POPB 6 Board of Works for the popular District. REPORT on the Sanitary Condition of the BOW DISTRICT, Comprising the Parish of St. Mary Stratford-le-Bow, BY RUSSELL MAIN TALBOT, Medical Officer of Health.. YEAR ENDING DECEMBER 31st, 1896. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the NORTH DISTRICT, Comprising the Parish of St. Mary Stratford-le-Bow. To the Chairman and Members of the Poplar District Board of Works. Gentlemen,— As the Medical Officer of Health for the North or Bow District of the area within the jurisdiction of your Board, I have the honour to submit to you my 22nd Annua! Report, together with the Annual Reports of the Sanitary Inspectors of the parish of Bow, and the Annual Report of the Inspector of Nuisances in Factories and Workshops, so far as it relates to my District. Appended are the Statistical Tables of mortality from all causes and of the cases of notifiable disease occurring in Bow, as required by the regulations of the Local Government Board. I have also prepared various charts and tables with a view of completely explaining the sanitary position of the District and of defining the condition of its public health. The period reviewed by this Report is for the twelve months ending the 31st of December, 1896. As a matter of fact the compulsory annual return required from medical officers of health consists solely of the official tables, and 2 possibly a model health officer's report is that of the Registrar General, who presents his figures almost without comment. But a broader and more liberal view of this annual duty seems desirable in the case of a district medical officer of health. If this Report is to be of practical use to those to whom it is presented and not to find a resting place in some obscure corner in the archives of his Board, some comment and explanation is justifiable and imperative, especially as his words may through various channels reach the public, who admittedly have neither the time nor the taste for gathering the lessons conveyed by mere statistics. In these days of high pressure and competition we must read as we run or else not at all. In endeavouring, however, to make such a report interesting and free from the criticism of sameness, a medical officer of health experiences some difficulty, particularly if the period under review has been marked by the absence of exceptional circumstances or features. Health work is pre-eminently detail work, and it is only generalities and principles which are popular and attractive. Genius alone can put breath in the dry bones of routine and statistics, teaching halfforgotten truths and recalling altogether neglected facts. Yet what can be more salutary than that the ratepayer should be impressed by the work that is done for the community with his money, and that some of the public ignorance regarding the scope and object of your Board's operations from day to day should be removed. If therefore it is thought that in this Report I am re-travelling oft-trodden ground or treating of time-worn topics, the character of my work is responsible (though staleness and familiarity ought not to be criterions of value or public utility), while the 21 Annual Reports which have preceded this render the breaking of virgin soil almost impossible. CENERAL SUMMARY AND STATEMENT. Bow is not an unhealthy area; on the contrary there are many evidences to show that it is naturally salubrious. Its artificial conditions and circumstances, however, discount the physical advantages, but these in their turn are combatted by a sanitary administration which the local authority may with 3 confidence submit to the closest inspection and examination. The sanitary condition of the District is one of efficiency, and there is now not the slightest ground to modify my former statements that "the sanitary condition of the District will bear most favourable comparison, not only with any other eastern portion of the metropolis, but also with any district in the whole of London, a circumstance of which all concerned may reasonably feel proud, which shows that the efforts of the Sanitary Authority to reach a high standard have been attended with success." The year 1896 is conspicuous through the absence of any special features in regard to the public health of Bow, and if the large number of deaths from measles and whooping cough and the renewed trouble as to the water supply of the East London Company are excepted (which are referred to in detail under their respective headings), there is not anything in the whole of the twelve months which can be described as abnormal. No other disease reached even approximately epidemic proportions, and if the number of deaths from measles and whooping cough had been the same as in 1895, the zymotic death rate would have been lower than it was in that period—viz., 2.6 against 2.8, lower in fact than has ever been the case since Bow became a separate sanitary district in 1881. The facts prove that sanitary effort, constant and well-directed, is telling. Zymotic diseases are preventable, and this is the reason why so much official care is taken in recording their incidence and in dealing individually with the cases as they arise. A lessening in the number of their victims ought to result from the expenditure of labour and money. With the exception of Mile End Old Town, the Bow death rate of 20.4 is the lowest of any area in the Eastern District, the figures for which are, for the whole of the Poplar District, 20.6; for Mile End, 19.9; for Limehouse, 22.9; for St. George's-in-the-East, 24.5; for Whitechapel, 20.6; for Bethnal Green, 22.1; and for Shoreditch, 21.4. On the average the death-rate for all these districts is 4 siderably less than it was for the preceding year. The London deathrate for 1896 was 18.2. Comparing the zymotic death-rate the figures stand: —Bow, 3.8; Poplar District, 3.7; Mile End Old Town, 3.61; Limehouse, 3.99; St. George's-in-the-East, 3.26; Whitechapel, 2.62; Bethnal Green, 4.25; and Shoreditch, 4.31. London's zymotic death-rate during the same period was 3.11. THE POPULATION. The estimated population for the year was 41,747. The fact that a census was taken for parochial purposes in March enables a more correct estimate to be made than is usual. A decennial census leaves very much to be desired, as I explained at length in my last Annnal Report. In March, 1896, the parochial census was taken with the result that the population of Bow was returned at 41,687. Allowing for the average natural increment, the estimated population of 41,747 shows an addition to the population of Bow in 1896 of 1,369 persons beyond the estimated population of 1891, and a decrease of 103 on the estimated population of 1895, thus the method for estimating the population of London directed by the Registrar-General for adoption by Medical Officers of Health is shown to be inaccurate, at any rate in so far as regards Bow, where nearly all the land has been utilised for building purposes that is available. As was pointed out on this subject in my last Report, as a matter of accuracy the population should have been given at 41,774, or 87 more than the census taken a few months later revealed was actually the case. With the apparent decline in the rate of increase in the population of such districts as Bow a different method of estimating the population will have to be adopted, or else a census will have to be taken more often than once in every ten years, though it is to be remembered that the difference of a few scores, or even hundreds, only affects the vital statistics so far as death, birth, and disease rates are concerned by an inappreciable fraction. 5 The following table gives the official census for the last 90 years :— TABLE I. Years. Population of Bow. Years. Population of Bow. 1801 2101 1851 6999 1811 2259 1861 ii,57s 1821 2349 1871 26,005 1831 3371 1881 37,063 1841 4626 1891 40,378 1896 41,687 The density of the population was lower than in the year 1895— viz., 7.3. The number of inhabited houses was increased by 49 The following table is the record since 1871 :— TABLE II. Inhabited Houses. Estimated Population. No. of Inhabitants per House. 1871 3829 26,055 6.7 1881 5002 37,063 7.3 1891 5249 40,378 7.6 1893 5741 41,143 7.3 1894 5572 41,495 7.4 1895 5628 41,850 7.4 1896 5677 41,747 7.3 VITAL STATISTICS. BIRTHS AND DEATHS. The number of births registered in Bow during the twelve months of 1896 was—males 674, females 681, total 1355, as against 1423 for 1895, and 1353 in 1894. The excess of births over deaths in the parish was 500, as against 598 for 1895, and 576 for 1894. The annual birth-rate was 32 4 per 1000, as against 34 per 1000 for 1895, and 32.3 for 1894. 6 The following table gives the excess of births over deaths since 1880 TABLE III. Bow—1880 794 Bow—1888 727 1881 709 1889 611 1882 757 1890 514 1883 812 1891 484 1884 757 1892 408 1885 745 1893 434 1886 807 1894 576 1887 669 1895 598 1896 500 During the year 1896 the deaths have been 855—males 430, females 425; as against a total of 826 for 1895, and 777 for 1894. 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 37. The annual death-rate for Bow for 1896 was 20.4 per 1000 of the inhabitants, as against 19.7 for 1895, and 18.8 for 1894. TABLE IV. S/iowing Population, Birth-rate, Death-rate, and Zymotic Death-rate since 1871. Year. Population. (Bow & Bromley.) Birth-rate. (Bow & Death-rate. Bromley.) Zymotic Death-rate. (Bow & Bromley.) 