Poplar 1893 POP B1 ANNUAL REPORT of the MEDICAL 0FFICER OF HEALTH for BOW DISTRICT, Comprising the Parish of St. Mary Stratford-le-Bow. To the Members of the Poplar District Board of Works. Gentlemen, I have the honor to submit my annual report as Medical Officer for the North or Bow District, together with the reports of the Sanitary Inspectors of that district, and the report of the Inspector of Nuisances in Manufactories, so far as it concerns the parish of Bow. It should be borne in mind that the period reviewed by this report is for the twelve months ending the 31st December, 1893, and that the statistics and the tables, prepared according to the requirements of the Local Government Board, cover the same period. While these statistics refer only to the parish of Bow, consequent upon the arrangements of the sanitary districts which took place last year on the 1st of April, Bromley then being joined to Poplar for sanitary administrative purposes, leaving Bow solely to my care, the parish of Bromley was for the first three months of 1893, under my supervision, and the statistics for that period relating to Bromley are given separately. The annual death rates for Bromley I am, therefore, unable to present to you. In comparing the figures of work done, or mortality rates, or diseases statistics, with those in my last report, it must not be forgotten that this alteration in the areas should be taken into account, otherwise the comparisons will be misleading and totally inaccurate. B 2 My tenure of office as Medical Officer for Bow and Bromley combined terminated on the 31st March, 1893. Since then a large increase in the staff of the whole district has been made, and the working of the new arrangements has justified with results the departure then made. While the demands under the old system upon the time and energy of the staff were always met and grappled with, and everything possible done to render the large area sanitarily in excellent condition, it can be understood that the division of such area has enabled the staff" to give yet more detailed attention to the houses, more of which, in proportion, have been put in a state of efficiency. This will be clearly apparent from the reports of the Inspectors appended hereto, but the result of the appointment of the additional Sanitary Inspector will be more appreciable at the end of next year, he only having been at work a short time during the period reviewed by this report. It is a source of pleasure to be placed under the obligation of repeating what I reported last year, that:— "The work of the Sanitary Department has, during the year, been carried on with vigour and efficiency. New duties and increasing obligations have been laid upon Sanitary Officers generally by recent legislation, to place which in force a laudable attempt has been made, the spirit as well as the letter of the law having been observed. This has naturally created additional demands upon the time and the energies of the officers, demands which I am glad to say in Bow and Bromley have always been recognised, and met with a cheerful performance of duty. Epidemics of infectious disease have likewise led to an important increase in the ordinary work of the Department, which has loyally grappled with an emergency so seriously affecting the well-being of the inhabitants of the districts." Public attention has been particularly directed during the year to the prevalence of and to the abnormal increase of diphtheria and 3 diphtheritic complaints. The subject is one of immense importance, and I have deemed it to be advantageous to devote special attention to the matter as concerns the parish of Bow, where several outbreaks of the disease have occurred. In this prefatory introduction, I call to the notice of the members of the Board my remarks and conclusions under the head of Diphtheria and Membranous Croup, as the question of the notification of diseases, under the Infectious Diseases (Notification) Act, 1889, has on several occasions been under discussion. Not only so, but there is no doubt that the question of extending the number of diseases notifiable under that Act, is likely to be brought forward in the interests of sanitary science before many years have passed away. Already several provincial sanitary authorities have approached the Local Government Board to this effect. As the proposal is one of great importance to the general community, it is well that the principles which guide to a settlement of so valuable an adjunct towards efficient official supervision and sanitary knowledge should be properly recognised. Population and its Density. By the Census returns for the year 1891, the population of the parish of Bow was given as 40,378; in 1881, it was 37,063; and in 1871, it was 26,055. The Local Government Board requires the population of each sanitary district to be estimated to the middle of the current year. I have therefore done so, and found it to be 41,143, taking that as the basis of my calculations. In order to ascertain the density of the present population, it was necessary to obtain the number of inhabited houses in Bow, and this information has been furnished to me by Mr. Robert Logan, the Clerk to the Vestry of St. Mary Stratford-le-Bow. An examination of the rate books for the quarter ending Christmas, 1893, gives a return of the inhabited houses for that parish of 5741, allowing 2 per cent. for empties gives us 5627. This shows an actual increase of 492 over the year 1891, with a density of population, or number of inhabitants 4 per house in Bow, of 7.3 as against 7.6 for 1891, showing a slight decrease in density as by the following table:— Inhabited Houses. Population. No. of Inhabitants per House. Bow 1871 3829 26,055 6.7 1881 5002 37.063 7.3 1891 5249 40,378 7.6 1893 5741 41,143 7.3 Vital Statistics—Births. During the year 1893 the number of births registered in Bow were males, 731, females, 673—1404, as against 1308 for 1892. The excess of births over deaths in the parish was 434 as against 530 for 1892. The annual birth rate was 34.0 per 1000 of the population, comparing with 32.1 per 1000 last year. Vital Statistics—Deaths. During the year 1893 the number of deaths recorded for the parish of Bow was 970, as against 900 for 1892. These deaths include those of inhabitants which occurred in outlying institutions, and exclude those which occurred in the Grove Hall Lunatic Asylum, these latter being 39. The annual death rate for Bow was 23.5 per 1000 as against 22.1 for 1892, which is an increase of over 1 per 1000. Considering the epidemics which have prevailed in London during the twelve months, especially that of diphtheria, I do not think that the increase in the death rate of the parish can be regarded as in any way showing the existence of an abnormal state of things, and that it is merely the ordinary fluctuation which will be noticed in a long period in any area. The following tables, prepared in accordance with the directions of the Local Government Board, give the details of the various diseases, and show which have been most and which have been the least fatal in my district. Total Deaths of Inhabitants of BOW, occurring both within and without the District, during the year 1893. Mortality from the following Diseases. Under 1 year. 1 year, and under 5. 5 years, and under 15 15 years, and under 25 25 years, and under 65 65 years and upwards. At all ages 1st Quar. 2 andQuar 3rd Quar. 4th Quar. Total. 1st Quar. 2ndQuar. 3rd Quar. 1 4th Quar. Total. 1st Quar. 2ndQuar. 3rd Quar. 4th Quar. Total. 1 st Quar. | 2ndQuar. 3rd Quar. 4th Quar. Total. 1st Quar. 2ndQuar. 3rd Quar. 4th Quar. Total. 1st Quar. 2ndQuar. 3rd Quar. 4th Quar. Total. Small Pox ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Scarlatina ... ... ... ... ... 5 2 1 ... 8 2 2 1 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Diphtheria ... 1 ... 2 3 10 8 18 17 53 10 6 7 3 26 ... ... 1 1 2 ... ... 2 ... 2 ... ... ... ... ... 86 Membranous Croup ... ... ... ... ... ... 1 ... 3 4 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... ... ... ... ... 1 ... ... 1 ... 2 ... 2 4 ... 2 ... ... 2 ... 3 4 1 8 ... ... ... ... ... 15 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 2 ... ... ... 2 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... ... ... ... ... 5 Measles ... 1 2 1 4 1 ... ... 2 3 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Whooping Cough 1 3 1 ... 5 5 2 3 1 11 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Diarrhoea and Dysentery ... 8 11 1 20 ... 2 3 1 6 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... 2 ... 2 30 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 2 ... 2 1 ... ... ... 1 4 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis 1 2 1 1 5 2 3 1 ... 6 ... ... 2 ... 2 ... 1 4 1 11 15 11 7 13 46 1 ... ... 2 3 73 Bronchitis, Pneumonia and Pleurisy 6 6 12 18 42 13 11 3 14 41 1 1 ... 2 4 ... 4 2 4 10 23 26 1 19 74 7 10 1 12 30 201 Heart Disease ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 3 ... 1 1 1 3 5 10 7 5 27 6 3 2 5 16 49 Injuries 4 1 1 1 7 3 ... 1 ... 4 2 2 1 ... 5 2 ... ... 2. 8 2 4 4 18 1 1 6 ... 8 44 All other Diseases 25 31 65 35 156 9 14 10 3 36 1 7 6 4 18 2 4 3 5 14 20 31 24 33 108 22 21 20 24 87 419 Total 39 53 94 59 245 48 44 40 42 174 19 21 18 13 71 9 12 11 12 44 72 83 59 75 289 38 35 31 43 147 971 Table of Population Births, and of New Cases of Infectious Sickness coming to the knowledge of the Medical Officer of Health, during the First Quarter of the year 1893, BROMLEY Division of the Sanitary District of Poplar; classified according to Diseases, Ages and Localities. Names of localities adopted for the putpose of these Statistics; Public Institutions being shown as separtare localities. Parish of Bromley. Poplar and Stepney Sick Asylum. Poplar Hospital. Stepney Union Workhouse. City of London Union. Totals. Population at all Ages— Say— (b) Census 1891 17,000 ... ... ... ... 17,000 (c) Estimated to middle of 1893 17,336 ... ... ... ... 17,336 (d) Registered Births 685 ... ... ... ... 685 New Cases of Sickness in each Locality, coming to the knowledge of the Medical Other of Health. Diseases. Parish of Bromley. Poplar and Stepney Sick Asylum. Poplar Hospital. Stepney Union Workhouse. City of London Union. Totals. un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 Smallpox ... 1 ... 11 ... ... ... 16 ... 3 ... 31 Scarlatina 34 56 ... ... 1 ... ... ... ... ... 35 56 Diphtheria 8 24 ... ... ... ... ... ... ... ... 8 24 Membranous Croup 2 ... ... ... ... ... ... ... ... ... 2 ... Fevers. Typhus ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid 2 8 ... 1 ... ... ... ... ... ... 2 9 Continued 2 3 ... ... ... ... ... ... ... ... 2 3 Relapsing ... ... ... ... ... ... ... ... ... ... ... ... Puerperal ... 1 ... ... ... ... ... ... ... ... ... 1 Cholera ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 6 18 ... ... ... ... ... ... ... ... 6 18 Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospitals. Diseases. Parish of Bromley. Poplar and Stepney Sick Asylum Poplar Hospital. Stepney Union Workhouse. City of London Union. Totals. un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 Smallpox ... 1 ... 11 ... ... ... 16 ... 3 ... 31 Scarlatina 11 17 ... ... 1 ... ... ... ... ... 12 17 Diphtheria 2 6 ... ... ... ... ... ... ... ... 2 6 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... Fevers. Typhus ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid 1 1 ... 1 ... ... ... ... ... ... 1 2 Continued ... ... ... ... ... ... ... ... ... ... ... ... Relapsing ... ... ... ... ... ... ... ... ... ... ... ... Puerperal ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... 