HAML 8 REPORT OF THE MEDICAL OFFICER OF HEALTH to THE VESTRY of Mile End Old Town. ANNUAL REPORT, JUNE, 1860. London: PRINTED BY F. S. NEWELL, ASSEMBLY ROW, MILE END ROAD. 1860. REPORT. Gentlemen, The deaths which in 1859 took place in Mile End Old Town exceeded in number those of the previous year by twenty two. In searching for the reason of the apparent increase, or for circumstances which would account for it, I had the satisfaction to find, that it might be said practically not to exist. The numbers arc correct, but the first return in the present year was for Saturday the first day in January, and the last for Saturday the 31st of December;—so that in 1859 we have the events of fifty three weeks to compare with those of fifty two weeks in 1858. Supposing that the average number of deaths be thirty weekly, the difference will be seen to be slightly in favour of the year on which it is now my duty to report to you. And when the progressive increase of the population is further taken into consideration, the result will be found to be still more favourable. Had the mortality of the year been greater than that of the preceding year, it would hardly have led to a supposition that the number of deaths was generally increasing, for, in my 4 last year's Report, I represented to the Vestry that the low mortality of the year (1858), should be considered entirely as a kind of privileged exception in the ordinary course of events; that our District had probably been less exposed to sundry occult causes of disease, than others on every side of us, including some which possessed natural advantages superior to our own, and which in some degree had the privilege of the supervision and authority which a reapplied to large towns, while they also approximated in another direction to the state of freedom of atmospheric circulation which renders rural districts at once attractive and salubrious. It is therefore with pleasure that I am able to announce to you, a state of the public health equally favourable with that of the previous year, which was at that time so good as to be considered beyond probability of early repetition. How far this sensible diminution of mortality is attributable to the means which have been employed, with the earnest purpose of effecting it, time alone will conclusively show. Whether it be so or not, it is perfectly clear that the major portion of the reduction has closely followed the extensive general improvements which have been made in the Hamlet, and in one or two instances so rapidly that it is unreasonable to look for any other material cause. The population is increasing fast, and in such a manner that it is next to impossible to ascertain exactly either its rate of increase, or its aggregate number. We may, however, be certain of a minimum in the excess of births over the deaths, which, last year, amounted to 1200 and upwards. The considerable addition to the number of inhabited houses will show us that the increase of inhabitants is not limited to that number, and it is not easy to estimate by how much it is increased by the influx of new residents. The census which will be taken next April will supply much useful information which is now deficient; it will enable me to test the mode hitherto adopted of computing the continual addition to our population, and either give 5 confidence in the method used, or suggest some other more correct means of calculating progressive increase. I have been accustomed to add 2½ per cent. per annum, but I believe that in the last two years that allowance is insufficient. The Tables I have used would admit, I am aware of some improvement, but the advantage of uniformity is great where tables are used for statistical comparison, and for the sake of that advantage I have not deviated from the forms used in the past years. The first Table contains a statement of the Births and Deaths which have been registered in the Hamlet. TABLE I. BIRTHS, 1859. Births. Deaths. Excess of Births over Deaths. First Quarter. 716 390 326 Second Quarter 671 327 344 Third Quarter. 642 463 239 Fourth Quarter 708 413 295 Total 2737 1533 1204 The second,—the Ward population, acreage, population to the acre, the mortality in the different Wards, the sex of those who died, and the rate of deaths per 1000 persona living. 6 TABLE II. wards. Population as estinaated in 1856. Acres. Number of Persons to the Acre deaths, 1859. Rate ot Deaths per annum to every 1000 persons living. 1st ter. 2st ter. 3rd ter. 4th Quarter. Total. m. f. m.