POPB 4 Board of Works for the Poplar District. REPORT on the SANITARY CONDITION, VITAL & HEALTH STATISTICS, &c., of the Bow District, comprising the Parish of St. Mary, Stratford-le-Bow, FOR THE YEAR, 1898, BY RUSSELL MAIN TALBOT, licentiate of the royal college of physicians, edinburgh; member of the royal college of surgeons, england; licentiate of the apothecaries society, london; fellow of the society of medical officers of health, and of the hunterian society, MEDICAL OFFICER OF HEALTH for the DISTRICT. 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 privilege to submit my 24th Annual 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 occuring in Bow, as required by the regulations of the Local Government Board. I have also the pleasure to submit various charts and tables which completely explain the sanitary position of the district and the condition of its public health. The period reviewed by this Report is for the twelve months ending the 31st December, 1898. A 2 GENERAL SUMMARY. The year 1898 presents, I am happy to say, merely normal conditions. The sanitary condition of my district continues excellent; a low rate of mortality has been maintained; as in 1896 and 1897 the statistics with regard to the various notifiable and other diseases do not call for special comment, except perhaps to note the great reduction in notification. I cannot do better than repeat what I reported to you in my last Annual Report. "That an East End district should be so placed speaks volumes, not only for the progress of sanitation, but also for the administration of health laws, which in these days of congested population are of such moment for the well-being of the whole community." "Such a state of affairs appears to me, and will, I think, also commend itself to you, as being highly satisfactory and encouraging. It proves as I have before insisted that conscientious, persistent, and intelligent sanitary administration must in time tell in the improvement of the health of a district. The fruits of many years labour and great expenditure are now ripening for gathering, and I feel sure that when the ratepayers know these facts they will consider their money has been well and wisely spent for the benefit of the community." "But the efforts of administrators must not be relaxed; there is still only too much ground to cover, still only too many bad conditions to remove. Health problems will always confront us, as populations increase, and areas become more densely inhabited. Having got a community healthy, the object then will be to keep it healthy. Disease must be regarded as a dweller on the threshold, ever waiting the opportunity to make entry into the teeming life of our towns and cities." POPULATION. The population of the parish of Bow for the year 1897 is estimated to the middle of the year (as required by the Registrar General) at 42,080, and the following table gives the official census for the last 100 years official census for the last 100 years:- 3 TABLE I. Years. Population of Bow. Years. ation of Bow. 1801 2IO1 1861 11,575 1811 2259 1871 26,005 1821 2349 1881 37,063 1831 3371 1891 40,378 1841 4626 1896 41,687 1851 6999 1897 42,080 The density of the population was the same as in the year 1897, viz., 7.3, and the number of inhabited houses was 5696, a decrease of 5 only. The following Table shows 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 1897 5701 41,949 7.3 1898 5696 42,080 7.3 VITAL STATISTICS. The number of births registered in Bow during the twelve months of 1898 was, males 688, females 658, total 1346, as against 1445 in 1897, 1335 in 1896, and 1423 in 1895. The excess of births over deaths was 214 males, and 268 females, total 482, as against 651 in 1897, 500 for 1896, and 598 for 1895. The annual birth-rate was 31.9 per 1000, as against 34.4 for 1897, 32.4 for 1896, and 34 for 1895. 4 The following Table gives the excess of births over deaths since 1880:— TABLE III. Bow—1880 794 Bow—1890 5'4 1881 709 1891 484 1882 757 1892 408 1883 812 1893 434 1884 757 1894 576 1885 745 1895 598 1886 807 1896 500 1887 669 1897 651 1888 727 1898 573 1889 611 During the year under review the deaths have numbered—males 474, females 390, total 864, as against 774 for 1897. The annual death-rate for Bow was 20.5 per 1000, as against 18.4 for 1897, 20.4 per 1000 for 1896, and 19.7 for 1895. TABLE IV. Showing Population, Birth-rate, Death-rate, and Zymotic Death-rate since 1871. Year. Population. (Bow & Bromley.) Birth-rate. Death-rate. Zymotic Death-rate (Bow & Bromley.) (Bow & Bromley.) 1871 68,024 41.9 27.24 6.3 (Bow.) (Bow.) (Bow.) (Bow.) 1881 37,063 38.5 19.6 3.4 1891 40,378 32.8 21.0 3.0 1892 40,714 33.9 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 1897 41,949 34.4 18.4 2.7 1898 42,080 34.0 20.5 3.4 5 The annual table showing the number of new cases of sickness coming to my knowledge during each week of the year deserves a brief perusal. The notifications as a whole show a great reduction on the previous year. In the 13th week a record was established, not a single case being reported; in the 18th there was only one of diphtheria; and in the 21st only two, erysipelas and diphtheria; precisely the same return was made in the 47th week; in nine weeks there were three cases only each week, and the highest number in any one week was thirteen, which happened on two occasions, the 14th and 44th weeks; in the first of these there were eight cases of scarlet fever, and in the second cases there were four scarlet fever and four typhoid. This is in many respects a remarkable return. The following Table shows the health conditions of Bow, as compared with those of London at various periods during the year. TABLE V. Periodical Reports to Sanitary Committee Date of Report. No. of weeks covered. Bow Annual Death-rate London Annual Death-rate Bow Zymotic Deathrate. London Zymotic Deathrate. No. of Zymotic Deaths in Bow. No. of Notifica tions. Annual Rate of Notification. Jan. 27 5 28.7 23.0 5.4 3.2 22 33 8.1 Feb. 24 4 28.1 21.4 5.8 2.6 19 19 5.9 Mar. 24 4 21.4 21.4 4.3 2.8 14 20 6.2 Apl. 28 5 17.9 19.8 3.9 2.7 16 26 6.6 May 26 5 19.0 16.3 1.8 2.3 6 10 3.0 June 23 4 17.5 15.5 0.2 1.4 3 15 4.6 July 28 5 17.3 14.5 2.2 1.7 9 21 5.1 Sept. 8 6 23.8 20.4 6.0 4.9 29 28 5.5 „ 22 2 38.9 22.2 8.2 5.8 15 11 6.8 Oct. 28 5 18.2 19.1 2.9 3.0 12 33 8.1 Nov. 24 4 13.5 16.3 1.5 1.5 5 34 10.4 Dec. 22 4 17.2 17.0 1.5 1.6 4 22 6.8 6 Once again it is a pleasure to be able to report that there have during the year been no deaths from small pox or typhus fever, nor any notifications of the latter. The deaths from zymotic disease total 145, as compared with 116 in 1897, 164 in 1896, 117 in 1895, 159 in 1894, and 181 in 1893. The zymotic death rate was 3.4, against 2.7 in 1897, 3.8, 2.8 and 3.8 for 1896, 1895 and 1894 respectively. This increase in the zymotic death rate is not satisfactory. It is accounted for by treble the number of deaths from measles, and slight increases in deaths from scarlet fever, whooping cough, and diphtheria, in the latter case, which is the most serious, the deaths being just double, viz., 16 as compared with 8. The figures for 1897 were, however, in these respects, exceptionally favourable. Of these 145 deaths exactly 53, or over one-third were those of children below 1 year of age, and 68 were those of children under 5 years of age, 13 were those of children between 5 and 15, 3 of persons between 15 and 25, 6 those of persons between 25 and 65, and only 2 over 65, which latter were due to erysipelas and diarrhoea. Forty-seven infants died from whooping cough and diarrhoea, and 65 children under 5 from diphtheria, measles, whooping cough, and diarrhoea. Measles is the blot on the year, and this disease is not notifiable, though efforts have been and are being made in various districts to make it so. Diarrhoea was the blot in 1897, and considering the prolonged hot weather last summer and autumn, it is somewhat remarkable that the deaths under this head should show a decrease of 5. I have dealt with the incidence and prevalence of zymotic disease in previous annual reports that it is unnecessary to again repeat my views. I refer those who are interested in the subject to those reports, for comparative and other purposes. 7 With regard to the notifications of infectious disease they totalled 278, against 515 in 1897. As in previous years the notifications were principally due to diphtheria and scarlet fever, which totalled 76 and 109 respectively, the next in order being typhoid fever and erysipelas. These matters will be found fully dealt with in the various statistical tables, and also separately under their proper heads. The zymotic death-rate for Bow during 1897 was 3.4 per 1000, and the notification rate 6.6, comparing with 2.7 and 12.2 respectively for 1897. This is a remarkable result, for the number of notifications is less by almost one half than in the previous year. 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:— 8 Table of Deaths during the year 1898, in the BOW Division, (Metropolitan) Poplar Sanitary District, classified according to Diseases, Ages, and Localities. Table A. 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 under65 65 and upwards Parish of Bow 864 274 165 33 31 233 128 Grove Hall Lunatic Asylum 53 ... ... ... 