VESTRY OF THE HAMLET OF MILE END OLD TOWN. ANNUAL REPORT UPON THE PUBLIC HEALTH AND Sanitary Condition of the District, FOR THE YEAR 1895, BY THOMAS TAYLOR, MEDICAL OFFFICER OF HEALTH. LONDON: PRINTED BY W.J. HASTED & SON 306 MILE END ROAD, E. 1896 THIS BEING THE SPECIAL FILE COPY FOR LIBRARY B.M.A., IT IS PARTICULARLY REQUESTED THAT IT MAY BE RETURNED AT AS EARLY A DATE AS POSSIBLE. VESTRY OF THE HAMLET OF MILE END OLD TOWN. ANNUAL REPORT UPON THE PUBLIC HEALTH AND Sanitary Condition of the District, FOR THE YEAR 1895, BY THOMAS TAYLOR, MEDICAL OFFICER OF HEALTH LONDON: PRINTED BY W.J. HASTED & SON 306, MILE END ROAD, E . 1896. The Annual Report OF THE MEDICAL OFFICER OF HEALTH. For the Year 1895. To the Vestry of the Hamlet of Mile End Old Town. GENTLEMEN, I have much pleasure in presenting to you my Ninth Annual Report for the year ending 1895. I know that the Members of the Vestry will appreciate the difficulties under which one labours in formulating a report of this description; as prima facie each report bears similarity to those preceeding it. We have to deal with Infectious diseases of all kinds, the Sanitation of the Hamlet, the work that is in progress at the present time, and that which has been carried out. It must be well known to most of you that an important Act of Parliament, which is of great interest to Sanitary Authorities, has been added during the last year to the Statute Book, and is now in operation, viz.: The Facftory and Workshops' Art 1895. This Art will entail an extra amount of labour on my Department; but I have no doubt that its provisions, when carried into effect, will improve the health of the workingclass, and be of great benefit to the community at large. It will prevent overcrowding, ensure proper ventilation, which is most essential, wearing apparel will no longer be allowed to be made on any premises which are not subject to inspection, and when infectious disease occurs on any premises where Clothing is being manufactured, the Act invests the Sanitary Authorities with full power to at once stop such work and take means to prevent infectious disease being spread broadcast. This subject is treated fully in another part of this report (page 34.) 4 During the past year we have had to deal with many important and vital matters affecting the health of the Hamlet, such as an epidemic of Small Pox; the want of a proper water-supply; and the consequences arising therefrom; the seizure of a large quantity of unsound food; and other matters which are dealt with in the following pages Vital Statistics. The Population of the Hamlet, estimated to the middle of the year 1895, is 108,443, and it is on these figures that the statistics in the following tables are based. As there is to be another census in the coming year, in my next report I shall be able to state the exact population. In. Intercensal periods one can only give the numbers approximately, but the above figures may be regarded as substantially accurate. During the last ten years our residential population has been undergoing a remarkable metamorphosis. As old residents die or migrate into the suburbs they are replaced, in many cases, by aliens of a very mixed class. Births and Birth Rate. The number of Births during the last twelve months is 4,205, giving an annual birth-rate of 38.9 per 1,000. Deaths and Death Rate. The number of Deaths that have occurred during the year from all causes is 2436, giving a death-rate of 22.5 per 1,000 per annum, that of the Metropolis being 19.4 for the same period. Table X. contains a comparison for the last five years of the death-rates for London, the Eastern districts, and Mile End Old Town. This year our death-rate bears the same comparison with London as it did last year. It cannot be expected that this district can compare as favourably as the West End parishes, bearing in mind the differences in circumstances of its inhabitants; but it is worthy of note that with the Eastern districts as a whole, whose people are to a large extent in the same station of life as our own, we always have and do this year compare favourably. TABLE A. / STATISTICS AS REQUIRED BY THE LOCAL GOVERNMENT BOARD. TABLE OF DEATHS during the Year 1895,in the Sanitary District of Mile End Old Town, classified according to DISEASES, AGES and LOCALITIES. Names of Localites adopted for the purpose of these Statistics; public institutions being shown as separate localities. Mortality from all causes, at subjoined ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all ages. under 1 year 1 and under 5 5 and under 15 5 and under 25 25 and under 65 65 and upwards 1 2 3 4 5 6 7 8 9 10 11 12 3 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diptheria. Membranous Croup. fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea & Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis. Pneumonia, and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) Mile End Old Town 1788 676 352 50 55 372 283 Under 5 12 48 8 4 78 36 108 8 216 7 2 501 1028 5 upwds. 1 8 5 3 1 2 1 92 175 90 5 377 760 Mile End Infirmary 254 6 2 9 130 107 Under 5 1 1 4 6 5 upwds. 1 4 2 42 44 43 4 108 248 City of London Union 68 2 21 45 Under 5 1 1 2 5 upwds. 1 6 12 3 44 66 East End Mothers' Home 8 5 3 Under 5 5 5 5 upwds. 3 3 South Grove Workhouse 58 1 13 44 Under 5 1 1 5 upwds. 2 26 1 28 57 Totals 2176 688 354 52 64 539 479 Under 5 12 49 8 4 78 36 108 8 217 7 3 512 1042 5 upwds. 1 8 6 4 3 1 7 1 140 260 137 9 557 1134 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto. 394 75 90 26 30 131 42 Under 5 1 10 39 1 2 3 8 3 21 1 71 165 5 upwds. 2 9 9 I 2 3 23 21 22 9 128 229 Deaths occurring within the district among persons not belonging thereto 134 6 2 37 89 Under 5 1 7 8 5 upwds. 3 6 41 4 72 126 TABLE B. STATISTICS AS REQUIRED BY THE LOCAL GOVERNMENT BOARD. Table of Population, Births, and of new Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1895, in the Hamlet of Mile End Old Town Sanitary 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. Population at all Ages. Registered Births. Aged under 5 or over 5 New Cases of Sickness in each Locality coming to the knowledge of the medical officer of health. Nomber of such cases Removed From Their Home in The several Localities forTreatment in Isolation Hospital 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 1 6 1 7 1 8 1 9 10 11 Census 1891. Estimated to middle of 1895. Smallpox. Scarlatina. Diphtheria. Membranous Croup. fevers. . Smallpox Scarlatina. Diphtheria. Membranous Croup. fevers. Typhus. Enteric or Typhoid. Continued Relapsing Puerperal Cholera. Erysipelas Typhus. Enteric or Typhoid. Continued Relapsing Puerperal Cholera. Erysipelas. (a) (b) (c) (d) (e)#] Mile End Old Town 107592 108443 4205 Under 5 7 210 133 13 2 18 7 72 39 5 upwds. 26 384 234 1 58 2 2 151 25 161 47 7 Mile End Infirmary Under 5 2 2 5 upwds. 1 1 1 12 1 London Hospital Under 5 1 31 49 1 1 1 10 12 5 upwds 13 51 67 19 36 13 16 31 Children's Hospital, Shadwell Under 5 2 7 1 0 3 5 upwds. 4 9 2 7 Smith Grove Workhouse Under 5 1 5 upwds. 1 1 4 Tower Hamlets Under 5 1 Dispensary 5 upwds. St. Bartholomew's Under 5 Hospital 5 upwds. 1 3 2 1 1 1 Totals Under 5 8 245 190 13 3 21 8 85 54 5 upwds. 41 440 312 1 81 2 2 205 40 l80 85 8 TABLE X. Shewing the Death-rate per 1000 persons living, from the undermentioned causes in London, the Eastern Districts of London, and Mile End Old Town, 1891 to 1895. london. eastern districts. mile end old town. 1891. 1892. 1893. 1894. 1895. Average for the Five Years. 1891. 1892. 1893. 1894. 1895. Average for the Five Years. 1891. 1892. 1893 1894. 1895. Average for the Five Years. Principal Zymotic Diseases 2. 2 2. 8 3. 0 2. 6 2. 6 2. 6 2. 7 3. 7 3.7 3. 5 4. 0 3. 5 2. 7 3.6 3. 6 4.0 3. 9 3. 5 Small Pox .06 .04 .02 .01 .02 ... .01 .06 .03 .01 .02 .. ... .07 .03 ... .02 Measles .4 . 7 .3 .7 .6 .5 .5 .8 .5 1.1 1.1 .8 .3 .6 .3 1.1 1. 0 .6 Scarlet Fever .1 2.0 .3 .2 .2 .5 . 1 .4 .4 .2 .2 .2 .1 .3 .3 .3 .2 .2 Diphtheria .3 .4 .7 .6 .6 .5 .5 .5 .9 .7 .8 .6 .3 .7 .7 .7 1. 0 .6 Whooping Cough .6 .5 .5 .4 .3 .4 .7 .9 .9 .6 .4 .7 .4 1.0 .7 .6 .4 .6 Typhoid Fever .1 .09 .1 .1 .1 .07 .1 .1 .2 .1 1. .1 .1 .1 .2 .1 .1 .1 Diarrhoea .5 .5 .7 .4 .8 .5 .6 .6 1.1 .5 1.0 .7 .5 .6 1.1 .6 1.0 .7 Deaths from all causes 21.0 20.3 20. 8 17.4 19.4 19. 8 23. 1 24.3 25.8 21.8 24. 3 23.8 21.2 23. 0 22. 8 21.1 22.5 22.1 Deaths under one year to 1000 Births registered 154 154 164 142 165 156 163 166 181 161 180 170 149 153 150 155 165 154 RETURNS OF MORTALITY IN THE Including the Deaths occurring in the Workhouse Infirmary and excluding the Deaths in the Jewish Home, Stepney Green; Moses Alms Houses, Devonshire Street; Trinity Alms Houses; City of London Union; The East End Mothers Home; and South Grove Workhouse. DISEASES. AGES. 0 1 1 5 5 15 15 25 25 65 65 90 Smallpox ... ... ... ... ... ... Scarlatina 4 8 1 ... ... ... Diphtheria 5 43 7 1 ... ... Membranous Croup 1 7 ... ... ... ... Typhus Fever ... ... ... ... ... ... Enteric or Typhoid Fever ... ... 1 3 2 ... Continued Fever ... ... ... ... ... ... Relapsing do. ... ... ... ... ... ... Puerperal do. ... ... ... ... ... .... Cholera ... ... ... ... ... ... Erysipelas 4 ... ... ... 1 3 Measles 26 52 1 2 ... ... Whooping Cough 15 21 1 ... ... ... Diarrhoea and Dysentery 85 23 1 ... ... 3 Rheumatic Fever ... ... ... ... 1 ... Ague ... ... ... ... ... ... Phthisis 5 3 6 26 99 3 Bronchitis, Pneumonia and Pleurisv 127 90 5 7 108 99 Heart Disease 3 4 6 6 71 50 Injuries 2 1 ... 1 8 ... All other Diseases 405 100 23 18 212 232 682 352 52 64 502 390 HAMLET OF MILE END OLD TOWN FOR 1895. Deaths of Parishioners of Mile End old Town which occurred in Public Institutions outside the Hamlet, such as Hospitals, Asylums, &c. Total Deaths from all causes. AGES. AGES. 0 1 5 15 25 65 0 1 5 15 23 65 l 5 15 25 65 90 1 5 15 25 65 90 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 9 2 ... ... ... 5 17 3 ... ... ... 7 32 8 ... 1 ... 12 75 15 1 1 ... ... ... ... ... ... ... 1 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 2 ... ... ... 4 7 4 ... ... ... ... ... ... ... ... ... ... ... ... ... .... .... .... ... ... ... .... .... .... .... .... ... .... ... ... ... 1 ... ... ... .... ... 1 ... 1 ... ... .... 2 ... 5 ... ... ... 3 3 1 6 ... ... ... ... 27 58 1 2 ... ... 2 1 ... ... ... ... 17 22 1 ... ... ... 7 1 ... ... 2 1 92 24 1 ... 2 4 ... ... .... ... .... ... ... .... ... ... 1 .... ... .... .... ... ... ... ... .... ... ... ... .... 1 2 2 4 l6 1 6 5 8 30 5 4 9 12 ... 1 14 6 136 102 5 8 122 105 ... ... 3 2 13 4 3 4 9 8 84 54 ... 1 2 2 5 ... 2 2 2 3 13 ... 