasure I have felt in promoting, so far as was iu my power, the sanitary welfare of St, Pancras. I have the honor to be, Gentlemen, Your obedient Servant, SHIRLEY F. MURPHY, Late Medical Officer of Health for the Parish of St. Pancras. SAINT PANCRAS —Return shewing the Sanitary Work accomplished during the past 10 years. 1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 No. of Complaints received during the year 1206 1815 2166 1717 1830 1411 2965 513 506 649 No. of Houses, &c., Inspected 1400 2000 3000 3641 3046 3485 6687 4259 10218 9241 Results of Inspection. Orders issued for Sanitary Amendments 814 1347 1900 1346 1304 888 2469 2600 4840 4557 Houses, &c., Cleansed, Repaired, or Whitewashed 342 937 1305 768 724 603 1556 578 425 417 Houses Disinfected after Infectious Disease 156 293 247 423 271 270 872 296 341 690 House Drains Repaired, Cleansed, Trapped, and Ventilated, &c. 408 794 709 497 486 343 738 373 376 310 New Drains provided .. .. .. .. .. •• 19 10 19 21 Privies and w.c.'s Repaired, Cleansed, &c 329 432 610 234 465 422 506 154 250 250 Supplied with Water 217 288 355 160 316 207 1138 1474 1607 1560 Dust-bins—New provided 19 55 48 42 22 25 72 105 256 221 Do. Repaired, Covered, &c 48 77 171 131 116 101 254 281 237 289 Water Supply. Cisterns—New erected 4 18 15 9 11 9 22 11 23 31 Do. Cleansed, Repaired, and Covered 85 248 196 141 168 95 235 123 254 260 Cesspools abolished .. .. .. .. 12 9 4 3 7 7 Miscellaneous. Removal of Dung, Stagnant Water, Refuse, &c. 37 97 102 58 62 45 114 24 35 45 Animals Removed, being improperly kept 17 19 17 24 17 1 16 2 5 19 Licensed Cow-sheds Inspected 69 65 66 66 51 67 56 49 50 49 Licensed Slaughter-houses Inspected 61 59 59 59 51 50 45 50 40 38 Legal Proceedings, i.e., Summonses 33 35 10 7 27 63 81 60 72 Cases of Overcrowding .. .. 109 35 14 13 20 37 75 202 Smoke Nuisance .. .. . . . . 5 16 23 24 6 11 Paving Defects .. .. .. .. .. .. .. 29 165 191 Bake-houses inspected 231 .. 196 196 225 225 •• •• •• 211 Table I. Showing the Population, Inhabited Houses, Marriages, Births, and Deaths for the year 1884, and 10 years preceding. Gross Numbers. The Year. Estimated Population. Estimated No. of Inhabited Houses. Marriages. Registered Births. Corrected Number of Deaths, Deaths in Public Institutions. Total all Ages. Cinder One Tear. Under Five Years. 1884 240,000 25,000 2,288 7,905 4,795 1,224 1,952 1,066 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 1,234 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 1,159 1876 £34,000 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 1,031 Average of 10 Years, 1874-83 235,640 25,197 2,222 8,040.0 5,000.4 1,215.8 1.997.7 1,101.8 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 acre#, 2,672. Table II. Showing the Annual Birth Kate, Death Rate, Death Rates of Children, and Proportion of Deaths in Public Institutions in a thousand Deaths for the Year 1884, and 10 years preceding. The Year. Birth Rate 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 100 of total deaths. Deaths in Public Institutions, per 1000 of total deaths. 