BET 5 REPORT on the Sanitary Condition and VITAL STATISTICS of the Parish of St. Matthew, Bethnal Green, DURING THE YEAR 1898. 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 ; Hon. Consulting Physician to Queen Adelaide's Dispensary; A Justice of the Peace for the County of London and Medical Officer of Health for the Parish of Bethnal Green. LONDON: Printed by J. S, Forsaith & Son, 329, Bethnal Green Road. 1899. St. Mathem, Bethnal Green. SANITARY COMMITTEE. Mr. JAMES PARNELL (Chairman). „ DANIEL JONES (Vice-Chairman). Mr. W. H. BELSHAM. „ C. B. BLOW. „ G. CALLOW. „ W. M. CLARK. „ J. COLE. „ W. DANIEL. „ M. GOLD. „ O. R. HALES. Mr. J. G. HILDITCH. „ T. KIPPINS. „ F. LOUGHLIN,J.P. „ J. NORRIS. „ G. J. PITT. „ J. RICHARDS. „ E. ROBERTS. „ R. WILLIAMS. STAFF OF THE SANITARY DEPARTMENT. Inspectors. H. FREDERIC BRIDEL. AMOS S. HENLEY. JOSHUA LAPWORTH. F. W. MEADWAY. EVAN RICHARDS. BENJAMIN S. WESTON. All holding the Certificate of the Sanitary Institute. ALFRED T. MILLS, Drainage Foreman. JOHN JONES, Clerk. Chief Inspector. JOHN FOOT (Certif. San. Institute). Medical Officer of Health. GEORGE PADDOCK BATE, M.D. SUMMARY. 1897. 1898. 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 2,761 2,872 Total number of Births in the year 4,818 4,779 Total number of Marriages 1,415 1,296 Marriage Rate—Bethnal Green 21.9 20.0 Marriage Rate—London 18.5 18.7 Death Rate—Bethnal Green 213 22 2 Death Rate - London 18.2 18.7 Birth Rate—Bethnal Green 37.3 37.0 Birth Rate—London 30.0 29.5 Infantile Death Rate (on Births)—Bethnal Green 169 184 Infantile Death Rate (on Births)—London 159 166 Young Children's Death Rate (on estimated number of Young Children) 70.0 79.3 Old People's Death Rate (on estimated number of Old People) 99.4 91.4 Zymotic Death Rate—Bethnal Green 3.4 3.8 Zymotic Death Rate—London 2.5 2.7 Inquest Cases 302 290 Uncertified Deaths (no Inquests held) 1 3 Snnopsis of MEDICAL OFFICER'S ANNUAL REPORT. 1898. Vital Statistics— page Population 6 Births 9 Deaths 9 Death Rate 10 Birth Rate 13 Marriages 14 Deaths of Infants 15 Deaths of Young Children 15 Old Persons' Death Rate 15 Special Causes of Death 15 Table of Deaths during the year 1898 in the Bethnal Green Metropolitan District, classified according to Diseases, Ages and Localities 16 Death Rates of London Sanitary Areas during 1898 17 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 1898 21 The Seven Principal Zymotic Diseases 23 Notification of Infectious Diseases 24 Small Pox 29 Scarlet Fever 29 Enteric Fever 30 Diphtheria (including Membranous Croup) 31 Asylums Board Hospitals 32 Table G.—Infectious Cases, 1898 33 Report of Fever and Diphtheria Cases admitted into Fever Hospitals during the year 1898 34 Table Mii (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 1898, in the Sanitary District of Bethnal Green, classified according to Diseases, Ages and Localities 35 Puerperal Fever 36 Whooping Cough 36 Measles 36 Diarrhœal Diseases 36 Tubercular Diseases 37 Respiratory Diseases 38 5 Mortuary and Coroner's Codrt 38 Supervision of Trade Premises 38 Customs and Inland Revenue Act 39 Proceedings under the Public Health (London) Act, 1891 39 Sale of Food and Drugs Act 39 Housing of the Working Classes Act 40 Proceedings taken under the Housing of the Working Classes Act, 1890, during the year 1898 41 Tables— I.—Showing Population, Births, Deaths and Marriages for 1S98, and ten years preceding 45 II.—Annual Birth Rate, Rate of Mortality, Death Rate among Children and Deaths in Public Institutions for the year 1898, and ten years preceding 46 M3 (A).—Table of Deaths, during the year 1898, in the Bethnal Green District, classified according to Diseases, Ages and Localities 47 IV.—Showing the Mortality from certain classes of Diseases and proportions to Population, and to 1,000 deaths, 1898 48 V.— Showing the number of Deaths from the Seven Principal Zymotic Diseases, inclusive of Hospital Deaths, in the ten years, 1888 to 1897, and in the year 1898 49 VI.—Sanitary Improvements, New Drains, W.C.'s, &c., in the Parish, during the year 1898 50 VII.—Inspectors' Report of Sanitary Work 52 VIII.—Number and Nature of the Samples of Food taken during the year 53 IX.—Mortuary Return 53 Street List 54 REPORT. —♦— Gentlemen, I beg to submit for your consideration my Twenty-third Annual Report. It deals with the vital and mortal statistics of Bethnal Green for the year 1898. POPULATION. The initial difficulty a Medical Officer of Health has to face in the preparation of a report of this nature is to estimate the population of the district under his charge. Upon the accuracy of this estimate depends the value of the whole of the statistics in the report. My difficulties this year are increased by the facts that three years are elapsed since the census enumeration of 1896, and that the population to be dealt with is a shifting one. The incursion of Jewish aliens continues and is increasing. Complaints of the overcrowding caused by these people are frequent, though difficult to verify and still more difficult to remedy. The Boundary Street Area, cleared more than eight years ago by the London County Council, has been partially re-built, and now houses between five and six thousand persons. Most of these are new-comers; for we can only trace about eleven families of the old residents of Friars' Mount amongst them. In addition to the Boundary Street Area, several other sites have been cleared by private owners, and blocks of model dwellings have been erected upon them. The tenements in these new blocks are eagerly competed for and are let even before they are ready for occupation. During the past year 107 houses have been demolished and 241 tenements or new premises have been completed and occupied, and still the cry goes up for more house-room. 7 Small property in Bethnal Green often changes hands at a price which will only return the purchaser in rent a bare five per cent, on his capital. This leaves no margin for the necessary outlay on lepairs or for other expenses. The new landlord calculates on being able to recoup himself by screwing up the rents, and the unfortunate tenants must pay or submit to be turned out. In the Chief Inspector's report will be found particulars of some of these cases of abnormally increased rents. He instances some streets where the tenants had paid for many years 9/- and 9/6 per week for their houses. The property changed hands and the rents were raised to 11/- and 11/6 ; again the houses were sold, and the new owner promptly increased the rents to 18/-, 19/- and 19/6 per week. Now the incomes of the people who inhabit these small houses are not elastic, so that in order to meet the increased rent they are constrained to take in lodgers and to sublet to the utmost capacity of the dwelling, hence overcrowding. When the overcrowding caused in this way was discovered, notices were served upon the owners to abate it, and several families were turned out. The committee however felt compelled to discontinue proceedings as some of the unfortunate persons who were ejected were absolutely unable to obtain accommodation elsewhere, and something very nearly approaching a public scandal resulted. Mr. Foot found two families living in the yards and washhouses of the premises from which they had been evicted. One family, consisting of a man, his wife and three children, had had no shelter for a fortnight, beyond the walls of a back-yard into which their sticks of furniture had been thrown. They were wet through and shivering with cold, but they were not legally destitute as the husband had work and they were not without money. Full details will be found in Mr. Foot's report. Official enquiry into the numbers of inhabitants is often looked upon with considerable suspicion. I have reluctantly arrived at the conclusion that very litle faith can be placed upon the accuracy of the replies given to questions of this nature by the occupants of 8 houses in certain parts of Bethnal Green. People fear that if the true state of things becomes known they will be turned into the streets, and they are well aware of the difficulty that they will experience in finding new quarters. The Registrar-General is of opinion that the population of Bethnal Green is decreasing, for he estimates it at 129,027 only ; but taking into consideration the facts I have detailed, one is drawn to the conclusion that our numbers must be increasing. On the other hand the number of births returned by the local registrars was thirty-nine fewer in 1898 than it was in 1897. Now this would appear tc confirm the opinion of the Somerset House authorities, and to indicate an actual decrease of population, were it not for the fact that the birth rate for the whole of London has decreased proportionately, and is the lowest on record. Under these circumstances I think it will be fair to assume that our numbers are stationary, and that the estimate for 1897 represents our population in 1898. A birth rate for Bethnal Green in 1898 calculated upon the estimate for 1897 gives a figure which is still 7J per 1000 in excess of the general Metropolitan rate for the same period, a proportion identical with that of 1897. POPULATION IN REGISTRATION SUB-DISTRICTS (ESTIMATED). DISTRICT Estimated in 1898. 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 9 BIRTHS. The total number of births registered in Bethnal Green during the year is 4779 against 4818 in 1897, indicating a decrease of 39. The excess of the births over the deaths is 1907. This excess of births over deaths should show the natural increase of our numbers were it not more than counterbalanced by the emigration which is constantly going on. TABLE B. 1897. 