HAML 22 VESTRY OF THE HAMLET OF MILE END OLD TOWN. ANNUAL REPORT upon the PUBLIC HEALTH and Sanitary Condition of the District. FOR THE YEAR 1896, by THOMAS TAYLOR, Medical Officer of Health. london: printed by w. j. hasted & son, 306, mile end road, e. 1897. THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1896. To the Vestry of the Hamlet of Mile End Old Town. Gentlemen, I beg to present you my tenth Annual Report as to the Sanitary condition of the Hamlet. It is difficult for one to break new ground in the text of a report of this kind, especially after nine previous ones have been presented. It is my intention only to speak generally in these introductory remarks. During the year which has elapsed no new or very startling developments have taken place which affect the Hamlet, the work of my Department has been carried on as in previous years with the view of making the district as healthy as it is possible; the inhabitants being principally composed of the artizan classes, their habitations require more supervision than those holding a better position in life, consequently the work at all times is heavy. There has been no special legislation during the past year to call for comment affefting sanitation, although at the present time there is an important Bill before Parliament which has a distinct bearing on the welfare of the female portion of the population, who employ Midwives, viz. :—The "Midwives Registration Bill," but inasmuch as I shall in another part of this report comment on this matter, it will be sufficient for me to say here that it has my heartiest support. 4 Vital Statistics. The population of Mile End Old" Town has varied considerably during the last fifteen years. Although almost every available plot of land was built over at that time, the increase of the population goes steadily on, for the reason that during the last ten years there has been a large influx of aliens, who have migrated to the Hamlet, and who are content to live several families in one house. It is not uncommon for three or four families to occupy a house which used to be previously tenanted by one. The Census in 1881 was 102,573. „ „1891 „ 107,565. ,, ,, 1896 ,, 111,060. In the beginning of the present year a census for rating purposes was taken of the whole of London, so that I am enabled to present a correct estimate of the population of this district to the middle of the year, and it is on these figures that the calculations in the present report are based. The estimated population is 111,226. Births and Birth Rate. The number of births during the year was 4,297, 2,187 males and 2,110 females, giving a birth-rate of 37.8 per 1,000. Deaths and Death Rate. The number of deaths which occurred in Mile End Old Town during the past year, from all causes, was 1998. From these figures deductions have to be made owing to the fact that part of this number, although dying in Mile End, belonged to other parishes, and some deaths occuring in other districts belonging to Mile End, after making the necessary deductions the number of deaths is, 2,252, giving a death-rate of 19.9 per 1,000 per annum, that of the Metropolis being 18.2 for the same period, whilst that of the Eastern districts taken as a whole was 21.7. TABLE A. STATISTICS AS REQUIRED BY THE LOCAL GOVERNMENT BOARD. TABLE OF DEATHS during the Year1896, in the [???] 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 15 and under 25 25 and under 65 65 and upwards 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diptheria. Membranous Croup. fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea & Dysentery. Rheumatic Fever. Phthisis. Bronchitis. Pneumonia, and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. {a) (b) (c) (d) (e) (e) (g) (h) (i) Mile End Old Town 1677 641 313 62 46 386 229 Under 5 13 29 8 2 59 72 62 1 7 196 4 501 954 5 upwds. 4 12 9 3 6 1 2 8 2 102 124 116 4 330 723 Mile End Infirmary 197 10 1 3 4 95 84 Under 5 11 11 5 upwds. * 27 21 21 117 186 City of London Union 61 1 1 24 35 Under 5 1 1 5 upwds. 2 10 5 43 60 South Grove Workhouse 38 10 28 Under 5 5 upwds. 2 8 2 26 38 Vintners' Trinity Almshouses 5 5 Under 5 5 upwds. 1 4 5 Jews' Hospital 10 1 9 Under 5 5 upwds. I 2 7 10 East End Mothers' Home 10 9 1 Under 5 9 9 5 upwds. 1 1 Totals 1998 660 315 65 53 515 390 Under 5 13 29 8 2 59 72 62 1 7 196 4 522 975 5 upwds. 4 12 9 3 6 1 2 9 2 133 166 144 4 528 1023 The subjoined numbers have also to be taken into account in judging of the abo ve records of mortality. Deaths occurring outside the district among persons belonging thereto. 387 72 88 31 i 22 140 34 Under 5 15 39 1 1 3 3 5 21 1 8 63 160 5 upwds. 6 8 5 1 3 1 1 24 18 24 11 125 227 Deaths occurring within the district among persons not belonging thereto. 133 9 1 1 4 40 78 Under 5 10 10 5 upwds. 1 7 21 8 86 123 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 1896, 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 im each Locality coming to the knowledge of tae ivledical officer of health. n umber of such cases removed from their homes in the several Localities forTreatment in Isolation Hospital 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 Smallpox. Scarlatina. Diphtheria. Membranous Croup. fevers. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. fevers. Cholera. Erysipelas. Census 1891. Estimated to middle of 1896. Typhus. Enteric or Typhoid. Continued Relapsing Puerperal Typhus. Enteric or Typhoid. Continued Relapsing Puerperal (a) (b) (c) (d) (e) Mile End Old Town 107565 111226 4297 Under 5 231 152 7 4 11 65 46 5 upwds. 407 251 4 82 2 4 134 176 73 18 Mile End Infirmary Under 5 2 2 5 upwds. 1 1 10 1 London Hospital Under 5 37 51 13 12 5 upwds I 63 65 22 45 1 20 13 Children's Hospital, Shadwell Under 5 4 7 4 5 upwds. 9 11 5 4 6 South Grove Workhouse Under 5 1 1 5 upwds. 1 4 1 Tower Hamlets Dispensary Under 5 3 5 upwds. 2 1 St. Bartholomew's Hospital Under 5 2 5 upwds. 1 2 Totals Under 5 280 210 7 4 11 82 62 5 upwds. 1 483 327 4 111 2 5 195 I 202 92 18 RETURNS OF MORTALITY IN THE HAMLET OF MILE END OLD TOWN FOR 1896. 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. 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. DISEASES. AGES. AGES. AGES. 0 1 5 15 25 65 0 1 5 15 25 65 0 1 5 15 25 65 1 5 15 25 65 90 1 5 15 25 65 90 1 5 15 25 65 90 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina ... 13 4 ... ... ... 3 12 5 1 ... ... 3 25 9 1 ... ... Diphtheria 1 28 9 1 2 ... 5 34 8 ... ... ... 6 62 17 1 2 ... Membranous Croup ... 8 ... ... ... ... 1 ... ... ... ... ... 1 8 ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever 2 ... 4 1 4 ... ... ... 2 ... 2 1 2 ... 6 1 6 1 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing do. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal do. ... ... ... 1 2 ... ... ... ... ... 1 ... ... ... ... 1 3 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... 4 2 ... ... ... 1 1 1 ... ... ... 1 5 3 Measles 14 45 1 ... ... ... 1 ... ... ... ... ... 15 45 1 ... ... ... Whooping Cough 35 37 1 1 ... ... ... 3 ... ... ... ... 35 40 1 1 ... ... Diarrhoea and Dysentery 49 13 1 ... 3 4 3 ... ... 1 ... ... 52 13 1 1 3 4 Rheumatic Fever ... 1 1 1 ... ... ... ... ... ... ... 1 ... 1 1 1 ... 1 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis ... 7 5 17 102 2 2 3 2 2 18 2 2 10 7 19 120 4 Bronchitis, Pneumonia and Pleurisy 113 83 11 4 77 53 14 7 2 4 11 1 127 90 13 8 88 54 Heart Disease 4 ... 4 11 72 49 ... 1 1 3 19 1 4 1 5 14 91 50 Injuries ... ... ... ... 3 1 3 5 1 ... 9 1 3 5 1 ... 12 2 All other Diseases 433 79 23 12 206 201 40 23 10 10 79 26 473 102 33 22 285 227 651 314 64 49 475 312 72 88 31 22 140 34 723 402 95 71 615 346 16 Zymotic Diseases. The total number of the notifiable zymotic diseases was 1640 and the total number of deaths 407, giving a death rate of 3.6 per 1,000, rather less than during the last two years. Small Pox. I am pleased to say that the district has been practically free from this disease during the past year, only one case having been notified in this Hamlet, against 225 in London as a whole. In common with some other districts, particular interest is taken in this disease in Mile End Old Town, where opposition to what is considered by competent authorities to be a great protection against Small Pox has for some years been pronounced. The Board of Guardians, which is the local authority for administering the Vaccination Act, has adopted the policy of allowing parents to exercise their own discretion in regard to having their children vaccinated, with the result that the proportion of the children vaccinated amounts to only 43 per cent., or much less than half of the births registered. Most of you are aware that the Government some seven years ago appointed a Royal Commission to investigate into the effects of Vaccination, and at the end of this year the final Report was issued. It is not my intention to traverse the whole of this report, but in order that those members of the Board who are not conversant with the subject should become acquainted with it, I beg to state the object and duty of the Commission was to report on the following five issues :— 1. To report on the effect of Vaccination in reducing the prevalence of mortality from Small Pox. 2. What means, other than vaccination, can be used for diminishing the prevalence of Small Pox; and how far such means could be relied on in place of vaccination. 3. The objections made to Vaccination on the ground of injurious effect alleged to result therefrom, and the nature and extent of any injurious effects which do, in fact so result. 17 4. Whether any, and, if so, what means should be adopted for preventing or lessening the ill effects, if any, resulting from vaccination ; and, whether, and, if so, by what means, vaccination with animal vaccine should be further facilitated as a part of public vaccination. 5. Whether any alterations should be made in the arrangements and proceedings for securing the performance of vaccination, and, in particular, in the provisions of the Vaccinations Acts with respect to prosecutions for noncompliance with the Law. Of these issues the first and third are the most important. In reply to the first question the Commission sum up as follows :— In reply to No. 1 We think :— 1. That it diminishes the liability to be attacked by the disease. 2. That it modifies the character of the disease, and renders it (a) less fatal, and (b) of a milder or less severe type. 3 That the protection it affords against attacks of the disease is greatest during the years immediately succeeding the operation of Vaccination, It is impossible to fix with precision the length of this period of highest protection. Though not in all cases the same, if a period is to be fixed, it might, we think, fairly be said to cover in general a period of nine or ten years. 4. That after the lapse of the period of highest protective potency, the efficacy of vaccination to protect against attack rapidly diminishes, but that it is still considerable in the next quinquennium, and possibly never altogether ceases. 5. That its power to modify the character of the disease is also greatest in the period in which its power to protect from attack is greatest, but that its power thus to modify the disease does not diminish as rapidly as its protective influence against attacks, and its efficacy during the later periods of life to modify the disease is still very considerable. 6. That re-vaccination restores the protection which lapse of time has diminished, but the evidence shows that this protection again diminishes, and that, to ensure the highest degree of protection which vaccination can give, the operation should be at intervals repeated. 7. That the beneficial effects of vaccination are most experienced by those in whose case it has been most thorough. We think it may fairly be concluded that where the vaccine matter is inserted in three or four places, it is more effectual than when introduced into one or two places only—and that if the vaccination marks are of an area of half a square inch, they indicate a better state of protection than if their area be at all considerably below this. 18 In reply to No. 3 the following is the conclusion of the Commission :— A careful examination of the facts which have been brought under our notice has enabled us to arrive at the conclusion that, although some of the dangers said to attend vaccination are undoubtedly real and not inconsiderable in gross amount, yet when considered in relation to the extent of vaccination work done they are insignificant. There is reason further to believe that they are diminishing under the better precautions of the present day, and with the addition of the further precautions which experience suggests will do still more in the future. I have in my previous reports studiously avoided comment on the question of vaccination, as it would have ill become me to anticipate the result of the Commission, hut now that it has become public property it is my duty to place its conclusions before you. We have not been visited for many years past by any serious epidemic such as that which has recently occurred in Gloucester, Sheffield, and other towns, and this no doubt is in a large measure due to the prompt isolation which is practised in cities like London. But the evidence which has been so