BET 70 St. Matthew, Bethnal Green, SANTARY COMMITTEE. Mr. J. PARNELL (Chairman). ,, D. JONES (Vice.Chairman). Mr. F. ALLARD. A BARNARD. W. H. BELSHAM. C. B. BLOW. J. A. CATHERALL. J. COLE. W. DANIEL. M. GOLD. Mr. C. GRIST. „ J. G. HILDITCH. „ H. LAING. „ F. LOUGH LIN. „ E. A. LUFFINGHAM. „ J. NORRIS. „ G. J. PITT. „ A. J. WILLETT. STAFF OF THE SANITARY DEPARTMENT. Inspectors : H. FREDERIC BRIDEL. AMOS S. HENLEY. JOSHUA LAPWORTH. All holding the Certificate of the F. W. MEADWAY. Sanitary Institute. EVAN RICHARDS. BENJAMIN S. WESTON. ' ALFRED T. MILLS, Drainage Foreman. JOHN JONES, Clerk. Chief Inspector: JOHN FOOT (Certif. San. Institute). Medical Officer of Health: GEORGE PADDOCK BATE, M.D. REPORT OF THE Sanitary Condition AND Vital Statistics OF THE Parish of St. Oatthem. BETHNAL GREEN, DURING THE YEAR 1897. by GEORGE PADDOCK BATE, M.D., Fellow of the Royal College of Surgeons and Licentiate of the Royal College of Physicians of Edinburgh; Fellow of the Royal Microscopical Society; Fellow.of the Obstetrical Society of London; Vice.President of the Incorporated Society of Medical Officers of Health ; J.P. for the County of London ; and Medical Officer of Health for the Parish of Bethnal Green. London: Printed by J. WILLIAMS.COOK, 326, Bethnal Green Road. 1898. SUMMARY. 1896. 1897. Estimated population of Bethnal Green at all ages 129,200 129,200 „ „ Young Children under 5 years 18,000 18,000 „ „ Old People, over 65 years 4,748 4,748 Area—755 Acres Number of Inhabited Houses 16,542 (Census 1891) Average number of Persons to each Acre 171 171 Total number of Deaths in the year 2,909 2,761 Total number of Births in the year 4,869 4,818 Total number of Marriages 1,384 14,15 Marriage Rate—Bethnal Green 214 21.9 Marriage Rate—London 18.0 185 Death Rate—Bethnal Green 22. 5 21.3 Death Rate—London 18.2 18.2 Birth Rate—Bethnal Green 37.7 37.3 Birth Rate—London 30.2 30.0 Infantile Death Rate (on Births)—Bethnal Green 170.3 169. 0 Infantile Death Rate (on Births)—London 160. 0 158.0 Young Children's Death Rate (on estimated number of Young Children) 82.6 70.0 Old People's Death Rate (on estimated number of Old People) 93.5 99.4 Zymotic Death Rate—Bethnal Green 4.2 3.4 Zymotic Death Rate—London 2.1 2.5 Inquest Cases 29.6 30.2 Uncertified Deaths (no Inquests held) 0 1 Synopsis of MEDICAL OFFICER'S ANNUAL REPORT, 1897. Vital Statistics— page Population 5 Births 6 Deaths 7 Death.Rate 7 Correction for Age and Sex Distribution 8 Birth Rate 12 Marriages 13 Deaths of Infants 14 Deaths of Young Children 14 Old Persons' Death Rate 14 Special Causes of Death 14 Table of Deaths during the year 1897, in the Bethnal Green Metropolitan District, classified according to Diseases, Ages, and Localities 15 Analysis of the Vital and Mortal Statistics of the Sanitary Districts of the Metropolis, after Distribution of Deaths occurring in public Institutions, during the year 1897 20 The Seven Principal Zymotic Diseases 22 Notification of Infectious Diseases 23 Table G. Infectious Cases, 1897 26 Small Pox 27 Scarlet Fever 27 Enteric Fever 28 Typhus 28 Asylums Board Hospitals 28 Report of Fever and Diphtheria Cases admitted into Fever Hospitals during the year 1897 29 Diphtheria (including Membranous Croup) 30 Puerperal Fever 31 Whooping Cough 37 Measles 37 Diarrhœal Diseases 38 Phthisis 39 Respiratory Diseases 39 Mortuary and Coroner's Court 40 Supervision of Trade Premises 40 Tenement House Regulations 45 Customs and Inland Revenue Act 51 Proceedings under the Pullic Health (London) Act, 1891 53 Housing of the Working Classes Act 55 Proceedings taken under the " Housing of the Working Classes Act, 1890," during the year 1897 56 Mortality Statistics, Pott Street Area 65 Tables— I.—Showing Population, Births, Deaths, and Marriages, for 1897, and ten years preceding 70 II.—Annual Birth Rate, Rate of Mortality, Death Rate among Children, and Deaths in Public Institutions for the year 1897, and ten years preceding 71 K.2ll (B).—Table of Population, Births, and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1897, in the Sanitary District of Bethnal Green ; classified according to Diseases, Ages, and Localities 72 K 2 3 (A).—Table of Deaths during the year 1897, in the Bethnal Green District, classified according to Diseases, Ages, and Localities 73 IV.—Showing the Mortality from certain Classes of Diseases and proportions to Population, and to 1000 Deaths, 1897 74 V.—Showing the number of Deaths from the Seven Principal Zymotic Diseases, inclusive of Hospital Deaths, in the ten years, 1887 to 1896, and in the year 1897 75 VI—Inspectors'Report of Sanitary Work 76 VII.—Sanitary Improvements, New Drains, W.C.'s, &c., in the Parish, during the year 1897 77 Street List 79 REPORT. Gentlemen, I beg to present herewith my twenty.second annual report dealing with the vital and mortal statistics of the parish of Bethnal Green for the year 1897. The usual tables on the forms settled by the Society of Medical Officers of Health will be found in the appendix, and also those specially prepared in accordance with the instructions of the Local Government Board, and designated K23 (A) and K211 (B) It will be noticed that the figures in table K.3 (A) do not agree with those in the remainder of the report. The explanation of the discrepancy is, that the table is prepared in accordance with the following directions of the Board :—" The deaths classified in table K23 (A) and summed up in the horizortal lines of totals are the whole of those registered as having actually occurred in the several localities comprised within the district." The other tables take cognizance only of the deaths of persons actually belonging to Bethnal Green, no matter where the actual death took place, the deaths of non.parishioners in public institutions within our boundaries being carefully excluded. POPULATION. The census taken in March, 1896, showed a total population of 129,162 persons living at that time in Bethnal Green. My estimate to the middle of 1896 was 129,200. As the numbers of births and deaths have actually decreased during the past twelve months, I do not think our population can have increased, and therefore consider that the estimate for 1896 fairly represents the true number in the middle of 1897, and I have again taken it as the basis of my calculations for the present report. The estimated populations of the three registration sub.districts are shown in the accompanying table. The number of inhabited houses for 1891 is also given, for purposes of comparison with the 6 enumeration of that year. I regret that I cannot ascertain the actual number of occupied houses in the parish at the present date ; all I can obtain from the rate collectors is an opinion that '' the houses number about 17,000." POPULATION IN REGISTRATION DISTRICTS (ESTIMATED;. DISTRICT. Estimated in 1897. Enumerated in 1891. Inhabited houses. North 49,339 51,520 6,607 South 34,194 33,489 4,579 East 45,667 44,123 5,356 Total 129,200 129,132 16,542 BIRTHS. The total number of births registered in the parish during the year was 4,818, against 4,869 in 1896, indicating a decrease of 51 on the year, but as the registration year 1896 included 53 weeks, whilst 1897 only includes 52, this decrease is apparent and not real. The excess of the births over the deaths was 2,057. Table " B '' shows this and compares the two years TABLE B. 1896. 1897. Estimated population in the midile of the year 129,000 129,200 Total Births 4,869 4,818 Total Deaths 2,909 2,761 Excess of Births over Deaths, shewing the natural increase of the Population 1,960 2,057 7 The North Sub.district contributed 1961 of the births as against 1892 in the previous year; the South 1333 as against a similar number in the previous year; and the East 1524 as against 1644. DEATHS. During the past year, a total of 2551 deaths was registered in the parish, equal to an uncorrected death.rate of 17.4. By the exclusion of the deaths of 148 non.parishioners dying within the parish, and the inclusion of the deaths of 358 parishioners registered in other parts of the Metropolis, a net total of 2761 is obtained. The deaths in each sub.district, corrected by distribution in a similar manner, were as under :— North 1,028 South 803 East 930 Total 2,761 DEATH RATE. Upon the basis of the estimated population I calculate a death rate of 21.36. This is a decrease of one per thousand from the rate of the previous year (of fifty.three weeks), but it is no less than 3.0 in excess of the corresponding rate for the whole of London; which was only 18 2. The mortality in the three sub.districts was as under :— North 2083 South 23.48 East 20.36 It will be noticed that the South district is in the unenviable position of having the highest mortality. This is accounted for by the fact that this district, which is situated between Whitechapel and Bethnal Green Road, contains three unhealthy areas which are veritable plague spots, and handicap all our attempts to reduce the general death rate of an otherwise fairly healthy parish. In one 8 of these areas the average death rate of the past three years was no less than 40 per thousand. To this matter I shall refer later on when speaking of our proceedings under the Housing of the Working Classes Act. CORRECTION FOR AGE AND SEX DISTRIBUTION. A district like Bethnal Green, which contains a larger than average proportion of young adults will necessarily show a lower death rate than one in which the average distribution prevails. A like observation applies to the proportions of the sexes, as the death rate among males is higher than among females at all ages. The Registrar General has prepared and published in his annual summary for 1896, a series of factors for correcting the death rates of all London districts for varying age and sex distribution, taking England and Wales as unity. The opportunity is thus given for obtaining the true comparative mortality of any district, by multiplying its crude death rate by the proper factor. I extract the following table from Mr. Shirley Murphy's last published annual report:— * Note, the three years referred to are 1864, 5, 6. See page 69. Corrected Death Bates per 1,000 persons living in Sanitary Districts of London adjacent to Bethnal Green. Sanitary Area. Standard Death Rate. Factor for correction for Age and Sex distribution. Crude Death Rate, 1886.1895. Corrected Death Rate, 1886.1895. Comparative Mortality figure, 1886.1895. London 1000. Crude Death Rate, 1896. Corrected Death Rate, 1896. Comparative Mortality figure, 1896. London 1000. England and Wales. 19.15 ... ... ... ... ... ... ... London 17.96 1.06626 19.7 21.0 1,000 18.1 19.3 1,000 Bethnal Green 18.39 1.04133 23.1 24.1 1,148 22.1 23.0 1,192 Hackney 18.30 1.04645 ... ... ... 15.7 16.4 850 Mile End Old Town 18.58 103068 21.4 22.1 1,052 19.9 20.5 1,062 Poplar 18.49 1.03569 21.2 220 1,048 20.6 21.3 1,104 Shoreditch 18.45 1.03794 23.1 24.0 1,143 21.4 22.2 1,150 Whitechapel 17.74 1.07948 23.1 24.9 1,186 20.6 22.2 1,150 10 111 the following table the mortality rates for London and for Bethnal Green are compared by quarters; the rainfall and mean temperature for each three months is also shewn :— TABLE C. Quarter ending. London Death Rate. Bethnal Green Death Rate. Mean Temp. Falir. Rainfall (inches.) April 3rd 18.0 21.3 41.1 7.35 July 3rd 15.1 18.0 53.1 4.80 October 2nd 18.9 21.3 60.9 6.29 Jan. 1st 19.0 25.3 46.0 3.69 Average 18.2 21.4 Mean 50.3 Tl. R.F 2.213 Temp. for 1897. Death Bates in Bcthnal Green during the Four Quarters of 1897, after distribution of Deaths in Public Institutions. (Estimated Population, 129,200.) Quarter Ending All Causes. Principal Zymotic Diseases. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Simple Fever. Diarrhœa. Phthisis. Deaths under one year to 1,000 births registered. 3rd April 21.3 2.42 ... 0.81 0 .09 0.90 006 ... 0.16 0 .03 0.37 1.58 139 3rd July 18.0 2.43 ... 1.21 0.22 0.43 019 ... 0.16 ... 0. 22 1.52 12 2nd October 21.3 5.22 ... 0.40 0 22 0.47 0 50 ... 009 ... 3.54 1.93 228 1st January, 1898 25.3 3.58 ... 1.12 0 25 0.81 1.03 0.03 0.12 ... 0.22 2.89 194 12 BIRTH RATE. The births registered during the year were 4,818, and are equal to a rate of 37.3 per thousand population at all ages. At first sight this rate appears slightly lower than that of the preceding year, which was recorded as 37 7 for a registration year of fifty.three weeks; but both years have an identical rate for a year of fifty.two weeks. The birth rate of Bethnal Green is seven-and-a-balf per thousand in excess of the general metropolitan rate, which is 30.0. A calculation, based upon the estimated population of women living in Bethnal Green between the ages of 15 and 45, gives a birth rate of 158"8 per thousand, against 114.2 for the whole of London, calculated in a similar manner. The birth rates in the sub.districts are shown in the table below 'f the death rate in each is also given for purposes of comparison:— It is often asserted that a high birth rate necessarily entails a correspondingly high death rate. That this statement is incorrect is exemplified by a comparison of the rates in the North and South sub.districts; for though the birth rate in the North is slightly higher than that in the South, yet the death rate in the South exceeds that in the North by nearly three per thousand. As a matter of fact, the vital and mortal statistics of any large community are greatly influenced by the proportion of healthy people between the ages of 15 and 45 living amongst them. A population composed of such persons, with the sexes in due proportion, might be trusted to show, for a series of years, enormous birth rates, with a very low mortality. About 17 per cent, of the children born would probably die within a year of their birth, though (even under unfavourable conditions) a large proportion of the remainder would survive and increase the population of children Sub-district. North South East Birth Rate- Death Rate. 39.7 20.83 39.0 23.48 33.7 20.36 13 And young adults, the mortality amongst whom would be so low as to more than counterbalance the infant mortality. The following table compares the birth.rates for Bethnal Green ,&nd for London by quarters:— Quarter ending London. Bethnal Green. April 3 311 39.7 July 3 29 1 36. 3 October 2 30. 3 37.2 Jauuary 1 29. 5 35.8 MARRIAGES. In this parish there are fourteen Churches, fifteen Chapels, and one Registry Office licensed for Marriages : of these there were in the Quarter ending. Church of England. Before Registrar. Total. 31st March 227 18 245 30th June 377 16 393 30th September 317 25 342 31st December 409 26 335 Total 1330 85 1415 This total of 1415 indicates a marriage rate of 10 9 to every thousand persons living or, as in each marriage there are two contracting parties, 21.9 of our population enters the bonds of matrimony during the year. Eighty.five of these weddings were purely civil contracts inasmuch as the presence of the Registrar was necessary to legalize the ceremony, though most of the weddings took place in chapels. 14 As the law stands at present, Jews and Quakers are the only religious persuasions in England (outside the Established Church) whose ministers are able to join couples in matrimony without the presence of the Registrar. A Bill is now before Parliament which proposes to relieve Non.conformist ministers from this disability. DEATHS OF INFANTS. Twenty.nine and a half per cent, of the deaths from all causes were those of infants aged less than twelve months; for, out of 4,818 children born alive, 814 died before reaching the age of one year, thus giving a death rate, calculated upon the births, of 169 0 whilst the corresponding rate for the whole of London was 158. DEATHS OF YOUNG CHILDREN. Nearly half the deaths (1,259, that is 45.6 per cent.) were those of children aged less than five years, giving a proportion equivalent to a rate of 70 0, calculated upon the estimated population of young children. OLD PERSONS DEATH RATE. The deaths of old people, that is to say persons over sixty.five years of age, numbered 472. This gives a rate of 99.4 per thousand, calculated upon the estimated population of persons over that age. SPECIAL CAUSES OF DEATHS. Table III. is prepared from the weekly death returns of the District Registrars, and from the monthly return of extra.parochial Institution deaths received from Somerset House. At the foot of the table is shewn a mortality rate for each of the diseases or classes of disease therein enumerated. TABLE III. Table of Deaths during the year 1897, in the Bethnal Green Metropoliton District, classified according to Diseases, Ages, and Localities (institution deaths have been distributed and non-parishioners excluded). Names of Localties adopted for the purpose of these Statistics ; public institutions being shown as separatelocalities (Columns for Population and Births are in Table B.) Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 5. | 5 and under 15. 15 & under 25. 25 & under 65. | 05 & upwards. Smallpox. Scarlatma. Diphtheria. Membranous Croup. Fevers. Cholera. J Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis Pneumonia & Pleurisy. Heart Disease. Influenza. Injuries. All Other Diseases. Total. Typhus. Enteric or Typhoid. | Relapsing. Puerperal. Deaths at home 709 300 133 20 17 163 76 Under 5 ... 