2 38 13 Totals 917 274 165 33 33 271 141 Deaths occurring outside the District among persons belonging thereto 187 18 16 9 10 92 42 Deaths occurring within the District among persons not belonging thereto 53 ... ... ... 2 38 13 Mortality from Subjoined Causes, distinguishing Deaths of Children under Five Years of Age. Diseases. Parish of Bow. Grove Hall Lunatic Asylum Totals. Deaths occurring outside the district among persons belonging thereto Deaths occurring within the district among persons not belonging thereto. un. 5 ov. 5 un. 5 ov. 5 un. 5 ov. 5 un. 5. ov. 5. un. 5. ov. 5. Smallpox ... ... ... ... ... ... ... ... ... ... Scarlatina 3 3 ... ... 3 3 2 3 ... ... Diphtheria 11 5 11 5 7 3 ... ... MembranousCroup ... ... ... ... ... ... ... ... ... ... Fevers. Typhus ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid ... 6 ... ... ... 6 ... 4 ... ... Continued ... ... ... ... ... ... ... ... ... ... Relapsing ... ... ... ... ... ... ... ... ... ... Puerperal ... 1 ... ... ... 1 ... ... ... ... Cholera (Infantile) 1 ... ... ... 1 ... ... ... ... ... Erysipelas 1 2 ... ... 1 2 ... ... ... ... Measles 33 5 ... ... 33 5 1 ... ... ... Whooping Cough 32 ... ... ... 32 ... 3 ... ... ... Diarrhoea and Dysentery 40 2 ... ... 40 2 1 ... ... ... Rheumatic Fever ... 3 ... ... ... 3 ... ... ... ... Phthisis 7 74 ... 7 7 81 2 23 7 ... Bronchitis, Pneumonia & Pleurisy 113 87 ... 7 113 94 7 24 7 ... Heart Disease ... 49 ... 4 ... 53 ... 17 4 ... Injuries 5 21 ... ... 5 21 1 12 ... ... All other Diseases 193 167 ... 35 193 202 10 67 35 ... Totals 439 425 ... 53 439 478 34 153 53 ... Area and Population of the District or Division to which this Return Relates. Area in Acres 563 Population (Last Census) 40,378 „ (Estimated to middle of 1897) 42,080 Death Rates — General 205 per 1000 Population, estimated to middle of 1897 Infants (under 1 year of age) 203 per 1000 Births registered. 9 Table of Population, Births, and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health during the year 1898, in the BOW Division of the Metropolitan Sanitary District of Poplar; classified according to Diseases, Ages and Localities. Table B. Names of Localities adopted for the purpose of these Statistics ; Public Institutions being shewn as separate localities. Parish of St. Mary Stratford, Bow. Grove Hall Lunatic Asylum. Total. Population at all Ages— Last Census (1896) 41,687 ... 41,687 Estimated to middle of 1898 42,080 (452) 42,532 Registered Births 1,346 ... 1,346 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 ... ... ... ... ... ... ... ... Scarlatina 31 75 ... ... ... ... 31 75 Diphtheria 29 46 ... ... ... ... 29 46 MembranousCroup ... 1 ... ... ... ... ... 1 Fevers. Typhus ... ... ... ... ... ... ... ... Enteric or Typhoid 1 37 ... ... ... ... 1 37 Continued ... ... ... ... ... ... ... ... Relapsing ... ... ... ... ... ... ... ... Puerperal ... 3 ... ... ... ... ... 3 Cholera ... ... ... ... ... ... ... ... Erysipelas 2 44 ... ... ... ... 2 44 Number of such Cases returned 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 12 59 ... ... ... ... 12 59 Diphtheria 18 29 ... ... ... ... 18 29 MembranousCroup ... ... ... ... ... ... ... ... Fevers. Typhus ... ... ... ... ... ... ... ... Enteric or Typhoid 1 26 ... ... ... ... 1 26 Continued ... ... ... ... ... ... ... ... Relapsing ... ... ... ... ... ... ... ... Puerperal ... 1 ... ... ... ... ... 1 Cholera ... ... ... ... ... ... ... ... Erysipelas ... 5 ... ... ... ... ... 5 10 Total Deaths of Inhabitants of BOW, occurring both within and without the District, during the year 1898. 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 ... ... ... ... ... 2 1 ... ... 3 ... 1 1 ... 2 ... ... ... 1 1 ... ...... ... ... ... ... ... ... ...... ... 2 2 1 1 6 Diphtheria ... 1 ... ... 1 3 1 2 4 10 1 1 1 2 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 3 3 6 16 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 1 ... ... ... 1 ... 1 1 1 3 ... ... ... ... 1 1 3 1 6 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 Cholera (Infantine) ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Erysipelas ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... 1 2 ... ... 1 3 Measles 2 1 ... ... 3 17 8 5 ... 30 2 2 ... ... 4 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 22 11 5 ... 38 Whooping Cough 9 5 1 1 16 14 1 1 ... 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 6 2 1 32 Diarrhœa, and Dysentery ... ... 28 3 31 ... ... 9 ... 9 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... 1 ... ... 38 4 42 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... 1 1 1 3 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis 1 1 1 ... 3 ... ... 2 2 4 2 1 ... 3 3 4 3 3 13 21 11 12 12 56 1 ... 1 ... 2 28 17 19 17 81 Bronchitis. Pneumonia and Pleurisy 17 14 10 18 59 32 6 5 11 54 1 ... ... ... 1 1 1 ... 1 3 19 8 5 11 43 24 8 1 7 40 94 37 21 48 200 Heart Disease ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 3 ... ... ... 1 1 11 6 3 6 26 5 5 6 3 19 16 13 10 10 49 Injuries 1 ... 1 ... 2 2 1 ... ... 3 ... 1 2 1 4 2 1 ... 3 ... 7 1 2 10 1 2 1 4 4 13 5 4 26 All other Diseases 24 35 72 26 157 8 7 15 6 36 ... 4 2 2 8 3 3 2 ... 8 28 26 20 16 90 19 12 15 15 61 82 87 126 65 360 Total 55 57 114 48 274 78 25 39 23 165 6 13 9 5 33 9 10 6 6 31 79 59 44 51 233 51 27 24 26 128 278 191 236 159 864 11 Total Deaths of Inhabitants of BOW, occurring without the District during the year 1898. Mortality from the following Diseases. Under 1 year. 1 year and under 5. 5 years and under 15 15 years and under 25 25 years and under 65 65 years and upwards At all Ages. Small Pox ... ... ... ... ... ... ... Scarlatina ... 2 2 1 ... ... 5 Diphtheria ... 7 3 ... ... ... 10 Membranous Croup ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... 2 ... 2 ... 4 Continued Fever ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... Measles ... 1 ... ... ... ... 1 Whooping Cough 1 2 ... ... ... ... 3 Diarrhoea and Dysentery 1 ... ... ... ... ... 1 Rheumatic Fever ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... Phthisis 1 1 ... 4 17 2 25 Bronchitis, Pneumonia and Pleurisy 6 1 ... ... 10 14 31 Heart Disease ... ... ... 12 4 17 Injuries ... 1 ... 2 8 2 13 All other Diseases 9 1 1 3 43 20 77 Total 18 16 9 10 92 42 187 12 Total Deaths of persons (not inhabitants) in Grove Hall Lunatic Asylum, occuring during the year 1898. Mortality from the following Diseases. 15 years and under 25. 25 years and under 65. 65 years and upwards. At all Ages. 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 ... ... ... ... Rheumatic Fever ... ... ... ... Ague ... ... ... ... Phthisis ... 7 ... 7 Bronchitis, Pneumonia and Pleurisy 1 6 ... 7 Heart Disease ... 2 2 4 Injuries ... ... ... ... All other Diseases 1 23 11 35 Total 2 38 13 53 BOARD OF WORKS FOR THE POPLAR DISTRICT. Annual Table, shelving the number of * Notifications of Infectious Sickness coming to the knowledge oj the Medical Officer of Health week by week during the year 1898, 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 „ 1 16th ,, 17th „ 18th „ 19th ,, 20th „ 21st ,, 22nd 23rd „ 24th „ 25th „ 26th „ 27th „ 28th „ 29th „ 30 th ,, 31st „ 32nd ,, 33rd „ 34th „ 35th „ 36th „ 37th „ 38th „ 39th „ 40th „ 41st „ 42nd „ 43rd „ 44th ,, 45th „ 46th ,. 47th „ 48th „ 49th „ 50th „ 51st „ 52nd ,, Totals. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 1 1 2 1 1 2 1 ... 1 ... 2 1 ... 4 1 2 1 1 1 ... 1 1 ... 3 1 ... 3 2 2 ... ... ... 1 2 2 2 2 2 3 1 2 ... 1 3 1 4 1 2 2 6 1 2 76 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 3 ... 2 ... 1 ... ... 2 1 2 2 1 ... ... 2 ... ... ... 1 1 1 1 1 1 1 ... 1 1 ... 1 2 ... 1 ... ... ... 1 1 2 1 2 ... 1 2 5 ... 1 2 1 ... ... 2 50 Fevers— Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid ... 2 1 ... ... 2 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 1 1 3 ... ... + 1 2 1 2 1 1 3 2 4 ... 1 ... 1 1 1 1 1 39 Relapsing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Scarlet 4 3 1 3 1 4 3 1 1 1 6 3 ... 8 1 3 3 ... 1 2 ... 2 3 ... 2 0 1 1 ... 2 1 3 1 2 5 3 2 3 2 1 3 2 5 4 2 2 ... 2 2 1 1 ... 109 Totals 8 6 6 4 3 8 5 3 3 3 11 5 *0 13 4 5 4 1 3 3 2 4 4 4 5 4 6 5 3 4 4 6 3 4 7 6 7 7 9 4 8 5 9 13 8 7 2 7 6 8 3 5 277 * Record. † Typhoid imported. 14 PARISH OF BOW. Return of Schools attended by children residing in the district and notified as suffering from Infectious Diseases within the district. School. Scarlet Fever. Diphtheria. Typhoid. Erysipelas. Totals. Atley Road 9 3 ... ... 12 * Bow Church 1 ... ... ... 1 Coopers School 1 ... ... ... 1 * Christ Church 1 1 ... ... 2 Chisenhale Road 1 ... ... 1 Dace Road 1 ... ... 1 Fairfield Road 6 ... 1 ... 7 Gainsboro Road 8 1 ... ... 9 * Harley Street 1 ... ... ... 1 *Jubilee Hall 2 ... ... ... 2 Malmesbury Road 3 l 2 ... 6 Miss Osborne's Bow Road 1 ... ... ... 1 * Morley Hall 1 ... ... ... 1 Monteith Road 9 6 ... ... 15 Olga Street 1 4 1 ... 6 Old Palace 2 ... ... ... 2 Roman Road 6 5 1 ... 12 Smeed Road 21 6 2 ... 29 Stafford Road 5 6 2 ... 13 * St. Mark's 3 1 ... ... 4 Thomas Street ... 1 ... ... 1 Tredegar Road 2 2 ... ... 4 Wright's Road 2 ... ... ... 2 Totals 85 39 9 ... 133 * Sunday Schools. 