46 25 6 1 75 30 451 125 29 35 287 262 75 90 26 36 131 42 757 442 78 94 633 432 6 Small Pox. Of all the diseases of the zymotic class, Small Pox is by far the most loathsome: it is the one disease that the Public as a body dread, not only for its loathsomeness, but on account of the disfigurement to the person which years ago was so prevalent; this rarely occurs now-a-days owing in a great measure to vaccination and other prophylactic means that have been adopted in the scientific treatment of the disease, and also to improved sanitation. The disease when it becomes epidemic in a city like London, is very difficult to stamp out, and were it not that isolation and proper treatment have been adopted during later years, the disease would have had a more serious effect on the mortality than it has had. The fact that there was an epidemic of Small Pox in London during the past year cannot be disguised. This epidemic began to manifest itself on the south side of the Thames in July, and rapidly spread to other parts of the Metropolis, In the week ending July 6th there were thirty-five cases, the weeks ending July 14th thirty-three cases, July 21st nineteen cases, July 28th one hundred and six cases, Aug. 4th fifty-one cases, and so it went on until the commencement of September, when the disease showed marked signs of abatement. Altogether nine hundred and seventy-nine cases occurred in London during the year. The disease on the whole was not of a malignant type ; in fact it was of a very mild character, and the mortality was extremely low, only fifty-five fatal cases occurring, the percentage of deaths being 17.8. It is only just to the Asylums Board Authorities to remark that they proved themselves equal to the occasion and spared neither pains nor money in the prompt removal of the cases when called upon by the Local Authorities, and the public are indebted to them for their skilful and humane treatment in their isolation hospitals. I have had many opportunities of seeing patients who have re-covered, and they have without exception expressed their gratitude for the treatment they received. 17 In order to give those members of the Vestry who are not on the Sanitary Committee, some idea of the prevalence of the disease in Mile End, I may state that for about a fortnight previous to its appearance in the Hamlet your officials had seen the gradual progress of the epidemic towards this district, and preparation was made for its reception. On the 22nd of July the first case occurred in Harford Street; the man worked at Southwark, where the disease was rife. He was promptly removed to the isolation hospital, and the clothing disinfected; the walls of the room stripped of thiir paper and disinfected also. The next case occurred on the 25th July in Mulberry Street, close to Whitechapel; this case was removed and similar precautions taken. On July 26th seven cases occurred in various parts of the Hamlet, on July 27th seven cases, on July 30th three cases, on July 31st two cases, and so on in a desultory manner until August 30th, when the epidemic may be said to have subsided, but it will be seen from the Tabulated Statement (page 20) that several isolated cases occurred after this date. There is no doubt that the disease was imported from the neighbouring parish of Whitechapel where it seems to have originated to a large extent in the Salvation Army Shelter. In fact, these organizations in other parts of London helped materially to spread, if not propagate, the disease; this is no more than could be expected since that large bodies of vagrants are herded together without proper air space being allotted to them. So much for the origin of the disease in our district. The means which were adopted in almost every case to prevent the spread of the disease were the same—to remove each patient as early as possible to the Asylums Board's Hospital. Enquiries were made at each house where the outbreak occurred as to the origin and source of the disease, the previous employment of the patient, the address of the employer (who was written to), and as to vaccination of the patient and inmates of the house. Disinfection was carried out, and where the clothes were very old and dirty they were 18 burnt, and the owners compensated. The Surveyor kindly co-operated with me in having all the refuse cleared away from the houses daily for a fortnight, the house drains and sewers in the immediate locality were Hushed with disinfectants, and instructions given to the inmates what to do if any other cases occurred. In several instances where the Medical men were in doubt as to the diagnosis of the disease, I saw the patients and consulted with them. I must say that the officials of my department worked regardless of time and trouble to prevent the disease from spreading. Such was the pressure of work that the men had to be kept at the disinfecting oven, whilst others were stripping the rooms, and disinfecting, etc., all one Sunday. As soon as the outbreak became epidemic, in accordance with the order under which I hold my appointment, I made a special report to the Vestry, a copy of which was sent to the Local Government Board. The following is the text of this report:— To the Mile End Vestry. Special Report on the Epidemic of Small Pox in Mile End Old Town. July 31st, 1895. Gentlemen, It is my duty to inform you that during the last week an epidemic of Small Pox has broken out in the district. Twenty cases have been reported to me since Thursday last; they are not confined to any part of the district, but are scattered all over the Hamlet. Nearly all of them have been traced as originating from the parish of Whitechapel. Every precaution which we have power to take is being made use of, and so far all the cases have been removed to isolation Hospitals. It is very desirable that vaccination and re-vaccination should be carried out on the inmates of the houses where the diseases have occurred. I should recommend that the Guardians be asked to empower their District Medical 19 Officers to vaccinate these inmates at their homes as early as possible. I am, Gentlemen, Your obedient servant, THOMAS TAYLOR, Medical Officer of Health. The fact that the epidemic made its appearance at this period of the year was most unusual, as November is the month when we may reasonably expect a recrudescence of this disease, and this circumstance called forth the appended letter from the Local Government Board. Local Government Board, Whitehall, S.W. Sir, 2nd August, 1895 I am directed by the Local Government Board to bring under the attention of the Vestries and District Boards in the Metropolis, the fact that Small pox has recently undergone considerable increase in London, and thai, its extension tends to involve a number of Metropolitan sanitary districts. The circumstance is more noteworthy, since at this season of the year Small-pox in London is, as a rule, at its lowest ebb. The Board attach very great importance to the most energetic measures being taken in connexion with the cases which are occurring, with the view of preventing the spread of infection, and they will be obliged to the Authority it they will specially instruct their Medical Officer of Health in every case which may be notified to him or which may come to his knowledge, immediately to visit the house where the disease has broken out, and at the earliest possible moment to take such measures as may be necessary to secure as far as practicable the isolation of the patient, the vaccination of any persons who may have been exposed to infection, and the disinfection of the premises, and any further action which the circumstances will admit of, for the purpose of checking the extension of the disease. The Board deem it desirable that the Authority should as regards each case be informed precisely of the measures which have been taken by the Medical Officer of Health, and they will be glad to be furnished with copies of the reports which are made by him on the subject. I am, Sir, Your obedient Servant, HUGH OWEN, Secretary. As soon as the epidemic had subsided I made another special report to the Vestry (a copy of which was also sent to the Local Government Board) stating the means that had been adopted to prevent a spread of the disease, and enclosing a copy of the tabulated statement showing the information that was obtained relative to each case. TABULAR STATEMENT OF occuring in Mile Name of Patient. Address. Age Occupation. E. H. 55. Jubilee Street, 18 G. H. ,, ,, 12 J.G. 158, Harford Street 24 Porter S. w. 11, Mulberry Street 16 Cigar Maker F. M. 34, Sceptre Street 2½ H. G. 10, Greenwood Street 19 Porter in Book Shop. J. v. 88, Exmouth Street 24 Labourer W. P. 25, Lomas Buildings 19 Glass Traveller G. B. 55, Romford Street 23 Tea Porter J. w. 16, Lydia Street 20 Coal Porter S. T. 17, Romford Street 67 Rag Sorter s. c. 88, Stepney Green 29 Medical Student I.J 17, Stepney Green 17 Mechanic H. F. 8, Whitehorse Lane 23 Clerk M. F. 11, Copley Street 20 Bookbinder W. K. 36, South Grove 20 Mechanic W. L. 75, Greenfield Street 15 Wheelwright G. S. 47, Wilson Street 18 Labourer H. T. 17, Canal Road 24 Warehouseman S. B. 36, Grove Road 9 I. K. 55, Varden Street 18 Shoemaker C. I. 35, Myrdle Street 13 W. R. 44, Varden Street 10 A. P. 158, Harford Street 3 CASES OF SMALL POX End Old Town. Condition as to Vaccination. Date of Notification. If removed to Hospital. Remarks as to Cause, etc. Not known Feb. 4 Yes Had been staying at Leytonstone, where patient was taken ill. Vaccinated „ 18 ,, No doubt caught from previous case. Vaccinated July 22 ,, Works at Southwark Bridge Road. Several cases occurred in S. A. shelters in Southwark. ,, ,, 25 ,, Visited London Music Hall on the 12th inst. Unvaccinated „ 26 ,, One child in house unvaccinated. Two vaccinated. Vaccinated ,, ,, ,, Works at Fenchurch Street. Two children, both vaccinated. ,, ,, ,, ,, Works at Bell Foundry,Whitechapel. Close to S. A. shelter. ,, ,, ,, ,, Three children, all vaccinated. Works at Hackney Road. ,, ,, ,, ,, Two children in house, all vaccinated. Works at Eastcheap. ,, ,, ,, ,, Tramp. House shut up. ,, ,, ,, ,, Six children in house, all vaccinated. Works at Goswell Road. ,, „ 27 ,, No children in house. Probably contracted disease at London Hospi tal. ,, ,, ,, ,, No children in house. Works at Engineers, Whitechapel. ,, ,, ,, ,, Three children, all vaccinated. Clerk at Old Change. ,, ,, ,, ,, All vaccinated in house. Employed in the City. Unvaccinated „ 28 ,, Three children, all vaccinated. Works at Minories. Vaccinated ,, 27 ,, Works in Yalford Street, Whitechapel Cause, probably among workpeople. ,, ,, ,, ,, Works at Brass Foundry, Commercial Road. ,, ,, 30 ,, Four children in house, all vac. Works in Friday Street, City. Unvaccinated ,, ,, ,, All in house vaccinated. not known ,, ,, ,, One child in house vaccinated. Vaccinated ,, ,, ,, Four children in house, vaccinated. Probably caught disease at Swimming Bath, Whitechapel. ,, ,, 31 ,, Four children in house, all vac. Unvaccinated Aug. 2 ,, Second case in the house. SMALL POX of Patient Address. Age. Occupation. J. w. Mile End Casual Ward Vagrant A. M. 32, Heath Street 27 I. B. 23A, Tollett Street 18 Shoe-black E. L. 34, Sceptre Street 35 L. W. 28, Mile End Road 6 F. H. 33, Clark Street 25 Labourer W. C. 15, Doveton Street 19m A. C. 1, Cornwall Street 3½ H. S. 2, Stayners Road 26 Drayman H. H. 10, Monteagle Street 20 Servant W. M. 46, Longnor Road 12 I. P. Manor House, White-h.