PRELIMINARY REPORT ON THE SANITARY CONDITION OF SHOREDITCH, BY ROBERT BARNES, M.D., L.R.C.P., fellow of the statistical society of london ; medical officer of health to shoreditch; physician to the seamen's hospital, dreadnought. (Ordered to he printed 10th April, 1856.) Report of Medical Officer of Health. TO THE VESTRY OF ST. LEONARD'S, SHOREDITCH. GENTLEMEN, In drawing up a preliminary report, I shall keep steadily in view— 1. The great end for which your Medical Officer of Health has been appointed. 2. The means that are placed within his power, and the measures that ought to be pursued in order to aid him in the attainment of that end. The provision for the appointment of a Medical Officer of Health indicates clearly, that the Vestries and District Boards, elected under the Metropolis Local Management Act, are charged not only with the general care of the property of the ratepayers, but also with the care of preserving the health of the inhabitants. It is impossible to call into action such a well-devised sanitary administration as will effect material diminution in the rate of sickness and mortality in a district, which will not pari passu increase the value of the property, and lessen the burdens upon it. To communities, as well as to individuals, there is nothing so expensive, so fatal to prosperity, as sickness. To a productive and labouring community, such as that of Shoreditch, health is the chief estate. If we observe the analogy that exists between the welfare of an individual and the welfare of a community—and the analogy is so true that it is the basis of all sound political economy and good government—do we not find that in the case of sickness in an individual, if one organ is diseased, increased labour is thrown upon the rest, that the functions of all are disturbed and weakened, and that the whole system suffers A community is but a system of individuals; if, therefore, one portion of that system be disabled by sickness, every other portion will feel the blow; the whole community will be taxed to support that part which is rendered incapable of supporting itself. It is then a plain matter of self-interest, as well as a solemn obligation, to exercise the most vigilant care in preserving to the poor their only worldly possession—their health and capacity for self-support. It is to advise and assist the Vestry in this vitally important duty that the Medical Officer of Health is appointed. 4 The successful working of a well organized sanitary administration has been amply established by the experience of Liverpool and the City of London. There is no reason to doubt that a similar administration will not effect the like good results elsewhere. I have now to consider what means are in my possession, and what measures ought to be pursued in order to aid me in the efficient discharge of my responsible duties. The first point is to investigate and determine the conditions under which the vast population dwelling within the boundaries of Shoreditch is living. It must be my first duty to make an elaborate and minute medical survey of the parish; many most important features of this survey will necessarily demand much organized labour, and a continuous observation extended over a considerable period of time. But there are some features, and those of fundamental importance, which, by diligent search into the mortality records and statistical calculation, may be at once brought into evidence. The other features that require a lengthened observation will be gradually developed and worked out, so as to complete the whole scheme which I have set before me of a complete Medical Sanitary Survey. Gentlemen, I invite your present attention to the following points illustrative of the sanitary condition of Shoreditch. With many of the facts, your general knowledge of the locality will have made you acquainted. The conclusions are either the obvious deductions • • of reason, or are warranted by the laws of medical science. The area of Shoreditch comprises 646 statute acres, or about one square mile. From an interesting map of a survey of the parish, made in 1745, which a member of the Vestry (Mr. Green) has afforded me the opportunity of consulting, I find that there were then 2302 inhabited houses in the parish, and that of these, 1397, or considerably more than one-half, stood in the Liberties of Holywell and Moorfields. Now, if we allow seven and a half inhabitants to each house, which is the present London rate, we shall find that the entire population in 1745 was only 17,255; and it is probable that even this estimate is excessive. Let us see to what numbers we have now attained. By the census of 1831, the population was 68,564; in 1841, it had risen to 83,432; and in 1851, to 109,257. During the decenniad from 1841 to 1851, the gross population of London increased at the rate of something less than two per cent. annually. But I find, upon calculation, that the Shoreditch annual rate of increase during the same period, has been 2.79 per cent. In estimating the population of 1856, we must therefore multiply in the latter proportion; this will give an aggregate population of 125,000 persons in round numbers; 125,000 persons are therefore crowded and compressed within the 646 acres comprised within the boundary of 1745. But I think it useful to pursue the analysis of the population statistics into further detail, in order to show by what process the present enormous population has been attained, and to throw light upon some of the conditions affecting its health. It will be necessary 5 to observe the growth of the population in the six Registration Districts. For this purpose I have drawn out the following table:— Table showing the Growth of the Population of Shoreditch during the Ten Years, 1841—50. registration districts. Area in Statute Acres. population. Births and Deaths in the Ten Years. Excess of Population in 1851 over 1841. Excess of Births over Deaths, in 1851 over 1841. 1841. 1851. Births. Deaths. 1. Holywell 68 16,740 17,245 6214 4125 505 2089 2. St. Leonard 75 17,987 19,449 7093 5339 1462 1754 3. Hoxton New Town 130 15,777 23,505 7343 5651 7728 1692 4. Hoxton Old Town 116 14,022 17,431 5652 3190 3409 2462 5. Haggerstone, West 132 12,037 20,276 6231 5284 8239 947 6. Haggerstone, East 125 6,998 11,351 4217 2101 4353 2116 Total 25,696 11,060 Actual excess of population, as determined by census, over natural increase by excess of Births over Deaths 14,636 From this table we learn two most instructive facts:—1. That Holywell and St. Leonard's have actually sustained a loss of population, between 1841 and 1851, as measured by the natural growth resulting from the excess of births over deaths. 2. That of the enormous growth of the population of Shoreditch, from 1841 to 1851, amounting to 25,696 souls, only 11,060 can be accounted for by the natural law of increase of births over deaths. We have thus left a surplus of 14,636 persons to be accounted for. Whence did these come ? There can be but one answer. This increase is the result of immigration. There is a constant and rapid flow of population into Shoreditch. It is in this circumstance that I see one of the most alarming dangers to the health of the district. The area does not enlarge, and yet year after year, dense crowds of human beings, bringing with them other crowds of the living creatures that attach themselves to man, are packed and squeezed into that limited area. The most cursory glance into the courts and by-places of the district, will satisfy us that the growth of the population has far outstripped the growth of the sanitary 6 provisions necessary to provide for the accommodation and health of the masses pouring in. The progress in the construction of sewers, drains, the supply of water, the improvement of the dwellings, is, daily, more and more disproportionate to the necessities of the inhabitants. The causes of disease are therefore increasing at an accelerated ratio, and may at any moment assume an activity and a virulence beyond controul. But let me, for one moment, call your attention to another circumstance connected with the immigrant population. It is certain that an immense