HAC 46 REPORT ON THE SANITARY STATE OF THE HACKNEY DISTRICT, FOR THE YEAR 1866. BY JOHN W. TRIPE, M.D., Medical officer of health to the district. licentiate of the royal college of physicians, ED., etc. author of numerous essays relative to vital statistics, and on medical meteorology. Printed By Order of the Board, BY Andrew T. Roberts, 5, Hackney Road, London. N.E. 1867 Sanitary Report for the Year 1866. TO THE Board of Works for the Hackney District. Gentlemen, The two most important matters which have to be discussed in the Medical Report for 1866, are, the Cholera outbreak and the Sanitary Act. As the Sanitary Committee has already presented its report on the manner in which it has carried out the Orders in Council, and the measures necessary for suppressing the disease, and as I have also, in my report on the epidemic, reviewed its progress and mortality, I need now say but little on this subject. The provisions, however, of the Sanitary Act, are so important, and have thrown so great an amount of additional labour on me and the other members of the sanitary staff, that I feel called upon to lay before you, a brief epitome of the Act, so far as concerns my department Prior to the Cholera outbreak, there was but one 4 Inspector of Nuisances for this large District of 3929 acres, containing a population of about 100,000 persons. Immediately on the outbreak of Cholera, several additional inspectors were appointed, some of whom were dismissed as soon as their services could be dispensed with, but two additional inspectors and a clerk are still actively and constantly engaged with the new work arising out of the Sanitary Act. I have arranged the work as follows: one inspector, Mr. Jones, is engaged in measuring houses, making a periodical inspection of houses under £20 a year rental, to ascertain their state of repair and the number of inhabitants: in disinfecting premises in which infectious diseases have appeared, also the beds and bedding of the patient; and entering in a book the particulars of the inspections as regards drainage; the amount of water supply; condition of water-butts and water-closets, dust-bins, and the houses generally; state of the yards; and number and health of the inhabitants. Another inspector, Mr. Self, serves notices on the owners, requiring them to remove the nuisances discovered on inspection, and follow up the cases, to obtain if possible, their abatement without legal proceedings. The immense number of nuisances discovered on inspection, frequently raises the number on Mr. Self's list to 500 or more. Of course it is impossible, that so large a number of notices can be served without leading to objections by the owners of property to do the required work, so that I make it a rule to inspect all premises when the owners and inspector do not agree as to the work to be done. Should Mr. Self fail 5 to obtain an abatement within a reasonable time, I direct peremptory notices to be served, and if they are unsuccessful, that the cases shall be transferred to Mr. Valentine. Up to this point, all the notices served, are what we call 'friendly notices,' so that the next step is to obtain from the Board or Sanitary Committee, the necessary orders to serve the statutory notices. Previously to this being done, Mr. Valentine, and in all important cases myself as well, visit the premises complained of, when Mr. Valentine lays the information in accordance with the Acts of Parliament, then serves the statutory notices, if necessary takes out summonses, and attends with me at the Police Court to give evidence, and superintends the carrying out of the Magistrate's order. Mr. Valentine also attends to all complaints, amounting to many hundreds, in the course of the year. There have been 343 orders for legal proceedings issued between November 1st, 1866 and March 30th, 1867, aud 50 summonses heard and adjudicated on by the Magistrates of the Worship Street and Clerkenwell Police Courts. It has been necessary to attend at the Police Court several times in some of the cases, but as we have often taken out more than one summons for one day, the number of attendances have been rather less than the number of summonses. Before the Sanitary Act was framed, I need scarcely say that the mode of proceeding was very different. Except a periodical inspection of some of the poorest courts in this district, no regular house to house 6 tion was made, or indeed, was required by law. We waited for complaints, unless small-pox or fever became epidemic in a locality, in which case I inspected the infected houses myself. The average number of nuisances attended to in this district, in the course of a year, previously to the passing of the Sanitary Act, was about 1,500, but between the 1st day of August, 1860, and the 31st day of March 1867, they have amounted to the large number of 4285, which I have classified as follows: Cesspools emptied, filled up, and drained into the sewer 288 Stable manure, and other refuse removed 138 Premises repaired and lime-whited 1576 „ ventilated 913 Pigs and Pigsties removed 58 Choked drains cleansed and repaired 408 Other nuisances 904 4285 The immense disparity between the work in previous years and that which is now being carried out, has chiefly arisen from the powers conferred on the Board to make regular and strict inspection of