-lane 11 C. W. 23A, Tollett Street 27 Shoe-black A. A. 18, Coutts Road 2 E. C. ,, ,, 42 Labourer E. G. 4, Cornwall Place No occupation H. O. 1, Cornwall Square 8 A. W. 25, Albion Street 18 Traveller I. R. 37, Albion Street Brush Hand M. S. 1, Brad well Street 20 L. B. 66, Exmouth Street 3½ J. K. 17, Lincoln Street 23 Butcher G. L. H. 69, Harford Street 2½ M. M. 18, Bancroft Road 40 J.C. 107, Moody Street 37 CASES (continued.) Condition as to Vaccination. Date of Notification. If removed to Hospital. Remarks as to Cause, etc. Vaccinated Aug. 5 Yes Slept at S.A. shelter, Royal Mint St. ” ” 8 ” And vaccinated in house. Was at Ramsgate 10 days previous. ” ” 10 ” Shoeblack outside Bow Station. ” ” ” ” Second case in the house. ” ” ” ” Cause not known. ” ” 12 ” Works at Cooper's Tea Warehouse, Crutched Friars. Unvaccinated ” ” ” Father works as porter at Billingsgate. ” ” 14 ” Father Cabinet Maker, works in City. Vaccinated ” 16 ” Four children, three of which unvaccinated. Cause not known. ” ” 19 ” Patient only lived here three weeks previous to attack. ” ” 20 ” Father Coffee House Keeper. All children in house unvaccinated. ” ” ” ” Mother Charwoman. All family vaccinated. ” ” 21 ” Stands at Cornhill. Second case in the house. Unvaccinated ” 24 ” Father Dock Labourer, three other children unvaccinated. Vaccinated ” 25 ” Out of work. ” ” 24 ” Family friendly with No. I, Cornwall Square, where there was a case. ” ” 25 ” Second case in the house. ” ” 28 ” Cause not known. ” ” 29 ” Works at Brush Makers, Mile End Road. ” ” 30 ” Related to patient at 46, Longnor Road. ” Sept 1 ” Patient returned from Margate 14 days previous. In infancy ” 15 ” Butcher, business at 302, Manchester Road, Cubbitt Town. No children. No lodgers. Unvaccinated Oct. 1 ” Friend of lather played with child and his family had recently had Small-pox. Unknown ” 8 No. Not known. Vaccinated Nov. 18 ” Husband works at Salmon & Gluckstein, Farringdon Street, E.C. Table shewing Deaths from all causes, and also from the principal Zymotic Diseases, in the various Metropolitan Districts as well as Mile End Old Town, during the year 1895. Name of District. Total Deaths from all causes. Small-pox, Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Simple and Undefined Fever. Diarrhoea. Death Rate per 1,000 living. Deaths under 1 year to 1000 Births register'd Registration London 55 2628 829 2289 1480 5 596 10 3574 19.4 165 Paddington ... 19 14 47 20 ... 13 94 17.2 164 Kensington ... 34 28 90 38 ... 15 1 116 16.5 172 Hammersmith 1 27 17 44 43 ... 12 ... 81 16.7 166 Fulham ... 51 21 77 50 ... 12 1 130 18.7 187 Chelsea 1 11 25 57 35 ... 13 ... 79 19.2 168 St. George, Hanover Sq. 1 10 10 24 26 ... 9 1 36 15.9 138 Westminster ... 25 6 21 15 ... 3 ... 41 21.3 185 St. James, Westminster ... 2 3 4 10 ... 6 ... 6 17.8 144 Marylebone 9 25 14 35 39 ... 23 1 93 20.8 138 Hampstead ... 9 8 14 7 1 9 1 29 12.0 135 St. Pancias 1 228 52 131 94 ... 30 ... 205 20.5 174 Islington 1 141 67 146 79 1 30 2 219 17.2 143 Hackney 1 120 41 83 65 1 45 ... 189 17.4 ... St. Giles, Bloomsbury 2 13 6 13 13 ... 2 ... 28 22.9 160 St. Martin-in-the-Fields 1 2 2 7 6 ... 1 ... 5 18.1 265 Strand 2 6 9 13 3 ... 5 ... 11 25.3 175 Holborn ... 45 6 7 8 ... ... ... 24 25.2 212 Clerkenwell ... 93 17 34 41 1 11 ... 53 23.0 192 St. Luke, Middlesex ... 106 5 20 21 ... 6 ... 66 30.2 184 City of London ... 15 4 8 3 ... 13 ... 12 21.4 157 Shoreditch 2 106 30 58 87 ... 22 ... 155 23.3 199 Bethnal Green 4 116 30 101 34 ... 17 ... 139 21.4 162 Whitechapel 4 82 23 58 19 ... 10 ... 51 24.1 157 St. George in-the-East ... 88 20 50 21 ... 7 ... 60 29.5 196 Stepney 1 86 20 45 40 ... 10 ... 59 27.3 202 Mile End Old Town. 1 88 25 104 40 ... 15 ... 123 22.5 165 Poplar 1 216 48 152 80 ... 33 ... 147 22.6 183 St. Saviour, Southwark ... 17 6 13 13 ... 1 ... 26 25.5 205 St. George, Southwark ... 49 14 17 38 ... 7 ... 69 25.4 198 Newington 4 132 16 52 71 ... 15 1 110 24.1 201 St. Olave, Southwark ... 3 ... 4 7 ... 2 ... 15 24.1 206 Bermondsey ... 114 16 29 20 ... 11 ... 80 22.3 162 Rotherithe 1 19 8 31 10 ... 9 ... 32 19.3 148 Lambeth 2 150 53 112 132 ... 26 2 264 19.6 152 Battersea 1 98 30 92 53 1 22 ... 145 17.4 177 Wandsworth 2 30 16 46 24 ... 26 ... 106 14.8 132 Camberwell 7 111 46 179 68 ... 33 ... 204 18.3 164 Greenwich 3 49 36 184 65 ... 17 ... 121 18.9 150 Lewisham ... 12 9 14 32 ... 7 ... 52 14.4 135 Woolwich ... 6 11 14 3 ... 9 ... 30 17.5 153 Plumstead 2 24 10 36 5 ... 30 ... 46 15.2 133 Stoke Newington ... 7 1 5 5 ... 4 ... 17 13.4 116 Cases of Infectious Disease notified to the several Metropolitan Medical Officers of Health, under the provisions of the Public Health (London) Act, 1891, in the Fifty-two weeks ended Saturday, 30th December, 1895. Name of District. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Totals. Estimated Population in the middle of 1895. Registration London 1076 20654 11426 3710 15 107 249 5994 461 30 13722 4392346 Paddington 13 441 246 73 ... ... 9 112 9 1 904 122756 Kensington 8 525 365 99 ... 3 7 269 13 ... 1289 167671 Hammersmith 8 391 204 59 ... 5 2 91 6 ... 766 108429 Fulham 2 353 389 65 ... 3 9 112 16 ... 949 117745 Chelsea 5 590 321 82 ... 2 8 113 2 ... 1123 99930 St. George, Hanover Sq. 4 327 114 41 ... 3 1 72 5 ... 567 74037 Westminster 6 187 112 28 ... ... 3 31 2 ... 369 54003 St. James, Westminster 1 94 49 14 ... 1 1 24 1 ... 185 23149 St. Marylebone 115 567 252 144 ... 4 9 258 3 1 1353 137392 Hampstead 4 331 119 67 ... 3 4 53 3 ... 584 77592 St. Pancras 17 1150 582 170 ... 4 18 443 19 ... 2403 233513 Islington 25 1814 612 214 4 9 23 365 18 ... 3084 335929 Hackney 18 1081 520 272 1 6 14 316 13 1 2242 215623 St. Giles, Bloomsbury 14 163 66 26 ... ... 1 65 6 ... 311 37654 St. Martin-in-the-Fields 8 40 23 16 ... ... ... 7 ... ... 89 13536 Strand 5 112 39 23 ... ... ... 18 2 ... 199 22586 Holborn 40 167 58 21 ... ... 1 70 5 ... 362 32188 Clerkenwell 12 346 143 58 1 5 4 101 16 ... 686 65036 St. Luke, Middlesex 3 161 105 35 ... 1 2 91 6 ... 401 40763 City of London 6 167 50 40 ... 1 2 26 ... ... 292 33824 Shoreditch 19 603 260 109 ... 4 2 196 19 1 1213 122932 Bethnal Green 111 791 471 131 ... 2 7 820 39 ... 1872 130061 Whitechapel 109 561 316 32 1 ... 1 117 14 ... 1151 75820 St. George-in-the-East 20 328 249 39 ... 2 1 75 5 ... 719 45227 Limehouse 24 418 198 55 ... 1 2 78 5 ... 781 56885 Mile End Old Town 49 685 502 84 ... 2 2 226 14 ... ... 108443 Poplar 30 1021 750 181 1 13 8 294 45 ... 2343 171230 St. Saviour, Southwark 4 106 67 11 ... ... 1 21 2 ... 212 26570 St. George-the-Martyr 50 186 106 45 ... ... 2 63 4 1 457 60168 Newington 23 431 281 89 ... 1 9 149 17 ... 1000 119358 St. Olave, Southwark 1 36 23 2 ... ... 1 4 ... ... 67 13065 Bermondsey 8 815 119 60 ... 1 4 80 6 ... 593 83861 Rotherithe 48 280 140 42 1 ... ... 89 9 4 613 40713 Lambeth 64 1453 676 226 1 20 17 393 27 17 2894 284883 Battersea 25 857 388 140 1 6 10 262 41 ... 1730 165130 Wandsworth 18 669 272 137 ... 3 7 229 21 2 1358 185956 Camberwell 87 892 912 246 ... 2 17 323 14 2 2495 252737 Greenwich 43 878 877 156 2 ... 19 217 19 ... 2211 175183 Lewisham 1 288 123 43 ... 1 8 73 3 ... 540 82410 Woolwich 1 190 67 55 ... ... 2 34 ... ... 349 42768 Plumstead 18 329 138 230 ... 2 6 51 9 ... 786 61494 Port of London 2 ... 4 3 1 ... 1 ... ... 11 ... Stoke Newington ... 141 61 33 ... ... 1 30 4 ... 270 35234 26 Scarlet Fever. The epidemic of this disease, which commenced in London some time ago, is still prevalent. At intervals during the past year it has shown signs of abatement. In the months July, August, and September, so great was the increase in the number of cases that all the available Fever Hospitals were full, and a large number had to be treated at their homes ; this naturally led to a rapid increase of the disease. In this district at one time we were ten days waiting for a vacancy, a state of things particularly deplorable in a crowded district like Mile End ; there is no doubt that this was a means of propagating the disease. In a number of instances amongst the poorer classes the patient occupied the same apartment in which the family lived. This condition was not singular to our district, and as a result a conference of the various Sanitary Authorities was held at Marylebone, at which delegates from this Vestry and myself attended to consider what remedial steps should be taken, The result of the conference was that a resolution was passed calling on the Asylum Board authorities to open for fever patients the Gore Farm Hospital, containing 600 beds (which had been kept specially for the isolation of Small Pox cases, and was then unoccupied). Shortly after this conference the Gore Farm Hospital was opened, and was of considerable service in relieving the pressure of cases. It was stated at the meeting that two additional Fever Hospitals were in course of construction and would be completed in March, 1896. When the epidemic assumed such a serious form, I thought it necessary to communicate with every Medical Practitioner in the district, asking them to notify for removal only such cases as were without proper isolation and accommodation. The number of cases which occurred in our district during the past year was 685, and the number of fatalcases 265. The accompanying chart will show, week by week, the rise and fall of the disease. 