1898. Estimated population in middle of the year 129,200 129,200 Total Births 4,818 4.779 Total Deaths 2,761 2,872 Excess of Births over Deaths, showing the natural increase of the Population 2,057 1,907 DEATHS. During the past year a total of 2,633 deaths was registered in the parish. This is equal to an uncorrected death rate of 20.38. By the exclusion of the deaths of 119 non-parishioners who died within the parish, and the inclusion of the deaths of 358 parishioners registered in other parts of the Metropolis, a net total of 2,872 is obtained. Amongst these 358 parishioners, registered as having died in public institutions in various parts of London, I have been unable to correctly allocate 54 to their proper sub-districts. Most of the deaths were those of persons who had been removed for care and treatment to Asylums. As the last place of residence of most of these people was the Workhouse Infirmary, r.o other address is known to the authorities at the Asylum, and the Somerset House return of the death merely contains the note, " lately of Bethnal Green " or " of Bethnal Green Infirmary." B 10 In these circumstances it would be manifestly unfair to credit these deaths to the East sub-district in which the Infirmary is situated, so I have apportioned them amongst the three sub-districts, taking the number of known deaths as a basis of calculation. The deaths in each sub-district, corrected by distribution and apportionment, were as under :— North (1,101 and 21) 1,122 South (837 and 16) 853 East ( 880 and 17) 897 Total 2,872 DEATH RATE. Upon the basis of the estimated population I calculate a death rate of 22.23. This is an increase of nearly one (.87) per thousand over the rate of the previous year, but it is also 3½ in excess of the corresponding rate for the whole of London. This was only 18.7, a rate practically identical with that of the previous year. The mortality in the sub-districts was as under:— East I9.6 North 22.7 South 24.9 The South sub-district still continues to be the unhealthiest portion of the parish, with a mortality of 25 per 1000. This district is the most densely populated of the three ; it contains no open spaces other than a few disused churchyards, and has by far the largest proportion of old worn-out houses. The East sub-district is the healthiest, it has a mortality only very slightly above the average of the rest of London. Here are situated Victoria Park, Museum Gardens, Bethnal Green Gardens, and Meath Gardens. II In the following table the mortality rates for London and for Bethnal Green are compared by quarters; the rainfall and the mean temperature for each three months is also shewn :— TABLE C. Quarter ending. London Death Rate. Bethnal Green Death Rate. Mean Temp. Fahr. Rainfall (inches). March 31st 21.3 27.2 41.5 3.21 July 2nd 16.0 19.1 52.8 5.48 Sept. 30th 18.9 21.3 62.5 2.36 Dec. 31st 16.7 21.3 48.4 7.76 Average 18.3 22.2 Mean Temp 51.3 TI.R.F. for 1898 18.81 Death Rates in Bethnal Green during the Quarters ending March, June, September and December, 1898, after distribution of Deaths in Public Institutions. Quarter ending Per 1,000 Persons Living Deaths under one year to 1,000 births registered. Deaths from All Causes. Principal Zymotic Diseases. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Simple Continued Fever. Diarrhœa. Phthisis March 31st 27.3 5.07 .. 1.43 0.16 0.62 2.64 .. 0.03 .. 0.19 2.27 176 July 2nd 19.2 3.27 .. 1.43 0.03 0.53 0.90 .. 0.16 .. 0.22 2.14 154 September 30th 21.4 4.52 .. 0.71 0.03 0.12 0.12 .. 0.06 .. 3.48 2.33 247 December 31st 21.4 2.76 .. 1.15 0.12 0.65 0.03 .. 0.28 .. 0.53 1.93 159 Average Rate for Year 22.3 3.84 .. 1.17 0.08 0.49 0.85 .. 0.13 .. 1.10 2.10 184 13 BIRTH RATE. The births registered during the year were 4,779, and are equal to a rate of 37.0 per thousand population at all ages. This rate is slightly lower than that of the preceding year, which I calculated at 37.3. The general Metropolitan birth rate has also decreased, and stands at 29.5 per thousand population. This is the lowest London birth rate on record, and is (as was the case in 1897) seven and a half per thousand below our own. The birth rates in the sub-districts are shown in the table below. The death rate in each sub-district is also given for purposes of comparison. Sub-District. Birth Rate. Death Rate. North 39.9 22.7 South 37.7 24.9 East 32.2 19.6 The following table compares the birth rates for Bethnal Green and for London by quarters. Quarter ending London. Bethnal Green. March 31st 30.8 40.3 July 2nd 28.8 34.9 September 30th 29.5 35.6 December 31st 28.9 37.1 14 MARRIAGES. In this parish there are fourteen Churches, fifteen Chapels, and one Registry Office, licensed for marriages. The number of marriages celebrated in the parish is distributed as follows: — Quarter ending Church of England. Before Registrar. . 31st March 203 16 219 30th June 330 33 363 30th September 318 28 346 31st December 350 18 368 Total 1,201 95 1,296 The proportion of persons married is 20 per thousand of the population ; the corresponding rate for the whole of London is 18.9. On April 1st, 1899, the new Marriage Act comes into operation. It legalises marriages in Roman Catholic and Nonconformist Chapels without the presence of the Civil Registrar, which has hitherto been necessary in the case of marriages celebrated elsewhere than in a Church, with the exception of those taking place in Jewish Synagogues and Quaker Meeting Houses. For the future, Roman Catholic Priests and Dissenting Ministers will have the same right to unite in matrimony, to give valid certificates of marriage, and to take fees for the same, as has hitherto been restricted to the Clergy of the Established Church. The new law enacts certain regulations as to registers and safe custody of documents, and moreover requires that particulars of all marriages celebrated shall be forwarded to the Superintendent Registrar of the district within three months after the ceremony. 15 DEATHS OF INFANTS. Over 30 per cent. (30.7) of the deaths from all causes were those of infants aged less than twelve months; for out of 4,779 infants born alive, 884 died before reaching the age of one year ; thus giving a death rate, calculated upon the births, of 184.3, whilst the corresponding rate for the whole of London is 166. DEATHS OF YOUNG CHILDREN. Nearly half the deaths (1,427, that is 49.7 per cent.) were those of children aged less than five years, giving a proportion equivalent to a rate of 79.3 calculated upon the estimated population of young children. OLD PERSONS' DEATH RATE. The deaths of old persons, that is to say people over 65 years of age, numbered 434, this gives a rate of 91.4 per thousand calculated upon the estimated population of persons over that age. SPECIAL CAUSES OF DEATH. Table III. is prepared from the weekly mortality returns of the District Registrars and from the monthly returns of extra-parochial Institution deaths received from Somerset House. At the foot of the table is shown a mortality rate for each of the diseases or classes of diseases therein enumerated. TABLE OF DEATHS during the Year 1898, in the Bethnal Green 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 ok Children under Five Years of Age. At all ages. Under I year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1 Smallpox. 1 Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Other Tubercular Diseases. I Bronchitis, Pneu! monia it Pleurisy. Heart Disease. Injuries. All Other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. NORTH 1101 373 197 27 32 298 174 Under 5 ... 5 5 3 ... 1 ... ... ... ... 1 40 41 47 ... 6 38 123 6 29 217 572 5upwds. ... 1 3 1 ... 10 ... ... ... ... 1 2 3 3 4 99 2 132 64 16 166 529 Total ... 6 18 4 ... 11 ... ... ... ... 2 42 44 52 4 105 40 275 70 45 383 i ioi SOUTH 837 265 180 35 24 240 93 Under 5 ... 3 13 1 ... ... ... ... ... ... 2 58 40 35 1 1 4 93 3 18 136 445 5 upwds. ... 0 3 ... ... 1 ... ... 3 ... 0 6 1 2 4 71 6 109 34 19 131 392 Total 3 18 1 1 3 2 64 41 37 5 72 47 :o2 37 37 267 837 EAST 880 243 166 36 38 252 145 Under 5 ... 2 14 1 ... ... ... ... ... ... 1 41 23 43 ... 2 25 96 4 T5 142 409 5 upwds. ... 0 7 1 ... 5 ... ... ... ... 4 4 2 8 2 85 6 102 63 13 169 471 Total 2 21 2 5 5 45 25 51 2 87 3' 198 67 28 3" 880 Previous resi- dence not known 54 3 ... ... 2 27 22 U nder 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 3 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 8 ... 10 13 1 16 5 Total ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 8 ... 11 13 1 18 54 Totals 2872 884 543 98 96 817 434 Under 5 ... 10 42 5 ... 1 ... ... ... ... 4 139 104 125 1 9 104 313 13 62 497 1429 5 upwds. ... 1 15 2 ... 16 ... ... 3 ... 5 12 6 18 10 263 14 373 174 49 482 1443 Grand Total ... ... ... ... ... ... ... ... ... 11 57 7 ... 17 ... ... 3 ... 9 151 110 143 11 272 118 686 187 111 979 2872 Mortality per thousand population at all ages ... 0.49 ... 0.13 ... ... 0.02 ... 0.06 1.17 0.55 1.10 0.08 2.10 0.91 5.31 1.45 o.85 7.58 22.23 17 I am indebted to the British Medical Journal for the following extract. It will probably be noticed that the B.M.J. mortality rates differ in some few instances from those given in the body of my own report. This apparent discrepancy is due to the fact that the cause of death is often assigned in medical certificates to more than one disease. Some of the diphtheria deaths, for instance, might be quite correctly classified as scarlet fever, or as measles, or as whooping-cough, according as one or other of these diseases preceded or accompanied the throat affection which ultimately proved fatal. It would conduce to uniformity if the Registrar-General would publish some instructions as to classification, so that all Medical Officers of Health could formulate their statistics on one plan. THE DEATH RATES OF LONDON SANITARY AREAS DURING 1898. " 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 1898. The mortality figures relate to persons actually belonging to the various 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 132,432 births registered in London during 1898 were equal to a race of 29.5 per 1,000 of the population, estimated at 4,504,766 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 30.9 per 1,000. In the various sanitary areas the birth rates showed, as usual, wide variations, owing principally to the differences in the sex and age distribution of their populations. In Kensington, St. George Hanover Square, Westminster, St. James Westminster, St. Martin-in-the-Fields, and London City, 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. George Southwark, and Bermondsey sanitary areas. 