premises, under the 20th section of the Sanitary Act. It has also been partly caused by the New Nuisances created by the 19th section, and to a small extent by the regulations under the 35th section. I shall now proceed to consider briefly, each section 7 of the Act, which has to be carried out under my direction. The first section to he considered, is the 4th, by which the Sewer authority may, at a meeting specially called for that purpose, appoint a committee to which it may delegate all or any of its powers. The Board has appointed the committee nominated to carry out the Orders in Council, to be the committee under this section with the name of the "Sanitary Committee." The Board also appointed the same committee to act under the 5th section of the Nuisances Removal Act, as a committee for the removal of nuisances. No question therefore, can arise as to the power of the Sanitary Committee to order proceedings in the Police Courts, which might otherwise have occurred, in consequence of the peculiar division of the duties between the Nuisances and the Sewer authorities. The first section which the Sewer authority has to enforce, is the 10th, which provides for the efficient drainage of houses which are either not drained at all, or are insufficiently drained. A very few notices only have been served under this section, as although it gives the power to do the works necessary to remove the nuisance, and charge the owner, should he neglect to do it himself, yet it provides only for the drainage of the house and not of the cesspools, when these are at a distance from the house, which often occurs in this district. Part 2 of the Sanitary Act, is incorporated with the. 8 Nuisances Removal Act, and the Amendment Act under the term "Nuisances Removal Acts," and is most important, for it creates several new nuisances and gives very large additional powers to the Board. It is true, that these powers might be used so as to become an annoyance to the inhabitants of the district, but I trust, that although they have been actively enforced, yet that sufficient discretion has been observed in carrying them out. One of the most important of the new provisions of the Sanitary Act, is that which enacts that "any house or part of a house, so overcrowded as to be dangerous or prejudicial to the health of the inmates," is to be considered a nuisance. There is also another section of the Sanitary Act, viz., the 35th, which authorises the Board to fix the number of inmates who may occuppy a house; but under this section, the remedy is against the landlord, and not against the tenant or person causing the over-crowding. When over crowding notices were first served, we took proceeding against the owners, but found, that in many instances, the tenants had obtained possession by mis-representing the number of their family, or, had taken in lodgers contrary to arrangement. As it seemed manifestly unjust to summons a person when he was not the offender, I directed notices to be served on the parties causing the overcrowding. These notices were served in accordance with the provisions of the 12th section of the Nuisance Removal Act, and of the 19th and 21st sections of the 9 Sanitary Act. These notices have been so successful, that out of 78 notices for over-crowding, which have been served during the first three months of this year, the whole have boen obeyed without any summons having been heard. The mode of proceeding is as follows: the inspector measures the rooms, and reports to me the number of persons occupying them, I then fix the number of persons who may legally occupy them; after which, a notice is filled up and served on the person causing the over-crowding, requiring him to abate it within fourteen days, under a penalty of ten shillings a day The occupier is sometimes unable to obtain other or additional rooms in the time allowed, when he usually applies to me for an extension of time, which is always granted, except in very bad cases. It might be supposed, that an order for a penalty, would be treated as waste paper by persons who are almost without money or goods, but as the Magistrate can send to the House of Correction, any person neglecting to pay the penalties, the order is almost invariably obeyed. The only person by whom it was disobeyed, was the owner of a dust yard, who was sent to the House of Correction, with hard labour, for seven days, for refusing to pay the penalties imposed on him for keeping open his dust yard contrary to the Magistrate's order. Section 19, is divided into three parts, the first, as just stated, refers to over-crowding, the second, gives the Board or its officers, power to inspect factories, workshops, or work-places, to ascertain if they are kept in a cleanly state, properly ventilated, and not 10 over-crowded, so as to be dangerous or prejudicial to the health of the inmates. In many districts, this part of the Act will be of very great importance, but in this district, there are comparatively few workshops or workplaces: I have not as yet found it necessary to serve notices under this part of the Act, except in one instance. The third division of 19th section, provides that any fireplace or furnace not being the chimney of a private dwelling house, sending forth black smoke, and which does not so far as practicable consume the smoke arising