&F. North 12,188 162 75 74 57 70 79 125 155 280 22.9 East 7,262 193 37 42 40 37 34 77 76 153 21. West 11,712 78 150 70 60 81 82 154 139 293 25. Centre 16,775 135 124 92 80 110 80 185 177 362 21.5 South 13,511 113 119 84 70 81 106 168 173 341 25.2 Workhouses - - — 26 19 20 31 38 58 96 - Hospitals — — — 2 1 4 1 5 3 8 - Totals 61,448 681 390 327 103 413 752 781 1533 Mean rate for 1859 23.1 The mortality, by this table, will be seen to have diminished in some of the wards, which have been noticed as having generally an undue proportional number of deaths; and the whole number of deaths appear to be tolerably equally distributed according to the ward population. The rate of mortality in all London was in 1859, 22.29 per 1,000 persons living. The deaths in the Workhouses are not more numerous although the occupation of the new buildings has largely increased the number of persons. Cases of Fever and Small-pox which as they occurred last year were sent to the Fever Hospital, are now sent to the Infirmary of the workhouse. The healthy state of the workhouse may be still better understood, when it is known that in addition to nearly 400 adult poor, there are about 200 children in the part of the establishment specially devoted to them 7 Some deaths are necessarily returned for the East Ward which do not properly belong to its own mortality. The number is increased by the bodies of those who are found drowned in the Regent's Canal being nearly always taken to the east side, which is in the East Ward, there being no convenience for their reception on the other side. The proportion of Zymotic diseases to those of an ordinary character is greater by one third than in 1858,—and the Centre Ward appears to have been visited more heavily than the others—one of every three deaths which were there registered was the result of Zymotic influence, snch as are regarded as being to a great extent capable of prevention. The general proportion last year of Zymotic disease to the whole number was about 1 to 3.8, in the year 1858 it was 1 to 5. TABLE III. DEATHS FROM THE SIX PRINCIPAL ZYMOTIC DISEASES. WARDS. Deaths from all Diseases Deaths from Zymotic Diseases. Or in the proportion of 1 to— North 280 82 3.4 East 153 37 4.1 West 293 83 3.5 Centre 362 120 3. South 341 73 4.6 Workhouses 96 8 12 Hospitals 8 — — Total 1533 403 Diseases of this kind produced the greatest number of deaths in the third week in July and the second week in 8 August, 29 and 23 respectively; the Centre Ward standing first on the list from its large population, and, as I expect the census will inform us, the greater proportion of children to adults;—in that Ward there were 11 in July, 12 in August. In the same week, i.e. the second in August, there were 10 deaths from Zymotic diseases in the West Ward; in the other wards the mortality from each causes being comparatively low. The variety of terms used in the medical certificates with respect to Cholera, would indicate even in the absence of a low return of cases of that disease that it was not epidemic. One case in the North Ward, and one in the West, were returned as Choleraic Diarrhoea, and in the Centre four cases termed respectively—Cholera Asiatica,—Cholera,—Cholera Auglica,—and Cholera Infantum, and one in the South Ward called Cholera Sporadica. (Sporadic diseases are those which are opposite in character to contagious disease.) Thirteen persons are said to have died from Diphtheria, 5 in the Centre, 3 in the North, 2 in the South, 2 in the East, and 1 in the West. Scarlatina and Measles have both been fatal to an extent to be lamented; no class of persons appears to have been spared by either disease, and I am not able to suggest any mode of prevention, except that to which I intend hereafter to allude in this Report, viz.—the adoption of systematic visitation of houses, upon which alone can reliance be placed to prevent the frequent recurrence and extension of diseases of this class. Of the former 128 deaths are registered, 53 in the first quarter of the year, 30 in the second, 14 in the third and 31 in the fourth. The deaths from Measles were 39:—22 in the first quarter, 5 in the second, 7 in the third, and 5 in the fourth. In the next Table are set forth the ages of the individuals at the time of death; a large proportion will be noticed of children under 5 years, which great preponderance is mainly owing to the extent to which Scarlatina has prevailed. 9 TABLE IV. DEATHS AT PARTICULAR AGES. AGES. DEATHS. 1st Qr. 2nd Qr. 3rd Qr 4th Qr. Total. Under 5 years 157 135 231 179 699 From 5 to 10 years 16 21 21 19 77 „ 10 „ 15 „ 6 4 5 5 20 „ 15 „ 20 „ 7 7 6 8 28 „ 20 „ 30 „ 24 19 24 19 86 „ 30 „ 40 „ 27 24 20 37 108 „ 40 „ 50 „ 28 23 27 26 104 „ 50 „ 60 „ 27 36 20 20 103 „ 60 „ 70 „ 35 25 16 36 112 70 and upwards 63 36 33 64 196 390 327 403 413 1533 10 TABLE V. CAUSES OF DEATH. DISEASES: DEATHS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4lh Quartet Total Fever 11 15 11 17 54 Small Pox 5 9 6 13 33 Measles 5 7 5 22 39 Scarlatina and Cynanche Maligna 31 14 30 53 128 Diarrhœa 3 1 4 . 