18 The deaths of persons belonging to London registered during last year were 82,037, equal to a rate of 18.3 per 1000 of the population, against 19.4, 18.2, and 17.7 per 1000 in the three preceding years; this rate was 1.0 per 1,000 below the mean rate in the ten preceding years, 1888-97. The lowest death rates last year in the various sanitary areas were 117 in Hampstead, 13.2 in St. George Hanover Square, 13.7 in Stoke Newington, 14.4 in Wandsworth, 14.9 in Lee, and 15.3 in Lewisham (excluding Penge); the highest rates were 23.6 in St. Saviour Southwark, 23.8 in Limehouse, 24.4 in St. George Southwark, 24.8 in St. George-in-the-East, 24.9 in Holborn, and 25.7 in St. Luke. During the year under notice 12,482 deaths were referred to the principal zymotic diseases in London ; of these, 1 resulted from small-pox, 3,069 from measles, 581 from scarlet fever, 1,756 from diphtheria, 2,157 from whooping-cough, 3 from typhus, 554 from enteric fever, 9 from simple and ill-defined forms of continued fever, and 4,352 from diarrhœa. These 12,482 deaths were equal to a rate of 2.77 per 1,000, against 2.62, 3.11, and 2.56 in the three preceding years; this rate slightly exceeded the mean rate in the ten preceding years, 1888-97, which was 2.69 per 1,000. In the various sanitary areas the zymotic death rates ranged from 0.88 in St Martinin-the-Fields, 1.29 in St. George Hanover Square, 1.40 in Hampstead, 1.51 in St. James Westminster, 1.56 in Stoke Newington, and 1.76 in Strand, to 3.90 in Bethnal Green, 3.95 in Shoreditch, 3.99 in St. George Southwark, 4.04 in St. Luke, 4 13 in Woolwich, and 4-26 in Limehouse. Compared with the averages in the ten preceding years, the mortality from measles and from diarrhœa showed an excess, while that from each of the other principal zymotic diseases was below the average. The single fatal case of small-pox registered in London during 1898 belonged to St. George Hanover Square sanitary area. During last year only 5 cases of small-pox were admitted into the Metropolitan Asylums Hospitals, and no case remained under treatment 19 at the end of the year. Measles showed the highest proportional fatality in Hammersmith, Chelsea, Westminster, Islington, Holborn, Bethnal Green, Limehouse, and Woolwich sanitary areas. Scarlet fever was proportionally most fatal in Fulham, St. Pancras, St. Luke, St. George Southwark, Bermondsey, and Rotherhithe sanitary areas; 12,480 scarlet fever cases were admitted into the Metropolitan Asylums Hospitals during 1898, and 2,883 patients remained under treatment at the end of December last. Diphtheria caused the highest proportional fatality in Hackney, Clerkenwell, St. Luke, Mile End Old Town, St. Saviour Southwark, St. George Southwark, Newington, and Battersea sanitary areas ; there were 7,390 diphtheria patients admitted into the Metropolitan Asylums Hospitals during 1898, and 1,239 remained under treatment at the end of December last. Whooping-cough was proportionally most fatal in Westminster, Shoreditch, Bethnal Green, St. George-in-the-East, Limehouse, Poplar, and St. Olave Southwark sanitary areas ; enteric fever in St. Pancras, Hackney, Strand, City of London, Greenwich, and Woolwich sanitary areas ; and diarrhœa in Fulham, Clerkenwell, St. Luke, Shoreditch, Limehouse, Poplar, St. George Southwark, and Newington sanitary areas. During the year under notice 7,746 deaths from phthisis were registered in London, equal to an annual rate of 1.72 per 1,000; this disease was much more fatal in Central and in East London than in any other part of the Metropolis. In West London the phthisis death rate was 1.52 per 1,000, in North London it was 1.54, and in South London 1.66; while in East London it was 2.06, and in Central London as high as 2.66 per 1,000. Among the various sanitary areas the lowest phthisis death rates were 0.74 in Hampstead, o.88 in Lewisham, 1.04 in Stoke Newington, 1.13 in Wandsworth, 1.16 in Lee, and 1.26 in Kensington ; and the highest rates, 2.64 in St. Luke, 2.70 in St. George-in-the-East, 3.06 in St. Saviour Southwark, 3.17 in Holborn, 3.18 in St. George Southwark, 3.32 in Strand, and 3.34 in St. Giles. 20 Infant mortality in London, measured by the proportion of deaths under 1 year of age to registered births, was equal to 166 per 1000, and exceeded by 11 per 1,000 the mean rate in the ten preceding years. The lowest rates of infant mortality were 108 in Stoke Newington, 120 in St. George Hanover Square, 125 in Hampstead, 128 in City of London, and 132 in Marylebone and in St. Olave Southwark; while they ranged upwards in the other sanitary areas to 191 in Poplar, 195 in St. George-in-the-East, 196 in Clerkenwell and in Shoreditch, 208 in Limehouse, 211 in St. Saviour Southwark, and 221 in Holborn." Analysts of the Vital and Mortal Statistics of the Sanitary Districts of the Metropolis, after Distribution of Deaths occurring in Public Institutions during the Year 1898. Sanitary Areas. Estimated Population middle of 1898. 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 i year of age to 1,000 Births. Births. Deaths. Principal Zymotic Diseases. LONDON 4,504,766 132,432 82,037 29.5 18.3 277 12,482 1 3,069 581 1,756 2,157 3 554 9 4,352 7,746 166 West Districts. Paddinerton 127,480 2,967 2,041 23.3 l6.1 2 .41 307 .. 93 8 61 44 .. 17 1 83 l75 161 Kensington 172,174 3,633 2,809 21.2 l6.4 2 .02 347 .. 120 24 26 52 2 13 .. 110 217 181 Hammersmith 107,370 3,026 1,964 28.3 l8.1 3.19 342 .. 129 22 23 36 .. 12 .. 120 159 183 Fulham 125,275 4,307 2,155 34, 5 17. 2 3. 16 395 .. 59 35 61 41 .. 18 1 l80 184 168 Chealse 96,713 2,332 1,752 24 .2 18 .2 2.73 262 .. 92 15 41 26 .. 14 .. 74 168 176 St. George Hanover Sq 80,608 1,411 1,059 17.5 13. 2 1.29 104 1 35 4 10 16 .. 9 .. 29 105 120 Westminster 52,574 1,081 1,090 20.6 20 .8 3.00 157 .. 52 5 22 43 .. 3 .. 32 138 182 St. James Westminster North Districts. 22,200 446 411 20.1 18. 6 1.51 33 .. 15 2 5 1 .. 1 .. 9 42 177 Marylebone 140,483 4,061 2,565 29.0 183 2.36 331 .. 129 13 45 43 .. 22 79 251 132 Hampstead 78,755 1.516 917 19.3 11.7 1.40 110 .. 26 3 19 27 .. 10 1 24 58 125 St .Pancars 243,416 6,857 4,061 28.3 19.2 2.49 602 .. 111 53 96 87 .. 41 .. 234 482 170 Islington 344,616 9,442 5,712 27.5 166 2.78 958 .. 334 26 90 180 1 6 .. 291 501 159 Stoke Newington 32,660 839 475 24.3 137 1.56 54 .. 10 1 5 9 .. 2 .. 27 36 108 Hackney 219,630 6,445 3,588 29.4 164 2.64 576 .. 111 30 120 94 .. 41 .. 180 304 152 Central Districts. St. Giles 37.519 1,026 756 27.4 20 2 1.88 71 .. 26 2 6 9 .. 5 .. 23 125 137 St. Martin-in-Fields 12,424 179 192 14.4 15.5 0.88 11 .. 1 1 3 1 .. 1 .. 4 22 156 Strand 23,284 496 532 21.4 22 .9 1.76 41 .. 13 2 4 4 .. 4 .. 14 77 171 Holborn 30,056 807 747 26 .9 24.9 3 .37 101 .. 35 2 22 12 .. 2 .. 28 95 221 Analysis of the Vital and Mortal Statistics—Continued. Sanitary Areas. Estimated Population middle of 1898. Births. Deaths. Annual Rate per 1,000 Living. Deaths from Principal Zymotic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Typhus. I 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. Clerkenwell 66,120 2,072 1,432 31.4 21.7 3.75 246 .. 61 13 36 35 .. 7 .. 94 155 196 St. Luke 41,076 1,853 1,054 45.2 25.7 4.04 165 .. 37 15 24 24 .. 2 .. 63 108 150 London City 29,088 469 555 16.2 19 .1 117 34 .. 8 O2 10 2 .. 6 1 5 54 128 East Districts. Shoreditch 121,485 4,266 2,707 35.2 22.3 3.95 480 .. 108 21 44 98 .. 17 .. 192 245 196 Bethnal Green 129,027 4,779 2,872 37.1 22.3 3.90 503 .. 152 11 62 119 .. 17 .. 142 279 184 Whitechapel 80,559 3,123 1,622 38.9 20.2 2.10 169 .. 45 8 20 24 .. 9 .. 63 209 144 St. George-in-the-East 48,241 2,083 1,192 43.3 24.8 3.31 159 .. 33 6 14 39 .. 7 .. 60 130 195 Limehouse 58,661 1,912 1,390 32.7 23.8 4.26 249 .. 57 5 26 62 .. 8 1 90 140 208 Mile End Old Town 112,528 4,294 2,229 38.3 19.9 3.51 393 .. 93 8 63 74 .. 13 .. 142 164 155 Poplar 170,220 5,907 3,605 34.8 21. 2 3.72 629 .. 130 22 89 120 .. 10 1 237 311 191 South Districts. St. Saviour Southwark 24,562 739 577 30. 2 23. 6 3.09 76 .. 17 1 15 14 .. 4 .. 25 75 211 St. George Southwark 60,461 2,138 1,470 35.5 24.4 3.99 241 .. 43 20 36 34 .. 9 .. 99 192 188 Newington 123,183 4,165 2,520 33.9 20 .5 3.17 388 .. 55 24 72 45 .. 10 .. 182 298 173 St. Olave, Southwark 11,288 357 232 31.7 20.6 2.31 26 .. 5 1 3 11 .. 1 .. 5 25 132 Bermondsey 85,738 3,090 1,771 36.1 20.7 3. 02 258 .. 59 19 44 47 .. 9 .. 80 184 l57 Rotherhite 40,840 1,289 773 31.0 19.0 2.24 91 .. 33 10 11 15 .. 1 .. 21 74 169 Lambeth 304,073 9,266 5,422 30.6 17.9 2.50 755 .. 135 30 114 159 .. 35 1 281 506 154 Battersea 171,921 5,157 2,897 30.6 16.9 2.93 503 .. 114 28 120 68 .. 14 2 157 257 166 Wandsworth 202,526 5,186 2,902 25.7 14.4 2. 40 484 .. 111 16 89 86 .. 16 .. 166 229 144 Camberwell 26l,l89 7425 4,26l 28.5 164 2.41 628 .. 117 18 87 108 .. 26 .. 252 398 160 Greenwich l80,44I 5.625 3 336 31.3 185 3. 08 555 .. 108 21 44 122 .. 38 .. 222 272 176 Lee 39.717 891 592 22 ,5 14.9 1.97 78 .. 6 7 14 14 .. 7 .. 30 46 160 Le wisham 88,562 2.317 1.350 26 2 153 2 50 221 .. 35 10 26 32 .. 6 .. 112 78 161 Woolwich 41.478 1,253 844 30.3 20.4 4.13 171 .. 58 5 19 27 .. 8 .. 54 86 173 Plumstead 62,531 1,896 1,0l6 30.4 16.3 2.85 178 .. 58 12 15 33 .. 3 .. 57 92 155 23 THE SEVEN PRINCIPAL ZYMOTIC DISEASES. The total number of deaths from this class of disease is 496 ; of these, 426 were those of young children aged less than five years. In Table D the deaths from each of these diseases are shewn and compared with those of the preceding year. TABLE D. 1898. 1897. Small Pox 0 0 Measles 151 109 Scarlet Fever 11 24 Diphtheria.. 64 87 Whooping Cough 110 53 Typhus Fever .. .. 0 1 Enteric Fever 17 18 Simple Fever .. .. .. 0 1 Diarrhoea .. .. .. 143 147 Cholera 0 4 496 444 Seventeen per cent. of the total deaths from all causes were referred to the diseases included in table D, against sixteen per cent, in 1897. The actual increase in number is 52. The 496 zymotic deaths exceeded the decennial average for the ten years 1888 to 1897, Table V. in the appendix shows this figure to be 485. An inspection of Table D will show that the increase in the number of deaths is due to measles and whooping cough. The spread of both of these diseases is practically outside sanitary control, neither is notifiable, and isolation or removal to hospital cannot be enforced; both are spread through the agency of Schools. 24 On the other hand the deaths from scarlet fever and diphtheria show a well-marked decrease. This indicates the good results which follow early removal of infectious sick to hospital, and the prompt and careful subsequent disinfection of premises and bedding. The number of enteric and diarrhoea deaths vary very little in the two years. The death rate from these seven zymotic diseases is 3.8 against 3.4 in 1897, whilst the corresponding rates for London are 2.5 in 1897 and 2.7 in 1898. Table F shows the percentage of deaths from each disease as compared with the total number of zymotic deaths. TABLE F. Small Pox per cent., or 0 in 49G deaths. Measles 3044 „ 1 in 328 Scarlatina 2 21 ,, ,, 45 08 ,, Diphtheria.. 1290 .. .. 774 .. Whooping Ccugh 2218 ,, ,, 450 ,, Typhus Fever — — Enteric Fever 342 ,, .. 2918 Simple Fever — - Diarrhœa 2884 „ ,, 346 NOTIFICATION OF INFECTIOUS DISEASES. Twelve hundred and seventy notification certificates have been forwarded to me by Medical Practitioners, giving a rate of 9-8 on the estimated population. Seventy-seven of the certificates were duplicate notifications. Table M. 11(B) in the appendix shows the part of the parish in 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 form about six per cent of the whole. 