3 10 ... ... 2 ... ... ... ... 45 10 37 ... 4 106 2 ... 19 186 433 5 upwds. ... 9. 2 ... 1 2 ... 2 ... 1 3 ... 6 1 59 83 25 2 8 79 276 NORTH In Hospital 319 21 37 20 10 140 91 Under 5 ... 8 15 ... ... ... ... ... ... ... 3 1 6 ... ... 8 ... ... 4 13 58 5 upwds. ... ... 3 ... ... 2 ... ... 1 ... ... ... 1 ... 41 76 129 ... 12 96 261 Total 1028 321 170 40 27 303 167 ... ... 13 30 ... 1 6 ... 2 1 1 51 20 50 1 104 273 56 2 43 374 1028 SOUTH Deaths at home 549 218 102 22 20 141 46 Under 5 ... ... 5 2 ... ... ... ... 1 ... 17 16 40 ... 3 63 4 ... 23 146 320 5 upwds. ... 1 4 1 ... ... ... ... 1 1 2 1 2 2 39 61 3b 4 1U b4 229 In Hospital 254 25 37 13 12 106 61 Under 5 ... 2 13 ... ... ... ... ... ... ... ... 3 4 ... 1 11 ... ... 4 24 62 5 upwds. ... ... 4 ... ... 4 ... ... ... ... ... ... 1 ... 33 34 26 ... 21 69 192 Total 803 243 139 35 32 247 107 ... ... 3 26 3 ... 4 ... ... 2 1 19 20 47 2 76 169 66 4 58 303 803 East Deaths at home 630 233 114 13 30 141 99 Under 5 ... 3 12 3 ... ... ... ... 1 ... 36 12 39 ... ... 61 1 1 10 168 347 5 upwds. ... 2 1 ... ... 5 ... 2 ... ... 2 5 1 38 68 34 3 16 106 283 In Hospital 300 17 22 10 16 136 99 Under 5 ... 1 9 ... ... ... ... ... ... ... 1 1 5 1 ... 2 ... ... 4 15 39 5 upwds. ... 2 3 ... ... 4 ... ... ... 2 ... ... 1 1 36 63 22 ... 17 110 261 Total 930 250 136 23 46 277 198 ... ... 8 25 3 ... 9 ... 2 1 2 39 13 50 3 74 194 57 4 47 399 930 Totals 2761 814 445 38 105 827 472 Under 5 ... 17 64 5 ... 2 ... ... 2 ... 102 52 131 1 8 251 7 1 64 552 1259 5 upwds. ... 7 17 1 1 17 ... 4 2 4 7 1 16 5 246 385 172 9 84 524 1502 Grand Total ... ... ... ... ... ... ... ... ... 24 81 6 1 19 ... 4 4 4 109 53 147 6 254 636 179 10 148 1076 2761 Mortality per thousand population at all ages ... 0.18 0.67 0.00 0.14 0.03 0.03 0.03 0.84 0.41 1.14 0.04 1.96 4.93 1.38 0.07 1.14 8.33 21.38 16 I am indebted to the British Mcdical Journal for the following Extract:— THE DEATH.EATES OF LONDON SANITARY AREAS DURING 1897. " In the accompanying table will be found summarised the vital statistics of the forty.three sanitary areas of the Metropolis, based upon the Registrar.General's returns for the year 1897. The mortality figures relate to the deaths of persons actually belonging to the respective sanitary areas, and are the result of a complete system of distribution of deaths occurring in the public institutions of London among the various sanitary areas in which the patients had previously resided. The 133,618 births registered in London during 1897 were equal to a rate of 30.0 per 1,000 .of the population, estimated at 4,463,169 persons in the middle of that year; this rate was lower than in any of the ten preceding years, during which the birth.rate averaged 312 per 1,000. In the various sanitary areas the birth.rates showed, as usual, wide variations, owing principally to the differences in the age and sex distribution of their populations. In St. George Hanover Square, St. James Westminster, Hampstead, St, Martin.in.the.Fields, City of London, and Lee, the birth.rates were considerably below the average; while they showed a marked excess in St. Luke, Bethnal Green, Whitechapel, St. George.in.the.East, Mile End Old Town, St. Olave Southwark, and Bermondsey sanitary areas. The deaths of persons belonging to London registered during last year were 78,971, equal to a rate of 17.7 per 1,000 of the population, against 17.4, 19 4, and 18.2 in the three preceding years. The rate in 1897 was 1.8 per 1,000 below the mean rate in the ten preceding years, and with one exception was lower than in any year on record. The lowest death.rates last year in the various sanitary areas were 11.8 in Hampstead, 12.8 in Lewisham (excluding 17 Penge), 13.2 in St. George Hanover Square and in Lee, 13 4 in Wandsworth, 13.7 in Plumstead, and 14.3 in Stoke Newington; the highest rates were 231 in Holborn, 23 7 in St. George Southwark, 24.6 in St. Saviour Southwark, 251 in Limehouse, 25 7 in St. Luke, and 26.4 in St. George. in.the.East. During the year under notice 11,453 deaths resulted from the principal zymotic diseases in London ; of these 4,089 were referred to diarrhœa, 2,240 to diphtheria, 1,927 to measles, 1,837 to whooping.cough, 778 to scarlet fever, 566 to different forms of " fever" (including 1 to typhus, 557 to enteric fever, and 8 to simple and ill.defined forms of fever), and 16 to small.pox. These 11,453 deaths were equal to a rate of 2 56 per 1,000, against 2.64, 2 62, and 311 in the three preceding years; this rate was lower than that recorded in any year since 1391, and was 018 per 1,000 below the mean rate in the ten preceding years, 1887.96. In the various sanitary areas the zymotic death. rates ranged from 110 in St. George Hanover Square, 1.16 in Hampstead, 1.19 in St. Martin.in.the.Fields, 143 in Lee, 1.61 in Marylebone, and 163 in St. Giles to 3 61 in Clerkenwell, 3 66 in St. Saviour Southwark, 3 82 in St. Luke, 4.07 in Shoreditch, 4 27 in St. George.in.the.East, and 435 in St. George Southwark and in Bermondsey. Compared with the averages in the ten preceding years the mortality from small.pox, measles, scarlet fever, and " fever " was below the average, while that from diphtheria and from diarrhoea showed an excess. The 16 fatal cases of small.pox registered in London during 1897 exceeded by 7 the number in the preceding year, and included 5 which belonged to Camberwell. 2 to Strand, and 2 to Greenwich sanitary areas. During the year under notice 86 cases of small.pox were admitted into the Metropolitan Asylums Hospitals, all of which were admitted during the first seven months of the year; and no patients have been under treatment in these hospitals since August last. B 18 Measles showed the highest proportional fatality in St. Luke, Bethnal Green, Shoreditch, St. George.in.the.East, Limehouse, St. Saviour Southwark, St. George Southwark, and Berrnondsey sanitary areas. Scarlet fever was proportionally most fatal in St. James Westminster, St. Luke, St. George.in.the.East, St. Saviour Southwark, Berrnondsey, Rotherhithe, and Battersea sanitary areas; 15,256 scarlet fever cases were admitted into the Metropolitan Asylums Hospitals during 1897, and 3,507 patients remained under treatment at the end of December last. Diphtheria caused the highest proportional fatality in Hackney, Clerkenwell, Shoreditch, Bethnal Green, Poplar, Berrnondsey, Battersea, Camberwell, and Woolwich sanitary areas ; there were 6,592 admissions of diphtheria patients into the Metropolitan Asylums Hospitals during 1897, and 1,066 cases remained under treatment at the end of December. Whooping.cough was proportionally most fatal in Holborn, Clerkenwell, St. Luke, Limehouse, Newington, St. Olave Southwark, and Berrnondsey sanitary areas; enteric fever in Stoke Newington, City of London, St. George.in.the.East, Mile End Old Town, and Poplar sanitary areas ; and diarrhcea in Fulham, St. Luke, Shoreditch, St. George.in.the.East, St. George Southwark, Newington, St. Olave Southwark, and Berrnondsey sanitary areas. During the year under notice 7,629 deaths from phthisis were registered in London, equal to a rate of 171 per 1,000; this disease was much more fatally prevalent in Central and in East London than in any other part of the Metropolis. In West London the phthisis death.rate was 1.53 per 1,000, in North London 1.55, and in South London 162, while in East London it was 2 03, and in Central London as high as 2.69 per 1,000. Among the various sanitary areas the lowest rates were 0 74 in Hampstead, 0 94 in Lewisham, 1.10 in Lee, 1.13 in Paddington, 1.14 in Wandsworth, and 116 in St. George Hanover Square ; and 19 the highest rates 2.84 in St. George Southwark, 2 88 in St. Olave Southwark, 2 99 in St. Giles, 3T1 in St. Luke, 3.22 in St. Saviour Southwark, and 3.36 in Strand. Infant mortality in London during 1897, measured by the proportion of deaths under 1 year of age to registered births, was equal to 158 per 1,000, and slightly exceeded the mean rate in the ten preceding years. The lowest rates of infant mortality were 116 in Plumstead, 121 in Stoke Newington, 127 in Hampstead, 129 in Lewisham, 133 in St. George Hanover Square and in City of London, and 135 in Wandsworth ; while they ranged upwards in the other sanitary areas to 183 in Shoreditch, 184 in Holborn and in Clerkenwell, 189 in St. George Southwark, 190 in Berrnondsey, 193 in Limehouse, 193 in St. Saviour Southwark, and 197 in St. George.in.the.East. B 2 Analysis of the Vital and Mortal Statistics of the Sanitary Districts of the Metropolis, after Distribution of Deaths occurring in Public Institutions, during the Year 1896. Sanitary Areas. Estimated Population middle of 1897. Births. Deaths. Annual Rate per 1,000 Living. Deaths from Principal Zymotic Diseases. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping-Cough. Typhus. Enteric Fever. Simple and Undefined Fever. Diarrhoea. Phthisis. Deaths of Children under 1 year of age to 1,000 births. Births. Deaths. Principal Zymotic Diseases. LONDON 4,463,109 133,618 78,971 30 0 17.7 2.56 11,453 10 1,927 778 2,240 1,837 1 557 8 4,089 7,629 158 West Districts. Paddington 126,161 3,018 1,814 24.3 14.4 1.94 243 ... 2 21 64 44 ... 9 1 102 142 149 Kensington 171,427 3,683 2,077 21.5 15.7 1.78 304 ... 32 30 81 19 ... 21 1 120 247 166 Hammersmith 105,959 3,139 1,760 29.7 16.7 1.99 211 ... 5 11 30 28 ... 8 1 128 146 171 Fulham 120,040 4,106 2,034 34.3 17.0 3.04 362 ... 51 26 63 61 ... 12 1 148 184 162 Chelsea 90,692 2,549 1,713 26.4 17.8 2.55 244 ... 18 17 54 41 ... 14 ... 100 175 161 St.GeorgeHanoverSq 80,330 1,369 1,059 17.1 13.2 1.10 89 ... 17 7 17 13 ... 10 ... 25 93 133 Westminster 53,027 1,237 1,004 23.4 19.0 2.47 131 ... 20 13 23 16 ... 6 ... 47 143 106 St JamesWestmnstr. 22,570 459 393 20.4 17.5 1.87 42 ... 13 8 3 6 ... 3 ... 9 51 103 North Districts. Marylebone 140,808 4,135 2,572 29.5 18.3 1.61 227 ... 9 9 46 41 ... 14 ... 108 246 136 Hampstead 77,275 1,479 911 19.2 11.8 1.16 90 ... 9 6 17 25 ... 5 ... 28 57 127 St. Pancras 242,255 7,017 4,518 29. 0 18.7 2.47 597 1 87 24 114 124 ... 38 ... 209 486 168 Islington 341,134 9,845 5,387 28.9 15.8 1.91 653 1 99 61 129 134 ... 45 ... 184 491 130 Stoke Newington. 34,130 835 488 24.5 14.3 2.12 72 ... 7 2 19 15 ... 10 ... 19 40 121 Hackney 216,698 6,312 3,573 29.2 16.5 2.90 626 ... 127 37 134 97 ... 35 ... 190 310 147 Central Districts. St. Giles 37,840 981 696 26.0 18.4 1.63 61 ... 9 7 7 18 ... 6 ... 14 113 146 St Martin-in-Fields 12,711 109 206 13.3 16.3 1.19 15 1 1 2 3 5 ... 1 ... 2 33 178 Strand 23,552 570 501 24.3 21.3 2.06 48 2 10 3 5 6 ... 4 ... 18 79 161 Holborn 30,493 781 703 25.7 23.1 2.79 85 ... 6 14 16 19 ... 5 ... 35 84 184 Sanitary Areas. Estimated Population middle of 1897. Births. Deaths. Annual Rate per 1,000 Living. Deaths from Principal Zymotic Diseases. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping-Cough. Typhus. Enteric Fever. Simple and Undefined Fever. Diarrhœa. Phthisis. Deaths of Children under 1 year of age to 1,000 births. Births. Deaths. Principal Zymotic Diseases. Clerkenwell 66,162 2,092 1,459 31.7 22.1 3.61 238 1 49 14 48 49 ... 11 ... 66 155 184 St. Luke 41,279 1,860 1,056 45.2 25.7 3.82 157 ... 40 13 21 28 ... 4 ... 51 128 149 London City 30,222 478 642 15.9 21.3 1.66 50 1 7 8 10 10 ... 10 ... 5 57 130 East Districts. Shoreditch 121,883 4,314 2,627 35.5 21.6 4.07 496 1 116 29 78 63 ... 20 ... 189 247 183 Bethnal Green 129,098 4,818 2,761 37.4 21.4 3.41 439 ... 114 25 84 57 ... 17 1 140 255 171 Whitechapel 79,724 3,150 1,623 39.6 20.4 2.16 171 ... 45 15 34 16 ... 8 ... 53 200 148 St. George-in-East 47,917 2,029 1,262 42.5 26.4 4.27 204 ... 68 14 28 24 ... 10 ... 60 132 197 Limehouse 58,508 1,997 1,462 34.2 25.1 3.54 206 ... 63 12 29 37 ... 4 ... 61 149 193 Mile End Old Town 111,883 4,257 2,085 38.2 18.7 2.97 330 ... 77 12 62 58 ... 23 ... 98 156 149 Poplar 169,811 5,849 3,353 34.5 19.8 3.07 519 ... 83 28 120 83 ... 30 ... 175 319 170 South Districts. St. Saviour Southw'k 24,919 769 611 30.9 24.6 3.66 91 ... 32 7 12 12 ... 2 ... 26 80 195 St. George Southw'k 60,388 2,114 1,426 35.1 23.7 4.35 262 1 67 14 28 32 ... 10 1 109 171 189 Newington 122,191 4,248 2,588 34.9 21.2 3.59 439 ... 85 33 65 62 ... 9 ... 165 269 177 St. Olave Southw'k 11,480 434 253 37.9 22.1 2.96 34 ... 6 2 2 8 ... 1 ... 15 33 154 Bermondsey 85,629 3,176 1,883 37.2 22.1 4.35 371 ... 76 34 62 62 ... 13 ... 124 174 190 Rotherhitne 40,643 1,258 766 31.0 18.9 3.26 132 ... 21 22 21 17 ... 2 ... 49 64 174 Lambeth 300,048 9,388 5,247 31.4 17.5 2.65 791 ... 140 42 144 144 ... 26 ... 295 500 151 Battersea 168,877 5,266 2,734 31.3 16.2 2.79 470 ... 79 47 106 79 ... 19 ... 140 251 152 Wandsworth 195,612 5,042 2,606 25.8 13.4 1.91 370 ... 27 29 111 42 ... 16 1 144 222 135 Camberwell 257,575 7,483 4,276 29.1 16.6 2.91 750 5 141 32 170 111 ... 31 ... 260 386 159 Greenwich 178,367 5,563 3,058 31.3 17.2 2.27 405 2 35 32 70 57 ... 29 ... 180 263 157 Lee 39,215 881 516 22.5 13.2 1.43 56 ... 6 3 17 5 ... 3 ... 22 43 135 Lewisham 86,152 2,186 1,099 25.4 12.8 1.71 147 ... 17 9 36 19 ... 7 ... 59 81 129 Woolwich 41,409 1,307 735 31.7 17.8 2.54 105 ... 2 8 33 8 ... 4 ... 50 79 158 Plumstead 61,057 1,975 834 32.4 13.7 1.97 120 ... 3 6 24 22 ... 3 1 61 95 116 22 THE SEVEN PRINCIPAL ZYMOTIC DISEASES. The total number of deaths from this class of disease was 444 ; of these, 375 were those of young children under five years of age. In table " D " the deaths from each of these diseases are shown and compared with those of the preceding year. From this it will be seen that Scarlet Fever, Measles, and Whooping Cough show a marked decrease, whilst Diphtheria and Diarrhoea have increased. TABLE D. 1897. 1896. Small Pox ... ... Measles 109 149 Scarlet Fever 24 40 Diphtheria 87 77 Whooping Cough 53 151 Typhus Fever 1 ... Enteric Fever 18 21 Simple Fever 1 ... Diarrhœa 147 108 Cholera 4 1 Total 444 547 Sixteen per cent, of the total deaths from all causes were referred to the diseases included in table " D," against eighteen per cent, in 1396. The actual decrease in number was 103, the decennial average for the ten years 1887 to 1896 being 482 (see table V). The death rate from these seven Zymotic diseases was 3.4r 23 against 4.2 in 1896, whilst the corresponding rates for London were 21 in 1896 and 2.5 in 1897. Table " F " shows the percentage of deaths from each disease as compared with the total number of Zymotic deaths. TABLE F. Small Pox 0 per cent., or 0 in 444 deaths. Measles 24.55 1 in 4.07 „ Scarlatina 5.40 „ 18.50 „ Diphtheria 19.60 „ 510 „ Whooping Cough 11.94 „. 8.38 „ Typhus Fever 022 „ „ 444.00 „ Enteric Fever 405 „ „ 24.67 „ Simple Fever 0.22 „ 444.00 „ Diarrhoea 34.01 „ 2.94 „ NOTIFICATION OF INFECTIOUS DISEASES. Eighteen hundred and seventy-eight notification certificates have been forwarded to me by Medical Practitioners. This gives a rate of 14.5 on the estimated population, as against 10 2 for the whole of London. One hundred and ten of the certificates were duplicate notifications. Copies of all these certificates were duly forwarded to the Asylums Board as they were received. The head teachers of schools were also notified as required by law, and in addition this was followed in due course by a certificate of disinfection in each instance. Table K211 (B) in the appendix shows the part of the parish in 24 which the residence of the sick person was situated, and table " G " gives particulars of the numbers of cases month by month, together with the Hospital admissions and discharges. The duplicate notifications were about six per cent, of the whole, and represent a cost of about thirteen pounds for fees. The expenditure of this sum is pure waste, though necessitated by the wording of the Act. In my opinion, duplicate notifications by associated Medical Practitioners (partners, principal and assistant, and institution colleagues) should no longer be required or paid for. In nine instances the notification certificates were withdrawn by the Medical Attendant, the lapse of time having afforded an opportunity to correct the original diagnosis. In ten instances it was necessary to return the certificate for amendment, as the address first given was found incorrect. In twelve instances the usual notification fee of half.a.crown was disallowed by order of the Sanitary Committee. In two of these there was unnecessary delay in forwarding the certificate. In ten cases I reported that there were no grounds to justify the Medical Practitioner reporting the case as one of infectious disease. A medical man certified thirteen cases of Membranous Croup within a month. I made no examination of the first half dozen, but could not help noticing that the patients did not appear urgently ill when I visited the premises in the ordinary course of my duties. One morning I received four of these certificates, so I warned the certifier that I should personally examine these and any future cases of Membranous Croup he might report. I did so, but failed to find symptoms of laryngeal obstruction in any instance. I reported the result of my examination to the Sanitary Committee, and the fees for the certificates were disallowed as to the cases I had personally investigated, together with another certified on Post Mortem examination only. This was the subject of an Inquest. The child was