8 Cholera . . 6 . 6 Dysentery . . . . . Diphtheria 3 4 3 8 18 Whooping Cough 12 9 11 4 36 Croup 2 4 4 7 17 Erysipelas 1 1 1 3 6 Diseases of Abdominal Organs 9 11 6 12 38 Pulmonary Consumption 43 51 47 30 171 Inflamation of the Lungs 36 23 15 48 122 Diarrhœa, Bronchitis, and Pneumonia of Children under 3 years 30 30 97 29 186 Water on the Brain, and Convulsions of Infants 34 35 21 31 121 Dropsy 6 5 11 5 27 Cancer 2 6 7 3 18 Hernia . 1 . . 1 Diseases of the Heart and large Bloodvessels 20 13 5 14 52 Apoplexy, Paralysis, and Diseases of the Brain 26 18 14 25 83 Puerperal Fever 2 1 2 3 8 Premature Birth, an Debility from Birth 24 12 18 13 67 Violence, Privation, and Poison 9 3 6 5 23 Natural Decay 43 30 24 45 142 Other Diseases, chiefly Chronic 33 24 49 23 129 Total 390 327 403 413 1533 11 The following statement of the mortality of the first quarter of the present year, will bring the whole up to the period prescribed by the Act of Parliament. QUARTERLY SUMMARY OF THE MORTALITY RETURNS IN MILE END OLD TOWN, FOR THE QUARTER ENDING MARCH 25, 1860. Births 774 Deaths 514 Excess of Births over Deaths 260 Of the 513 deaths, 239 were males, and 275 females. The weekly average of deaths was,— 1860. 1857. 1858. 1859. In January 41 33 31.8 35.2 In February 40 32 27.5 30.25 In March 38 31.75 30.25 34.25 The comparative mortality of the five Wards of the Hamlet will be shown by the following statement;— North. East. West. Centre. South. Workhouses. Hospitals. 95 52 107 102 125 29 4 WATER ANALYSIS. The quality of the water which forms so large a portion of daily aliment is of such importance in a sanitary view, 12 that I cannot allow it to pass unnoticed. It is important on account of the quantity consumed, and the observed influence which its constituent content has had upon the occurrence and course of endemic disease. I have in former reports pointed out the effects likely to be occasioned by the use of well-water, which is more injurious than other water from the quantity of impurity it has too frequently been found to contain. To prevent an unnecessary occupation of space in exposition of the subject, I have reduced to a Table the analysis of various waters, made by Dr. Thomson for the Registrar General's Report. July, 1859. Aug. 1859. Sept. 1859. Oct. 1859. Nov. Total impurity per gallon. Organic Impurity per gallon. Total Im per gallon. Organic impurity per gallon Total Impurity per gallon. Organic Impurity per gallon. Total Impurity per gallon. Organic impurity per gallon. Total Impurity per gallon. gs.or ds. gs or ds gs or ds. gs or ds gs or ds. gs or ds. grs.or drs. gs.ords. gs.ords. Pure Distilled Water 0.0 0.0 Loch Katrine Water (new supply to Glasgow) 2.14 0.80 2.14 0.8 2.14 0.8 2.14 0.8 2.14 Clyde (old supply to Glas 9.57 gow 1.08 Manchester Water supply Thames Water London Bridge 159.20 16.80 Pumps and Wells. Aldgate 49.12 13.94 Camberwell 62.67 10.69 Ditto Church Street 112.56 13.44 Ditto ditto GrosvenorCottagesPimlico 82.40 8.0 Military Well, Newcastle 100.32 ParkCresent, Regents Park Newton Well, Wisbeach Ditto ditto . Pall Mall Sandgate St. Thomas' Street, South- wark Thames Companies. Chelsea 15.48 .92 17.20 1.52 15.90 1.0 18.56 2.08 18.44 Southwark 14.76 .76 16.40 1.60 14.76 0.96 17.20 1.64 18.04 Lambeth 16.00 1.16 17.28 1.20 16.00 1.36 17.60 1.20 21.50 Grand Junction 15.40 1.20 16.06 0.84 15.52 1.60 17.96 0.96 22.16 West Middlesex 15.72 .72 15.40 0.72 15.60 1.84 17.52 1.20 19.96 Other Companies. East London 16.36 .92 17.28 0.80 18.76 1.16 22.80 1.88 21.16 New River 14.60 1.16 15.24 0.88 17.32 1.16 18.80 1.60 22.40 Kent 21.68 1.84 21.84 2.32 23.84 1.72 23.32 2.04 28.28 13 Two deductions will be at a glance made from an examination of the Table. One, the great amount of impurity contained in well-water, and the other that the water we consume, that of the East London Company, does not stand out very favourably in comparison with that supplied through most of the other London Companies. I do not wish it to be inferred that the impurity of the water supplied by the East London Company is so great that the water is at present in any degree unwholesome, but at the same time wish to point out its inferiority. 1859. Dec. 1859. Jan, 1860. Feb, 1860, March, 1860. Apr, 1860. May, 1860. June, 1860. Organic Impurity per gallon Total Impurity per gallon. Organic Impurity per gallon. Total Impurity per gallon. Organic Impurity per gallon. Total Impurity per gallon. Organic Impurity per gallon. Total Impurity per gallon. Organic Impurity per gallon. Total Impurity per gallon. Organic Impurity! per gallon. Total Impurity per gallon. Organic impurity per gallon. Total Imparity per gallon. Organic purity per gallon. gsords. gs. ords gsords. gs. ords. gs ords gs. ords. gsords. gs. ords. gs. ords gsords gsords. gsords. gsords. gsords. gsords. 