1871 68,024 (Bow.) 41.9 (Bow.) 27.24 (Bow.) 6.3 (Bow.) 1881 37,063 38.5 19.6 3.4 1891 40,378 32.8 21.0 3.0 1892 40,714 31.9 22.1 3.6 1893 41,143 34.0 23.5 4.3 1894 41,495 32.3 18.8 3.8 1895 41,850 34 19.7 2.8 1896 41,747 32.4 20.4 3.8 7 TABLE V. Periodical Reports to Sanitary Committee. Date of report. No. of weeks covered. Bow annual death-rat London annual e. death-rate. Annual rate of notification Bow annual zymotic in. death-rate. No. of notification. Jan. 2 5 weeks 18.1 17.6 28 4.9 113 Jan. 23 3 weeks 19.8 19.1 17.5 2.4 43 Feb. 27 5 weeks 25.1 19.4 13.3 3.0 55 Mar. 26 4 weeks 22.4 20.3 12.0 4.9 39 April 23 4 weeks 18.4 18.8 11.3 4.3 37 May 21 4 weeks 24.9 18.3 15.4 11.3 50 June 19 5 weeks 16.2 16.9 10.3 3.6 42 July 16 3 weeks 16.8 18.4 17.8 3.2 34 Aug. 22 6 weeks 27.9 21.5 12.9 5.7 63 Sept. 24 4 weeks 13.5 15.2 15.0 0.9 49 Oct. 22 4 weeks 17.5 15.4 13.5 1.2 44 Nov. 26 5 weeks 15.5 19.4 10.5 0.7 43 Dec. 17 3 weeks 23.4 18.6 17.5 2.3 28 Date of report. No. of weeks covered. London annual zymotic rate. No. of deaths in Bow from zymotic diseases. Jan. 2 5 weeks 2.9 20 Jan. 23 3 weeks 2.9 6 Feb. 27 5 weeks 2.4 25 Mar. 26 4 weeks 2.9 16 April 23 4 weeks 3.8 14 May 21 4 weeks 2.9 37 June 19 5 weeks 3.7 13 July 16 3 weeks 3.2 8 Aug. 22 6 weeks 5.9 28 Sept. 24 4 weeks 5.2 3 Oct. 22 4 weeks 2.2 4 Nov. 26 5 weeks 1.8 3 Dec. 17 3 weeks 1.5 5 The figures in the above table are taken from the monthly reports of the Sanitary Committee, and they serve to show the periodical rise and fall of the death rate and the zymotic death rate in Bow, which are at the same time compared with those for inner London. The 8 cases of notifiable diseases and the notification rate, with the actual number of deaths from zymotic diseases are also given. The table covers a period of 55 weeks. It will be seen that the second half of the year was by far the healthiest, while the occurrence of only 15 cases of zymotic deaths from the beginning of September to the middle of December speaks volumes for the parish from a health point of view. The highest death rate was in February, following with May, December and March. The highest zymotic death rate was in May, when it reached the abnormal figure of 11.3 owing to the prevalence of measles and whooping cough. The facts are dealt with under those heads. The highest zymotic death rate in August of 5.7 was due to the prevalence of diarrhœa, which in the 4 weeks ending August 24th was responsible for 12 deaths. Naturally the hot weather experienced during this period, as can be seen from the mean readings of the thermometer in Death chart, may be regarded as the primary and unavoidable cause. In the latter half of the year the Bow zymotic death rate compares very favourably with that for London generally. In regard to zymotic diseases, which it is the chief function of the local Sanitary Authority to lessen, 1896 does not stand out so favourably. ZYMOTIC DISEASES. There have been no deaths from smallpox or typhus fever, nor even any notification of the latter, yet the number of deaths from zymotic diseases was in 1893, 181; 1894, 159; 1895, 117, and in 1896 the number increased to 164. The zymotic death rate was 3.8 as against 2.8 in 1895, and 3.8 in 1894. With the exception of simple cholera, measles and whooping cough, there was a decrease in all the zymotic diseases over 1895 amounting to 17 in all. In whooping cough there was an increase of 12, in measles 31, and cholera 1. The fatality of the two first named diseases is the one blot on the year's record. Only once during the year did the zymotic death rate reach a figure which could cause apprehension, and then the rise was due to measles nnd whooping 9 cough. As was the case in 1895 three-fourths of the notifications of infectious diseases were due to two diseases alone, diphtheria and scarlet fever, the next highest as before being typhoid fever and erysipelas. Of the deaths from zymotic diseases more than twothirds were due to measles and whooping cough, the remainder being due chiefly to diphtheria, diarrhoea and scarlet fever. These will be found fully recorded in the statistical tables and are also dealt with under their proper heads. In the whole of London there were 14,009 deaths from all the principal zymotic diseases, giving a zymotic death rate of 3.11, the notifications amounting to 49,705, with an annual rate per thousand of 7.1. In 1896, the number of notifications of all infectious diseases in Bow was 549, equal to an annual rate of 13.0 per thousand. These figures compare with London as follows—total notifications, 49,705; annual rate per thousand, 7.1. For the Eastern districts the figures for notifications and percentages fell as follows:—Shoreditch, 1506, 12.1; Bethnal Green, 2191, 16.7; Whitechapel, 1195, 14.9; St. George's 719, 14.9; Limehouse, 769, 15.0; Mile End Old Town 1634, 14.5; Poplar, 2189, 12.7. The notifications for the whole Poplar district were 12.7; in the other East End districts the figures were, Poplar 12.7, Shoreditch, 9.4, Bethnal Green, 13.6, Whitechapel, 13.8, St. George's-in-the-East, 14.4, Limehouse, 13.1, and Mile End, 13.8. As I stated in my last Annual Report, this shows a different condition as contrasted with the mortality from zymotic diseases, but it is, I feel certain, due entirely to the encouragement given by your Board to medical practitioners generally to acquaint your sanitary staff with the existence of even suspicious rases of infectious disease. It is not necessary again to refer to the question of notification as practised in Bow, for I fully explained in my last report that a safe and careful method of notifying suspicious cases may convey the impression that the district is not in such a good condition as compared with other areas where a similar policy is not followed. 10 INFANT MORTALITY. Neither is it necessary to again refer in detail to the important question raised by the continued high rate of infant mortality, a rate which is common to most districts in London, Bow included. This year, the deaths of infants under one year amounted to 250, as compared with a total number of deaths of 855. According to the annual table published by the "Lancet" the deaths of infants under one year in London amounted to 160 to every thousand births, the proportion in the Eastern districts being—Shoreditch 180, Bethnal Green 170, Whitechapel 141, St. George's 154, Limehouse 176, Mile End Old Town 157 and Poplar 176. In the Bow district the number per thousand was 170. If, however, we include the number of children who died between one year and five years, the total is brought for the year in Bow to 421, or nearly half the total number of deaths from all causes. These figures incidentally reveal a condition of things upon which I animadverted in my last annual report, and when we have this annual loss of life concretely illustrated in this manner, the need for more stringent laws to protect infant and child life is manifest. In the House of Lords, Earl Denbigh has re-introduced his Infant Life Protection Bill, which last year met with such opposition from various insurance companies and friendly societies. In several important respects, the measure has been modified, but its object, that of preventing suffering and saving life, is the same. All those who have any knowledge of this dark side of life must wish this measure a successful passage through the two Houses of Parliament. Those who are brought into daily contact with the working classes, not only in the East of London but elsewhere, do not need the education provided by occasional shocking revelations in baby farming cases to understand how cheaply infant life is held by many, and how utterly unsuited a considerable percentage of men and women are to take upon themselves the responsibilities of parentage. OFFICIAL TABLES. The following tables are prepared in accordance with the directions of the Local Government Board, and they give amongst other information the details of the various diseases that have occurred during the year, the mortality from all causes at different ages, the infectious diseases notified, and the total deaths from all causes: — 11 table of deaths during the year 1896, in the BOW Division, Poplar Sanitary District, 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 25 25 and under 65 65 and upwards Parish of Bow 669 231 151 41 24 155 67 Grove Hall Lunatic Asylum 37 ... ... ... 1 24 12 totals 706 231 151 41 25 179 79 Deaths occurring outside the District among persons belonging thereto 186 19 20 11 15 77 44 Deaths occurring within the District among persons not belonging thereto 37 ... ... ... 1 24 12 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. s un. 5 ov. 5 un. 5 ov. 5. un. 5. ov. 5. Smallpox ... ... ... ... ... ... ... ... ... ... Scarlatina 2 1 ... ... 2 1 3 1 ... ... Diphtheria 12 6 ... ... 12 6 1 2 ... ... Membranous Croup 2 ... ... ... 2 ... ... ... ... ... fevers. Typhus ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid 1 1 ... ... 1 1 ... 2 ... ... Continued ... ... ... ... ... ... ... ... ... ... Relapsing ... ... ... ... ... ... ... ... ... ... Puerperal ... 2 ... ... ... 2 ... 1 ... ... *Cholera 5 1 ... ... 5 1 ... ... ... ... Erysipelas ... 2 ... ... ... 2 ... ... ... ... Measles 53 4 ... ... 53 4 5 ... ... ... Whooping Cough 81 1 ... ... 31 1 1 ... ... ... Diarrhœa and Dysentery 21 3 ... 2 21 5 1 ... ... 2 Rheumatic Fever ... 3 ... ... ... 3 ... ... ... ... Phthisis 14 48 ... 6 14 54 3 25 ... 6 Bronchitis, Pneumonia & Pleurisy 84 48 4 84 52 10 22 4 Heart Disease 1 32 ... 6 1 38 ... 22 ... 6 Influenza ... 4 ... ... ... 4 ... ... ... ... Injuries 9 16 ... 2 9 18 3 16 ... 2 All other Diseases 147 115 ... 17 147 132 12 56 ... 17 Totals 382 287 ... 37 382 324 39 47 ... 37 *English Cholera.—Under 5, 2; over 5, 1. 12 Table of Population, Births, and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1896, in the BOW Division of the Metropolitan Sanitary District of Poplar; classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics ; Public Institutions being shewn as separate localities. Parish of Bow. Total. Population at all Ages— Census 1891 40,378 40,378 Estimated to middle of 1896 41,747 41,747 Registered Births 1,355 1,355 New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Diseases. Parish of Bow. Grove Hall Asylum. Harley House. Totals. un. 5 ov. 5 un. 5 ov, 5 un. 5 ov 5 un. 5 ov. 5 Smallpox ... 1 ... ... ... ... ... 1 Scarlatina 77 166 ... ... ... ... 77 166 Diphtheria 59 96 ... ... ... ... 59 96 Membranous Croup 7 4 ... ... ... ... 7 4 Fevers. Typhus ... ... ... ... ... ... ... ... Enteric or Typhoid 7 26 ... ... ... ... 1 26 Continued ... 2 ... ... ... ... ... 2 Relapsing ... ... ... ... ... ... ... ... Puerperal ... 4 ... ... ... ... ... 4 Cholera ... ... ... ... ... ... ... ... Erysipelas 11 89 ... ... ... ... 11 89 Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital. Diseases. Parish of Bow. Grove Hall Asylum. Harley House. Totals. un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 Smallpox ... ... ... ... ... ... ... ... Scarlatina 15 69 ... ... ... ... 15 69 Diphtheria 12 19 ... ... ... ... 12 19 Membranous Croup 1 ... ... ... ... ... 1 ... Fevers. Typhus ... ... ... ... ... ... Enteric or Typhoid 2 13 ... ... ... ... 2 13 Continued ... ... ... ... ... ... ... ... Relapsing ... ... ... ... ... ... ... ... Puerperal ... 1 ... ... ... ... ... 1 Cholera ... ... ... ... ... ... ... ... Erysipelas 1 10 ... ... ... ... 1 10 Total Deaths of Inhabitants of BOW, occurring both within and without the District, during the year 1896. 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. 2nd Quar. | 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar, 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina 1 1 ... ... 2 3 ... ... ... 3 2 ... ... ... 2 ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 6 1 ... ... 7 Diphtheria ... 1 ... ... 