found dead in bed ; the Jury brought in a verdict of suffocation, on the medical evidence; on the same afternoon I received a notification that the child had suffered from Membranous Croup, though nothing was said about this before the Coroner. I may just mention that this was the only fatal case out 25 of the whole thirteen, a magnificent testimonial to the skill of the doctor, supposing his diagnosis tc have been correct!! The medical man referred to wrote protesting against his fees being disallowed, but took no further action beyond ceasing to certify Membranous •Croup. I visited some premises in Eavenscroft Street on an anonymous complaint, and found two children with well.marked Scarlet Fever, under the care of a practitioner residing in a neighbouring parish. I wrote to this gentleman to ask the reason for his failure to notify (he had excused himself on a previous occasion on the ground of forgetfulness), in reply I got two notification certificates, but no answer to my letter. The Sanitary Committee directed two summonses to be taken out for failure to comply with the law, and Mr. Haden Corser inflicted fines of one pound and fourteen shillings and sixpence costs, in the first [case, and a similar penalty in the second. TABLE G. Infectious Cases, 1897. CERTIFICATES OF INFECTIOUS CASES RECEIVED BY THE MEDICAL OFFICER OF HEALTH. Admitted to Asylums Board's Hospitals. Small Pox. Fevers & Diphtheria! Small Pox Typhus Cholera Puerperal Fever Scarlet Fever. Diphtheria and Membranous Croup Enteric Fever Erysipelas Admitted Discharged Died Remaining Admitted Discharged Died Remaining January 0 0 0 0 42 40 8 27 0 0 0 0 39 91 2 132 February 0 0 0 0 35 34 8 29 0 0 0 0 33 72 6 92 March 0 0 0 1 46 44 6 31 0 0 o 0 44 45 5 86 April 0 0 0 0 44 43 8 25 0 0 0 0 39 43 3 79 May 0 0 0 1 38 31 2 30 0 0 0 0 38 35 6 76 June 1 0 0 0 47 36 4 30 o 0 0 0 45 40 0 81 July 0 0 0 0 71 51 12 40 0 0 0 0 62 32 7 104 August 0 1 1 2 105 60 3 45 0 0 0 0 97 46 4 151 September 0 0 0 1 106 64 14 34 0 0 0 0 95 68 4 174 October 1 0 0 0 86 81 21 47 0 0 0 0 67 80 7 154 November 0 0 0 2 86 55 19 34 0 0 0 0 58 80 6 126 December 0 0 0 1 56 45 7 36 0 0 0 0 57 48 8 127 Total 2 1 1 8 762 £84 112 408 0 ° 0 0 0 679 680 58 127 27 SMALL POX. (No deaths. Decennial average 2.3.) Only two cases of this disease were notified during the year; both were found to be chicken pox ; one was removed to hospital before I saw it and was sent home again ; the other I saw before removal and advised its being kept at home, it proved to be a bad case of chicken pox such as a medical man who had never seen the true disease might be justified in notifying. As there is often considerable doubt in the minds of inexperienced practioners as to the diagnosis between small pox and chicken pox, I think the latter disease should be made notifiable as chicken pox. SCARLET FEVER. (24 deaths. Decennial average 50'5.) The number of Scarlet Fever cases notified during the year was 700 ; about half the number reported during the previous year. The deaths numbered 24, a rate on the notifications of 3'43 per cent. The Scarlet Fever death rate was equal to 018 per thousand population at all ages; whilst that for the whole of London was 0.17. In the North district 309 cases were reported ; thirteen resulted in death; in the South there were 191 with three deaths, and in the East 187 cases with eight. Amongst the notified cases in this last district were one at the Workhouse and nine at the Children's Home in Bonner Boad, none of which were fatal. The Inspectors' report of the sanitary condition of the houses where Scarlet Fever was notified give the following particulars :— In 310 instances everything was found to be in a fairly satisfactory condition. In 162 the closets were faulty; in 27 the internal drainage arrangements were defective; and in 23 the outside drainage arrangements required amendment; in three the domestic water supply was found to be drawn from the W.C. cistern; in two instances the premises were overcrowded ; whilst other minor insanitary conditions were present in 233. Eighty.three of the cases occurred amongst families inhabiting 28 one room only; 439 persons suffering from Scarlet Fever were removed to Hospital, where thirteen of them died. ENTERIC FEVER. (19 deaths. Decennial average 23.) The total number of Enteric Fever cases reported during the year was 104 ; and of these eighteen died, representing a case mortality of 18.3 on the notifications. A death was also certified as continued fever; this was probably a case of Typhoid. The deaths are equal to a rate of 0.14 per thousand population. Of the cases, 37 were notified from the North district with six deaths, 39 from the South with four deaths, and 27 from the East with nine deaths. In 53 instances the residence of the patient was found to be in a satisfactory condition, but in 27 the water.closets were defective. In ten the external drainage arrangements were faulty; in six the drains inside the house were leaky ; and other insanitary conditions were found in 36 instances. Six cases occurred in families inhabiting one room only. The patients removed to Hospital numbered 70, of whom ten died. TYPHUS. The death of one man was registered as from this cause, he was a wood.carver, aged 72, and he died comatose at 19, Tyrell Street. The case was notified to me after death by the Medical Attendant. I carefully inquired into the circumstances of the case but could find nothing to confirm the diagnosis of Typhus. I may mention that this was the only death registered in London as from Typhus during 1897. ASYLUMS BOARD HOSPITALS. The following table shews the admissions to, and discharges from Asylums Board Hospitals, of patients suffering from Diphtheria and fevers of various kinds. In addition to these some cases of Typhoid were treated in General Hospitals, and some Diphtheria cases requiring immediate operation were admitted to the London Hospital and the North Eastern Hospital for children. REPORT OF FEVER AND DIPHTHERIA CASES ADMITTED INTO FEVER HOSPITALS DURING THE YEAR 1897. Hospitals. No. of Cases remaining at end of 1896. No. of Cases admitte.1. Discharged. Died. No. of Cases remaining at end of 1897. Eastern Hospital (Homerton) 27 260 134 and S3 transferred to Winchmore Hill. 34 36 Northern Hospital (Winchmore Hill) 66 1 and 83 from Eastern Hospital, 76 from North.Eastern Hospital, 38 from North.Western Hospital, and 4 from New Cross Hospital. 243 0 25 North.Western Hospital 16 112 72 and 38 transferred to Winchmore Hill. 10 8 North.Eastern Hospital 30 166 85 and 76 transferred to Winchmore Hill. 6 29 New Cross Hospital 19 110 58 and 46 transferred to Gore Farm, and 4 to the Northern. 4 17 South.Western Hospital 8 18 19 and 3 transferred to Gore Farm. 2 2 Western Hospital 0 o 0 0 0 Shooter's Hill Hospital 0 11 6 and 2 transferred to Gore Farm. 2 1 Gore Farm Hospital 20 1 and 46 from New Cross Hospital, 3 from South.Western Hospital, and 2 from Shooter's Hill Hospital. 63 0 9 Totals 186 679 680 58 127 30 DIPHTHERIA : (Including Membranous Croup). (Total deaths 87. Decennial average 95.) The number of cases reported under the two heads was 543, the deaths registered were:— Diphtheria 81 Membranous Croup 6 = 87 This indicates a mortality rate of 16 0 on the notifications. On the estimated population at all ages the mortality was 0 67 per thousand living, giving almost identical results with that of the previous year, while the general Metropolitan rate was 0.50. Of the cases 214 were reported from the North district with 30 deaths ; 184 from the South with 26 deaths; and 145 from the East with 25 deaths. In 252 instances the residence of the patient was found to be in a satisfactory sanitary condition, but in 141 the closets were defective ; in 17 the external drainage was faulty; and in 30 the drains inside the house were leaky; whilst various other insanitary conditions were noted in 198 instances; 64 cases occurred in families occupying one room only. Out of 256 cases removed to Hospital 37 died. Some of the cases notified as diphtheria were reported by medical men who did not take the trouble to warn their patients as to the infectious nature of the disease from which they were supposed to be suffering. Under these circumstances the instructions of the Sanitary Inspector as to isolation were sometimes received with indignation, perhaps followed by an appeal to a second medical opinion for confirmation or refutation. It should not be forgotten that a person may have well.marked diphtheria without at first feeling very ill, and that if he exposes himself in this condition he will be certain to spread infection. It is sometimes impossible to make an absolutely certain diagnosis by a mere inspection of the throat, but proper isolation of the true disease is none the less imperative. It would be a great help to me if I were authorised to 31 make arrangements with the British Institute of Preventive Medicine for a bacteriological examination in doubtful cases. As an illustration of the difficulties we sometimes experience I may mention the case of a hairdresser in the Bethnal Green Road, who was notified to me as suffering from Diphtheria. On visiting the premises I found the man in a very infectious condition, at work in his shop. I warned him of the consequences of his behaviour, but ineffectually, since the inspector found him two days afterwards still at his business, and a source of infection, for two cases were traced to this cause. When the man was free from infection he was summoned to Worship Street, where he was fined twenty shillings and three shillings costs—a somewhat inadequate penalty for such reckless behaviour. PUERPERAL FEVER. The number of cases notified to me under this head was eight; the number of deaths registered was four. In two instances the first intimation'I received of the occurrence of the disease was the entry of the death in the weekly return of the District Registrar. In the first of these two cases the death was certified to be caused by " Peritonitis after labour, 12 days." I felt sure that this must be a case of Puerperal Fever, as the medical practitioner who signed the certificate had, a few weeks previously, notified to me a similar case on the day the patient died; accordingly I wrote to this gentleman to ask why he had failed to report the case; he answered apologising for his neglect, which he sought to excuse on the ground that the illness and death of his patient so upset him that he had forgotten to send the certificate. I reported the case to the Sanitary Committee, but they refused to accept the apology and directed a prosecution. The case was heard in due course before Mr. Cluer, at Worship Street. The defendant was not present, but sent a representative, who was prepared to admit the offence and pay such penalty as might be inflicted. 32 Mr. Winter, the District Registrar, produced the certificate which he identified by a private mark as one out of a book supplied by himself to defendant; he swore to the signature as being in the same handwriting as that of many other death certificates bearing defendant's name at the foot, but he had never seen him write, and of course could not swear that defendant had written this particular certificate. The husband of deceased proved the receipt of a death certificate from the doctor who attended his wife, but as he could not read he was unable to swear that the certificate produced was the one given to him. My evidence was to the effect that from the wording of the death certificate, and from such other information as I was able to obtain, I was satisfied that the deceased woman had died of puerperal fever, but in answer to the Magistrate's question I was unable to say positively that peritonitis following labour was invariably due to puerperal fever, and I was not permitted to put in defendant's letter acknowledging the facts, as I had not seen him write it. I explained to the Magistrate that the term " puerperal fever" (one of the diseases required by Section 55 of the Public Health, London, Actr 1891, to be notified) had been expunged from the Official Nomenclature of Diseases and ordered to be no longer used for registration purposes. The direction substituted is that " conditions included under the term Puerperal Fever should be returned under Affections Consequent on Parturition, the word puerperal being in all cases prefixed to the word denoting the local process," so that defendant was acting strictly according to oflicial instructions in wording the certificate as he has done in this case, except that he used the ordinary expression " after labour" instead of the scientific term " puerperal." Eventually the Magistrate dismissed the summons on the ground that he was not satisfied from the evidence produced that the deceased woman had suffered from puerperal fever; neither did he consider that we had proved that the death certificate produced was written by defendant. 33 The second case referred to was stated in the death certificate, dated January, 1898, to have died from " puerperal fever," and as I had received no notification I wrote to the certifying practitioner for an explanation of his failure to comply with the law. He replied that he had already notified the case to me, and blamed the postal authorities. I investigated the circumstances and discovered that the friends were unaware that the deceased woman had suffered from any infectious disease, and that the two nurses who had attended upon her were at the time of my visit nursing two other women who had been recently delivered, and that as they also were unaware of the infectious nature of the deceased woman's illness they had undergone no process of disinfection. The fact that these two parturient women escaped puerperal fever is providential. The above particulars were reported to the Sanitary Committee, but after our unfortunate experience in the previous case it is not surprising that they declined to prosecute. With reference to the first case I had some correspondence with Dr. Tatham, the statistical superintendant at Somerset House. In one of his letters to me this gentleman remarks, " As the name puerperal fever occurs in the Public Health (London) Act, 1891, I should have thought that a definition of that term ought to have been appended to that Act." In this opinion I certainly concur. In a poor district like Eethnal Green, with an enormously high birth rate, the practice of midwifery provides a large proportion of the income of medical practitioners. Now a case of childbed fever is justly regarded by prospective patients as a blot on the reputation of the doctor in whose practice it occurs ; the temptation is, therefore, great on the part of a medical man to conceal the existence of such a disease, and to call it by some of the less known synonyms; and this may safely be done as if ultimately fatal the death may be truly certified without the use of the obnoxious term. Under such circumstances no precautions as to the spread of the disease are likely to be taken, though the disease under consideration is eminently a preventible one, and urgently requires that proper means of disinfection should be used in order to prevent conveyance of infection. C 34 The following remarks are extracted from a recent number of the Lancet, and are so much to the point that I reproduce them here :— PUERPERAL INFECTION. A coroner's inquest was held last week at Market Harborough, Leicestershire, upon a woman who died of puerperal fever. The circumstances pointed to infection of the woman by the midwife who attended her. But the medical evidence was not absolutely clear as to the facts, and the medical opinions were not expressed without the admission of a doubt. The evidence was that on January 1st the midwife delivered a woman, who died of puerperal fever. It was said that the medical officer of health then directed the midwife that she ought not to attend a case of labour for at least a month. The midwife said she had not understood this, and the jury gave her the benefit of the doubt, and accepted her statement on the point. The midwife attended another woman on January 20th, who did well. See then attended, on January 25th, the woman on whom the inquest was held, who died of puerperal fever. Two of the doctors who gave evidence at the inquest, said that, although they thought it probable that the midwife had given puerperal fever to the patient, yet they could not be absolutely certain of it. The jury accordingly found that the woman died from puerperal fever ; that there was not sufficieit evidence to show that the patient's death was due to the midwife's negligence; that the midwife had been guilty of gross and culpable negligence, which was deserving of punishment, and that they thought she ought to be severely censured. We do not see how, upon the evidence, the jury could have come to any other verdict. We observe a comment in a local newspaper to the effect that, from the conduct if the midwife in court, and the way in which she replied to the coroner, it was evident she did not realise the serious nature of the se. This shews that it is well that inquests should be held in 35 such cases, in order to impress upon the public and upon midwives