15 HOSPITAL ACCOMMODATION. Of the cases removed to hospital during the year, 5 typhoid and 1 puerperal fever were admitted to the London Hospital; 5 erysipelas and 4 typhoid cases went to the Poplar and Stepney Sick Asylum; 1 typhoid to St. Bartholomew's, and the remainder to the hospitals of the Metropolitan Asylums Board. Perhaps one of the most gratifying advances in sanitation in the eastern districts is the popularity of removal to hospitals in cases of infectious sickness. Twenty-five years ago there were but two hospitals in London available for infectious disease cases, the Fever Hospital in Liverpool Road and the Highgate Smallpox Hospital. Only selected cases could be removed, and after considerable trouble had been taken by parents and officials; then those institutions required heavy payments which the individual had to find. But now we have the Metropolitan Asylums Board with its palatial hospitals, and magnificent attention to minute details, prompt removal, and, above all, freedom from charge, and after a few years of popular education the receipt by the sanitary authority of a notification of a case of infectious disease is often accompanied by a request for removal. This has only to be contrasted with the state of things in former years, when accommodation was limited and popular prejudice was almost insurmountable, to appreciate the progress which in this one aspect of sanitation alone has been made. During the year the sanitary staff has experienced little or no difficulty in securing the prompt removal of cases where it was either necessary or desired. Section 55 of the Public Health (London) Act, 1891, sub-section (b) is thus worded, and has frequently given rise to most interesting discussions as to the duty and action of the medical practitioner and other responsible authorities, our own included:— "Every medical practitioner attending on or called in to visit the 16 patient shall forthwith, on becoming aware that the patient is suffering from an infectious disease to which this section applies, send to the medical officer of health of the district (f) stating the full name and the age and sex of the patient, the full postal address of the house, and the infectious disease from which in the opinion of such medical practitioner the patient is suffering, and stating also whether the case occurs in the private practice of such practitioner or in his practice as a medical officer of any public body or institution, and where the certificate refers to the inmate of a hospital it shall specify the place from which and the date at which the inmate was brought to the hospital, and shall be sent to the medical officer of health of the district in which the said place is situate. The discussions have nearly always risen round the action of the medical practitioner, who presumably obeying the words "in the opinion of such medical practitioner," has notified a case of illness as being one of the notifiable diseases, and subsequently has been unfortunate enough to find his diagnosis contradicted, either by a brother practitioner or by the medical superintendent of a hospital; in this latter case, the contradiction accompanied by the return of the patient home and more or less damage to the notifying practitioner's reputation. I am not sure that the practice lately adopted by the Metropolitan Asylums Board of notifying medical officers of health of these errors of diagnosis will not tend to make medical men over careful—if that be possible—in notifying; it certainly ought to make them more careful in signing removal orders. I think it must rarely occur that a patient without the pronounced symptoms of one of the scheduled diseases should be removed to a hospital for the benefit of others, in other words I think should undeniably show the acknowledged symptoms of the disease notified before the machinery for removal is set going, expense incurred, and 17 the risk of removal taken. We must bear in mind that the primary object of this section is not to benefit the patient nor to save the parents the cost of medical treatment and attendance, but to prevent injury to the health of others. I am aware that some cases, notably of scarlet fever or diphtheria present but very faintly marked symptoms and are yet infectious, but I am of opinion that in such cases the infection could generally be kept within bounds at home. Naturally the household wants to free itself from a case of infectious disease, thnt parents may work and children go to school, but I think that unless the diagnosis is assured neither notification nor removal should take place. It is, I think, well that we should endeavour in every way to get the most good possible out of this section, and I do not think we shall do so unless we encourage medical practitioners to notify. Differences of opinion will occur as to the nature of illnesses, but it is better by far that a few should be notified incorrectly than that cases of infectious disease should go unnotified. The public, I think, may be left with confidence to safeguard its own interests. SMALL-POX. Once more throughout the year there was not a single death from this dreaded disease, making the third year in succession in which Bow has had a completely clear sheet. For six years from 1886 to 1892 there was also perfect immunity; 1 death and 21 notifications in 1893,4 deaths and 35 notifications in 1894— a year which might be regarded as the septennial period for this disease; in 1895 no deaths and 5 notifications, and in 1896 no death and only 1 notification; this year there has been no death and no notification. The following is the record of small-pox for Bow since 1880:— b 18 Deaths. Deaths. Notifications. 1880 7 1890 0 0 1881 3 1891 0 0 1882 0 1892 0 0 1883 0 1893 1 21 1884 8 1894 4 35 1885 1 1895 0 5 1886 0 1896 0 1 1887 0 1897 0 6 1888 0 1898 0 0 1889 0 The record of the deaths from small-pox in Bow since 1880 is therefore exceptionally favourable, there having been only 24 deaths in 15 years. VACCINATION. We are about to commence a year under the provisions of a new Vaccination Act, and as there has been for so many years so wide a gulf separating those who believe in the virtue of vaccination and those who believe in its vices—and good and conscientious men are ranged on both sides—I think it is advisable, if possible, to bridge over this gulf; at any rate I will try, and in my endeavour shall consider dispassionately that both sides are equal in their desire to promote the general good. At the start you must know that, as I have frequently before stated, I am a firm believer in the preventive power of vaccination against small-pox; I here mean the introduction of vaccine lymph alone into the human system, properly performed. A brief description of the operation, as it has been performed, will indicate, by its impropriety, what I do not mean by the term vaccination. At the request of the mother or nurse it has frequently been done in less than four places, sometimes in one only. It has been done 19 with stale lymph and impure lymph; it has been done with irritant drugs, and also with one so harmless as glycerine alone; it has been done, particularly re-vaccination, by unqualified persons, with drugs as stated, and with dirty lancets. In my opinion these are some of the main reasons why vaccination has gained such a bad repute. I do not propose to give figures, but I think it is well known and accepted that very many of the cases attended by serious results occurred in the practices of public vaccinators where the children were massed together and arm-to-arm vaccination was performed (originally adopted, apparently, for convenience and economy). These methods are now abolished. The infants are not collected in one room, and the lymph to be used is to be prepared with glycerine; and I anticipate that an end will be put to these deplorable cases. It would not be very wise to discuss why vaccination has been in such bad odour; carelessness, inefficiency, even fraud, on the one hand, danger on the other. It is fair, though, to offer an explanation of the reason why vaccination may possibly have lost some of its protective influence, especially when humanised lymph is used : but if we admit this and the argument used in support of it, we must also admit that from the same cause small-pox has largely lost its infectiveness and malignancy. It is well known that on several occasions when an infectious disease has been first introduced to a population, it has killed off that population with a vigour never again experienced unless after an absence for some generations. Measles, even, has been known to be eventually fatai when introduced to savages. In our own time we have had the reintroduction of two infectious diseases, neither of which completely by one attack exhausts the soil and renders the patient safe from a second; I allude, of course, to diphtheria and influenza, both absent for two or three generations, then attacking us with greater violence, but now it would appear as if these attacks were much 20 modified. Is it not possible that neither our small-pox nor our vaccine are what they were in Jenner's day? Undoubtedly, improved hygienic conditions in daily life and in the sick room do a very great deal, particularly when, let us hope, our enemy is weakened. It is, of course, not practicable to discuss the possible effects of vaccination under the new Act, but it is to be hoped