27 Diphtheria. This disease has during the year been very prevalent throughout the Metropolis, and the faCt that its origin has not been satisfactorily proved, makes it more difficult to deal with. We are aware of many causes which are favourable to its spread, not the least of which is the congregating of large bodies of children in schools, and defective and badly-ventilated sewers and drains. It is our duty to use every endeavour to prevent its spread. In this district we had notified 190 cases under five years of age, and 312 over five. In each instance enquiries were made as to whether any children in the house were attending school; if so, this was at once stopped until the patient was well enough to allow disinfection to take place. The drainage in each house, when considered necessary, was tested with the smoke apparatus. During the past year 402 drains were tested in this manner, and 112 found to be defective. In my last annual report I spoke of the investigation that was being carried out with the " Antitoxin treatment," in London and elsewhere, which treatment briefly consists of the inoculation of a specially-prepared serum into the system of the patient. The results of this investigation in London, Paris, and Berlin are as follows:— An important report, signed by the medical superintendents in the hospitals where the antitoxin treatment had been employed, was presented to the Metropolitan Asylums Board recently. The period covered by the Board extended from January 1st, 1895, to December 31st of the same year. During that time, with the exception of an interval of three months at the Eastern Hospital, when its use was suspended; of periods of four months at the Western and North-Western, of three months at the Fountain, and to a considerable extent throughout the year at the South-Eastern Hospital, when all cases were consecutively treated, irrespective of their severit)—the serum was administered only to cases which at the time of admission were severe, or which threatened to become so. In ► 28 a certain number the patients being moribund at the time of their arrival and beyond the reach of any treatment, no antitoxin was given. No change took place during the year in local treatment of the cases, and there was no new factor in the treatment other than the injection of antitoxin. The report went on to say that it must be clearly understood that, with exceptions pointed out, it had been the practice at each of the hospitals to administer serum to those cases only in which the symptoms on admission were sufficiently pronounced to give rise to anxiety, the mild cases not receiving any. 61.8 per cent. of the admissions were treated with antitoxin. No less than 46.4 per cent. of the antitoxin cases were under five years of age, against 32.5 per cent. in the non-antitoxin group, and only 16.1 per cent. in the former class were over ten years of age, against 33.8 per cent. in the latter. The high fatality of diphtheria in the earlier years of life is notorious. It was obvious, therefore, that to compare the mortality of those treated with antitoxin with that of those which during the same period were not so treated would be to institute a comparison between the severe cases and those of which a large proportion were mild. That would clearly be misleading. The only method by which an accurate estimate could be obtained as to the merits of any particular form of treatment was by comparing a series of cases in which the remedy had been employed with another series not so treated, but which were similar, as far as could be, in other respects. That in the present instance, was impossible; but having regard to the fact that 61.8 per cent. of the 1895 cases were treated with serum, an approximately accurate comparison could be drawn by contrasting all cases of diphtheria completed during 1894. For that purpose a number of tables were given, showing that of 3,042 patients of all ages treated during 1894, 902 died—a mortality of 29.6 per cent.; whereas, of 3,529 cases treated during 1895, 796 died—a mortality of 22.5 per cent.; the difference in percentage between the two rates being therefore 7.1 That, assuming that the former rate would otherwise have been maintained, represented a saving of 250 lives during the past year. In tables which showed the cases exclusively dealt 29 with by antitoxin during 1895, and those with all cases in 1894, striking differences were observed in the figures giving the results of treatment commenced upon the first and second days of illness. In the antitoxin cases the mortality per cent. for the first day was only 4.6 per cent., and for the second day 14.8 per cent.; whilst for 1894 the figures were 22.5 per cent. and 27 per cent. respectively. In another table it was shown that the combined tracheotomy mortality for all the hospitals, which in 1894 was 70.4 per cent., had fallen to 49.4 per cent. in 1895. That was a lower death-rate than had ever been recorded in any single hospital of the Board for a year's consecutive tracheotomies. In other words, rather more than 50 per cent. of children on whom the operation had been performed had been saved since the employment of antitoxin. In one of the hospitals no less than a fraction under 60 per cent. survived, although the recoveries in that hospital in any former year did not exceed 25 per cent., and in the preceding year— viz., 1894—were as low as 10 per cent. The medical superintendents conclude their report by the following statement: The improved results in the diphtheria cases treated during the year 1895, which are indicated by the foregoing statistics and clinical observations, are—(I) a great reduction in the mortality of cases brought under treatment on the first and second day of illness; (2) the lowering of the combined general mortality to a point below that of any former year; (3) the still more remarkable reduction in the mortality of the laryngeal cases; (4) the uniform improvement on the results of tracheotomy at each separate hospital; (5) the beneficial effeCt produced on the clinical course of the disease. A consideration of the foregoing statistical tables and clinical observations, covering a period of twelve months and embracing a large number of cases, in our opinion sufficiently demonstrates the value of antitoxin in the treatment of diphtheria. It must be clearly understood, however, that to obtain the largest measure of success with antitoxin it is essential that the patient be brought under its influence at a comparatively early date—if possible not later than the second day of the disease. 30 From this time onwards the chances of a successful issue will diminish in proportion to the length of time which has elapsed before the treatment is commenced. This, though doubtless true Of other methods, is of still greater moment in the case of treatment by antitoxin. Certain secondary effects not infrequently arise as a direct result of the injection of antitoxin in the form in which it has at present to be administered; and even assuming that the incidence of the normal complications of diphtheria is greater than can be accounted for by the increased number of recoveries, we have no hesitation in expressing the opinion that these drawbacks are insignificant when taken in conjunction with the lessened fatality which has been associated with the use of this remedy. We are further of the opinion that in antitoxic serum we posses a remedy of distinctly greater value in the treatment of diphtheria than any other with which we are acquainted. The Chairman moved that the report be circulated at the discretion of the clerk to the press and the public. In Paris before using serum the mortality from diphtheria in the hospitals has scarcely ever been below 50 per cent.; since its use, the mortality has fallen to less than 24 per cent., all of the cases baing diagnosed bactariologically. In one of the hospitals in Paris, from February 1st to July 24th, 1894, the serum treatment was applied on four hundred and forty-eight children, of whom one hundred and nine died, equal to 24.5 per cent. mortality. During the same time at this hospital, where the serum treatment was not used, there were five hundred and twenty cases, of which three hundred and sixteen died, equal to 60 per cent. mortality. During my recent visit to Paris I was much impressed by this method of treatment as carried out bv our Parisian brethren. In one of the hospitals in Berlin. three hundred and three cases were treated with serum, and had a per centage death-rate 31 of 13.2; whilst two hundred and thirty treated without serum had a percentage death-rate of 47.8. Typhoid Fever. In 1895 only 81 cases were notified to me as occurring in the Hamlet. There is much more certainty in the diagnosis of this disease than of diphtheria, for instance. We may, therefore, take these notifications as being correct, only 15 of which proved fatal. In seventy instances the drains were tested and twenty-two found to be defective. The defects were remedied under the direct supervision of the Inspectors. It often happens in the testing of drains after infectious diseases, as well as on complaints, that the house drains are found to be sound, and the smoke is seen issuing in volumes through the flap trap of the nearest street gully. This happens very frequently in narrow streets, where the gullies are situated just outside the front doors of the houses. They are from time to time not only a great nuisance but also a source of danger to the public health. During the past year when complaints have been made and the matter brought specially before the Sanitary Committee, gullies having a water seal have been fixed, and this prevents sewer gas escaping through them from the sewers. The work of reconstructing all the gullies in the Hamlet on this principle ought to be undertaken without delay; and although it would be a costly matter, the benefit to the public health would repay the outlay. Measles. Although Measles is one of the least dangerous of the Zymotic class, it spreads contagion rapidly, especially amongst children. This disease is not at present notifiable under the Act, and therefore it is difficult to know when it assumes an epidemic character. Principally by the mortality returns wo become aware of its presence in this form. During the month of March it was found to be abnormally high in the East Ward, and on making inquiries I discovered that a severe 32 epidemic was taking place in the neighbourhood of St. Paul's Board School. On visiting the school I found that about onesixth of the children were away, said to be suffering from this disease. The teachers rendered me all the assistance possible, and from them I learnt that these children were scattered over the districts of Mile End, Poplar, and Limehouse. Inquiries were made by the officials in the outside parishes, and at the addresses given, and also at those in our own district, when it was discovered that an epidemic of a severe type existed. I therefore decided, in the interests of the remaining scholars, to close the school at once. On April 4th the necessary requisition under Article 88 of the Educational Code was made to the School Board, signed by Mr. Kerwin, Mr. Catmur, and members of the Vestry, and by myself as Medical Officer of Health. Due consideration was given by the School Board to it, and the school was ordered to be closed forthwith. Twelve days later I received an application to allow the school to be re-opened, but the circumstances did not justify my acceding to the request, and I deferred doing so until the lapse of a further period of seven days. Owing to this energetic action the spread of the epidemic was arrested. Chart Shewing Week by week the Number Of CasesOf Small Pox& Scarlet Fever. Notified try Medical Practiition as having occured in the Hamlet of Mile End Old Town during the Year 