1884 32.5 19.72 154.8 255.2 407.0 222.3 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 . 155.3 246.8 411.0 209.4 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 21.71 162.9 265.1 436.0 216.0 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 23.38 159.0 235.5 375.3 201.9 1874 35.0 21.75 145.9 231.4 352.0 203.3 Average of 10 years 1874.1883 34.1 21.28 151.3 243.0 399.6 219.8 Note—All the Death Rates are calculated on the corrected number of Deaths. Table NO. III. PARISH OF SAINT PANCRAS. Deaths Registered at several groups of Ages from different causes during the Year 1884. 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 CLASSES. 1. Zymotic Diseases 291 288 61 42 41 33 24 18 14 9 1 879 8 19 2. Parasitic Diseases 11 — 2 — — — — — — — — 11 13 3. Dietic Diseases 4 — — 5 8 8 — 2 — — 4 27 4. Constitutional Diseases 162 130 32 86 165 177 125 91 46 11 — 292 1046 5. Developmental Diseases 158 1 — — — — — 3 60 135 48 139 407 6. Local Diseases 355 282 68 76 108 182 219 290 308 164 23 637 2044 7. Deaths from Violence 51 6 14 7 10 10 12 9 9 7 2 87 148 8. Ill defined 192 21 5 2 3 9 10 17 23 12 1 213 297 Total 1224 728 202 212 332 395 398 427 464 338 75 1952 4795 Class I.—Zymotic Diseases. Order 1.—Miasmatic. 1 Smallpox. Vaccinated ... ... 1 7 6 6 1 ... 1 ... ... ... 22 2 Unvaccinated 3 3 4 3 4 1 2 ... ... 1 ... 6 21 3 No Statement 2 2 2 3 5 2 2 ... ... ... ... 4 18 4 Measles 16 66 6 ... ... 1 ... ... ... ... ... 82 89 5 Scarlet Fever 3 21 18 ... 2 ... ... ... ... ... ... 24 44 6 Typhus ... ... ... ... ... ... ... 1 ... ... ... ... 1 7 Whooping Cough 72 122 8 ... ... ... ... ... ... ... 194 202 8 Diphtheria 3 29 8 1 1 2 ... i ... ... ... 32 45 9 Simple Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Enteric or Typhoid Fever ... 3 10 18 8 8 6 1 "i ... ... 3 55 11 Chicken Pox ... 2 ... ... ... ... ... ... ... ... ... 2 2 Order 2.—Diarrhæl. 1 Simple Cholera 2 ... 1 1 ... 1 ... v ... 1 ... 2 6 2 Diarrhoea, Dysentery 159 36 3 ... 1 2 4 2 6 6 1 195 221 Order 3.—Malarial. 1 Remittent Fever ... 1 ... ... ... ... ... ... ... ... ... 1 1 2 Ague ... ... ... ... ... ... ... ... ... ... ... ... Order 4.—Zoogenous. 1 Cowpox and Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Other Diseases {e.g., Hydrophobia, Glanders) ... ... ... ... ... ... ... ... ... ... ... ... ... Order 5.—Venereal. 1 Syphilis 28 ... ... ... ... 1 1 1 ... ... ... 28 31 2 Gonorrhoea, Stricture ... ... ... ... ... 1 ... ... ... ... ... ... 1 Order 6—Septic. 1 Erysipelas 3 2 ... 2 2 2 4 7 5 ... ... 5 27 2 Pyaemia, Septicæmia ... 1 ... 3 1 5 4 2 1 ... ... 1 IV 3 Puerperal Fever ... ... ... 4 11 1 ... ... ... ... ... ... 16 Class II.—Parasitic Diseases. 1 Thrush, and other Vegetable Parasitic Diseases 11 ... 1 ... ... ... ... ... ... ... ... 11 12 2 Worms, Hydatids, and other Animal Parasites ... ... 1 ... ... ... ... ... ... ... ... ... 1 Class III.—Dietic Diseases. 