1 ... ... ... ... ... ... ... ... ... 1 Table of Deaths during the year 1893, in the BOW Sanitary District of the Poplar Board of Works, classified according to Diseases, Ages, and Localities. Mortality from all Causes, at subjoined Ages. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. At all ages. Under 1 year. 1 and under 5. 5 and under 15 15 and under 2 25 and under 65 65 and upwards Parish of Bow 757 225 144 53 28 199 108 Grove Hall Lunatic Asylum 39 ... ... ... 1 31 7 Totals 796 225 144 53 29 230 115 Deaths occurring outside the District among persons belonging thereto... 214 20 30 19 16 90 39 Deaths occurring within the District among persons not belonging thereto 39 ... ... ... 1 31 7 Mortality from Subjoined Causes, distinguishing Deaths of Children under Five Years of Age. Diseases. Parish of Bow. Grove Hall Lunatic Asylum Totals.. Deaths occurring outside the district among persons belonging thereto. Deaths occurring within the district among persons not belonging thereto. un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5. un. 5 ov. 5 Smallpox ... ... ... ... ... ... 1 ... ... ... Scarlatina 5 3 ... ... 5 3 3 3 ... ... Diphtheria 44 22 ... ... 44 22 12 8 Membranous Croup 4 1 ... ... 4 1 ... ... ... ... Fevers. Typhus ... ... ... ... ... ... . ... ... ... Enteric or Typhoid ... 11 ... ... ... 11 1 3 ... ... Continued ... ... ... ... ... ... ... ... ... ... Relapsing ... ... ... ... ... ... ... ... ... ... Puerperal ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... Erysipelas 3 2 ... ... 3 2 ... ... ... ... Measles 5 1 ... ... 5 1 2 ... ... ... Whooping Cough 15 ... ... ... 15 ... 1 ... ... ... Diarrhœa and Dysentery 24 2 ... 1 24 3 2 ... ... 1 Rheumatic Fever ... 4 ... ... ... 4 ... 2 ... ... Ague ... ... ... ... ... ... ... ... ... ... Phthisis 9 39 ... 4 9 43 2 23 ... 4 Bronchitis, Pneumonia & Pleurisy 74 81 ... 6 74 87 9 37 ... 6 Heart Disease ... 40 ... 8 ... 48 ... 9 ... 8 Injuries 9 20 ... ... 9 20 2 13 ... ... All other Diseases 177 161 ... 20 177 182 15 66 ... 20 Totals 369 388 ... 39 369 427 50 164 ... 39 Table of Population, Births, and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1893, in the BOW Division of the Sanitary District of Poplar; classified according to Diseases, Ages and Localities. Parish of Bow. Total. Population at all Ages— Census 1891 40,378 40,378 Estimated to middle of 1893 41,143 41,143 Registered Births 1,401 1,401 New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital. Diseases. Parish of Bow. Totals. Diseases. Parish of Bow. Totals. un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 Smallpox 3 18 3 18 Smallpox 3 10 3 10 Scarlatina 97 216 97 2:6 Scarlatina 17 60 17 60 Diphtheria 149 357 149 357 Diphtheria 25 37 25 37 Membranous Croup 7 1 7 1 Membranous Croup ... ... ... ... Fevers. Typhus ... ... ... ... Fevers. Typhus ... ... ... ... Enteric or Typhoid 6 58 6 58 Enteric or Typhoid ... 17 ... 17 Continued ... 1 ... 1 Continued ... ... ... ... Relapsing ... ... ... ... Relapsing ... ... ... ... Puerperal ... 2 ... 2 Puerperal ... ... ... ... Cholera ... ... ... ... Cholera ... ... ... ... Erysipelas 13 104 13 104 Erysipelas ... 8 ... 8 Deaths of Inhabitants of Bromley occurring during the first Quarter Year, 1893. Mortality from the following Diseases. Under 1 Year 1 Year and under 5. 5 Years and under 15 15 Years and under 25 25 Years and under 65 65 Years and upwards At all Ages. Small Pox ... ... ... ... ... ... ... Scarlatina ... 15 2 ... ... ... 17 Diphtheria ... 3 1 ... 2 ... 6 Membranous Croup ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... 1 1 ... ... 2 Continued Fever ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... 1 ... 1 Cholera ... ... ... ... ... ... ... Erysipelas 1 ... ... ... 2 1 4 Measles l 1 ... ... ... ... 2 Whooping Cough l 1 ... ... ... ... 2 Diarrhoea, and Dysentery l 1 ... ... ... ... 2 Rheumatic Fever ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... Phthisis 1 2 2 1 18 ... 24 Bronchitis, Pneumonia, & Pleurisy 23 19 3 6 64 19 134 Heart Disease 1 1 3 ... 20 4 29 Injuries 9 2 2 ... 3 1 17 All other Diseases 54 19 3 5 40 30 151 Total 92 64 17 13 150 55 391 9 Smallpox. I was able to report last year that there had been an almost complete immunity from smallpox in Bow and Bromley, not a single death being recorded from that scourge. It was the seventh successive year in which the disease had been practically absent from London, where during 1892 there had been only 41 deaths as compared with 8 for 1891, 4 for 1890, and 1 for 1889. On that head the RegistrarGeneral for the first time passed by this disease without comment in his annual report. I regret that I am not in a position to report that the same favourable state of things existed either in London or in my district of Bow during 1893. A useful return has been published by the Lancet, giving an analysis of the sickness and mortality statistics throughout the whole of London for the year 1893, and it is prepared according to Table B of the Local Government Board. From this it appears that the total number of notifications of smallpox in London in 1893 were 2813, 217 being from the Poplar District, or about one-fifteenth of the whole. The total deaths from smallpox in London reached the large number of 186, or over four times as many as in 1892. Of these deaths 12 occurred in the Poplar District, or practically the same proportion as the District had in the matter of notifications. In Bow during the year there were 21 such notifications, and in Bromley during the three months in which that parish was under my supervision 20. The deaths from this disease only number 1 in Bow. This occurred in a child under 1 year of age; various members of the two families who resided in the house in Wendon Street being attacked. The child was unvaccinated. The following particulars are taken from my monthly report:— Nine cases of smallpox occurred in a house in Wendon Street. First case 8 months, unvaccinated, followed by a mother and infant of another family sent to Sick Asylum. Disease afterwards developed; baby was unvaccinated, and died. Other cases were : mother of first 10 case, 36 years, mild, two faint vaccination marks; and two daughters, aged 7 years and 4 years, both unvaccinated; father of second case, 30 years; brother of second case, 4 years, unvaccinated; and sister of second case, 6 years, unvaccinated. Two other children in the house, aged 11 years and 8 years, had been vaccinated, and escaped the disease. All the cases were removed to hospital, and the premises thoroughly disinfected. As every case was notified, prompt attention was given, and whenever possible the source of the infection was traced. Of the 21 cases notified in Bow, 13 were sent to hospital; and of the 20 cases in Bromley during the first three months, 18 were sent to hospital. In my report to the Sanitary Committee for February, I asked the approval of the Committee to communicate with the keepers of all common lodging houses in the district to furnish information of all suspicious cases, as it appeared from a circular from the Metropolitan Asylums Board that the majority of the cases admitted to their institutions were persons of no fixed abode. On the 20th July the Sanitary Committee reported on the outbreak of the disease at the Convent in the Bow Road, where 4 cases occurred. The patients were at once isolated, the school broken up, and the remaining inmates revaccinated. Thus, whereas in 1892 we had not a single death from this cause in Bow or Bromley for the whole year, and only 3 notifications, we had no less than 20 cases in the first 3 months of 1893 in Bromley; 21 cases in Bow in the 12 months; and 1 death in Bow. These are facts which demand serious attention, and I desire to emphasise my remark in connection with this subject in my last annual report, that "The enforcement of the Vaccination Acts is an important public duty imposed by the Legislature upon Boards of Guardians, who according to the strict letter of the law have little if any option in the matter. Medical testimony of the highest authority is overwhelmingly in favour of vaccination as a mitigator and preventor of smallpox, and that with the aid of sanitary science should in the end overcome the disease." 11 Measles. During the year the deaths from this complaint in the parish of Bow were for the four quarters respectively, 1, 1, 2, 4, and in Bromley for the first quarter 2. This is a decidedly satisfactory decrease on the figures for last year, when in Bow the total deaths from this cause numbered 21, which figure was double that of the year 1891. Since 1880 on only two occasions have the cases been less, viz., in 1884, when the Bow cases were 6, and in 1889 when they were but 3. Thus for 1893 the death rate from measles is 0.19; comparing with 0.50 as the Bow rate for 1892. The following is the complete record from 1880 for Bow :— Bow—1880 11 1887 22 1881 19 1888 31 1882 23 1889 3 1883 28 1890 46 1884 6 1891 10 1885 28 1892 21 1886 27 1893 8 For several years I have persistently drawn attention to the fact that it is the reckless treatment of this disease which is, without doubt, the explanation of so much mortality, and it would be gratifying to be able to think that it is a change for the better in this direction which has led to the marked reduction in the number of fatal cases among the children of Bow. It may be added that the deaths from measles in London during 1893 were 1658, to which the Poplar District only contributed the small number of 32 as against 129 from Shoreditch, St. Pancras reaching the highest total with 154. Scarlet Fever. This disease, which last year made its appearance in an epidemic form, although in a mild type, has in the parish of Bow this year 12 shown a marked decrease, but for the first 3 months in Bromley displayed an alarming increase, the figures for the period being 17 deaths against 3 in the same period in 1892. In London generally there were in 1893 no less than 36,901 notifications of scarlet fever, the deaths numbering 1587, as against 1883 and 105 respectively for the Poplar District. The deaths showed an increase in the Metropolis of over 20 per cent. Under these circumstances it is satisfactory that the deaths in Bow only should show an actual decrease of 2. In Bow for the year the notifications numbered 310, of which 77 were removed to hospital. For the first 3 months in Bromley the notifications were 31, of which 10 were removed to hospital. It should be noted that of these 31 cases as many as 17 proved fatal, 15 being children between one year and five. In Bow the deaths for the four quarters were respectively 7, 4, 2, o, and may be taken as an indication of the decrease of the epidemic. The annual death rate for Bow was 0.31 as against 0.36 for 1892. Those who have experience in sanitary administration have long been forced to the conclusion, now generally admitted, that efficient sanitation, with a view to remedy the defects in houses, together with the removal of patients, or their isolation, conduce to a diminution in this disease. Since 1880 the record of Bow stands :— Bow—1880 20 1887 7 1881 33 1888 50 1882 18 1889 4 1883 36 1890 7 1884 21 1891 3 1885 6 1892 15 1886 8 1893 13 Whooping Cough. A continued decrease in deaths from this cause is to be noted in 13 Bow, and there is no doubt that if parents would recognise the dangerous nature of this disease in itself, and remember its infectious character, and especially the susceptibility