from the combustible, is a nuisance, and exposes the owner to proceedings. Notices have been served in two instances, and several inspections of furnaces have been made. In one case, that of a furnace working a steam engine, in the Hertford Road, a summons was taken out against the owner, and led to the adaptation of an apparatus to the furnace. The nuisance however, in this case, was but little abated, as wood was burnt in the furnace as well as coal, so that the white vapours which escaped are as annoying as the black smoke. As the chimney was very low, I wrote to the Commissioners of Police, asking them to enforce the Smoke Act, which they have promised to do. By section 20, the Board is required "to make from time to time, either by itself or officers, inspection of "the district, with a view to ascertain what nuisances "exist calling for abatement under the powers of the "Nuisances Removal Acts, and to enforce the provisions "of the said Acts, in order to cause the abatement 11 "thereof," also to enforce the "Smoke Act." The maimer in which this section has been carried out, has already been referred to, and I trust, that the health of the inhabitants of the district, will be improved to an extent corresponding with the sanitary exertions which have been made. The number of nuisances discovered on inspection in each month was as follows: in August 1866, 816; in September, 383; in October, 370; in November, 507; in December, 812; in January 1867, 547; in February, 334; and in March, 516. During the corresponding period of 1865-66, the totals were as follows: in August, 1865, 97; in September, 208; in October, 89; in November, 102; in December, 98; in January, 1866, 71; in February, 90; and in March, 124, making a total of 879 under the old arrangement, against 4,285 under the new. I think these figures shew incontestably the necessity for a house to house inspection, such as has been carried out. The next section, the 21st, is one of very considerable importance, as it defines anew, the parties on whom notices shall be served under the Nuisances Removal Acts, and is therefore the section which must be referred to in taking proceedings, instead of the 12th section of the old Act. It also gives very considerably increased power, as it states that "where the nuisance arises "from the want or defective construction of any struc"tural convenience," notice shall be served on the owner. It also provides, that where the person causing 12 the nuisance cannot be found, and it is clear that the nuisance does not arise from default of the owner, then the nuisance authority may itself abate the same without further order. I have heard complaints that the Law is not sufficiently stringent, and that fresh powers are requisite. I cannot, except as regards water-supply and apparatus, agree with this view of the matter, and am persuaded, that with this exception, the powers are ample if the Nuisance and Sewer authorities will carry them out with sufficient energy, and the Magistrates enforce them as they should do. I have rarely failed for want of power under the Nuisances Removal Acts, and the other Acts, but have occasionally from some error in the notices or summonses. The next section, the 22nd, is also one of considerable importance, and if properly used, affords a powerful means for checking the spread of infectious and contagious diseases. The course which has been adopted, is to have a list of premises requiring disinfection inserted in a certificate to the Board or Sanitary Committee, and then to have notices served on the owners, requiring them to disinfect the premises, and to whitewash or lime-white the ceilings, walls of the rooms, staircase, and passages. They are required to perform the disinfection within 48 hours, and to cleanse and whitewash the premises immediately after the recovery of the sick. We have served 100 notices of this kind during the first three months of this year, of which only 23 remained to be carried out on the 1st of April. 13 The landlords are very anxious to carry out these requirements, so that it has not been necessary to take any proceedings before a Magistrate. I have also embodied in the same notice, the provisions of the 89th clause, by which landlords are prohibited, under a penalty not exceeding £20, from letting a house, room, or part of a house, in which any person suffering from any dangerous infectious disease has been, without having such house or room disinfected, as well as all articles of clothing, likely to retain infection, to the satisfaction of a qualified medical man, as testified by a certificate given by him. I think it very likely that the heavy penalty so provided, assists materially in inducing the landlords to do the work. The 23rd section, which is very important, has not been well carried out in the Hackney District, as the large disinfecting apparatus at the Hackney workhouse has been damaged and is not yet repaired, whilst the small one is only capable of disinfecting articles of clothing. By this section, the Board is empowered to provide an apparatus for the disinfection of "woollen "articles, clothing, or bedding, which have become "infected, and may cause any articles brought for dis"infection to be disinfected free of charge." This section has not been carried out in this district, although it has been