1 Want of Breast Milk, Starvation 4 ... ... ... ... ... 1 ... ... ... ... 4 5 2 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Chronic Alcoholism ... ... ... ... 5 6 6 ... 1 ... ... ... 18 4 Delirium Tremens ... ... ... ... ... 2 1 ... 1 ... ... 4 Class IV.—Constitutional Diseases. 1 Rheumatic Fever, Rheumatism of the Heart ... ... 1 ... 1 1 2 ... ... ... ... ... 5 2 Rheumatism ... ... ... 1 ... 1 3 ... 1 2 ... ... 8 3 Gout ... ... ... ... ... 2 2 ... ... 1 ... ... 5 4 Rickets 3 4 1 ... ... ... ... ... ... ... ... 7 8 5 Cancer, Malignant Disease ... 1 ... 1 6 18 43 49 28 6 ... 1 152 6 Tabes Mesenterica 51 26 1 1 ... 1 ... ... 1 ... ... 77 81 7 Tubercular Meningitis, Hydrocephalus 57 73 23 ... ... 2 ... 1 1 ... ... 130 157 8 Phthisis 18 14 21 79 155 149 73 38 9 1 ... 32 557 9 Other forms of Tuberculosis, Scrofula 33 12 1 ... ... 2 ... ... ... ... ... 45 48 10 Purpura, Hæmorrhagic Diathesis ... ... 2 1 1 ... 1 ... 1 1 ... ... 7 Ill Anasmia, Chlorosis, Leucocythæmia. ... ... ... 1 ... ... ... ... 1 ... ... ... 2 12 Diabetes ... ... 2 2 2 1 1 3 2 ... ... ... 13 13 Other Constitutional Diseases ... ... ... ... ... ... ... ... 2 ... ... ... 2 Class V.—Developmental Diseases. 1 Premature Birth 131 1 ... ... ... ... ... ... ... ... ... 132 132 2 Atelectasis 12 ... ... ... ... ... ... ... ... ... ... 12 12 3 Congenital Malformations 15 ... ... ... ... ... ... ... ... ... ... 15 15 4 Old Age ... ... ... ... ... ... ... 5 60 135 48 ... 248 AGES. CAUSE OF DEATH. 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. Nervous System. 1 Inflammation of Brain or Membranes 10 6 4 2 4 1 1 3 2 2 1 ... 16 35 2 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ... 1 2 7 19 26 54 66 37 5 ... 217 3 Insanity, General Paralysis of the Insane ... ... ... ... 2 2 7 13 23 20 3 ... 70 4 Epilepsy ... 3 1 1 5 5 2 1 3 ... ... 3 21 5 Convulsions 96 24 3 ... ... ... 1 ... ... ... ... 120 124 6 Laryngismus Stridulus (Spasm of Glottis) 9 11 1 ... ... ... ... ... ... ... ... 20 21 7 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... 1 1 3 4 5 5 2 ... ... 21 8 Other Diseases of Nervous System ... ... ... ... ... ... ... ... 1 ... ... ... 1 2. Organs of Special Sense. ... 1 ... ... ... 1 ... ... ... ... ... 1 2 3. Circulatory System. 1 Pericarditis ... 1 8 4 ... 2 3 1 ... ... ...... 1 19 2 Acute Endocarditis ... ... ... 2 1 1 ... 1 ... 1 ... ... 6 3 Valvular Diseases of Heart ... ... 2 9 9 5 9 13 "7 5 1 ... 60 4 Other Diseases of Heart ... 1 8 10 14 16 34 37 33 15 ... 1 168 5 Aneurism ... ... ... ... 1 3 1 1 2 1 ... ... 9 6 Embolism, Thrombosis ... 2 ... ... ... ... 3 1 3 1 ... 2 10 7 Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Respiratory System. 1 Laryngitis 3 12 3 1 1 ... 1 ... ... ... ... 15 21 2 Croup 7 19 3 ... ... ... ... ... ... ... ... 26 29J 3 Emphysema, Asthma ... ... ... ... ... 4 8 20 9 4 ... 45 4 Bronchitis 147 124 10 3 4 21 33 64 86 44 10 271 546 5 Pneumonia 26 40 6 10 13 15 17 12 18 2 ... 66 159 6 Pleurisy ... ... ... 