that all will do their best to make its operation a success. As before stated, the blot on the health record of Bow for 1898 is the great number of deaths from measles, a disease which MEASLES is non-notifiable. There were 38 deaths—all but one occurring in the first nine months of the year. It will be seen these deaths were more than treble those of the previous year, and nearly half the number for 1896. The death rate from this disease was o 9 per 1000, against 0.02 in 1897, 1.4 in 1896, 0.59 in 1895, and 1.3 in 1894. I repeat with emphasis what I said in last year's report:— "This disease is not notifiable, and it is therefore impossible to say to what extent it was prevalent, except as indicated by the number of deaths. "In former reports I have frequently alluded to the reckless treatment of this disease by parents and others having the care of children as being primarily responsible for its fatal character and infectiveness. In emphatically expressing the opinion that this disease should be notifiable, I believe that most medical officers of health share that view. The metropolitan branch of the Incorporated Society of Medical Officers of Health have passed a resolution to this effect, and possibly sooner or later some reform in the desired direction will be inaugurated. The occasional fall of the figures, as during this year, cannot be regarded as a permanent improvement, and at 21 any time we may be face to face with the alarming conditions of 1896. Even though hospital accommodation cannot at once follow notification, yet it is demonstrable that the bringing of knowledge of the existence of measles to the sanitary authority will produce good results, and doubtless lead indirectly, if not directly, to saving many young lives. " 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 among 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." The following is Bow's record since 1880 :— 1880 11 1890 46 1881 19 1891 10 1882 23 1892 21 1883 28 1893 8 1884 6 1894 57 1885 28 1895 25 1886 27 1896 62 1887 22 1897 12 1888 31 1898 38 1889 3 On May 26th, I submitted the following report to the Sanitary Committee;— 22 "Measles is just now very prominent in some parts of London. In Bow 3 deaths were registered during the week ending April 30th, but it not being notifiable, I am not able to give the number of cases which have occurred. From one of the Board Schools, however, I had two lists under date May 3 and May 6, giving me 146 addresses where measles was stated to be present. Many of these addresses were in adjoining districts, and neither of the deaths mentioned occurred at the addresses given. I wrote asking if the cases given in the lists were verified by medical certificates, but to that query I have had no answer, further than that the Master had written to the Board for ' instructions.' I believe no medical certificate is required, and I should therefore say that the returns are unreliable." A satisfactory return can be presented with regard to this disease There were only 6 deaths as compared with 10 in the SCARLET FEVER previous year; the notifications dropped from 295 to 109. There were no deaths in the autumnal months of October and November, when the notifications were also few. The death-rate from this disease was .11 per 1000 as against .23 for 1897, .16 for 1896, .19 for 1895. The notification rate 2.5 as against 7.0 in 1897. The Bow death record of scarlet fever is as follows :— 1880 20 1890 7 1881 33 1891 3 1882 18 1892 15 1883 36 1893 13 1884 21 1894 8 1885 6 1895 8 1886 8 1896 7 1887 7 1897 10 1888 50 1898 6 1889 4 23 As in the case of measles, the number of deaths from whooping cough increased considerably, the deaths numbering 32 WHOOPINC COUCH. as against 24, 33, 18 and 4 for 1897, 1896, 1895 and 1894 respectively. Considering the record for the last fifteen years the 1898 figures are not satisfactory. I cannot do better than repeat what was contained in my last year's Annual Report on this head. "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 annual death-rate per 1000 last year for Bow in respect to whooping cough stands as follows for the last five years--1898, .76; I897, .57; 1896, .77; 1895, .53; 1894, .09 Since 1880 the deaths have fallen thus : — 1880 21 1890 57 1881 30 1891 45 1882 47 1892 31 1883 14 1893 17 1884 21 1894 4 1885 89 1895 18 1886 12 1896 33 1887 69 1897 24 1888 17 1898 32 1889 44 24 Bow's record for 1898 as in 1897 in the matter of fever is not unsatisfactory. There have been no deaths or notifications FEVERS. of typhus, relapsing, or continued fevers. During the whole 24 years of my service I have never had to report a death from typhus fever. Three cases of puerperal fever were notified, one of which proved fatal. Last year there were two cases notified and one death. With regard to enteric or typhoid fever, there were the same number of deaths, viz., 6, as in 1897, as against 4 in 1896. The 1898 and 1897 positions were as nearly as possible matched by that of 1895. The annual rate per 1000 in Bow 1898 was .14, 1897 was .14 as against .09 for 1896. The notification rate was .95. The typhoid record of deaths stands :— 1880 2 1890 9 1881 2 1891 12 1882 13 1892 10 1883 11 1893 15 1884 9 1894 7 1885 5 1895 6 1886 4 1896 4 1887 8 1897 6 1888 15 1898 6 1889 4 Practically the condition of the district in regard to diphtheria remains the same as in the previous year, there being DIPHTHERIA. 16 deaths as compared against 12 for 1897, and 23, 29 and 112 for 1896, 1895 and 1894 respectively. There was a large decrease in the number of notifications, viz., 76 as against 101, 155 and 200 for 1897, 1896 and 1895 respectively. 25 The death rate was .38 as against .28 in 1897, as against .55 in 1896, and .71 in 1895. The notification rate was of coarse also reduced ; as I stated last year :— "To what other cause than a generally improved sanitary condition of the houses I am unable to attribute it, but I hope the coming year will show that the improvement is permanent. In previous reports I have explained the importance of giving every possible attention to this disease, and how unsafe from a public health point of view it would be to do anything which would prevent suspicious cases of sore throat coming to the knowledge of the sanitary authority. Notification supplies the intelligence upon which sanitary officials can wisely direct their efforts towards the weakest spots." The record of deaths since 1880 stands:— 1880 14 1892 Diphtheria 37 43 1881 13 Croup 6 1882 23 1893 Diphtheria 86 91 1883 9 Croup 5 1884 10 1894 Diphtheria 40 42 1885 13 Croup 2 1886 14 1895 Diphtheria 28 29 1887 14 Croup 1 1888 Diphtheria 11 18 1896 Diphtheria 21 and 1 23 Croup 7 Membranous 1 Croup 2 . 1889 Diphtheria 5 16 1897 Diphtheria 8 12 Croup 11 Croup 4 1890 Diphtheria 12 25 1898 Diphtheria 16 l6 Croup 13 Croup 0 1891 Diphtheria 27 36 Croup 9 26 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 suffered from Throat illness state illness. ' Result of Drain Test. Condition of W.C. Water Supply. Jan. 4 3 6 0 No Negative Fair From main 14 1 2 2 No do. do. do. 18 1 2 6 No do. do. do. 19 3 9 8 No do. do. do. 28 1 2 3 No do. do. do. Feb. 5 2 3 6 No do. Soil pan foul. do. 10 2 4 8 No do. Fair From covered cistern off ground floor. 10 2 4 6 No do. do. From main 14 2 5 3 No do. do. Soil pan foul do. 28 2 6 5 No Defective soil pipe Damp walls Flush Defective do. Mar. 18 2 6 5 No Negative Soil pan foul No flush do. 19 2 4 2 No do. From cistern 23 3 6 3 No do. Fair From main April 6 1 2 8 No do. do do. 9 1 2 8 No do. do. do. 9 1 2 8 No do. do. do. 15 1 2 4 No do. do. do. 18 2 5 3 Recently recovered from measles. do. do. do. 20 2 3 5 No W.C. drain choked Drain choked. do. 25 1 2 4 No Negative Fair do. May 6 1 3 3 No do. do. do. 10 2 6 4 No do. do. do. 27 2 4 7 No do. do. do. June 1 2 4 3 No do. do. do. 14 2 4 7 No do. do. do. 35 3 7 5 No do. do. do. 18 3 7 5 No do. do. do. 18 3 7 5 No do. do. do. 19 3 7 4 No do. do. do. July 5 1 5 5 No do. do. do. 6 1 3 4 No do. do. do. 15 1 5 5 No do. do. do. 21 2 4 6 No do. do. do. 20 2 3 8 No do. do. do. Aug. 10 2 4 10 No do. do. do. 20 4 7 2 No do. do. do. 20 1 4 3 No Defective in scullery and front area. do. do. 27 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. 22 2 4 3 No Negative fair. From main 30 2 2 4 No do. do. do. Sept. 2 2 4 2 No do. Soil pan foul do. 7 1 3 2 No do. Flushing apparatus defective do. 17 1 2 2 No do. Fair do. 20 2 5 5 No do. do. do. 23 1 2 2 No do. do. do. 24 2 4 3 No do. dc. do. 27 2 5 6 No Defective at w.c. Drain defective do. 29 1 2 5 No Negative Fair do. 29 2 6 5 No do. do. do, Oct. 4 2 4 5 No do. do. do. 11 3 6 7 No do. do. do. 12 1 2 5 No do. do. do. 29 2 7 1 No do. do. do. 31 2 4 5 No do. do. do. Nov. 2 2 4 6 No do. do. do. 2 2 3 7 No Yard gully obstructed do. do. 14 2 4 2 No Negative do. do. 14 1 3 2 No do. do. do. 15 2 4 2 No do. do. do. 17 1 7 4 No do. do. do. 18 1 2 3 No do. Pan foul and broken do. 19 1 2 3 No do. Pan foul and broken do. 30 2 4 7 No do. Fair do. Dec. 7 1 3 5 No do. do. do. 13 1 2 2 No Yard gully choked do. do. 14 1 2 3 No do. Roof defective do. 15 2 4 3 No Negative Fair do. 15 1 2 5 No do. do. do. 22 1 5 1 No do. do. do. 28 2 6 1 No do. do. do. 29 2 4 3 No do. do. do. The greatest number of deaths from any one zymotic disease was 42 from diarrhoea, with one case of infantile cholera. Apparently the extremely trying heat wave of the summer had little effect, for in 1897, with its much cooler summer, the deaths number 48 all told. All the cases, however, DIARRHŒA AND CHOLERA. 