of other children, a yet further decrease in the death rate from whooping cough would be noted. According to the Lancet return, there were 2327 deaths from this disease in London generally in 1893, those attributable to the Poplar District being 74. In 1892 the deaths were 2477 as against 2876, so that generally the decrease is apparent. In Bow the total deaths were 17, and for the first quarter in Bromley only 2. The annual death rate for Bow is therefore 0.41 as against 0.76 for 1892. Since 1880 the record for Bow is :— Bow—1880 21 1887 69 1881 30 1888 17 1882 47 1889 44 1883 14 1890 57 1884 21 1891 45 1885 39 1892 31 1886 12 1893 17 Diphtheria. To over-estimate the extreme importance which should be attached to this dangerous and perplexing disease would be impossible, while its subtle and varying nature justifies the most minute and anxious attention of those entrusted with conserving the health of the community. In the Sanitary Committee's report dated the 6th April, the following notes appear in reference to my monthly report:- "Last month he had to report the presence of several cases of Diphtheria amongst the scholars attending the Schools in Stafford 14 Road, Bow; since then nine had occurred amongst these scholars, and several of those previously reported had proved fatal. Of the 9, two- were second cases occurring in the houses of former patients, leaving 7 to be accounted for. " During the month 44 cases had been notified in No. 3 District. "With this report he presented a table of all the patients notified in No. 3 District since February 1st of this year; it will be found to contain details of 94 cases, of which 35 attended the school in question. He had exerted himself to the utmost to discover the cause of this alarming outbreak, and in placing his position before the Sanitary Committee, he would draw their attention to the following facts :— (a) A. F., 6 years (of 34 Stafford Road), was taken ill on February 2nd, and was not notified till February 15th. (b) On the 9th and 10th of February school parties were given which were largely attended by scholars—amongst whom was A. F.—and parents and friends. One child, not a scholar, attended one of the parties, and was taken ill a few days after of diphtheria. (c) The majority of the cases were notified between the 17th and 23rd of February. (d) The school premises had been most carefully inspected, and the drains tested without any defects of a serious kind having been found. The drinking water was from the main. "His opinion, based upon these facts, was that the probable source of the epidemic was the case of A. F., and the occasions of the school parties were the chief dates of the spread of the infection. On those occasions he had been told that the room was crowded for several hours from floor to ceiling, and great excitement prevailed. 15 He could not imagine more favourable conditions for the spread of such an infection; at the same time he must ask the Committee not to consider this report as final,* as he was still prosecuting the enquiry. "It had been suggested to him that the cause of the epidemic lay in the fact that an opening had been made in the Sutherland Road sewer at the point of the bi-section of that road by the Eglinton Road. The sewer was broken into for the purpose of making a man-hole, on the 16th February, and kept open until the 18th February, and no deposit was removed. "On reference to the map which he also presented, showing the position of the Stafford Road Schools, and the opening in the sewer it would be seen that 15 of the cases reported from this School from February 16th inclusive up to February 27th inclusive would not have occasion to pass this opening on their way to School, and 10 would. Not only that; had this opening been a centre of infection many more cases in the immediate neighbourhood must have occurred. "He gave here a table of all cases of Diphtheria notified in No. 3 District between February 17th and February 28th inclusive. The Committee would see there were particulars as to date, address and the school which was either attended by the patient or by children from the infected house, of 40 cases, and that the schools in question were implicated in 27 out of the 40. There was also a note as to the * Subsequent to the Meeting of the Committee the Medical Officer continued his enquiries, and under his supervision the drains of the Schools were opened and examined, and found not to run under the school building, and to be in good condition. As regards the water closets, he found several of the connections imperfect. The water closets were to be entirely remodelled on a new plan. Reviewing the whole of the evidence with this most recent addition, he was still of opinion that the outbreak was caused by the introduction amongst the assembled scholars, on one or both of the nights of the parties, of the infection by some one attending them, probably " A. F.," as previously mentioned. 16 cases occurring at 34, Stafford Road, the residence of A. F., previously mentioned. date. address. school. Feb. 17 57 Sutherland Road 1 Stafford Road School. 17 137 Bow Road 2 do. 17 30 Vernon Road 3 do. 17 15 Morville Street 4 do. 17 27 Sutherland Road 5 do. 17 15 Norman Road 1 Malmesbury Road. 17 52 Tredegar Road 6 Stafford Road School 17 15 Ford Street 2 Montieth Road. 17 40 British Street 7 Stafford Road School 17 62 Eglinton Road 8 do. 18 34 Vernon Road 9 do. 20 44 Malmesbury Road 3 Tredegar Road School 20 62 Eglinton Road 10 Stafford Road School 20 45 Stafford Road 11 do. 20 10 Lacey Street 12 do. 20 10 Saxon Road 13 do. 20 38 Vernon Road 14 do. 20 36 Vernon Road 4 None. 21 55 Vernon Road 15 Stafford Road School. 21 Cottage in Rosebank Road 16 do. 21 9 Tamar Street 17 do. 21 166 Monier Road Ballance Road School, Homerton. 21 10 Mostyn Road 18 Stafford Road School. 22 12 Saxon Road St. Johns, Bethnal Green, and Malmesbury Road. 22 34 Stafford Road 19 Stafford Road School. 22 47 Stafford Road 20 do. 22 30 Vernon Road 21 do. 22 166 Monier Road Ballance Road School, Homerton, 22 17 Rosebank Road 22 Stafford Road School 22 1 Gawthorn Street 23 do. 22 17 Morville Street 24 do. 17 24 35 Sutherland Road 8 Tredegar Road School 23 36 Vernon Road 9 None. 26 26 Ruston Street 10 Atley Road and Montieth Road. 25 35 Sutherland Road 11 Tredegar Road School. 27 53 Armagh Road 25 stafford Road and 12 Tredegar Road Schools. 27 34 Stafford Road (3rd case) 27 Stafford Road School. 28 34 Stafford Road (4th case) 27 Stafford Road School. 28 4 Campbell Road 14 None. "He thought these facts disposed of the suggestion. " The cases that occurred at 34 Stafford Road were as follows :— Feb. 15.—A. F., 6 years Feb, 22.—E. G., 6 years. Feb. 22.—R. G., 4 years. Feb. 27.—M. G., 2 years. Feb. 28.—E. F., 4½ years. "On examination of the above-mentioned premises, the drains under w.c. were proved defective, iron D trap in yard defectively set, roof and gutter of washhouse defective, ceiling of kitchen on first floor dirty, drinking water was from the main, w.c. fair condition—the defects referred to had since been remedied. "The day after closing the school for Easter he had the school thoroughly disinfected by burning sulphur : the floors, woodwork, and furniture washed with a disinfectant under his personal supervision; and had, with the consent of the Secretary of the Schools, arranged that the drains of the Schools be opened and examined; he hoped to be in the position to report the result of this inspection to the Committee at their meeting." The occurrence in London during the past year of between 13,000 and 14,000 cases of diphtheria, and the apparently growing prevalence of this disease have naturally largely engaged my attention, C 18 and the more so because although the population of Bow was in 1891 but as 1 in 104 of the population of all London, yet the local cases of diphtheria notified to me were as 1 in 27 of the number for all London. My object is now to lay before you facts explanatory of this condition, and for this purpose I have carefully analysed the weekly returns of notifications for all London as sent to Metropolitan Medical Officers of Health, and have prepared a special table (No 2) showing not only, the totals in London and Bow but allotting the cases to their different periods of life, i.e. 5 years and under, 6 to 15 years, and over 16. Column 5 of this table gives the total number of notifications in the year from Bow, and we do not find a very high percentage until we reach the week ending February 18th, when the cases amounted to 1 in 17 of the whole number, followed by 1 in 7 in the week ending February 25th. Referring to my report for the month ending February 25th, an extract from which I have given, we find that at the commencement of the outbreak I was able to connect it with a school in the district; thanks to the notification system and the enquiries which the Sanitary Inspectors in my district are required to make in all cases of infectious disease, a copy of which enquiry form is here inserted :— Date Address Name and age of Patient in full Nature of Disease from which Patient is suffering Name of Medical Practitioner notifying Result of Drain test Defects Water supply Condition of W.C Schools attended by Children Milk supply from If removed to Hospital 19 Turning again to the Table it will be seen that 38 cases were notified during the 4 weeks ending March 25th, the previous extract from my monthly report gives the result of a further examination into the cause of the school epidemic, and my conclusions thereon appeared in the report mentioned. These are sufficient in my opinion to exonerate the school from fault. Continuing my investigation I reported on April 22nd, "that only 3 cases of diphtheria had occurred during the past month among the scholars of that school, and they occurred before the Easter recess, not a single case had occurred since the assembly of the scholars on the 10th inst." Since then I have seen no reason to connect the cases with any particular school; a most noticeable fact, however, existed throughout the whole year, that in two "localities " of the district, bounded, North, Marsh Land, Wallis Road and White Post Lane, South, Embankment of Main Drainage, East, River Lea, West, Cadogan Terrace and Wick Lane — numbering in all 878 houses, with an estimated population of 6314, only 20 cases occurred, being at the rate of 3.3 per 1000 inhabitants, the rate being for the rest of the district (Bow) 13.9. It is well known that less than 20 years ago, the majority of these houses were poorly built on made-up land. Mr. Rugg, the new Sanitary Inspector, is now making a house-to-house inspection of that portion of the district, and finds in almost every house sanitary defects, some of a serious character. Much scepticism exists in the minds of many of the laity as well as of some of the profession, as to the very existence of epidemic Diphtheria this year in London. I give you the number of deaths from that disease allotted to their respective ages; this will indicate the actual state of things which prevailed in the Bow District during 1893— 20 During 4 weeks ending- 5and under. 5 to 15 Over 15 Totals. Jan. 28 1 (went in to Hospital with Scarlet Fever 1 and at the end of 47 days contracted Diphtheria) Feb. 25 H 1 H 2 1 4 Mar. 25 H7 3 H 2 2 14 Apr. 22 h2 1 3 May 20 H 1 2 H 1 1 5 June 17 H 1 H 1 1 1 4 July 15 5 H 1 1 7 During 6 weeks ending— Aug. 26 7 H 1 2 (one c'ase came from Skegness and died next day 10 During 4 weeks ending— Sept. 23 H 5 3 2 10 Oct. 21 8 3 1 12 Nov. 18 H 2 6 1 9 During 6 weeks ending— Dec. 30 H 1 7 1 H 1 10 48 13 6 89 Hospital 15 6 1 Totals 63 19 7 Note—These returns include Membranous Croup. The epidemic account is as follows :— 516 notifications—89 deaths, about 1 in every 5, of these 21 died in hospitals. Of the 510 notifications, 199 referred to children 5 years of age and under; of these 199, 63 died, about 1 in 3, 14 died in hospitals. 