0.8 2.14 .8 2.14 9.8 2.14 0.8 3.36 0.96 3.2 0.96 3.16 .0 1.18 0.80 4.32 0.96 96.48 5.92 100.05 15.05 15.92 348.80 21.00 481.76 49.6 106.24 6.68 40.96 5.20 89.70 10.40 1.72 17.44 1.44 18.00 2.12 20.36 1.68 20.56 1.60 19.84 1.44 17.84 1.48 14.92 0.80 2.36 20.80 2.00 23.60 3.0 21.92 l.76 20.56 1.48 19.76 1.52 17.08 1.64 16.64 l.76 2.20 19.60 1.76 20.80 1.20 21.84 1.80 19.68 1.68 19.20 1.68 20.80 1.40 16.20 1.30 2.52 23.88 1.68 22.72 2.72 21.62 1.68 20.56 1.76 20.0 1.60 20.72 2.00 17.32 1.08 1.84 22.56 2.32 21.60 2.60 20.84 1.96 20.40 1.84 19.04 1.36 20.08 2.08 16.72 1.48 0 1.92 25.12 2.40 22.84 1.80 24.00 2.00 22.40 2.00 22.59 2.0 23.64 3.20 20.00 2.00 2.24 21.52 l.40 21.87 1.48 21.20 1.44 20.72 2.00 20.92 1.92 18.52 1.66 17.00 1.00 1.92 27.2 3.56 23.24 1.72 27.52 2.00 25.92 2.08 22.80 2.24 21.68 2.96 20.00 1.30 14 SLAUGHTER-HOUSES. In the course of the inspection of the Slaughter-houses which was made in October by myself and the Inspector of Nuisances, for the purpose of opposing or recommending the granting of the licences by the Magistrates at the Quarter Sessions, your Medical Officer observed that but few of the premises already licensed were applied to the use for which they were intended, and for which the license was obtained; most of them being used as stables or lumber sheds,—so that the witholding of the assistance of the Vestry to obtain a license, if it were deemed requisite, would be injurious to the individual but to a trifling extent, if, in fact, it would be so at all. It does not appear, however, that it would be for the public advantage that the continuation of a license for premises of the kind should be, in ordinary cases, discouraged ; because as long as they are designated as Slaughter-houses, and so licensed, they are placed under the supervision of the local authority ; whereas, if unlicensed, the occasional or periodical visits of the Inspector of Nuisances would be avoided and the places lost sight of, except they were complained of as productive of nuisance, or injury to health. The conversion of old premises into Slaughter-houses appears to be an impossibility if the terms of the Statute are observed, and in most instances the erection of new ones would be attended with much difficulty. The Metropolitan Building Act of 1844 prohibits, in very clear terms, the introduction of any addition to the number of Slaughter-houses except under conditions with regard to distance from a dwelling-house or a public highway, which almost amounts to a total prohibition. The 55th clause in the Act is so important and peremptory, and at the same time satisfactory in diminishing responsibility, that I have transcribed a portion of it for insertion in this Report, the Act itself being extensive. 15 7 and 8 Victoria, cap. 84, see. 55. "And now for the purpose of making provision concerning Businesses offensive or noxious, be it enacted, with regard to the following Businesses that is to say,— Blood-boiler, Soap-boiler, Bone-boiler, Tallow-melter, Fellmonger, Tripe-boiler, Slauohterer of Cattle, Sheep, or Horses, and any other like Business offensive or noxious, so far as relates to the erection of buildings in the neighbourhood of any such business, and so far as relates to the carrying on of any such business in the neighbourhood of any public way, or of other buildings of the First or Dwelling-house Class. That it shall not be lawful hereafter to erect any buildings of the first or Dwelling-house class nearer to than Fifty feet from any building which shall be in use for any such offensive or noxous business; but if a building already existing within Fifty feet be hereafter burnt pulled down, or destroyed by tempest, such building may be rebuilt; and that it shall not be lawful for any person to establish or newly carry on any such business either in any building, or vault, or in the open air, at a less distanco than Forty feet from any public way, or than Fifty feet from any other such buildings as the First or Dwelling-house class; and that if any such business be now carried on in any situation within such distances, then, from the expiration of the period of Thirty years next after the framing of this Act, it shall cease to be lawful to continue to carry on such business in such situation, save as hereinafter provided; and that if any person erect any building in the neighbourhood of any such business contrary to this act, then, on conviction thereof beforo Two Justices he shall forfeit a sum not exceeding Fifty Pouuds for every day during which such building shall remain near to such otfensive or noxious business; or if any person establish anew any such business, or carry on any such business contrary to this Act, then, on conviction