1 4 2 3 3 12 2 2 3 1 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 5 6 4 21 Membranous Croup ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 1 ... ... ... 1 1 ... 1 1 2 4 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 2 ... ... ... ... ... ... ... 1 2 3 Cholera English 1 1 I 1 1 J a 3 Infantile ... ... 2 ... 2 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... 1 2 Measles 4 8 1 ... 13 15 30 ... ... 45 ... 3 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 19 41 1 ... 61 Whooping Cough 6 4 1 1 12 13 6 1 ... 20 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 19 11 2 1 33 Diarrhoea, and Dysentery ... ... 15 ... 15 ... ... 7 ... 7 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 1 ... ... ... 1 1 1 23 ... 25 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... ... ... 1 1 1 3 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis 1 ... 4 4 9 ... 5 3 ... 8 ... 1 1 ... 2 3 ... 4 9 20 8 15 14 14 51 ... ... ... ... ... ... 25 26 27 90 Bronchitis, Pneumonia and Pleurisy 19 12 9 16 56 17 8 3 10 38 2 2 1 1 6 1 ... ... 3 4 10 4 6 12 32 11 7 1 9 28 60 33 20 51 164 Heart Disease ... ... ... ... ... ... ... ... 1 1 4 ... 1 i 6 ... ... 1 4 5 15 6 1 4 26 4 2 6 5 17 23 8 9 15 55 Injuries 4 ... 2 ... 6 2 2 1 1 6 ... 3 3 4 10 1 ... ... 1 2 8 ... 3 5 16 1 ... 3 ... 4 16 5 12 11 44 All other Diseases 29 16 58 30 133 3 10 8 5 26 3 3 4 1 11 1 3 1 2 7 29 22 28 19 98 12 11 20 17 60 77 65 119 74 335 Total 64 42 93 51 250 57 64 29 21 171 13 16 14 9 52 6 7 6 21 40 71 50 55 56 232 29 20 30 32 111 240 198 227 190 855 Total Deaths of Inhabitants of BOW, occurring without the District, during the year 1896. 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. 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar- Total. 1st Quar. 2ndQuar. 3rd Quar. 4th Quar. Total. 1st Quar. 2ndQuar. 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar 3rd Quar. | 4th Quar. Total. 1st Quar. 2ndQuar. 3rd Quar. 4th Quar. Total. | 1st Quar. | 2ndQuar. 3rd Quar. 4th Quar. Total. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina 1 1 ... ... 2 1 ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 4 Diphtheria ... ... ... ... ... 1 ... ... ... 1 1 ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 3 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 1 ... ... ... ... ... ... 1 ... 1 2 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 ... ... ... 2 2 1 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 ... ... 5 Whooping Cough ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Diarrhoea and Dysentery ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis ... ... 1 ... 1 ... 2 ... ... 2 ... ... ... ... ... 1 ... ... 3 4 2 1 8 7 21 ... ... ... ... ... 3 6 9 10 28 Bronchitis, Pneumonia and Pleurisy 3 ... ... 1 4 5 ... ... 1 6 ... ... ... ... ... 1 ... ... 1 2 1 1 ... 4 6 4 3 ... 7 14 14 4 ... 14 32 Heart Disease ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... ... 1 2 3 4 3 ... 1 8 2 1 5 1 9 8 4 6 4 22 Injuries ... ... ... ... ... 1 1 ... 1 3 ... 1 ... 2 3 1 ... ... 1 2 5 ... 3 2 10 ... ... 1 ... 1 7 2 4 6 19 All other Diseases ... 2 4 3 9 ... 2 1 ... 3 1 2 ... ... 3 ... 1 ... 1 2 11 4 11 5 31 3 4 8 5 20 15 15 24 14 68 Total 6 3 6 4 19 11 6 1 2 20 5 3 1 2 11 3 1 1 10 15 23 13 22 19 77 9 8 14 13 44 57 34 45 50 186 Total Deaths of Inhabitants of BOW, occurring within the District, during the year 1896. 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. 1 st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. ^rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina ... ... ... ... ... 2 ... ... ... 2 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 3 Diphtheria ... 1 ... ... 1 3 2 3 3 11 1 2 2 1 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 5 4 4 18 Membranous Croup ... ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 2 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... 1 1 2 Cholera, English ... ... 1 ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 3 ... 3 Infantile ... ... 2 ... 2 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... 1 2 Measles 2 8 1 ... 11 13 29 ... ... 42 ... 4 ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 41 1 ... 57 Whooping Cough 6 4 1 1 12 12 6 1 ... 19 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 11 2 1 32 Diarrhoea and Dysentery ... ... 14 ... 14 ... ... 7 ... 7 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 1 ... ... ... 1 1 1 22 ... 24 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... ... ... 1 1 1 3 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis 1 ... 3 4 8 ... 3 3 ... 6 ... 1 1 ... 2 2 4 4 6 16 6 11 6 7 30 ... ... ... ... ... 9 19 17 17 62 Bronchitis, nia and Pleurisy 16 12 9 15 52 12 8 3 9 32 9 2, 1 1 6 ... ... ... 2 2 9 3 6 8 26 7 4 1 14 46 29 20 37 132 Heart Disease ... ... ... ... ... ... ... ... 1 1 2 ... 1 1 4 ... ... ... 2 2 11 3 1 3 18 2 1 1 8 15 4 3 11 33 Injuries 4 ... 2 ... 6 1 1 1 ... 3 ... 2 3 2 7 ... ... ... ... ... 3 ... ... 3 6 1 ... 2 ... 3 9 3 8 5 25 All other Diseases 29 14 54 27 124 3 8 7 5 23 2 1 4 1 8 1 1 1 1 4 18 18 17 14 67 9 7 12 12 40 62 49 95 60 266 Total 58 39 87 47 231 46 58 28 19 151 8 13 13 7 41 3 5 5 11 24 48 37 33 37 155 20 12 16 19 67 183 164 182 140 669 16 Total Deaths of persons (not inhabitants) in Grove Hall Lunatic Asylum, occuring during the year 1896. Mortality from the following Diseases. 15 years and under 25 25 years and under 65 65 years and upwards At all Ages. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar. and Quar. 3rd Quar. 4 th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. 1st Quar. 2nd Quar. 3rd Quar. 4th Quar. Total. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea and Dysentery ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 2 ... ... ... 2 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis ... ... ... ... ... ... 1 ... 5 6 ... ... ... ... ... ... 1 ... 5 6 Bronchitis, Pneumonia and Pleurisy ... ... ... ... ... 3 ... ... ... 3 ... ... ... 1 1 3 ... ... 1 4 Heart Disease ... ... ... ... ... 1 1 1 2 5 ... ... 1 ... 1 1 1 2 2 6 Injuries ... 1 ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... 1 ... i 2 All other Diseases ... ... ... ... ... 4 2 1 1 8 2 4 ... 3 9 6 6 1 4 17 Total 1 1 9 4 2 9 24 3 4 1 4 12 12 9 3 13 37 BOARD OF WORKS FOR THE POPLAR DISTRICT. Annual Table, shewing the number of * Notifications of Infectious Sickness coming to the knowledge of the Medical Officer of Health during each week of the year 1896, in the Bow Division of the Sanitary District of Poplar. Diseases. 1st Week 2nd „ 3rd „ 4th „ 5th „ 6th „ 7th „ 8th „ 9th „ 10th ,, 11th „ 12th „ 13th „ 14th ,, 15th „ 16th „ 17th „ 18th ,, 19th „ 20th „ 21st „ 22nd 23rd „ 24th „ 25th „ 26th ,, 27th „ 28th „ 29th „ 30th ,, 31st ,, 32nd ,, 33rd „ 34th „ 35th „ 36 th „ 37th ,, 38th „ 39th ,, 40th ,, 41st „ 42nd ,, 43rd „ 44th „ 45th „ 46th „ 47th „ 48th „ 49th „ 50th 51st „ 52nd ,, Total. Small Pox ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 3 ... 3 1 6 8 2 4 4 2 3 3 6 2 2 5 2 7 5 5 3 3 2 5 5 3 3 2 2 2 2 6 5 3 2 1 1 5 4 3 5 2 ... 1 1 3 1 3 2 4 3 3 163 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 3 ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... 11 Erysipelas 2 2 2 1 2 1 2 1 1 1 2 1 ... 2 3 1 2 6 6 2 3 1 1 3 2 2 3 1 2 1 5 2 5 1 5 2 ... 1 3 4 2 2 ... 3 3 1 ... 1 3 5 1 5 113 Fevers— Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid ... ... ... 1 1 1 1 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 2 ... ... 2 ... 1 ... ... ... 1 4 1 4 1 ... 2 ... ... ... 2 ... ... 1 1 ... ... 1 ... ... 2 33 Relapsing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Puerperal ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... 4 Scarlet 6 8 16 3 9 4 4 3 7 5 9 4 2 3 2 6 7 3 ... 5 5 1 3 4 5 ... 13 6 6 3 4 5 11 8 7 5 3 4 8 7 8 ... 3 4 3 6 5 4 3 4 4 3 264 Totals 11 10 21 6 18 14 10 9 12 8 14 8 9 8 8 14 11 20 11 14 12 6 8 12 12 7 19 10 11 6 11 14 25 13 18 9 4 12 15 15 15 12 4 8 8 11 6 8 9 14 8 13 591 *It must be understood that occasionally more than one notification is received concerning the same case. 18 PARISH OF BOW. Return of Schools attended by children residing in the district and notified as suffering from Infectious Diseases, showing the average number of attendances at the Schools within the district. School and average number of attendances. Diphtheria. Scarlet Fever. Typhoid. M. Croup. Erysipelas. Continued Fever Total. *Atley Road 436 4 24 2 ... 1 ... 31 §Barnardo, Dr. ... 1 ... ... ... ... ... 1 §*Bromley High Street 359 2 ... ... ... ... ... 2 §*Chisenhale Road ... 1 1 ... ... ... ... 2 *Fairfield Road 199 1 5 ... ... ... ... 6 §*Gainsboro Road ... ... 4 2 ... ... ... 6 §‡Guardian Angel ... ... ... 1 ... ... ... 1 *Malmesbury Road 401 20 7 1 I ... ... 29 *Monteith Road 1750 16 23 ... ... 2 ... 41 §*Olga Street 1210 3 8 ... ... ... ... 11 §‡Saint Agnes 395 ... ... ... ... 1 ... 1 *Smeed Road 1355 3 19 1 1 2 ... 18 ‡Stafford Road 437 8 8 ... ... ... ... 26 ‡Tomlin's Grove ... ... 1 ... ... ... ... 1 ‡Tredegar Road 427 2 7 ... ... ... ... 9 †Robins, Miss 21 ... 1 1 ... 1 ... 3 *Roman Road 488 9 20 ... 1 2 ... 32 Totals 70 128 8 3 9 2 220 * Board Schools, †Private Schools. ‡Denominational Schools. § Not in the Parish of Bow. No return of average attendances. 