176 referred to children between the ages of 6 and 15, of these 19 died, 6 in hospitals; the remaining 141 referred to persons over 16, and of these 7 died, 1 in a hospital. 21 The account for all London was—Notifications 13,791. Cases 5 years and under, 5414: 6 to 15 years, 4042; over 16 years, 4335. It is worthy of note that an analysis of all the cases shews that the incidence of the disease at different periods of life was almost the same in Bow as in all London, and still nearer that of the district which is our antipodes—Kensington. In the face of these figures there can be hardly any doubt as to the existence of the epidemic. Possibly many cases of sore throat, due to the infection of diphtheria, have not been notified, and I consider it to be probable that many cases of non-infectious throat have been notified as diphtheria. In the early stages and the aborted conditions no medical man can venture positively to negative the diagnosis of diphtheria. One case which came under my notice was as follows:—A child had the characteristic membrane, and 3 days after the mother complained of sore throat; an examination of the throat showed nothing characteristic, no cause could be discovered in the house for the attack: was it not very probable that the mother contracted her sore throat from the child ? and had anyone seen the mother's throat without knowing of the child's illness, what guide was there in the case to point to its cause? Medical men may justly be divided into two bodies—the one never notifies "diphtheria" without the case is typical and complete, and the other does not wait for developments. If we consider that the intention of the Legislature in the Public Health Act (London) 1891, and previously in the Notification of Infectious Diseases Act, was to enable Sanitary Authorities to obtain the earliest and surest information of the presence of infectious disease, and give them an opportunity of searching for insanitary conditions, we shall conclude that it is to the latter class of medical men that the best thanks of the community are due. There are more infectious throats than the diphtheritic, and it has long been recognised that insanitary conditions frequently cause sore throats. An alteration in the schedule of diseases, adding to it "Infectious sore throat" or even simple "sore throat" would remove the conscientious scruples entertained by some medical men on the score of notifying "diphtheria." Notification of Cases of Diphtheria, 1893. For all London. Bow. Proportion to total number of cases. During the week ending 1893 Total S years and under. 5 to 15 years. 15 years and over. Total 5 years and under. 5 to 5 years. 15 years and over. January 7 171 66 56 49 3 ... 2 1 1 in 57 14 122 56 35 31 1 ... 1 ... 1 ,, 122 21 122 48 43 31 2 ... 2 ... 1 „ 61 28 171 68 55 48 2 1 1 ... 1 „ 85 February 4 181 73 50 49 3 1 1 1 1 „ 60 11 177 70 50 57 2 1 ... 1 1 „ 88 18 191 93 70 28 14 4 6 4 1 ,, 13 25 189 88 55 46 28 14 14 ... 1 ,, 6 March 4 147 72 42 33 12 7 5 ... 1 ,, 12 11 179 86 56 37 8 4 2 2 1 „ 22 18 161 80 39 42 9 4 2 3 1 „ 18 25 173 74 71 28 9 6 2 1 1 ,, 19 April 1 141 68 31 42 7 4 ... 3 1 „ 20 8 186 83 45 58 9 2 3 4 1 ,, 20 15 154 65 38 54 4 2 ... 2 1 ,, 38 22 170 84 52 34 3 1 ... 2 1 ,, 56 29 204 88 66 50 13 7 3 3 1 „ 15 May 6 235 113 62 60 7 2 1 4 1 ,, 33 13 243 101 79 63 11 6 3 2 1 ,, 22 20 219 80 74 65 4 1 2 1 1 ,, 54 27 220 86 76 58 6 2 2 2 1 „ 36 June 3 199 72 73 54 3 2 ... 1 1 ,, 66 10 267 95 85 86 9 2 4 3 1 ,, 29 17 315 118 101 96 22 8 9 5 1 ,, 14 24 319 120 103 96 17 4 10 3 1 ,, 18 July 1 305 106 108 91 11 7 4 ... 1 ,, 27 8 289 108 62 119 7 1 5 1 1 „ 41 15 311 106 97 108 15 4 7 4 1 ,, 20 22 289 105 82 102 12 2 7 3 1 „ 24 29 296 111 88 97 12 5 3 4 1 „ 24 August 5 313 104 94 115 12 4 5 3 1 ,, 26 12 239 96 65 78 6 3 ... 3 1 „ 39 19 292 109 69 114 5 ... 2 3 1 „ 58 26 270 103 64 103 8 2 2 4 1 „ 33 September 2 277 89 84 104 12 5 7 ... 1 ,, 23 9 322 101 109 112 16 6 6 4 1 ,, 20 16 362 131 113 118 20 6 7 7 1 „ 18 23 449 152 116 181 29 11 6 12 1 „ 15 30 429 150 114 165 18 7 5 6 1 „ 23 October 7 419 155 107 157 21 8 3 10 1 „ 19 14 402 156 116 130 12 6 1 5 1 „ 33 21 406 148 116 142 4 1 1 2 1 ,, 100 28 367 126 120 121 12 4 5 3 1 „ 30 November 4 395 159 104 132 14 5 4 5 1 ,, 28 11 323 145 88 90 12 3 5 4 1 ,, 26 18 369 142 89 138 8 3 2 3 1 „ 46 25 388 154 103 131 6 3 1 2 1 ,, 64 December 2 307 134 77 96 7 4 2 1 1 „ 44 9 288 125 81 82 9 5 4 ... 1 ,, 32 16 304 126 96 82 7 4 2 1 1 „ 43 23 269 116 81 72 6 2 2 2 1 ,, 44 30 255 113 82 60 7 3 3 1 1 ,, 36 13791 5414 4042 4335 516 199 176 141 CHART shewing the rise and fall in the Notifications of Diphtheria week by week during the year 1893. Giving also the weekly death returns from that disease. Notifications Deaths 23 I append a Chart shewing the marked rise and fall of the notifications and the deaths from this disease in Bow during the year. In London generally in 1893 there were no less than 13,791 notifications of diphtheria, of which 1149, the largest total of any parish, came from the Poplar District; the deaths numbered 3196, of which 168 were recorded against the Poplar District. In Hackney the disease was the most fatal, there being 206 deaths against 200 for Islington, and 201 for St. Pancras; Poplar being the fourth highest Lambeth coming in between with 185. In Bow for the four quarters the deaths were respectively, 20, 15, 28, 23, total 86; and in Bromley for the first three months the deaths were 6. The annual death rate from diphtheria, including membranous croup, in Bow was therefore, 2.21, a fact which should be seriously taken into consideration, because it is the highest local death-rate from any zymotic disease. The great and steady increase on the figures for last year will be seen by a reference to the table given below. The deaths returned as due to membranous croup were in Bow for the year 5, as against 6 for 1892, and none for the first 3 months in Bromley. Since 1880 the record stands : — Bow—1880 14 1889 Diphtheria 5 16 1881 13 Croup 11 1882 23 1890 Diphtheria 12 25 1883 9 Croup 13 1884 10 r89i Diphtheria 27 36 1885 13 Croup 9 1886 14 1892 Diphtheria 37 43 1887 14 Croup 6 1888 Diphtheria 11 18 1893 Diphtheria 86 91 Croup 7 Croup 5 N.B.—In every instance where the word "diphtheria" is used it includes membranous croup. Diarrhœa and Cholera. For the first three months in Bromley and for the whole year in Bow we show a clean sheet as regards cholera, no death being 24 attributable to this cause. It was otherwise with respect to diarrhoea and dysentery. In Bow during the 12 months there were 30 deaths, and 2 in Bromley for the first quarter. The majority of cases were those of young children under a year old, most occurring in the summer months. The return shows an increase on the figures for Bow during 1892, when they stood at 24, the death rate being 0.58 against 0.72 for 1893. Every suggestion made by the central authorities for the prevention of the introduction of cholera, and dealing with it in the event of an outbreak, were carefully considered, and proper and adequate arrangements made in the Bow District. Happily these have not yet been put to the test, and with due attention to the milk and water supplies it is to be hoped that any attack may be successfully repelled. On July 20th I reported specially as to precautions to be taken and here give that report. " Special Report as to Preparations which should be made for the reception of cholera in the event of its visiting the District:— July 17 th, 1893. Gentlemen, In accordance with your reference of the 5th inst., I now report as to the arrangements which the Local Government Board's regulations would require us to make for the prevention and treatment of cholera, in the event of its visiting us. These regulations comprise— (a) Appointment of Committees. (b) Division of District. (c) Medical visitors for poorer houses. (d) Medical attendance, nursing and medicine. (e) Disinfectants. (f) Hospitals. 25 (g) Places of refuge for persons not actually sick, whom it might be right to keep under observation, or to accommodate while their houses were either under disinfectionor were devoted to sick persons who could not properly be removed. The suggestions I would make are as follows:— (а) (b) Division of District. Four sub-divisions— 1. All Bow (South of Great Eastern Railway). 2. That part between Great Eastern Railway and Old Ford Road. 3. That part bounded South by Old Ford Road; North by Duckett's Canal; East by North London Railway. 4. That part bounded West by North London Railway; North- East by boundary of the District; South by the Sewer Embankment. (c) Medical visitors for poorer houses, to discover cases of cholera and diarrhœa. [Thinking that senior Medical Students would be the best and most available medical visitors, I wrote to the Secretary of the London Hospital on the subject, and the matter is under consideration. I think 8 would be sufficient; it would be their duty to report cases to the Medical Officer in charge of their district]. (d) Medical Attendance. I have asked the following medical men if they would take medical charge of part of the district, and they have consented. District No. 1. Dr. Wallace, Bow Road. ,, 2. Dr. Bennett Tredegar Road. Dr. Roberts Dr. Thornton, St. Stephens Road. 26 District No. 3. Dr. Wallace, Old Ford Road. Dr. Dornford, Hewlett Road, Roman Road. „ 4. Drs. Thornton and Bennett. (e) Nursing. I have left open. (f) Supply of Medicines. I have seen Messrs. Thompson, Bow Road; Dean, Fairs, and Garman, Roman Road, Chemists, and they are willing to dispense and supply medicines. (g) Disinfectants and Disinfecting. This, I have no doubt, you will leave in my hands; but I cannot too strongly remind you that the apparatus is, as you know, nearly useless, and we have no place for destroying bedding. (h) Provision of Hospital Accommodation. I have written to the London Hospital on this subject and also to the Metropolitan Asylums Board, and append the replies. Note.— Since writing this a new disinfecting apparatus has been purchased. [It would be seen by a letter from the London Hospital that it will take a few of the early cases, and the Asylums Board will move them, of course, if the disease became epidemic, this accommodation would not suffice. A hospital of your own would then be necessary. There is plenty of vacant land well away from dwellings near Duckett's Canal, on the Monier Road part of the district, and I should advise the purchase of a site there. Humphreys or Croggon could quickly erect a building when wanted.] (i) Places of Refuge. I think empty houses might be secured for this purpose. [In addition to these arrangements I shall be prepared 27 to convert my house in the Bow Road into a central bureau, and couple with my work of superintendence any other that may eventuate.] In conclusion, I would remind you that it is the opinion of many eminent authorities that this disease is air-borne in many instances and the opinion of all that insanitary conditions are those in which it thrives best; with both of these opinions I agree, and respectfully submit to you the necessity of re-considering your decision not to allow me a second Inspector, my present one does as much as he can, but in my opinion it is impossible for him to keep Bow in the condition most hostile to the invasion of any epidemic, much less that of cholera. Note.