28 varied during the hot weather. We had practically a clear sheet in regard to cholera; it was infantile in character and occurred in the third quarter of the year. The deaths from diarrhoea were mostly those of infants under one year, 31 falling in the third quarter and 9 of these under 5 in the second out of a total of 42. But for this heavy mortality and also that in measles, the present health record for Bow would have been exceptional. The annual death rate from these diseases was as high as 1.0 per 1000, as against 1.1 per 1000 for 1897, 0.5 for 1896, 0.59 lor 1895, while the year 1894, which only showed 12 deaths from this cause, had a very cold and wet summer. The death record stands :— 1880 26 1892 24 1881 27 1893 3° 1882 20 1894 12 1883 17 1895 24 1884 32 1896 25 1885 6 1896 cholera 6 1886 32 1897 diarrhoea 47 1887 32 1897 cholera 1 1888 17 1898 ( diarrhœa 42 43 1889 12 ( cholera 1 1890 28 1891 16 There were 3 deaths from erysipelas as in 1897, comparing with 2 for 1896, 2 in 1895, and 5 in 1894, and 50 notifications ERYSIPELAS. as compared with 69 for 1897, 99 for 1896, and 96 for 1895. This is a disease which calls for little remark. The number of deaths certified as due to complicated influenza were 11, as against 4 for 1897, but this disease, as last INFLUENZA. year was of a mild character. Most of the deaths occurred in the early part of the year. POPULATION. 42080. CHART showing the total number of inhabitants of Bow who died both within the District and in outlying InMituIicris during the year 1898 from Zymotic Diseases. DEATH CHART showing rise and fall of DEATHS from all causes (with a Zymotic Wave) during the year 1838 in their weekly occurrence with the Meteorological observations as Published in the Registrar Generals weekly returns. I ' i ■ 29 Opposite will be found a complete chart of the deaths from zymotic diseases, including influenza, viz. : small-pox, diphtheria, CHARTS. 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 between weather and disease, both in the whole Metropolis and Bow. WEATHER AND DISEASE CHART. The lines in the chart indicate the rise and fall of the total and zymotic death rates. consumption of the lungs known medically as phthisis. Great attention has been paid by the medical profession generally and the Local Government Board to the incidence of tuberculosis or phthisis. Recent discoveries led to the explosion of the former view that phthisis was due only to the predisposing cause of heredity. The tubercle bacillus has been found and cultivated, and although predisposition still has the greatest effect in determining whether or not a person is likely to or does acquire tuberculosis, still there is not the slightest doubt that the disease is infectious. PHTHISIS. This has led to a revolution in medical thought and treatment, and sanitary authorities are properly turning their attention to the question of preventing the spread of infection by those suffering from the disease among the healthy. A National Society for the Prevention of the Spread of Consumption has been formed, and Royal support has led to a movement that may be described as national. The Harben lectures by Sir Richard Thorne Thorne, the Medical Officer of Health to the Local Government Board, were devoted to 30 this important question. The remedies he advocated were attention to meat and milk supplies; the provision for the notification and isolation of consumptive persons being regarded as premature, at all events at present. It will be interesting to notice Bow's record in this important particular. During the year there were 81 deaths from phthisis; 3 occurred in infants, 4 in children under 5, 3 in children under 15, 13 in persons under 25, and 56 in persons under 65, and 2 in persons over that age. The death rate from the disease for the year was 1 2 per 1000. Last year the deaths numbered 101 from this cause. No doubt a good deal might be done by issuing directions for general use of affected persons, and this is a direction in which the sanitary authority might work in with advantage. But in regard to the more immediate preventive measures, such as notification and isolation, I am of opinion that it is, in the present state of knowledge on the subject, too early to settle a definite policy. Of course, the strictest attention should be given to the meat and milk supplies, but these are matters which have always engaged the sanitary staff in Bow, sometimes with markedly good results. Considering that the subject of advance during the year which has obtained most attention has been the notification, treatment by isolation in open air of consumption, slight amplification seems desirable. As a sanitary authority we are chiefly, if not wholly, concerned with the notification and isolation, though perhaps under the term "isolation" treatment may have to be considered. What were the effects of notification as at present ordered by the Public Health (London) Act, 1891:— 31 a. Isolation of the patient, and to some extent that of the nurses. b. Exclusion from school, and also of all other children from the house, exclusion of men and women from the workshop, the desk, and the counter. c. Exposure in public places becomes penal. d. Disinfection and cleansing at termination of case. —others collateral. If we bear in mind that an ordinary case of consumption lasts from seven to ten years, it is easily seen how almost impossible it would be to isolate during that period, entirely so, unless we have the necessary institutions, then isolation and treatment might go together ; but here we are met by a great unfairness to the patient. I mean the injury done to him by being obliged to herd with similar sufferers—them alone. My opinion is that a hospital or any place where consumptives congregate is inadmissable for a consumptive. We ought to find virgin soil. I am informed that at the great home for consumptives, Davos Platz, in Switzerland, where twenty years ago cases were never met with among the natives they are now frequent enough, and therefore Davos Platz cannot be so suitable now as it was when first recommended. The same may be said of Ventnor, Isle of Wight. Taking this view, it is apparent that for the patient segregation is the better for his fellow citizens' aggregation. I do not believe that Parliament would permit us to be clothed with the same powers under the Act quoted, for the treatment of the notifications as we at present possess for the treatment of the scheduled diseases, but we might do something as follows:—Notify all forms of Tubercle as Phthisis, consumption of the lungs; hydrocephalus, membraneous; hydrocephalus (water on the brain) of the brain ; 32 tabes mesenterica, bowels—and make it the duty of the medical officer of health to visit the home and enquire into the surroundings, business or otherwise, and unless the patient could be retained in the community with safety to it then he should be removed to some centralised place, working possibly, provided by the State free of cost. If an earnest effort is to be made to eradicate consumption this should be done, a bye-issue would I think occur in the shape of injudicious marriages, and that alone would diminish the cases. I am assuming that as before shown the knowledge that consumption is not hereditary is general, but the knowledge that consumption clings to places rather than individuals is not so general; therefore good might be done by imparting the knowledge that the disease germ is held by places and advice and aid given to prevent such retention. To conclude this question, I say that sanitary authorities might do good on the lines shown if it had institutions of the most special kind at command. Panic must not possess us nor must apathy or unbelief, and everything of a special kind will be required Special notification, special investigation, special accommodation, special treatment—in short, much as I dislike the terms "leper" and "pariah from society," if consumption is to be exterminated from our islands, consumptives must be looked upon as lepers and treated as pariahs from society, and this I do not recommend. For over three months there was, for the third time, a stoppage of the constant service of the East London Water Works Company. The year was one of unexampled drought, and this is alleged by the Company to have been the main cause of the deplorable occurrence. Immediate steps were taken by your Board to minimise the ill effects of this stoppage, and the members of the sanitary staff spared neither pains, time nor effort to cope with the difficulty. I need not refer in detail to the steps that were taken, but I think that what was done in this district was THE WATER SUPPLY 33 second to none of similar measures in other affected districts. I am happy to be able to report that there was no increase of sickness directly traceable to the stoppage of the supply ; that this was so may be taken as some evidence of the effectiveness of what was specially done during August, September and October. The public