carefully compiled by the Commission tends to prove that Small Pox attacks the unvaccinated more readily than the vaccinated. It is to be hoped, now that the Commission who have heard the views of the most scientific men of the day, and have called in evidence all that could be produced both in favour of vaccination and against vaccination have reported in favour of the former, that in the event of the Legislature acting on the recommendations of the Commission that whatever authority is responsible for the operation of the Vaccination Act there will be a proper and uniform administration of the Law. Of course, the views held and explained by the minority of the Commissioners will receive due consideration by Parliament. Scarlet Fever. This disease has been very prevalent during the year, 763 cases were notified to me ; in a large proportion the cases were of a very mild type, so much so that there were only 38 deaths, and it is this very fact which is so conducive to its spread, as numbers of children whilst desquamating were allowed to 19 mix with those who were healthy, and so the disease spreads, this occurs more amongst the uninformed ; as far as we possibly can we try to minimise the spread by directions as to disinfection, &c., but in many cases a medical man is only consulted once, when he notifies the case to me, and frequently on the house being visited the patient is found playing about the streets, sowing infection broadcast. I think, when a favourable opportunity arises in the future, some stringent measure should be taken to shew the parents of these children their duty, and a prosecution instituted to prevent this wholesale spread, it would no doubt have a salutary effect. Diphtheria. Five hundred and thirty-seven cases have been notified to me during the past year as against 512 of last year; judging from the mortality the disease must indeed have been of a mild character, seeing that there only 78 fatal cases. 154 were treated in the various hospitals. The origin of this disease still remains obscure; that it is a septic disease admits of no doubt. In all cases the house drains are tested, the numbers being, 408 tested, 81 of which were found defective, so that we cannot say it is wholly caused by defective drainage. Diphtheria and Scarlet Fever were so prevalent throughout the metropolis during the summer months that the Asylums Board Hospitals were full, and a large number of cases had to be treated at their homes, in many of these instances to the danger of other occupants of the dwelling, last year the same state of things occurred. Surely this ought not to be in a city like London, with its ever increasing population, that year after year the authorities should be in this serious position. Typhoid Fever. The number of cases of Typhoid Fever notified to me during the year was 115, 16 of which proved fatal there can be no doubt that inhalation of sewer gas plays an important part in this disease, and whether it is from the house drains or from the sewers in the street, it is equally certain that in either of the instances it is highly detrimental to health. The number of 20 drains tested after this disease is 95, and 21 were found defective. In my last year's report I stated that when testing house drains it frequently happened that the smoke from the testing machine was seen issuing in volumes from the nearest street gully. I am glad to see that my remarks have borne fruit, and the necessary trapping of these street gullies (too long delayed) is being carried out. I cannot altogether approve of the kind of traps being laid down for various reasons, but while in their proper working order, they prevent the gases from the sewers being inhaled by foot passengers, which is of very great importance. Cholera. A great deal of excitement was caused recently by the news that Cholera was prevalent on a troopship anchored at Plymouth, and it was feared that unless the greatest possible care was taken it would find it way into the towns. The Port Authorities, however, dealt very energetically with the matter, and not a single case occurred after the troops and passengers were landed. Precautions were taken in accordance with the recent regulations issued by the Local Government Board to all Port Sanitary Authorities dealing with Cholera, Yellow Fever and Plague. By the Order : " No person on board an infected ship shall be permitted "to land unless he satisfies the Medical Officer of the Port "as to his name, intended place of destination and in" tended address, which is communicated to the Local " Sanitary Authorities in order that the Officers of the " Sanitary Department may keep such persons under " observation." In the case of all the passengers from the infected ship this Order was complied with. Comparative Statistics. In table X will be found an interesting comparison of the mortality rates in Mile End for various causes with those of London generally, and also the other districts in the Eastern Division. CHART SHEWING WEEK BY WEEK THE NUMBER OF CASES OF DIPHTHERIA & TYPHOID FEVER. Notified by Medical Practitioners as having occurred in the HAMLET OF MILE END OLD TOWN DURING THE YEAR 1896. CHART SHEWING WEEK BY WEEK THE NUMBER OF CASES OF SCARLET FEVER. Notified by Medical Practitioners as having occurred in the HAMLET OF MILE END OLD TOWN DURING THE YEAR 1896. 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, 1892 to 1896. LONDON. EASTERN DISTRICTS. MILE END OLD TOWN. 1892. 1893. 1894. 1895. 1896. Average for the Five Years, 1892. 1893. 1894. 1895. 1896. Average for the Five Years. 1892. 1893. 1894. 1895. 1896. Average for the Five Years. Principal Zymotic Diseases 2.8 3.0 2.6 2.6 3.1 2.8 3.7 3.7 3.5 4.0 3.6 3.7 3.6 3.6 4.0 3.9 3.6 3.7 Small Pox .06 .04 .02 .01 .002 .02 .01 . 06 .03 .01 ... ... ... .07 .03 ... ... ... Measles .7 .3 .7 .6 .8 .6 .8 .5 1.1 1.1 .9 .8 .6 .3 1.1 1.0 .7 .7 Scarlet Fever 2.0 .3 .2 .2 .2 .5 .4 .4 .2 .2 .2 .3 .3 .3 .3 .2 .3 .2 Diphtheria .4 .7 .6 .6 .5 .5 .5 .9 .7 .8 .6 .7 .7 .7 .7 1.0 .8 .7 Whooping Cough .5 .5 .4 .3 .6 .4 .9 .9 .6 .4 .8 .7 1.0 .7 .6 .4 .7 .6 Typhoid Fever .09 .1 .1 .1 .1 .08 .1 .2 .1 .1 .1 .1 .1 .2 .1 .1 .1 .1 Diarrhoea .5 .7 .4 .8 .7 .6 .6 1.1 .5 1.0 .9 .8 .6 1.1 .6 1.0 .8 .8 Deaths from all causes 20.3 20.8 17.4 19.4 18.2 19.2 24.3 25.8 21.8 24.3 21.7 23.5 23.0 22.8 21.1 22.5 19.9 21.8 Deaths under one year to 1000 Births registered 154 164 142 165 160 157 166 181 161 180 164 170 153 150 155 165 157 156 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 1896. Name of District. Deaths from all causes. Small-pox. Measles. Scarlet Fever. Diphtheria. * Whooping Cough. Typhus Fever. Enteric Fever. Other continued Fevers. Diarrhoea. Annual Rate per 1,000 living. Death rate per 1000 living. Registration London 81721 9 3692 940 2663 2931 5 564 13 3922 3.1 18.2 Paddington 1947 1 103 22 65 49 ... 