25 In two instances there was unnecessary delay in forwarding the certificates, and fees for the same were disallowed by the Sanitary Committee. In one instance the certificate was returned to the Medical Practitioner as the address given was outside Bethnal Green. In another case the medical attendant inadvertently notified the same case twice over, and the second certificate was returned. A medical man was prosecuted for failing to notify as puerperal fever a fatal case of peritonitis following labour. The particulars of this case were detailed in my last annual report, and it will probably be remembered that the magistrate dismissed the summons on the ground that he was not satisfied, from the evidence produced, that the woman had suffered from puerperal fever; neither did he consider that we had proved that the death certificate was written by the defendant. In view of the uncertainty that exists as to what diseases should be reported as puerperal fever, the Vestry resolved to request the London County Council to add to the diseases included in Sec. 55 (b), the names of those diseases which are usually considered to be due to septic infection during the puerperal state. To this application the following reply was received :— London County Council, Spring Gardens, S.W. 1st December, 1898. Sir, I am directed to forward, for the information of your Vestry, the enclosed copy of a report of the Public Health Committee on the subject of the diseases which should be regarded as being included in the term "puerperal fever" for the purposes of section 55 of the Public Health (London) Act, 1891. The report was submitted to and adopted by the Council at its meeting on the 29th ultimo, and in accordance with its resolution I am directed to state that the Council is advised that the diseases c 26 referred to in your letter of 14th March last, are covered by the term "puerperal fever" in section 55 of the Act and notifiable as such. I am, Sir, Your obedient Servant, C. J. STEWART, Clerk of the Council. The Clerk of the Vestry of Bethnal Green. COUNCIL, 29th November, 1898. Report of the Public Health Committee. puerperal fever. * 2.—We have had under consideration a letter from the Vestry of Bethnal Green, asking the Council to add to the list of notifiable diseases named in section 55 of the Public Health (London) Act, 1891, the names of diseases included under the head of puerperal fever by the Registrar-General as follows— Both peritonitis and metritis when occurring in connection with parturition, as well as puerperal pyaemia, puerperal septicaemia, and puerperal sapraemia. Eleven other sanitary authorities have also written in support of the proposal, while one has txpressed an adverse opinion, and another has made an alternative suggestion. We understand that many medical practitioners regard the five diseases mentioned by the Vestry as being merely various types of, and all included in the term, "puerperal fever" in section 55, but that in the proceedings instituted by the Vestry against a medical practitioner who failed to notify a case of puerperal peritonitis, the magistrate held that puerperal peritonitis was not included in the disease called puerperal fever in section 55. If these diseases are all covered by the term " puerperal fever," it is of course unnecessary for the Council to pass any such resolution 27 as the Vestry suggests. To do so, moreover, would in effect be merely to define the meaning of the term "puerperal fever" for the purpose of the section, which the Council has no power to do. It seems to us unfortunate that the Vestry did not appeal against the Magistrate s decision, and we have thought it well, before coming to a conclusion on the question, to obtain the highest possible opinion as to whether the diseases mentioned are properly covered by the words "puerperal fever." We have accordingly addressed a letter to Sir Samuel Wilks, Bart., M.D., F.R.S., President of the Royal College of Physicians, asking him whether in his opinion the various diseases in question are included in the term "puerperal fever " and notifiable as such. Sir Samuel Wilks has been good enough to lay our letter before a committee of the Royal College, who have devoted very careful attention to the matter, and have now unanimously passed the following resolution— "That this committee is of opinion that, with a view to the limitation of dangerous infectious diseases, the London County Council would be acting rightly in adopting the view that the expression "puerperal fever," as contained in section 55 of the Public Health (London) Act, 1891, should be taken to include septicaemia, pyaemia, septic peritonitis, septic metritis, and other acute septic inflammations in the pelvis occurring as the direct result of childbirth." In forwarding this resolution for the information of the Council, Sir Samuel Wilks adds that he entirely approves of it. It thus appears that the highest medical advice is to the effect that the term "puerperal fever" does cover the diseases mentioned, and it is therefore unnecessary for the Council to make any such order as that asked for by the Vestry of Bethnal Green. We think that the Council should so inform the Vestry, and should, at the same time, forward a copy of our report on this question to all the London sanitary authorities. It will, we are sure, be the desire of the Council to express to Sir Samuel Wilks its appreciation of the courtesy with which he has received our application for his advice on this question, and of the 28 trouble taken in the matter by himself and the Royal College over which he presides. We recommend— (a) That a letter be addressed to Sir Samuel Wilks, Bart., M.D., F.R.S., President of the Royal College of Physicians, thanking him for the advice afforded to the Council with regard to the notification of puerperal fever, and for the trouble taken by himself and the Royal College in the matter. (ib) That a copy of this report be sent to the Vestry of Bethnal Green, with an intimation that the Council is advised that the diseases referred to in their letter are covered by the term "puerperal fever" in section 55 of the Public Health (London) Act, 1891, and notifiable as such. (c) That a copy of this report be forwarded to each of the other London sanitary authorities for its information. From this correspondence it will be seen that the Council declines to help us on the ground that the Royal College of Physicians has expressed a pious opinion that the diseases we wished to be added to section 55 are already included in the term "puerperal fever"; but as this opinion is not binding upon the magistrates at the Worship Street Police Court, we are left just where we were. If we take another similar case into Court we shall most likely fail to convince the magistrate that puerperal peritonitis invariably means puerperal fever. I propose that the following notice shall for the future be attached to all books of notification forms issued, this would be a help in deciding the meaning of the term " puerperal fever." puerperal fever. A committee of the Royal College of Physicians of London has recently endorsed the view that the expression "puerperal fever "should be taken to include "septicaemia, pyaemia, septic peritonitis, septic metritis, and other acute septic inflammations in the pelvis occurring as the direct result of childbirth." The Council of the Obstetrical Society of London suggests the following inclusive definition of the term "puerperal fever": that is, "septicaemia and pyaemia, including peritonitis, and all cases of acute pelvic inflammation occurring in connection with childbirth." 29 SMALL POX. (No deaths. Decennial average 2.2.) No case of this disease was reported to me during the year; indeed, only one death occurred throughout the whole of the Metropolis. My attention was called by a medical practitioner to some severe cases of chicken-pox under his care, which he thought might be small-pox, a disease he had never seen. I was able to relieve his anxiety and assure him that his patients were suffering from chickenpox only. In view of the fact that we in London have had no epidemic of small-pox for many years, and that few medical men of the younger generation have any experience of the disease, I am strongly of opinion that chicken-pox should be made notifiable. The slight early cases of an epidemic of small-pox might very easily be mistaken for the milder disease, and would not be reported. Amongst a well-vaccinated community this error would be a matter of minor importance; but I have very little doubt that the dangerous paltering with the Vaccination Law recently sanctioned by Parliament will lead to great neglect of vaccination; and, if so, it will be little short of criminal to overlook even the slightest chance of nipping an epidemic of small-pox in the bud. It is mournful that the centenary of the publication by Jenner of his great discovery should have been selected by the powers that be to throw discredit upon the effectiveness of the protection afforded by vaccination against the disfiguring ravages of this foul disease. SCARLET FEVER. (77 deaths. Decennial Average 46.8.) The number of scarlet fever cases notified during the year was 447, only about half the number reported during the previous year. The deaths numbered n, a rate on the notifications of 2.4 per cent. The scarlet fever death rate is equal to 0-08 per 1,000 population at all ages, whilst that for the whole of London is 0.13. In the North 30 district 163 cases were reported, six resulted in death; in the South there were 113, with three deaths; and in the East 171, with two. Amongst the notified cases in the East district were 20 at the Children's Home, in Bonner Road, none of which was fatal. The Inspectors' reports on the sanitary condition of the residences of the infected persons give the following particulars:— In 157 instances the premises were in fairly good condition; in 88 the closets were out of order; in 22 the drains inside the houses were leaky, and in a similar number the outside drains were defective; in three the domestic water supply was found to be drawn from the w.c. cistern; in one instance the premises were overcrowded; whilst various minor insanitary defects were noted in 142; 43 of the cases occurred amongst families inhabiting one room only; 268 persons suffering from scarlet fever were removed to hospital, where eight of them died. ENTERIC FEVER. (17 deaths. Decennial Average 22.2.) The total number of cases of enteric fever reported during the year is 97: of these 17 died, representing a case mortality of 17.5 on the notifications. The deaths are equal to a rate of 0.13 per 1,000 population. Of the cases, 42 were notified from the North district, with 11 deaths; 31 from the South, with one death; and 24 from the