thereof before Two Justices, such person is hereby made liable to forfeit for every day during which such business shall be carried on, a sum not exceeding Fifty Pounds, as the said Justices shall determine." The rest of the clause relates to Costs, and mode of enforcing the penalty. The Building Act subsequently passed in 1855, 18 and 16 19 Victoria, Cap. 122, repeals the whole of the previous Act of 1144, except the Section above quoted, the one before it, and eight others immediately following, namely from the 54th section to the 63rd. The premises already licensed far exceed at present the requirements of the trade, and the license must be mostly sought to give a little additional value to the premises in the event of their being offered for transfer or sale. The Slaughter-houses which were but little used being for the most part in a worse condition than those constantly in use, I believe that a periodical inspection of them and a return of the existing state by the Inspector of Nuisances would be advantageous It would, at least, ensure the performance of occasional cleansing and white-washing which now are avoided. HOUSE VISITATION. It is a truth which will not admit of the slightest doubt that the Hamlet of Mile End Old Town has been during the last four years manifestly improved in condition. Ample proof is afforded by the statistical returns, that the public health has derived, from the various improvements made by public and private expense, considerable advantage. I hope it will not be considered either out of place or a useless repetition, if I again revert to the principal cause of the extent of Zymotic disease amongst us. I refer to the defective state of the habitations of the poorer class, and to point out, that the remedy for the evil is only to be secured by a systematic house visitation. To look this subject fairly iu the face it will be well to consider that the existence of disease by infection involves certain conditions,—and that some of those conditions which are indispensable to its origin and progress, may be easilyrecognised, and when found, without much difficulty suppressed. 17. Cursorily to follow to a short distance this view, we must suppose for the existence of such disease,— 1st. A source generated by one or more persons, or by an impure state of atmosphere; and then take into consideration,—2nd, the local condition, whether capable of largely diluting and dispersing, or of confining, aud concentrating the means of infection previously generated;—3rd, the personal condition of those who are exposed to its influence. The local condition, or that of the interior of houses, especially those of small size, is that to which I am desirous to draw your attention, inasmuch as small houses are more usually defective than houses of a superior class, the defects being there more speedily reformed where discovered. More power, too, rests with the occupier in this case than in the former, a poor tenant seldom being able to do much more than to change from bad to worse. It is true that much remains with the tenants themselves, some preferring filth to cleanliness, and who almost universally select unwholesome places for residences, if they are to be had. It is obvious that the best opposition would be to have no such places for persons of such perverse habits to shelter in. Certain diseases affect individuals alnost indiscriminately who have not previously undergone the ordeal of a sustained attack; others are only to be avoided by attention to ordinary but important preventive measures; but, if the first are to be considered as almost a natural evil, the force of such diseases is to be foiled and their fatality conseequently reduced, while for the very existence of the latter we are in a great measure responsible. The undisturbed concentration of those subtle agents which cause disease, and to which the term infection or contagion is applied, should by every reasonable means be opposed and counteracted, but obviously mainly by cleanliliness; with the exterior, or public portion of the Hamlet, such as streets, roads, and pavements, the Vestry have amply 18 dealt, and have improved the large district under their charge, not only in appearance, but in reality. The quantity of pavement which has been placed on the footways is not only agreeable to the eye and pleasant for use, but by preventing dampness to houses, contributes a large share towards the improved state of the health of the public. The continual addition to the general system of drainage has also contributed its proportional advantage. The clearing away in some places of unhealthy houses, and the substitution of others constructed according to modern ideas of fitness, is another great feature in the improvements which