13 1 66 2.5 15.3 Kensington 2914 ... 173 40 70 99 ... 16 1 60 2.6 16.8 Hammersmith 1828 ... 62 21 52 62 1 13 2 85 2.8 17.2 Fulham 2057 ... 101 29 77 69 ... 9 ... 134 3.6 17.6 Chelsea 1850 ... 110 23 115 63 ... 10 1 66 3.9 18.8 St. George, Hanover Sq. 1108 ... 32 11 24 15 ... 9 ... 20 1.4 13.6 Westminster 978 ... 18 10 20 26 ... 9 ... 35 2.2 18.0 St. James, Westminster 397 ... 31 3 2 3 ... 3 ... 10 2.2 17.0 Marylebone 2855 ... 195 26 74 70 ... 20 ... 68 3.2 19.9 Hampstead 916 ... 58 7 30 22 ... 7 ... 17 1.8 11.9 St. Pancras 4442 ... 133 37 99 128 ... 31 ... 180 2.5 18.1 Islington 5871 1 275 57 255 247 ... 47 1 160 3.0 17.1 Stoke Newington 434 ... 5 8 19 16 ... 5 ... 27 2.3 12.7 Hackney 3414 ... 95 36 103 147 1 37 1 192 2.8 15.7 St. Giles, Bloomsbury 737 ... 41 7 7 14 ... 4 ... 16 2.3 19.0 St. Martin.in.the.Fields 214 ... 11 3 3 5 ... 3 ... 5 2.3 16.2 Strand 550 ... 28 6 3 8 ... 1 ... 13 2.4 22.7 Holborn 736 1 33 12 27 1 5 ... 22 3.2 23.4 Clerkenwell 1393 ... 53 15 42 42 ... 15 ... 88 3.8 20.7 St. Luke, Middlesex 1059 ... 35 21 26 23 ... 4 ... 52 3.8 25.1 City of London 626 ... 6 7 11 7 ... 10 ... 5 1.4 19.6 Shoreditch 2656 1 143 39 74 126 ... 17 ... 136 4.3 21.4 Bethnal Green 2902 ... 153 35 75 160 ... 20 1 113 4.2 22.1 Whitechapel 1655 ... 51 20 48 36 ... 9 1 45 2.6 20.6 St. George in-the-East 1187 ... 28 18 30 17 ... 5 ... 60 3.3 24.5 Limehouse 1357 ... 62 15 49 61 ... 3. ... 46 4.0 22.9 Mile End Old Town 2252 ... 61 38 97 77 ... 16 ... 74 3.6 19.9 Poplar 3550 ... 147 33 105 158 ... 26 ... 168 3.7 20.6 St. Saviour, Southwark 587 ... 17 5 18 19 ... 1 ... 23 3.2 22.8 St. George, Southwark 1472 ... 77 17 40 55 ... 7 ... 64 4.2 24.0 Newington 2527 1 98 29 71 66 ... 18 ... 127 3.3 20.5 St. Olave, Southwark 261 ... 11 5 9 13 ... 2 ... 17 4.8 22.0 Bermondsey 1873 ... 75 20 73 97 ... 11 ... 52 3.8 21.6 Rotherhithe 834 ... 43 10 26 36 ... 11 ... 31 3.8 20.3 Lambeth 5084 2 182 65 139 140 1 24 1 175 2.4 I6.9 Battersea 2985 ... 179 32 82 138 ... 16 1 186 3.6 17.7 Wandsworth 2749 ... 151 29 40 158 ... 21 ... 121 2.7 14.3 Camber well 4602 ... 206 52 260 196 1 37 ... 176 3.6 17.8 Greenwich 8323 2 193 51 140 127 ... 32 1 120 3.7 18.5 Lewisham (exclu.Penge) 1216 ... 39 7 75 28 ... 9 ... 60 2.6 14.3 Woolwich 861 ... 72 9 31 22 ... 2 1 28 3.9 20.5 Lee 526 ... 14 8 17 18 ... 2 ... 15 1.9 13.4 Plumstead 936 ... 69 18 55 35 ... 4 ... 33 3.5 15.4 * Including deaths from membranous croup. 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, 1896. Name of District. Small-pox. Scarlet Fever. Diphtheria. * Typhus Fever. Enteric Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Cholera. Totals. Estimated Population in the middle of 1896. Registration London 225 25647 13808 6 3190 103 277 6436 13 49705 4421955 Paddington 4 795 247 ... 61 1 10 119 ... 1237 124838 Kensington 13 1020 372 ... 95 7 8 275 ... 1790 170660 Hammersmith 3 532 218 1 51 4 9 121 ... 939 104551 Fulham 2 628 353 ... 54 5 9 99 ... 1155 115008 Chelsea 2 571 488 ... 66 2 6 120 ... 1255 9b657 St. George, Hanover Sq. 1 342 124 ... 54 1 2 56 ... 580 80041 Westminster 2 224 109 ... 35 2 1 79 ... 452 53477 St. James, Westminster 3 75 37 ... 6 ... 2 20 ... 143 22955 St. Marylebone 4 811 292 ... 107 ... 3 248 ... 1465 14114 Hampstead ... 289 199 ... 58 2 6 54 ... 608 75812 St. Pancras 6 1079 482 ... 200 1 21 355 ... 2144 241066 Islington 51 2047 1117 ... 236 6 31 394 ... 3882 337639 Stoke Newington 2 226 80 ... 16 ... 1 40 ... 365 33615 Hackney 8 1533 593 ... 202 7 6 311 ... 2660 213774 St. Giles, Bloomsbury ... 180 60 ... 21 ... 1 80 ... 342 38158 St. Martin-in-the-Fields 1 73 16 ... 18 2 1 12 ... 123 13003 Strand ... 132 37 ... 8 ... 1 11 ... 189 23820 Holborn 1 123 72 ... 30 1 2 65 ... 295 30932 Clerkenwell 5 461 246 ... 67 ... 4 108 ... 891 66195 St. Luke, Middlesex 2 264 133 ... 38 2 2 133 ... 574 41478 City of London 2 197 72 ... 21 1 ... 34 ... 327 31409 Shoreditch 1 708 371 ... 117 9 3 297 ... 1506 122265 Bethnal Green 2 1257 460 ... 129 1 12 327 ... 2191 129151 Whitechapel 4 638 351 ... 62 ... 2 138 ... 1195 78886 St. George-in-the-East 2 378 214 ... 33 1 2 89 ... 719 47589 Limehouse 7 350 270 ... 27 1 4 110 ... 769 58347 Mile. End Old Town 1 763 548 ... 115 2 5 206 ... 1640 111226 Poplar 9 964 701 ... 184 8 7 315 1 2189 169379 St. Saviour, Southwark 4 140 83 ... 9 ... ... 35 ... 271 25276 St. George-the-Martyr 3 335 193 ... 48 ... 3 95 ... 677 60301 Newington 3 677 407 ... 88 1 9 194 ... 1379 121191 St. Olave, Southwark ... 62 44 ... 9 ... ... 21 ... 136 11673 Bermondsey 4 394 258 ... 55 ... 5 131 ... 857 85508 Rotherhithe 5 198 123 ... 45 1 6 113 1 492 40432 Lambeth 18 1595 692 1 165 14 20 355 6 2866 296036 Battersea 8 1175 419 ... 109 1 10 253 ... 1975 165864 Wandsworth 2 1000 299 ... 102 8 11 265 ... 1688 188908 Camberwell 13 1222 1430 3 175 ... 16 319 1 3179 253975 Greenwich 14 1163 836 ... 113 3 17 242 ... 2388 176293 Lewisham (exclu.Penge) 1 343 365 ... 58 ... 9 79 ... 855 83795 Woolwich 1 146 102 ... 21 3 1 45 ... 319 41334 Lee 1 168 75 ... 28 ... 6 37 ... 315 38714 Plumstead 4 363 208 ... 29 3 3 43 1 654 59610 Port of London 5 5 6 ... 17 ... ... 2 ... 35 ... * Including membranous croup of which there were 11 in Mile End. 24 SANITARY WORK Carried out during the Year. The work of my department has been steadily going on during the year, the house to house inspection of the district has been expedited and in large numbers of streets a second house to house inspection has been made; in the first inspection very many important improvements were effected under our supervision, such as water supply to W.Cs., separating the drinking water from that used to supply cisterns for flushing the W.Cs., dustbins provided, etc.; in the second inspection more time has been devoted to the reconstruction of the drainage of individual houses, the drains of hundreds of houses have been tested, and when found to be defective have been remedied. I consider that a proper water supply and proper drainage system the most essential conditions for the health of the people, and in seeing that the drainage of houses is properly carried out the Inspectors have had to use much tact and discretion in getting the amount of work done which they have, with so little expense to the Vestry. In some districts in the Metropolis the house drainage has cost the Vestries hundreds of pounds, whilst in this Hamlet although proportionatelv more house drains have been re-constructed it has cost the Vestry comparatively little. On referring to the