East, with five deaths. In 37 instances the residence of the patient was found to be in a satisfactory sanitary condition; but in 27 the w.c.'s were defective; in seven the external drainage arrangements were faulty; in 14 the drains inside the house were leaky, and other insanitary conditions were found in 40 instances. Five cases occurred in families inhabiting single-room tenements, and in three instances the premises were overcrowded; 66 of the patients were removed to hospital, of whom 12 died. In only one case was it necessary to take legal proceedings to enforce removal. This was at a tworoomed house in Moss Street, occupied by a family of Jews. The ground floor room was used as a shop, in which articles of food in 31 special request among Jews were retailed. As it was impossible to isolate the sick child, and the parents refused to allow it to be taken to a hospital, a magistrate's order was obtained, and the patient was removed the same evening in the Asylums Board ambulance. DIPHTHERIA (including Membranous Croup). (Total Deaths 64. Decennial Average 101-1.) The number of cases reported under the two heads was 324 ; the deaths registered were:— Diphtheria 57 Membranous Croup 7 64 This indicates a mortality rate of 19.7 on the notifications. On the estimated population at all ages the mortality is 0.49 per 1,000 living, whilst the general Metropolitan rate is 0.39. Of the cases, 124 were reported from the North district, with 22 deaths; 91 from the South, with 19 deaths; and 109 from the East, with 23 deaths. In 120 instances the residence of the patient was found to be in a satisfactory sanitary condition; but in 88 the closets were defective; in 11 the external drainage was faulty, and in 17 the drains inside the house were leaky; in three instances the domestic water supply was drawn from the w.c. cistern; in two cases the premises were overcrowded; whilst various other insanitary conditions were noted in 145 instances; 39 cases occurred in families occupying one room only. Out of 192 cases removed to hospital, 32 died. By the authority of the Sanitary Committee, I have made arrangements with the Clinical Research Association for a bacteriological examination in doubtful cases of diphtheria, &c. 32 ASYLUMS BOARD HOSPITALS. The following table shows the admissions to and discharges from Asylums Board Hospitals of patients suffering from diphtheria and fevers of various kinds. In addition to these, some of the cases of typhoid were treated in general hospitals, and some diphtheria cases requiring tracheotomy were retained in the London Hospital and the North-Eastern Hospital for Children. TABLE G. CERTIFICATES OF INFECTIOUS CASES RECEIVED BY THE MEDICAL OFFICER OF HEALTH. ADMITTED TO ASYLUMS BOARD HOSPITALS. SMALL-POX. FEVERS AND DIPHTHERIA Small-pox Enteric Fever Continued Fever Puerperal Fever Scarlet Fever Diphtheria and Membranous Croup Erysipelas Admitted Discharged Died Remaining Admitted Discharged Died Remaining January 0 6 0 0 54 26 23 0 0 0 0 67 64 6 125 February 0 4 0 2 31 23 23 0 0 0 0 36 46 3 112 March 0 2 0 0 41 23 29 0 0 0 0 36 46 3 99 April 0 9 0 0 47 26 23 0 0 0 0 28 46 2 79 May 0 5 0 0 42 23 15 0 0 0 0 36 59 3 53 June 0 4 0 0 43 35 19 0 0 0 0 39 21 5 66 July 0 4 0 0 35 24 12 0 0 0 0 26 31 0 61 August 0 8 1 0 34 19 32 0 0 0 0 29 37 3 50 September 0 9 0 0 24 11 35 0 0 0 0 30 16 1 63 October 0 18 1 0 29 35 32 0 0 0 0 53 21 3 92 November 0 16 0 1 38 39 34 0 0 0 0 47 35 5 99 December 0 12 0 1 28 40 40 0 0 0 0 31 43 2 85 Totals 0 97 2 4 447 324 317 0 0 0 0 458 465 36 85 REPORT OF FEYER AND DIPHTHERIA CASES ADMITTED INTO FEVER HOSPITALS DURING THE YEAR 1898. Hospitals. No. of Cases remaining at end of 1897. No. of Cases admitted. Discharged. Died. No. of Cases remaining at end of 1898. Eastern Hospital (Homerton) 36 179 128 and 58 transferred to Winchmore Hill. 19 10 Northern Hospital (VVinchmore Hill) 25 58 from Eastern Hospital, 26 from North-Eastern Hospital, 1 from North-Western Hospital, and 4 from New Cross Hospital. no 0 4 North-Western Hospital 8 15 20 and 1 transferred to Winchmore Hill. 2 0 North-Eastern Hospital 30 77 77 and 26 transferred to Winchmore Hill. 4 0 New Cross Hospital 17 179 71 and 66 transferred to Gore Farm and 4 to Winchmore Hill. 11 44 South-Western Hospital 2 0 2 0 0 Shooter's Hill Hospital 1 0 1 0 0 Gore Farm Hospital 9 66 from New Cross Hospital 50 0 25 Park Hospital 0 8 6 0 2 Totals 128 458 465 36 85 m ii.—Table of Population, Births, and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1898, in the Sanitary District of Bethnal Green ; classified a c cot ding to Diseases, Ages and Localities. Names of Localities adopte l 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 Hospital. Last Census. Estimated to middle of 1898. Scarlatina. Diphtheria ' and Membranous Croup. fevers. Erysipelas. Scarlatina. Diphtheria and Membranous Croup. fevers. Enteric or Typhoid. Continued. Puerperal. Enteric or Typhoid. Continued. North, Sub-District 49,301 49,339 1971 Under 5 68 48 3 .. .. 6 35 36 2 .. 5 upwards 95 76 39 .. 2 122 57 40 28 .. South, Sub-District 34,I94 34,194 1291 Under $ 54 43 2 .. .. 5 32 25 1 .. 5 upwards 59 48 29 .. 1 55 34 26 18 .. East, Sub-District 45.667 45, 667 1517 Under 5 57 53 2 .. .. 5 37 33 1 .. 3 upwards 93 54 22 .. 1 77 53 31 16 .. Workhouse .. .. Under 5 .. .. .. .. .. 1 .. .. .. .. 5 upwards 1 .. .. .. .. 46 .. .. .. .. Mildmay Hospital .. .. Under 5 .. .. .. .. .. .. .. .. .. .. 5 upwards .. .. .. .. .. .. .. .. .. .. Victoria Park Hospital .. .. Under $ .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Bethnall House Asylum .. .. Under 5 .. .. .. .. .. .. .. .. .. .. 5 upwards .. 1 .. .. .. .. .. .. .. .. Children's Home, Bonner Road.. .. .. .. Under 5 .. .. .. .. .. .. .. .. .. .. $ upwards 20 .. .. .. .. .. 20 .. .. .. Totals .. .. •• Under 5 179 144 7 .. .. 17 104 94 4 .. 5 upwards 268 180 90 2 4 300 164 98 62 1 grand totals 129,162 129,200 4779 447 324 97 2 4 317 268 192 66 1 36 PUERPERAL FEVER. The number of cases notified to me under this head was four; all died except one. Some remarks as to the definition of this disease will be found on page 26. WHOOPING-COUGH. (Deaths 110 Decennial average 95.8.) The mortality from this disease, though more than double that of the previous year, is still below the average. All the deaths, except six, were amongst young children aged less than five years, a death rate of 6-i on the estimated population of young children. In nine instances, some other disease (diphtheria, measles, or phthisis) contributed to the fatal termination. The deaths are therefore classified under the heading of the graver disease. MEASLES. (Deaths 151. Decennial average 117'8.) Measles caused 151 deaths, all, except 12, amongst young children. The mortality from measles is in the proportion of 7.7 per 1,000 on the estimated population of young children. DIARRHCEAL DISEASES. (Deaths 143. Decennial average 99'5.) Diarrhoea is stated to have been the cause of 143 deaths, all except 18 of which were amongst young children. I fully anticipated that the scarcity of water experienced during the summer months would have increased the deaths from this cause. The numbers were watched carefully from week to week and compared with those of preceding years, but no increase was noted. 37 TUBERCULAR DISEASES. Two hundred and seventy-two deaths were referred to phthisis and 118 to other forms of tubercular disease. The death rate from phthisis alone is equal to 2.1 per 1,000 in Bethnal Green, whilst that for the whole of London is 1.7. This disease, which is the curse of large towns, caused the highest mortality in the Central and East districts of the Metropolis, where the density of the population is the greatest. The death rate in Central London from this cause is 2.6, and in East London 2.0. This disease has been proved to be infectious, and the time has arrived when Sanitary Authorities must seriously consider what means can be adopted to check its spread. It has been proposed to make pulmonary phthisis a notifiable disease, but to this course the medical advisers of the Local Government Board are opposed. The disease seems to hang about particular houses, and is undoubtedly communicated by dried sputa in the form of dust. In order to prevent the spread of phthisis, proper methods of isolation and disinfection are indispensable, but the practical difficulties in the way of isolation are enormous. An open-air life affords the consumptive the best prospect of recovery, and most sufferers have sufficient health and strength during the greater portion of their illness to earn their own living. Under such circumstances, phthisical patients would naturally resist any restrictions in the way of isolation, and we have no compulsory powers. I am afraid all we can do at present is to distribute precautionary handbills and to proffer disinfection after fatal cases. Ordinary fumigation is nearly useless, as the dried sputa which contain the germs of the disease are not disinfected by sulphur dioxide in the absence of moisture. Formaldehyde is much better; but the most effectual method is to scour all woodwork of the infected rooms with soap and hot water, strip the paper from the walls, &c., and afterwards brush all exposed surfaces with some wash containing perchloride of mercury. The paper removed should be burnt at once, and all carpets, curtains, rugs and bedding should be removed and disinfected in the Washington Lyon steam apparatus, as is done in the case of other infectious diseases. 