majority of the immigrants is precisely of that class which most largely increases the danger of disease by thickening a population. You are largely, and I strongly feel, most unjustly burdened with the pauperism of other and wealthier districts. The burden is doubly grievous: for it taxes your property, your labour, and gives strength to the elements of disease amongst you. The density of the population may be expressed in other forms. Thus, I find that there are 192 persons to every acre; or, in other words, that there is only the 005 part of an acre to each person. In the Strand and Holborn Districts the density is somewhat greater; but it must be borne in mind, that the parts of Shoreditch where the elements of disease are most rife, are densely inhabited to a much greater degree than the general average of the district, so that it is probable that there is no spot in London more crowded with life than many places in Holywell or St. Leonard's. I will now examine the sanitary condition of the district as expressed by the mortality. In 1855, the total deaths registered in Shoreditch amounted to 2985; of these, 639 were caused by typhus, smallpox, scarlatina, and other epidemic or endemic diseases. That is, one death in every five and two-thirds arose from causes directly traceable to removeable causes; and from facts which have been made manifest to me by the practice I have for some time past followed, of preserving a register of all the diseases that have come before me in the hospitals to which I have been attached, I am satisfied that the number of deaths referred to epidemics, is very far from adequately expressing the destruction of human life, or the impairment of health, resulting from removable causes. In the quarter ending on the 29th March last, there died from epidemic diseases 86 persons, of which, 56 were from typhus alone—a disease which marks, perhaps, more emphatically than any other, the action of causes injurious to health. In the week ending on the 5th April, there died again ten persons from epidemic diseases, of which, six were cases of typhus. Indeed it is doubtful whether typhus—a disease really more terrible than the cholera itself, because it is ever insidiously at work sapping the strength of the community, has ever been absent from Shoreditch. It has made itself a home in the parish, where it lives, —an unwelcome parasite—upon the life-blood of its hosts. It is endemic in several places in the vicinity of the Regent's Canal; and cases are of constant occurrence, not only in 7 the more crowded parts of the parish, but also in the better class of houses where the sewerage is defective, and other insalubrious causes are in operation. The deaths in the last week are less by twelve than in the week preceding. This comparative diminution in sickness is general over London. It is, however, no justification for security and inactivity. Such lulls or remissions are often nothing more than the forerunners of a pestilence. As the heats of July approach, it may be surely foretold, that the seeds of disease now lying comparatively dormant amongst you, will germinate into vigour. You will have a clear idea of the high death-rate of Shoreditch, if I state, that it amounts to 28 deaths for every 1000 persons living, annually. This is the highest figure attained by any district in the metropolis. Dr. Farr has fixed the normal death-rate— that is the rate at which people die in healthy districts—at 17 in 1000. It thus appears that the death-rate of Shoreditch exceeds the natural rate by 11 in the 1000. Here I must make a remark in anticipation to an objection that may be raised against stating the death-rate of Shoreditch at 28 in 1000 ; this includes the deaths in St. Luke's Workhouse, and it may be plausibly urged that these deaths must be struck off. I answer, that if some deaths take place within the boundaries of Shoreditch, which do not belong to its population, so there are others, and not a few of the population of Shoreditch, whose mortal diseases are contracted in the parish, and who die in the hospitals. For example, there is a bill at the workhouse from the Smallpox Hospital for the care of 28 cases of small-pox, admitted from this parish in 1855. I have, under consideration, plans for arriving at something like precise information as to deaths taking place out of the parish. There are one or two other points touching the sanitary condition of the parish which we may here record. An important element in a medical survey is the elevation of the district. The general elevation of Shoreditch is 48 feet above Trinity high-water mark. This elevation is in itself a most fortunate circumstance; and it becomes even more so because it exceeds the elevation of most of the surrounding districts : thus, the elevation of Bethnal Green is only 36 feet; of Whitechapel, 28; of East London, 42; and although the general elevation of Islington is 88 feet, that part which is contiguous to Shoreditch is little above the level of Shoreditch. You are, therefore, elevated above the influence of the pestiferous Thames; and did you not create and entertain especial local morbific influences, your district might reach a high degree of salubrity. The next point is the Water Supply. There are three principal sources. The New River Company and the East London Company supply the greater portion of the inhabitants. The workhouse, with its population of 800 souls, is supplied by an Artesian well. I have taken specimens of each of these waters for analysis, and shall report upon their condition hereafter. I believe that all will prove to be of good qualtity. But this is not enough. In many of the most wretched abodes, water cannot be had in sufficient quantity for the purposes of health; in many others, it is rendered unwholesome by storage 8 in tanks and butts, and exposure to contaminating influences, and I do not believe that the water from the ordinary wells can be safely used for drinking without previous filtration through charcoal or boiling. The soil is sodden with foecal matter—the soakage of cesspools ; and more or less contamination from this and other sources, must necessarily reach the wells. I conclude this lengthy preliminary report with a brief outline of the arrangements made or contemplated, with a view to keeping the Vestry and myself constantly informed upon all points connected with the sanitary condition of the parish. I acknowledge, with pleasure, the liberal promise of aid from the Medical Officers of the Parish. I confidently expect similar assistance from the medical oificers of the various dispensaries, whose charitable operations extend into this parish. Through these gentlemen I shall learn, from week to week, what fresh cases of fever occur, and be enabled to turn especial attention to the worst localities. It is my intention to inspect these places myself. I have also devised, with Mr. Edwards, a form of entering the cases of sickness admitted into the workhouse, by which, the abodes of the patients, that is, the spots where their diseases are contracted, will be registered. This information, not hitherto taken, will, I believe, prove of value in other respects. In order to discover and remove causes injurious to health in other localities, it will be necessary to institute a systematic inspection of the more crowded spots by the aid of the Inspectors of Nuisances. I shall be happy to co-operate with the Sanitary Committee of the Vestry. I trust tbe Vestry will excuse the presentation of a report necessarily imperfect. The apology I have to offer, is my yet brief tenure of office; that the office itself is new, and that much time must necessarily be occupied in organising a system of operations, and making the preliminary arrangements. I have the honour to be, Gentlemen, Your faithful servant, ROBERT BARNES, M.D. 10th April, 1856. ALABASTER AND PASSMORE, PRINTERS, WILSON STREET, FINSBURY. SHOR 4 First Quarterly Report on the HEALTH AND SANITARY CONDITION OF SHOREDITCH, with observations on the SOIL, WATER, AND AIR, by ROBERT BARNES, M.D., member of the royal college of physicians; fellow of the statistical society; physician to the seamen s hospital, dreadnought medical officer of health to shoreditch. FOR QUARTER ENDING JUNE 28th, 1856. \ PRINTED IN PURSUANCE OF A RESOLUTION OF THE VESTRY OF 19th JUNE, 1856. FIRST QUARTERLY REPORT of the MEDICAL OFFICER OF HEALTH. TO THE Destry of Saint Leonard, Shoreditch. GENTLEMEN, In drawing up my first Quarterly Report on the Health of the Population of Shoreditch, and the sanitary condition of the district, it will be convenient to arrange what I have to submit to your consideration under three heads: I. The Mortality and Health-movement for the three months just terminated. II. Some further contributions to the Sanitary Survey of the District, in continuation of those submitted in my Preliminary Report, including observations on the Soil, Water, and Air. III. Observations on measures for diminishing the causes of Sickness. 