appended Table will be found a summary of the work carried out by the Inspectors, which will prove to be of an instructive character and will shew at once that your Inspectors, who are second to none in the Metropolis, have an interest in their work. On looking at the district as a whole and comparing it with its condition of a few years ago, one cannot help being struck 25 with the vast improvements that have taken place, of course there is a large portion of the district still in an unsatisfactory condition and so I am afraid it always will be, partly owing to the age of the property and the natural decay, and partly owing to the class of tenant occupying it. Workshops. The duty of inspecting workshops has been carried out by your officers. The number now under our inspection is 242, the fact that they are periodically inspected has had a very beneficial effect, one very rarely finds any overcrowding, and for the most part they are kept in a cleanly condition. Notices have been served and complied with, so that it has not been found necessary to take legal proceedings, except in one case, and that was for the erection of an additional W.C. The duty of abating overcrowding in workshops ought really to devolve on the Factory Inspectors as they have larger powers granted to then by the Secretary of State than we possess. I understand in a neighbouring parish this duty has been cast on the Factory Inspector by the Sanitary Authority, who found the difficulties so great as to render a prosecution almost impossible. A large number of the domestic workshops have been abolished during the year and a number of workshops changed hands ; this to a large extent is due to the migratory habits of the Hebrew occupiers of most workshops. Reference was made by the Vestry to the Sanitary Committee as to the advisability of appointing a Female Inspector so as to visit workshops where women are employed. I considered the matter and reported as follows:—In the whole district there are only 30 workshops where females are alone employed numbering 158, and 212 workshops where men and women are employed, the number of men being 161, females 594, so that altogether there are 752 women employed in the Hamlet. I should like to state that in all the workshops where men and women are engaged, proper separate sanitary conveniences are provided for each sex. Looking at the fact that such a small number of women are employed in the whole district it is in my opinion quite unnecessary to appoint a female inspector. 26 Food. The importance of preventing unwholesome food being sold to the public is one of the most important duties of Sanitary Officers, and as many of you know, it is one in which a great deal of care and skill is required in order, on the one hand that no injustice should be done to the purveyor, and on the other hand to protect the public. During the year 1895 we had a very difficult and delicate case to deal with, and in the early part of this year another case equally intricate came under our notice. On entering certain premises in the district a very large quantity of unsound food stuffs was found on the premises of a tradesman, something like two tons: the whole of this was in tins and had to be sorted by Mr. Twaits and myself before seizing what was unsound, which was taken to the police-station and condemned by the Magistrate as unwholesome and unfit for human food. The Vestry had all the faCts of the seizure placed before them and they decided to prosecute, it is needless for me to go through the whole matter, it will be sufficient to say the case occupied several days at the Police-court, and a great deal of work was thrown on your officers engaged in getting up the case, and although we were able to prove to the satisfaction of the Magistrate that this food was kept in close proximity to the part of the building used as a cheap eating house, and also that the defendant had previously been engaged in selling tinned meat for food when he had given an undertaking to sell the same for manure, yet it spite of this, because we could not prove that any of this particular lot seized was being used as food, the Magistrate in giving his judgment stated "I have been considering— I was going to say without "any doubt and that degree of certainty which such a "result called for, can I say without any doubt that the "defendant has been guilty of this offence? Well, looking "at the matter and giving the best attention possible I can "to this difficult case, I have come to the conclusion that "I cannot say this with that degree of certainty which "the case requires. 27 "I accept the defendant's explanation that this large "quantity of bad food was the accumulation from time "to time of consignments which he had, that he might "have been dilatory in the matter, and that he did con"template selling that to the manure merchants in order "that it might be destroyed, and used as manure. "I certainly think, in conclusion, that this is a matter "which called for enquiry, especially as the onus, under "the Act of Parliament, is upon the defendant. There"fore no condemnation can attach to the local authority "in putting this case before me with the care and ability "they have thought proper to employ, and even if a great "deal of expense has been incurred in this enquiry, the "ratepayers must not consider it wasted, because it will "show persons, if there are any persons committing this "offence, that the Sanitary Authority will not only exercise "the vigilance which their officers exercise, but that they "will spare no money and no pains for the purpose of "properly conducting the enquiry. Therefore, I dismiss "the summons." In March last your Inspector called my attention to a carcase of a cow that was hanging up in a slaughter house in the district; I examined it carefully and found it had suffered from Tuberculosis, and was unfit for food. I ordered the owner to have it sent at once to the horse slaughterers, and I subsequently received a note that it had been taken there. In this case there was just a doubt whether the man would have sold it for human consumption, and so proceedings were not taken against him. SUMMARY OF WORKS CARRIED OUT DURING THE YEAR BY THE SANITARY INSPECTORS IN THEIR RESPECTIVE DISTRICTS. No. 1 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 1700 1469 l66l 4830 „ „ reinspected 2766 2480 3047 8293 „ „ cleansed 36 40 31 107 Bakehouses inspected and reinspected 44 42 22 108 Bakehouses cleansed 12 3 2 17 Workshops inspected and reinspected 102 99 507 708 Workshops measured 21 9 36 66 „ cleansed 2 7 20 29 „ overcrowding in, abated 2 0 9 11 Workshops, additional