38 The death rate from tubercular diseases of all kinds formed 13½ Percent. of the total mortality from all causes, and is equal to a rate of 3.0 per 1,000 population at all ages. The tubercular diseases of young children (in which category I include tabes mesenterica, tubercular meningitis, and tubercular diseases of bones and joints) caused 113 deaths, eight per cent, of the total deaths of young children, a mortality on the estimated population of young children of six per 1,000. RESPIRATORY DISEASES. The deaths from the diseases of the respiratory organs numbered 686, and formed nearly one quarter (24.8 per cent.) of the total mortality from all causes. This is equal to a rate of 5.31 per 1,000 population at all ages. Nearly half the respiratory deaths were amongst young children, a mortality of 17.4 per 1,000 on the estimated population of young children. These figures do not include the large number of deaths classified as measles or whooping-cough, though the immediate cause of death in the majority of these was some form of lung trouble. MORTUARY AND CORONER'S COURT. A total of 423 bodies were received at the Mortuary; 296 of these were removed by order of the Coroner, 120 at the request of relatives, and seven for sanitary reasons. The Coroner held 299 inquests, and 98 post-mortem examinations were made by medical men. SUPERVISION OF TRADE PREMISES. The 18 cow-houses and the 10 slaughter-houses in the parish have been frequently inspected. All are in a fairly satisfactory condition, and none of the licences was opposed. The bake-houses, 102 in number, have been kept under observation. They call for no special remark, as all the requirements of our notices were obeyed. Eighty complaints of defective sanitary conditions in workshops were received from H.M. Inspectors of Factories. All 39 were verified by your own Officers, and details as to the condition of the premises complained of were laid before the Sanitary Committee by Mr. Foot. By direction of the Committee, "proceedings" under the Public Health (London) Act, 1891, were authorised, and the nuisances were abated in due course. CUSTOMS AND INLAND REVENUE ACT, 1890 AND 1891. I received applications for certificates under this Act for 365 separate tenements during the year; 335 certificates were granted; the remaining 30 were refused, as due provision had not in my opinion been made for the sanitary requirements of the tenants. PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Two thousand seven hundred and seventy-four statutory notices were served, and each of these was preceded by an intimation notice, as required by sec. 3. One hundred and thirty summonses were taken out at Worship Street, but as 39 of the defendants had completed the work before the hearing, they were simply ordered to pay costs; five were fined, and abatement orders were made against 26. Thirty-five summonses were withdrawn, the work having been completed and the costs paid before the date of hearing. The remainder of the summonses are returnable in 1899. SALE OF FOOD AND DRUGS ACT, 1875 TO 1879. One hundred and forty-six samples were taken, and submitted to Mr. Stokes, the analyst; 36 of these were found to be adulterated, including 27 of butter, eight of milk, and one of mustard. Proceedings in respect of all the adulterated samples were taken, and the vendors, without exception, were cast either in penalties or costs, and a sum of £150 os. 6d. was recovered and paid to the Vestry's account. Particulars of all these cases will be found in Mr. Foot's report. 40 HOUSING OF THE WORKING CLASSES ACT, 1890. During the past year I have only certified 14 houses under Part II. of this Act; three of these were closed by magistrate's order, and n had been repaired before the hearing. Eight summonses were issued against tenants for failing to vacate premises after notice and order. All were either fined or paid costs, and one man who obstinately refused to turn out was sent to prison. With the exception of the facilities given by this Act for getting rid of tenants, proceedings under Part II present no advantages over those under the Public Health (London) Act, 1891, unless demolition be contemplated; but as we have never yet, and probably never shall, go to this extremity, I do not propose to recommend further proceedings under the Housing Act. As a matter of fact, we have cleared out all the very bad property, and such as we are likely tc take in hand now is capable of some sort of repair, unsatisfactory though it may be. My opinions upon this subject are too well known to require recapitulation here. In addition to the 14 houses certified in 1898, proceedings with respect to other representations made before 1898 are still in progress. Full details of these will be found in the subjoined table. D PROCEEDINGS TAKEN UNDER THE " HOUSING OF THE WORKING CLASSES ACT, 1890," DURING THE YEAR 1898. 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. 72, Collingwood street 16th March, 1897 18th May, 1897 18th Jan., 1898 ........ Premises closed in 1897 and the Magistrate's Closing Orders determined in 1898. 74, ditto ditto ditto ditto ........ 76, ditto ditto 31st July, 1807 ditto ........ 78, ditto ditto 23rd June, 1897 ditto ........ 80, ditto ditto 31st July, 1897 ditto ........ 82, ditto ditto j 2nd Nov., 1897 ditto ........ 84, ditto ditto ditto ditto ........ 86, ditto ditto ditto ditto ........ 88, ditto ditto ditto ditto ........ 90, ditto ditto ditto ditto ........ 47, ditto 30th Nov., 1897 . 6th Dec., 1897 9th Feb., 1898 ........ 49, ditto 21st Dec., 1897 . 2nd March, 1898 ........ 13th June, 1898 Premises demolished. 51, ditto ditto 27th May, 1898 ........ ditto 53, ditto ditto 16th March, 1898 ........ ditto 55, ditto ditto 2nd March, 1898 ........ ditto 57, ditto ditto ditto ........ ditto 59, ditto ditto 16th March, 1898 ........ ditto 61, ditto ditto 2nd March, 1898 ........ ditto 63, ditto ditto 14th March, 1898 ........ ditto 65, ditto ditto 26th Jan., 1898 ........ ditto ditto 27th April, 1898 ........ ........ Premises repaired, 71, ditto ditto ditto ........ ........ 73, ditto ditto 27th May, 1898 ........ ........ 77, ditto ditto 27th April, 1898 ........ ........ 79, ditto ditto ditto ........ ........ 85, ditto 30th Nov., 1897 10th Dec., 1897 ........ ........ 87, ditto ditto 3rd Jan., 1898 ........ ........ Proceedings taken under the " Housing of the Working Classes Act, 1890," during the year 1898.—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. 5, Type street (east side) ........ About 2 years ago. ........ 6th Jan., 1898 Premises demolished and two houses since built on the site. 6, ditto ditto ........ ditto ........ ditto 64, Wadeson street 22nd Nov., 1897 22nd Nov., 1897 10th Aug., 1898 ........ Premises closed in 1897 and re-opened in 1898. 1, George Gardens No Order made ........ ........ ........ Premises repaired 22nd July, 1898, and the Summonses were withdrawn. 2, ditto ditto ........ ........ ........ 3, ditto ditto ........ ........ ........ 4, ditto ditto ........ ........ ........ 5, ditto ditto ........ ........ ........ 6, ditto ........ ........ ........ 276, Brick lane 1st Feb., 1898 8th June, 1898 ........ ........ Remain closed. 278, ditto ditto 26th May, 1898 ........ ........ 280, ditto ditto 8th June, 1898 ........ ........ 43, Chilton street No Order applied for. 2nd May, 1898 ........ 11th May, 1898 Premises demolished and the site since covered with workshops and factories. 45, ditto ditto ditto ........ ditto 47, ditto ditto ditto ........ ditto 49, ditto ditto ditto ........ ditto 51, ditto ditto ditto ........ ditto 58, Bacon street ditto 2nd March, 1898 ........ ditto 6o, ditto ditto ditto ........ ditto Proceedings taken under the " Housing of the Working Classes Act, 1890during the year 1898.—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. 470, Bethnal Green road No Order applied for. ........ ........ ........ Premises repaired 9th July, 1898. 472, ditto ditto 2nd March, 1898 9th Nov., 1898 ........ Premises repaired and re-opened. 6, Crossland Square No Order made ........ ........ ........ Premises repaired 4th August, 1898. 7. ditto ditto ........ ........ ........ 8, ditto ditto ........ ........ ........ 9, ditto ditto ........ ........ ........ 10. ditto ditto ........ ........ ........ 44 I regret that this report should be somewhat uneventful, but it is considerably discounted by the issue of the Chief Inspector's report some months since. This valuable document contains many interesting details which it would be superfluous to reproduce here, and to which I beg to refer all interested in the work of my department. In conclusion, I desire heartily to thank the Sanitary Committee for their kindness and courtesy to me. My acknowledgments are also due to my colleagues in the Sanitary Department for the cheerful assistance they have invariably afforded me. I need hardly say that without their aid little could be done to prevent disease in the parish, and I gladly take this opportunity of expressing my obligations to them and my recognition of their loyal and invaluable assistance. I have the honour to be, Gentlemen, Your very obedient servant, 45 BETHNAL GREEN SANITARY DISTRICT. TABLE I. Showing 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. 1898 129,200 1296 4779 2872 884 1429 620 1888 130,500 2282 4936 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 2642 709 1244 570 1895 128,050 1310 4771 2769 772 1304 625 1896 129,200 1384 5869 2909 829 1489 638 1897 129,200 1415 4818 2761 814 1259 663 Average of 10 yrs. 1888 to 1897. 127,925 l68l 4924 2946 785 1382 627 TABLE II. Shewing the Annual Birth Rate, Rate of Mortality, Death Rate among Children, and Deaths in Public Institutions for the year 1898, 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; per centage of Total Deaths. Per centage 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. 1898 37.0 22.23 30.78 18.5 49.7 620 1888 37.82 22.65 26.03 15.60 48.78 556 1889 37.70 20.67 26.51 l4.10 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 1897 37.03 21.36 29.48 16.90 45.60 663 Average of 10 years, 1888 to 1897. 37.84 23.03 26.54 16.32 46.90 627 Table of DEATHS during the Year 1898, in the Bethnal Green 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 arc in Table B.) Mortality from all causes, at subjoined causes. 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 and under 25. 25 and under 65. 65 and upwards. Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. 1 uherculosis. Injuries. All Other Diseases. Total. Enteric or Typhoid. Puerperal. North, Sub-District 807 344 161 17 16 179 90 Under 5 1 7 2 1 .. 1 38 39 44 .. 6 109 4 36 24 193 505 5 upwards 1 1 4 .. 1 2 3 2 1 55 99 45 2 8 78 302 South, Sub-District 589 240 144 18 18 124 45 Under 5 2 5 1 .. .. 2 55 40 30 1 .. 75 1 35 15 122 384 5 upwards .. 1 .. .. 3 .. 6 1 1 3 28 62 24 3 13 60 205 East, Sub-District 617 226 132 24 21 123 91 Under 5 .. 8 1 .. .. 1 38 21 40 .. 1 84 4 20 11 129 358 5 upwards .. 3 1 1 1 4 4 1 3 2 46 58 39 3 4 90 259 Workhouse 503 28 20 3 14 255 183 Under 5 .. .. .. .. .. .. 3 5 11 .. .. 12 .. 2 1 14 48 5 upwards .. .. .. .. .. .. .. 1 3 .. 105 132 32 .. 5 177 455 Bethnall H'se Asylum 31 2 16 13 Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwards .. .. .. .. .. .. .. .. .. .. .. 15 5 2 .. 9 31 Mildmay Hospital 24 1 3 4 2 14 Under 5 .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 1 1 4 5 upwards .. .. .. 1 .. .. .. .. .. .. 2 1 4 2 2 8 20 Victoria Park Hosp 62 4 23 35 Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwards .. .. .. 1 .. .. .. .. .. .. 36 3 14 .. 2 6 62 Totals 2633 839 460 70 96 746 422 Under 5 3 20 4 1 .. 