inconvenience and danger arising from the partial suspension ot the water supply in so crowded an area as ours needs no comment. The matter is so vital that it justifies all the attention that was given to it by the Local Government Board, the Royal Commission on the London Water Supply, and by the Government, who it is announced contemplate the introduction of important measures, in addition to those to be promoted by the Company itself, with a view to prevent the recurrence of an evil. For the purposes of record I reproduce my reports to the Sanitary Committee:— September 8th. water supply—intermittent or short. "On August 19th, the East London Waterworks Company issued handbills that 'on and after August 22nd the supply of water will be restricted; the water will be turned on twice a day for about three hours each time, and at the same hours as nearly as possible daily.' "Knowing the discomfort and inconvenience which must ensue— the more because no time was mentioned—on the 22nd I sent a special messenger to the Secretary for information as to the hours of supply, and as to whether he intended to place stand pipes at convenient points, and was told that a time bill and other information would be sent on when prepared. "We have received the necessary information, and the District is to be placarded with copies. "Inspector Field has prepared a map showing the points where stand pipes should be placed; this I should suggest sending to the C 34 Water Company (and the Committee directed the Clerk to send the plan to the Water Company). Two perambulating water carts will be required, up to now one has sufficed, but now we have only four hours supply and not pressure enough to reach many of the cisterns in the larger houses. "I should like disinfecting tanks to be sent round in charge of our men that the closets in certain parts of the district might be periodically flushed. "Careful observation of the stand pipes shows their great utility, but I think they should be placed under the direct control of the Company's servants. "At present no injury to health is recorded ; the Model Dwellings suffer most, as the following details show :— water supply to so-called model dwellings. "Leonard's Buildings is under notice, not having in my opinion a 'proper water supply,' all the supply coming through a cistern—no part direct from main. "This block has had no water since the 30th ultimo, a standpipe has been inserted opposite the dwellings and is on regularly for about 14 hours daily ; there are 20 sets of rooms, and five jars have been supplied. "It would be well in this case and that of Rothbury Buildings if an arrangement for supply were made similar to Craven Buildings, as follows :— craven buildings, wansbeck road. "Water from main and cistern. "Water will not reach cistern when turned on at the usual time. The owner has arranged with the Water Company to fill the cistern 35 every evening, for which purpose water is specially turned on and high pressure main used to give sufficient force. " There is therefore no dearth of water all day. " rothbury buildings, rothbury road. " Water from main with draw-off taps in each tenement. " Water turned on twice each day. " Great difficulty to catch water on the second and third floors; merely a dribble. The Clerk was directed to communicate with the Water Company requesting that similar arrangements be made as regard to Leonards and Rothbury Buildings as had been made in the case of Craven Buildings. " Water jars supplied. " Cart calls each day. " W.cs. in foul condition for want of water." September 22nd. " The death-rate during the past fortnight has reached the enormous height of 38.9, and is entirely due to death amongst infants and very young children from diarrhœal debility, and diseases of the stomach and bowels, 36 of the 50 deaths having occurred amongst children under two years of age, and the large majority of those were infants of a few months. I have no doubt that the extraordinary and persistent high temperature has been largely the cause of these deaths. The weakest have gone to their graves. I have not been able at present to connect any death directly with the short water supply: but I can well imagine that the sufferings of these babies may have been much increased by lack of water for cooling purposes. The arrangements decided upon to relieve, as far as possible, the shortage of water, are complete and in full work. The Medical Inspector of the Local Government Board has been down and C 36 expressed himself satisfied with them : they consist in flushing the gulleys, school lavatories, and houses, where necessary, with liquid disinfectants, perambulating water vans, standpipes at all points where necessary: as far as possible, water for the roads to be drawn from other sources. The water is now laid on to the Schools from 9 to s, model dwellings are supplied daily from standpipes and water vans. A large number of jars have been given away. In connection with these it is well the public should be warned to keep them clean : a handful of coarse gravel will answer admirably if well washed round two or three times a week." "But all these arrangements will be useless unless the Company supplies us better than it has been doing during the last few days. On Saturday last, after about eleven in the morning, there was literally no water to be had in Addington Road and its neighbourhood: complaints were numerous and bitter: even the water carts had to go to Old Ford for water for that part of Bow, none being obtainable either at the Company's standpipes in Landseer Road or Harley Street." November 24th. "During the period of the short water supply I have not signed any Water Certificates, and have many houses waiting those certificates. Now that the time has been extended, I consider the houses fit for the certificate; each has a separate cistern, and a supply direct from the main. Is it your pleasure to grant these certificates ? The houses are in Kelday Road, Rothbury Road, Wansbeck Road and Hepscott Road." And the Committee directed that water certificates be given. On May 26th I submitted the following report to the Sanitary Committee:— " A death was registered after an inquest and post mortem, 'phosphorus necrosis.' The person was employed in a PHOSPHORUS large match works in Bow. Questions have been asked NECROSIS. and answered in the House of Commons concerning this case, and in replying, the Home Secretary said: 'The factory 37 inspector attended the inquest and visited the works; he reported that in other respects, i.e., not notifying the case, the special rules have been observed; further, no other cases of phosphorus poisoning have been reported since the Act of 1895. I do not therefore think that I should be justified in the unconditional prohibition of the use of yellow phosphorus' But on May 12th the Home Secretary stated that he had decided to take proceedings against the firm (I believe police-court summonses have been applied for), and that he thought it desirable to have an enquiry. I have visited the works in question and have enquired thoroughly into the case, and am of opinion that unless the use of yellow phosphorus is prohibited these unfortunate cases will occur. The Committee directed that the view expressed by the Medical Officer be communicated to the Home Secretary." The matter of the condition of Messrs. Bryant and May's factory has engaged my constant attention, and my report for December 22nd contained the following: " I have enquired into the question of match-making as carried on in Bow, and in addition to the information gained at the MATCH- three works in that parish, I have, through the liberal- MAKING. mindedness of R. Bell and Co., Bromley-by-Bow, in permitting me to go over their works, obtained quite a store of information, which has been most useful for the purposes of comparison. The three works in Bow are: Bryant and May, Palmer and Co., The Salvation Army. " To take the last first, the Salvation Army Works are but small, employing between 80 and 90 hands, have been established in Lamprell Street about six years, do not use yellow phosphorus, and have never had a case of phosphorus necrosis. Their sanitary arrangements are to my satisfaction. " Palmer and Co., Palace Works, Old Ford, is also small, established about 30 years, about 50 hands, male and female, employed. Their 38 specialties are braided fusees and wax matches. Their sanitary arrangements are to my satisfaction. One case of phosphorus poisoning in 30 years. "Bryant and May's Works are in Fairfield Road, and are by far the largest, employing about 1100 hands. All the buildings are on the ground level, the mixing department being a separate building; there are three mixing pots closed with pipes, conveying fumes away to the back of the Old Ford Road. The filling department, where matches are exploding all day long in the atmosphere, is dim and laden with these fumes, is, in my opinion, not sufficiently lighted or ventilated. On one of the days when I visited, though not at all a dark day, the girls were working by gas-light. The sanitary arrangements are now satisfactory, the hot water boilers for tea-making and the drinking water apparatus having been moved to a part of the building away from