1 2 6 6 2 ... 1 ... ... 18 7 Other Diseases of Respiratory System 9 6 2 3 3 3 3 2 3 1 ... 15 35 5. Digestive System. 1 Dentition 16 13 1 ... ... ... ... ... ... ... ... 29 30 2 Sore Throat, Quinsey ... 1 ... 1 ... ... ... ... ... ... ... 1 2 3 Diseases of Stomach 2 ... 1 ... 2 1 ... 1 ... ... 1 2 11 4 Enteritis 9 7 1 1 1 ... 2 ... 1 1 1 16 24 5 Obstructive Diseases of Intestine 4 2 2 1 2 2 8 8 5 4 ... 6 38 6 Peritonitis 4 4 2 6 11 2 5 4 3 3 ... 8 44 7 Ascites ... 1 ... ... ... 1 2 4 2 1 ... 1 11 8 Cirrhosis of Liver ... ... ... ... 3 14 15 12 5 4 ... 53 9 Jaundice and other Diseases of Liver 8 ... ... ... 2 2 ... 7 6 6 ... 8 31 10 Other Diseases of Digestive System 2 1 2 ... ... ... 2 3 5 1 ... 3 16 6. Lymphatic System. Disease of Lymphatics and Spleen ... ... ... ... 1 1 2 ... ... ... ... ... 4 7. Bronchocele and Addison's Disease ... ... ... ... ... ... ... ... ... ... ... ... ... 8. Urinary System. 1 Nephritis ... ... 3 4 3 4 6 3 3 ... ... ... 26 2 Bright's Disease, Albuminuria ... ... ... 1 3 7 10 14 9 3 ... ... 47 3 Disease of Bladder or of Prostate ... ... ... 1 1 ... 2 4 2 ... 10 4 Other Diseases of the Urinary System ... 1 ... 1 3 2 3 3 3 1 ... 1 17 9. Reproductive System. A—Of Organs of Generation. 1 Male Organs 1 ... ... ... ... ... ... 2 ... ... ... 1 3 2 Female Organs B—Of Parturition. ... ... ... 1 2 2 ... ... ... 1 ... ... 6 3 Abortion, Miscarriage ... ... ... ... 2 ... ... ... ... ... ... ... 2 4 Puerperal Convulsions ... ... ... 3 ... ... ... ... ... ... ... ... 3 5 Placenta prœvia, Flooding ... ... ... 1 1 1 ... ... ... ... ... ... 3 6 Other Accidents of Child Birth 10. Bones and Joints. ... ... ... 3 4 1 ... ... ... ... ... ... 8 1 Caries, Necrosis... ... ... 2 ... ... 1 ... ... 1 ... ... ... 4 2 Arthritis, Ostitis, Periostitis ... 1 1 1 ... ... ... ... ... ... ... 1 3 3 Other Diseases of Bones and Joints ... ... 1 2 1 ... 2 ... ... ... ... ... 6 11. Integumentary System. 1 Carbuncle, Phlegmon ... ... ... ... ... ... ... ... 1 ... ... ... 1 2 Other Diseases of Integumentary System 2 1 ... ... ... ... ... ... 1 ... ... 3 4 Class VII.—Violence. 1. Accident or Negligence. 1 Fractures and Contusions 2 3 7 2 4 8 7 5 2 2 2 5 44 2 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Burn, Scald ... 1 3 1 ... 1 ... ... ... ... ... 1 6 5 Poison ... ... 1 ... ... ... ... 2 1 ... ... ... 4 6 Drowning 1 1 2 ... 1 2 1 ... 1 1 ... 2 10 7 Suffocation 38 1 ... 1 ... 1 ... ... ... ... ... 39 41 8 Otherwise 2 ... 1 ... 2 ... ... ... 1 ... ... 2 6 2. Homicide. 1 Manslaughter 1 ... ... ... ... ... ... ... ... ... ... 1 1 2 Murder 7 ... ... 2 ... ... ... ... ... ... ... 7 9 3. Suicide. 1 Gunshot Wounds ... ... ... ... 1 ... ... ... ... 1 ... ... 2 2 Cut, Stab ... ... ... 1 1 1 ... ... ... 1 ... ... 4 3 Poison ... ... ... ... ... ... 1 ... 1 l ... ... 3 4 Drowning ... ... ... ... ... 2 ... 1 2 ... ... ... 5 5 Hanging ... ... ... ... ... 1 1 1 l l ... ... 5 6 Otherwise ... ... ... ... 1 ... 2 ... ... ... ... ... 3 Class VIII.