19 Bow's immunity from the dreaded disease of small-pox, which formed a feature in last year's report, has happily been continued. SMALL POX During the twelve months not a single death was registered from that disease, and only one notification of it was received, the particulars of which are given below. For six years, from 1886 to 1892, there was not a single death from smallpox, but in 1893 there was one death and 21 notifications, and in 1894 there were four deaths and 35 notifications. Last year there were no deaths and only 5 notifications. This exceptional record has been improved upon in 1896, when there was only one notification, which occurred in February, and in that month I reported thereon to the Sanitary Committee as follows:— "A case of small-pox was notified on February 15th from 10, Wrights Road—male, aged 36 years. He was removed to hospital on the 16th inst., and the premises were disinfected by your officers on the same day. Since then the rooms occupied have been stripped of their paper, limewhited, and re-papered. The Medical Officer visited the premises, and learned from the patient's wife that the patient had been vaccinated in infancy, but not since, and that he had been for some weeks engaged in drainage work at the " German Flag " public-house, St. George's-in-the-East. In the patient's family are wife and four children, ranging from 3 years to 12 years—all vaccinated in infancy and in good health." In August the following letter was received from the Local Government Board and for the purpose of placing it on record I nsert it here "Local Government Board, "Whitehall, S.W. " 2nd August, 1895 " Sir, " I am directed by the Local Government Board to bring under the attention of the Vestries and District Boards in the Metropolis 20 the fact that Small Pox has recently undergone some considerable increase in London, and that its extension tends to involve a number of Metropolitan Sanitary Districts. " The circumstance is the more noteworthy since at this season of the year Small Pox in London is as a rule at its lowest ebb. " The Board attach very great importance to the most energetic measures being taken in connexion with the cases which are occurring, with the view of preventing the spread of infection, and they will be obliged to the Authority if they will specially instruct their Medical Officer of Health, in every case which may be notified to him, or which may come to his knowledge immediately to visit the house where the disease has broken out, and at the earliest possible moment to take such measures as may be necessary to secure as far as practicable the isolation of the patient, the vaccination of any persons who may have been exposed to infection, and the disinfection of the premises, and any further action which the circumstances will admit of for the purpose of checking the extension of the disease. " The Board deem it desirable that the Authority should as regards each case be informed precisely of the measures which have been taken by the Medical Officer of Health, and they will be glad to be furnished with copies of the reports which are made by him on the subject. " I am, Sir, " Your obedient Servant, "HUGH OWEN, " Secretary." In London last year there were only nine deaths from small-pox, the death-rate being 0.00. Of these deaths only one occurred in the 21 Eastern division, namely Shoreditch, where the death-rate was 0.01. In the whole of London there were 225 notifications of small-pox of which the following occurred in the Eastern Division—Shoreditch 1, Bethnal Green 2, Whitechapel 4, St. George's 2, Limehouse 7, Mile End 2, and Poplar 9—Bow 1. The attention paid to this disease by the Medical Inspectors of the Local Government Board indicates the importance which is attached by that Authority to prompt information respecting its appearance, and their opinion of the need for exceptionally vigilant 'attention on the part of the local authority. Fortunately the Royal Commission on Vaccination has by the presentation at the close of the year of its long-expected report closed an important stage in the vaccination controversy. As was to be expected from the circumstances of the case the conclusions arrived at by the majority of the Commissioners has not by any means settled the issues of the controversy. All that has been done is to increase its proportions and to a certain extent to shift the battle-ground. Both the majority and the minority reports are most ably drawn up and their contents have received such publicity in the lay and professional journals that it is unnecessary for me to here detail them. In the face of the conclusions arrived at by the Commission it does not seem reasonable on the part of anyone to any longer doubt the theoretical value of vaccination. Those conclusions demand the most earnest consideration of sanitary authorities, and it is to be hoped that in the event of legislation following the report that a loyal observation of the law will be generally experienced. Further comment upon the position appears to be unnecessary in view of the interim condition of the controversy. The record of the deaths from small-pox in Bow since 1880 is exceptionally favourable, there having been only 24 deaths in 15 years. The figures are :— 22 Bow—1880 7 1881 3 1882 0 1883 0 1884 8 1885 1 1886 0 1887 0 1888 0 1889 0 1890 0 1891 0 1892 0 1893 1 1894 4 1895 0 1896 0 The Vaccination Officer of the Poplar Union has furnished me with the following statement of the vaccination returns in Bow for 1896. Total births, 1364; vaccinations, 648; insusceptible, 4; dead, 151. During the last 15 years there has never been a period in which the deaths from the most fatal of all the zymotic diseases, measles, were so many as in 1896. The nearest approach was in 1894, when 57 were registered. Last year they happily fell to 25, but in 1896 MEASLES. they rose to the alarming figure of 62. The death rate from measles in 1896 was 1.4 per thousand; in 1895 it was 0.59, and in 1894 1.3. The following is the record from 1880 :— Bow—1880 11 1881 19 1882 23 1883 28 1884 6 1885 28 1886 27 1887 22 1888 31 1889 3 1890 46 1891 10 1892 21 1893 8 1894 57 1895 25 1896 62 From year to year in my Annual Report I have insisted upon the reckless treatment of this disease as being primarily responsible for its fatal character. This truth cannot too often be emphasised, and in view 23 of the figures this year it seems to be an imperative duty on the part of sanitarians to agitate for some reform in regard to the attitude adopted by Local Authorities to this complaint. Personally I have no hesitation in expressing the firm opinion that one of the first steps should be notification. At present measles, though classed as a zymotic disease, is not included amongst the diseases that are notifiable under the Public Health (London) Act of 1891, so there is only the mortality data to convey any information as to its prevalence during any given period. Desirable as it is that the principle of providing hospital accommodation for notifiable diseases should be preserved, yet with the circumstances of 1896 before us I feel inclined to modify my former opinion that notification and hospital accommodation for measles must make their debut together. Doubtless years will elapse before the hospital accommodation could be provided, even supposing that the Legislature were to sanction the necessary expenditure. That sanction, however, will take longer to acquire than the buildings themselves, on account of the differences of opinion which exist amongst experts on the subject. It seems to me that with the figures before us of the prevalence of this disease, which was the only one in 1896 in Bow which showed an excessively epidemic tendency, the objections to notification and hospital accommodation will be greatly weakened. In Shoreditch there were 143 deaths, in Bethnal Green 153, Whitechapel 51, St. George's 28, Limehouse 62, Mile End 84, and in Poplar 147. The total deaths in the Metropolis were 3,692, as against 2,628 for 1895. In May, when the zymotic death rate in Bow rose phenomenally to 11.3 per thousand, I presented the following report to the Sanitary Committee :— " I have again, as in last month's report, to draw your attention to the prevalence and fatality of measles and whooping cough. Last month the deaths had advanced to measles 10; whooping cough 3; the totals for the current year having been measles 26, whooping cough 20. But for this month only I have to report measles 26, whooping cough 7. I trust that you will agree with me that it is but 24 little consolation to know that these two diseases have been somewhat epidemic throughout London during this year, and that the prevalence of east and north-east winds in all probability has had a good deal to do with their fatality during the past 4 weeks. Whether the fatality is the resultant of the inherent malignancy of the disease, or of indifference on the part of the parents during the initial stage, and careless or improper treatment both as regards medicine and nursing, or of the inclemency of the winds, we cannot shut our eyes to the knowledge that both these diseases spread rapidly by infection amongst infants and young children, and we, a Sanitary Authority, are literally powerless to check it. Years ago, during similar epidemics, I carried out in fatal cases of measles, disinfection as after scarlet fever, &c., but I was not at all satisfied with the results. I cannot too strongly again express the opinion that we must one day have notification and hospital accommodation for measles." Once again the fact has to be recorded that two-thirds of the total number of infectious diseases notified during the year related to SCARLET FEVER. scarlet fever. Generally speaking these notifications were spread pretty equally over the whole of the year, autumnal increase, however, not being observed. The highest number occurring in any one week was in the 3rd week, when there were 16. The highest number in 1895 was 20, in the 46th week. In two weeks, the 19th and 26th in the year, there were no notifications of this disease, as against three weeks in the preceding year, namely the 13th, 16th and 18th. There were considerably fewer notifications than in the preceding year, and there was one less death, namely 7, as against 8. The annual death-rate was 0.1, as against 0.19 per thousand for 1895 and 0.18 for 1894. Scarlet fever occupies again the first place both in London generally and in the Eastern Districts in regard to notification. In London there were 25,647 cases, as against 19,757 for the preceding year, with 940 deaths as against 829. The notifications and deaths in the Eastern Sanitary Districts were respectively as follows:—Shoreditch, 708, 39; Bethnal Green, 1257, 35; Whitechapel, 638 20; St. 25 George's, 378, 18; Limehouse, 350, 15 ; Mile End, 764, 34; Poplar, 964, 33 The hospital accommodation of the Metropolitan Asylums Board was at times, through pressure, found insufficient to cope with the number of cases needing removal, but the delay was not so great as that experienced in the preceding year. Additional hospitals are in course of erection by the Board. The Bow death record of scarlet fever is as follows :— Bow—1880 20 1881 33 1882 18 1883 36 1884 21 1885 6 1886 8 1887 7 1888 50 1889 4 1890 7 1891 3 1892 15 1893 13 1894 8 189 8 1896 7 As in the case of measles the number of deaths from whooping cough increased by nearly 50 per cent. In 1894 there was the record return of only 4 deaths, and in 1895 the figures rose to 18. The 1896 return, however, is by no means abnormal, for during the last 1 c years on six occasions the number of deaths last year was WHOOPING COUCH. exceeded, the highest being in 1887 with 69, and 57 in 1890. Happily, therefore, high water mark has not been touched, but at the same time it appears that so great a death rate from a disease of this character should not exist. As in the case of measles I have often called attention to the culpable carelessness of mothers in their almost studied indifference to the needs and requirements of their children when suffering from whooping cough as being the primary cause of its fatal character. Right treatment and average attention should bring the little patient safely through this distressing malady, and the evil will not be remedied until more value is set upon children's lives and a prompter recognition of the dangerous character of the disease exists. The death rate from whooping cough in Bow in 1896 was 0.7. as against 0.53 in 1895 and 0.09 in 1894. Whooping cough is not a notifiable disease and therefore there are no means of ascertaining its prevalence except by the mortality statistics. In London generally whooping cough stands third in the list of deaths from zymotic diseases, the total being 2931, with a death rate of 0.65. In the Eastern Districts the deaths and the death rate were respectively as follows:— Shoreditch, 126, 1.01 ; Bethnal Green, 160, 1.22; Whitechapel, 36, 0.45; St. Georges's, 17, 0.35; Limehouse, 61, 1.03; Mile End, 83, 0.73 ; Poplar, 158. 