4 134 105 125 1 8 281 9 93 52 459 1299 5 upwards 5 2 7 3 5 12 6 9 6 272 370 163 12 34 428 1334 Grand Total The subjoined number 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 45 85 33 24 135 36 Under 5 6 23 •• •• •• •• 5 •• 3 •• •• 32 3 14 9 35 130 5 upwards 2 9 •• 10 8 •• •• •• 2 2 22 29 32 3 17 100 228 Deaths occurring within the district among persons not belonging thereto. 119 4 5 6 18 66 20 Under 5 •• •• •• •• •• •• 1 1 2 •• 1 2 •• •• •• 2 9 5 upwards •• •• •• 1 •• •• •• •• •• •• 31 13 15 9 2 39 110 48 BETHNAL GREEN SANITARY DISTRICT. TABLE IV. Shewing the Mortality from certain classes of Diseases, and proportions to Population and to WOO deaths, 1898. DIVISION I. (All Ages). Total Deaths. Deaths per 1000 of Population (all ages). 3.84 Proportion of Deaths to 1000 Deaths (all ages). 1. Seven Principal Zymotic Diseases 496 172.7 2. Pulmonary Diseases (other than Phthisis) 686 5.31 238.9 3. Tubercular Diseases (including Pulmonary Phthisis) 390 3.02 135.8 DIVISION II. (Young Children under Five Years of Age). Deaths. Deaths per 1000 young children. Proportion of Deaths to 1000 Deaths of young children. 4. Pulmonary Diseases 313 17.4 219.0 5. Zymotic Diseases 426 23.6 298.1 6. Tubercular Diseases 113 6.2 79.1 NOTES. 1 and 4. Includes: Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Fever and Diarrhoea. 2. Includes : Pleurisy, Bronchitis, Pneumonia, Asthma, and other nonTubercular Lung Diseases. 3 and 6. Includes: Phthisis, Tubercular Diseases of Bones and Joints and Tabes Mesenterica. BETHNAL GREEN SANITARY DISTRICT- TABLE V. Showing the Number of Deaths from the seven principal Zymotic Diseases, inclusive of Hospital Deaths, in the 10 years 1888 to 1897 and in the year 1898. Disease. 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 Annual Average of 10 years 1888-1897. Proportion of Deaths to 1000 Deaths in 10 years, 1888-1897. 1898 Proportion of Deaths to 1000 Deaths in 1898. Small Pox 1 0 0 0 5 7 5 4 0 0 2.2 0.7 0 0 Measles 124 132 106 100 131 82 135 110 149 109 117.8 39.9 151 52.6 Scarlet Fever 120 40 34 29 53 71 27 30 40 24 46.8 15.9 11 3.8 Diphtheria 52 102 133 69 119 137 133 102 77 87 101.1 34.3 64 22.3 Whcoping Cough 167 62 113 128 122 59 70 33 151 53 95.8 32.5 110 38.3 Fever 21 21 29 19 22 26 26 17 21 20 22.2 7.5 17 5.9 Diarrhoea 67 95 94 77 74 128 54 146 109 151 99.5 33.7 14.3 49.9 Total in Bethnal Green. 552 452 509 422 526 510 450 442 547 444 485.4 164.5 496 172.8 5° TABLE VI. TABLE OF SANITARY IMPROVEMENTS. The number of Sanitary Improvements, New Drains, W.C.'s, &c., in the Parish during the Year 1898, together with the Totals for the previous Year. PREMISES. &c.— Years 1897 1898. Number of Premises, &c , cleansed, repaired, and 2,708 2.495 Houses disinfected after infectious disease 1,139 742 HOUSE DRAINS— Repaired, amended, and made good 359 198 Trapped and ventilated 254 290 Cleared (year 1897 included in drains repaired) — 145 New provided (by the owners) 257 579 Rain-water pipes and waste pipes disconnected 186 226 Sink and bath waste pipes trapped — 12 WATER CLOSETS— Repaired , cleansed, &c. 1,812 1,803 Supplied with water and water-supply apparatus 739 738 Ventilated 58 55 Abolished 5 24 New provided 32 71 Partitions provided round W.C.'s to separate same from living rooms or workshops — 11 WATER SUPPLY— Houses provided with water supply 101 106 House supply disconnected from closet cistern 14 22 Cisterns repaired, covered, cleansed, &c 20 45 Cistern overflow-pipe disconnected from soil pipe — 1 MISCELLANEOUS— Paving of vards repaired 946 1,004 Wash-houses paved 64 104 Forecourts and areas paved and drained 115 50 Stables paved and drained 46 35 Removal of accumulations of dung and other refuse 173 159 New dung-pits provided 73 48 Receptacles for fish offal provided — 8 Removal of animals, &c., improperly kept 49 61 Illegal occupation of cellars and basements discontinued 3 10 Cellar entrances to yards closed — 2 Urinal accommodation provided 9 16 Offensive effluvia abated 34 18 Cellars paved and drained 3 8 Overcrowding abated 37 102 Unsuitable occupation of premises discontinued — 3 Smoke nuisances abated 6 14 Number of dust complaints received and attended to 21 35 Bakehouses periodically inspected 102 102 Licensed cowhouses periodically inspected 19 18 Licensed slaughterhouses periodically inspected 10 10 51 OTHER MISCELLANEOUS TOTALS. 2,744 Intimation Notices were served. 2,744 Statutory Notices were served. 869 Final Notices were served. 6,911 Articles of Bedding, Clothing, &c., were disinfected. 742 Rooms were fumigated. 60 Articles of Bedding, Clothing, &c., were destroyed. 1,897 Notices in respect of Dust Receptacles were served. 1,783 Dust Pails were sold and delivered to various Premises in the Parish, and the sum of £222 17s. 6d. in respect of same paid into the Vestry's Account. 1,827 Letters were written. 2,117 Persons called at the Office respecting Notices served, Enquiries as to Works, &c. 155 Notices were served in respect of Combined Drains, 455 Notices were served on different Occupiers, and the Premises entered and the Drains opened up. 49 Cases of Combined Drains reconstructed by the Vestry, representing 402 Premises. 4 Cases, Works were carried out at request of Owners, and the sum of £20 18s. 10½d. received in respect of same. 145 Notices, Letters, &c., were sent to the District Surveyors, respecting Dangerous Structures, Bulged Walls, &c. 7 Dead Bodies were, on sanitary grounds, removed to the Mortuary. 15 Certificates, under Section 48 Public Health (London) Act, were given in respect of 19 Premises, and three Blocks of Buildings, viz., Ravenscroft Buildings, 1 to 24, Temple Buildings, and 1 to 15, Iffley Buildings. 80 Complaints were received from H M. Inspectors of Factories. 35 Complaints received from the Mansion House Council. TABLE VII.—TOTAL NUMBER OF INSPECTIONS MADE DURING THE YEAR 1898. A District. B District. C District. D District. E District. Totals. Inspector Weston Richards Lapworth Bridel Henley Weston Bridel Henley Richards Lapwortb 1897 1898 Year 1897 1898 1897 1898 1897 1898 1897 1898 1897 1898 Infectious Cases 237 199 276 188 261 130 308 170 272 187 1,354 874 Complaints 382 458 299 302 391 608 279 245 238 237 1,589 1,850 House-to-House Inspections 370 363 599 566 542 554 1,059 506 667 785 3,237 2,774 Trades' Inspections 52 50 52 77 96 62 73 158 70 60 343 407 Re-Inspections 3,806 3.948 4.463 4.017 3,766 4,480 4,381 3.923 4,250 3.663 20,666 20,031 Totals 4,847 5,018 5,689 5.150 5,056 5.834 6,100 5,002 5,497 4,932 27,189 25,936 Nuisances abated 637 8n 807 697 804 759 1,010 781 799 706 4.057 3,754 Number of Re-Inspections to each case abated 5.95 4.86 5.53 5.76 4.68 5.9 4.33 5.02 5.32 5.18 .. .. Average number per week of Inspections of all kinds made by each Inspector during the year 93.21 96.5 109.403 99.03 97.23 112.19 117.307 96.19 105.71 9484 .. .. N umber of Cases in hand at end of year .. 61 .. 170 .. 100 .. 127 .. 110 .. 568 The change of the Inspectors' Districts took place on the 14th February, 1898. 53 TABLE VIII. The number and nature of the Samples of Food taken during the year and submitted to the Analyst. Article of Food. Total Number of Samples taken. Result of Analyses. Genuine. Adulterated. Butter 80 53 27 Milk 40 32 8 Bread 7 7 .. Flour 1 1 .. Coffee 4 4 .. Arrowroot 3 3 .. Sugar 4 4 .. Mustard 4 3 1 Pepper 2 2 .. i 1 .. Totals I46 110 36 MORTUARY RETURN from 1st Jan. to 31st Dec., 1898. Number of Bodies Removed by Order of Coroner 296 ,, ,, „ Sanitary Inspector 7 ,, „ at request of Relatives 120 Total Number of Bodies Removed to Mortuary 423 Number of Inquests held during the Year 299 Post Mortem Examinations made 98 54 ST. MATTHEW, BETHNAL GREEN. STREET LIST. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Abbey street 2 ... 2 5 9 Bishops road ... 1 1 9 11 Abingdon street 3 1 ... 2 6 Blythe street ... 1 5 5 11 Ada place 1 1 ... 4 6 Bonner road ... ... 2 2 4 Ainsley street ... 2 1 5 8 Bonner street 2 1 1 2 6 Albert road ... ... ... ... ... Bonwell street 1 ... 2 5 8 Albion place ... ... ... ... ... Boreham street ... 2 ... 2 4 Alfred place 1 ... ... 1 2 Boundary street ... ... 1 1 Alma road 1 1 2 6 10 Bradys buildings ... ... ... 1 1 Ames place ... ... ... ... ... Brady street 1 2 5 9 17 Ames street 2 1 1 4 Braemar street ... 1 1 ... 2 Andrews road ... ... 1 4 5 Bratley street ... 1 ... 1 2 Angela gardens ... 1 1 3 5 Brick lane 5 6 6 15 32 Anglesea street ... 1 2 1 4 Brierley street ... 1 2 2 5 Anns place ... ... ... ... ... Buxton street ... ... 1 ... 1 Antill road 1 ... 2 4 7 Buckhurst street 5 2 1 6 14 Approach road ... 2 ... 4 6 Bullards place 1 ... 1 ... 2 Arbery road 1 1 ... 2 4 Bunsen street ... 1 ... ... 1 Archer street ... ... 1 ... 1 Burgoyne road ... ... ... 1 1 Arline street 1 ... ... 2 3 Burnham square ... ... ... 1 1 Artillery street ... ... 1 4 5 Burnside street ... ... ... 2 2 Arundel street ... 5 3 7 15 Busby street 2 1 2 7 12 Ash well road ... 1 2 1 4 Busby square ... ... ... ... ... Auckland road ... 2 ... 7 9 Butlers buildings 1 1 ... ... 2 Austin street 1 2 ... 2 5 Butler street 1 ... ... 1 2 Cadell street ... ... 5 ... 5 Bacon street 4 2 9 9 24 Calvert avenue ... ... ... ... ... Baden place ... ... ... ... ... Cambridge circus 4 1 2 1 8 Baker street ... ... ... 1 1 Cambridge street ... ... ... 1 1 Bakers court ... ... ... ... ... Cambridge road 9 4 5 17 35 Bakers rents ... ... ... 3 3 Cambridge bldgs ... 3 2 3 8 Bandon road ... 1 1 8 10 Camden street 1 4 2 7 14 Barnet grove 2 ... 2 7 11 Canrobert street 5 2 3 13 23 Barnsley street 3 4 2 5 14 Carlisle street ... ... ... ... ... Baroness read 1 3 3 6 13 Carlton place ... ... ... ... ... Bath grove 1 ... ... 3 4 Carter street ... ... ... ... ... Bath street ... ... ... ... ... Catherine street ... ... ... 3 3 Baxendale street 4 2 3 3 12 Centre street 1 3 1 1 6 Bedford row ... ... ... ... ... Chambord street 6 2 4 6 18 Bellhaven street 2 ... ... 4 6 Chance street ... 1 ... ... 1 Bethnal green road 3 1 5 12 21 Chapel street ... ... ... ... ... Birkbeck street ... ... ... 1 1 Chapel place ... ... ... ... ... 55 STREET LIST (continued). Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Chapman gardens ... ... ... ... ... Darling row 1 1 ... ... 2 Charles court ... ... ... 2 2 Davis place ... ... ... 1 1 Charlotte court ... ... ... ... ... Delta street ... ... 1 2 3 Charlotte street ... 1 2 4 7 Derbyshire street 4 2 3 8 17 Charlotte buildings ... ... ... ... ... Derby place 1 ... 1 1 3 Cheshire street 1 5 3 4 13 Devonshire place ... ... ... ... ... Chester street 1 ... ... 2 3 Devonshire street 1 ... ... ... 1 Chester place ... ... ... ... ... Digby street 4 ... ... 3 7 Chilton street 1 1 3 4 9 Digby walk ... ... ... 6 6 Chisenhale road 4 1 6 7 18 Dinmont street 3 ... ... 1 4 Church street 1 1 5 4 11 Diss street 1 1 i 3 Church row 1 2 1 2 6 Dixie street ... 