-Ill-defined Causes. 1 Dropsy ... 1 ... 1 ... 2 1 3 9 7 ... 1 24 2 Debility, Atrophy, Inanition 186 18 2 ... 1 ... 3 3 3 ... 204 216 3 Mortification ... ... ... ... ... ... ... 2 8 1 ... ... 11 4 Tumour ... ... ... ... ... 2 1 ... 1 1 ... ... 5 5 Abscess ... ... ... ... 1 ... 1 1 1 ... ... 1 5 6 Haemorrhage 1 ... ... 1 ... 2 2 2 ... 1 ... 1 9 7 Sudden Death (cause not ascertained) ... ... ... ... 1 1 ... 3 2 2 1 ... 10 8 Causes not Specified or Ill-defined 5 1 3 ... ... 2 2 3 1 ... ... 6 17 57 Table IV. PARISH OF ST. PANCRAS, Showing the number of deaths at all ages in 1884 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 724 2.8 150.9 2. Pulmonary Diseases 803 8.8 167.4 3. Principal Tubercular Diseases 694 2.8 144.7 Division II. Infants under One Year. Total Deaths. Deaths per 1000 of Births. Deaths per 1000 of Total Deaths under one year. 4. Wasting Diseases 321 40.6 262.2 5. Convulsive Diseases 179 22.6 146.2 Notes. 1. Includes Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Typhus, Enterio (or Typhoid), and Simple Continued Fevers, Diarrhoea, and Cholera. 3. Includes Phthisis, Scrofula, Tuberculosis, Rickets, and Tabes Mesenterica. 4. Includes Marasmus, Atrophy, Debility, Want of Breast Milk, and Premature Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Convulsions, and Teething. Table V. Shewing the Number of Deaths from the principal Zymotic Diseases in 1884, and in the 10 years 1874 to 1883. Disease. 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 Annual Average of 10 years, 1874-83 Proportion of Deaths to 1000 Deaths in 10 years, 1874-83. Total Deaths is 1881. Proportion of Deaths to 1000 Deaths in 1884. Small Pox 3 2 22 129 94 19 18 84 6 3 38.0 7.6 61 12.7 Measles 64 82 117 143 48 129 58 172 130 99 104.2 20.8 89 18.5 Scarlet Fever 95 240 137 89 138 144 156 180 66 61 130.6 26.1 . 44 9.1 Diphtheria 35 55 38 22 23 25 34 70 51 78 43.1 8.6 45 9.3 Whooping Cough 121 232 198 141 217 154 293 122 288 72 183.8 36.7 202 42.1 Typhus Fever 10 8 5 20 4 4 1 1 .. 2 5.5 1.1 1 0.2 Enteric Fever 38 35 60 58 59 57 43 66 69 132 61.7 12.3 55 11.4 Simple Continued Fever 25 16 7 10 4 5 4 8 .. 2 8.1 1.6 .. .. Diarrhœa& Simple Cholera 222 178 239 155 229 118 204 211 119 162 183.7 36.7 227 47.3 Totals 613 848 823 767 816 655 811 914 729 611 758.7 151.5 724 150.6 Totals—London 11,327 13,340 12,536 12,232 14,619 12,010 13,735 13,811 13,553 10,801 12,796 142.8 13,629 164.1 Table VI. Report of the Sanitary Work carried out in the year 1884. No. of Complaints received during the year. No. of Houses, Premises, &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. Underground Dwellings, Prevention of occupation of. Houses Disinfected after illness of an Infectious Character. Repaired, Cleansed, Trapped, &c. New provided. Repaired, &c. Supplied with Water. New provided. Repaired, Covered, &c. j 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 649 9,241 4,557 417 384 690 310 21 250 1,560 221 289 31 260 7 45 19 49 38 72 202 1 191