0.92. In Bow the deaths were 33, the annual rate per thousand being 0.7. The following is the record since 1880:— Bow—1880 21 1881 30 1882 47 1883 14 1884 21 1885 39 1886 12 1887 69 1888 17 1889 44 1890 57 1891 45 1892 31 1893 17 1894 4 1895 18 1896 33 In the matter of fevers, Bow's record is again most satisfactory and an improvement in some respects upon the record of last year. Once more no deaths occurred from typhus fever, so FEVERS that the unique position I hold of never having had a death from that disease in my district is still preserved; also there were not in 1896 any notifications as against an incorrect one in the preceding year. London still shows comparative freedom from this disease, there 27 having been only 5 deaths, the same as last year, with six notifications as against 14 for 1895. In the case of enteric fever there is an improvement in Bow's record, there having only been 4 deaths as against 6 for last year. In the whole of London there were 564 deaths with a rate of 0.13, as against 0.09 for Bow. The notifications numbered 3190, and they fell in East London as follows:—Shoreditch, 117, 17 deaths; Bethnal Green, 129, 20; Whitechapel, 62, 9; St. George's, 35, 5; Limehouse, 27, 3; Mile End, 113, 16; Poplar, 124, 26. There were during the year in Bow 33 notifications, as against 38 in 1895 and 45 in 1894. The record of deaths stands :— Bow—1880 2 1881 2 1882 13 1883 11 1884 9 1885 5 1886 4 1887 8 1888 15 1889 4 1890 9 1891 12 1892 10 1893 15 1894 7 1895 6 1896 4 No cases of relapsing fever occurred, and there were six cases of continued fever, none of which proved fatal. With regard to puerperal fever the record is not at all satisfactory. Two cases were notified in 1895, but there were no deaths. In 1896 four cases were notified, three of which proved fatal. In the whole of London there were 277 notifications of this disease, the record for the Eastern District being—Shoreditch, 3; Bethnal Green, 12; Whitechapel, 2; St. George's, 2; Limehouse, 4; Mile End, 5; and Poplar, 7. The following is my report to the Sanitary Committee on two of the cases :— " Two fatal cases of puerperal fever have occurred in the practice of one of the midwives to the Royal Maternity Society residing in Old Ford. As soon as he received the notification of the first case he wrote both the midwife and the nurse, requesting them to retire for a time. The midwife had already given notice to her society, and was suspended; but before she became aware of the nature of the case she had attended another patient, and infected her. Both women died. Through disobedience to the Secretary's order to permit the Boards officials to disinfect her working clothes, the midwife was dismissed from the Society's service. Then, and then only, she gave up her clothes for disinfection." In 1895 the figures relating to diphtheria showed that there had been the least number of deaths during that period than any since 1891. I am glad to say that in this respect Bow's record DIPHTHERIA. for 1896 shows still better, for the number of deaths was less than in any year since 1889, the figures being 23, as against 29 in 1895 and 42 in 1894. Further there were fewer notifications— viz., 155,as against 200 in 1895. The death rate was 0.5 as against 0.71. The satisfactory diminution noted last year continued, although, as remarked in my last annual report, nothing can be regarded as absolutely satisfactory of a disease which still continues to kill the largest number of persons of any notifiable zymotic disease. In speaking of diphtheria the word is understood to include membranous croup. The facts connected with this disease prove conclusively how unsafe it would be to do anything to prevent suspicious cases of sore throat coming to the knowledge of a sanitary authority. In 1895 I reported—" In London generally diphtheria ranks third on the fatal list, diarrhoea and measles taking the first and second places. There were in the Metropolis 11,223 notifications and 2289 deaths. In the Eastern sanitary districts the incidence of notification 29 and fatality was respectively as follows : —Shoreditch, 251 and 58; Bethnal Green, 474 and 101; Whitechapel, 289 and 58; St. George'sin-the-East, 219 and 50; Limehouse, 190 and 45; Mile End, 483 and 111 ; and Poplar 777 and 152, the major portion of the last named being from the parishes of Bromley and Poplar, not Bow, which only had 29 deaths and 215 notifications." In 1896 in London generally diphtheria ranked fourth in the list of fatal diseases, there having been 13,808 notifications with 2663 deaths, the death-rate being 0.59. These notifications, deaths, and death-rates were spread over the Eastern Districts as follows Shoreditch, 371, 74, 0.60; Bethnal Green, 460, 75, 0.57; Whitechapel, 351, 48, 0.60; St George's, 214, 30, 0.62 ; Limehouse, 270, 49, 0.83; Mile End, 551, 97, 0.86 ; Poplar, 701 105, 0.85. It will be seen that the Poplar Sanitary District therefore has the largest number of notifications and the largest number of deaths for the whole of the Eastern Districts from this disease. Bow's figures were 243,23,0.55 respectively. The record since 1880 stands :— Bow —1880 14 1881 13 1882 23 1883 9 1884 10 1885 13 1886 14 1887 14 1888 Diphtheria 11 Croup 7 18 1889 Diphtheria 5 Croup 11 16 1890 Diphtheria 12 25 Croup 13 1891 Diphtheria 27 36 Croup 9 1892 Diphtheria 37 43 Croup 6 1893theria 86 91 Croup 5 1894 Diphtheria 40 42 Croup 2 1895 Diphtheria 28 29 Croup 1 1896 Diphtheria and membranous Croup 23 Appended is the special table showing the summarised results made in accordance with the desire of the Medical Officer of Health of the London County Council. 30 MEDICAL OFFICER of HEALTH'S REPORT. Bow District. Result of Special Inquiry into cases of Diphtheria, as desired by the Medical Officer of Health of the London County Council. Date. No. of families in House. No. of Adults. No. of Children If recently suf fered from Throat illness, state illness. Result of Drain Test. Condition of w.c. Water Supply. Jan. 1 2 4 4 No Negative Fair From main 2 2 5 7 No do. do. do. 14 2 3 4 No Defective under w.c. do. do. 18 2 6 3 No Negative do. do. 22 2 4 6 No Defective under w.c. Inefficient flush From uncovered cistern in washhouse 28 2 5 4 No do. Long hopper F. riser From main 29 2 6 2 No do. Long hopper, side inlet do. 30 2 5 6 No Negative Fair do. 30 2 6 4 No do. do. do. Feb. 1 2 4 2 No Defective in washhouse Inefficient flush do. 3 1 2 3 No Negative Fair do. 6 2 6 4 No do. do. do. 6 1 2 4 No do. do. do. 6 2 4 4 No do. do. do. 6 2 2 2 No do. do. do. 7 2 4 4 No do. do. do. 8 2 3 1 No Defective under w.c. do. do. 12 2 6 2 No do. Pan cracked do. 13 2 4 5 No do. No water supply do. 19 2 6 1 No do. Inefficient flush do. 20 1 2 2 No Negative Pan foul. No water supply do. 24 1 4 3 No do. Fair do. Mar. 2 2 9 2 No do. do. do. 4 2 4 7 Sore throat 3 weeks ago do. do. do. 5 2 4 8 No do. do. do. 12 2 5 2 No do. do. do. 18 3 9 4 No Defective under w.c. Inefficient flush do. 19 2 4 5 No Defective under w.c. and yard Pan foul, floor broken do. 22 1 4 6 No Negative Fair do. 23 2 4 7 No do. do. do. 23 2 4 9 No do. do. do. 25 2 4 6 No do. Pan long hopper do. 26 2 4 4 No Defective under w.c. Inefficient flush From cistern in washhouse accessible only from under floorof scullery April 3 2 4 6 Frequently suffered from sore throat Negative Pan foul and cracked From main 9 2 4 6 No do. Fair do. 11 2 4 6 No Defective under w.c. and washhouse Inefficient flush do. 13 1 2 4 No Negative do. Fair do. do. do. 31 Date. No. of families in Houses. No. of Adults. No. of Children. If recently suffered from Throat illness, state illness. Result of Drain Test. Condition of W.C. Water Supply. Apl. 5 1 2 3 Had scarlet fever since Christmas Negative Fair From main 16 1 4 3 No do. do. do. 18 1 2 3 No do. do. do. 22 1 4 2 No do. No water supply to w.c. do. 23 2 2 6 No do. Fair do. 27 2 4 3 No do. do. do. 29 1 5 4 No do. do. From cistern inside W.C. 29 2 4 5 No Defective under w.C. Pan cracked. From main 29 2 4 4 No Negative Fair do. May 1 3 5 8 No do. do. do. 5 2 5 8 Sore throat April 27th Defective under w.c. Long hopper Main 6 2 4 4 No do. Pan foul do. 31 2 3 2 No Negative Fair do. 13 2 5 7 No Defective under w.c. Inefficient flush do. 20 2 4 11 Subject to Sore throat Negative Fair do. 21 2 4 9 No do. do. do. 26 2 6 6 Chronic Sore throat do. do. do. 26 2 4 3 No do. do. do. June 2 2 5 2 No Defective under yard do. do. 2 1 2 2 No Negative Flushing apparatus defective do. 1 1 2 0 No do. Fair do. 5 2 6 9 No do. do. do. 8 2 6 6 No do. do. do. 16 1 2 4 No Defective under w.c. do. do. 16 1 4 0 No Defective Pan foul. Inefficient flush do. 23 2 6 2 No Defective under w.c. Inefficient flush do. 23 1 3 3 No do. do. do. 27 2 6 0 No do. Fair do. July 2 1 4 4 Sore throat 3 weeks ago Negative do. do. 2 1 5 2 Subject to Sore throat Very defective Pan cracked do. 4 2 5 2 No Defective Pan foul do. 6 1 4 4 Sore throat 3 weeks ago Negative Fair do. 13 2 5 4 Quinsy a month ago Defective under w.c. do. do. 15 2 5 3 No Negative do. do. 15 3 6 15 No Defective under w.c. Inefficient flush do. 23 2 6 6 No Negative Fair do. 24 2 4 10 No do. do. do. 31 1 5 4 No Defective do. do. 29 1 4 2 No Negative do. do. Aug. 4 2 4 3 No do. Pan foul do. 8 2 4 5 No do. Fair do. 12 2 5 4 No do. Inefficient flush do. 12 1 2 3 No do. Fair do. 12 1 2 5 No do. do. do. Date. No of families in House. No. of Adults. No. of Children. If recently suffered from Throat illness, state illness. Result of Drain Test. Condition ot W.C Water Supply Aug. 14 2 2 4 No Negative Fair Main 17 2 6 2 No do. do. do. 25 2 4 2 No do. do. do. 26 1 4 0 No do do. do. Sept. 1 2 4 5 No do. do. do. 2 1 3 1 No do. do. do. 2 2 6 6 No do. do. do. 7 2 7 1 No do. do. do. 12 2 4 2 No do. do. do. 15 2 4 5 No do. do. do. 22 2 7 0 Sore