in some others. There can be no doubt that it would afford a very important means of preventing the spreading of contagious diseases. The small apparatus now in use at the workhouse is 14 quate for such a district as Hackney, and it is to be hoped that a large one will be provided by this Board before long. The 24th section, which enacts, that it shall be lawful for the Board to provide and maintain a carriage, suitable for the conveyance of persons suffering from any contagious or infectious disorder, has been partly provided for by the cab which is kept at the workhouse, and was used last year for the conveyance of cholera patients. This cab is also used by the authorities of the German Hospital, whenever they have to remove a case of small-pox to the Small-Pox Hospital, but it is not such a conveyance as will enable the patients to be in a recumbent position when removed. I have thus prominently brought before the Board, the provisions of these two sections, as they are the only ones which have not been energetically carried out. As regards the 25th section—which prohibits persons suffering from any dangerous infectious disorder using a public conveyance, without previously notifying to the owner or driver thereof, that he is so suffering,—handbills, containing the clause at length, have been printed and distributed throughout the district. A similar course has been taken as regards the 38th clause, which prohibits any person suffering from any dangerous infectious disorder, from wilfully exposing himself in any street, public place, or conveyance; or any 15 person in charge of one so suffering. Also, the owner or driver of a public conveyance who may carry any person so suffering, without immediately disinfecting the vehicle; also, any person who may lend, transmit, or send any articles of clothing which may have been exposed to infection. I think these clauses should be printed and distributed at stated intervals, and summonses taken out if necessary. Section 26, which is next in order, provides for the removal to a hospital, on a Justice's order, of any person suffering from an infectious disease, who is without proper lodging or accommodation, or lodged in a room occupied by more than one family. It has not been as yet, necessary to take action under this clause, in this district; but it is most important, as it provides for the removal of a person so affected, against his own will, if in the opinion of the Medical Officer of Health, or any other qualified medical man, he be not provided with proper lodging or accommodation. The question to be decided, of course would be, what is proper lodging or accommodation; but 1 have no doubt, that the Magistrate would be guided by the medical opinion in such a case. Clause 27, which directs, that the Nuisance authority may provide a proper place for the reception of the dead, has been carried out in this district, and has been verv J useful, for no less than G2 bodies have been deposited therein. In order to carry out the clause, two notices are used, one which is served on the friends without 16 waiting for a Magistrate's order, and the other which would have to be served after obtaining an order. We have not as yet, had occasion to serve the latter notice, as the order for the speedy burial of the dead has always sufficed. I believe, that much good has been done under this clause. The Magistrates can only order the removal or burial of the dead body, when it is retained in a room in which persons live or sleep, or when the body itself is in such a state as to endanger the health of the inmates of the same house or room. There is therefore, no fear that the susceptibility of persons will be unnecessarily wounded. Clause 28, which enacts, that a Post Mortem room may be provided, has also been carried out, and has been found very useful for the deposit of dead bodies found in the river Lea, or in public places. These bodies are often in an advanced state of putrefaction, and are disinfected with Burnett's fluid directly they are brought to the Post Mortem room. A keeper of the Mortuary and Post Mortem room has been appointed and has one set of keys, another set has been given to the police, and a third is kept at the Town Hall. A form is kept at the Police Station, and forwarded to the keeper of the Mortuary directly a body is deposited there or in the Post Mortem room. The next section which concerns this Board, is No. 31, which extends the time for making an inspection of business premises. By the 11th section of the 17 sances Removal Act, power of entry was given, only between the hours of 9 a.m. and 6 p.m., but by this clause, it is extended to any hour during which the business is carried on. It has not been necessary to make any inspection at present, except in one instance, after G p.m., but cases may arise, in which this clause may be very useful. The 34th section enables the Board to require the payment of the costs and expenses of removing nuisances from the owner, or from any person who then or at any time thereafter occupies such premises. The claim has usually been made on the owner rather than on the occupier, as the latter can only be called on to pay the amount of rent due, whereas the owner can be compelled to pay in the manner ordered by the Magistrates. It is true that notice can be served on the