that puerperal fever is a preventable disease, and that it is somebody's fault if it is not prevented. The case raises the question as to the efficacy of abstinence from practice as a means of purification. It is the opinion of many leading obstetricians (as may be seen in the discussions of the Obstetrical Society) that without disinfection 110 mere lapse of time will prevent conveyance of infection ; and, if thorough disinfection is carried out, it is not necessary for a doctor or midwife to discontinue practice for a longer time than that necessary for the disinfection. No lapse of time will sterilise a septic dress or syringe, nor will it change the habits of & woman who never uses a nailbrush. On the other hand, if the midwife will burn her infectious garments and put on clean ones, will scrub her nails till they are spotless, make a practice of boiling her syringe, catheter, etc., and of carrying about and using antiseptics, it is not needful that she should abstain from practice. This, we may believe, is the current teaching of those who are best qualified to form an opinion on the subject." A report on the method of certifying puerperal fever was laid before the Sanitary Committee, and after discussion the following recommendation was sent up to the Vestry and by them adopted :— The Committee find that considerable uncertainty exists as to what diseases should be reported to the Medical Officer of Health under Section 55 of the Public Health (London) Act as " the fever known as puerperal " ; they have also ascertained that owing to its indefinite meaning the term ''puerperal fever" has been expunged from the Official Nomenclature of Diseases, and therefore recommend that:— The London County Council be requested to take the necessary steps under Section 55 (6) of the Public Health (London) Act, to add to Section 55 (8) of the same Act the names of 36 the diseases included under the heading of " puerperal fever " by the Registrar-General, viz. :— " Both peritonitis and metritis, when occurring in connection with parturition, as well as puerperal pyaemia, puerperal septicaemia, and puerperal sapraemia." It would have been competent for the Vestry to take the necessary steps in the direction indicated, so far as Bethnal Green is concerned, but since the matter is one of Metropolitan interest it was felt that the proper body to deal with it is the London County Council; and it now remains to be seen what action that authority will take. I sent a copy of the above report to the Editor of the British Medical Journal, and in a recent issue the recommendation is quoted in full with the following observations :— PUERPERAL FEVER AND NOTIFICATION. The Bethnal Green Vestry, acting doubtless on the advice of Dr. Bate, their medical officer of health, have passed the following resolutions :— "That considerable uncertainty exists as to what diseases should be reported to the medical officer of health under Section 55 of the Public Health (London) Act as ' the fever known as puerperal" ; they have also ascertained that, owing to its indefinite meaning, the term ' puerperal fever ' has been expunged from the official nomenclature of diseases, and therefore recommend that the London County Council be requested to take the necessary steps under Section 56 (6) of the Public Health (London) Act, to add to Section 55 (8) of the same Act the names of the diseases included under the heading of puerperal fever by the Registrar-General, namely, Both peritonitis and metritis, when occurring in connection with parturition, as well as puerperal pyaemia, puerperal septicaemia, and puerperal sapraemia.' " Many persons think that the inclusion of puerperal fever among those diseases, notice of which must be given by the practitioner to the medical officer of health, 37 was a mistake. They argue that epidemics of the zymotic diseases can be controlled and often prevented by means which the medical officer of health, by virtue of the powers entrusted to him, can employ, but that no such thing as an epidemic of puerperal fever has ever been known to occur. (A sequence of cases in the practice of a dirty-fingered midwife, it is argued, is not an " epidemic " in the true sense of the word, which denotes a disease affecting a people or community). On the other hand, the reasons assigned for requiring the notification of puerperal fever are, first and foremost, that it affords some opportunity of obtaining control over " dirty persons," midwives, or others; and secondly, that it gives an opportunity for examining the dwelling and obtaining an order for the correction of gross sanitary defects and overcrowding. But accepting the legal obligation to report such cases, the addition suggested by the Bethnal Green Vestry seems to us a good one. We would suggest that after " peritonitis " " cellulitis" might be inserted, and after "puerperal " where the word first occurs, the words " or childbed." It should be understood that the new words are explanatory and not to be regarded as a complete definition of everything included under the head of " the puerperal fever.'' WHOOPING COUGH. (.Deaths 53. Decennial average 100.6.) Whooping cough caused 53 deaths, a little over one-third of the mortality of the previous year ; all the deaths except one were amongst young children aged less than five years, a mortality of 29 on the estimated population of young children. MEASLES. (Deaths 109. Decennial average 114.2.) Measles, which is eminently a children's disease, caused 109 deaths. All except seven were amongst children under five. In four other instances in addition to measles, diphtheria was stated in 38 the certificate to have contributed to the fatal termination. As this latter is a notifiable disease whilst the former is not, I have preferred to classify the deaths under the heading of Diphtheria. The mortality from measles was in the proportion of 5 6 per thousand on the estimated population of young children. This disease, the most fatal amongst the Zymotics, is constantly with us and the mortality does not vary very greatly from year to year. A proposal to include measles amongst the diseases notifiable under sec. 55 of the Public Health (London) Act, 1891, was laid before the Vestry, and was negatived on the report of the Sanitary Committee, Measles is most difficult to isolate as it is intensely infectious from the first onset of the catarrhal symtoms, and the mischief of communicating the disease to other children is done before any precautions can be taken. There is no hospital for the isolation of measles, and if there were, I very much doubt whether parents would permit the removal of their children to it. Under these circumstances I do not consider that notification, under the present law, would be worth the expense. The disease is fatal in about five per cent, of the persons attacked, and its inclusion in Sec. 55 would mean an addition of at least 2,000 half-crowns yearly to the notification account of Bethnal Green. But I do think that a modified form of notification would be useful, and not very expensive ; I would limit medical certification to the first case in each household, and enforce the report of subsequent cases on the parent or guardian. If we knew of the first case in each house or family, we could notify the Schools so that all children from such houses could be excluded, and the premises kept under observation.. DIARRHCEAL DISEASES. (Deaths 151. Decennial average 967.) Diarrhoea was the cause of 148 deaths, all except eighteen of which were amongst young children. In addition three deaths were registered as " Choleraic Diarrhœa " or English Cholera, and one, which was also notified as true Cholera. This was the case of a female rag-sorter, aged 17, who died cyanosed after a few hours I 39 ness at 69, Somerford Street, the case was the subject of an inquest and clinically was one of " Cholera," accordingly a verdict to this effect was returned by the jury on the medical evidence. Portions of the intestine, etc., were submitted to Dr. Klein for Bacterioscopic examination, though with a negative result. I investigated the case with great minuteness, and visited the factory where the girl was employed on several occasions. The " rags " she was engaged to sort were book-binders' refuse and quite clean, the sanitary arrangements of the factory were good, and I could discover nothing to account for the illness beyond the fact that the girl had partaken of a meal of fried potatoes and lemon ice a few hours before the symptoms commenced. PHTHISIS. (254 deaths.) Tubercular diseases, of which Phthisis is the chief and most common, are of special importance to sanitarians inasmuch as they are essentially due to a microbe called the tubercle bacillus. Persons suffiering from phthisis are centres of infection and are responsible for the distribution of these bacilli. Fortunately most people are able to resist the invasion of the microbes unless they are weakened by insanitary surroundings (particularly overcrowding and damp dwellings), or unless they have an hereditary predisposition to the disease. Nearly nine and a half per cent, of the total mortality from all causes is referable to pulmonary tuberculosis, which caused 254 deaths ; this is equal to a rate of 196 per thousand persons living ; the corresponding Metropolitan mortality was 1.71. RESPIRATORY DISEASES. The deaths from chest diseases formed twenty-three per cent, of the total mortality and numbered 636. This is equivalent to a rate of 4 93 per thousand population of all ages. 40 MORTUARY AND CORONER'S COURT. A total of 422 bodies were received at the mortuary, 316 of these were removed by order of the Coroner, 101 at the request of the relatives, and five on my order. The Coroner held 316 inquests, and 104 post mortem examinations were made by medical men. SUPERVISION OF TRADE PREMISES. The nineteen cow-houses and the ten slaughter houses have been kept under careful observation. All are in a satisfactory condition ; and no opposition was offered to the renewal of the licenses. The 102 bakehouses have also been regularly inspected and have been kept in a more cleanly condition. Under Sec. 26 of the Factory and Workshops Act H. M. Inspectors forward to us notices of all new workshops opened in the parish; but as we keep no trade register and make no periodical inspection of these places the notices have not been utilized. H.M. Inspectors have also forwarded 57 complaints of various insanitary conditions found by them in workshops. All these complaints were investigated by the district inspectors and their reports subsequently laid before the Sanitary Committee. The gravamen of a large number of the complaints (forty-one) was unsanitary conditions of W.C.'s. On this matter Mr. Foot complains that " The filthy and destructive habits of many of the workpeople are almost enough to cause a sanitary officer to despair. I have seen workshops provided with sanitary conveniences, in all respects properly fitted up and suitable for the hands employed, and on revisiting a short time after, the places have been found to be filthy, and in a state of disrepair that could only have been brought about by the most improper and destructive usage." There were twenty-seven complaints of dirty walls and ceilings, six of defective ventilation, five of overcrowding, and six of insufficient W.C. accommodation. In a few instances the nuisance had been abated before the visit of the Sanitary Inspector ; in every other instance (with the exception of the two complaints of 41 tive W.C. accommodation mentioned below) either a letter was written or a notice was served calling on the owner to abate the nuisance complained of; as this notice was in each instance obeyed no Police-court proceedings were necessary. Complaint was made that at a workshop in Hackney Road, one W.C. had to serve for five females and four males, and in addition, for three persons in the household, twelve in all. At another workshop in Mount Street only one W.C. was provided for four men and two women. Both complaints were investigated, verified, and reported to the Committee, but they decided to take no action, as they were of opinion that the accommodation provided was in both cases sufficient. Only one complaint as to overcrowding during overtime occupation was received. This referred to a workshop in Green Street, where four males and six females were employed in tailoring. The capacity of the workroom was found to be 2,526 cubic feet. I visited the premises, but did not happen to pitch upon an evening when overtime was being worked. The matter was reported to the Committee; they rather demurred at serving a notice as to a complaint which had not been verified by one of their own officers ; eventually they decided to do so; and I had some correspondence with Major Vaughan, H.M. Inspector for the district, on the matter. It was ultimately agreed that, in the event of a prosecution being necessary for failure to comply with our notice, one of H.M. Inspectors should attend at the Police Court to prove the overcrowding. In the last issued report of the Chief Inspector of Factories, Major Vaughan makes the following remarks upon this subject:— Overcrowding, which is one of the most serious evils with which we have to deal, presents itself in its ugliest form in the workshops of the east of London, in which the sweated clothing trades are carried on. The employers are for the most part poor, profits are small, and competition keen; whilst the workshops are very generally disused bed and living rooms, with low ceilings and primitive ventilation. In the busy season the temptation is very great to fill a 42 workshop with as many workers as can be crowded into it ; and consequently overcrowding is the rule rather than the exception. Long hours are bad enough, but employment in an overcrowded, ill-ventilated den, in which artificial light is frequently burning 10 or 12 out of the 24 hours (for the men at any rate work on until the small hours of the morning), is infinitely worse. A woman may survive occasional long hours without any serious ill-effects; but continued confinement in such places and under such conditions must produce physical deterioration and permanent ill-health. When long hours are superadded to overcrowding, as is often the case, we have an insanitary condition which demands serious attention. Prior to the introduction of the Act of 1895, although there was no regulation as to the amount of cubic space to be allowed during the daytime, we had power under an order of the Secretary of State, to deal with overcrowding during overtime, when its effects are worst. The Act of 1895, which for the first time regulated the amount of cubic space which must be allowed both during the daytime and during the overtime, marks a distinct advance in the right direction ; but, unfortunately, these most salutary regula tions cannot be enforced with the machinery available for the purpose. The section of the Act which deals with these matters is included amongst those the provisions of which are enforced in the first instance by the local authority, and this authority has neither the administrative machinery nor the legal powers to cope satisfactorily with the evils at which those provisions are aimed. There is not a sufficient staff of sanitary inspectors to ensura systematic inspection; inspection at night, i.e., during overtime, is such a new departure that it is, in most districts, not seriously attempted ; whilst the local authority is further debarred by the Public Heath (London) Act from dealing summarily with a nuisance, without in the first instance serving a notice to abate it. 43 Prior to 1896 our efforts to deal with overcrowding during overtime met with some measure of success. Magistrates took a serious view of this offence, and inflicted heavy penalties, and occupiers were beginning to learn that the game was not worth the candle. In my own district I had 11 convictions for overcrowding during the last two months of 1885, and I am confident that, if the power to deal with it had been left with one department, the evil would have gradually disappeared under firm repressive treatment. Contrast the course pursued at present. A workshop is found overcrowded and a complaint is sent to the local authority. In due course the sanitary inspector visits the workshop, and if it is then found to be overcrowded a notice is served on the occupier to abate the nuisance. On the expiry of the time allowed in this notice, another visit is paid, when the occupier takes good care that his workshop does not contain more than the legal number of hands; the nuisance is 'written off as abated, and the occupier starts with a fresh lease of life. He again overcrowds, until he is again caught, when the same tortuous interminable procedure is re-enacted with the same abortive result. The occupiers in the East end are quite alive to the change in the mode of attack, and are beginning to enjoy a new sense of security in the presence of an enemy who only employs blank cartridge. Moreover, even if the overcrowding is not abated on the expiry of the notice served, the local authority is under the disability of being obliged to satisfy a court that it constitutes an injury to health under the Public Health Act. One of the ablest and most conscientious of the medical officers of health in my district told me that he would under no circumstances take proceedings in court for overcrowding, on account of the uncertainty of obtaining a conviction. Again it is anomalous that we enforce the exhibition in a workshop of a notice specifying its cubic capacity and the numbers who may be employed, thus touching the fringe of the evil, whilst the evil itself is left to the control of an authority 44 which cannot, if it will, seriously attack it. In a recent case in which I prosecuted an occupier for not affixing this notice, and informed the court that his workshop was usually overcrowded, the magistrate very pertinently asked why I had not taken proceedings with regard to the overcrowding. The answer, if obvious, is not satisfactory. The present position is more than unsatisfactory, and is a glaring instance of the unfortunate results of a dual control. It is a blot upon factory administration that an evil, more serious than most with which our department has to deal, should grow unchecked before our eyes. There appears to be only two possible remedies for this condition. Either the administrative and legal powers of the local sanitary authorities should be increased, or the administration of the law as to overcrowding should rest in the first instance with us. If the local authority had a staff sufficient to provide for systematic inspection, by night as well as by day, and if it were empowered to proceed against an occupier in flagrante delicto, without the cumbrous preliminary of a notice to abate a nuisance, there would be reasonable grounds for hoping that the evils of overcrowding would be checked. In the provinces a sanitary authority has the same power with regard to taking proceedings as one of H.M. Inspectors of Factories, and it is not quite clear why this power is withheld from a sanitary authority within the area of the Public Health (London) Act. On the other hand there appear to be grounds for distinguishing the question of overcrowding from other sanitary provisions contained in the Act, which fall within the province of the local authority. It is unquestionable that the local authority is the proper power to deal with questions of drainage, W.C. accommodation, &c., in regard to which its officers are experts. But, owing to the precise definition contained in section 1 of the Act of 1895, overcrowding is now simply a question of fact, involving no opinion, expert or otherwise. 