throat do. do. do. 28 1 i 2 No do. do. do. 30 1 2 4 No do. do. do. Oct. 2 2 3 6 No Defective under w.c. Pan foul do. 5 2 4 5 No do. Fair do. 6 1 2 2 No Negative do. do. 6 1 3 4 No do. do. do. 7 2 6 2 No do. do. do. 13 1 5 6 No do. do. do. 14 1 2 1 No do. do. do. 15 1 4 0 No do. do. do. 15 1 2 4 No Defective under w.c. do. do. 19 2 3 6 No Negative do. do. 20 1 2 9 No Defective under w.c. Inefficient flush do. 20 3 7 4 No Negative Fair do. 23 2 6 9 No do. do. do. 27 3 7 2 No do. do. do. 28 1 3 3 No do. do. do. Nov. 24 1 5 2 No Defective under w.c. Pan foul From uncovered cistern in washhouse 10 2 2 1 No Negative Fair do. 19 2 3 5 No do. do. Main 25 2 5 6 No do. do. do. 25 2 4 3 No do. do. do. Dec. 1 2 7 4 No Defective under w.c. Inefficient flush do. 4 1 3 2 No Yard gully choked Fair do. 7 2 5 3 No Negative Inefficient flush do. 12 2 4 8 No do. Fair do. 14 2 5 4 No Defective under w.c. Inefficient flush do. 21 2 6 5 No Negative No water supply do. 23 2 2 1 No do. Fair do. 30 2 4 4 No do. do. do. 31 2 4 4 No do. do. do. 32 33 In only two weeks in 1896—namely, the 2nd and the 43rd, was there 110 notification of the existence of diphtheria in Bow. The highest number of notifications in any one week was 8, which was reached on one occasion, the 6th week. As in 1894 and 1895, the last year passed without any fear of an epidemic of Asiatic cholera, although at intervals there were the DiARRHŒA & CHOLERA customary newspaper scares. Bow shows a clean sheet, as, though there were 6 deaths ascribed to cholera, two were qualified as " infantile," and the remaining four as " English," not one was notified as infectious, and all occurred in the two hottest months of the year. It would be a safe opinion to say that these cases of cholera could be correctly described as " infantile diarrhoea." With regard to diarrhoea, the number of deaths remained practically the same. There were 25 in 1896 and 24 in 1895, and only 12 in 1894, which was a very cold summer. The death-rate from diarrhoea in 1896 was 0.5, as against 0.59 per 1000 for 1895. In 1895 in the whole county diarrhoea in point of numbers was the most fatal of any zymotic disease. In 1896 it stands second on the list with 3192, and a death-rate per 1000 of 0.71. The numbers in the Eastern Districts were—Shoreditch 136, Bethnal Green 113, Whitechapel 45, St. George's 60, Limehouse 49, Mile End 95, and Poplar 168. The Bow record since 1880 for diarrhoea is as follows :— Bow—1880 26 1881 27 1882 20 1883 17 1884 32 1885 6 1886 32 1887 32 1888 17 1889 12 1890 28 1891 16 1892 24 1893 30 1894 12 1895 24 1896 25 1896 cholera 6 34 About the same number of notifications of erysipelas were received as in 1895—namely, 99 as against 96. The deaths number 2, with a death-rate of 0.04, or the same as in 1895, when ERYSIPELAS. there were 2 deaths, 5 in 1894 and 4 in 1893. There have only been 4 deaths from influenza, and there is still little data from which to draw certain conclusions with regard to the origin of this complaint. The attacks were of a mild INFLUENZAChracter, and again quite unlike what was experienced a few years ago. The deaths for the year 1895 numbered 7. Opposite will be found a complete chart of the deaths from the zymotic diseases—namely, small-pox, diphtheria, typhoid fever, puerperal fever, diarrhoea, cholera, and erysipelas. I have also prepared the accompanying chart with a view of showing the relation which existed during the year WEATHER AND DISEASE between weather and disease, both in the whole MetroCHART. polis and Bow. The lines in the chart indicate the rise and fall of the total and zymotic death-rates. Following this Report will be found the Annual Reports of Inspectors Boyce and Field, the Sanitary Inspectors for the West and East Divisions of the North District, and I think it SANITARY right to state that during the year their work has been WORK. diligently and zealously performed. To the uninitiated the work of a Sanitary Inspector may appear unimportant and essentially routine in character, but while their duties are undoubtedly matters of detail, their work can in no sense be regarded as unimportant. Without the information obtained by continual inspection sanitation could not go forward, and while attention to drains, waterpipes, yards, and bricks and mortar may seem particularly tame and unhcroic, yet when it is remembered that these officers in discharging POPULATION 41747. DEATH CHART shewing rise and fall of deaths from all causes (with a zymotic wave) during the year 1896 in their weekly occurance with the Meteorological observations as published in the Registrar* Generals weekly returns. 35 their daily duties carry their lives in their hands as surely as a soldier on the battle-field it is clear that a proper appreciation of their work s not only due from the Sanitary Authority, but unless it is given there is an absence of that stimulus and encouragement which leads to greater efforts on behalf of the public service The statistics Mr. Boyce and Mr. Field set out in their reports compare most favourably with those of last year, the total inspections being 6046 as against 5305 for 1895 in the case of Mr. Boyce, and 6379 in the case of Mr. Field, whose appointment at the end of 1895 does not allow a comparison being made between the two years. To properly understand the work of the Sanitary Department a perusal of the Inspectors' Reports is necessary. There is also attached the Annual Report of Mr. C. W. Raymond, the Inspector of Nuisances in Manufactories, so far as it relates to the North District, and in this case also I desire to express my indebtedness to his care and attention in every case brought under his notice and to the hearty manner in which he has assisted me whenever particular work has rendered it necesary for us to co-operate. The nuisances experienced from the pollution of the River Lea by the West Ham authorities, and other nuisances caused by factories on the borders of the District, have during the year received Mr. Raymond's attention with satisfactory results in the case of the latter. The question of the pollution of the River Lea is a difficult one and is still under the consideration of Committee. LEGAL Details of cases in which legal proceedings were taken, PROCEEDINGS, with the results, will be found in the Inspectors' Reports. These buildings, with the slaughter-houses in the District, have been regularly inspected, and the necessary steps taken to insure the BAKEHOUSES AND COWHOUSES regulation various Acts relating to them being observed. Generally speaking the cowhouses, slaughterhouses and bakehouses in the district have been in a satisfactory condition.. 36 Among other legal proceedings which during the year it was found necessary to take is included a summons against a person for EXPOSINC INFECTIOUS PATIENTS. exposing adopted child who was suffering from scarlet fever. Upon the circumstances of the case being brought to my notice by Mr. Boyce, I took the necessary steps, and obtained the promise of the medical practitioner in whose surgery the exposure occurred to support a case before a magistrate. The child had also been exposed in a trap hired from a jobmaster and the person in whose charge the child was acting as she had done had rendered herself liable to a penalty of £5 under the Public Health (London) Act of 1891. The case appeared to be such a wilful one of exposure that the Committee ordered proceedings to be taken, with the result that a fine of £1 with 12 s. 6d. costs was inflicted. Arising out of the seizure of bad meat at Old Ford in the early part of the year, proceedings were taken against the meat salesman who had purveyed it to the local manufacturer, and after BAD MEAT. a hearing at the police-court the defendant was committed for trial with the result that in February he was sentenced to three months' hard labour at the County of London Sessions, the case being described by Sir Forrest Fulton as a very bad one. Another case occurred in August, when a second seizure was made on the premises, 136, St. Stephen's Road. Proceedings were taken at the Worship Street Police Court, and on August 11th Mr. Hayden Corser said he had not the slightest doubt the meat seized was unfit for food, and that but for the action of the sanitary officers it would have been consumed by the public. A fine of £50 for each of the three parcels of meat, or £150 in all, or in default three months' hard labour, was the sentence passed on the defendant. The penalty being recoverable by distraint, the defendant was given a week in which to pay. On the 18th August he applied to the magistrate for an extension of time. This was refused and the defendant accordingly went to prison. 37 Another seizure of unwholesome meat (not in the process of manufacture) was made by Mr. Boyce in June. Proceedings were taken and on July 7th the defendant was fined £10 and £5 5s. costs. Continued attention in regard to this important matter of bad food has been given by me and the inspectors. During the summer the constant service of the East London Waterworks Company was, as in 1895, interrupted, and for some weeks, in consequence of continued drought, the consumers were THE WATER placed on short allowance. This made the third occasion QUESTION. jn r g months in which the water supply of the district was seriously interfered with. A renewed agitation was the means of drawing the direct attention of the Local Government Board to the subject, and the President, the Right Hon. Henry Chaplin, M. P., not only received a deputation from local authorities, but also himself visited the area of the Company. Mr. Chaplin could not see his way to blame the Company but promised that the matter would be taken into serious consideration by the Government, and after a lapse of time the Government announced its intention of appointing a small Royal Commission of experts to consider the whole question, particularly in view of the water purchase Bills promoted by the London County Council. At an early date legislation to remove some of the disabilities of the consumer was also promised, but in the period covered by this Report no action was taken. In August I reported as follows to the Sanitary Committee :— " For the emergency meeting you will recollect that I marked a map of Bow indicating the positions were I thought standpipes were made desirable; since then their number has been considerably increased, and now the adventitious wants of the consumers may be considered fairly well provided for. " Having noticed on several occasions three or four weeks ago 38 considerable yellow turbidity in the water, I at once drew off the water which remained half-an-hour