W.C.'s provided to, for use of workpeople 4 3 25 32 Intimations of Nuisances served under Public Health Act 703 503 964 2170 Statutory notices served re Sanitary amendments 188 164 358 710 Notices re infectious diseases 410 340 416 1166 Drains tested 394 343 520 1257 „ found defective 142 99 137 378 „ reconstructed 89 93 144 326 „ cleansed and repaired 143 59 79 291 „ trapped (new stoneware gullies) 92 150 146 388 Drains provided to areas 24 4 52 80 „ „ warehouses „ „ stables and stable yards 15 6 8 29 Sanitary closets provided in accordance with London County Council Bye Laws 393 318 520 1231 W.C.'s provided with water and water supplies to closets reinstated 5 14 68 77 W.C.'s ventilated and lighted 1 12 27 40 „ new provided 2 5 16 23 „ water supply disconnected from domestic cistern 29 0 6 35 W.C.'s removed from unsuitable positions 0 6 14 20 SUMMARY OF WORKS CARRIED OUT DURING THE YEAR BY THE SANITARY INSPECTORS IN THEIR RESPECTIVE DISTRICTS. No. 1 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. New soil pipes fixed and ventilated 1 6 12 18 Urinals provided with water 0 3 4 7 Cisterns cleansed 0 8 0 8 Yards paved 149 228 282 659 Washhouses paved 3 12 48 63 Areas paved 2 18 58 78 Forecourts paved 6 26 11 43 Stables and stable yards paved 0 5 8 13 Bakehouses, floors concreted, etc. 1 0 0 1 Sanitary dust receptacles provided 74 171 156 401 Manure receptacles provided in accordance with London County Council Bye Laws 1 8 5 14 Sink waste pipes disconnected from direct connection with drains 53 68 32 15 3 Rain water pipes disconnected from direct connection with drains 4 60 39 103 Bath and lavatory waste pipes disconnected 0 0 4 4 Dampness in walls remedied 2 1 0 3 Houses ventilated under floors 4 66 157 227 Separate occupation of underground rooms discontinued 0 0 2 2 Overcrowding in dwellings abated 0 0 2 2 Offensive accumulations removed 3 0 3 6 Miscellaneous repairs, floors, roofs, gutters, &c. 18 38 35 91 Removal of animals improperly kept 0 1 0 1 Cowhouses and slaughterhouses inspected 7 9 15 31 Smoke nuisances abated 2 0 0 2 Summonses taken out under Public Health Act 1 5 13 19 Magistrates' orders obtained 1 2 13 16 Proceedings taken under the Public Health (London) Act, 1891. Situation of Premises. Nature of Complaint. Date of Vestry's Order. Date of Summons. Result. Name of Inspector. (E. Harrison) Conveyance of fish offal in an unsuitable carriage. Jan. 10 Fined £1. Mr. Cox. 89, Oxford Street Drain defective. Feb.12 Mar. 23 Order to abate nuisance in 14 days. Mr.Twaits. 61a, Sidney Street Foul and offensive drain. Feb. 18 Mar. 27 Order to close house. „ Kings' Yard No water to W.C. W.C. without any connection with drains, causing an accumulation of filth. Mar. 24 May 23 Order to abate nuisance in 14 days. Mr. Lyon. 85, Greenfield St. Insufficient W.C. accommodation. Apl. 29 9 Fined £3. Mr.Twaits. 2, John's Place House dirty and dilapidated, yard paving defective walls damp, no under floor ventilation, etc. May 27 June 5 Order to close house. „ 6, „ Part of house dirty and dilapidated, yard paving defective, closet unsuitable, insufficient W.C. accommodation. „ „ ditto „ 8, „ Part of house dirty and dilapidated, W.C. connections defective, yard paving defective. „ „ ditto „ 9, „ Part of house dirty and dilapidated, W.C. connections defective. „ „ Order to abate nuisance in 14 days. „ 19, „ Kitchen dilapidated, W.C. foul and defective, no proper dust receptacle. „ „ Order to close house. „ 23, „ Part of house dirty and dilapidated, W.C. foul and without water supply. „ „ ditto „ 25, „ W.C. foul and insufficiently flushed, yard paving defective. „ „ ditto „ 27, „ Drain choked, yard paving defective, closet defective and insufficiently flushed. „ „ ditto „ 33, „ Drain connections to W.C. defective, yard paving defective, no under floor ventilation. „ „ Order to abate nuisance in 4 weeks. „ 36, Redmans Road Drains defective, house dirty and dilapidated, W.C. defective and unsuitable. July 29 Oct. 8 Work done, summons withdrawn. Mr. Lyon. 10, High Street Drains defective, house dirty and dilapidated, &c., &c. „ „ Order to abate nuisance caused by defective drain in 4 weeks. „ 40, Heath Street Drains defective, house dirty, yard paving defective W.C. filthy. Sept. 16 Oct. 10 Order to close house. Mr.Twaits. 9, Ernest Street Drains defective. Sept. 30 Oct. 31 Work done, summons withdrawn. Mr. Lyon. 11, „ Ditto. „ „ ditto „ Proceedings taken under the Housing of the Working Classes Act Date of Representation to Sanitary Committee. Situation of Property. Nature of Representation. Time allowed to make Premises habitable State of Premises on Re-inspection Date of Re-inspection Subsequent Action taken by the Medical Officer of Health Jan. 1 39, Raven Row Walls dilapidated and damp no water in W.C. 21 days Jan. 15 24, Old Church Road House old and dilapidated 21 days House now April 20 „ 28, „ „ „ habitable „ „ 30, „ „ „ „ „ „ 116, „ „ „ „ „ Took out summons „ 128, „ „ „ „ „ „ 1, Hayfield Yard House dilapidated; no ventilation; drains defective „ Work not done May 20 June 1st, Magistrates, order to close „ 2, „ „ September.— Took out summons, adjourned 1 month for work to be carried out. November.— Houses closed, summons adjourned sine die „ 3, „ „ „ 4, „ „ Jan. 29 29, John's Place „ „ 9, Coke Street House dilapidated; drains defective; floorboards defective 21 days Nothing done Mar. 20 March 26. Took out summons work in progress, adjd. for 2 wks Feb. 12 2, John's Place „ „ „ „ Took out summons, adjourned sine die Mar. 25 45, Ocean Street House dilapidated; walls „ „ 74, „ ,, damp „ „ 76, „ „ „ June 3 Rear of 244 Mile End Road Walls damp; floor boards rotten „ House shut up Aug. „ 17, Perth Street Walls damp; fls. notventiled. „ Work completed June 12 3, Single Place Walls damp; floor defective; roof defective; no under floor ventilation „ House shut up „ 4, „ „ ii „ 5, „ „ „ „ 6, „ „ „ „ 7, „ „ „ „ 12, „ „ „ „ 13, „ „ „ „ 14, „ „ „ Sep.16 1, Ferriers Court House damp and dilapidated no ventln. under boards 21 days House shut up Nov. „ 2, „ „ „ Cleansing has been done but no underfloor ventln. Work in hand „ 3, „ „ „ „ 4, „ „ „ Sep.30 126, Old Church Rd. Walls damp; ceiling defective floor boards defective. „ Oct. 14 124, „ „ „ „ „ 130, „ „ „ „ Nov. 25 54, Cadiz Street House dilaptd; walls damp „ „ „ 56, „ „ „ „ „ 58, „ „ „ „ Dec. 9 3, Wade's Place House dilapidated and dirty; walls damp „ „ „ 8, „ „ „ „ 34 The Housing of the Working Classes Act. The above Act is, as most of you are aware, a most stringent one and its very stringency makes it very slow of locomotion. Its provisions deal with single houses and also groups of houses, with single houses