1.—MORTALITY AND SICKNESS. The information I have to lay before you on the mortality and sickness of the quarter, is not so complete as I could wish. For the first two or three weeks the arrangements for obtaining regular reports had not come into operation. I commenced receiving weekly returns of the Fever-cases attended by the District Medical Officers on the 19th April; I commenced receiving weekly returns of the cases of Sickness admitted into the Workhouse, on the 3rd May; since those dates the returns in question have been made with great regularity. The immediate application of the information contained in those returns, has been of the greatest practical value, by enabling me in many instances to diminish causes of sickness in active operation in particular localities. The future statistical applications will I anticipate be both interesting and important. The cordial aid I have thus derived from the District Medical Officers—aid voluntarily undertaken in addition to duties already too laborious and exacting—calls for my warmest thanks. The facts relating to the Mortality are derived from the weekly reports issued by authority of the Registrar-General; these facts do not embrace all that is necessary to the carrying out of local sanitary administration. It is however anticipated that 4 arrangements will very shortly be completed, by which complete copies of the District Registrars' mortuary-returns will be supplied to the Vestries. At least 95 per cent. of all the reliable information as to the causes of death is supplied gratuitously by the members of the medical profession; this information they continue to give on public grounds and for the public benefit. There is no application more useful and more legitimate of the knowledge thus acquired as to the causes of death, than that which in the hands of the Medical Officers of Health is made immediately subservient to the preservation of life. For the purpose of greater distinctness and condensation, I have arranged the facts relating to sickness and mortality in a series of Tables. The first Table shews the number of cases of epidemic disease attended by the District Medical Officers during the 77 days, and the total number of cases of sickness of all kinds during the 91 days, ending 28th June, 1856. TABLE I. Shewing the number of cases of Epidemics under the charge of the District Medical Officers during 77 days, ending 28th June, 1856, and the total number of cases of sickness during the 91 days ending on same day. DISTRICT. Medical Officer. Small Pox. Measles. Scarlatina. Hooping Cough. Diarrhœa. Typhus. Total Epidemics. Total cases of Sickness. Church End North Mr. Greenwood 1 ... 8 ... ... 36 45 633 Church End South Dr. Burchell 3 ... ... ... ... 88 91 640 Hoxton Mr. Coward 11 ... 17 ... ... 9 37 591 Holywell & Moorfields Mr. Collier 8 ... ... ... ... 92 100 856 Workhouse Mr. Clark (*) ... ... ... ... (*55) (*50) 648† Total 24 ... 25 ... ... 280 324 3368 * The Returns from the Workhouse extend over 63 days only. Five cases of Fever, having been previously under the care of the Medical Officers out of the House, have to be subtracted. Small-pox cases are not admitted into the Workhouse, but are sent to the Small-pox Hospital. † This number includes all cases of sickness treated in the Workhouse during the quarter. One out of every 38 inhabitants of the Parish has, therefore, been under the care of the Poor-Law Medical Officers during the quarter. The incompleteness of the Sickness Returns during the first quarter of our sanitary administration, precludes accurate statistical analysis. The Table, however, as it stands, exhibits distinct facts, suggests useful deductions, and will serve to mark what it is desirable to effect with more precision in future Reports. The same 5 pleteness also renders it impracticable to apportion the cases of sickness amongst the six registration sub-districts, for the purpose of comparison, &c., with the mortality returns. The Medical Districts and the Registration Sub-districts do not correspond. It will involve considerable labour to assign each case of sickness attended by the Medical Officers to its proper Registration Sub-district; but since this distribution is the most convenient for illustrating the comparative healthiness of different parts of the Parish, I shall henceforward endeavour to accomplish it, at least as far as Epidemics are concerned. TABLE II. Shewing the Mortality from six Epidemic diseases in each of the six Registration Subdistricts, during the 13 weeks ending 28th June, 1856. REGISTRATION SUB-DISTRICT. Small-pox. Measles. Scarlatina. Hooping Cough. Diarrhoea. Typhus. Total of Epidemics. 1. Holywell 1 2 4 7 ... 8 22 2. St. Leonard's ... 2 4 8 ... 3 17 3. Hoxton New Town, Including St. Luke's Workhouse. 1 1 10 7 3 24 46 4. Hoxton Old Town 4 1 4 5 1 2 17 5. Haggerstone West, Including Shoreditch Workhouse. ... 6 3 9 1 21 40 6. Haggerstone East ... 4 3 3 1 5 16 Total 6 16 28 39 6 63 158 Not being supplied with the Mortality Returns of each Registration Sub-district, I have not the means of exhibiting side by side with the mortality from Epidemics, the gross mortality of each Sub-district; we can only compare the Epidemic mortality with the mortality of the whole Parish. TABLE III. Shewing the Weekly Meteorological Phenomena, and the total Deaths in Shoreditch and all London; the deaths from Epidemics in Shoreditch and all London, and the proportions borne by Shoreditch. Week Ending Average Temperature. Barometer. Difference between Dew-point Temperature and Air-Temperature. WIND. Rain in Inches. TOTAL DEATHS Proportion of deaths from all causes in Shoreditch to all London. DEATHS FROM EPIDEMICS Proportion ot Deaths from Epidemics in Shoreditch to all London. General Direction. Amount of Horizontal Movement. in Shoreditch. in all London. in Shoreditch. in all London. April 5 46.4° in. 29.766 10.5 S.E. 1195 0.09 51 1284 1/25 10 193 1/19 „ 12 47.1 29.272 5.6 S.W. 1480 0.57 61 1115 1/28 9 201 1/22 „ 19 46.0 29.856 8.7 N.E. 750 0.17 45 1043 1/21 16 176 1/11 „ 26 48.5 29.775 9.9 E. 360 0.27 47 1048 1/22 7 151 1/22 May 3 41.3 29.564 6.2 N.W. 750 0.75 46 1087 1/22 6 173 1/28 „ 10 44.3 29.795 7.4 N. 1220 0.33 59 1154 1/19 11 184 1/16 „ 17 51.2 29.493 5.6 S.W. 960 1.24 45 1094 1/24 13 209 1/12 „ 24 53.1 29.564 7.3 S.W. 1130 1.08 55 1041 1/19 16 193 1/12 „ 31 53.3 29.691 5.9 S.W. & N.E. 840 0.97 44 1027 1/23 14 185 1/13 June 7 56.7 29.902 10.2 S.W. 530 0.00 48 1068 1/22 22 205 1/9 „ 14 59.1 29.829 7.1 S.W. 895 0.53 39 1027 1/26 11 289 1/26 „ 21 55.6 29.734 6.1 S.W. 490 1.21 41 963 1/23 10 200 1/20 „ 28 63.4 29.999 6.4 variable. 