—Since writing this a second Inspector has been appointed." In London, during 1893, the deaths certified as due to diarrhoea were 3436, of which the Poplar District was responsible for 185. Since 1880 the Bow record stands :— Bow—1880 26 1887 32 1881 . 27 1888 17 1882 . 20 1889 12 1883 . 17 1890 28 1884 . 32 1891 16 1885 . 6 1892 24 1886 . 32 1893 30 I may with advantage repeat what I stated in my last annual report:— "Various preventive steps were taken, and I think the public should be strongly cautioned against putting their trust in any of the many so-called specifics for cholera, diarrhoea, or allied diseases: it cannot be too widely known that there is no specific for these diseases, and that the wisest plan to adopt if attacked by any of the well-known symptoms, is to seek the advice of a Medical Man, and if he pronounces the symptoms ' choleraic,' communicate at once with the 28 Medical Officer. I inspected the water-courses of the district, and found them in very fair condition." "On the 2nd March, 1893, the Clerk to the Board, under instructions, informed the Medical Officer to the London County Council, that in the unfortunate event of an outbreak of cholera, the Board would be fully prepared to take whatever steps might be necessary to grapple with the emergency." Typhus and Enteric Fever. Bow, and for the first three months, Bromley, show a clean record in the matter of typhus fever, from which in all London during 1893 there were 5 deaths, one of these being in Poplar. This is the third successive year in Bow in which there has not been any death from typhus. In London there were 675 deaths from enteric fever, and 20 deaths from continued fever, the Poplar District contributing 62 cases of enteric fever, but none of continued fever. In Bow during the year the deaths due to enteric fever were 15, and 2 for the first quarter in Bromley. As far as Bow is concerned this is an increase on the figures for 1892, when the death rate was 0.24; the death rate for 1893 being 0.36. The Bow record since 1880 is- Bow—1880 2 1887 8 1881 2 1888 15 1882 13 18894 1883 11 1890 9 1884 9 1891 12 1885 5 1892 10 1886 4 1893 15 Influenza. The tables of the Local Government Board make no provision for recording the deaths attributed to influenza, these having to be placed 29 under "All other diseases." Slight epidemics of influenza were experienced during the year, but not of so severe a character as was the case in 1892. In Bow the deaths due to bronchitis, pneumonia, and pleurisy were 202, and for the first quarter in Bromley 134, or a slight increase on the previous year, when the Bow rate was 4.84, as compared with 4.90 for 1893. Sanitary Requirements in Bow. In April I presented the following report to the Sanitary Committee in accordance with their reference:— "In accordance with your reference of the 6th inst., I beg to report to you on the question of the Sanitary Staff and its requirements, so far as the District of Bow is concerned. House-to-House Inspection. In 1891 there were 5249 inhabited houses; of these I should say 4000 should be inspected at least once in two years. One Inspector for this might prove sufficient. Houses Let in Lodgings. Sec. 94 of the Public Health (London) Act, 1891, requires every Sanitary Authority to make and enforce the requisite bye-laws:— (а) For fixing the number of persons occupant, and separation of sexes. (b) Registration. (c) Inspection. (d) Drainage, cleanliness, ventilation. (e) Cleansing, &c., at stated intervals. (f) Precautions in case of epidemic disease. 30 I would here draw attention to the Board's regulations. I should say the 4000 houses above-mentioned would require registration as Houses let in Lodgings. The question of how many Inspectors will be required to do this part of the work is the most serious one in this report, and I should prefer a consultation with the Committee before expressing an opinion as to the number of Inspectors required. Mortuary and Coroner's Court. The necessity for fresh arrangements having been admitted by the Committee, and the whole question being put under their consideration, comment of mine on this head is superfluous. Workshops, Outworkers Bakehouses, Cowhouses, Slaughterhouses, Mews, Stables, Fishmongers, Greengrocers, Food Stores, Stalls and Barrows of all Descriptions, Rag and Bone Shops. All these, and places of a like kind, might well occupy the whole time of one Inspector. Notification of Infectious Diseases and Nuisance Complants. Yet the attempt might be made to include in his duties the investigation into cases of infectious disease as notified, and the exercise of such surveillance as would tend to bring about the carrying-out of our instructions. Factory Nuisances and Smoke Nuisances. I would leave these to Mr. Raymond. Disinfecting Apparatus. I am of opinion that it is absolutely necessary that we should have an entirely new apparatus, on a new site, the present apparatus being antiquated by its process, and inefficient and structurally dilapidated, and the site most incommodious. 31 Disinfector. I append Inspector Boyce's detailed report, with plan. copy. April 18th, 1893. Sir,- The apparatus in use in your District for disinfecting bedding, &c., is one known as "Fraser's Patent." It consists of a brick oven, with doors in front; in the lower portion of this is a covered furnace, with flues, capable of raising the air inside the chamber after from three to five hours, to a temperature of 200° F., sulphur fumes being used at the same time. The flues mentioned above were originally of iron, but owing to their worn condition have been taken out and brick flues substituted. These latter flues, although good in their way if built under a drying closet, are of no use for the object in view at this apparatus. The doors are ill-fitting, and permit much of the heat to escape from the chamber when in use, so that I have to depend more upon sulphurous acid as a disinfecting agent than dry heat, as the disinfecting heat can rarely be got, and from a reference to reports which I made to you in the years of 1891 and 1892 respectively, you will note that in the cases of feather beds which were subjected to an average temperature of 230° F. for a period of three hours, the temperature of the interior of the beds did not reach 100° F., and in the case of flock beds did not exceed 112º F., and other detail matter. The foregoing experiments were made before the iron flues were taken out. The ground on which the disinfecting chamber is built has an area of 2,955 square feet, and slopes towards the river Lee. The stokehole is below the level of the adjoining ground, and at its lowest point much of the surface water from the Old Ford Road accumulates here, and has to be baled out before work can be commenced. High tides also occasion much worry. An attempt was made about 18 months ago to keep the tidal water out by driving sheet piling along the font of the canal bank, but this has proved ineffectual. 32 Any bedding that is destroyed is burned in the open air, there being no destructor for that purpose. The men engaged in handling infected clothing have no convenience for washing themselves until they get home. The removal truck needs repair badly. The yard is nearly wholly lumbered up with materials used for road-making. The adjoining premises are used as a dust wharf, and there is a large accumulation of dust, extending the whole length of our yard, and piled above and against the party fence to such a height that quantities have often to be shovelled back to enable the truck used for the removal of bedding access to and from apparatus. A plan of the premises accompanies this report. I am, Sir, Your obedient Servant, W. BOYCE, Inspector No. 3. Offices, Clerk, Shelter for Families while Houses are being disineected, etc. I can only say that the present office accommodation is insufficient even for the Inspectors, and that there is none at all for me. If I might, I would suggest an office for my Inspectors alone, and a room for myself; or if space will not permit the latter, I shall be happy to do my work at home, as I have always done." Most of the matters here alluded to have either been dealt with or are at the present time receiving the careful consideration of the Committee, but I may remark that the appointment of an additional Sanitary Inspector for the sub-district of Bow, will in my opinion be attended with the best results. Board Schools in Bow. During the year, especially in the summer and at the time of the 33 outbreak of diphtheria, the Board Schools in my district were systematically inspected. Where defects were found to exist, the necessary notices were served, and in the course of time all such sanitary defects were remedied. The schools in Bow are now in a satisfactory sanitary condition. I may add that in various instances the filters in use in the schools were in a decidedly dangerous state, and I cannot too strongly repeat the opinion that I have on frequent occasions given, that no filters should be used. Gullies. During the year the condition of the gullies in the Bow parish has been brought under my notice. I have submitted lists at various times of those gullies requiring examination, and from time to time the work has been put in hand. Some have been remodelled, some repaired, some cleansed, and some flushed. BYE-LAWS. In pursuance of the provisions of the Public Health (London) Act, 1891, various bye-laws have been made by the Board as the Sanitary Authority for the District; these bye-laws were approved by the Local Government Board on the 20th day of October, 1893, and are as follows:— FOR THE PREVENTION OF NUISANCES. Interpretation of Terms. Throughout these byelaws the expression "the Sanitary Authority" means the Board of Works for the Poplar District. For the prevention of nuisances arising from any snow, ice, salt, dust, ashes, rubbish, offal, carrion, fish, or filth, or other matter or thing in any street. The occupier of any premises fronting, adjoining, or abutting on any street not repairable by the inhabitants at large shall, as soon as conveniently may be after the cessation of any fall of snow, remove or cause to be removed from the footways and pavements adjoining D 34 such premises and forming part of such street all snow fallen or accumulated on such footways and pavements, in such a manner and with such precautions as will prevent any undue accumulation in any channel or carriageway or upon any paved crossing. The person in occupation of or having the charge, management, or control of the premises, or if there is no such person, then any person in occupation of or having the charge, management, or control of any part of the premises, and in the case of any premises the whole of which is let in tenements or to lodgers, the person receiving the rent payable by the tenants or lodgers, either on his own account or as the agent of another person, shall for the purposes of this law be deemed to be the occupier. Every person who shall remove any snow from any premises on to any carriageway shall deposit the same in such a manner and with such precautions as to prevent any accumulation thereof in any channel or upon any paved crossing. If in the process of such removal any snow be deposited upon any footway or pavement in any street, he shall forthwith remove such snow from such footway or pavement. Every