that are unfit for human habitation these either have to be made fit, otherwise they can be shut up and demolished; groups of houses are taken as insanitary areas and are demolished and better structures erected in their place. I have, during the year made thirty-eight representations to the Sanitary Committee of single houses under the Aft, and in 29 cases the houses have by structural improvements been made habitable. One of the houses has been permanently closed and eight have been re-modelled. With the other part of this Aft we have made slow progress. I did hope by this time to have been able to report that the insanitary area, Lomas Building, had been finally dealt with, but at present the matter is at a standstill. During last year a public enquiry was held by an Inspector of the Local Government Board, at the Vestry Hall, as to whether it was an insanitary area under the Act, and after hearing all the evidence, he reported that the Area was an insanitary one and ought to be demolished. The Local Government Board in giving their sanction to the scheme stipulated as a condition, that the Vestry must rebuild to provide for the people displaced (a number something like 60). Representations have been made to the Board stating that there was ample accommodation in the neighbourhood, and asking them to waive the re-housing condition, and so the matter stands. I can only hope that this condition will not be enforced; it seems to the most casual observer absurd to provide for the small number displaced in this manner and would be a waste of the ratepayers' money. If these houses are not demolished under the scheme I shall feel it my duty to make a vigorous attempt to close the houses under the Public Health Aft, as some of them are in a disgraceful condition. 35 Bakehouses. The bakehouses have been regularly inspected during the past year, and where necessary, orders have been served to cleanse and limewhite the premises. We have 54 bakehouses above ground and 22 underground; speaking generally they are kept in a much more cleanly condition than they were a few years ago, and would compare very favourably with those in the west of the metropolis. Fish Offal. The removal of this refuse through the streets was up to the last year or so a standing disgrace; but after the Bye-laws regulating this matter came into force we took action against a number of owners of vehicles who created a nuisance by reason of the imperfeCt construction of their vans; this had a very good effeCt on most of the removers of this offal; although during last summer we were on the look out for any breach of the Bye-laws being committed, we only succeeded in finding one van that was not in a proper condition, the owner was summoned at the Police-court and fined £1. Disinfection. One of our sheet anchors in dealing with the spread of Infectious Disease is disinfection, and if thoroughly carried out there is no doubt these diseases could be limited. I have from time to time drawn the Vestry's attention to our insufficient apparatus, and I hoped by this time to be able to chronicle the fact that Mile End was keeping pace with the times and favourably comparing with other districts. I very much regret to say I cannot do so. This question has been brought to the notice of the Sanitary Committee on many occasions, and for reasons partly economic, the matter has been postponed. It was only last year in my report to the Vestry I commented upon the unsatisfactory working of the disinfedting oven, and I again urge upon the Vestry to consider my recommendation in the serious spirit it 36 merits and provide an efficient disinfecting oven. Surely in a matter of- this kind expense should not be considered. It is my opinion that if the oven does not do the work it is called upon to do (and I am far from being convinced that it does destroy the germs of infectious disease) it is useless, and is only calculated to place ourselves and the public in a false position. This is a very serious matter, and should we ever have any epidemic of, say, Cholera or Small Pox, and your officers are not provided' with the proper means of dealing with it the responsibility or consequences must rest upon the Vestry. Midwives Registration Bill. A Bill for the purposes of the proper Registration of Midwives is at the present time before Parliament; it is, as its name implies, for the purposes of placing all women who aCt as midwives under proper supervision, they will have to produce evidence of being specially qualified before being placed on a register ; this to my mind is a very wise provision, and will be a great protection to poor women who cannot afford to have medical men to attend them. The Bill proposes that each Local Authority shall appoint the Medical Officer of Health, or some other practitioner to be the supervising authority. Cases are constantly occurring where unskilled women attend the poorer classes, and frequently 'carrying the infection of the disease known as Puerperal or Child-bed Fever from patient to patient; if the proposed ACt is found to be the means of diminishing the deaths from this disease, it will greatly benefit the class of persons who employ midwives. The evidence is incontestible that the uneducated midwife is chiefly responsible for this disease which is of a very fatal character. The following table will illustrate how it has affected the various sanitary districts of the metropolis during the past five years:— 37 Table shewing the relative incidence of cases of Puerperal Fever in the respective Parishes of the London Sanitary District from 1891 to 1895. No. in Maps. Parish. No. of notified cases per 1000 births. No. in Maps Parish. No. of notified cases per 1000 births. 