45 TENEMENT HOUSE REGULATIONS. Regulations were first adopted by this Vestry under the Sanitary Act of 1866. They were, however, never put in operation and consequently lapsed. Bye-laws as to houses let in lodgings were made, as required by Section 94 of the Public Health (London) Act, 1891, in November, 1894, and were sanctioned by the Local Government Board in January, 1895. Under these bye-laws power is reserved (Clause 2) by the Vestry to limit their application solely to such lodging houses as they deem it necessary to register. As they have, up to the present date, deemed it unnecessary to register any lodging house in the parish, no action can be taken under the regulations. The Sanitary Committee have no power to register, and though I have on one or two occasions reported certain houses as suitable for registration, no action has been taken in the direction indicated, except that in 1896 the Sanitary Committee resolved to recommend the Vestry to register certain houses in Fuller Street. The resolution met with considerable opposition, and at the following meeting was rescinded. From time to time, enquiry as to the working of the bye-laws has been made, addressed on behalf of the London County. Council both to your Vestry Clerk and to your Medical Officer. Our only answer has been, "No houses on the register at present." Similar enquiries were addressed to the officers of every other London district. The replies to these queries seem to have satisfied the London County Council and their Medical Officers that the regulations were workable and useful where they had been put in operation and given a fair trial. This opinion was evidently not shared by all the sanitary authorities of the Metropolis ; for, though all had made bye-laws, yet in many districts these remained a dead letter. Further enquiries and further reports were made by Mr. Shirley Murphy, the Medical Officer of the Council, and in September Dr. Hamer, the Assistant Medical Officer, presented a full report to the Council showing what was being done in every metropolitan parish. This report shows that in 31 districts houses have been 46 registered, varying in numbers from six in Plumstead to 1,500 in Kensington. In ten of the London districts, including Bethnal Green, the regulations have not been enforced, though the authorities of some of these ten districts appear to have made a show of compliance, e. g., Battersea has inspected, measured, and registered a large number of houses, but has taken no steps to make them subject to the bye-laws. In some of the ten defaulting districts the bye-laws have only just been confirmed, whilst in others, officers have been appointed with a view of dealing with the subject. In Bethnal Green, however, the report says " the authorities do not see n to have attempted to take any action with regard to houses let in lodgings." The Public Health Committee of the London Council, after digesting this report, appear to have formed the opinion that an example ought to be made of Bethnal Green for the purpose of encouraging the others, and the lash is to be applied in the shape of a complaint to the Local Government Board under Section 101 of the Public Health (London) Act. 1891. The result of this complaint will be an enquiry by the Local Government Board, and if they are satisfied that the complaint is well founded they may make an order requiring us to enforce the regulations within a given time. If we do not obey this order, they may either mandamus us or they may require the County Council to do the work at our expense. In accordance with these views the Public Health Committee of the London County Conncil recommended:— (a) That complaint be made by the Council to the Local Government Board, pursuant to Sec. 101 of the Public Health (London) Act, 1891, that the Vestry of Bethnal Green have made default in executing the provisions of Sec. 94 of the Act with regard to the enforcement of byelaws relating to houses let in lodgings. (b) That copies of the Medical Officer's further report on this question, and of the Committee's report and the Council's resolution thereon, be sent to each of the London sanitary authorities. When this report came up for consideration at the Council, the 47 late Mr. Charles Harrison, M.P., one of the representatives of Bethnal Green, requested the Chairman of the Council to permit the consideration of the report to stand over until the Vestry had had an .opportunity of expressing their views on the subject. The Council accordingly agreed to postpone the consideration of the report for a fortnight, for the purpose of arranging a conference between the Public Health Committee and a deputation from this Vestry. In accordance with the instructions given I attended at Spring Gardens with Mr. Foot. We were most courteously received by Mr. Branch, by whom we were introduced to the Public Health Committee, and were given the fullest opportunity to express the objections of the Vestry to the proposed course of action, which I stated under the following heads :— In the opinion of the Vestry the bye-laws as drawn up are (1) harsh and oppressive. The standards as to overcrowding and the separation of the sexes are too high and are impracticable in Bethnal Green. Moreover, these regulations are unnecessary and would serve no useful purpose which cannot be equally well obtained under the Public Health Act; for by improved methods of working this law, and a more perfect supervision by the existing staff, insanitary conditions have been very largely removed, and a house-tohouse inspection of the whole parish is being vigorously carried out. (2) If the regulations are attempted to be enforced on tenants, Magistrates will either refuse to convict or will adjourn sine die; and prosecution of the nominal "Landlord" under the bye-laws will be rendered nugatory by frequent changes and by appointing men of straw. (3) The regulations could not be worked with the present staff (at least, another inspector and an additional clerk would be required). The Sanitary Committee are of opinion that the time taken up iu making the necessary inspections, keeping the registers, etc., could be much more profitably occupied. 48 (4) Overcrowding and its evils are not denied, but in the opinion of the Vestry and its officers these bye-laws are in no sense a remedy. The Vestry maintain that they are already adopting the best possible methods to abate overcrowding, and consider it most invidious that they should have been singled out by the Council for report to the Local Government Board, whilst other Vestries who have merely made a show of obedience are not attacked. The whole matter was thoroughly discussed, many questions were put to us, and I was pressed to give an undertaking that some attempt should be made to work the regulations. Of course I was unable to do this. After the subject had been thoroughly thrashed out we retired for the Committee to deliberate, and on re-admission were informed that the following resolution had been passed :— "That the Council be recommended to pass the resolution recommended in the report, but that the Committee be empowered to delay the complaint to the Local Government Board until the first meeting after the Vacation so as to give the Vestry an opportunity of further considering the matter." During the afternoon it was made very clear to both Mr. Foot and myself, that the Council and their medical officers were determined that the law should be obeyed and these regulations enforced throughout the County of London. Let us fairly consider what advantages are to be expected if the regulations are put in force. (1) Increased facility for ensuring and maintaining the proper cleanliness of passages, staircases, rooms and yards of tenement houses. (2) The improvement of the ventilation and lighting of the rooms of such houses. (3) The more early and certain detection of sanitary defects, such as bad water supply and choked drains, by means of regular periodical inspections. 49 (4) The early isolation and removal of infectious cases. (5) The definition and detection of overcrowding and indecent occupation. It is well known that overcrowding takes place mostly at night and can only be discovered by domiciliary visits. I think it is the power given by the regulations to make such visits that has raised such a storm of opposition against them. But it is only by means of occasional night visits that overcrowding and indecent occupation can be detected. Such detection can in no way be considered a remedy for the evil conditions found, as the final arbiter in any proceedings for the prohibition of, or punishment for, continued offence in this direction, is the sitting Magistrate at the Police Court, and our experience is that, unless it can be conclusively shewn that a man with a large family occupying two small rooms can find and pay for additional;accommodation, the Magistrate will refuse to order him to do so. To find a remedy for overcrowding is a very big order, and Tenement House regulations, though good so far as they go, do not touch the fringe of the subject. Improvident early marriages and intemperance are a fruitful source of the evil; and until the British workman can be taught to keep out of the Public house and to curb his sexual appetite the only remedies I know against overcrowding are a general cheapening of rents, or an universal raising of wages, neither of which is at all likely to happen. But the overcrowding clauses of the regulations are not the only ones or even the most useful ones. It does not follow that because the Vestry puts the regulations in force that the officers are bound to carry them out to the bitter end. They must be worked with care, common sense and discretion, especially when invading the sanctity of home life by night visits. We are not obliged to prosecute at the police court. We have not yet found it necessary to proceed under the other bye-laws made either by the Vestry or by the Council; the fact that bye-laws exist and can be enforced if necessary is found to be sufficient; and I am sure that, if we are permitted to use them, we shall be able to work the lodging house regulations in the same spirit, D 50 Unfortunately a good deal of feeling seems to have been imported into the discussion, both at the County Council and at the Vestry. So far as I am concerned, I have always advised my Sanitary Authority to the best of my judgment, and have never felt hurt or offended at my advice being rejected. Reference to my past annual reports will show that I have always disclaimed any experience in the working of these regulations. I merely advised that they should be enforced tentatively. My opinion at that time was that the registration of a few bad lodging houses would be followed by such an obvious improvement that the regulations would soon be extended to other houses of a similar class, but I certainly had no idea that, when I made the suggestion, I was bringing such a hornet's nest round my ears. My opinion as to the usefulness of the bye laws was supported by your Chief Sanitary Inspector, who has had practical experience in their working in Chelsea. The only point upon which we differed was that of machinery. I suggested a limited application of the bye-laws without any increase of staff. Mr. Foot demurred to this on the ground that the working of the newly-arranged department would be hampered, as the officers would make the additional duties an excuse for shirking more important work, such as house-to-house inspection. I now withdraw my original suggestion, and quite fall in with Mr. Foot's view of the matter; for I feel sure that the bye-laws could not be efficiently worked without an increase of staff. It has been suggested that as Bethnal Green is acknowledged to be doing such excellent work under the Public Health Acts without the bye-laws, refusal to enforce them should be condoned by the Local Government Board. This seems to me a very inadequate excuse and one not likely to be entertained. It resembles that of the dirty boy who pleads that, as he has carefully washed his hands and face, it will be unnecessary for him to perform a similar operation on the remainder of his body. Since this report was commenced the Council has made complaint to the Local Government Board and Bethnal Green has been called upon for its defence. It now remains either to set the Council at defiance and advance 51 the best possible case against the regulations upon the enquiry, or else to apply for permission temporarily to appoint an additional inspector and a clerk, so that we can set about inspection and registration. If after twelve months' experience the bye-laws are found to be useless I feel sure that the Local Government Board will relieve us of the burden. CUSTOMS AND INLAND REVENUE ACT. Applications for certificates under this Act for 45 houses, containing some 400 separate tenements, have been received by me. The premises were carefully examined, and I have granted 25 certificates and refused 20. If after examination I am able to certify that the house for which the certificate is requested is so constructed as to afford "suitable accommodation" for each of the families or persons inhabiting it, and that "due provision is made for their sanitary requirements," the Landlord is granted a certain relief as to inhabited house duty. There are no fixed regulations under which such tenements may be certified. The granting or withholding of the certificate is left entirely to the discretion of the Medical Officer of Health for the district in which the premises are situated. I have hitherto held that the "accommodation" to be "suitable" should be in accordance with the Building Acts and the bye-laws of the Vestry and the County Council. "Due provision for sanitary requirements" I have held to mean separate W.C., sink, water tap, copper, and dust receptacle for each tenement. The construction of the W.C. and the drainage is to be in accordance with the bye-laws of the Council and of the Vestry. Unless these requirements have been complied with I have refused to grant the certificate. None of the applications present any special features except the following:— 1 to 35, Culham Buildings, owned by the London County Council. This block consists of five floors, with seven tenements on each, three of which are single room lettings and four others are two room c 2 52 lettings. There are on each floor three W.C.s, and only one siuk with water tap over, for the seven lettings; no other washing accommodation is provided, except at the public lavatory.—May 25, 1897. Certificate refused. 