occupier not to pay any rent to his landlord without first deducting the claim of the Nuisance authority, but as the goods of the owner can be distrained upon, and in the event of the goods being insufficient, the owner sent to the House of Correction, no difficulty should arise in obtaining payment from the owner, provided that the proper legal steps have been taken before doing the work. The 35th section, under which the regulations for lodging houses have been framed, is one of the most important in the Sanitary Act, but so far as I have seen, requires much care in carrying it out. Before the passing of the Act, there was not any difficulty in 18 obtaining convictions for over-crowding, under the Nuisances Removal Act, at some Police Courts but I believe there was in others. This section has this great advantage, that the district authorities have been able to obtain a regulation stating what is, and what is not, overcrowding. The first district for which regulations were obtained, was Hackney, and the minimum space, viz. 300 cubic feet for each adult in a sleeping room, may be considered as the minimum for other districts. The Secretary of State objected to this space as too small, but he granted it as being the first application to him to fix the breathing space requisite for an individual, and expressed a hope that a larger number of cubic feet would be afforded after a time; I can scarcely agree with this hope, and find great difficulty in enforcing this regulation. As regards the registra tion of houses, we have a book in which the size and cubical contents of every room in houses let at <£20 a year and under, are entered, and the legal number of occupants who may use the rooms for sleeping, or for sleeping and dwelling in. Nearly 5,000 houses have been measured and examined, and a large proportion entered in the book. The advantage of carrying out the Act in this way, is that there is no difficulty in finding the particular house in the register, whereas if entered in any other way, the index would be very cumbrous and difficult to use. We have not found it necessary as yet, to take out any summonses under the regulations, inasmuch as the ordinary powers under the Nuisances Removal Acts, have been found sufficient. 19 The great error, so far as I perceive, in framing the regulations has been, that no district has fixed a minimum penalty, while all have adopted the maximum penalty mentioned in the Act. As a copy of the regulations will he appended to my report, I need not refer to them at greater length, except to say, that they provide for proper water-supply and proper water-supply apparatus, which we cannot obtain under the Nuisances Removal Act. I may also mention that several houses above £20 a year, have been brought under the regulations. The 37th section, which allows the Vestries or Boards to provide Hospitals for the sick, has not been carried out in Hackney, as the Guardians have provided a small hospital for infectious diseases, and Mr. Gathorne Hardy's Act will give the Poor-Law Board all necessary authority for carrying out the objects of this section. The next section which I shall mention, is the 48th which empowers any Local Board to appoint any officer or member to institute and carry on any proceeding which the Nuisance authority is authorised to institute and carry on under the Nuisances Removal Acts and the Sanitary Act. This is a very important power as it enables the officer appointed, to conduct cases in the absence of the clerk. 1 have been authorised to do so for this Board, but I cannot act as advocate and witness in the same case, which renders the appointment less valuable than it otherwise would be. 20 The last section to which I shall refer, is the 53rd, which authorises the Nuisance Authority to issue a notice for the removal of manure or other refuse matter from mews, stables, and other premises, at such intervals as they may see fit, under a penalty of twenty shillings a day. In this district, notices have been served requiring its removal at least twice a week, but at present no prosecutions have been instituted for enforcing penalties. The brief resume I have made of this most important Act, shows the tendency which exists in the government of this country to subordinate private rights to public convenience. It can no longer be endured that a person shall spread disease and death amongst the population, and especially the poor, by neglecting to provide the most ordinary requirements of civilised life. But it must also be remembered, that a large proportion of the poorest inhabitants of all large cities, are so careless in their habits, to use no harsher term, that nothing but improved education, as well as constant sanitary supervision, can make the homes of the poor fit and proper habitations for bringing up a healthy population. The great end of all legislation, has been to improve the health of the population at large, and this fact must not be lost sight of in carrying out the various Sanitary Acts. I mean, that I do not consider it my duty to interfere with mere nuisances, but that there must be some evidence to show that the nuisances complained of are injurious to health. This has always 21 been laid down with more or less distinctness at the various Police Courts, and more especially since the passing of the