340 0.00 48 1118 1/23 13 270 1/21 Total 629 14069 1/22 158 2629 1/16 No. of Column 1 2 3 4 5 6 7 8 9 10 11 12 7 The facts thus exhibited suggest several interesting considerations. The population of all London is now estimated at about 2,500,000; the population of Shoreditch as estimated in my preliminary report is about 125,000; the population of Shoreditch is thus one twentieth part that of all London; the proportion of sickness and mortality borne by Shoreditch should be therefore one twentieth that of London. In Table III. I have given the deaths from all causes, and the deaths from Epidemics occurring in Shoreditch week by week, side by side with those occurring in all London. In column 9, it will be seen that in ten weeks out of thirteen, Shoreditch contributed less than its due proportion of deaths; whilst during the whole quarter it contributed one twenty-second part of the aggregate mortality of the metropolis. On the other hand, to counter-balance this apparently favourable result, instead of one twentieth only of the aggregate deaths from Epidemics, Shoreditch yielded one sixteenth. It is therefore owing to the fact that Epidemics are more rife and more destructive amongst us, that the mortality is so great. The mortality from all causes in Shoreditch was 629, from Epidemics 158.. Instead of 158, Shoreditch should have lost 131 only. One-fourth or twenty-five per cent. therefore of the total deaths were owing to epidemic or preventible disease, a proportion considerably exceeding that of all London. The deaths during the quarter have been at the rate of twenty per thousand per annum, a number, of course, considerably below the average of the whole year, namely, 28. The geueral mildness of the spring quarter lessens the mortality from chest affections, which contribute so enormously to the aggregate mortality. The diminution of other fatal diseases, of course, raises the relative proportion of deaths by fever to the whole, although the absolute number may not vary. The columns devoted to meteorological phenomena do not demand any remarks at present. Recorded side by side with the mortality, they will hereafter offer materials for comparison, and perhaps lead to useful conclusions. It is difficult without very large materials, and those very carefully sifted and classified, to draw demonstrable conclusions as to the causes of sickness from the comparison between the meteorological phenomena of a given date and the contemporaneous mortality. Few diseases kill very suddenly; before a man expires from fever he has commonly struggled for one or more weeks; by looking at the mortality alone we thus constantly run the risk of assigning to the atmospheric conditions of one week the causation of diseases which began in previous weeks. It was this consideration which led me to urge the importance of 8 registering cases of sickness as well as deaths. By recording a disease during life we approach more to the time of invasion, and touch more closely the cause which produced it. I wish, however, to submit one observation upon the meteorological column. I have given the direction of the wind, and the weekly sum of its horizontal movement in order to aid in illustrating and testing hereafter the accuracy of an opinion I have formed as to the influence of ventilation in diluting and rendering comparatively harmless, the poisonous miasms which, in their concentrated state, lurking in stagnant courts and the stifling dwellings of the poor, generate low fevers and add to the virulence of ordinary Epidemics. It may be useful to append here, some facts exhibiting the amount of Pauperism in Shoreditch, extracted from the printed Weekly return made to the Trustees of the Poor. On the 21st June last, there were 745 Inmates in the Workhouse; 291 Children at Brentwood; 185 Lunatics in Asylums; and 2882 persons receiving Out-door relief. Thus, out of 125,000 inhabitants, 4103 or about 1 in 30, were maintained at the public cost. Some facts published in my Preliminary Report clearly prove that a large proportion of this burden has been unjustly cast upon Shoreditch, by other and wealthier parishes. 9 II.—THE SOIL, WATER, AND AIR. the soil. The health of a community is intimately dependent upon the condition of the soil upon which it dwells. The water drawn from that soil, and the air floating above it, both partake of its characters. Universal experience has made it familiar to mankind that certain soils are favourable to the preservation of the health of the inhabitants upon them, and that other soils are productive of disease. It is equally proved that unhealthy soils are susceptible of much improvement by artificial means; that their morbific influences may b.e, more or less, effectually counteracted. Ague is no longer known in localities where, not many years ago, it was endemic. But if unhealthy sites may be made healthy by care, it is equally true that sites naturally the most salubrious may, by neglect, become pestiferous and deadly. It also appears to be true that sites formerly characterised by particular forms of disease may, in the course of occupation, undergo such changes in their condition as to get rid of their original morbid characteristics, and generate new diseases of a different character. Sometimes, again, the old forms of disease may persist, whilst new ones are superadded. Thus, the neighbouring district of Whitechapel still supplies numerous cases of ague, indicating that the original malarious character of the soil is retained through all the changes produced by a dense population; whilst low fevers and other epidemics springing from fresh causes of empoisonment of the soil are constantly generated. It is possible that intermittent fevers were at one time prevalent in Shoreditch also, but through the dryness of the soil, brought about by the construction of drains, sewers, wells, and houses, these have now in a great measure, if not entirely, disappeared. The epidemic diseases that have replaced those indigenous to the soil are principally due to the new sources of empoisonment arising from a dense population. I showed in my preliminary Report that the great danger to the inhabitants of this district arose from the rapid growth of its population, which had far outstripped all provisions for the proper accommodation of the inhabitants. No body of men can long occupy the same spot of ground and preserve their health, unless they take certain means for removing the impurities they generate. Nomadic tribes are driven to shift their encampments not alone because the surrounding pastures are exhausted, but also by the great sanitary necessity of escaping from a site rendered insalubrious by their occupation. In like manner, armies, and even regiments, are under the alternative of frequently moving their ground, or of paying the penalty of sickness and death. But the condition of civilized life is a permanent dwelling-place. The inhabitants of towns can only preserve their health by constant and vigilant attention to the purification of the soil which it is their lot to occupy. 10 Let us examine the soil occupied by the inhabitants of Shoreditch. The sections which accompany this Report supply a generally correct illustration of the geological structure of the district. The section made from the borings executed in the construction of the Artesian well at the workhouse, exhibits all the strata down to the great chalk-bed. Accounts that have been furnished to me of other borings made in different parts of the Parish show none but unimportant variations in the upper strata of coloured clays and sands. The strata which are of the greatest interest in a sanitary point of view are those which form the outer crust or surface. These strata exhibit considerable variety in their disposition in different localities. We are chiefly concerned with the soil to the depth of thirty feet. Proceeding from the surface, we have a bed of variable thickness, commonly called "made earth." The mode in which it is "made" deserves serious attention. It is strictly an artificial stratum. The proportion of "virgin soil" to that of common earth is now reduced to a very insignificant amount. The great bulk is made up of the accumulations of refuse of every kind; some brought from a distance and deliberately deposited by builders and roadmakers who had excavations to fill up, and by scavengers, nightmen, and everybody who had useless and offensive materials to get rid of. This upper stratum, so constituted, has been further polluted, and its noxious qualities intensified by innumerable perforations for cesspools, and constant saturation from defective sewers and drains, the poisonous exudations from gas-pipes, and every conceivable abomination, resulting from the offscourings of a population of 125,000 souls. This layer of foul earth, or the Pest-Stratum, as it may be most