person who shall throw any salt upon any snow on the footway of any street shall do so in such quantity and in such manner as effectually to dissolve the whole of such snow, and he shall forthwith effectually remove from the footway the whole of the deposit resulting from the mixture of the salt with the snow. He shall not place any part of such deposit on the carriageway of such street elsewhere than in proximity to any channel at the side of such carriageway, and he shall not remove any part of the same into any such channel unless it is sufficiently liquid to flow along such channel. No person shall throw any salt upon any snow on the carriageway of any street, unless it shall be practicable forthwith effectually to remove the whole of the deposit resulting from the mixture of the salt with the snow. Every person who shall throw any salt upon any snow on any such carriageway shall forthwith effectually remove the 35 whole of the deposit, but he shall not place any part thereof on the footway of such street, or on any paved crossing, or on the carriageway, in such a manner as to interfere with the carriage traffic, nor shall he place any part thereof in the channel at the side of the carriageway, unless it is sufficiently liquid to flow along such channel. A person shall not throw, cast, or lay or cause to be thrown, cast or laid, any dust, ashes, rubbish, offal, carrion, fish, or filth, or other like matter or thing in or upon any part of a street: Provided always that this byelaw shall not apply to any act which is for the time being an offence within the meaning of any public general Statute, or of any byelaw made by the London County Council and in force in the place where such act is done: Provided also that it shall not be an offence against this byelaw to lay any ashes or other suitable material in any street in time of frost to prevent accidents. Every person who shall lay or cause to be laid in any street any litter or other matter in case of sickness to prevent noise, shall lay the same so that it may be evenly distributed over the surface of the part of the street intended to be covered, and shall, when the occasion ceases, within forty-eight hours thereafter remove or cause to be removed from such street the litter or other matter so laid in such street. For preventing nuisances arising from any offensive matter running out of any manufactory, brewery, slaughter-house, knacker's yard, butcher's or fishmonger's shop, or dunghill, into any uncovered place, whether or not surrounded by a wall or fence. The occupier of a manufactory, brewery, slaughter-house, knacker's yard, butchers or fishmongers shop, or of any premises comprising a dunghill, shall not cause or suffer any offensive matter to run out of such manufactory, brewery, slaughter-house, knackers yard, butchers or fishmongers shop, or dunghill, into any uncovered place, whether or not surrounded by a wall or fence, so as to be likely to become a nuisance. 36 For the prevention of the keeping of animals on any premises in such place or manner as to be a nuisance or injurious or dangerous to health. The occupier of any premises shall not keep nor allow to be kept any animal on such premises in such a place or in such a manner as to pollute, or to be likely to pollute, any water supplied for use or used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man, or any water used or likely to be used in any dairy. Every occupier of a building or premises wherein or whereon any horse or other beast of draught or burden, or any cattle may be kept, shall deposit or cause to be deposited in a suitable receptacle all dung, manure, soil, filth, or other offensive or noxious matter other than urine and other liquid filth which may, from time to time, be produced in the keeping of any such animal in such building or upon such premises. He shall likewise provide in connexion with such building or premises a sufficient drain, constructed in such a manner, and of such materials, and maintained at all times in such a condition, as effectually to carry away all urine and liquid filth or refuse therefrom. Except where the Sanitary Authority, by notice duly given under the statutory provision in that behalf, shall have otherwise required, he shall, once at least in every week, remove or cause to be removed from such building or premises all dung, manure, soil, filth, or other offensive or noxious matter produced in or upon such building or premises, and deposited in a receptacle as hereinbefore required. Provided that this requirement shall not apply to the occupier of any stable or cow-house from which the Sanitary Authority remove or contract for the removal of manure and other refuse matter. Where for the purpose of preventing the keeping of any horse or other beast of draught or burden or any cattle on any premises so as to be a nuisance or injurious or dangerous to health, it is necessary that the floor of the building in which such animal is kept should be impervious to liquid matter, no person shall keep any animal in such 37 building unless or until the floor thereof shall have been paved with a hard and impervious pavement, evenly and closely laid, and so sloped as to effectually carry off all liquid matter therefrom to a properly trapped inlet to the drain hereinbefore required to be provided. As to the paving of yards and open spaces in connexion with dwelling-houses. The owner of every dwelling-house in connexion with which there is any yard or open space shall, where it is necessary for the pre vention or remedy of insanitary conditions that all or part of such yard or open space shall be paved, forthwith cause the same to be properly paved with a hard, durable, and impervious pavement, evenly and closely laid upon a sufficient bed of good concrete, and so sloped to a properly constructed channel as effectually to carry off all rain or waste water therefrom; and he shall cause such pavement to be kept in proper repair. Penalties. Every person who shall offend against any of the foregoing bye-laws shall be liable for every such offence to a penalty of five pounds, and in the case of a continuing offence to a further penalty of forty shillings for each day after written notice of the offence from the Sanitary Authority: Provided, nevertheless, that the justices or court before whom any complaint may be made or any proceedings may be taken in respect of any such offence may, if they think fit, adjudge the payment, as a penalty, of any sum less than the full amount of the penalty imposed by this bye-law. WITH RESPECT TO THE KEEPING OF VVATERCLOSETS SUPPLIED WITH SUFFICIENT WATER FOR THEIR EFFECTIVE ACTION. With respect to the keeping of waterclosets supplied with sufficient water for their effective action. The occupier of any premises in or for which any watercloset is for the time being provided, shall cause such watercloset to be at all 38 times properly supplied with a sufficient quantity of water for securing its effective action. Where, however, any watercloset is provided for the use of persons occupying two or more separately occupied premises, and there is a person having the care and control of such watercloset, the foregoing requirement shall apply to such person. The person in occupation of or having the charge, management, or control of the premises, or if there is no such person, then any person in occupation of or having the charge, management, or control of any part of the premises, and in the case of any premises the whole of which is let to lodgers, the person receiving the rent payable by the lodgers, either on his own account or as the agent of another person, shall, for the purposes of this byelaw, be deemed to be the occupier. Penalties. Every person who shall offend against the foregoing byelaw shall be liable for every such offence to a penalty of five pounds, and in the case of a continuing offence to a further penalty of forty shillings for each day after written notice of the offence from the Sanitary Authority: Provided, nevertheless, that the justices or court before whom any complaint may be made, or any proceedings may be taken in respect of any such offence, may, if they think fit, adjudge the payment, as a penalty, of any sum less than the full amount of the penalty imposed by this byelaw. WITH RESPECT TO THE CLEANSING OF CISTERNS. For securing the cleanliness and freedom from pollution of tanks, cisterns, and other receptacles used for storing of water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. The owner of any premises who shall provide thereon a tank, cistern, or other receptacle to be used for storing of water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man, shall cause the same to be so constructed and placed that it may conveniently be cleansed. 39 The owner of any premises on which a tank, cistern, or other receptacle not provided by the occupier of such premises is used for storing of water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man, shall cause every such tank, cistern, or other receptacle which is erected outside a building or which being erected inside a building is not placed in a suitable chamber, or otherwise constructed or placed so as to prevent the pollution of the water therein, to be provided with a proper cover. The occupier of any premises on which a tank, cistern, or other receptacle is used for storing of water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man, shall empty and cleanse the same, or cause the same to be emptied and cleansed, once at least in every six months, and at such other times as may be necessary to keep the same in a cleanly state and free from pollution. He shall cause every such tank, cistern, or other receptacle which as erected outside a building, or which, being erected inside a building, is not placed in a suitable chamber, or otherwise constructed or placed so as to prevent the pollution of the water therein, to be kept at all times properly covered. Provided that in every case where any tank, cistern, or other receptacle used for storing of water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man, is used for suppliying water to persons occupying two or more separately occupied premises the foregoing requirements shall apply to the owner of such premises instead of to any occupier thereof. The person in occupation of, or having the charge, management, or control of the premises, or if there is no such person, then any person in occupation of, or having the charge, management, or control of any part of the premises, and in the case of any premises the whole of which is let to lodgers, the person receiving the rent payable by the lodgers, either on his own account, or as the agent of another person, shall, for the purposes of this bye-law, be deemed to be the occupier. 