1 3 2 6 Clare street 3 4 2 2 11 Doveton street ... ... ... ... ... Claremont street ... ... ... ... ... Ducal street ... 1 ... ... 1 Clarkson street 2 2 ... 5 9 Durant street ... ... 1 3 4 Clarence street ... ... ... 2 2 Cleveland street 1 ... 3 4 8 Eastman street 2 ... 3 3 8 Club row ... ... ... ... ... Ebor street ... ... ... ... ... Code street 2 ... ... 5 7 Eckersley street ... ... ... ... ... Collingwood place ... ... ... ... ... Edward place 1 1 1 1 4 Collingwood street 10 5 7 11 33 Ezra street ... ... ... ... ... Colliers court ... ... ... ... ... Elwin street ... ... ... 1 1 Collins place ... ... 1 6 7 Elliott row ... ... ... ... ... Columbia square 2 ... 1 5 8 Ellesmere road 6 ... 3 2 11 Columbia road 4 4 6 10 24 Elvidge court ... ... ... ... ... Conyer street ... 3 ... ... 3 Emma street 1 ... 3 6 10 Coopers gardens 2 ... 1 3 6 Ernest place ... 1 ... ... 1 Cordova road 3 3 2 3 11 Corfield street 7 4 4 11 26 Faith street ... ... ... 1 1 Cottage place ... ... 1 1 2 Falcon buildings ... ... ... 1 1 Coventry street 4 4 7 12 27 Felix street 1 2 2 ... 5 Coventry place ... ... ... ... ... Fellbrigg street 3 4 1 7 15 Cranbrook street 2 1 1 5 9 Finnis street 7 2 1 10 20 Cranbrook road ... ... 1 ... 1 Fleet street hill ... ... ... ... ... Craven buildings 1 ... 1 3 5 Flint court ... ... 1 ... 1 Crescent place 3 ... 1 3 7 Florida street ... 5 ... 7 12 Cross street ... ... ... ... ... Foster street 2 1 3 3 9 Crossland square ... 1 2 1 4 Fountain court ... ... 1 ... 1 Cudworth street ... 1 1 4 6 Fournier street ... ... ... 1 1 Culham buildings ... ... ... ... ... Fox street 1 ... 1 ... 2 Cymon street ... 1 1 1 3 Foxs buildings ... ... ... ... ... Cyprus street 3 2 4 15 24 Fuller street 3 2 4 11 20 Cygnet street ... ... ... 1 1 Gales gardens 2 4 4 4 14 Garden place ... ... ... ... ... Dagnall place 2 3 2 2 9 Gardners road 3 ... 2 8 13 Daniel street 3 2 2 2 9 Garden row ... ... ... ... ... STREET LIST (continued). Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Gascoyne place ... ... 1 3 4 Helens place ... ... ... ... ... Gawber street ... ... ... 3 3 Henley buildings ... 1 ... 3 4 Georges place ... ... ... ... ... Henrietta street 2 ... ... ... 2 Georges terrace ... ... ... ... ... Hereford street 2 2 1 3 8 Georgina gardens ... ... ... 1 1 Hereford buildings ... ... ... ... ... George gardens 2 ... 1 3 6 Hersee place 1 1 2 ... 4 Gernon road 2 1 ... ... 3 Hill street 1 1 1 1 4 Gibraltar place ... ... ... ... ... Hollybush gardens 2 2 5 2 11 Gibraltar gardens 1 2 ... 3 6 Hollybush place ... ... ... ... 1 Gibraltar walk 3 1 4 9 17 Holmes avenue ... ... 2 ... 2 Gibraltar buildings ... ... ... ... ... Horatio street ... 1 3 3 7 Gillman street 1 ... 1 2 4 Horts yard ... ... ... ... ... Glass street 1 ... ... ... ... Hunslett street ... ... ... 1 1 Globe road 2 2 S 10 19 Huntingdon bldgs. ... 2 ... 3 5 Gloster street 3 ... 2 5 10 Hurley buildings ... ... ... ... ... Gloster gardens ... ... ... ... ... Godfreys place ... ... ... 1 1 Gore road ... ... ... 2 2 Ion square 1 1 2 1 5 Gosset street 3 2 ... 8 13 Ivimey street ... ... 1 ... 1 Granby row ... ... ... ... ... Granby street 5 1 2 9 17 Granby place ... ... ... ... ... lames street 4 3 1 6 14 Green street 7 5 6 18 36 James court ... ... ... ... ... Grove street ... ... 2 1 3 James place ... ... ... ... ... Grove place ... ... 1 1 2 Jane street ... 1 1 ... 2 Grove road 5 4 5 13 27 I ersey street 1 1 7 5 14 Guinness buildings 3 3 10 8 24 Jubilee place ... ... ... ... ... Grove row ... ... ... ... ... Kay street 1 ... 3 2 6 Hackney road 3 5 8 21 37 Kelsey street ... ... ... 3 3 Hague street ... ... 1 5 6 Kenilworth road 2 ... 1 1 4 Hague place ... ... 1 ... 1 Kerbela street 3 ... 7 12 22 Hague buildings ... ... ... ... ... Key street 1 1 3 ... 5 Half Nichol street 1 ... ... 2 ... Key court ... ... ... ... ... Hammonds gardens ... 1 ... ... 1 Kings place ... ... ... 1 1 Hamilton road 3 2 2 4 11 King street ... ... ... ... ... Hare row ... ... ... ... ... Knottisford street 3 1 1 2 7 Hare marsh ... ... ... 1 1 Hare street 6 6 4 16 32 Hare court ... ... ... ... ... I.ansdell place ... ... 1 3 4 Harold street 2 ... ... 4 6 Lark row 3 ... ... ... 3 Hartley street 1 2 1 2 6 Law franc road ... ... 1 ... 1 Harts lane ... ... ... 1 1 Letchford place ... ... ... ... ... Hassard street 4 ... 1 7 12 Leopold buildings. 1 2 ... 2 5 Hassard place ... ... ... ... ... Lessada street ... 2 1 3 6 Havelock place ... ... 2 3 5 Linden buildings 1 1 2 4 8 56 STREET LIST (continued). Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Lisbon street 2 1 1 5 9 North place 2 2 .. 2 6 Ltle. Collingwood st. 1 ... ... 2 3 Northampton street 2 2 2 2 8 Little York street ... ... ... ... ... Norton street 2 .. 3 .. 5 London street 2 ... 1 3 6 Lucas street 2 ... 1 ... 3 Lyte street 1 ... ... 3 4 Octagon street .. 2 1 2 5 Old Bethnal green 3 2 8 7 20 Mace street 4 2 3 4 13 Manchester bldgs ... ... 1 ... 1 Old Ford road 4 5 6 23 38 Manchester place ... ... ... ... ... Old Nichol street .. .. .. 1 1 Mansford street 3 5 5 15 28 Olga street .. .. .. 1 1 Mape street ... ... 2 3 5 Orange street 3 .. 1 .. 6 Margaret place ... 2 ... 2 4 Oval 2 4 .. 1 7 Marian street 1 1 1 1 4 Oxford street .. .. .. .. .. Marian place ... ... 1 ... 1 Marian square ... 1 2 3 6 Marlow build1ngs ... 1 1 1 3 Martha court ... ... ... ... ... Palestine place .. .. .. .. .. Matilda street ... ... 3 3 6 Palm street .. 1 1 3 5 Mead street ... ... ... ... ... Palmers road .. .. .. .. .. Medhurst road 2 ... 1 2 5 Park street 2 .. .. 4 6 Medway road 3 ... ... 5 8 Park place .. .. .. .. .. Menott1 street 5 2 4 4 15 Parliament place .. .. .. .. .. Middleton street ... 1 3 5 9 Parliament street .. 1 .. .. 1 Middle walk 1 ... 1 3 5 Parmiter street 2 2 1 6 11 Minerva street 1 4 5 6 16 Patriot square 1 .. 2 5 8 Minto place ... ... ... ... ... Peacock street 1 1 .. 1 3 Morpeth street 1 ... 2 12 15 Peacock place .. 1 .. 2 3 Morpeth road 1 1 ... 3 5 Pedley street 2 .. 2 2 6 Moss street 4 3 3 4 14 Peel grove 1 1 .. 3 5 Mount street 1 1 1 3 6 Pereira street 12 3 .. 3 23 Mowlem street ... ... 2 ... 2 Peter street .. 2 .. 4 6 Pitt street 1 1 .. 4 9 Pleasant place .. .. .. .. .. Nant street ... ... ... 1 1 Pollard row .. .. .. 5 8 Neath place 1 ... 4 3 9 Pollard street 1 1 5 4 11 Nelson street ... ... 2 4 6 Pott street .. .. .. 2 2 Nelson place 1 ... 1 ... 2 Poyser street 1 .. 2 3 6 New Castle street ... ... ... ... ... Preston street 1 1 4 5 11 New Church street ... ... 1 1 2 Primrose street .. .. .. 1 1 New Tyssen street 3 ... ... 3 6 Princes court .. .. 1 5 8 New square ... ... ... 1 1 Princes place .. .. .. .. .. Newling street ... ... 1 3 4 Pritchards road 5 2 6 10 23 Nichols row ... ... ... ... ... Prospect terrace .. 1 .. 2 3 Norah street 1 ... 2 6 9 Providence place .. .. 1 .. 1 North passage ... ... Punderson gardens 1 1 7 9 18 57 58 STREET LIST (continued). Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Queen street .. .. .. .. .. Southboro'gh place .. .. .. .. .. Queens buildings 2 2 .. 3 7 .. .. .. .. .. Oueen Caroline pice .. .. .. I i Squirries street 3 1 1 3 8 Quilter street 4 I .. 5 12 St. Andrew street .. .. 2 2 4 Quinns square 10 4 11 17 42 St. James road .. .. .. 2 2 St. John street 2 2 1 .. 5 Ramsey street 1 .. .. 1 2 St. Jude street 1 5 1 3 10 Ravenscroft street 4 2 2 10 18 St. Matthias place .. .. .. .. .. Reform square .. .. .. .. .. St. Peter square .. .. .. .. .. Rappley place .. .. .. .. St. Peter street 2 1 1 5 9 Reuben street 1 2 1 5 9 Stainsbury street 1 .. 1 .. 2 Riders court .. .. .. .. .. Strahan road 2 .. .. 5 7 Roan Horse yard .. .. .. .. .. Streatley buildings .. 1 .. 3 4 Robert street 1 .. 2 2 5 Stroud place .. .. .. 1 1 Robinson road 1 .. .. 2 5 Sugarloaf walk 1 1 1 1 4 Roman road 2 6 3 9 20 Summerford street 3 2 4 9 18 Rooks place .. .. .. .. .. Sunbury buildings 2 2 1 4 9 Ropley street .. 1 1 1 3 Surat place 1 .. 2 3 6 Royal Victor place .. .. .. .. .. Sweet Apple square .. 1 .. .. 1 Royston street 2 2 6 5 15 Sidney street .. 1 .. 3 4 Russia lane 2 1 3 6 12 Tagg street 1 3 3 9 16 Sabbage yard .. .. .. .. .. Taplow buildings .. 1 2 2 5 Sale street 1 .. 5 9 13 Tapp street 1 .. 1 2 4 Sanford buildings .. .. .. .. .. Tavistock street .. .. .. .. .. Sarah street .. .. .. .. .. Teale street 1 1 1 1 4 Satchwell rents .. .. .. 2 2 Teesdale street 3 2 4 8 17 Satchwell street .. .. 1 3 4 Temple street 1 1 5 5 12 School place .. .. .. .. .. Tent street .. .. 1 5 6 Sclater street 2 .. 1 4 8 Theydon road .. 1 2 1 4 Scott street 1 .. 3 4 8 Thomas passage .. .. .. 1 1 Seabright street 2 2 7 6 17 Thomas place .. .. 1 .. 1 Seabright gardens .. .. 1 2 3 Thorold street 3 2 1 2 8 Selby street 4 .. 3 4 11 Three Colts corner .. .. .. .. .. Sewardstone road 3 4 1 11 19 Three Colts lane 1 2 1 5 9 Shacklewell street .. .. .. .. .. do. Waterlow dwellings .. .. .. .. .. Sheep lane .. .. .. .. .. Sheldon place .. 1 2 1 4 Thurlow place 1 .. 1 1 3 Sherwood place .. .. .. .. .. Totty street 2 2 1 3 8 Shipton street 1 .. 1 4 6 Tread way street 5 2 2 14 23 Shiplake buildings .. .. .. 1 1 Trinity ground .. .. 1 2 3 Smart street .. .. .. 1 1 Turin street 1 4 2 3 10 Smiths place .. .. .. .. .. Turville street .. .. .. .. .. Sonning buildings 1 .. 2 2 5 Tuscan street .. 1 .. .. 1 Southampton place .. 1 .. .. 1 Type street 1 1 4 6 12 Southampton cottgs .. .. .. 1 1 Tyrrell street 1 1 1 1 4 Southampton terrace .. .. .. 1 1 Toyes buildings .. 1 1 2 3 59 STREET LIST (continued). Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Usk street 2 •• 4 7 13 Wennington road •• 4 3 5 12 Wharf road •• •• 1 1 2 Wharncliffe street . 1 1 •• 1 3 Vallance road 6 3 6 II 26 Whites court •• •• •• •• •• Valley place •• •• •• •• •• Whitechapel road •• •• 1 •• 1 Viaduct street •• 1 1 9 11 William place •• •• •• 1 1 Viaduct place •• •• •• •• •• Willow walk •• •• 1 3 4 Victoria street 3 2 •• 2 7 Wilmot street 4 3 3 8 18 Victoria place •• •• •• •• •• Wimbolt street 2 2 1 1 6 Victoria Park square 1 •• 1 3 5 Winchester place 1 1 1 •• 3 Violet street 1 •• 2 •• 3 Winchester crescent •• •• •• •• •• Violet row •• •• •• 2 2 Winchester street 2 1 •• 2 5 Virginia road 1 2 10 10 23 do. dwellings •• •• •• •• •• Vivian road 2 I 2 2 7 Wolverley street 1 2 2 5 10 Wood street 1 1 •• 1 3 Wadeson street •• 2 3 2 7 Woods close •• •• •• •• •• Walter street 2 2 4 1 9 Walton buildings •• 2 2 3 7 York place •• 2 •• 1 3 Warner place 4 •• 5 8 17 Warley street •• 5 4 7 16 Waterloo place •• •• •• •• •• Bethnal H. Asylum •• •• •• 1 1 Waterloo terrace 1 1 1 1 4 Mildmay Hospital •• 1 •• 2 3 Waterloo road •• •• 2 1 3 Regents Canal •• •• •• •• •• Weaver street 1 2 4 8 15 Victoria Park Hos. •• •• •• •• •• Weldon street •• •• •• •• •• W'rkho'se previous resid'nce not kwn. 4 8 9 44 65 Wellington row 4 . . 5 9 18 Wellington place •• •• 1 •• 1