appropriately called, varies in thickness from one or two feet to sixteen or more. It lies upon the gravel, the next stratum. This layer is also irregularly disposed. It varies in thickness; it extends, in some places which I have examined, or of which I have authentic information, to a depth of 27 or 30 feet; in other places it is much shallower. The clay, which is immediately beneath, follows of course, the corresponding irregularities. The uneven disposition of the upper surface of the clay is attended by this peculiarity: it forms in various places hollows or basins, filled with gravel; these basins more or less completely isolate the portions of gravel they contain from the general bed of gravel of the district. This arrangement has an important effect upon the drainage and surface-water supply. Rain falling on the surface above these clay pits, or basins, percolates through the upper pest-stratum and the gravel, and collects at the bottom of the basin, where it is retained by the impermeable nature of the clay. If a well is dug into the gravel of such a basin, it will have a water-supply measured in quantity by the superficial area of the gathering-ground, the rain-fall, and the capacity of the basin, and affected in quality by the accidental character of the ingredients composing the upper foul 11 stratum. Cut off from the general gravel-bed it will, of course, be unaffected by the variations in the amount of water contained in this bed, and it will also be secure, so long as the integrity of the clay-basin is unimpaired, from being dried by operations which may drain the gravel-bed. It is only by tapping the lower part of the basin that its character of a reservoir can be destroyed. Unless it be so tapped, which may happen in the course of excavations for houses or sewers, the portions of ground overlying it will, in all probability, be imperfectly drained; they will remain damp, and apt to generate miasm and noxious emanations, arising from the decomposition of the animal and vegetable matters on the surface, or carried in solution into the soil. A pump connnected with such a well will constitute a useful means of drainage. It is important however, to bear in mind that a pump of this description should be regarded truly as a drain, and not as a source of water fit for human consumption. Section B. has been constructed in order to show the course, depth, and probable effect of the projected "Northern Middle Level Intercepting" Sewer of Mr. Bazalgette. The line of this sewer will run at a general depth of about 24 feet below the surface. It will, consequently, run, for the most part, through the gravel-stratum, which it will in many places bottom, having a diameter of from 9ft. Gin. to 10ft.; it will occupy in its course a considerable proportion of the entire thickness of the gravel. If the gravel-stratum were evenly disposed throughout the district, the effect of this would be, that, owing to the easily-permeable property of gravel, the whole stratum would be drained, even to a considerable distance. All the surface-wells would be dried. But the peculiar arrangement of the clay in basins, to which I have adverted, will greatly prevent this, to my mind, most desirable tendency. If this great sewer should also serve as a great land-drain, two objects of the utmost importance in their influence upon health would be accomplished: First, the general dryness of the surface would be promoted,—withdrawal of moisture is the removal of one essential element in the production of miasm and pestiferous vapours. Secondly, the drainage of the surface-wells would cut off a source of water laden with salts, the results of decomposition, and with organic matter dissolved from the putrifying filth of the pest-stratum. The analyses of some examples of water taken from these surface-gravels will abundantly demonstrate their utter unfitness for human consumption. I cannot, therefore, but anticipate the most beneficial results from the drainageaction, so far as it may extend, of the proposed great sewer of Mr. Bazalgette. THE WATER. Analysis, Chemical and Microscopical, of the various Waters used in Shoreditch. SOURCE. Date. Total Impurity in degrees, or Total Residue in grains per gallons. Organic matter. Nature of living and dead vegetable and animal matter, ascertained by microscope. Mechanical Impurity A. Surface-Gravel or Landdrainage Wells 1. Pump opposite Shoreditch Church 9th June 1856 92.50 9.00 A few sporules and threads of fungus; many ova-cases, a bit or two of vegetable tissue, and many oxytrichæ Trifling. 2. Pump in Plum ber Street 10th June 1856 117.50 9.50 nitrates Water greenish, even before evaporation; many sporules and threads of fungus; a hair or two; many fragments of dead vegetable tissue; no diatomaceæ, but a good many infusoria of genus oxytricha, of which there were two species. Decided but not large 3. Pump in Curtain Road, opposite Chapel Street. 10th June 1856 134.00 11.00 A good many ova-cases, in large bunches; two species of fungus; fragments of vegetable tissue; a large number of animalcules, chiefly oxytrichæ. Not great. 4. Pump in Curtain Road near Old St., Road 9 th June 1856 75.50 5.5 Many vorticella?, oxytrichæ, and actinophrydes, and vibriones; myriads of sporules of fungus and thallus, or root-like portions of two species of fungus. Not great. B. Deep-Sand Wells. 1. MrStanbridge's 12 th June 1856 41.50 2.50 Organic debris, sporules, and a few branches of a fungus; brown ova-cases; three or four fragments of decaying vegetable tissue; a few oxytrichæ. Very small yellowish 2. Independent Gas Works 12th June 1856 34.00 2.00 Organic debris; a few ova-cases; a little fungus; some oxytrichæ. Scarcely any. C. Chalk Water, called Artesian. 1. Shoreditch Workhouse 12 th June 1856 39.00 2.00 A light film floating on the surface, consisting of organic debris; some threads of fungus; a hair of a mammal; a few fragments of vegetable tissue; a few animalcules. A little of a yellow color. D. Water Companies. 1. New River. 13, Devonshire Square 12th June 1856 18.50 3.00 traces of nitrates Abounding in organic matter, dead and living; many frustules of diatomaceæ, of different species; a great many infusoria and shells of entomortraceæ. Considerable. 2. East London. from Mr. Roper's 12th June 1856 23.50 3.50 Organic debris; threads of fungus; a few frustules of diatomaceæ; rather many infusoria, chiefly oxytrichæ, but two or three actinophrydes. (Not unlike contents of Thames water). Trifling. 13 the water. The preceding table (p.12) illustrates all the principal facts concerning the watersupply of the district; it shows that there are four kinds or sources of supply. 1st,— the surface-drainage, or superficial gravel waters. 2nd,—the deep-sand wells. 3rd,—the chalk or Artesian wells. 4th,—the water-companies. A few remarks upon each of these may be useful. 1st.—The surface-drainage wells. The character of these I have already touched upon in describing the soil. The water drained from them is literally a solution of the foul and festering constituents of the upper layer of the soil, imperfectly purified by filtration in the gravel. The differences in the amount of contamination exhibited by the different wells of this class may be accounted for by the fact already adverted to—that the clay forms detached basins, or reservoirs, which catch the drainage-waters of different portions of the surface. It may thus be inferred that the water in the reservoir in Curtain Road, opposite Chapel Street, is exposed to some special and fearful source of empoisonment. 2nd.—The deep sand wells. The water from these wells is of excellent quality; but it is not available for general domestic use. The difference in the ingredients held in solution in waters drawn from different wells belonging to the same stratum seems also to indicate the existence of causes of local and partial influence. In some instances there has been reason to believe that direct sources of contamination have existed. It is known that some abandoned wells have been used for cesspools, and receptacles for waste and refuse liquors of various manufactories. It may well be that, in the case of wells situated near together, and of similar depth, the foul matters discharged from the bottom of one may be sucked up into the other. The utmost vigilance should be exerted to prevent such reckless and mischievous proceedings. 