40 The occupier of any premises or any other person shall not obstruct or interfere with the owner of such premises, or with any person duly authorised by him in that behalf, in the execution of any work to which the foregoing byelaws relate. Penalties. Every person who shall offend against any of the foregoing laws shall be liable for every such offence to a penalty of five pounds, and in the case of a continuing offence to a further penalty of forty shillings for each day after written notice of the offence from the Sanitary Authority: Provided nevertheless, that the justices or court before whom any complaint may be made or any proceedings may be taken in respect of any such offence may, if they think fit, adjudge the payment, as a penalty, of any sum less than the full amount of the penalty imposed by this byelaw. Increase in the Death Rate. Some apprehension having arisen as to the gradually increasing death rate in Bow, I thought it wise in the interest of the parish and the district to analyse the figures, and in October last I presented a report to the Sanitary Committee on the subject. I have neither to add to this report nor to modify the conclusions arrived at, beyond pointing out that the return of the inhabited houses for 1893, shows that the density of the population in Bow has slightly decreased. Appended will be found the Sanitary Inspectors' Reports for the year. In concluding my report, I desire to express my indebtedness both to the members of the Board and the members of the Sanitary Committee for the courteous assistance and sympathy at all times extended to me in the performance of frequently delicate and difficult duty ; together with my appreciation of the loyal and willing help of the Board's Sanitary Staff, particularly and generally. I am, Gentlemen, Your obedient Servant, RUSSELL MAIN TALBOT. 41 List of Cases of Diphtheria in the Parish of St. Mary Stratford Bow, during the year 1893 with dates and numbers of houses. No. of House. Street. Date. No. of House. Street. Date. 41 Addington Road March 27 8 Beale Place Oct. 15 5 ,, Aug. 10 2 Beale Road May 6 39 Alfred Street Jan. 31 12 ,, June 11 9 Allanmouth Road ,, 3 48 ,, Aug. 30 7 ,, Oct. 18 13 ,, Sept. 10 7 ,, „ 24 13 ,, ,, 16 150 Antill Road April 26 13 ,, „ 16 150 ,, „ 26 7 ,, „ 19 142 ,, Oct. 14 2a ,, „ 26 51 Appian Road June 4 2a ,, Oct. 3 52 ,, Oct. 8 2a ,, ,, 8 86 Armagh Road Jan. 30 41 ,, Nov. 27 53 ,, Feb. 25 16 ,, Dec. 23 122 ,, March 3 137 Bow Road Feb. 17 4 ,, „ 5 5 ,, March 18 4 ,, „ 10 15 ,, April 19 15 ,, „ 11 54 ,, May 28 122 ,, „ 29 4 ,, June 24 92 ,, April 7 239 ,, July 9 21 ,, June 11 81 Cadogan Terrace Feb. 1 122 ,, „ 15 115 ,, July 25 127 ,, ,, 21 17 Candy Street April 11 127 ,, ,, 30 34 ,, May 4 88 ,, July 3 7 ,, July 21 88 ,, „ 6 69 ,, Aug. 16 6 ,, „ 18 44 ,, „ 22 6 ,, „ 18 27 Cardigan Road April 3 142 ,, Aug. 1 34 ,, „ 24 119 ,, „ 20 29 ,, July 21 27 ,, „ 28 34 ,, Sept. 7 54 ,, Sept. 2 33 ,, ,, 16 92 ,, „ 6 33 ,,* ,, 17 13 ,, „ 16 6 ,, Oct. 2 121 ,, „ 16 39 ,, Dec. 9 57 ,, „ 17 Chad Street Sept. 5 130 ,, „ 28 24 ,, ,, 28 130 ,, „ 28 6 Chisenhale Road July 29 130 ,, „ 28 37 Clay Hall Road Aug. 14 168 ,, Oct. 26 47 ,, Sept. 12 25 ,, Nov. 11 47 ,, 25 119 ,, Dec. 12 96 Coborn Road „ 15 62 ,, „ 29 32 Coborn Street June 7 24 Athelstane Road May 10 5 ,, ,, 13 8 ,, Sept. 6 27 ,, „ 19 8 ,, „ 10 27 ,, ,, 22 1 Atley Road Feb. 7 5 ,, „ 25 7 Autumn Street Oct. 23 5 ,, July 7 3 Balmer Road March 14 28 ,, ,, 9 4 ,, Dec. 2 27 99 Aug. 14 42 No. of House Street. Date. No. of House Street. Date. 14 Coborn Street Dec. 9 16 Ford Street Dec. 27 6 Comboss Road Aug. 18 1 Gawlhorn Street Feb. 20 6 Douro Street Feb. 23 26 ,, J uly 18 127 Driffield Road May 6 26 ,, „ 19 22 ,, ,, 9 26 ,, „ 20 25 ,, „ 15 26 ,, Aug 2 29 ,, ,, 26 3 ,, „ 29 73 ,, June 6 31 ,, Sept. 16 47 ,, ,, 10 31 ,, ,, 16 38 ,, „ 12 31 ,, Nov. 13 65 ,, July 25 20 Guerin Street Oct. 23 36 ,, Aug. 5 16 ,, „ 25 7 ,, „ 18 16 ,, „ 25 54 ,, Sept. 19 22 Harley Street Oct. 27 20 ,, „ 27 32 Hewlett Road Feb. 27 82 ,, Oct. 14 78 ,, March 10 88 ,, Nov. 15 78 ,, „ 7 88 ,, „ 15 53 ,, April 23 88 ,, Dec. 12 46 ,, May 2 11 Eglinton Road Jan. 4 23 ,, ,, 6 62 ,, Feb. 16 7 ,, July 29 62 ,, „ 19 19 ,, „ 31 15 ,, May 25 27 ,, Sept. 9 30 ,, June 13 27 ,, „ 10 66 ,, July 10 27 ,, „ 16 40 ,, Aug. 1 52 ,, ,, 16 25 ,, Sept. 6 43 ,, „ 17 52 ,, ,, 7 31 ,, „ 21 57 ,, ,, 17 30 ,, Oct. 4 6 ,, „ 27 62 ,, Nov. 8 47 ,, Oct. 3 40 ,, Dec. 18 39 ,, „ 7 42 ,, „ 19 89 Fairfield Road Oct. 29 79 ,, „ 26 44 ,, Nov. 10 8 High Street Sept. 10 81 Ford Road Oct. 25 2 Iceland Road Aug. 1 72 ,, March 9 10 Lacey Street Feb. 18 11 ,, April 6 39 Lamprell Street Aug. 28 11 ,, ,, 6 14 Landseer Road Aug. 3 26 ,, June 22 3 Lawrence Road June 14 86 ,, July 21 3 ,, ,, 14 79 ,, Aug. 3 3 ,, „ 16 21 ,, Sept. 9 3 ,, „ 16 652 ,, „ 20 5 ,, Sept. 11 68 ,, Oct. 3 9 Lefevre Road Feb. 20 35 Ford Street June 22 55 ,, ,, 28 44 ,, „ 25 111 ,, March 14 7 ,, July 6 12 ,, April 2 79 ,, „ 30 12 ,, ,, 2 79 ,, ,, 30 28 ,, May 11 22 ,, Aug. 24 20 ,, „ 31 23 ,, July 6 4 ,, June 15 4 ,, July 28 4 ,, June 15 22 ,, Sept. 7 118 ,, July 8 85 ,, Oct. 31 100 ,, Aug. 5 43 No. of House Street. Date. No. of House Street. Date. 116 Lefevre Road Aug. 28 166 Monier Road Feb. 15 5 ,, Sept. 16 166 ,, „ 20 61 ,, Oct. 2 166 ,, „ 21 64 ,, „ 24 166 ,, „ 23 93 ,, „ 29 144 ,, March 10 93 ,, „ 31 157 ,, ,, 14 5a ,, Nov. 11 143 ,, June 10 48 ,, Dec. 13 8 ,, „ 17 29 Libra Road June 12 23 Monteith Road March 14 79 ,, „ 19 9 ,, Aug. 19 52 ,, „ 23 2 ,, Sept. 5 51 ,, „ 25 11 ,, Oct. 6 61 ,, „ 30 15 Morville Street Feb. 17 72 ,, July 11 15 ,, Feb. 21 60 ,, ,, 12 15 ,, March 1 69 ,, „ 12 15 ,, „ 5 88 ,, „ 22 6 ,, ,, 17 59 ,, „ 27 2 ,, ,, 19 78 ,, Aug. 1 6 ,, „ 29 54 ,, Sept. 9 39 ,, April 23 86 ,, „ 27 31 ,, May 21 86 ,, Oct. 9 31 ,, „ 29 45 ,, „ 13 7 ,, July 8 83 ,, „ 30 117 ,, Aug. 8 61 Locton Street May 10 24 ,, „ 23 61 ,, „ 15 23 Mostyn Road Sept. 9 61 ,, „ 15 15 Norman Road Jan. 17 9 ,, „ 30 25 ,, Feb. 7 59 ,, June 4 15 ,, „ 16 26 ,, Aug. 19 45 ,, May 10 62 ,, „ 28 32 ,, June 4 42 ,, Oct. 26 30 ,, ,, 29 42 ,, Nov. 2 331 Old Ford Road Jan. 24 44 Malmesbury Road Feb. 19 528 ,, March 3 177 ,, April 25 642 ,, ,, 5 63 ,, Sept. 9 373 ,, „ 16 63 ,, „ 14 279 ,, „ 31 63 ,, ,, 14 362 ,, April 1 63 ,, „ 15 520 ,, „ 10 30 ,, „ 26 331 ,, „ 25 1 Maverton Road Jan. 25 271 ,, May 6 26 ,, Dec. 21 528 ,, „ 15 15 Milton Road Feb. 26 700 ,, June 6 17 ,, March 1 700 ,, ,, 9 60 ,, April 17 534 ,, ,, 19 60 ,, „ 26 505 ,, „ 19 60 ,, ,, 27 540 ,, Aug. 2 55 ,, May 8 333 ,, Sept. 19 4 ,, „ 17 594 ,, „ 25 71 ,, „ 26 520 ,, Oct. 4 41 ,, June 19 520 ,, Oct. 4 64 ,, Nov. 27 432 ,, ,, 5 43 ,, Dec. 13 634 ,, ,, 19 43 ,, ,, 14 668 ,, Dec. 11 44 No. of House Street. Date. No. of House. Street. Date. 38 Parnell Road March 13 50 Stephen's Road Dec. 19 150 ,, „ 22 12 Saxon Road Feb. 20 99 ,, April 6 3 ,, March 10 96 ,, „ 25 4 ,, June 3 143 ,, June 12 2 ,, July 15 143 ,, „ 13 7 ,, Aug. 10 10 ,, „ 19 34 Safford Road Feb. 14 10 ,, „ 23 45 ,, ,, 16 113 ,, „ 25 34 ,, ,, 20 132 ,, „ 27 34 ,, ,, 20 134 ,, „ 29 47 ,, ,, 21 129 ,, July 15 34 ,, „ 25 108 ,, „ 17 34 ,, ,, 27 131 ,, Nov. 3 16 ,, March 21 147 ,, „ 25 22 ,, April 21 22 Ranwell Street ,, 17 26 ,, June 16 3 ,, Sept. 13 26 ,, ,, 23 23 Remus Road July 10 26 ,, „ 23 11 ,, „ 25 26 ,, „ 23 65 Rippoth Road Oct. 31 29 ,, July 2 15 Roman Road Jan. 12 50 ,, ,, 7 15 ,, „ 19 27 ,, „ 13 199 ,, March 3 21 ,, Oct. 2 "Ranelagh Arms" „ 9 23 ,, ,, 2 168 Roman Road „ 22 51 ,, ,, 5 131 ,, May 25 24 ,, „ 29 272 ,, July 19 27 Sutherland Road Feb. 17 256 ,, Sept. 16 27 ,, „ 22 256 ,, „ 16 35 ,, „ 24 256 ,, „ 16 35 ,, ,, 24 256 ,, „ 22 29 ,, „ 28 239 ,, Dec. 25 29 ,, „ 38 239 ,, ,, 25 50 ,, April 13 17 Rosebank Road Feb. 21 60 ,, „ 24 17 ,, May 3 19 ,, Oct. 23 26 Ruston Street Feb. 24 36 ,, Nov. 21 7 ,, May 3 56 ,, „ 21 20 ,, ,, 22 36 ,, „ 23 7 ,, Oct. 30 9 Tamar Street April 22 69 St. Stephen's Road March 21 1 Taylor's Bldgs, Old Ford Oct. 3 3 ,, May 1 52 Tredegar Road Feb. 15 "Gunmaker's Arms " June 7 10 99 June 6 8l St. Stephen's Road „ 12 10 99 „ 11 2a ,, 22 42 99 „ 17 56 ,, July 6 12 99 Sept. 10 1a ,, ,, 9 45 ,, „ 17 1a ,, ,, 9 112 ,, „ 23 28 ,, „ 11 112 ,, ,, 23 60 ,, Oct. 3 96 ,, „ 30 95 ,, Oct. 5 130 ,, Oct. 5 26 ,, ,, 24 152 ,, Oct. 6 99 ,, Dec. 2 42 ,, Nov. 20 99 ,, ,, 9 163 ,, „ 29 99 ,, ,, 9 157 ,, ,, 28 45 No. of House. Street. Date. No. of House. Street. Date. 12 Trego Road March 18 34 Vernon Road Feb. 17 45 ,, Oct. 26 36 ,, „ 17 159 Usher Road Jan 4 55 ,, „ 18 7 ,, March 11 38 ,, „ 19 20 ,, ,, 11 30 ,, „ 21 7 ,, „ 15 36 ,, „ 22 122 ,, „ 18 43 ,, April 7 22 ,, April 11 45 ,, „ 19 37 ,, July 10 44 ,, ,, 20 168 ,, ,, 16 43 ,, ,, 26 122 ,, ,, 23 51 ,, June 13 165 ,, Sept. 16 11 Wansbeck Road Dec. 4 168 ,, „ 25 28 Wendon Street July 23 82 ,, ,, 27 66 ,, Oct 7 56 ,, Oct. 1 8 ,, Aug. 14 31 ,, ,, 11 74 Whitepost Lane Feb. 13 42 ,, „ 12 14 ,, Sept. 13 55 ,, Nov. 15 30 Wright's Road ,, 4 138 ,, „ 20 31 ,, ,, 4 168 ,, Dec. 26 8 ,, Oct. 3 30 Vernon Road Feb. 16 8 ,, „ 10 30 ,, Feb. 15 30 Wyke Road July 20 30 ,, „ 16 List of Cases of Scarlet Fever in the Parish of St. Mary Stratford Bow, during the year 1893, with dates and numbers of houses. No. of House. Street. Date. No. of House. Street. Date. 63 Appian Road Jan. 11 52 Lefevre Road Jan. 14 63 ,, ,, 11 89 Monier Road ,, 2 137 Armagh Road ,, 3 77 Morville Street ,, 17 23 Atley Road ,, 25 35 Norman Road ,, 14 17 Chad Street „ 22 766 Old Ford Road ,, 7 4 Iceland Road ,, 10 688 ,, „ 10 14 Lacey Street ,, 20 95 ,, Feb. 1 2 Landseer Road ,, 4 46 List of Cases of Small Pox in the Parish of St. Mary Stratford, Bow, during the year 1893, with dates and numbers of houses. No. of House. Street. Date. No. of House Street. Date. Bow Road- 57 Sutherland Road Mar. 7 "St. Catherine Convent" June 30 107 Tredegar Road Sept. 13 „ July 15 46 Wendon Street July 29 „ „ 15 46 „ Aug. 12 „ „ 15 46 „ „ „ „ 31 46 „ „ „ „ 31 46 „ „ 28 Lefevre Road May 12 46 „ „ 71 Milton Road June 14 46 „ „ 171 Monier Road „ 23 46 „ „ 463 Old Ford Road May 17 20 Wyke Road May 8 454 „ Aug. 12 List of Cases of Membranous Croup in the Parish of St. Mary Stratford, Bow, during the year 1893, with dates and numbers of houses. No. of House. Street. Date. No. of House. Street. Date. 1 Douro Street May 6 274 Roman Road Aug. 31 31 Gawthorne Street Nov. 13 15 Spring Street June 19 93 Lefevre Road Oct. 29 24 Stafford Road Oct. 29 10 Mostyn Road Feb. 19 11 Wansbeck Road Dec. 4 96 Parnell Road April 25 47 List of Cases of Typhoid Fever in the Parish of St. Mary, Stratford, Bow, during the year 1893, with dates and number of houses. No. of House. Street. Date. No. of House. Street. Date. 30 Addington Road Nov. 30 39 „ Aug. 15 16 „ Dec. 3 7 Norman Road Aug. 24 42 Armagh Road Nov. 17 782 Old Ford Road June 16 6 Atley Road July 29 536 „ Nov. 19 40 Cardigan Road June 25 439 „ „ 20 4 Chisendale Road May 24 439 „ „ 24 38 Coborn Street May 6 439 „ „ 25 27 „ June 22 263 „ Dec. 14 27 „ „ 23 Ordell Road, "Tredegar Works " May 19 8 Coniboss Road Oct. 12 12 Denbigh Road April 21 155 Parnell Road April 4 12 „ „ 96 „ May 17 162 Ford Road April 27 38 „ June 17 37 Ford Street „ 11 63 „ „ 23 35 „ June 22 168 „ July 18 37 Gawthorne Street April 25 62 „ Dec. 4 22 „ July 18 31 Rippoth Road Nov. 11 35 Hewlett Road April 11 31 „ Dec. 20 9 Jodrell Road „ 28 31 „ „ 20 9 „ „ 28 31 „ „ 23 9 „ „ 28 31 „ „ 29 33 Lawrence Road Oct. 1 176 Roman Road April 21 27 Malmesbury Road June 15 280 „ June 12 18 Maverton Road Sept. 15 131 St. Stephen's Road May 11 18 „ Nov. 17 56 Sutherland Road July 10 29 Mostyn Road June 15 21 Wright's Road May 7 List of cases of Erysipelas in the Parish of St. Mary Stratford Bow, during the year 1893, with dates and numbers of houses. No. of House. Street. Date No. of House. Street. Date 17 Addington Road Oct. 5 37 Beale Road April 27 154 Antill Road June 4 54 „ Oct. 18 138 „ Nov. 1 42 Bow Road Jan. 23 59 Appian Road Sep. 10 188 „ March 22 54 „ „ 23 166 „ June 21 122 Armagh Road March 3 166 „ „ 22 54 „ May 24 192 „ Aug. 3 86 „ Aug. 20 106 Cadogan Terrace March 21 48 „ „ 29 31 Candy Street June 8 87 „ Sept. 20 48 „ June 23 100 „ Oct. 2 22 Cardigan Road Oct. 10 90 „ Nov. 15 5 Driffield Road Dec. 9 18 Atley Road March 8 70 Egilinton Road Jan. 3 48 No. of House. Street. Date. No. of House. Street. Date. 56 Fairfield Road June 5 153 Monier Road Oct. 21 40 „ July 19 1 Monteith Road April 26 "Caledonian Arms" Sept. 26 35 „ June 13 26 Fairfield Road Nov. 25 27 „ Dec. 20 87 Ford Road Aug. 26 26 Morville Street April 5 18 „ Sept. 18 48 „ Sept. 18 11 Ford Street Sept. 16 48 „ „ 23 87 „ Nov. 22 38 Mostyn Road July 31 6 „ Dec. 3 19 „ Aug. 8 69 „ „ 29 45 Norman Road May 10 19 Guerin Street Nov. 11 49 „ Oct. 26 8 Hepscott Road Jan. 10 18 „ Dec. 11 57 Hewlett Road Feb. 7 339 Old Ford Road April 7 40 „ Dec. 18 39 „ „ 27 78 „ March 10 688 „ Aug. 15 78 „ „ 7 596 „ „ 23 77 „ April 30 483 „ Oct. 21 59 „ May 1 71 Ordell Road Sept. 20 56 „ Nov. 4 108 Parnell Road Oct. 2 83 High Street Sept. 30 65 „ Nov. 25 46 Lamprell Street Aug. 20 19 Rippoth Road June 8 29 „ Sept. 29 252 Roman Road Jan. 21 111 Lefevre Road March 14 167 „ Feb. 14 61 „ Oct. 25 1 „ Sept. 12 61 „ „ 26 252 „ Nov. 6 60 Lefevre Road Nov. 4 26 St. Stephen's Road Oct. 24 48 „ „ 20 50 „ Dec. 19 48 „ Dec. 13 28 „ April 10 10 Libra Road Jan, 4 24 Saxon Road June 15 61 „ June 6 9 Tamar Street April 13 70 „ July 10 21 Trego Road July 29 39 „ „ 19 19 „ Nov. 9 25 Malmesbury Road June 12 25 „ „ 26 85 „ Oct. 2 17 Trellis Street Dec. 4 124 „ „ 16 55 Usher Road May 26 7 Mitford Terrace Jan. 28 44 „ Aug. 25 7 „ Jan. 31 19 „ Oct. 18 153 Monier Road Oct. 10 8 white Post Lane Nov. 5 49 Sanitary Department. December 31st, 1893. To the Medical Officer of Health, Bow District. Sir, I beg to lay before you my fourth Annual Summary of the Sanitary work carried out in my District during the year ending December 31st, 1893, as follows:- Of the total number (2000 houses and other premises) of primary inspections made, 1 found that in 81.3 per cent. of the premises thus inspected, various works of Sanitary amendment—requiring the service of 2518 Intimations and 1004 Notices—were needed to be carried out. In a majority of these cases, the required works were executed by the respective persons liable, on the service of the usual written Intimations, which in all cases preceded the Sanitary Notices served ; but in 10 cases it was found necessary to have recourse to legal proceedings, necessitating 10 attendances at the Police Courts to ensure their enforcement; in 9 cases the works were completed upon summons only, and in the remaining case the needed works were not completed until a Magistrate's Order for their execution had been obtained under the provisions of the "Public Health (London) Act, 1891. Owing to the worn condition of the disinfecting apparatus at Old Ford, it had again during the year to undergo repair. The following particulars show the work done in connection with infectious cases within my district during the year:- Infectious Patients removed to Hospital 206 Rooms fumigated after Infectious Diseases 670 Infected Bedding, Clothing, &c., removed to the Board's apparatus at Old Ford, there disinfected, and safely returned to their respective owners 650 Number of disinfections certified by private medical practitioners to have been done on premises 112 In each house where an infectious case occurred, disinfectants have E 50 been supplied (gratis), the premises inspected, and the drains tested by smoke, with a view of detecting insanitary conditions, the results of such inspections have been entered from time to time in the book kept for that purpose, as prescribed by the "Public Health (London) Act, 1891." The Licensed Slaughterhouses in the West Division number 9 The Licensed Cowhouses 7 all of which have been subjected to periodical inspection throughout the year. The market places have also been regularly inspected throughout the year, but in no instance was any article of food exposed for sale at the time of my visits, in such a condition as to justify seizure. By the direction of Mr. Young, the Public Analyst, I have obtained 84 samples of Food and Drugs for Analyses. Under the direction of the Board legal proceedings were instituted against 10 of the respective vendors; in 4 of these cases convictions were obtained, the penalties inflicted by the Magistrates varying from Thirty shillings to Eleven pounds. The foregoing report for the first half of the year relates to that part of the Poplar Sanitary District known as No. 3 District, for the second half year to the Parish of Bow only, excepting from the beginning of the last three weeks, since when, my duties have been confined to the West Division. I am, Sir, Your obedient Servant, WILLIAM BOYCE, Sanitary Inspector, and Inspector under the Sale of Food and Drugs Act Bow (West Division). 51 APPENDIX. Number and nature of Sanitary Works executed in No. 3 District during the year ending December 31st, 1893. Houses and other premises inspected 2000 Walls and ceilings of houses cleansed{throughout 48 Partially 291 Drains opened and cleansed 239 Defective drains repaired 766 Inlets to drains properly trapped 511 Sink waste pipes properly disconnected from drains 285 Rainwater pipes do. do. 253 Roofs made watertight 119 Roof, guttering and rainwater pipes repaired 148 Water laid on to soil pans of W.C.'s 349 New soil pans provided 181 Foul soil pans cleansed 135 Soil pans trapped 6 Ventilation of W.C.'s improved 30 Dead bodies removed to Wellington Road Mortuary to await burial 2 Yards, areas, and forecourts, paved 338 Water supplies to houses reinstated 82 Water service for domestic purposes altered or improved 270 Water service fittings repaired 40 Overcrowding abated 4 Accumulations of dung and refuse removed 63 Other nuisances remedied, chiefly dilapidations 240 Drains tested by the application of the smoke drain test, of which 56.75 per cent. were proved defective 1214 WILLIAM BOYCE, Sanitary Inspector, Bow (West Division) 52 December 31st, 1893. To the Medical Officer of Health. Sir, I beg to lay before you a Summary of the Sanitary work carried out in No. 2 District during the quarter ending March 31st, 1893. Total number ot inspections made 505, which were as follows:— Fair condition 66 House-to-house— Coventry Cross Cottages Violet Road }30 Dunkeld Street On complaints of nuisances 305 On account of 270 cases of Infectious Disease notified 170 Of 170, 49 were found to be in good sanitary condition. I have to further inform you 550 Intimations and Statutory Notices were served, and in 12 cases it was found necessary to have recourse to legal proceedings, necessitating 6 attendances at the Thames Police Court to ensure their enforcement. Walls and ceilings of houses cleansed{throughout 10 partially 66 Walls and ceilings of washhouses and closets cleansed 35 Houses, ventilated under ground floors 18 Houses, means of ventilation improved 4 Drains reconstructed where old and defective, inlets effectually trapped 100 Drains freed from obstruction 40 Soil pans cleansed, reinstated where defective or unsuitable, and drains in connection with same trapped 45 Soil pans water supplies provided or reinstated 25 Water supplies reinstated where cut off through defective pipes, fittings or other causes 33 53 Water supply fittings defective causing nuisance from dampness amended 45 Water supplies improved where insufficient 7 Water supplies for domestic purposes altered or improved 83 Bath, sink, or lavatory waste pipes repaired, trapped, or disconnected from drains and soil pans 18 Rainwater pipes reinstated or disconnected from drains 46 Yards or areas paved 15 Washhouses paved 10 Roofs repaired or made watertight 15 Guttering reinstated 20 Other nuisances abated consisting principally of structural dilapidations 20 Licensed cow-houses under inspection 11 Licensed slaughter-houses under inspection 6 Bedding, clothing, &c., disinfected at the Board's apparatus 158 Bedding, &c., disinfected upon the premises 7 Patients removed to hospital 65 The drain smoke test has been applied in 194 instances. In 92 cases defects were discovered. I am, Sir, Your obedient Servant, RICHARD E. MINERS, Assoc. San. Inst., Sanitary Inspector, and Inspector under the Sale of Food and Drugs Acts, No. 2 District. To Dr. R. M. Talbot. 54 Sanitary Department. December 31 st, 1893. To the Medical Officer of Health, North District. Sir, I beg to lay before you a Summary of the Sanitary work carried out in Bow (East Division) tor three weeks ending December 30th, 1893, as follows:— Of the total number (94 houses and other premises) of primary inspections made, I found that in 93 63 per cent. of the premises thus inspected, various works of sanitary amendment —requiring the service of 81 Intimations—were needed to be carried out. In a majority of these cases, the required works were executed by the respective persons liable, on the service of the usual written Intimations, which in all cases precedes Sanitary notices. I am, Sir, Your obedient Servant, HUGH D. RUGG, Sanitary Inspector, Bow (East Division) 55 APPENDIX. Number and nature of Sanitary Works executed in Bow (East Division), during three weeks ending December 30th, 1893. Houses and other premises inspected 91 Walls and Ceilings of Houses cleansed{throughout 2 partially 6 Drains opened and cleansed 7 Defective drains repaired 30 Inlets to drains properly trapped 12 Sink waste pipes properly disconnected from drains 9 Rainwater pipes do. do. 8 Roofs made watertight 14 Roof, guttering and rainwater pipes repaired 5 Water laid on to soil pans of W.C.'s 11 New soil pans provided 6 Foul soil pans cleansed 5 Soil pans trapped Ventilation of W.C.'s improved 1 Privies abolished Additional W.C. accommodation provided Yards, areas, and forecourts, paved 38 Water supplies to houses reinstated Water service for domestic purposes altered or improved 9 Water service fittings repaired 1 Overcrowding abated Service improperly kept, removed Occupation of underground room discontinued Accumulations of dung and refuse removed 1 Other nuisances remedied 11 Drains tested by the application of the smoke drain test, of which 62.5 per cent. were proved defective 48 HUGH D. RUGG, Sanitary Inspector, Bow (East Division). 56 Summary of Notices and Improvements carried out at the different Manufactories and Workshops in the Bow District, for the year ending December 31st, 1893. Nature of Nuisance. Number of Notices served. Cause of Nuisance. How Remedied. Smoke Nuisances 15 Burning of inferior fuel, and absence of smokeconsuming apparatus. A better class of fuel is now used. Insufficient Latrine accommodation in factories and workshops 15 In each case the latrine accommodation was insufficient. In each case the accommodation has been increased, and fitted up on the most improved principle. Discharging chemical refuse into sewer 2 Refuse from acetic acid and soda works discharged into sewer. Means have been adopted for preventing offensive refuse passing into sewers. Wool cleansing 2 Nuisancecaused by treating animal refuse and fleshings. In both cases the works have been closed. Fish curing 1 Smoke nuisance from defective smoke holes. The smoke hole has been put into thorough repair. Sulphate of ammonia works 1 Large escape of sulphuretted hydrogen from main shaft. The condensing apparatus has been increased. Cork burning 1 Large quantity of cork cuttings burnt as fuel. Extra precautions taken to prevent escape of noxious vapours. Tin burning 1 Nuisance caused by burning out castor oil cans, etc. The process has been discontinued. Fat melting 1 Escape of noxious vapours from set of fat melting pots. The boilingapparatus has been put into thorough repair. Bakehouses 22 The whole of the bakehouses have been inspected twice during the year, and, where necessary, notices have been served for remedying defects. In each case the terms of the notices have been complied with. C. W. RAYMOND, Inspector of Nuisances in Manufactories and Workshops.