the factory and re-arranged. A dentist is also employed for the periodical and entry examination of teeth. "We now come to the points in which R. Bell and Co. contrast with these works; the dipping and mixing are done on the roof virtually open to the sky; in short, theirs may be called the open air system. The mixing, the most dangerous process, is done in a closed pot with an automatic stirring rod, just sufficiently covered to protect it from the weather. "The dipping redheads is also done on the roof, open to the sky no cowls were used, the drying rooms open on the dipping space, but of course, when in use, and powerful fans going, the doors are almost hermetically closed, and the fumes are blown clear away from the building. In this part of the building—in those departments where danger ordinarily exists—there is hardly any odour; and the fact that, though employing about 500 hands, and having been in this factory for some years, they have had no death, and only two mild cases of phosphorus necrosis, all the while manufacturing largely matches made with yellow phosphorus, obliges me to modify my 39 previously expressed opinion 'that these cases would occasionally occur,' for I now think that with factories constructed on this plan, and business conducted with the most minute precautions, it would be possible to carry on the use of yellow phosphorus without injury to the workers." Appended will be found the annual reports of Inspectors Boyce and Field, the Sanitary Inspectors for the west and east SANITARY divisions of my district. There is also attached the annual WOR K report of Mr. C. W. Raymond, the inspector of nuisances in manufactories so far as it relates to Bow. I again strongly urge a careful perusal of these reports, for they will show the energy and zeal of the staff, whose loyal co-operation, hard work, and practical intelligence I desire to emphatically recognise. In cold print the figures relating to their work may appear bald and uninteresting, but it is nevertheless true that a proper discharge of the duties there detailed have necessitated much persistent labour, and in many cases not a little anxiety. I desire that my staff shall receive credit for their work, which is sometimes unpopular, even in these days of enlightenment, and often unappreciated. That work has been thoroughly well done, and will contribute, I am sure, to a lasting benefit to the district. In conclusion, I am once more glad to be able to place on record my thanks to the members of the Board, the members of the Sanitary Committee, and my colleagues for the assistance they have at all times afforded me in carrying out the sanitary administration of Bow, while the confidence reposed in myself and staff generally is equally gratifying and encouraging . Stimulated and supported by the Board I have been able to place before you a very good year's work, work cheerfully and well done. Inspectors Raymond, Boyce and Field, and their assistants, not forgetting Disinfector Quested, have performed their parts as if they 40 strove from a generous spirit of emulation to make Bow the healthiest district in London. Under some of the chief headings we find— Houses Inspected 3147 Notices Served 812 Primary Police Court attendances 13 The whole crowned with a total death rate of 20.5 per 1000, including a zymotic death rate of 3.4 per 1000, a notification rate of 6.6 per 1000. I am, Gentlemen, Your obedient Servant, RUSSELL MAIN TALBOT. L.R.C.P. L.M. Edin: M.R.C.S. Eng: L.S.A. Lond : 41 Public Health Department, December 31st, 1898. To the Medical Officer of Health, Bow District. Sir,— I beg to lay before you my ninth Annual Summary of the Sanitary work carried out in my Division during the year ending December 31st, 1898, as follows :— Inspections on complaints of nuisances 510 Do. on notifications of infectious diseases 138 Do. on house-to-house visitation. 941 Re-inspections 3636 Making a total of 5225 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 (1589 houses and other premises) of primary inspections made, I found that 50.1 per cent. of the premises thus inspected various works of sanitary amendment—requiring the service of 769 intimations and 495 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 18 cases it was found necessary to have recourse to legal proceedings, necessitating 12 attendances at the police-court to ensure their enforcement; and in 10 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 8 cases the works were completed upon summons only. 42 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 14 partially 112 Drains opened and cleansed 113 Defective drains repaired 197 Inlets to drains properly trapped 82 Sink waste pipes properly disconnected from drains 37 Rainwater pipes do. do. 31 Water-closets re-constructed 1 Water laid on to soil pans of W.C.'s 104 Ventilation of W.C.'s improved 2 New soil pans provided where broken or unsuitable 24 Foul soil pans cleansed 39 Yards, areas, and forecourts, paved 142 Yards and areas drained 19 Nuisances from dampness remedied 86 Roofs made watertight 74 Eaves guttering of roofs and rainwater pipes repaired 101 Water supplies to houses reinstated 50 Water services for domestic purposes altered or improved 33 Water service fittings repaired 23 Public House urinals repaired and cleansed 10 Animals improperly kept (removed) Accumulations of dung and refuse removed 39 Bye-laws enforced 24 Other nuisances remedied, chiefly dilapidations Drains tested* by the application of the smoke drain test, of 206 which 23.6 per cent. were proved defective 834 Primary tests only. House to House Visitation. The house to house inspection referred to above comprised the whole of the houses in the under-mentioned roads and streets— Appian Road. Athelstone Road, Beale Place. Beale Road. Chad Street. Dane Place. Lefevre Terrace. Libra Road. Milton Road. Prince Arthur's Avenue. Ranwell Street. Tamar Street. Wrights Road. Victoria Cottages. 43 and sections of Armagh Road. Ford Road. Lamprell Street. Lefevre Road. Old Ford Road. Parnell Road. Roman Road. Rosebank Road. Norman Road. Saxon Road. St. Stephen's Road. Usher Road. New drainage systems, of which plans and particulars were submitted to the Board for approval, have been laid at the under, mentioned premises:— 5, Armagh Road. Congregational Chapel, Old Ford Road. I 3, 5, 7, 9, 11, Chad Street. 27, 29, Libra Road. 148, Parnell Road. "Joiners' Arms,'' p.h., Tredegar Road. The following particulars shew the work done in connection with infectious cases within my Division during the year:— Infectious patients removed to hospital 69 Rooms fumigated after infectious diseases 96 Infected Bedding, clothing, &c., removed to the Board's apparatus, there disinfected, and safely returned to their respective owners 96 Number of Disinfections certified by private medical practitioners to have been done on premises 18 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. 44 Parish of St. Mary Stratford, Bow (West Division). Comprising an area of 214 acres. Names of the Roads, Streets and Places. Total number of Dwelling Houses. Total number of Dwelling Houses. Antill Road, Nos. 131 to 143, odd Nos. ; Nos. 138 to Lacey Street 31 Lamprell Street 73 168, even Nos. 21 Lefevre Road 133 Appian Road 69 Lefevre Terrace 13 Armagh Road 175 Libra Road 83 Athelstone Road 38 Locton Street 72 Balmer Road 10 Milton Road 78 Beale Place 15 Monteith Road 42 Beale Road 60 Morville Street 99 Candy Street 78 Mostyn Road 56 Cardigan Road 60 Norman Road 45 Chad Street 25 Old Ford Road, No. 223 to 4°3, odd Nos.; No. 336 to 604, even Nos. 211 Chisenhale Road, Nos. 1 to 7, odd Nos.; Nos. 2 to 8, even Nos. Coborn Road, Nos. 94 to 8 Ordell Road 38 Parnell Road 173 110, even Nos. 8 „ Lock Cottages 2 Clark's Place 3 Prince Arthur's Avenue 9 Dane Place 10 Ranwell Street 32 Driffield Road 84 Roman Road, Nos. 117 to 337, odd Nos.; Nos. 152A to 348, even Nos. 221 Eglinton Road 73 Ford Road 93 Ford Street 95 Rosebank Road 18 Gawthorne Street 45 Ruston Street 38 Gunmakers' Lane 2 Saxon Road, Nos. 1 to 13, and 17 to 25, and Schoolhouse 23 Hewlett Road 95 Jodrell Road 77 St. Stephen's Road 166 Jodrell Terrace 4 Stafford Road 61 45 Total number of Dwelling Houses. Total number of Dwelling Houses. Sutherland Road . 60 Vernon Road 54 Tamar Street 9 Victoria Cottages 20 Tredegar Road 178 Wendon Street 49 Usher Road 180 Wright's Road 30 Giving a total number of 3450 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 Mr. Thomas Jones. 361, Old Ford Road Mr John Lewis. Slaughter Houses. 239, Old Ford Road Mr. David Mitchell. 220. Roman Road. Mr. William Gardener. 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 been regularly inspected throughout the year, but in no instance was any article of food exposed for sale at the time of my visits, in such a condition as to justify seizure. 46 The following premises have also received constant attention throughout the year. Public House Urinals 23 Marine Store Dealers 3 Butchers Shops 19 Fishmongers „ 12 Fruiterers „ 9 By the direction of Mr. Young, the Public Analyst, I have obtained 47 samples of food for analysis, of which 5 were certified by him to have been adulterated. Legal proceedings were instituted against 3 of the vendors, and a conviction obtained. I am, Sir, Your obedient Servant, WILLIAM BOYCE, Sanitary Inspector, and Inspector under the Sale of Food and Drugs Act, Bow ( West Division). 