3rd—The Chalk-water. The inmates of the Workhouse are supplied with this water, and are in this respect probably better provided for than any other inhabitants of the parish. The comparative freedom of this water, and that of the deep sand water, from organic matter renders them peculiarly fit for domestic use. The experience, however, of Mr. Braithwaite, and the observations of other scientific men, justify a doubt whether more than a limited supply can be counted 14 upon from the great chalk formation. In proportion as the number of these wells has increased, and the quantity of water drawn has been greater, the level of the water has gradually fallen. 4th.—The Water Companies. The quality of the water supplied by both the New River and East London Companies is so indifferent that it would scarcely answer any useful purpose to contrast them with a view to showing which is the best—both waters are essentially impure; they contain a large, and no doubt injurious amount of organic matter; they are both hard. the air. The air of a populous district derives its impurities from two principal sources: first, from the emanations rising from the soil; secondly, from the exhalations given off by the processes of animal respiration and transpiration. To these may be added a third source of contamination mostly of local action, but often of serious import:— the gases and effluvia arising from manufactories of various descriptions. In a certain degree of concentration, the poisonous properties imparted to the air from any one of these sources may be injurious to health, and even destructive of life. The virulence of the aerial poisons of the two first classes, when highly concentrated, has often been fatally exemplified. Men who have incautiously descended into sewers have been instantly killed: poisons which act thus powerfully in a concentrated state may be expected to act injuriously, although less obviously, when more diluted: that is, diffused through a larger body of air. If dilution be carried further still, so that the aerial poison shall be reduced to a very infinitesimal proportion of the air, it may be rendered, if not absolutely harmless, at any rate, very nearly so. These considerations point to one great agent in sanitary medicine, namely, the supply of abundance of fresh air, and its free circulation through every spot, and every house and room exposed to the evolution of aerial poisons. It unfortunately happens that many of those localities, where the developement of gaseous poisons is most active, present the most unfavourable conditions for ventilation. Fresh deleterious matter is being constantly poured into the air, whilst no adequate circulation exists to carry it off, or to dilute it. I have, for instance, become acquainted with several cases of the following kind:—in a row of houses there will be one situated on a lower level than the rest, and frequently at the same time more shut in and deprived of light and air. If the sewerage and drainage of this row be defective, the overflowing and oozings from the cesspools of the whole will gravitate towards the doomed house at the lowest level; the ground will be kept saturated with decomposing matter, always emitting 15 gaseous poisons into the air; and the absence of ventilation will favour the concentration of the poisons. The unfortunate inhabitants of this house will suffer more than their neighbours. In several cases which I have investigated, almost every inhabitant of a house thus situated has been struck down with fever, whilst those of the adjoining houses have only been affected to a less extent, and in a milder form. We are thus led to another conclusion: it is not only necessary to dilute the aerial poisons as they arise by free ventilation, but it is also imperative by every possible means to get rid of the materials from which they are generated. This is to be effected mainly by improvements in sewerage and drainage. III.—MEASURES FOR DIMINISHING THE CAUSES OF SICKNESS. The means of lessening the sickness and mortality of a district are of two kinds. First, the removal or diminution of the causes of disease; Secondly, the employment of measures calculated to lessen the injurious action of those causes which cannot be altogether removed. The entire removal of the causes of disease is not attainable in a crowded population. In all large communities there is necessarily some poverty; and indirectly poverty is a cause of disease. Although, indeed, no form of government can ever succeed in giving affluence or competence to all, there is nothing more certain or more demonstrable than the proposition that an effective and well-sustained sanitary administration can do much to obviate the most frequent and efficient cause of poverty, that is, disease. For some three centuries we have had in active operation, laws and machinery for dispersing over the whole community the cost and burden of maintaining the pauperism of the country; it is only in our day that the experiment has been tried of reducing the cost of pauperism by systematic sanitary operations levelled at the root of the evilTo arrive at an exact estimate of the amount of pauperism caused by disease is a difficult task. It has been stated at 75 per cent. But whether it reach that proportion or not, it is easy to satisfy ourselves that the real proportion must be very great; thus, during 63 days of the last quarter 55 cases of typhus fever alone were admitted into the workhouse. The cost of maintaining these, must in itself be considerable. A fever hospital capable of receiving 40 patients forms a distinct part of the establishment; yet this even is often insufficient to meet the pressure from without. Mr. Clark the Surgeon, informs me that he is often compelled to draft out the convalescents into the general infirmary wards, to make room for recent cases. This fever is moreover a disease that frequently attacks men and women in the most productive period of life. Where it does 16 not prove fatal, it leaves the frame so exhausted, that the sufferers are for the most part rendered incapable of work for many weeks. During this period their families have to be supported by the parish; and the instances are many in which the disease having killed a father, his children have become a permanent burden upon the rates. I believe that next to small-pox and scurvy, that form of low fever to which the name of typhus is commonly applied, is the most preventible of diseases. Retrospective reflection on the waste of human life and money, occasioned by the ravages of typhus, must be pregnant with regret; but the future is full of hope. The work of prevention is fairly begun. Important progress has been made under the direction of your Surveyor in purifying the soil. The efforts of your Inspectors have been most usefully exerted in aiding the same work, in enforcing the removal of nuisances injurious to health, and in promoting the general cleanliness of the district. During the past quarter—a broken one, owing to the unavoidable delays in bringing all the parts of a new organization into harmonious action—184 notices directing various important sanitary works in abolishing cesspools, completing drainage, cleansing houses, improving ventilation, &c. have been made. I anticipate with some confidence being able in a future report to state, that the localities where these works have been effected, have been marked by the diminution of zymotic disease. In concluding this report, I beg permission to submit some suggestions upon matters which will claim your attention. 