after the water was turned off, and found on examination considerable deposit of a yellowish character, which I believe to have been chiefly iron rust, as might be expected in the first or last flow through an almost empty iron tube. This condition frequently occurring is admittedly a source of danger. Careful microscopic examination of the sediment failed to disclose any living or dead organisms. " Increased sickness, an incidental result of our short water supply, has most likely been caused through the greater difficulty in obtaining water for cooking purposes, and that also being, through storage in open vessels in the living rooms, stale, and possibly polluted, throwing people more upon the use of tinned cooked foods, which when first opened may have been wholesome, and yet after a few hours'exposure become injurious to health. In this direction we may look for part of the increase in the number of cases of diarrhcea and allied diseases. Although through the action of the Board in watering as usual the roads and flushing the gulleys we have been, for the East, exceptionally comfortable during the hot weather, yet there is no doubt that w.c.s and house drains have not had their usual flushings." In conclusion it is once more a pleasure to be able to thank the Members of the Board and of the Sanitary Committee for the assistance they have at all times afforded me and my staff in the discharge of onerous duties, and to cheerfully acknowledge the confidence with which without exception they honour me. The courteous co-operation of the Board's whole staff is not less useful and personally gratifying, and I can state unhesitatingly that it will be my constant endeavour to preserve the harmonious relations which for so many years have existed between us all. I am, Gentlemen, Your obedient servant, January, 1897. RUSSELL MAIN TALBOT. 39 Sanitary Department, Deecmber 31 st, 1896. To the Medical Officer of Health, Bow District. Sir,— I beg to lay before you my seventh Annual Summary of the Sanitary work carried out in my Division during the year ending December 31st, 1896, as follows :— Inspections on complaints of nuisances 1016 Do. on notifications of infectious diseases 371 Do. on house-to-house visitation 127 Re-inspections 4532 Making a total of 6046 visits. Details and results of such inspections from time to time have been entered in the book kept for that purpose, as prescribed by the "Public Health (London) Act," 1891. Of the total number (1514 houses and other premises) of primary inspections made, I found that 77.88 per cent. of the premises thus inspected various works of sanitary amendment—requiring the service of 1178 intimations and 612 notices—were needed to be carried out. In many 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 the service of statutory notices ; but in 32 cases it was found necessary to have recourse to legal proceedings, necessitating 34 attendances at the police-court to ensure their enforcement ; and in 3 of these latter cases the needed works were not completed until Magistrates' orders for their execution had been obtained, under the provisions of the " Public Health (London) Act, 1891." In one other case a Magistrate's order not having been complied with, an additional summons was obtained and its enforcement secured thereby. In 21 cases the works were completed upon 40 summons only. 6 summonses were dismissed, the presiding Magistrate allowing technical objections which were raised. One summons was adjourned sine die. The details and nature of Sanitary Works executed in the West Division during the year are as follows:— Walls and ceilings of houses cleansed throughout partially 81 Drains opened and cleansed 291 Defective drains repaired 398 Inlets to drains properly trapped 125 Sink waste pipes properly disconnected from drains 49 Rainwater pipes do. do 53 Water-closets re constructed 53 Water laid on to soil pans of W.C.'s 317 Ventilation of W.C.'s improved 5 New soil pans provided 298 Foul soil pans cleansed 77 Yards, areas, and forecourts, paved 253 Yards and areas drained 36 Nuisances from dampness remedied 103 Roofs made watertight 154 Eaves guttering of roofs and rainwater pipes repaired 218 Water supplies to houses reinstated 49 Water services for domestic purposes altered or improved 50 Water service fittings repaired 11 Public House urinals repaired and cleansed 6 Animals improperly kept (removed) 1 Accumulations of dung and refuse removed 69 Overcrowding abated 2 Bye-laws enforced 28 Other nuisances remedied, chiefly dilapidations 324 Drains tested* by the application of the smoke drain test, of which 45 per cent, were proved defective 884 * Primary tests only. House to House Visitation. The house to house inspection referred to above comprised a section of :— Old Ford Road. 41 The following particulars shew the work done in connection with infectious cases within my Division during the year :— Infectious patients removed to hospital 97 Rooms fumigated after infectious diseases 236 Infected bedding, clothing, &c., removed to the Board's apparatus, there disinfected and safely returned to their respective owners 236 Number of disinfections certified by private medical practitioners to have been done on premises 39 In each house where an infectious case occurred, disinfectants have been supplied (gratis), the premises inspected and the drains tested by smoke, with the view of detecting insanitary conditions ; the results of such inspections, together with other particulars, have been duly recorded on special forms and submitted to you, invariably within 24 hours of the receipt of each individual notification. Parish of Saint Mary Stratford, Bow (West Division). Names of the Roads, Streets and Places. Total number of Dwelling Houses. Antill Road,Nos. 131 to 143, odd Nos.; Nos. 138 to 168, even Nos. 21 Appian Road 69 Armagh Road 175 Athelstane Road 38 Balmer Road 10 Beale Place 15 Beale Road 60 Candy Street 78 Cardigan Road 60 Total number of Dwelling Houses. Chad Street 25 Chisenhale Road, Nos. 1 to 7, odd Nos.; Nos. 2 to 8, even Nos. 8 Coborn Road, Nos. 94 to no, even Nos. 8 Clark's Place 3 Dane Place 10 Driffield Road 84 Eglinton Road 73 Ford Road 93 42 Total number of Dwelling Houses. Ford Street 95 Gawthorne Street 45 Gunmakers' Lane 2 Hewlett Road 95 Jodrell Road 77 Jodrell Terrace 4 Lacey Street 31 Lamprell Street 73 Lefevre Road 133 Lefevre Terrace 13 Libra Road 83 Locton Street 72 Milton Road 78 Monteith Road 42 Morville Street 99 Mostyn Road 56 Norman Road 45 Old Ford Road, No. 223 to 403, odd Nos.; No. 336 to 604, even Nos. 211 Ordell Road 38 Total number of Dwelling Houses. Parnell Road 173 Prince Arthur's Avenue 9 Ranwell Street 32 Roman Road, Nos. 117 to 337, odd Nos.; Nos. 152A to 348, even Nos. 221 Rosebank Road 18 Ruston Street 38 Saxon Road, Nos. r to 13, and 17 to 25, and Schoolhouse 23 St. Stephen's Road 166 Stafford Road 61 Sutherland Road 60 Tamar Street 9 Tredegar Road 178 Usher Road 180 Vernon Road 54 Victoria Cottages 20 Wendon Street 49 Wright's Road 30 Giving a total number of 3448 houses, and an estimated population of 25,101, or 7.28 per house. The following is a list of the Licensed Cow and Slaughter-houses Cow Houses. Address. Name of Licensee. 75, Armagh Road Mr. David Wm. Davies. 103, Armagh Road Mrs. Ann Davies. 10, Beale Road Mr. Humphrey Edwards. 19, Morville Street Mrs. William Jenkins. 361, Old Ford Road Mr. John Lewis. 43 Slaughter Houses. 239, Old Ford Road Mr. David Mitchell. 220, Roman Road Mr. Thomas George R. Smith. 258, Roman Road Mr. James Henry Cox. 288, Roman Road Mr. Thomas Skillington. 338, Roman Road Mr. Henry Wm. Jarrett. 114, Tredegar Road Mr. John Dennis. all of which have been subjected to periodical inspection throughout the year. The market places have also been regularly inspected throughout the year. In only one instance has seizure of food been warranted, but desiruction by the owner or at the Board's depot has occasionally been resorted to with the invitation or consent of the owner. By the direction of Mr. Young, the Public Analyst, I have obtained 64 samples of food for analysis, of which 8 were certified by him to have been adulterated. In 6 cases legal proceedings were instituted against the vendors, and convictions obtained in 3 cases. I am, Sir, Your obedient Servant, WILLIAM BOYCE, Sanitary Inspector, and Inspector under the Sale of Food and Drugs Act, Bow ( West Division). 44 Sanitary Department, February ist, 1897. To the Medical Officer of Health, Bow District. Sir,— I beg to lay before you the Annual Summary of the Sanitary work and improvements carried out in the Bow East Division during the year ending December 3rst, 1896. Inspections have been made as follows: — On notifications of infectious diseases 202 On complaints of nuisances 603 On house to house visitation 620 Total 1425 In 1042 instances varied Sanitary improvements were necessary, requiring the service of 890 intimations, 433 authorised statutory notices, and the issuing of 9 Police Court summonses, supplemented by 4954 re-inspections to secure proper compliance resulting in the following detailed works being executed :— Walls and ceilings of Houses cleaned throughout partially 97 Yards and areas paved 189 Yards and areas drained 191 Inlets to drains properly trapped 135 Defective drains repaired 334 Drains opened and cleansed 127 Sink waste pipes properly disconnected from drains 57 Rain water do. do. 72 Water laid on to soil pans of W.C.'s 68 New soil pans provided 17 Foul soil pans cleansed 46 Roof, guttering and rainwater pipes repaired 221 Roofs made watertight 166 Water supplies to houses reinstated 27 45 Water service fittings repaired 15 Water service for domestic purposes altered or repaired 62 Ventilation of W.C.'s improved 8 Nuisances from dampness abated 93 Accumulation of dung and refuse removed 25 Public house urinals cleansed and repaired 5 Bye-laws enforced 150 Overcrowding abated 6 Other nuisances remedied, chiefly dilapidations 443 Drains tested by the application of the smoke drain test, of which 35.04 per cent were proved defective 953 Entirely new drainage systems of which plans and particulars were submitted for approval and duly authorised, have been laid at the undermentioned premises:— 34, 35, Coborn Street, i, 9, Avenue Road, 23, 25, Douro Street, 11, 13, 26, 29, 31, 33, 35, Alfred Street, 149, 151, Bow Road, 784, 786, 788, 790, 792, 794, 796, 798, 800, 802, 804, Old Ford Road, 816, 818, 820, 824, 826, Old Ford Road, 36, Lawrence Road, 71, 73, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30 32, 34, 36, Fairfield Road, 26, 28, Autumn Street. The house-to-house inspection comprised the whole of the houses in the under-mentioned streets, viz. :— Maverton Road, Douro Street, Trellis Street, Creswick Road, Lawrence Road, Fairfield Road, Gandy Court, Autumn Street, Alfred Street, Guerin Street, Malmesbury Road Iceland Row, Spring Street, 46 and sections of:— Monier Road, Clay hall Road, Caxton Street, Davey Road, Brewery Yard, Rippoth Road. Of the premises on which the cases of infectious diseases occurred, 41.58 per cent, were found on inspection to yield a negative result from the drain test and otherwise appeared to be in fair condition. The removals to hospitals and particulars of fumigations, &c., being:— Number of infected patients removed to hospital 47 Number of rooms fumigated after infectious disease 99 Infected bundles removed to the Board's apparatus for disinfection 101 Number of disinfections certified by private practitioners 23 The Cow and slaughter houses, gipsy encampments, and waste lands in the District have received attention throughout the year, and the food supplies vigilently watched. In no instance has seizure of food been warranted, but destruction by the owner or at the Board's depot has occasionally been resorted to with the invitation or consent of the owner. At the request of Mr. Young, the Public Analyst, 48 varied samples, of food have been obtained and submitted to analysis, of which four were certified to have been adulterated in such proportion as to necesitate the institution of legal proceedings against the vendors. In each case a penalty with costs was inflicted and in two other cases the vendors were cautioned. 