Sanitary Act, as the Magistrates are of opinion, that the title of this Act, as well as of the others, point out the chief object for which the Acts were framed. I am enabled to give a return as regards the watersupply, of above 16,000 houses, through the courtesy of the East London and New River Water Companies, who have in accordance with my request, furnished me with the following particulars. The East London Water Company supplied at the date of their last examination, 9617 houses, and the New River Company 7000, The East London Company had 3826 houses on the constant and 5791 on the intermittent supply, whilst the New River Company had only 4 on the constant supply, except about 70 houses which "have a constant supply from two common cocks" in Cock and Castle Lane, Henry Street, Ebenezer Place, and James' Place. The East Loudon returns also showed that 5068 houses have cisterns, and 2185 good water butts, the remainder being indifferently provided with receptacles for storeage; that 6,006 closets have proper fittings and apparatus, and 3,059 have not any closet fittings, but are kept clear by throwing water into pans; the returns also showed that 812 houses are not supplied with water butts or cisterns of sufficient size. In a very large number of cases new water butts have been provided by the landlord, but I regret to say that 22 unless the Board will order water to be laid on to the closets, this cannot be entirely altered, as the magistrates have objected to order additional water butts in several cases latelv. The number of Births in the District was larger in 1866 than in any other year, having been 3,508 against 3,356 in 1865. The number of deaths was 2,394 against 2,187 in 1865. This was, as I shall presently show, a much smaller rate than that for all London. In comparing it with the death-rate of 1865, we shall find it to indicate a very much smaller increase than for all London. These arc extremely satisfactory results, especially when we consider our close proximity to the chief seat of the cholera outbreak. There were 211 deaths in the East London Union and German Hospital, which do not belong to this district, so that deducting these, there were 2,183 deaths of inhabitants. In calculating the proportion of deaths to population, I have allowed the rate of increase of population in the district to be a trifle more than 4 per cent, per annum, and have added the proportion of deaths in the London hospitals to the number of deaths in the district, so as to compare with the mortality for all London. The number of births to each 100 deaths has been calculated on the totals without deductions of any kind, so that they are fairly comparable, although not strictly accurate. The death-rate in London is that for the whole population, and for Hackney after corrections in the manner above stated. 23 I now give a table of the number of births ant deaths in Hackney for the last twenty years, the rate of births to deaths, the rate of deaths in each 10,000 inhabitants for London and Hackney during the same period, also the number of houses in St. John's a Hackney, and St. Mary, Stoke Newington, in 1851 1861, and 1867. Years. Hackney No. of Births. Hackney No. of Deaths. Hackney No. of Births to 100 Deaths. London Death-rate per 1000 Inhabitants. Hackney Death-rate per 10,000 inhabitants Hackney No. of Houses. 1847 1527 1128 135 269 234 1848 1541 1040 148 258 209 1849 1609 1194 135 301 231 1850 1656 924 179 210 178 1851 1799 1074 157 234 199 10,561 1852 2000 1117 179 225 199 1853 1891 1207 156 243 203 1854. 2038 1417 144 203 229 1855 2180 1419 150 243 205 1856 2275 1371 165 221 190 1857 2434 1484 165 224 192 1858 2454 1629 151 239 211 1859 2570 1663 164 227 197 1860 2632 1542 171 225 191 1861 2752 1745 157 231 206 14,296 1862 2768 1749 158 235 188 1863 3075 1932 159 244 214 1864 3170 2142 148 264 224 1865 3356 2187 153 243 208 1866 3508 2394 150 264 229 1867 18,753 47,235 30,288 156 240 207 This table shews that with the exception of the year 1853, the number of births in the district has increased annually, sometimes at a smaller, but at other times at a greater rate. The number of births in 1866 was more than double that for 1847, having been 3508 against 1527; and also the deaths, which amounted to 2394 in 1866 against 1128 in 1847. The average rate 24 of increase of population in the ten years 1851-61 was 4 per cent, per annum, which for the twenty years would be 80 per cent., but as both the births and deaths are more than double, we have every reason to assume that the population has also doubled itself in that time. The new houses which have been built since the last census in 1861, are also far larger in number than in the ten years 1851-61, 3735 houses having been built in the ten years, and no less than 4457 in the six years from Lady-day 1861, to Lady-day 1867. If the population has increased in a similar ratio, the death-rate for the last three or four years is decidedly too high. The third column shows that the average number of births to each 100 deaths was 156, having varied between 135 in 1847 and 1849, and 179 in 1850 and 1852. The total number of births was 47,235, and of deaths 30,288 or an excess of births over deaths of 16,947. A comparison between the rate of death in London at large and in Hackney, is very interesting, as it shows that in