1 to 20 and 21 to 40, Sonning Buildings, owned by the London County Council. Two blocks, each consisting of five floors, eight tenements (some two and some three room lettings) on each floor, separate W.C. to each tenement. There is one sink and water tap to each four tenements, or two on each floor, for the eight families ; no other washing accommodation except at public lavatory.—May 25, 1897. Certificates refused in each case. My refusal to grant the certificates entailed many interviews with the officers of the Council and much indignant correspondence, but it will be allowed that my action was fairly justified when it is remembered that the British Working Man has no chambermaid to empty his slops, never performs his ablutions in his bed-room if he can help it, and much prefers what he calls "a rinse at the sink." I have never seen, but can picture in my mind's eye, seven men in a row at 6 a.m., each waiting his turn for a wash before starting out to work. How the wives will manage I can form no idea. I did not consider the W.C. accommodation at Culham Buildings sufficient, but I was content to waive this as a large number of the tenements are single room lettings, but the defective washing arrangements I could not pass over. Since this report was written certain alterations have been made at my suggestion, after consultation with Mr. Shirley Murphy (who I am happy to say supported my action all through), and I have been able this month (March, 1898) to grant the necessary certificates. PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Under this Act 2,481 intimation notices and 3,795 statutory notices were served, 134 summonses were issued, of these 24 were withdrawn, the requirements of the notice having been met and the costs paid. In 32 cases the works were completed before the hearing and the defendants were merely ordered to pay costs. In 48 cases orders were made to do the works required. In 19 cases fines ranging from 2s. to £3 were imposed, and three houses were closed as unfit for habitation. Amounts of Penalties imposed under the Public Health (London J Act, 1891, during the year 1897. Nature of Offence. Amount of Penalty Imposed. Maximum Penalty prescribed by the Act. Non-compliance with Statutory Notice £3 and 2s. costs £10 Ditto Ordered to pay 2s. costs £10 Ditto £1 and 39s. costs £10 Ditto £2 and 23s. costs £10 Ditto 12s. 6d. costs £10 Ditto 2s. and 10s. 6d. costs £10 Ditto £1 3s £10 Ditto £1 10s. and 3s costs £10 Ditto Ditto £10 Disobedience to Magistrate's Order £1 and 11s. 6d. costs £30 Ditto 10s. 6d. and £1 11s. 6d. costs £39 Ditto £2 and 23s. costs £53 Ditto £1 and 9s. costs £66 Ditto 6s. costs £36 Ditto 5s. and 15s. costs £65 Non-provision of Ashpit after service of Notice for same £2 and 2s. costs £5 Ditto £2 and 23s. costs £5 Medical Practitioner failing to notify Infectious Case £1 and 14s. 6d. costs £2 Ditto £1 £2 Exposing Unsound Fruit for Sale £5 and 7s. costs £50 Wilfully exposing himself whilst suffering from an Infectious Disease £1 and 3s. costs or 6 months imprisonment without option. 54 The Number and Natuke of the Samples of Food taken during the year, and submitted to the analyst. Article of Food. Total Number of Samples taken. Results of Analyses. Genuine. erated. Milk 22 17 5 Separated Milk 4 4 ... Butter 45 27 18 Margarine 7 7 ... Pepper 4 4 ... Mustard 4 3 1 Coffee 2 2 ... Cocoa Nut Chips 1 1 ... Ground Ginger 3 3 ... Flour 2 2 ... Cornflower 2 2 ... Arrowroot 3 3 ... Chocolate Cream 1 1 ... Lard 1 1 ... Totals 101 77 42 In addition to the above, two samples of "well water" were taken, which upon analysis proved to be unfit for domestic purposes. Notices were served to this effect, and the users of the wells warned that the water was only fit for cleansing or trade purposes, and that in the event of its being used for domestic purposes the necessary proceedings to close the wells would be immediately taken. 55 HOUSING OF THE WORKING CLASSES ACT. During the past year I have certified a total of eighty-seven houses as unfit for habitation under part II. of the Housing of the Working Classes Act. I may here just refer to the method of procedure under this portion of the Act. The law requires that no matter how decayed or badly constructed a house may be, the only course a Vestry can take under the Act, after the representation by the Medical Officer of Health, is to call upon the owner to render the premises, the subject of the representation, fit for habitation, and this notice must be served, although it may be apparent that it is impossible to comply with it. All the eighty-seven houses certified were visited by the Sanitary Committee. In a few instances it was thought preferable (for reasons unnecessary to detail) to proceed under the Public Health (London) Act, 1891, but in sixty-two instance the formal notice " to render fit'' was served under the Housing Act. Following on these notices forty closing orders were obtained at Worship St. Police Court. Up to the present time 23 of the houses remain closed, 19 have been repaired and reoccupied, 20 are still under notice, and 36 have been demolished. A large number of other houses have been dealt with, representations as to which had been made by me before 1897. Full details will be found overleaf. Mr. Foot's report on the action taken is as follows:— Proceedings taken under the "Housing of the Working Classes Act, 1890," during the year 1897 Situation of Premises. Date of Closing Order made by Magistrate. Date of Closing of Premises. Date of Re-opening of Premises Repaired Date of Demolition of Premises. Remarks. 1, Abingdon court 20th May, 1892 7th June, 1892 ......... 28th June, 1897 Closed in 1892. Demol1 ished in 1897. 2, ditto ditto ditto ......... ditto 3, ditto ditto ditto ......... ditto 4, ditto ditto ditto ......... ditto 5, Collingwood street 21st June, 1892 21st Nov., 1892 ......... 6th April, 1897 7, ditto ditto ditto ......... ditto 181, Cambridge road No Order made 18th Jan., 1893 ......... 11th Sept., 1897 ... Closed in 1893. Demolished in 1897. 183, ditto ditto ditto ......... ditto 14, Centre street 16th July, 1894 29th Aug., 1894 6th April, 1897 ......... Closed in 1894. Repaired & re-opened in 1897. 16, ditto ditto ditto ditto ......... 19, Daniel street 31st May, 1895 16th Aug., 1895 ......... 29th May, 1897 Premises demolished. 86, Virginia road 13th July, 1897 8th Oct., 1897 ......... 23rd Oct., 1897 ... 88, ditto ditto 4th Sept., 1897 ......... 4th Oct., 1897 90, ditto ditto ditto ......... ditto 92, ditto ditto ditto ......... ditto 94, ditto ditto ditto ......... ditto 96, ditto 28th July, 1890 23rd Sept., 1890 ......... 6th April, 1897 98, ditto ditto 30th July, 1896 ......... ditto 100, ditto ditto ditto ......... ditto 102, ditto ditto 25th Aug., 1890 ......... ditto 104, ditto ditto 16th Sept., 1896 ......... ditto .... Proceedings taken wider the "Housing of the Working Classes Act, 1890," during the year 1897.—Continued. Situation of Premises. Date of Closing Order made by Magistrate. Date of Closing of Premises. Date of Re-opening of Premises Repaired. Date of Demolition of Premises. Remarks. 106, Virginia road 21st July, 1896 16th Sept., 1896 ......... 6th April, 1897 Premises demolished 108, ditto ditto 25th Aug., 1896 ......... 110, ditto ditto 23rd Sept., 1896 ......... 37, Chambord street ditto 16th Sept., 1896 ......... 39, ditto ditto 30th July, 1896 ......... 41, ditto ditto 30th Dec., 1896 ......... 1, Princes place No Order made 25th Aug., 1896 ......... 7, Virginia road 21st July, 1896 30th Sept., 1896 ......... 9, ditto ditto 23rd Sept., 1896 ......... 11, ditto ditto ditto ......... 13, ditto ditto 15th Dec., 1896 ......... 15, ditto ditto 14th Nov., 1896 ......... 17, ditto ditto 24th July, 1896 ......... 19, ditto ditto ditto ......... 1, Matilda street No Order made 24th June, 1896 ......... 3, ditto ditto ditto ......... 5, ditto ditto ditto ......... 33, ditto 21st July, 1896 8th Sept., 1896 2nd March, 1897... ......... Premises closed in 1896, and re-openedin 1897. 35, ditto ditto ditto ditto ......... 37, ditto ditto 24th July, 1896 ditto ......... 39, ditto ditto ditto ditto ......... Proceedings taken under the " Housing of the Working Classes Act, 1890," during the year 1897.—Continued. Situation of Premises. Date of Closing Order made by Magistrate. Date of Closing of Premises. Date of Re-opening! of Premises Repaired. Date of Demolition of Premises. Remarks. 33, Felix street 21st July, 1896 8th Sept., 1896 12th Jan., 1897 ......... Premises closed in 1896, and re-opened in 1897. 35, ditto ditto ditto ditto ......... 37, ditto ditto 28th Sept., 1896 ditto ......... 39, ditto ditto ditto ditto ......... 41, ditto ditto 1st Dec., 1896 ditto ......... 43, ditto ditto ditto ditto ......... 79, Brady street 23rd March, 1897 1st July, 1897 19th Oct., 1897 ......... Premises repaired and re-opened 81, ditto ditto ditto ditto ......... 32, Tent street ditto 28th April, 1897 ditto ......... 72, Collingwood street 16th March, 1897 10th May, 1897 ......... ......... Premises in course of repair. 74, ditto ditto ditto ......... ......... 76, ditto ditto 31st July, 1897 ......... ......... 78, ditto ditto 23rd June, 1897 ......... ......... 80, ditto ditto 31st July, 1897 ......... ......... 82, ditto ditto 2nd Nov., 1897 ......... ......... 84, ditto ditto ditto ......... ......... 86, ditto ditto ditto ......... ......... 88, ditto ditto ditto ......... ......... 90, ditto ditto ditto ......... ......... 44, ditto 18th May, 1897 29th June, 1897 19th Oct., 1897 ......... Repaired and re-opened. 46, ditto ditto ditto ditto ......... 23, Harold street 31st Aug., 1897 13th Sept., 1897 21st Dec., 1897 ......... Proceedings taken under the "Housing of the Working Classes Act, 1890," during the year 1897.—Continued. Situation of Premises. Date of Closing Order made by Magistrate. Date of Closing of Premises. Date of Re-opening of Premises Repaired. Date of Demolition of Premises. Remarks. 25, Harold street 31st Aug., 1897 13th Sept., 1897 21st Dec., 1897 ......... Repaired and re-opened. 47, Collingwood street 30th Nov., 1897 6th Dec., 1897 ......... ......... Premises in course of repair. 49, ditto 51, ditto 53, ditto 55, ditto 57, ditto 59, ditto Tenants under notice to vacate these premises. 61, ditto 21st Dec., 1897 ......... ......... ......... 63, ditto 65, ditto 67, ditto * 71, ditto 73, ditto 77, ditto 79, ditto 85, ditto 30th Nov., 1897 10th Dec., 1897 ......... ......... Premises in course of repair. 87, ditto ditto ......... ......... 5, Type street (East side] ......... About 2 years ago ......... ......... Remain closed. 6, ditto ditto ......... ditto ......... 60 I should like to draw special attention to the case of twenty-nine houses dealt with in Collingwood St. This portion of the South Sub-district is one of the unhealthy areas specially referred to on page 7, ante. The usual proceedings were taken and closing orders made on the whole of the 29 houses. They were in every instance damp, dilapidated, thoroughly worn out, and, in my opinion, only fit for demolition. The owner, who had only recently acquired the property, thought otherwise, and although he could not successfully oppose the closing order, he made a piteous appeal to the Sanitary Committee not to enforce it on the whole of the houses at one time, on the ground that the occupiers would have great difficulty in obtaining other dwellings. The Sanitary Committee considering this reasonable agreed to permit the owner to close and repair the houses in batches of five in accordance with a full specification which he presented. The repairing, or rather the botching up, of the first five of these houses was very badly done, the workmen employed and the materials used being of a most unsatisfactory description. As the work approached completion application was made for the re-opening of the houses, but upon examination such grave defects were still apparent that consent was refused; time after time the same request was made with a similar result, until our patience was well nigh exhausted. I should not like to say upon how many occasions Mr. Foot and I inspected these hovels; eventually just enough of the cheapest description of work was done and the houses were so far repaired that we could no longer say that they were absolutely unfit for habitation, and the closing orders were withdrawn. The same process went on with the next five, and I have no doubt will continue to the end of the chapter. In January my attention was drawn to the condition of Faith St., Cambridge Eoad. The houses were carefully examined and the following report was presented:— Gentlemen, I beg to report that I have examined the houses in Faith Street, Cambridge Road, Bethnal Green, and am of opinion that the 61 whole of them are unfit for habitation and should be dealt with under the provisions of the Housing of the Working Classes Act, 1890. Faith Street is a narrow blind street, or cul dc sac; it varies in width from a maximum of 13 feet 3 inches opposite No. 3, to a minimum of 12 feet 2 inches opposite No. 21; the end of the street most distant from Cambridge Road is closed by the boundary wall of the Trinity Alms Houses. There are 29 houses in the street, all of them two-roomed huts excepting the first and last houses on the right-hand side, the other 27 houses are almost identical in construction and measurement:— Lower rooms, 7x9x9.8 = a capacity of about 600 cubic feet each. 7.2 + 5.2 Upper rooms, 10x5x--------------= a capacity of about 560 cubic 2 feet each. Each house has a small yard in the rear, rather less than 100 square feet in arei3. The joists of the lower rooms are mostly laid upon the earth and the space beneath the boards is unventilated; in a few instances the floor boards are below street level, but usually they are flush with the pavement. The ceiling height of the upper rooms varies from 7.2ft. in front to 5 2ft. at the back; numbers 5, 11, 13, and 32 have small windows in the rear, the remainder are unprovided with back light or through ventilation. The whole of the houses in the street appear to have been originally constructed of old building materials, they are worn out and rotten, though they have been refronted and look much better from the street than they really are; many of the roofs are leaky and the walls throughout the street are more or less damp, though in many instances this dampness is hidden from view by matchlining. The condition as to cleanliness varies a good deal, a few inhabited by careful tenants appear clean and tidy, but in many instances the walls are dilapidated and filthy. Each house has a W.C. in the yard, in most instances fitted with a long hopper pan with a square inlet, and provided with a very inadequate water flush. 62 The underground drainage has been found to be in a very bad condition, where it has been examined, and the whole area upon which the houses stand must be saturated with sewage from the leaky pipes. The street is inhabited by 136 persons, 58 of whom are grown people, the remaining 78 being children of various ages. Overcrowding is prevalent, and is intensified by the fact that many of the rooms are too damp to sleep in, so that the occupants of some of the houses herd together in one of the two rooms. The average mortality, so far as I can ascertain, has been at the rate of 27 per thousand for the past three years, as against 21 for the whole of Bethnal Green; this does not represent the true mortality of the street, for many of the inhabitants, being children, contract the seeds of disease herein and develop them elsewhere. I am of opinion that these houses should be closed and demolished and the site cleared, for if repairs be permitted, such patching up as is possible will be of no real service, and the present evils will be perpetuated. I have the honour to be, etc. The houses were viewed by the Sanitary Committee and my report was confirmed. The drainage of this street has long been in a most unsatisfactory condition, but the exact responsibility for its reconstruction was a matter of doubt, pending the settlement of the " Drain v. Sewer question." The whole area, one of those referred to on page 7, ante, is sodden with sewage and is in a most unhealthy condition. A copy of the report was, as is required by law, forwarded to the Local Government Board and to the London County Council. The following reply was received from Mr. Stewart, the Clerk to the Council:— London County Council, Spring Gardens, S.W. 22nd February, 1897. Sir, Your letter of the 20th ultimo describing the condition of houses in Faith Street and stating that in your opinion the houses 63 should be closed and demolished and the site cleared, has been laid before the Housing of the Working Classes Committee. In reply, I am directed to state that it appears to the Committee that under such circumstances it is the duty of the Vestry to take the necessary steps to obtain closing and demolition orders in respect of the houses. Perhaps you will therefore suggest this course to the Vestry before taking any further action. I am, Sir, Your obedient Servant, C. J. STEWART, The Medical Officer of Health Clerk of the Council. of the Vestry of Bethnal Green. The Clerk of the Vestry was directed to make some enquiries as to the terms upon which the freehold and leasehold interests in the houses in Faith Street could be acquired, but such prices were asked by the owners that the Committee were of opinion that purchase was out of the question. I understand that in one instance a lease with 83 years unexpired, which had recently changed hands on a basis of 13 years' purchase, was offered at the exorbitant advance of 38 years' purchase. Temporary repairs have been done to some of the houses, but the scheme still remains under consideration. In December my attention was called to some houses in Pitt Street. Mr. Lapworth, the then inspector of the district, reported them for Police Court proceedings. On visiting I found the condition of the houses much too bad for an ordinary summons, and I reported accordingly. I was thereupon directed to make an examination of the houses in this and the adjacent streets, with a view to the bringing up of a full report; the result of my inspection was the following representation—this is the third of the unhealthy areas referred to on page 7, ante. Gentlemen, I have the honour to report that I have carefully examined the houses in Pitt St., Lucas St., Archer t., and the east side of 64 Pott St. shewn on the attached plan, and I find that eighty-four per cent. of the houses in this area are so dilapidated and decayed as to be quite unfit for habitation, I am of opinion that their continued occupation is injurious to the health of the inhabitants of these houses and the neighbouring buildings. I say, moreover, that the evils connected with these houses and the sanitary defects thereof cannot be effectually remedied otherwise than by an improvement scheme for the re-arrangement and reconstruction of the streets and houses within the area. Pitt St. contains:— 47 houses, 201 rooms, 259 inhabitants. 