47 Sanitary Department, December 31st, 1898. 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 31st, 1898. Inspections have been made as follows :— On notifications of infectious diseases 124 On complaints of nuisances 795 On house to house visitation 639 Total 1558 In 1136 instances varied Sanitary improvements were necessary, requiring the service of 916 intimations, 317 authorised statutory notices, and the issuing of 3 Police Court summonses, supplemented by 3935 re-inspections to secure proper compliance resulting in the following detailed works being executed :— Walls and ceilings of Houses cleaned throughout 30 partially 151 Yards and areas paved 11 Yards and areas drained 33 Inlets to drains properly trapped 12 Defective drains repaired 108 Drains opened and cleansed 230 Sink waste pipes properly disconnected from drains 9 Rain water do. do. 27 Water laid on to soil pans of W.C.'s 90 New soil pans provided, where broken or unsuitable 5 Foul soil pans cleansed 66 Roof, guttering and rainwater pipes repaired 120 Roofs made watertight 192 Water supplies to houses reinstated 45 48 Water service fittings repaired 20 Water services for domestic purposes altered or repaired 7 Ventilation of W.C.'s improved 5 Nuisances from dampness abated 74 Accumulations of dung and refuse removed 63 Public house urinals cleansed and repaired 8 Bye-laws enforced 15 Overcrowding abated 6 Other nuisances remedied, chiefly dilapidations 282 Drains tested by the application of the smoke drain test, of which 14.95 per cent were proved defective 722 New drainage systems of which plans and particulars were submitted for approval and duly authorised, have been laid at the undermentioned premises:— 123, Bow Road (back addition). Coborn Street (New Infants' School). 39, 41, 43, Rothbury Road (entire systems). 13, 14, 15, Hepscott Road (entire systems). 149, 151, Bow Road (entire systems). 14, Coborn Road (New w.c.). Fairfield Road, New Rectory (entire system). Bow Road, London and Westminster Bank (entire system). Sneed Road School (in hand) (entire system). Fire Station, Wick Lane. Lea Tavern, p.h., Davey Road (entire system). 8, 10, 12, 14, 16, 18, Allanmouth Road (entire systems). 52, Wansbeck Road (entire system). 1, 3. 5. 7, 9, 11, 15. 17, 19. 21, 23, 25, 27, 29, 31, 33, 33, 37, 39, 41, 43, 45, 47, 49, 51, 53. 55, Kelday Road (entire systems). New Coborn Schools, Bow Road (entire system). The reconstructions on the old lines are not included herein. 49 The house-to-house inspection comprised the whole of the houses in the under-mentioned streets, viz. :— Wyke Road. Iceland Road. Rippoth Road. Blondin Street Mitford Terrace Rothbury Road. Dace Road. Monier Road. School House Yard. Brewery Yard. Kelday Road. Hepscott Road. Summer Street. And sections of:— Allanmouth Road. Landseer Road. Douro Street. Trego Road. White Post Lane. Davey Road. Guerin Street. Remus Road. Of the premises on which the cases of infectious diseases occurred, 46.77 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 are as follows :— Number of infected patients removed to hospital 75 Number of rooms fumigated after infectious disease ... 90 Removals of infected goods to the Board's apparatus for disinfection 90 Number of disinfections certified by private practitioners 10 The cow and slaughter houses, gipsy encampments, and waste lands in the district have received attention throughout the year, and the food supplies vigilantly watched. D 50 Forty-five varied samples of food have been obtained and submitted to analysis of which three were certified to have been adulterated, and in two instances convictions were obtained with costs. Parish of Saint Mart Stratford, Bow (East Division). Names of the Roads, Streets and Places. Total number of Dwelling Houses. Total number of Dwelling Houses. Addington Road 49 Dace Road 47 Albert Terrace 15 Dye House Lane 7 Alfred Street 49 Ducketts Canal Cottage 1 Allanmouth Road 58 East Street 1 Atley Road 31 Eliza Place 4 Autumn Street 39 Fairfield Road 114 Avenue Road 10 Finchs Yard 3 Baker's Alley 15 Guerin Street 21 Bow Road 169 Gandy Court 11 Blondin Street 33 Harley Street 28 Brewery Yard 9 High Street 39 Coborn Street 26 Hepscott Road 16 Coborn Road 46 Hackney Cut Cottages 3 Caxton Street 33 Iceland Road 5 Creswick Road 8 Kelday Road 28 Clay Hall Road 50 Landseer Road 20 Comboss Road 27 Lawrence Road 31 Cadogan Terrace 61 Malmesbury Road 182 Clarnico Cottages 14 Mary Street 10 Davey Road 21 Mavert®n Road 34 Denbigh Road 17 Monier Road 160 Douro Street 33 Old Ford Road 167 51 Total number of Dwelling Houses. Total number of Dwelling Houses. Olivers Place 16 Trellis Street 15 Payne Road 3 Trego Road 62 Remus Road 21 Tredegar Road 1 Rippoth Road 79 Taylor's Buildings 6 Rothbury Road 56 Wansbeck Road 60 Smeed Road 11 Wyke Road 97 Spring Street 19 Wallis Road 10 Summer Street 16 Walter Court 7 School House Yard 2 Wick Lane 10 St. Mark's Road 2 Windsor Road 1 White Post Lane 59 Giving a total number of 2298 houses, and an estimated population of 16,821 or 7.32 per house. Cow Houses. Address. Name of Licensee. 3, Alfred Street Mr. Joseph Hunt. 24, Dace Road Mr. Samuel Clay. 457, Old Ford Road Mr. Henry Green. Slaughter-houses. 231, Bow Road Mr. William Knightbridge. 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 52 PARISH OF BOW (East Division). List of Summonses taken out at Police Courts, with Results. Situation. Nature of Complaint. Date of Proceedings. Result. 152, Bow Road Premises without a water supply 1898 Jan. 14th Adjourned 7 days. ,, 28th Closing order with costs. 152, Bow Road Acting contrary to closing order Feb. 14th Fined 40s. and costs. Canal Cottage, Wick Lane Roof-gutters defective and premises damp Jan. 18th Withdrawn. 53 PARISH OP 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. 65 Appian Road Walls and ceilings of premises dirty condition. Roof defective. Walls damp Jan. 19 Alntement order. 24, Norman Road Yard insufficiently paved and drained. No underfloor ventilation. Sink waste-pipe defective. Wall damp „ „ Withdrawn. Works completed. 24, Ford Road Drain and inlet thereto in yard defective. Sink waste and rain-water pipes connected direct to drain. No water supply to W.C. „ „ As above. Ditto Yard adjoining Yard and stable badly paved and drained. Receptacle for dung improperly constructed „ „ As above. 16, Candy Street Do. do. No receptacle for dung „ „ Abatement order. 14, Ford Road Walls and ceilings dirty condition. Drain and yard paving defective. No water supply to W.C. Mar. 16 Adjourned. 18, Ford Road Drain and roof defective „ „ Further adjourned. Subsequently withdrawn, 47, Ford Road Forecourt unpaved. Wall damp. No under-floor ventilation „ „ Withdrawn. Works completed. 49, Ford Road Walls and ceilings dirty condition. Eaves guttering defective. Walls damp „ „ As above. 49, Ford Road Forecourt unpaved „ „ Adjourned. Further adjourned. Subsequently withdrawn. 127a, Parnell Road Main drain choked „ „ Adjourned. Abatement order, ₤3 3s. costs. 72, Milton Place Walls and ceilings dirty condition. Yard and washhouse insufficiently paved. Drain defective. No water supply to W.C. Pan broken July 13 Adjourned. Further adjourned. Abatement order, 6s. costs. 74, Milton Place Walls and ceilings dirty condition. Drains defective. No water supply to W.C. „ „ As above. 76, Milton Place Drain and yard gully defective „ „ As above. 78, Milton Place Drain defective. Flooring of wash-house broken condition „ „ As above. 80, Milton Place Drain, yard paving, and roof defective „ „ As above. 82, Milton Place Yard drain inlet untrapped „ „ As above. 124, Parnell Road Drain, roof, rain-water pipe and eaves guttering defective. No under-floor ventilation. Walls and ceilings of premises dirty condition Sept. 20 Abatement order, 6s. costs. 54 Summary of Notices and Improvements carried out at the different Manufactories and Workshops in the Bow District, during the year ending December, 1898. Nature of Nuisance. Number of Notices served. Cause of Nuisance. How Remedied. Printing Ink Works 2 Escape from oil-boiling plant Furnace repaired. Nitric Acid Works 1 Escape of nitrous gas Condenser repaired. Smoke Nuisance 31 Burning of inferior fuel and defective apparatus Better class of fuel is now in use. In two cases convictions were obtained with recurring order and 25s. costs. Defective drains in Workshops 9 Drains tested and found defective In each case the drains have been repaired. Whalebone Boiling 1 Nuisance caused by boiling whalebone Apparatus fixed for dealing with the vapours. Sulphuric Acid Works 1 Leak in one of the evaporating pans Pan repaired. Burning Refuse 2 Nuisance caused by burning old meat tins. Process discontinued. Defective Water Apparatus 2 Water supply to w.c. defective Defects made good. Fat Extractors 1 Escape of noxious vapour from melting vat. The vat has been repaired. Meat Refuse 1 Nuisance caused by emptying tins of decomposed meat Process discontinued. Cork Burning 2 Nuisance caused by burning cork The process has been discontinued. Bakehouses 29 Inspected twice during year Cleansed and limewhited. C. W. RAYMOND, Inspector of Nuisances in Manufactories and Workshops.