1895. The Whitehall Press U?. Copyright Hasted & Son, Printers. Mile End, London Chart Shewing Week by Week the Number OF CASES OF DlPTHERIA & TYPHOID FEVER. Notified by Medical Practition as having occured in the Hamlet of Mile End OldTown during the Year 1895. The Whitehall Press Ltd. Copyright Hasted & Son, Printers, Mile End, London 33 Sanitary Work Carried on during the past Year. House-to-house. The work of inspecting the district systematically by houseto house visitation has been continued, and I am pleased to be able to report that practically the whole of the district has been inspected once. It is now about three years since this work was commenced in a systematic manner, and many lasting and important improvements have been effected which {inter alia) have considerably increased the value of property. But it is from a health point of view that we are interested. Thousands of families are now living under better conditions than they did previously. It will be seen from the tables of the work carried out under the direct supervision of Inspectors, an important item is the number of closets which have been re-constructed in accordance with the London County Council's bye-laws. The old hopperpan was largely in use. Besides being a nuisance in itself, the setting, as a rule, was so defective that on the smoke test being applied to any drain, the joints of such closets invariably were found to be faulty, and a constant source of danger, owing to the escape of sewer-gas. This work has taken up a considerable amount of the time of the Inspectors, the premises having to be constantly visited during the progress of the work to ensure it being carried out efficiently. 34 It is unnecessary for me to go through the whole of the various works accomplished by the Inspectors, for they are clearly shown by the tabulated statement (page 38). I should like, however, to draw attention to the large amount of drainage work which has been supervised by my department. It will be remembered that some time ago important regulations with regard to drainage work were adopted by the Board, and the Sanitary officers were appointed to supervise all drainage work except where new connections were made to the sewers. As a very large proportion of the drainage work comes under this heading much time and labour has to be expended in seeing it carried into effect. All drains are laid on a bed of concrete, and, where possible, manholes and inspection chambers are constructed, and proper ventilation provided; and it is not until the water test has been applied that the Sanitary officers are satisfied. Factories and Workshops. The Inspection and Re-inspection of both factories and Workshops is becoming an important part of the work of my department. During the last few years various Acts of Parliament have been passed to ensure the working classes healthier conditions whilst at work, and the responsibility of having them carried into effect devolves largely on Sanitary Authorities. The scope of the Factory and Workshop Acts of 1878-18831891 have been considerably extended by the Act of 1895, which comes into operation on January Ist, 1896. This Act is of great importance both to occupiers of workshops and their employees, and throws many new obligations 35 on the employer, the first of which is that he is compelled to have his workshop measured, and to affix a notice showing the number of people that may be employed at one time, allowing 250 cubic feet per head during the day, and 450 cubic feet during overtime. This provision of the Act, which is now compulsory on the occupiers, has for several years past been carried out by your officers, as it was self-evident to my mind that: "The fact that workshops being properly measured and the cubical capacity ascertained, and the number of workpeople allowed being affixed to the wall of the workshop in the form of a notice, would have the effect of preventing overcrowding." In practice this was found to be so, as in many cases where workshops were first measured, gross overcrowding was found to exist, but this did not occur subsequently. Another section provides that where an inmate of any dwelling house, any part of which is used as a workshop, is suffering from Small Pox or Fever, the occupier is liable to a fine of ten pounds, if he continues to carry on his work, or allows any work to be given out to any contractor. This applies to Factories, Workshops, and Laundries. A special feature of this Act is that Laundries and Bakehouses for the first time are brought within the operation of the Factories and Workshops Act, and are to be considered as workshops within the meaning of the Act. This is a very wise provision with respect to laundries, as it is most essential that the washing of clothes should be under proper sanitary supervision. The owners of factories and workshops are now compelled to make an annual return of all persons, ages, and sex, employed by them. The outworkers are not omitted from the Act {i.e., persons who take work home). To ensure wearing apparel being made under proper sanitary conditions, the Secretary of State issued 36 an order two years ago to all Local Authorities, calling on them to supervise the conditions of these dwellings. I pointed out in my annual report two years ago the great difficulties which would be experienced in carrying out this order for the whole of London satisfactorily. And although in this district we loyally endeavoured to fulfil its provisions, other neighbouring districts had not the sanitary staff to do so, and therefore the order became almost a dead letter. In the new Act this has been amended and instead of the Sanitary officials having to find out for themselves the addresses of these outworkers, the owners of workshops are now obliged to send to the Factory Inspector from time to time a complete list of the persons employed by them as outworkers. It will therefore be an easier matter for outworkers' homes to be under proper supervision. It is not generally known amongst the members of the Vestry how much or to what extent the Local Authorities exercise supervision over Factories and Workshops. At the present time these places are under a dual control, i.e., the Home Office and the Local Sanitary Authorities. In the case of factories we have jurisdiction only so far as to insure proper and sufficient sanitary conveniences being provided for the employees. As regards the fencing of machinery, working overtime, and the precautions necessary in dangerous trades, and also in overcrowding, the Factory Inspector is responsible. In that part of the Act relating to Workshops, the Local Authorities are responsible for the enforcement of proper and sufficient sanitary conveniences, regard being had to the number and sex of the workpeople, and also for the prevention of overcrowding and the proper ventilation of workrooms. The Act provides that should the Factory Inspector in course of his inspection of workshops note any insanitary conditions he is required to report the same to the Local Sanitary Authorities, and it is their duty to cause the same to be remedied and 37 to report what steps have been taken by their officers in regard to them within one month. I may say with respect to this important section of the Act, I have already had an interview with the Factory Inspector of the Home Office, and arranged a system of reporting periodically on these matters. This, briefly, is a synopsis of the new Act as it refers to my department. I do not think the dual control is the best system which could be adopted for Factories and Workshops. It is obvious, from the fact of occupiers being frequently visited by the officers of separate authorities for different purposes, that it will require an enormous amount of tact to prevent friction and misunderstandings. As will be seen from the table annexed (page 44), a large proportion of the workshops are separate buildings, and they are situated in the rear of dwelling-houses in most cases. When they form part of a house it is usually the top floor which has been adapted for the purpose of workrooms. It is a common practice to rent a house ostensibly as a dwelling, and immediately convert one or more of the rooms into a workshop. Numerous instances of this have been brought to our notice. The trades which are carried on in these places are almost entirely tailoring, but the proportion of the boot and slipper manufacturers is increasing, the employer and employees in nine-tenths of the cases being aliens. The number of workshops in our district has increased by about 60 during the last two years. We have now 280 on our register, exclusive of Laundries and Bakehouses, which have during the last year been inspected and re-inspected; and where any contravention of the 1891 Act was discovered, notices were served by your inspectors, which had in every case the effect of securing compliance with the law without recourse to legal proceedings. The situation of the workshops was up to the last few years almost exclusively confined to the West Wards, but they are now beginning to appear in the East Centre and North Wards. SUMMARY OF WORKS CARRIED OUT DURING THE YEAR BY THE SANITARY INSPECTORS IN THEIR RESPECTIVE DISTRICTS. No. i District. North Ward, North East Ward, South East Ward. C. COX. No. 2 District. North West Ward and East and West Centre Wards. F. H. LYON. No. 3 District. The whole of the South and West Wards. J. TWAITS. TOTALS. Houses and premises inspected 1878 1720 l8l8 5416 „ „reinspected 2734 2666 3097 8497 „ „ cleansed 39 87 77 203 Bakehouses inspected and reinspected 46 32 45 123 Bakehouses cleansed 3 4 7 14 Workshops inspected and reinspected 58 66 606 730 Workshops measured 12 8 76 96 „ notices served re number of employees allowed 36 26 203 265 Workshops cleansed 0 0 48 48 „ overcrowding in, abated 0 0 10 10 Worshops, additional W.C.'s provided to for use of workpeople 1 1 11 13 Intimations served under Section 3 Public Health Act 979 898 1l62 3039 Statutory notices served re Sanitary amendments 237 221 2 33 691 Notices re infectious diseases 365 335 353 1053 Drains tested 295 236 295 826 „ found defective 102 88 94 284 „ reconstructed 37 118 72 227 „ cleansed and repaired 111 85 83 279 „ trapped (new stoneware gullies) 355 379 449 1183 Drains provided to areas 18 4 62 84 „ „warehouses 0 10 0 10 „ „ stables and stable yards 11 4 1 16 Sanitary closets provided in accordance with London County Council Bye Laws W.C.'s provided with water 489 542 655 1686 and water supplies to closets reinstated l6 27 158 201 W.C.'s ventilated and lighted 0 6 53 59 „ new provided 4 0 0 4 „ disconnected from mestic cistern W.C's removed from unsuitable 23 9 9 41 positions 0 2 26 28 SUMMARY OF WORKS CARRIED OUT DURING THE YEAR BY THE SANITARY INSPECTORS IN THEIR RESPECTIVE DISTRICTS. No. i District. North Ward, North East Ward, South East Ward, c. COX. No. 2 District. North West Ward and East and West Centre Wards. F. H. LYON. No. 3 District. The whole ol the South and West Wards. J. TWAITS. TOTALS. New soil pipes fixed and ventilated o 4 10 14 Urinals provided with water 0 0 4 4 Cisterns cleansed and foul butts and cisterns abolished o 7 5 12 Yards paved 104 563 320 987 Wash houses paved 9 74 26 109 Areas paved 0 22 82 104 Forecourts paved 10 67 15 92 Stables and stable yards paved 0 3 3 6 Bakehouses, floors concreted 0 1 1 2 Sanitary dust receptacles provided... 