1. Slaughter-Houses—Under the provisions of the Metropolis Market Act, 14 & 5 Vic., cap. 61, all places used as slaughter-houses will have to be licensed at the Quarter Sessions. Every person wishing to have a license, must give notice to the Vestry, in order that cause may be shewn against the issue of a licence, where good cause may exist. It would be out of place to insist upon the general objections that may be urged against the practice of slaughtering in crowded neighbourhoods, The practical question is, to make such provisions for the space, cleanliness, watersupply, paving, ventilation, and removal of blood and offal, that the licensed slaughterhouses shall be as little offensive and injurious as possible. It may also be a question whether the interests of butchers and the convenience of the public, may not in some cases be promoted by the licensing of one or more abattoirs of a public character, to supply the wants of those butchers who may fail to satisfy the Vestry as to their claim for predate license 17 2. Water.—The facts and considerations submitted in this report relative to the water-supply point to the following conclusions:—first, the common pumps should be abandoned as sources of water for drinking, and culinary purposes; steps should be taken to make its unfitness known to those in the habit of using the water from this source. Secondly, it is important to draw the water from them for the purpose of draining the soil; the water may be usefully applied to the watering of the roads in summer, and for various purposes of cleansing and trades. Thirdly, the abandonment of the pumps, and the great deficiency of water in many localities occupied by the poor, call imperatively for a great extension of the supply afforded by the Water Companies. In the case of stand-pipes supplying courts and batches of houses, it must be remembered that even houses of four rooms generally contain twenty or more inhabitants. Ten such houses, no uncommon number to one stand-pipe, will probably hold 200 people. It is obvious that a small pipe running for fifteen or even thirty minutes, six days in the week, must utterly fail to supply enough water for the drinking, cooking, washing, and house cleansing of such a population. Instead of simply increasing the time during which the water is turned on, it would, I believe, be better to turn it on twice a day. This plan would greatly obviate the necessity of storing water in pails, pans, jugs, or other receptacles in confined dwellings. I submit this, not as a complete remedy, but as a temporary relief pending the introduction of the system of constant supply. From what I have witnessed as to the waste of water occurring from the absence of cocks to many of the common stand-pipes, and the pipes in the back yards of the poorer tenements, I am persuaded that even less water would be consumed if the water was turned on twice a day, if, at the same time, the pipes were properly fitted with cocks. The common plan I have observed is, to leave the water to flow as long as it is turned on : when the tub, if there be one, is full, the overflow is allowed to run over into the yard, whence, if the drain is permeable, part flows into the privy or cesspool. As no water is laid on to the privy, the theory is, that the surplus water thus discharged washes down the soil;—the practice is, that it is simply stirred up, set fermenting, and rendered a more active nuisance than if no water had been supplied. In addition to this, the back yards, mostly ill-paved, are kept wet and unwholesome. 3. Air Supply.—It is even more important to have a constant supply of air, than a constant supply of water. Stagnant polluted air is the most immediate cause in the production of low fevers. One great reason why these fevers lurk in blind alleys and ads-de-sac, is this stagnation of the air. I entertain a strong opinion that could we insure a continuous current of wind through even some of our worst localities and houses, fevers might be literally blown away. I would earnestly press the importance of taking every opportunity of piercing these places, and carrying a thorough commu- 18 nication into the open street beyond. The words "No Thoroughfare" are significant of incalculable mischief. 4. Construction of Houses.—Under the enactments now in force relating to the construction of new houses, sufficient provision is made for the salubrity of future habitations. The chief difficulty in sanitary administration is how to deal with the old ones. In a great many, palliative measures, such as vigilant attention to drainage, repairs, water supply, lime washing, and piercing new windows in back rooms or staircases, fitting ventilators, &c., may do much to obviate the mischief of original defective construction. In one of my earliest weekly reports, I suggested the expediency of giving some general notice to the landlords of small tenements, inviting them to put these tenements into habitable condition. I then expressed my belief that there were many owners of house property who would at once recognize the duty that devolved upon them, and be ready to act with the Vestry in improving the health of the Parish. Subsequent experience has not, I am happy to say, induced me to abandon that belief. It must be admitted that the powers put into the hands of the Vestry of enforcing improvements in house property are of a stringent, and even arbitrary character. I feel, very sensibly, the responsibility of advising the Vestry to exercise those powers in any but urgent cases; but the preservation of the health of the inhabitants is a paramount duty. The question, of putting houses into a condition fit for habitation, has two bearings. It is, first, a question between the landlords and the tenants, whose health is sacrificed by neglect. It is, in the next place, a question between the landlords and the rate-payers. If the landlords neglect to make the necessary outlay in improving their property, the expense of maintaining that property in its unhealthy condition is thrown upon the rate-payers; for these have to bear the burden of supporting the sick and destitute. But there is, I am sorry to say, another class of houses originally constructed in such perverse defiance of all the rules of common sense or decency, that no palliative measures can be of much avail. As an instance of this, I think it useful to draw your attention to Parsons' Squai"e, and Bowl Court. The houses in Parsons' Square are built back to back in a confined situation, so as to preclude the possibility of ventilation ; the rooms are small, with one storey over the ground floor; without water, and with privies, devoid of traps, under the staircase! The wretched occupants have to fetch water from a stand-pipe in the Court; the labour and difficulty of getting this in sufficient quantity is a bar to cleanliness. The property is vested, I understand, in the Ecclesiastical Commissioners, who, I am glad to hear, have laid a proposition before the Vestry to pull it down, and to erect better houses, and effect other 19 ments. I trust that no delay will be permitted in carrying out this most desirable object. If the site were devoted to the erection of a model lodging-house, or baths and washhouses, the project of the Commissioners would be twice blessed. The state of Bowl Court is, in many respects, similar. This is one of the most prolific nurseries of fever in the Parish, supplying a constant succession of cases to the Workhouse. The district abounds in courts, rows, and nests of houses, little, if at all, less unhealthy than the above. The condition of some of these I have brought under the notice of your Sanitary Committee; others are daily coming under inspection. I trust that before the period of my next Quarterly Report, many of these will have undergone material improvement. I have the honour to be, Gentlemen, Your faithful servant, ROBERT BARNES, M.D. 13, Devonshire Square, 7th July, 1856. andrew t. roberts, printer, opposite siioreditch church. Second Quarterly Report ON THE HEALTH AND SANITARY CONDITION OF SHOREDITCH BY ROBERT BARNES, M.D, L.R.C.P., F.S.S, &c., PHYSICIAN TO THE SEAMEN'S HOSPITAL, DREADNOUGHT; MEDICAL OFFICER OF HEALTH TO SHOREDITCH. For QUARTER ENDING SEPTEMBER 27th, 1856. PRINTED IN PURSUANCE OF A RESOLUTION OF THE VESTRY PASSED 19th JUNE, 1856. SECOND QUARTERLY REPORT of the MEDICAL OFFICER OF HEALTH. to the Vestry of Saint Leonard, Shoreditch. GENTLEMEN, I have the honor to submit my Second Quarterly Report on the Health and Sanitary condition