37 of these houses are unfit for habitation and should be closed. Pott St. (east side) contains:— 24 houses, 135 rooms, 96 inhabitants. 22 of these are unfit and should be closed. Lucas St. contains:— 12 houses, 60 rooms, 75 inhabitants. 11 unfit. Archer St. contains:— 3 houses, 11 rooms, 21 inhabitants. 2 unfit. A total of eighty-six houses inhabited by 451 persons living in 407 rooms. Of the 86 houses in the area 72 are unfit for habitation and should be closed, a proportion of eighty-three per cent. of the whole number. 65 MORTALITY STATISTICS, POTT STREET AREA, For Three Years, 1894-96. Street and Year. Zymotic. Tubercular. Respiratory. General. Total. Three Years Population. Pitt Street— 1894 3 1 6 10 1895 ... ... 2 3 5 1886 3 1 3 3 10 25 259 Pott Street— 1894 1 2 4 1 8 1895 1 ...' 2 2 5 1896 1 2 4 3 10 23 158* Lucas Street—1894 ... ... 1 3 4 1895 ... 1 ... ... 1 1896 ... ... 1 1 2 7 75 Archer Street—1894 ... ... ... ... ... 1895 3 ... ... 2 5 1896 2 ... ... ... 2 7 21 Totals 11 9 18 24 62 62 513 Three Years, 1894-5-6. Area. Bethnal Green. General average mortality from all causes ... ... 40.3 ...... 22.5 Zymotic diseases ... ... 7.1 ...... 4.2 Tubercular diseases ... ... 5.8 ...... 2.8 Respiratory diseases ... ... 11.7 ...... 5.0 *In preparing this table it was found impossible to exactly allocate the Pott Street deaths, as the street has been renumbered, so the total deaths for both sides have been taken, and the mortality has been calculated on the entire population, which was found to be 158. I have the honour to be, etc. 66 Plan of the Pott Street unhealthy area referred to in foregoing Report. Insanitary houses shewn in darker shade. Note.—472, Betlmal Green Road is wrongly numbered in the above plan as 478. 67 The conditions disclosed both as to the state of the houses and the health of the inhabitants, were so bad that I strongly urged the Sanitary Committee, who had visited and examined the area, to back me up in a representation to the London County Council under part I. of the Housing of the Working Classes Act. I am however, sorry to say I met with very little support. An opinion was generally expressed that the area was too small for the Council to touch, and that if a representation were made, it would either be referred to the Vestry for them to deal with, as was done in the previous case of Faith St., or that the Council would direct the Vestry to take the area under Part I., themselves contributing a small proportion of the cost. I was urged to take into consideration the enormous expenses now and shortly about to be incurred by the Parish for the new Infirmary, for Baths and Washhouses, and for the Electric light, etc., for with all these hanging over, the Committee were sure the Vestry would decline to spend the money of the ratepayers in buying up houses which had been permitted by their owners to get into such a state as to be unfit for habitation. I was pressed to certify the houses singly under Part II. of the Act, in order that they might be closed and the owners compelled to put their property into thorough repair, but with my recent experience of Collingwood St. I felt most unwilling to repeat what had been already done five years back. For as lately as 1893 the floors of all the houses in Pitt St. were taken up and the earth removed from beneath, ventilating bricks (and in some instances damp proof courses) were inserted, the yards were repaved, the W.C.s reconstructed and the houses generally repaired under full notices: notwithstanding all this, the present condition of these houses is (with the exception of the dampness) nearly as bad as it was before all this expense was incurred, and the average mortality during the past four years has been thirty-three in the thousand ! !! The matter is still under consideration and will form the subject of a further report. In the large majority of instances, a house can, by a more or less heavy outlay, be so repaired and remodelled, as to be made fit for habitation, but there are some houses, such as these in Pitt St. and Faith St., where the air space is so defective, owing to the smallness of the rooms, and the free circulation of the air is so retarded, by E 2 68 the narrowness of the street in which the houses are situated, that no amount of renovation or repair can ever convert them into healthy dwellings. According to modern standards these houses even when new would have been considered unhealthy, but at the time they were erected there was no Building Act, and no power on the part of the local authorities to forbid the building of houses in streets so narrow as to render free access of light and air impossible. Their original faulty construction is aggravated by the state of filth and dilapidation into which they have been permitted to fall, and though there ought to be no difficulty in compelling the owners to do their duty, in the way of cleansing and repair, yet as I said before, no mere repair can convert such houses into healthy dwellings, and money so spent would be for the most part wasted. Now it is highly desirable that a local authority, instead of forcing owners to spend money upon repairs, which, when completed, will effect very little mitigation of the insanitary condition of congested areas, should be in a position to acquire the freehold for the purpose of clearing the site and widening the streets, thereby effecting a real sanitary improvement; and the Housing of the Working Classes Act specially empowers a local authority to deal with cases of this nature in the manner indicated, though the method is slow and very costly. It is within my knowledge that former property owners on the "Boundary St. unhealthy area" obtained large sums for houses at the hands of the official arbitrators, yet these very persons had expressed to me their willingness to part with their interests, for a nominal sum before the improvement scheme was on foot. Certainly they had just bsen served with full notices to repair, and as they did not know where to find the necessary cash, they were inclined to look upon their property as a burden instead of a source of profit. It is common experience that when a property owner is approached by a public body with a view to the acquirement of his interests, the price goes up by leaps and bounds, and though he may not get all he asks yet he usually obtains much more than he would have done from a private purchaser. 69 Confiscation is an ugly word and the rights of property are held to be very sacred, but the health of helpless women and children is even more sacred. It may be unjust to punish the present owners of badly constructed houses for the faults of their predecessors who were the original builders, yet something very much more economical and expeditious than the present purchase clauses of the Housing Act is necessary before the improvement of these small congested areas is at all likely to be taken in hand in real earnest by the Vestries. In my opinion the owners of such property as Faith St. and Pitt St. should be compelled to part with their interest in the houses at something even less than the fair market value, and without any compensation for disturbance when it is apparent as in these cases that the continued occupation of the premises as dwellings endangers the health of the inhabitants. I have the honour to be, Gentlemen, Your very obedient servant, Mcclical Officer of Health for St. Matthew, Bcthnal Green. 70 BETHNAL GREEN SANITARY DISTRICT. TABLE I. Shewing the Population, Births, Deaths, and Marriages for the year 1897, and ten years preceding. GROSS NUMBERS. The Year Estimated Population Marriages Registered Births. Corrected number of Deaths. Deaths in Public Institutions. Total all Ages. Under One Year. Under Five Years. 1897 129,200 1415 4818 2761 814 1259 663 1887 129,895 2415 4989 2917 814 1412 598 1888 130,500 2282 4036 2958 770 1443 556 1889 131,000 2314 4939 2708 718 1311 561 1890 129,134 2015 4611 3199 791 1402 641 1891 129,134 1856 4998 3282 827 1449 707 1892 127,040 1447 4911 2984 779 1459 588 1893 123,000 1403 4756 3257 849 1467 722 1894 123,000 1390 4636 2G42 709 1244 570 1895 128,050 1310 4771 2769 772 1304 625 1896 129,200 1384 5869 2909 829 1489 638 Average of 10 years, 1887 to 1896. 127,995 1781 4841 2962 785 1398 6206 BETHNAL GREEN SANITARY DISTRICT. TABLE II. Shotting the Annual Birth Bate, Bate of Mortality, Death Bate among Children, and Deaths in Public Institutions for the year 1897, and 10 years preceding. YEAR. Birth Rate per 1000 of the Population. Annual Rate of Mortality per 1000 living Deaths of Children under 1 year; percentage of Total Deaths. Percentage of Deaths of Children under 1 year to Registered Births Deaths of Children under 5 years; percentage of Total Deaths. Total Number of Deaths in Public Institutions. 1897 3703 21.36 29.48 16.90 45.60 663 1887 38.41 22.45 27.90 16.31 48.40 598 1888 37.82 22.65 26.03 15.60 48.78 556 1889 37.70 20.67 26.51 14.10 48.40 561 1890 37.25 24.78 23.70 16.20 43.80 641 1891 38.70 25.41 25.22 16.54 44.12 707 1892 38.60 23.49 26.10 15.86 48.25 588 1893 38.60 26.47 26.00 17.70 45.00 722 1894 37.70 21.40 26.00 15.20 47.00 570 1895 37.30 21.64 27.88 16.18 47.10 625 1896 37.70 22.52 28.50 19.00 51.00 638 Average of 10 years, 1887 to 1896. 37.97 23.14 26.38 16.26 47.18 620 K211 (B). Table of Population, Births, and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1897, in the Sanitary District of Bethnal Green; classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics. Public Institutions being shown as separate localities. Population at all Ages. Registered Births. Ages under 5 or over 5 New Cases of Sickness in each Locality coming to the knowledge of the Medical Officer of Health. Number of such cases removed from their homes in the several Localities for treatment in Isolation Hospitals of Asylums Boards. Census 1896. Estimat'd to Middle of 1897. Small Pox. Scarlatina. Diphtheria & Membranous Croup. FEVERS. Cholera. Erysipelas. Small Pox. ' Scarlatina. Diphtheria & Membranous Croup. FEVERS. Typhus. Enteric or Typhoid. Puerperal. Enteric or Typhoid. North, Sub-District 49,301 49,339 1961 Under 5 1 108 83 ... 4 ... ... 17 1 73 51 1 5 upwards 1 201 131 1 33 2 ... 188 ... 123 47 23 South, Sub-District 34,194 34,194 1333 Under 5 ... 85 79 ... ... ... ... 5 ... 51 40 ... 5 upwards ... 106 105 ... 39 1 1 86 ... 69 51 31 East, Sub-District 45,667 45,667 1524 Under 5 ... 62 66 ... 1 ... ... 5 29 30 1 5 upwards ... 125 79 ... 26 5 ... 92 ... 76 37 14 Workhouse ... ... ... Under 5 ... ... ... ... 1 ... ... ... ... ... ... 1 5 upwards ... 1 ... ... ... ... ... 1 ... ... ... ... Mildmay Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... 3 ... ... ... ... ... 1 ... 3 ... ... Victoria Park Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... BethnalHouse Asylum ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... Children's Home, Bonner Road ... ... ... Under 5 ... 1 ... ... ... ... ... ... ... 1 ... ... 5 upwards ... 8 ... ... ... ... ... ... ... 8 ... ... Totals 129,162 190,200 4818 Under 5 1 256 228 ... 6 ... ... 27 1 154 121 3 5 upwards 1 444 315 1 98 8 1 368 ... 279 135 68 K23 (A). TABLE OF DEATHS during the Year 1897, in the Bethnal Creen Metropolitan District, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics ; public institutions being shown as separate localities. (Columns for Population and Births are in Table B.) Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years op Age. At all ages. Under 1 year. 1 and under 5. 5 andunder 15. 15 andunder 25 25 and under 65 65 & upwards. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis Pneumonia & Pleurisy. Heart Disease. Influenza. Injuries. All Other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Puerperal. North, Sub-District 707 300 133 20 17 163 76 Under 5 3 10 2 ... ... 2 ... ... ... ... 45 19 37 ... 4 106 2 19 186 433 5 upwds. 2 ... ... 2 ... 2 ... 1 3 ... 6 1 59 83 25 2 8 79 276 South, Sub-District 549 218 102 22 20 141 46 Under 5 ... 5 2 ... ... ... ... 1 ... 17 16 40 ... 3 63 4 ... 23 146 320 5 upwds. 1 4 1 ... ... ... ... 1 ... 2 1 2 2 39 61 36 4 10 64 229 East, Sub-District 630 233 114 13 30 141 99 Under 5 3 12 3 ... ... ... ... 1 ... 36 12 39 ... ... 61 1 1 10 168 347 5 upwds. 2 1 ... ... 5 ... 2 ... ... 2 ... 5 1 38 68 34 3 16 106 283 Workhouse 517 40 16 4 14 231 212 Under 5 ... ... ... ... ... ... ... ... ... 3 3 13 1 ... 9 1 ... ... 26 56 5 upwds ... ... ... ... 1 ... ... ... ... ... ... 3 1 79 156 41 9 169 461 Bethnal H. Asylum 37 0 0 0 1 21 15 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... 3 11 5 2 16 37 Mildmay Hospital 25 0 4 5 3 8 5 Undor5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 4 5 upwds. ... ... ... ... 1 ... ... ... ... ... ... ... ... 3 1 4 ... ... 12 21 Victoria Pk. Hosp. 84 0 2 5 13 62 2 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... 45 2 18 ... 1 16 82 Totals ... ... ... ... ... ... ... Under 5 6 27 5 ... 2 ... ... 9 101 50 129 1 9 239 8 1 55 527 1162 5 upwds 5 7 1 1 9 4 1 4 7 1 16 5 266 382 163 9 46 462 1389 Grand Total ... 2551 791 371 69 98 767 455 11 34 6 1 11 ... 4 3 4 108 51 145 6 275 621 171 10 101 989 2551 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto. 358 36 75 36 22 153 36 Under 5 1 1 37 ... ... ... ... ... ... ... 2 2 1 1 1 17 ... ... 8 31 111 5 upwds. 2 10 ... ... 6 1 ... 1 ... ... ... ... ... 21 21 32 39 114 247 Deaths occurring within the district among persons not belonging thereto 148 13 1 7 15 93 19 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 9. 5 1 ... ... 6 15 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... 42 18 23 ... ... 50 133 74 BETHNAL GREEN SANITARY DISTRICT. TABLE IV. Shewing the Mortality from certain classes of Diseases, and proportions to Population, and to 1000 deaths, 1897. DIVISION I. Deaths. Deaths per 1000 of Population (all ages). Proportion of Deaths to 1000 Deaths (all ages). 1. Seven Principal Zymotic Diseases 444 3.4 160.8 2. Pulmonary Diseases (other than Phthisis) 636 4.39 229.3 3. Phthisis 254 1.96 92.0 DIVISION II. (Young Children). Deaths. Deaths per 1000 Young Children Proportion of Deaths to 1000 Deaths of Children 4. Pulmonary Diseases 251 13.9 199.4 5. Zymotic Diseases 375 20.8 218.4 NOTES. 1 and 5. Includes : Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Fever and Diarrhoea. and 4. Includes : Pleurisy, ; Bronchitis, ; Pneumonia, BETHNAL GREEN SANITARY DISTRICT. TABLE V. Shewing the Number of Deaths from the seven principal Zymotic Diseases, inclusive of Hospital Deaths, in the ten years 1887 to 1896, and in the year 1897. DISEASE. 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 Annual Average of ten years, 1887—1896. Proportion of Deaths to 1000 Deaths in ten years, 1887.1896. 