242 260 452 954 Manure receptacles provided in accordance with London County Council Bye Laws 7 2 2 11 Sink waste pipes disconnected from direct connection with drains 102 113 160 375 Rain water pipes disconnected from direct connection with drains 14 104 109 227 Bath and lavatory waste pipes disconnected 0 0 3 3 Dampness in walls remedied 0 32 2 34 Houses ventilated under floors 4 132 59 195 Separate occupation of underground rooms discontinued 0 2 3 5 Overcrowding in dwellings abated 0 2 5 7 Offensive accumulations removed 1 0 2 3 Miscellaneous repairs, floors, roofs, gutters, &c. 8 73 58 139 Removal of animals improperly kept 0 0 1 1 Cowhouses and slaughterhouses inspected 6 9 l6 31 Smoke nuisance abated 1 0 1 2 Cesspools abolished 0 1 0 1 Summonses taken out under Public Health Act 9 17 l6 42 Magistrates' orders obtained... 7 6 l6 29 PROCEEDINGS TAKEN UNDER PUBLIC Situation of Premises. Nature of Complaint. 2, Freeman's Cot'ges, Old Church Road. W.C. foul, defective, and insufficiently flushed, yard paving broken and defective. 3, Zion Square Non-compliance with Magistrate's Order of 8th Nov. 1894. 5, „ ditto ditto 6, „ ditto ditto 12, „ ditto ditto 13, „ ditto ditto 14,Cologne Street The W.C. defective and unsuitable, the yard paving defective. 24, Ernest Street House dirty, yard improperly paved, W.C. defective no under floor ventilation. 198, Mile End Road House dirty, yard gully improperly trapped, yard improperly paved, washhouse paving defective, no proper dust receptacle, W.C. in yard filthy, defective, and stopped, upstairs W.C. and soil pipe defective. 56, Exmouth Street The W.C. connections defective. 83, Sidney Street 7, Nelson Street Drain defective, rain-water pipe connected, sink waste connected, W.C. defec., vard gullies imp. trapped, no ash-pit, basement PoDrs defective. Drain defective, W.C. defective, front area unpaved and undrained, no proper dust receptacle. 56, Jubilee Street Vard gully improperly trapped, W.C. foul and unsuitable, yard improperly paved. 19, Edwards Road House dirty and dilapidated, no sanitary bin, waste pipe of sink connected to drain, water supply connected to cistern supplying closet, roof defective, front area undrained, basement walls damp. Messrs. Maskell Bros. Conveyance of fish offal in unsuitable carriages. Nos. 3 and 14. 144, Harford Street W.C. defective and unsuitable, yard improperlypaved, house dirty and dilapidated. 35, Bale Street 45. Plumbers Row W.C. defective and unsuitable, yard gully improperly trapped, rain-water pipe connected, no dust receptacle, house dirty and dilapidated. Foul and offensive drain. 5, Sidney Square Yard gully improperly trapped, no proper ashpit, waste pipe sink connected to drain, W C. unsuit- 1 able and unventilated, front area unpaved and undrained. 7, Nelson Street Non-compliance with Magistrate's order of April 17, 1 1895. 14, Ernest Street Messrs. Maskell Bros. House dirty and dilapidated, W.C. defective and unsuitable, yard paving defective and insufficient, no underfloor ventilation. Conveyance of fish offal in an unsuitable carriage. Grove Mews, Grove Road No proper manure receptacle. HEALTH (LONDON) ACT, 1891. Date of Vestry's Order. Date of Summons. Result. Name of Officer taking Proceedings. 1894 Nov. 28 1895 Jan. 2 Order to abate nuisance within 14 days. Mr.Twaits. Apr. 25 „ Order to abate nuisance within 14 days and pay a fine of £3. „ „ „ Order to abate nuisance within „ „ „ 14 days, and pay a fine of is. ditto „ May 23 „ ditto „ „ „ ditto „ Nov. 14 1895 Feb. 20 1894 Mar. 23 „ Fined 2s., and order for prohibiting recurrence of nuisance. Order to abate nuisance within 14 days. Mr. Lyon. „ Dec. 19 „ ditto „ Nov. 28 Mar. 26 ditto M r. T waits. 1895 Jan. 23 „ ditto „ Mar. 6 „ ditto „ 1894 Apr. 10 Order to abate nuisance within 10 days. 2 7 1 June 27 „ Order to abate nuisance within 14 days. Mr. Cox. Oct. 17 May 9 Fined £2. „ 1895 „ Fined 10s. „ May 15 1894 June 10 Work done, summons withdrawn. Mr. Lyon. Dec. 19 1895 „ ditto „ May 22 June 12 Order to close house within 7 days. Mr.Twaits. May 1 „ Order to abate nuisance within 14 days. „ Mar. 6 „ Order to abate nuisance within 14 days and pay a fine of £2 10s. „ Feb. 20 1894 J uly 2 Work done, summons withdrawn. Mr. Lyon. Oct. 17 1895 „ Magistrate dismissed the case on the ground that summons was not served on owner. Mr. Cox. „ May 29 „ Summons dismissed, asdefendant only held premises on a three years' agreement. PROCEEDINGS TAKEN UNDER PUBLIC Situation of Premises. Nature of Complaint. (E. Harrison) Conveyance of fish offal in unsuitable carriages. Nos. 3 and 14. (E. Harrison) Conveyance of fish offal in unsuitable carriage. 24, Ernest Street Non-compliance with Magistrate's order. 66, Stepney Green Drain stopped, yard and areas improperly paved. 19, Greenfield Street Drains defective. 2, West Arbour St. Gullies in yard, front area and basement improperly trapped, W.C. insufficiently flushed, foul and unsuitable, sink waste and rain water pipes connected. 145, Globe Road House dirty and dilapidated, closet foul, yard improperly paved, drain foul, offensive, and defective, no receptacle for manure. (E. Harrison) Conveyance of fish offal in unsuitable carriage. 35, Latimer Street Drains'defective. 6, Entick Street House dirty, yard improperly paved, no dust receptacle, sink waste connected, W.C. defective and unsuitable, rain water pipe connected, yard gully improperly trapped, no under ventilation. 8, „ Items as No. 6, except sink waste. 91, Nelson Street House dirty and dilapidated, W.C. foul and dilapidated, yard pavement defective. Mitre Yard, White Horse Lane An accumulation or deposic which is a nuisance or injurious or dangerous to health. 4, Cadiz Street Non-compliance with regulations re houses let in lodgings. 20, „ ditto ditto 22, ,, ditto ditto 24, „ ditto ditto 56, Skidmore Street Carrying child through streets while suffering from scarlet fever. 53, Devonshire St House dirty and dilapidated, forecourt unpaved, no dust receptacle, no underventilation, W.C. defective and unsuitable. 55, „ W.C. defective, unsuitable, and insufficiently flushed, house dirty and dilapidated, floors rotten and defective, yard and forecourt without proper paving, walls damp. 57, „ House dirty .and dilapidated, walls damp, yard and wash house improperly paved, no dust receptacle, floors defective and unventilated. 6 &. 8, Entick Street Non-compliance with Magistrate's order of Oct. 9, 1895. HEALTH (LONDON) ACT, 1891 (continued). Date of Vestry's Order. Date of Summons. Result. Name of Officer taking Proceedings. 1894 Oct. 17 1895 July 12 Mr. Cox. „ July 12 Fined £3. „ 1895 Feb. 20 „ Summons adjourned, work completed. „ Sept. 11 Sept. 24 Adjourned for completion of work. „ Sept. 18 Sept. 28 Order to abate nuisance in 10 days. Mr.Twaits Sept. 11 „ ditto Sept. 25 Oct. 3 Order to do works—14 days. Mr. Cox. 1894 Oct. 17 1895 July 25 „ Fined £3. „ Oct. 4 Order to abate nuisance within 14 days. Mr. Lyon. Nov. 14 Work completed, summons withdrawn. June 26 Oct. 9 Order to do works—7 days, and pay a fine of £2. „| „ „ ditto „ Sept. 25 Oct. 26 Order to close. Mr. Twaits. „ Nov. 1 Nuisance abated.—Adjourned sine die. Mr. Lyon. May 15 Nov. 14 Order to comply with regulations and pay a fine of £2. Dr. Taylor „ „ ditto „ „ „ ditto „ „ „ ditto „ Oct. 23 Oct. 9 tt Nov. 20 Fined £3, or in default of distress 7 days' imprisonment. Summons withdrawn on completion of work. „ Mr. Lyon. Nov. 6 „ ditto „ Oct. 9 „ ditto „ June 26 „ Work done, summons withdrawn, order to pay costs. „ 44 Table showing the In the Hamlet of Mile End Old Town, the number Situation of Workshop. Number of Workshops that form part of Houses. Number of Workshops that are separate Buildings When Male and Female are employed in the same W orkshop. No. of Workshops. Males. Females. North Ward 4 4 2 5 6 North-East Ward 11 4 7 21 78 South-East Ward 14 3 5 8 35 East Centre 9 9 14 25 29 West Centre 4 6 4 16 11 North-West Ward 2 0 1 1 0 South Ward 5 8 7 60 49 West Ward 96 112 !56 528 383 Totals 145 146 196 664 591 45 Number of Workshops of people employed, and classification as to sex. When Females are separately employed. When Males are separately employed. Inspector in whose district they are situate. No. of Workshops. Females. No. of Workshops. Males. 2 10 4 13 Mr. Cox. 7 29 1 2 99 7 22 5 • •• 3 18 1 8 Mr. Lyon. 4 19 2 10 99 i 4 — 99 2 9 4 39 Mr. Twaits. 4 20 48 219 99 3° 131 65 305 46 Water Famine. In the earlv part of July, the inhabitants of Mile End were startled to find that the constant Water-supply was curtailed to an alarming extent. At first it was restricted to a few hours' supply, and in a short time two hours per day. This change without the slightest warning from the Water Company, was felt keenly. In the early month of the year there had been more or less drought, and one naturally thought this was the cause. On enquiry in different parts of the Metropolis we found that no other water authority was placing such restrictions on its consumers. From a sanitary point of view the effect of this short supply was at once apparent. The fact that nine-tenths of the houses have no storage cisterns contributed largely to the inconvenience which was felt all over the Hamlet, as well as the time when the supply would be cut off not being advertised. So it happened in hundreds of cases that the water was turned on and off at such an hour that it was impossible for working people, who were out the greater part of the day, to effect any storage whatever. The Sanitary Committee were called together and a deputation at once waited upon the East London Water Company, and the Committee were told that the Company had no alternative but to curtail the supply in the manner they had, as the reservoirs were nearly empty. The Committee urged on the Company the necessity, in order somewhat to mitigate the inconvenience, of allowing standpipes to be fixed in the more crowded parts of our district. This they agreed to, and promised to increase the hours of supply to the longest possible moment. The sewers and house drains were beginning to foul, and the road watering had to be restricted. The Harrilet was in this condition for at least six weeks ; had this continued much longer the effeCt on the public health must have been more disastrous : the death-rate went up by leaps and bounds, as the table following will show, and although it is difficult to exactly estimate what effeCt it had on the public health, there is no doubt that the immediate and also remote effeCts were injurious. One of the great dangers of an intermittent supply is the contamination of the water by sand, etc., 47 being drawn into the pipes of the consumers when they arc! broken. This was found to be so in Mile End. Leakages— very small ones, perhaps—go on for months without being found out, especially if they occur near an old sewer ; and in cases like these, when the water is suddenly turned off, the ' exhaust' is so great that part of the surrounding soil is drawn into the pipes, and so contaminates the next supply. I had a number of such complaints brought to my notice, and they were reported to the Vestry. For the benefit of the public it was found necessary to issue handbills, warning the inhabitants to boil all water. This practice was largely adopted. It will be remembered there was considerable agitation amongst the various local bodies in the East of London, and suggested combined action as to what steps should be taken to prevent a recurrence of such a disaster. The parish of Hackney made such representation to the Local Government Board, that an enquiry was instituted. I do not, on this occasion, comment on the inquiry, because, during the period reviewed by this report, the result of the inquiry had not been published. It must, however, in fairness be pointed out that the extremly short notice given by the Hackney Vestry to Medical Officers of Health, to submit their evidence, rendered it impossible to prepare the statistics and facts, with reference to the injurious effects upon the public health. As a matter of fact the effects in many cases would not become known until weeks after the supply had been reinstated. The following tables relate to the period when the supply was cut short, together with the subsequent three weeks. Death-rate per 1,000 for the weeks ending— June June July July July July Aug. Aug. 22 29 6 13 20 27 3 10 London 15.1 I6.9 18.0 21.0 23.7 23.0 21.4 19.0 Mile End 24.7 22.6 29.0 30.8 39.9 23.7 28.4 27.4 48 Table shewing Death-rate for the purpose of comparison during the eight weeks ending September 1st for the three years as under:— 1893 Death-rate 1894 Death-rate 1895 Death-rate All Diseases Zymotic Diseases All Diseases Zymotic Diseases All Diseases Zymotic Diseases London 21.1 5.0 l6.5 2.9 19.7 5.2 Mile End Old Town 20.1I 4.5 16.9 3.3 28.0 8.1 Unsound Food. The Sale, or Exposure for Sale, of any article which is unsound and unfit for food is such a serious matter, that the Legislature realized its importance by enacting Section 47 in the Public Health Act of 1891. Part of this Section is quite new, and extends the powers of previous Acts of Parliament by rendering the wholesale dealer, as well as the retailer liable to prosecution. Some of the Sanitary Authorities in various parts of London are fully alive to the provisions of this far-reaching Act as recent cases shew. The Public Health Act, by Sub-section 8 of Section 47, provides that in those cases where a person has in his possession any article which is unsound and unfit for the food of man, and has no intention of foisting such food on the public, he may give notice to the Sanitary Authorities, and have the same removed as trade refuse. A number of tradesmen in our district have taken advantage of this part of the Act, and during the past twelve months, a large quantity of fruit and salmon has been treated in this way. A receipt is always given specifying that such articles are removed as trade refuse, and were unsound and unfit for human food. In April last year, Inspector Mr. Lyon and myself, paid a visit to a preserved meat factory in this district; after some difficulty in gaining admission, we inspected the premises, and 49 although we did not then find any unsound food we saw a steam blast blowing into a vessel containing meat, a circumstance that was sufficient to make further enquiries as to the genuineness of this business. From that time the inspector and myself kept the place under observation, and it was not until July that an opportunity occurred to inspect the premises without preliminaries. In July, I found the door opened and walked in, when I seized a large quantity of manufactured tins of meat, and a number of large tins of corned beef, salmon, and lobster, all of which were unfit for food ; I had these taken to the Police Court and condemned. This matter was reported to the Vestry, who ordered a prosecution. On conferring with the Clerk it was thought best to let the matter stand over and keep fresh observations on the premises. This was done by your inspector and myself, both in the day-time and at night; we also employed a detective, but to no purpose, as the owners we found were well aware of what was going on. So matters went on until the 3rd of October, when Mr. Lyon and myself, finding the door of the premises open, walked in and seized 61 tins of soup, 15 tins of rabbit and beef, all of which were unsound and unfit for food, these were condemned by the magistrate. Still keeping observation of the premises, on the 10th of October, we made another inspection and seized 40 tins of corned beef, and a large quantity of manufactured small tins of bloater paste, etc. On this occasion the owners refused to open the tins. We had anticipated this, and provided ourselves with tin-openers and opened all these ourselves; they were found to be bad and unfit for food. They were taken to the Police Court and condemned. On the occasion of the first seizure I explained to the manufacturers the risks they were running in having bad meat 011 the premises; and also informed them, that if at any future time unsound food was found there,' it would be my duty to take proceedings against them. This warning, however, had 110 effect. The Board passed the necessary resolution that proceedings should betaken, and I obtained three summonses against each of the three partners of the firm. It will be needless for me to detail the various stages of the 50 prosecution. Suffice it to say that after three days at the Thames Police Court, the two principal defendants were committed for trial. The charge against the third defendant was withdrawn. They were tried at the Old Bailey, the trial lasting two whole days, the Counsel for the Vestry being Mr. Muir, and that for the Defendants, Mr. Gill. The jury found the defentants Guilty, and Sir Charles Hall, the Recorder, in passing sentence said, "that he was convinced that for the last four months at any rate, these persons had been guilty of retailing unsound food to the public, well knowing it to be unsound, and to the great danger of the public, the fact on their own admissions that they had turned over £40,000 in four months shewed to what extent this trade had been carried on, and said he should not be doing justice to the public at large by imposing a less sentence on each of the prisoners than six months' hard labour." It will readily be understood the great anxiety this case has been to the officers engaged, and it was felt that to protect the public, this infamous trade ought to be stopped. The severity of the sentence fully justified the prosecution. I feel that our success was largely due to your clerk, who spared neither time nor trouble in getting up the case, which bristled with legal and practical difficulties; and although the justice of the prosecution was apparent to those who knew all the circumstances, it required most skilful handling by your legal adviser. Fish Offal. Unfortunately, Mile End is the high-road, through which a very large quantity of fish offal and other offensive refuse is conveyed to its destination from all parts of London, and for years it has been a source of constant annoyance and complaint, especially during the summer months. To protect the public against this nuisance, Bye-laws were framed by the County Council compelling proper vehicles to be used for 51 ing the offal through the streets. These Bye-laws are enforced by the Vestry. Soon after they came into operation a copy was sent to every person engaged in this trade, and one firm who owned the largest number of vans at once had their vehicles altered to comply with our requirements. A number of smaller ones still continue to create the nuisance, but as a means of escaping our attention went through the district in the early hours. Their attention was again called to the Byelaws, but with no effect. We therefore determined to stop the nuisance, and our Inspector, Mr. Cox, on a number of occasions awaited the arrival of these particular carts as early as seven o'clock in the morning, and eventually succeeded in catching them in flagranti delicto. A messenger was sent for me, and legal proceedings were instituted, altogether six summonses were taken out which had the effect, so far, of mitigating the nuisance. Disinfecting. The subject of disinfecting houses and clothing after infectious disease is one which is of great importance to Health Officers, and it is our duty to make the system we carry out as perfect as possible. But the apparatus at the disposal of the Vestry is not all that could be wished; it has been repeatedly demonstrated within the last few years that the best method in the disinfecting of clothing is by superheated steam—that is steam under pressure. For many years we have employed the dry heat process: placing the clothing in an oven and heating it up to a certain temperature for a length of timo. I pointed out several years ago to the Sanitary Committee that this method was obsolete and unsatisfactory. As a means of temporizing, certain alterations were made to the " Old Frazer Oven," by which steam could be used. In theory, this seemed to have got over our difficulty, but in practice it has signally failed. The oven was not originally constructed to resist steam pressure, and will not do so, and although steam is injected into the oven from a small 52 portable boiler it is quite certain that bedding and mattresses cannot be properly disinfected unless the steam be under pressure. For some time past the Sanitary Committee have had the matter under their consideration, and one of the great difficulties we have to contend with is a selection of a proper site on which to erect a new apparatus. I trust that in the near future the difficulty will be overcome, and that we shall have a thoroughly efficient steam apparatus. Mortuary. In my Annual Report last year the Mortuary was well on the way towards completion. In April this year the building was finished and