1 Hampstead 3.64 22 Woolwich 1.85 2 Islington 3.48 23 S. Saviour, Southw'k 1.71 3 Battersea 3.25 24 Holborn 1.62 4 Wandsworth 3.12 25 Marylebone 1.59 5 Lewisham 3.02 26 St. George-in-theEast 1.55 6 Fulham 2.86 27 Shoreditch 1.47 7 Paddington 2.85 28 Newington 1.47 8 Greenwich 2.77 29 Poplar 1.47 9 St. James 2.71 30 St. George, Hanover-square 1.31 10 Bethnal Green 2.49 31 City of London 1.31 11 St. Pancras 2.48 32 Mile End Old Town 1.31 12 Hammersmith 2.46 33 Rotherhithe 1.31 13 Lee and Plumstead 2.41 34 Clerkenwell 1.30 14 Stoke Newingto and Hackney 2.29 35 Bermondsey 1.07 15 Kensington 2.26 36 St. George, Southwark 1.02 16 Chelsea 2.23 37 St. Olave 0.93 17 Limehouse 2.14 38 St. Giles 0.89 18 Camberwell 2.09 39 Strand 0.67 19 Westminster 2.6 40 St. Luke 0.53 20 Lambeth 1.86 41 St. Martin-in-the Field 0.00 21 Whitechapel 1.86 Cowhouses and Slaughterhouses. We have at the present time 20 cowhouses and 10 slaughterhouses which are licensed by the London County Council annually. It is most unlikely that any fresh licenses will be granted for either of these purposes in crowded districts like our own. At the last Licensing Session, where it was shewn that the buildings were not being used at the time the application for renewal was made, the Council in many cases refused 38 to accede to the request, so that although it will take time to do away with these places, they will as circumstances permit be abolished. In our own district there were two such cases, viz., two slaughterhouses; the rest have been regularly inspected, and found to be kept in a satisfactory condition. Houses let in Lodgings. During the present year this matter has again been brought before the Vestry. The County Council submitted a report made by one of their Medical Officers of Health, asking for the Vestry to comment thereon. The report was as to the working of the Bye-laws for regulating houses let in lodgings, in the various districts of London. It may not be known to all of you that under the Sanitary Act of 1866 and also the Public Health Act 1891, every Vestry is bound to make Bye-laws for regulating houses of this class, which means houses that are let to more than one family. From the report it appears that in every London district Bye-laws for the regulation of Houses let in Lodgings were adopted, but only in a limited number of districts has any considerable effort been made to enforce them. The Vestry of the Hamlet of Mile End Old Town was one of the first bodies in London to adopt regulations of this class; some years ago under the Sanitary Act 1866, a certain number of houses were placed under their influence, but the Sanitary staff at that time was so small that a thorough trial was never really made to enforce them. When the Public Health Act 1891 was passed, it became obligatory to those parishes who had not adopted regulations to do so, and the Council wrote to each district urging on them the necessity of at once complying. I find that about 27 districts responded, but only a limited number have as yet put them in practice. But inasmuch as we had the regulations in force it was not necessary to make new regulations under this Act. We have had for some time 174 houses under the regulations, and since the Sanitary staff was augmented we have enforced these Bye-laws. Dr. Hamer in his report says "It is impossible to require precisely the same methods to be adopted in all districts." With this I cordially 39 agree, and taking our district as a whole, quite two thirds come under the description, but at the same time we have but a comparative few that in my opinion require to be dealt with in this manner. In practice we find the Public Health Act so much simpler to deal with any insanitary conditions than these regulations, although under the latter it is contended that when once a house is placed under these Bye-laws and the necessary notices have been served on the owner and tenants, it is not necessary to repeat them, but to take summary action. We find that this class of tenant is constantly a moving one, and the property frequently changes ownership, we then have to serve fresh notices which makes the proceedings more delayed than by instituting action under the Public Health Act. At the present time I do not see any necessity for further extending the operation of these regulations. Water Famine. The question of a constant water supply was again brought home to us in the East End in almost as serious a manner as that in the summer of 1895; when the Local Government enquiry was held in 1895 to ascertain the cause of the failure, we were informed by the East London Water Company that such provision had now been made by enlargement, and new reservoirs, that the intermittent supply would be unnecessary in the future ; but here are the facts that in less than twelve months we were again face to face with the same difficulty. In July the water was cut off for many hours in the day, and had it not been for standpipes being fixed in the streets, the inconvenience would have been more serious; as it was for several weeks during very hot weather the drains were imperfectly flushed and in consequence the effluvia from sewer openings was very offensive. A Committee of influential men, Members of Parliament, County Councillors, and medical men was formed, and a deputation waited on the President of the Local Government Board in order to bring pressure to bear on the Water Company. 40 It was pointed out by the deputation that the shortened supply of water—six hours a day to the inhabitants was having a prejudicial effect on the health of the people, drains and sewers were beginning to stink, and it was feared if more water were not pumped into the district, serious results might follow. I pointed out the following facts, that for the fortnight ending July 17th, (the fortnight previous to the drought) LONDON MILE END General Death Rate 21.6 25.2 Gastro Enteritis 1.6 5.7 For the fortnight ending August 1st, (the period of the drought) LONDON MILE END General Death Rate 24.8 34.1 Gastro Enteritis 2.6 11.2 After hearing the various views of the speakers, the President promised to do what he could to bring about a happier state of things. Fortunately for the people and the Company soon after this rain fell enough to fully stock their reservoirs, so ending the drought. It is, of course, impossible for me to say what effect it had on the public health; the results of a shortened supply does not always manifest itself at once and the effects are felt in various ways long afterwards. It is, however, to be hoped that such provision has been made or wilj be made as to prevent any repetition of what must be and is a danger to the people, a restricted water supply. Mortuary The number of bodies deposited in the Mortuary during the past year was 160, and 19 Post Mortems were held. Several of these died from Infectious disease, and were placed in that part of the Mortuary specially built for Infectious cases. There is no doubt the Mortuary built as it is in the very centre of the Hamlet is a great convenience to the ratepayers generally, and also to those unfortunate persons who have to attend Inquests, viz., Jurymen and friends of the deceased. 41 In conclusion, I have to tender to the members of the Vestry and of the Sanitary Committee my thanks for their cordial co-operation with me in carrying out ofttimes difficult duties, and to recognize the confidence reposed in the officers in my Department and myself during the last ten years. I am, Your obedient servant, THOMAS TAYLOR, Medical Officer of Health.