every year, the mortality was less in Hackney. The table also shows that the largest deathrate in London was in the year 1849, and the next in 1847, when the influenza was so very prevalent, and the rate the same as in 1864 and 1866. The table for Hackney, shows a variation in these years, as the largest death-rate was in 1847, the next in 1849, the next in 1866, and the next in 1864. The proportion in London varied between 203 deaths in each 10,000 inhabitants in the year 1854, and 301 in 1849, whilst in Hackney it ranged between 178 per 10,000 25 habitants in 1850, and 234 in 1847. In 1866, the numbers were 264 for London, and 229 for Hackney. As before stated, I believe this figure, 229 for Hackney to be too high. The average rate of death per 10,000 inhabitants for the twenty years was 240 for the whole of London, and 207 for Hackney. I have not any means of comparing the age at death, for London and Hackney during these years, but I have ascertained them for a few years and found the results for Hackney to be far more favorable even than the death-rate. It can however, scarcely be expected that the difference in the death-rate for the whole of the metropolis and for Hackney, will be so great for the future, as during the past twenty years, because Hackney is favorably situated for drainage, and inhabited by a much more wealthy class of persons than the whole of London. Sanitary over-sight has therefore not produced so great an improvement in the health of the inhabitants as in London generally. The district also has become much more densely populated in certain parts, and a much smaller class of houses is in course of erection at Hackney Wick, and other localities. Indeed, I think there can be but little doubt, that a very large number of houses for the working classes Avill be built in this district, by which the poor-rates will be increased, and the death-rate become larger. An increased sanitary supervision will also be necessary for these houses, for a very large proportion of the nuisances lately discovered, were in the houses occupied by the poorer classes. 26 I next purpose considering the table published by the Registrar-General of Births and Deaths, shewing the per centage of deaths from Choleraic disease in the various Metropolitan Districts. I am of opinion, however that the rate assigned for Hackney is far too high, as its population is calculated at 97,120, whilst at 4 per cent, per annum increase, which I consider too low, it would have been 101,224 on July 1st, 1866. I believe the population to be about 105,000. Table showing the Size, estimated Population, Number of Deaths from Cholera and Diarrhoea, Rate of Mortality per 10,000 in 1866, from Register-General's Report. Area in Statute Acres. Estimated Population in 1866. Deaths in 1866 from Rate of Mortality for 10,000 inhabitants. All Causes. Cholera Diarrhoea Cholera Diarrhœa Cholera and Diarrhœa North Districts Marylebone 1,509 159,871 4,129 54 181 30 11.3 14.3 Hampstead 2,252 23,557 395 2 15 0.8 6.4 7.2 Pancras 2,716 211,825 5,248 138 205 6.0 9.7 15.7 Islington 3,127 193,648 5,135 120 167 4.3 8.6 12.9 Hackney 3,929 97,120 2,394 103 74 10.6 7.6 18.2 South Districts. Shoreditch 646 136,836 3,411 135 145 10.7 10.6 21.3 Bethnal Green 760 110,289 3,824 614 181 60.4 17.4 76.8 Whitechapel 406 76,386 3,499 900 123 84.0 16 1 100.1 St. George's East 243 47,779 1,877 387 82 87.9 17.2 105.1 Stepney 576 56,198 1,849 557 111 107.6 19.8 127.1 Mile End 681 80,695 2,427 503 98 67.7 12.1 79.8 Poplar 2,918 99,762 3,687 835 187 90.8 18.7 109.5 Totals 19,646 1,266,676 37,875 4348 1569 533.8 154.5 688.3 Average — — — — — 44.5 12.9 57.4 This table shews, that within an area of 19,646 statute acres, amounting to a population of 1,266,676 persons, there were 37,875 deaths from all causes, 4348 from cholera, and 1569 from diarrhoea, making a total of 5,917 from cholera and diarrhoea together. It also 27 shows, that the average rate of death from cholera in each 10,000 inhabitants was above 44, and of diarrhoea about 13, making together 57.4 from cholera and diarrhoea. As before stated, the population on which the calculations are based, is I believe under-estimated for Hackney, but is probably about correct for the districts as a whole. I have selected the north and east districts because they are adjacent to Hackney, and form a natural group with it. As to the north districts, we find that Hackney, which is the most easterly of the group, suffered more from cholera than any of the others, but less from diarrhoea. This might have been expected to a much greater extent than happened, as the table shews that the inhabitants of the adjoining parishes, Bethnal Green and Poplar, were amongst the severest sufferers from the epidemic. The rate of mortality from cholera and diarrhoea in Hackney, was 18, in Shoreditcli 21, in Bethnal Green nearly 77, in Whitechapel 100, in Saint George in the East 105, in Stepney 127, in Mile End nearly 80, and in Poplar 109, per 10,000 inhabitants. The death-rate in these districts from cholera, varied between 10.6 and 107.6; and from diarrhoea, between 7.6 and 19.8 per 10,000 inhabitants. This comparatively small difference in the death-rate from diarrhoea, and the immense difference in those from cholera, point to some agent acting as a cause of cholera, with greater intensity in one district than in another. The extreme rapidity with which the disease reached its culminating point, also points to 28 some cause which was only temporary but which acted with great energy. 