have doubtless caused the low rate of mortality. Although space is, according to the opinion of those men who have most carefully considered the subject, too much economised, and the houses too numerous for the space they occupy, yet, if only by establishing a more perfect contrast between the properly constructed, clean, and healthy dwelling, and the decayed, dirty, and unwholesome one, some benefit will accrue to compensate for the disadvantages arising from close congregation. It may also excite a sort of competition between the holders of house property, when it is discovered that, as persons proceed to distinguish their own interests with regard to health, and the interests of their families, the best landlords will alwavs secure the best ' •/ tenants. But although so much has been effected by the public improvements at the general expense, there remains much more to be done than is usually credited. If the low state of mortality we appear to have attained, is to be continued and perpetuated, it will be necessary to look beneath the exterior, which is acknowledged to approach a condition which leaves but little to be wished for. Having done so much for thestreets, pavementand drains, the improvements will lose half their salutary effect on the public health, if the interior of the dwellings, particularly those of the poorer class of inhabitants are not placed in a corresponding condition of 19 some cleanliness. Hitherto isolated cases have met with all the prompt attention desirable, for when it has been discovered that a foul drain, water-closet, or cesspool lias existed, any improper accumulation of filth, any defect in means of cleanliness, they have been cleansed, cleared away, or altered by the authority of the Vestry. But the information upon which cleansings have been made, have been for the most part accidental and fortuitous, the amount of such work is less than it should have been, and less than in numbers of our surrounding districts. It is known to be a grievous defect to have a foul drain, damp walls, &c., and I believe that they exist in much greater extent in Mile End than we are at present aware. To do away completely with so prolific a source of disease, and attendant expense and misery, it is only requisite to obtain the knowledge of the existence of that which, when known, is acknowledged to be injurious, in a methodical, systematic manner, instead of depending upon straggling information for direction. Without a general house inspection it is impossible to secure the proper entry to, and use of, the expensive sewers which have been and are now being constructed. The number of cesspools remaining in the Hamlet is, I believe, considerable, and as there is no dispute existing as to the propriety of their destruction, there can be but little doubt as to the advantage to be gained from greater readiness in discovering their existence. In endeavouring to promote by these remarks house inspection, I believe I am performing a clear act of duty, the nature of which requires I believe only to be understood to be disarmed of everything like unpleasantness and, offence to either proprietors of houses or tenants, both of whom would eventually be gainers by the results of examination. Suppose, for instance, that several deaths from contagious disease, such as fever, are reported to have taken place in a certain house, the house is then inspected by the officers of the Vestry in consequence of the event: it is perhaps found 20 defective in every particular, constituting a breeding place, a perfect hot-bed for generating disease; the sick are then cared for, the house purified and repaired, and the disease ceases both to exist and to disseminate germs which are capable of reproducing it in a similar form in other individuals. In this example, that which was done, should have been done before life became sacrificed ; it could not be done without the condition of the house was known, and the condition of the house could not be known without inspection. That which applies to one honse applies with greater force to the many, and the amount of suffering and disease capable of being prevented and saved by the adoption of the course recommended I believe would be great. Such inspection, without waiting for complaint, would be the surest way to avoid every cause of complaint. Even if Epidemic disease should, contrary to probability and expectaation, break out in places so regulated, it could not acquire any powerful poisoning force, and the outbreak would actually die out for want of its natural support. I have the honour to be, Gentlemen, Your most obedient servant, J. H. FREEMAN, Medical Officer of Health for Mile End Old Town. Town House, July 10th 1860. Newell, Printer, Assembly Row, Mite End Road.