1897 Proportion of Deaths to 1000 Deaths in 1897. Small Pox 1 1 0 0 0 5 7 5 4 0 2.3 0.7 ... ... Measles 73 124 132 106 100 131 82 135 110 149 114.2 38.5 109 39.5 Scarlet Fever 61 120 40 34 29 53 71 27 30 40 50.5 17.0 24 8.7 Diphtheria 26 52 102 133 69 119 137 133 102 77 95.0 32.0 87 31.5 Whooping Cough 101 167 62 113 128 122 59 70 33 151 100.6 34.0 53 19.2 Fever 31 21 21 29 19 22 26 26 17 21 23.3 7.9 20 7.2 Diarrhœa 123 67 95 94 77 74 128 54 146 109 96.7 32.7 151 54.7 Total in Bethnal Green 416 552 452 509 422 526 510 450 442 547 482.6 162.9 444 160.8 76 BETHNAL GREEN SANITARY DISTRICT. TABLE VI. Chief Inspector's Report of the Sanitary Work, &c., completed in the year ending December 31st, 1897. Inspector A District. Weston B District. Lapworth C District. Henley D District. Bridel E District. Richards Totals. Infectious Cases 237 276 261 308 272 1354 Complaints 382 299 391 279 238 1589 House-to-House Inspection 370 599 542 1059 667 3237 Trades' Inspection 52 52 96 73 70 343 Re-inspections 3806 4463 3766 4381 4250 20,666 Totals 4847 5689 5056 6100 5497 27,189 Nuisances abated 637 807 804 1010 799 4057 Number of Re-inspections to each case abated 5.95 5.53 4.68 4.33 5.32 Number of Inspections, of all kinds, made by each Inspector per week during the year 93.21 109.403 97.23 177.307 105.71 TABLE VIII . TABLE OF SANITARY IMPROVEMENTS. The number of Sanitary Improvements, New Drains, W.G.'s, &c., in the Parish during the year 1897. Premises, &c.— Number of Premises, &c., Cleansed, Repaired, and Whitewashed 2,708 Houses Disinfected after Infectious Diseases 1,139 House Drains— Repaired, Cleansed, &c. 359 Trapped or Ventilated 254 New Provided 308 Rain Water Pipes and Waste Pipes Disconnected 186 Water Closets— Repaired, Cleansed, &c. 1,812 Supplied with Water and Water Supply Apparatus 739 Ventilated 58 Abolished 5 New Provided 32 Water Supply— Houses Provided with Water Supply 101 House Supply Disconnected from Closet Cistern 14 Cisterns Repaired, Covered, &c. 20 Miscellaneous— Paving of Yards Repaired 946 Washhouses Paved 64 Forecourts and Front Areas Paved and Drained 115 Stables Paved and Drained 46 Removal of Accumulations of Dung, and other Refuse 173 New Dung Pits Provided 73 Removal of Animals improperly kept 49 Illegal Occupation of Cellars discontinued 3 Overcrowding Abated 37 Urinal Accomodation Provided 9 Offensive Effluvia Abated 34 Cellars Paved and Drained 3 Smoke Nuisances Abated 6 Smoke Holes Removed 1 Number of Dust Complaints received and attended to 21 Bakehouses Periodically Inspected 102 Licensed Cowhouses Periodically Inspected 19 Licensed Slaughterhouses Periodically Inspected 10 78 TABLE OF SANITARY IMPROVEMENTS (continued). Other Miscellaneous Totals— Articles of Bedding, Clothing, &c. Disinfected 6,914 Rooms Disinfected 1,139 Articles of Bedding, Clothing, &c., Destroyed 43 Notices in respect of Dust Receptacles Served 2,798 Dustpails sold and delivered to various premises in the Parish (and the sum of £268 2s. 6d. in respect of same paid into the Vestry's Account) 2,145 Letters written 1,763 Persons called at the Offices respecting Notices served, Enquiries as to Works, &c. 1,200 Notices served in respect of Combined Drains 51 Cases of Combined Drains reconstructed by the Vestry 17 Houses Redrained by Vestry's men (and the sum of £21 recovered from the Owner) 4 Notices served on different Occupiers, and the Premises entered and the Drains opened up 43 Notices, Letters, &c., sent to the District Surveyors respecting Dangerous Structures, Bulged Walls, &c. 119 Dead Bodies on Sanitary Grounds removed to the Mortuary 5 Certificates under Section 48, Public Health Act, given in respect of 23 Premises and 9 Blocks of Buildings on the Boundary Street Estate 22 JOHN FOOT, Chief Sanitary Inspector. 79 ST. MATTHEW, BETHNAL GREEN. STREET LIST. Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Abbey street 1 1 ... 2 4 Blythe street 2 3 1 4 10 Abingdon street 1 1 ... 1 3 Bonner road 1 ... ... 7 8 Accidental place ... ... ... ... ... Bonner street ... 4 ... 3 7 Ada place 2 1 ... 1 4 Bonwell street 1 1 ... 2 4 Ainsley street 2 ... ... 2 4 Boreham street ... 1 ... 1 2 Albert road ... ... ... ... ... Boundary street 1 ... ... 1 2 Albion place ... ... ... ... ... Bradys buildings ... 1 ... ... 1 Alfred place 1 2 ... 1 4 Brady street 1 3 4 7 15 Alma road 1 1 ... 4 6 Braemar street ... 2 1 2 5 Amos place ... ... ... 1 1 Bratley street ... ... 1 ... 1 Ames street 4 ... 2 6 12 Brick lane 4 8 5 17 34 Andrews road ... ... ... 2 2 Brierley street 2 ... ... 1 3 Angela gardens ... ... ... ... ... Buxton street ... ... ... ... ... Anglesea street 3 ... ... 3 6 Buckhurst street 1 2 2 6 11 Anns place ... ... ... ... ... Bullards place ... ... ... ... ... Antill road 1 ... ... 2 3 Bunsen street ... ... ... 1 1 Approach road 1 ... ... 6 7 Burgoyne road 2 ... 1 1 4 Arbery road 2 6 1 4 13 Bumham square ... ... ... 2 2 Archer street ... ... ... ... ... Burnside street ... 1 3 ... 4 Arline street ... 1 1 3 5 Busby street 3 3 ... 4 10 Artillery street 1 1 1 3 6 Busby square 1 2 ... 1 4 Arundel street 1 ... 2 9 12 Butlers bldings. ... ... ... 2 2 Ashwell road 2 ... ... 1 3 Butler street ... 2 1 1 4 Auckland road 1 4 4 2 11 Buxton street ... ... ... 1 1 Austin street 3 2 ... ... 5 Cadell street 1 1 ... 2 4 Bacon street 9 2 1 7 19 Calvert avenue ... ... ... ... ... Baden place ... ... ... ... ... Cambridge circus 1 4 2 4 11 Baker street ... ... ... ... ... Cambridge street ... ... ... ... ... Bakers court 1 ... 1 ... 2 Cambridge road 4 6 2 24 36 Bakers rents ... 1 ... ... 1 Cambridge bldgs 1 1 1 3 6 Bandon road ... 2 ... 6 8 Camden street 1 ... ... 4 5 Barnet grove ... 3 1 7 11 Canrobert street 2 4 3 5 14 Barnsley street 1 7 2 9 19 Carlisle street ... ... ... ... ... Baroness road ... 1 ... 5 6 Carlton place ... ... 1 ... 1 Bath grove ... ... ... ... ... Carter street ... ... ... ... ... Bath street ... ... ... 1 1 Catherine street 1 2 1 1 5 Baxendale street 1 7 2 4 14 Centre street 1 3 ... 2 6 Bedford row ... ... ... ... ... Chambord street 5 3 1 8 17 Bellhaven street 2 ... ... 2 4 Chance street ... ... ... ... ... Bethnal green road 4 6 7 17 34 Chapel street 1 ... ... 2 3 Birkbeck street ... 1 ... 3 4 Chapel place ... ... ... ... ... Bishops road 2 2 1 10 15 Chapman gdns. ... ... 1 ... 1 80 STREET LIST (continued). Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Charles court ... ... ... 1 1 Devonshire place ... ... ... ... ... Charlotte street 2 1 ... ... 3 Devonshire street ... ... ... 1 1 Cheshire street 2 5 1 10 18 Digby street 2 ... 1 3 6 Chester street 1 ... ... 4 5 Digby walk 1 1 1 2 5 Chester place ... ... 1 ... 1 Dinmont street 1 ... ... 1 2 Chilton street 3 4 ... 5 12 Diss street 1 ... ... 2 3 Chisenhale road 1 1 ... 7 9 Dixie street ... ... 2 13 15 Church street 1 4 2 9 16 Doveton street ... ... ... ... ... Church row 1 1 ... 5 7 Ducal street ... 1 1 4 6 Clare street 1 5 1 6 13 Durant street ... 1 ... 4 5 Claremont street 1 ... ... 2 3 Clarkson street 1 2 1 8 12 Eastman street 2 1 1 2 6 Clarence street 1 2 ... 1 4 Ebor street 1 ... ... ... 1 Cleveland street ... ... 1 8 9 Eckersley street 1 ... ... 3 4 Club row ... 1 ... ... 1 Edward place ... ... 1 1 2 Code street ... ... 1 3 4 Ezra street ... ... ... 2 2 Collingwood place 1 ... ... ... 1 Elwin street ... 3 1 3 7 Collingwood street 1 3 1 12 17 Elliot row ... ... ... ... ... Colliers court ... ... ... 1 1 Ellesmere road 3 ... ... 5 8 Collins place 4 3 0 6 13 Elvidge court ... ... ... ... ... Columbia square 3 4 2 2 11 Emma street 2 ... ... 2 4 Columbia road 10 10 6 23 49 Ernest place ... ... ... 1 1 Conyer street 1 ... ... 2 3 Cooper's gardens ... 5 1 2 8 Faith street 1 ... 1 ... 2 Cordova road 5 2 1 7 15 Falcon buildings ... 1 ... ... 1 Corfield street 4 11 1 13 29 Felix street 2 1 1 9 13 Cottage place 1 ... 1 ... 2 Fellbrigg street 1 1 1 9 12 Coventry street 1 3 5 8 17 Finnis street 3 7 1 14 25 Coventry place ... ... ... ... ... Fleet street hill ... ... ... 1 1 Cranbrook street 2 4 1 7 14 Flint court ... ... ... ... ... Cranbrook road ... 2 ... ... 2 Florida street 2 4 ... 5 11 Craven buildings ... ... ... 1 1 Foster street ... 1 2 1 4 Crescent place 2 3 ... 2 7 Fountain court ... ... ... ... ... Cross street ... ... ... ... ... Fox street ... ... 1 2 3 Crossland square 3 ... ... 3 6 Fox's buildings ... ... ... ... ... Cudworth street 2 3 ... 3 8 Fuller street 3 3 1 12 19 Culham bldngs ... ... ... ... ... Cymon street ... ... ... 1 1 Gales gardens 1 4 ... 8 13 Cyprus street 4 6 i 8 19 Garden place ... ... 1 1 2 Gardners road 3 3 l 3 10 Garden row ... ... ... ... ... Dagnall place 1 ... ... 2 3 Gascoyne place ... ... ... ... ... Daniel street 1 2 i 2 6 Gawber street 2 3 ... 2 7 Darling row ... ... ... 1 1 Georges place ... ... ... ... ... Davis place ... 1 ... ... 1 Georges terrace ... ... ... ... ... Delta street ... ... ... 1 1 Georgina gardens ... ... ... ... ... Derbyshire street 5 3 1 11 20 George gardens 2 2 1 1 6 Derby place ... 1 ... ... 1 Gernon road 1 ... ... ... 1 81 STREET LIST (continued). Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Gibraltar place ... ... ... ... ... Horts yard ... ... ... ... ... Gibraltar gardens i ... ... 1 2 Hunslett street ... 1 ... 1 2 Gibraltar walk ... 6 5 6 17 Huntingdon bldgs. ... 1 ... 5 6 Gibraltar buildings. ... ... ... 1 1 Hurley buildings ... ... ... ... ... Gillman street i ... ... ... 1 Glass street ... 1 1 2 4 Ion square 1 1 1 3 6 Globe road i 4 ... 11 16 Ivimey street ... 1 ... 1 2 Gloster street 3 2 1 5 11 Gloster gardens ... ... ... ... ... Godfreys place ... ... ... ... ... James street 1 2 1 5 9 Gore road 2 1 ... 3 6 James court ... ... ... ... ... Gossett street 3 5 3 7 18 James place ... ... ... ... ... Granby row 1 ... ... ... 1 Jane street 2 2 ... 2 6 Granby street 2 3 1 3 9 Jersey street 1 2 3 4 10 Granby place ... ... ... ... ... Jubilee place ... ... ... ... ... Green street 4 8 5 18 35 Grove row ... ... ... ... ... Kay street ... ... ... 1 1 Grove street ... ... ... ... ... Kelsey street ... 1 ... ... 1 Grove place ... ... ... 1 1 Kenilworth road 2 2 ... 5 9 Grove road 4 2 1 7 14 Kerbela street 4 7 3 12 26 Key street ... 2 1 1 4 Hackney road 5 7 3 20 35 Key court ... ... ... ... ... Hague street ... ... 1 7 8 Kings place ... ... ... 1 1 King street ... ... ... ... ... Hague place ... 1 ... ... 1 Knottisford street ... 1 ... 2 3 Hague buildings ... 1 ... 1 2 Hammonds gdns. ... ... ... ... ... Hamilton road 6 6 ... 5 17 Lansdell place ... 1 2 3 6 Hare row ... ... ... ... ... Lark row 2 1 ... 4 7 Hare marsh ... 1 ... 1 2 Lawfranc road ... 2 ... ... 2 Hare street 4 7 3 13 27 Letchford place ... ... ... ... ... Hare court ... 1 ... ... 1 Leopold buildings. ... ... ... ... ... Harrold street 1 3 1 4 9 Lessada street 2 4 2 3 11 Hartley street 3 6 2 7 18 Linden buildings ... 1 ... 2 3 Harts lane 3 1 2 1 7 Lisbon street 2 2 1 4 9 Hassard street 2 3 ... 6 11 Little Collingwood street ... ... ... 1 1 Hassard place ... ... ... ... ... Havelock place ... ... ... ... ... Little York street. 1 1 ... ... 2 Helens place ... ... ... ... ... London street 1 1 ... 3 5 Henley buildings ... 2 ... 2 4 Lucas street ... 1 1 2 4 Henrietta street 1 2 1 1 5 Lyte street ... 3 ... 1 4 Hereford street 1 4 ... 5 10 Hereford buildings. ... ... ... ... ... Hersee place 2 1 ... ... 3 Mace street 2 2 2 6 12 Hill street 1 2 ... 2 5 Manchester bldgs ... ... 1 ... 1 Hollybush gardens. 5 3 2 2 12 Manchester place ... ... ... ... ... Hollybush place 1 ... ... ... 1 Mansford street 4 19 ... 15 38 Horatio street ... 1 ... 1 2 Mape street 3 2 1 6 12 F 82 STREET LIST (continued). Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Margaret place ... ... ... 3 3 Palestine place ... ... ... ... ... Marian street ... 2 ... ... 2 Palm street ... ... ... 4 4 Marian place ... 1 ... ... 1 Palmers road ... ... ... ... ... Marion square ... 1 ... 3 4 Park street ... 1 2 ... 3 Marlow buildings 1 ... ... 1 2 Park place ... ... ... ... ... Martha court ... 2 1 1 4 Parliament place ... ... ... ... ... Matilda street 2 4 ... 3 9 Parliament street ... ... ... 1 1 Mead street ... ... ... ... ... Parmiter street ... 1 1 10 12 Medhurst road ... 2 ... 4 6 Patriot square 1 l 1 4 7 Medway road 1 1 2 2 6 Peacock street ... ... ... 2 2 Menotti street 5 ... ... 3 8 Peacock place ... ... ... 1 1 Middleton street 1 3 1 6 11 Pedley street ... ... 1 4 5 Middle walk 1 1 ... ... 2 Peel grove ... ... ... 3 3 Minerva street 5 2 ... 4 11 Pereira street l 3 ... 7 11 Minto place 1 ... ... ... 1 Peter street 5 1 ... 3 9 Morpeth street 3 2 1 9 15 Pitt street 2 2 ... 5 9 Morpeth road ... ... ... 3 3 Pleasant place ... ... ... 1 1 Moss street 3 5 3 4 15 Pollard row 3 3 2 10 18 Mount street 2 ... ... 2 4 Pollard street 1 2 1 5 9 Mowlem street ... 2 ... 5 7 Pott street 2 1 1 ... 4 Poyser street ... 3 3 4 10 Preston street 2 3 1 9 15 Nant street ... ... ... 1 1 Primrose street ... ... ... ... ... Neath place ... 1 ... 4 5 Princes court ... 7 1 2 10 Nelson street 1 3 1 2 7 Princes place ... ... ... ... ... Nelson place l ... l ... 2 Pritchards road 2 2 1 9 14 New Castle street ... ... ... ... ... Prospect terrace ... 1 ... 1 2 New Church street. ... ... 1 ... 1 Providence place ... ... ... ... ... New Tyssen street 2 1 ... 3 6 Punderson gardens 3 6 1 9 19 New square ... ... ... ... ... Newling street 1 2 ... 3 6 Nichol street ... 4 ... 3 7 Queen street ... ... ... ... ... Norah street 3 2 ... 4 9 Queens buildings 1 ... 1 2 4 North passage ... ... ... ... ... Queen Caroline place ... ... ... ... ... North place 3 1 2 1 7 Northampton street ... ... ... 3 3 Quilter street 1 4 2 6 13 Norton street 1 3 1 2 7 Quinns square 3 4 ... 9 16 Octagon street ... ... ... 4 4 Ramsey street 1 1 1 2 5 Old Bethnal Green road 5 3 1 10 19 Ravenscroft street ... 2 1 2 5 Reform square ... ... ... ... ... Old Ford road 10 8 4 12 34 Rappley place ... 1 ... 1 2 Old Nichol street ... 4 1 ... 5 Reuben street 2 1 ... 3 6 Olga street 3 ... ... ... 3 Riders court ... ... ... ... ... Orange street 1 1 1 3 6 Roan Horse yard ... ... ... ... ... Oval ... 1 ... 4 5 Robert street 1 1 ... 1 3 Oxford street ... ... ... 1 1 Robinson road ... ... ... 2 2 83 STREET LIST (continued). Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Roman road 1 3 ... 8 12 Sunbury bldngs ... ... ... ... ... Rook's place ... ... ... ... ... Surat place 1 2 ... 1 4 Ropley street ... ... ... 1 1 Sweet Apple square 1 1 ... ... 2 Royal Victor place ... ... ... ... ... Sidney street ... ... 1 5 6 Royston street 1 3 1 8 13 Russia lane 3 2 1 10 16 Tagg street 1 3 2 6 12 Taplow buildings ... ... ... 2 2 Sabbage yard ... ... ... ... ... Tapp street ... 1 ... 2 3 Sale street 2 3 ... 4 9 Tavistock street 1 1 ... 1 3 Sanford buildings ... ... ... ... ... Teale street 1 1 ... 1 3 Sarah street ... ... ... ... ... Teesdale street 2 1 2 3 8 Satchwell rents ... ... ... ... ... Temple street 2 3 2 11 18 Satchwell street 1 1 1 2 5 Tent street 1 1 3 3 8 School place ... ... ... ... ... Theydon road ... ... ... ... ... Sclater street ... 2 2 5 9 Thomas passage ... ... ... 1 1 Scott street 1 2 1 3 7 Thomas place ... ... ... ... ... Seabright street 2 5 1 9 17 Thorold street 2 2 ... 4 8 Seabright gardens ... ... ... 1 1 Three Colts corner ... 1 ... 2 3 Selby street 2 3 1 3 9 Three Colts lane ... 1 1 3 5 Sewardstone road ... 5 1 8 14 do. Waterlow dwellings ... ... ... ... ... Shacklewell street ... ... 1 ... 1 Sheep lane ... 1 ... ... 1 Thurlow place 1 1 ... 3 5 Sheldon place 1 1 ... 1 3 Totty street ... 2 1 4 7 Sherwood place ... ... ... ... ... Treadway street 8 8 3 5 24 Shipton street ... 3 3 6 12 Trinity ground ... 2 ... 4 6 Shiplake buildings ... ... ... 2 2 Turin street ... 5 2 10 17 Smart street 1 1 ... 2 4 Turville street ... 1 ... ... 1 Smith's place 2 1 2 1 6 Tuscan street 1 ... ... 1 2 Sonning buildings ... 1 ... 1 2 Type street 2 1 ... 1 4 Southampton place ... ... ... ... ... Tyrrell street 3 ... ... 3 6 Southampton cotgs. ... ... ... 1 1 Usk street 3 2 ... 4 9 Southampton ter ... ... 2 ... 2 Southborough place ... ... ... ... ... Spencer passage ... ... ... ... ... Vallance road 2 6 4 9 21 Squirries street 2 2 1 8 13 Valley place 1 ... 1 ... 2 St. Andrew street ... 2 ... 1 3 Viaduct street 4 4 1 4 13 St. James road ... 2 ... 3 5 Viaduct place ... 1 ... 1 2 St. John street ... 1 ... 5 6 Victoria street ... ... ... ... ... St. Jude street 1 ... ... 1 2 Victoria place ... ... ... 1 1 St. Matthias place ... ... ... ... ... Victoria park sqre. ... 1 ... 3 4 St. Peter square ... 2 1 ... 3 Violet street ... ... ... 1 1 St. Peter street 3 ... 1 5 9 Violet row ... 1 ... 3 4 Stainsbury street 1 ... 1 2 4 Virginia road 2 3 1 11 17 Strahan road 1 3 1 5 10 Vivian road 1 ... 1 6 8 Streatley bldngs ... ... ... ... ... Stroud place ... ... ... ... ... Wadeson street 1 2 1 6 10 Sugarloaf walk 1 3 1 2 7 Walter street 1 3 1 5 10 Summerford street 2 3 ... 9 14 Walton buildings ... 1 ... 1 2 84 STREET LIST (continued). Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Name of Street. Zymotic Diseases. Respiratory Diseases. Phthisis. General Diseases. Total. Warner place 1 ... 2 6 9 Winchester place ... ... 1 2 3 Warley street 4 5 ... 7 16 Winchester crsnt 1 ... ... ... 1 Waterloo place ... ... ... ... ... Winchester street 4 1 ... 2 7 Waterloo terrace ... 1 1 2 4 do. dwellings ... ... ... ... ... Waterloo road ... ... ... 1 1 Wolverly street ... 2 ... 3 5 Weaver street 2 3 2 8 15 Wood street ... 1 ... 1 2 Weldon street ... ... ... ... ... Woods Close ... ... ... ... ... Wellington row 1 4 3 11 19 Wellington place ... ... ... 1 1 York place ... 2 1 1 4 Wennington road 1 3 ... 3 7 Wharf road ... ... ... 1 1 Wharncliffe street ... 1 1 3 5 Bethnall H. Asylum ... ... ... 1 1 Whites court 1 ... ... 1 2 Mildmay Hospital ... ... ... 1 1 Whitechapel road ... ... ... 2 2 Militia Barracks ... 1 ... ... 1 William place ... ... ... ... ... Regents Canal ... ... ... 1 1 Willow walk ... ... ... 1 1 Victoria Park Hos. ... ... ... ... ... Wilmot street ... 3 3 12 18 W'rkho'se previous resid'nce not kwn. 2 7 2 33 44 Wimbolt street ... 2 1 3 6