ready for use. It is fitted with every convenience necessary; the Post-Mortem Room is supplied with hot and cold water, and a splendid case of instruments; there is also a retiring room for medical men, who have expressed to me satisfaction as to the arrangements made for their convenience. I should like to state that the opposition to its present location has subsided. We were told that it would be a nuisance to the surrounding neighbourhood; a danger to the health of the students at the People's Palace; and that it would have the effect of deteriorating property. As a matter of fact it has done neither one nor the other. I have not had a single complaint from anyone. Its present central situation is a great boon to both Coroner and jurymen, seeing that all the inquests are held at the Vestry Hall, which it adjoins. During the last nine months 115 bodies have been received at the Mortuary, 112 inquests have been held, and 8 post-mortems made. A custodian is in charge night and day, and has performed his duties satisfactorily. Regulations for the management of the mortuary were drawn up by myself and submitted to the Sanitary Council, and passed by the Board : a copy of these is appended. During the year I have had a number of bodies removed from houses where there was not sufficient and proper accommodation for them in the interval between death and interment. No case of infectious disease has been received at the Mortuary up to the present, although we have a separate 53 and specially-constructed chamber for these cases. I may add that the officers of the County Council visited the premises, and have expressed their satisfaction with the arrangements. Vestry of the Hamlet of Mile End Old Town. REGULATIONS as to the USE OF THE MORTUARY. i—Application for permission to deposit a body in the Mortuary, shall be made to the Custodian at the Mortuary, Vestry Hall, Bancroft Road 2 —A body, in case of emergency, may be deposited at any hour of day or night, but in ordinary cases only between the hours of 8 a m and 8 p.m. 3.—The ptrson depositing the body shall enter such particulars or furnish such information for entry in a book kept for that purpose, and shall sign the same. 4.—A body having been brought or sent in a shell or coffin, such shell or coffin shall under no circumstances be removed, other than for the burial of the body, unless permission be given by the Medical Officer of Health. 5.—Should any shell be found defective, a thoroughly sound and larger shell (in which the defective shell can be enclosed) must upon notice, be forthwith supplied by the person sending the body. 6.—A body may be viewed by the friends of the deceased, between the hours of 10 a m and 6 p m. 7.—A body deposited in the Mortuary shall not be allowed to remain after a reasonable time. 8.—When death has occurred from an infectious disease, the coffin shall no be opened after being deposited in the Mortuary, unless by order of the Coroner. 9.—When a body shall have been brought to the Mortuary by an order of a Justice, or the Coroner, or by the Medical Officer of Health, and the friends of the deceased person shall, after notice in writing, reluse or neglect to remove such body for interment by the time specified in such order, or by these Kegulations, notice shall be given to the Relieving Officer, and the body handed over to the Guardians of the 1'oor as unclaimed, and the interment shall take place, and the cost of such burial shall be recovered from the person or persons liable. 10.—No Post-mortem shall take place without either the order of the Coroner or the consent of the legal representative of the deceased. Such order or consent shall be produced to the Custodian of the Mortuary. 11.—The Custodian shall not take part in any way in a Post-mortem Examination beyond giving the necessary attendance upon the Medical Practioner making the examination. 12.—The Custodian shall not allow any person or spectator other than those authorised or assisting, to be present during any Post-mortem examinations. 54 I3-—Any leg illy qualified Medical Practitioner authorised to make a Postmortem examination shall produce to the Custodian such authorisation, and shall only be allowed to make such examination between the hours of 8 a m and 9 p.m., excepting under special circumstances. 14.—It shall be the duty of the Custodian to see that the above Kegulations are carried out, and that all persons having occasion to visit the Mortuary, conduct themselves in all respects with decency and propriety. By Order. Bakehouses. The Inspection of the Bakehouses in our district is an important one, seeing that in many cases it depends on this Inspection whether one of our principal food stuffs is made under proper sanitary conditions. Amongst the general public apparently it is of small concern what sort of a place their bread is manufactured in so long as it appears clean. No doubt they think the officers of the Sanitary Authority exercise proper supervision over them. In this district that is so. A system of inspecting twice a year the whole of the Bakehouses has been for some time instituted, and it will be of interest to know that these places are regularly limewhited and are kept in a cleanly state. A number of these are underground, which is not the best possible situation. By the new Factory and Workshops Act, any Bakehouses constructed after the passing of this Act shall not be allowed to be used if built underground. This is a step in the right direction, and in the future, as the present underground Bakehouses are abolished, they will be rebuilt above ground, where ample ventilation can be obtained. Cowhouses and Slaughterhouses. All the Cowhouses and Slaughterhouses have been regularly inspected, and many improvements effected, particularly in the proper pavement of yards and the construction of suitable manure receptacles. On the whole, they were found to be kept in a cleanly condition, and although they are often situated in crowded neighbourhoods there have been no complaints made to the Vestry during the year of any nuisance arising from them. 55 The Housing of the Working Classes Act. The Houses that have been reported to you under the Act (details of which are herewith presented in tabular form, page 56) were such that required more or less serious structural alterations before being made habitable, and could be more thoroughly dealt with by this Act than under the Public Health Act. I made twenty-nine representations under Sec. 30, and the result has been either to have the houses closed or various improvements carried out. In the majority of cases the houses were very old and decayed, and had been much neglected; this class of house is getting much rarer in our district than formerly, as a result of the systematic inspection now being carried out throughout the district. In my last year's report I expressed the hope that by this time the insanitary area known as "Lomas Buildings" would have been dealt with. I have used my best endeavours to accomplish this, but up to the present time the buildings are still standing a disgrace to the district. It may be remembered that this time last year we had got so far as to send plans and estimates of the scheme to the County Council, and to ask that body to contribute to the cost. On March 18th an answer was received from the Council, saying that they were prepared to contribute half the cost, provided the area was cleared and converted into an open space. The Sanitary Committee had another survey of these Buildings, and again approached the Council, in order that the cost should be as lightly felt locally as possible, to allow the area when demolished to be used as a builder's yard or rope walk, and so be a source of revenue to the Vestry. One June 22nd a reply was received, saying the Council would consent to this course being adopted. The Sanitary Committee reported the above facts to the Board, with the result that a resolution was passed on July 31st that a scheme should be prepared in accordance with the Act. A scheme was prepared by your surveyor, which received the sanction of the Board on Oct. 9th. Since that date the necessary notices have been served on the owners, and particulars of the scheme have been sent to the Local Government Board; and we are now awaiting their pleasure to hold an inquiry on this insanitary area. Proceedings taken under the Situation of Property. Date of Representation. Nature of Representation. I, Smith Place Jan. 2 Drains defective; house very dilapidated; floors and ceilings defective 2, „ „ „ 3„ „ „ 4„ „ „ 5„ „ „ 6„ „ „ 1 &2, Garden Street Jan.16 Drains defective; house dirty and dilapidated 4,„ „ „ 6„ „ „ 1 & 2, Foskett Buildings, Globe Road Feb. 22 House dilapidated ; floorboards defective 13, Lomas Buildings Feb. 27 Walls damp; house dilapidated 14, „ „ „ 58, Knott Street Mar. 27 Walls damp; house dirty and dilapidated 67, „ „ „ 68,„ „ „ 69 „ „ „ 52, Jubilee Street Apr. 24 House dilapidated; w.c. defective 31, Old Church Road Apr. 17 House dilapidated; drains defective 52, Knott Street May 8 Walls damp and dilapidated; ceilings defective 62, „ „ „ 6, White Horse Court „ Walls damp and dilapidated; no ventilation; w.c. and sink defective 7, „ „ „ 45, Plumbers' Row May 8 Drainage defective; house dilapidated 6, North Street May 23 r House dilapidated ; floorboards defective, &c. 7, „ „ „ 8, Garden Street June 20 Drains defective; house dirty and dilapidated 2i, Mary Street Nov. 27 House dirty and dilapidated; ceilings, walls and passages defective 1, Union Place, Whitehead Street Dec. 11 Walls very damp Housing of the Working Classes Act. Time allowed to render premises habitable. Re-inspected. Result of Re-inspection reported to Committee. Subsequent Action taken by the Medical Officer of Health. 21 days Mar. 19 Nothing done Interviewed owner, who closed the houses voluntarily „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ Summoned owner and closing order made „ „ „ „ „ „ „ „ „ Apr. 20 Houses now habitable „ Apr. 24 Houses closed „ „ „ „ May 7 House now habitable " „ „ " „ „ „ „ „ " June 3 House made habitable „ June 10 House now habitable „ July 1 House now habitable „ „ „ „ July 14 „ „ „ „ „ July 21 „ „ „ „ „ „ „ „ July 24 Work in progress „ Dec. 31 Nothing done „ Dec. 31 Nothing done 58 In concluding this report, I beg to tender my best thanks to the members of the Vestry for their courtesy and support in the discharge of my duties. I should also like to take this opportunity of expressing my appreciation of the manner in which the Sanitary Inspectors and Clerk have carried out their work, and I trust that the kindly feeling which exists between all the officials of my department may long continue. I am, Your obedient servant, THOMAS TAYLOR, Medical Officer of Health.