1856-66.—Deaths from Seven Epidemic Diseases. 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 49°0 51°0 49°2 50°7 47°0 49°4 49°5 50°3 48°5 50°3 49°8 Small-pox 13 1 0 5 2 1 2 41 12 6 31 Measles 39 22 36 10 43 36 32 37 79 22 26 Scarlet Fever 51 41 76 82 64, 58 83 125 64 98 68 Diphtheria — - 27 27 11 24 27 34 15 22 12 Whooping Cough 29 57 64 36 51 62 56 28 48 56 89 Diarrhœa 65 69 50 87 19 55 25 60 71 125 162 Fever 62 59 51 55 38 55 89 49 77 75 76 Total 259 249 304 302 228 291 314 374 366 404 464 Having mentioned a few additional facts connected with the great epidemic of last year, I shall now report very briefly on the mortality from the other seven most fatal epidemic diseases. This table shows that there were 464 deaths from small-pox, measles, scarlet fever, diphtheria, whooping-cough, diarrhoea, and fever. That of these 162 were caused by diarrhoea, so that if we exclude about 100 deaths which were probably produced by the choleraic poison, We should have about 364 from ordinary epidemic disease. This is a large number, especially as scarlet fever was on the decline, but it was partly caused by small-pox, the mortality from which was 31 against 6 in 1865, 12 in 1864, and 41 in 1863. There can be no doubt that a large proportion of these deaths could have been prevented by a more efficient system of vaccination and re-vaccination. I would, if space permitted, dwell especially on the importance of vaccination, but it will perhaps suffice to say, that a very large proportion of those who died last year from 29 small.pox, were either children who had not been vaccinated, or adults who had not been re.vaccinated. Measles, scarlet fever, and diphtheria produced a lower mortality than usual, whilst whooping.cough caused an unusually large number of deaths, and fever rather less than in 1864 and 1865, if we allow for increase of population. The numbers given in the above table are those actually registered, so that if used for comparison they should be increased, to allow for the increased population. Per Centages of Deaths in each Quarter, 1857 to 1866. Year 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 QUARTERS. First 27.5 27.7 24.4 31.8 29.2 27.1 28.3 28.2 25.7 24.6 Second 21.4 21.3 21.4 23.5 22.4 24.1 25.1 21.8 23.5 23.3 Third 24.4 21.8 27.2 20.0 24.6 201 24.5 22.8 23.6 27.2 Fourth 26.7 20.2 27.0 24.7 23.8 28.7 221 27.2 27.2 24.9 Totals 100 100 100 100 100 100 100 100 100 100 As might be expected, from the number of deaths from cholera and diarrhoea, the rate of death in the third quarter of the year, was decidedly in excess of the average. The only exception during the last ten years having occurred in 1859, when the rate of death was the same. The rate per 1,000 in each quarter, was as follows: in the first three months 246, in the second 133, in the third 272, and in the fourth 249. The mortality in the first quarter of 1865 and 1866, was, with the exception of 1859, the smallest in the corresponding quarters for the ten years. 30 The rate of mortality in the whole of London was 264, in the northern districts 253, and in Hackney 229 per 10,000 inhabitants. This is very satisfactory, when the close contiguity of this district to the chief seat of the cholera epidemic is considered, and affords good evidence of the salubrity of the district. The number of nuisances removed during the year was much larger than in any other year since the Board has been established. The attendances at the Police Courts have also been extremely frequent, especially in October and November, for no less than 53 summonses were taken out for hearing during the year. I attended with Mr. Valentine on each occasion, and obtained a favorable decision in almost every case. The nuisances abated in 1866, may he classed as follows: Privies emptied, filled up, and drained into the sewer 498 Privies nnd cesspools emptied 31 Choked drains cleansed and repaired 735—1264 Premises repaired and limewashed 1415 Premises ventilated 543—1958 Overcrowding abated 8 Dust, refuse, stable manure, &c., removed 941 Pigs removed, pig-sties repaired and cleansed 85 *Offensive places cleansed 59 Other nuisances abated 625 4940 *In addition to the above, all the Urinals were cleansed and tarred by the Surveyor's men, at least once during the Cholera epidemic. 31 The number of nuisances abated, is enormously above those of previous years, as the following numbers show: in 1856, 1567; in 1857, 1789; in 1858, 2515; in 1859, 1221; in 1860, 1267; in 1861, 1117; in 1862, 1135; in 1863, 1696; in 1864, 1410; in 1865, 1512. There were about 400 complaints of non-removal of dust and refuse in each year additional, except in 1866, when they are included. The number of summonses heard in each year was as follows: in 1856, 18; in 1857, 13; in 1858, 10; in 1859, 24; in 1860, 15; in 1861, 18; in 1862, 15; in 1863, 23; in 1864, 6; in 1865, 9; and in 1866, 53. I need scarcely say that the time and labour in superintending so large an amount of work, have been considerably in excess of former years; and so far as I can at present see, rhimu. will not be less for the future. I remain, Gentlemen, Yours obediently, JOHN W. TRIPE. June 1867