47 Parish of Saint Mary Stratford, Bow (East Division). Names of the Roads, Streets and Places. Total number of Dwelling Houses. Addington Road 49 Albert Terrace 14 Alfred Street 49 Allanmouth Road 52 Atley Road 31 Autumn Street 39 Avenue Road 10 Baker's Alley 15 Bow Road 170 Blondin Street 33 Brewery Road 9 Coborn Street 32 Coborn Road 46 Caxton Street 33 Creswick Street 8 Clay Hall Road 50 Comboss Road 26 Cadogan Terrace 61 Clarnico Cottages 14 Davey Road 21 Denbigh Road 17 Douro Street 33 Dace Road 47 Dye House Lane 7 Ducketts Canal Cottage 1 East Street 1 Eliza Place 4 Fairfield Road 113 Finchs Bard 3 Guerin Street 21 Candy Court 11 Harley Street 28 Total number of Dwelling Houses. High Street 39 Hepscott Road 12 Hackney Cut Cottages 2 Iceland Road 5 Landseer Road 20 Lawrence Road 31 Malmesbury Road 182 Mary Street 10 Malverton Road 34 Monier Road 160 Old Ford Road 167 Olivers Place 16 Payne Road 3 Remus Road 21 Ripporth Road 79 Rothbury Road 53 Smeed Road 11 Spring Street 19 Summer Street 16 School House Yard 2 St. Mark's Road 1 Trellis Street 15 Trego Road 62 Tredegar Road 1 Taylor's Buildings 6 Wansbeck Road 55 Wyke Road 97 Wallis Road 10 Walter Court 9 Wick Lane 10 Windsor Road 1 White Post Lane 59 48 Giving a total number of 2256 houses, and an estimated population of 16,394, or 7.28 per house. Cow Houses. Address Name of Licensee. 3, Alfred Street Mr. George Stone. 24, Dace Road Mr. Samuel Clay. 457, Old Ford Road Mr. Henry Green. Slaughter-houses, 178, Bow Road Mr. Robert Varnell. 231, Bow Road Mr. John Gurr. 12, Coborn Road Mr. Richard Cockerill. I am, Sir, Your obedient Servant, ALFRED J. FIELD, Sanitary Inspector, and Inspector under the Sale of Food and Drugs Acts. Bow East Division. 49 PARISH OF BOW (East Division). List of Summonses taken out at Police Courts, with Results. Situation. Nature ok Complaint. Date of Proceedings. Result. 14, Coborn Road Eaves-gutters, and rain-water pipe defective, walls damp, sink waste pipe connected direct to drain 1896 April 22nd Work completed. Summons withdrawn. 2, Mitford Terrace Drain, flushing apparatus, and roof defective. Forecourt unpaved April 14th Work completed. '.Summons withdrawn. 1, Davey Road (Lea Tavern public-house) Drain, soil pipe, sink waste pipe, and yard paving defective April 11th Adjourned. The premises about to be rebuilt. Since executed. 29, Alfred Street Drain and flushing apparatus defective, yard paving insufficient, walls damp, forecourt unpaved, front areas undrained July 9th Adjourned twice. Work completed. Summons withdrawn. 31, Alfred Street Drain defective, soil pan foul, rain-water pipe connected, yard paving insufficient, walls damp, front area undrained forecourt unpaved July 9th As above. 33, Alfred Street Drain defective, sink waste pipe connected, yard paving insufficient, walls damp, front area and forecourt unpaved and undrained July 9th As above. 35, Alfred Street Drain defective, sink waste and rain-water pipes connected, untrapped inlet in yard, insufficient yard paving and forecourt, and area undrained and unpaved, walls damp July 9th As above. 177, Malmesbury Road Yard paving insufficient - July 9th Adjourned twice. Dismissed. 56 Fairfield Road Roof defective Nov. 11th Work completed. Summons with drawn. 5° PARISH OF BOW (West Division), List of Summonses taken out at Worship Street Police Court with Results Situation of Premises. Nature of Complaint. Date of hearing. Result. Stables adjoining 62 Libra Road Yard and stable neither paved or drained. No receptacle for dung Jan. 27 Works completed. Ordered to pay costs of summons only. 17 Athelstane Road Defective drain. No water to W.C. Yard not paved. Sink waste pipe not disconnected from drain „ 27 Withdrawn. Works completed 96 Parnell Road Detective drain. Inefficient flush to closet pan. Yard and forecourt not sufficiently paved March 20 Adjourned. Subsequently withdrawn Works completed. 98 Parnell Road Defective drain. Inefficient flush to closet pan. Yard and forecourt not sufficiently paved. Roof, eaves guttering, and flooring of washhouse defective. No under-floor ventilation. „ 20 As above. 100 Parnell Road Defective drain Inefficient flush to closet pan. Yard and forecourt not sufficiently paved „ 20 „ 102 Parnell Road Defective drain. Inefficient flush to closet pan. Yard and fore-court not sufficiently paved. Roof, eaves guttering, and flooring of washhouse defective. Walls and ceilings dirty condition „ 20 „ 23 Lacey Street Defective drain. Inefficient flush to closet pan. Yard and forecourt insufficiently paved. No underfloor ventilation „ 20 Adjourned. Abatement order, 6s. costs. 582 Old Ford Road Defective drain. Rain-water pipe broken and not disconnected from drain. No water to W.C. Yard paving defective. No under-floor ventilation „ 20 Withdrawn. Works completed Stables adjoining 12 Eglinton Road No receptacle for dung April 15 As above 20 Norman Road Fore-court unpaved 15 16 Ordell Road „ „ „ 15 79 Morville Street Branch drain choked and defective July 9 Adjourned. Subsequently dismissed 81 Morville Street „ „ „ 9 Adjourned. Further adjourned. Subsequently withdrawn on completion of work 5i 83 Morville Street Branch drain choked and defective July 9 Adjourned. Subsequently withdrawn on completion of work. 35 Driffield Road Main drain defective „ 23 Dismissed. 37 Driffield Road „ „ „ „ 23 As above. 39 Driffield Road „ „ „ „ 23 „ 41 Driffield Road „ „ „ „ 23 Adjourned. Further adjourned. Subsequently withdrawn. Works completed. 43 Driffield Road „ „ „ „ 23 Dismissed. 45 Driffield Road „ „ „ „ 23 As above. 1 Rosebank Road Fixing improper closet pans Sept. 17 Fined 10s. 269 Old Ford Road Exposure of case of scarlet fever in a public thoroughfare Oct. 16 Fined 20s. and 12s. 6d. costs. 67 Appian Road Defective drain. Yard not sufficiently paved. No under-floor ventilation Nov. 10 Abatement order, 6s. costs 245 Roman Road Seizure of meat, unwholesome and unfit for the food of man July 7 Fined ,£10 and 5 guineas costs 14 Candy Street Rain-water pipe, yard paving and flooring of washhouse defective Walls and ceilings dirty condition Nov. 10 Withdrawn. Works completed. 24 Candy Street Defective drain „ 10 As above. 18 Ordell Road Defective drain. Roof and yard paving „ 10 Adjourned. Subsequently withdrawn Works completed. 420 Old Ford Road Front area not drained 10 Adjourned sine die. 50 Wendon Street Defective rain-water piping. Damp walls „ 10 Withdrawn Works completed. 54 Wendon Street „ „ „ „ 10 As above. 56 Wendon Street „ „ „ „ 10 „ 190 Roman Road Fixing improper flush pipe to W.C. Jan. 1, 1897 Withdrawn on alteration of work. 78 Libra Road Defective drain. Closet trap broken. W.C. dilapidated. No water to W.C. „ „ Adjourned. Subsequently withdrawn on completion of work. 162 Armagh Road Choked drain „ „ Withdrawn Drain cleared. 52 Summary of Notices and Improvements carried out at the. different Manufactories and Workshops in the Bow District, during the year ending December, 1896. Nature of Nuisance. Number of Notices served. Cause of Nuisance. How Remedied. Insufficient Latrine accommodation 2 Defective sanitary arrangements Accommodation increased and new latrines put in. Pipe Making 2 Chimney of kilns below window of adjoining houses The chimneys have been raised. State of Workshops 15 Walls and ceilings of workrooms dirty and dilapidated Workrooms thoroughly cleansed. Overcrowding in workrooms 4 In each case the rooms were found to be overcrowded Overcrowding abated. Smoke Nuisances 11 Burning of inferior fuel and defective apparatus Better class of fuel used and apparatus repaired. Laundries 3 Insufficient ventilation defective paving, etc. Ventilation improved, paving repaired. Felt Works 1 Noxious vapours were emitted from mixing tank The mixing tank has been repaired. Whalebone Works 1 Nuisance caused by boiling whalebone in open pot The process is now carried on in close vessels. Refuse Burning 2 Nuisance caused by burning bass refuse Nuisance discontinued. Cork Burning 1 Cork burning in the open. The operation is now carried on in a chamber Chemical Works 1 Large escape of noxious gases from main shaft The condensing power has been increased. 53 Nature of Nuisance. Number of Notices served. Cause of Nuisance. How Remedied. Sausage Manufactory 1 1 quarter of veal, 3 hind quarters ol pork and 2 bullocks' heads in process of cutting up the same being unsound, unwholesome, and unfit for the food of man. A Summons was issued and heard before Mr. Haden Corser at the Worship Street Police Court, on Tuesday, Aug. 11th, 1896. The magistrate, after hearing the evidence imposed a fine of £50 for each of the three parcels of meat (pork,veal and bullocks heads), £150 in all or three months hard labour, the penalty being recoverable by distraint, the Defendant was given a week in which to pay. This he failed to do and he was sent to prison. Bakehouses 29 The whole of the bakehouses have been inspected twice during the year, and where necessary notices have been served for cleansing same. In each case the terms of the notice have been carried out. C. W. RAYMOND, Inspector of Nuisances in Manufactories and Workshops