of your parish. It refers to the thirteen weeks ending on the 27th of September. In my Preliminary and first Quarterly Reports I entered in some detail into the facts of most interest concerning the Population, Area, Soil, Water, and Air of the District. The details there recorded will serve, and have already served, as indications for immediate material improvements, and will be further useful as terms of future comparison. The present Report will consist mainly in a Summary of the Weekly Statements laid before your Sanitary Committee. TABLE I. Has been constructed in order to show the weekly Mortality from all causes, and that from the six zymotic diseases in Shoreditch, compared with the mortality of all London, The weekly Meteorological Phenomena are recorded side by side, in order that the relations between these phenomena and the mortality may be the more readily traced. This table is similar to one in the first Quarterly Report. I have preferred comprising the proportional loss borne by Shoreditch in vulgar fractions, because the population of Shoreditch being one-twentieth that of the entire metropolis, this mode affords the most convenient and readily intelligible standard of comparison. TABLE I. Shewing the Weekly Meteorological Phenomena, and the Total Deaths in Shoreditch and all London; the Deaths from Epidemics in Shoreditch and all London, and the proportions borne by Shoreditch. Week Ending Average Temperature. Barometer. Difference between Dew-point Temperature and Air-Temperature. WIND. Rain in inches. TOTAL DEATHS. Proportion of deaths from all causes in Shoreditch to all London. (nearly.) DEATHS FROM EPIDEMICS. Proportionof Deaths from Epidemics in Shoreditch to all London. (nearly.) General Direction. Amount of Horizontal Movement, in Miles. In Shoreditch. In all London. in Shoreditch. in all London. July 5 59.2 in. 30.008 10.3 N.E. 315 0.00 50 1027 1/20 10 178 1/23 „ 12 57.6 29.658 5.9 W.&N.W. 975 0.31 41 959 1/23 14 223 1/16 „ 19 60.1 29.840 5.5 S.W. 685 0.33 60 1018 1/17 14 236 1/17 „ 26 64.2 29.738 6.0 s.w. 605 0.35 46 995 1/21 15 236 1/15 Aug. 2 67.6 30.006 8.4 S.W.&S. E. 305 .0.22 40 1025 1/25 14 275 1/19 „ 9 66.1 29.860 9.3 S.E. 215 0.21 47 1232 1/26 19 377 1/19 „ 16 66.9 29.763 9.1 S.W. 630 0.40 66 1250 1/19 17 391 1/24 „ 23 57.8 29.472 4.3 N.E. 150 1.54 78 1122 1/14 26 328 1/12 „ 30 61.0 29.821 7.1 S.W. 245 0.08 53 1081 1/20 21 300 1/16 Sept. 6 57.5 29.847 8.7 E. 420 0.09 64 1100 1/17 10 236 1/24 „ 13 58.7 29.852 7.0 N.E. 395 0.41 54 1087 1/20 17 273 1/16 „ 20 53.7 29.905 9.8 N.W. 810 0.25 38 1064 1/28 12 239 1/20 „ 27 52.9 29.241 6.5 S.W. 1020 1.43 40 1106 1/28 9 207 1/23 Totals 6770 5.62 677 14066 1/21 198 3499 1/18 No. of Column. 1 2 3 4 5 6 7 8 9 10 11 12 In column 9 of this Table it will be seen that in Nine Weeks out of Thirteen, the Mortality from all causes in Shoreditch was either less than, or did not exceed its rateable contribution to the Mortality of the Metropolis; and that the aggregate Mortality of the quarter was less in proportion than that of all London. Column 12 shews that the Mortality from Zymotic Diseases exceeded the due proportion in eight weeks, and that the aggregate of the quarter was also in excess. 5 This Table shows that the mortality from all causes in Shoreditch was 677; that from six specified zymotic diseases, 198. Had Shoreditch lost its exact proportional number relative to population, the gross mortality would have been 703 instead of 677. On the other hand its loss from zymotics would have been 175, instead of 198. This discrepancy (also marked in the preceding quarter), of a lesser gross mortality and a zymotic mortality in excess, as compared with all London, points to a problem in the vital Statistics of the District which it is very desirable to investigate. In order to elucidate this subject, I have examined in some detail the mortality from the different zymotics. TABLE II. Shewing the absolute and relative mortality from six Zymotic Diseases in Shoreditch, during the Quarter ending 27th September, 1856. Small Pox. Measles. Scarlatina, Hooping Cough. Sh. Lond. Prop. Sh. Lond. Prop. Sh. Lond. Prop. Sh. Lond. Prop 5 108 1/22 7 393 1/56 29 433 1/15 18 382 1/21 Diarrhœa. Typhus. All six Zymotics. Sh. Lond. Prop, Sh. Lond. Prop. Sh. Lond. Prop. 92 1610 1/18 47 573 1/12 198 3499 1/18 This Table exhibits a striking difference in the relative mortality from different zymotics. We lose less than our proportional number from Small Pox, Measles, and Hooping Cough; the excess is marked in Diarrhoea, in Scarlatina, and still more so in Typhus. The reason why our apparent loss from Small Pox is less, is undoubtedly owing to the circumstance that many cases of this disease are sent to be treated at Highgate, and that thus some die out of the Parish. It appears that during the quarter, six cases were sent to the Small Pox Hospital, of which two are reported as dead. If these two be added to the deaths included in the Shoreditch 6 mortality returns, our loss from Small Pox will be raised to the same proportion as that of all London. The great disproportion in Measles, is difficult to explain. The Mortality Returns and the reports of the Poor Law Medical Officers taken together seem to shew that Measles has been less prevalent in this than in other districts. But I doubt whether this would account for the Avhole difference. I am inclined to conjecture that something is due to differences in the mode of drawing up the individual certificates of the cause of death. Measles perhaps more often proves fatal through its sequela3, that is, from other diseases, such as Bronchitis, Pneumonia, Dropsy, which are its consequences, than in its primary and essential stage. It may be that the consecutive disease, that which immediately preceded death, is often the only one recorded. It is exceedingly important to preserve a history of each epidemic of Autumnal Cholera or Diarrhcea for the purpose of future comparison. I will therefore trace this as far as my information will permit. As evidenced in the Mortality Returns, Diarrhoea shewed indications of its rise in June, it increased in July, attained its acme in August, and declined in September, but has not yet disappeared in the beginning of October. The course of the mortality in Shoreditch may be conveniently expressed as follows, for the thirteen Weeks of the Quarter : July. 2, 2, 6, 3 August. 6, 8, 14, 15, 14 September. 6, 5, 7, 4 The Sickness Returns of the Poor Law Medical Officers do not ennmerat the cases of Diarrhcea previous to the 2nd August. From that date they exhibit tli following course:— Mr. Coward. Mr. Greenwood Dr. Burchell. 9 August 28 46 43 16 „ 32 41 47 23 „ 36 24 43 30 „ 19 15 29 6 Sept. 20 11 32 13 „ 23 12 29 20 „ 7 14 11 27 „ 0 8 5 165 171 239 7 But how are we to account for the enormous excess of deaths from Typhus ? It is probable in the first place, that all, or nearly all, the cases of fever classed together under this term, that arise in the district and prove fatal, terminate where they begin. The parish Workhouse is the refuge for a large proportion of the severe cases of fever, threatening a fatal termination. In the next place we have the Workhouse of St. Lukes' situated within our Registration boundaries: we must therefore, deduct the fever-mortality of St. Lukes'. Dr. Pavy, the Medical Officer of Health for that district, informs me that 12 persons died of fever in the Workhouse during the quarter. This will leave 35 as the true loss. If we substitute this figure for 47, the number given by the Registrar-General, this will give as the proportional fever-mortality 1/16, and a little over 1/19 as the proportional aggregate zymotic Mortality ; this still leaves an excess against Shoreditch. Instead of 35 victims from the Typhoid form of the Sewer-Scourge, the number should not have exceeded 28. It is also proper to bear in mind that as there is no general Hospital in Shoreditch, an unknown number of persons afflicted with various non-zymotic, acute, and chronic diseases, and surgical accidents die in the metropolitan hospitals. If this number could be ascertained and added to the District-Registrars' Returns, it might be found to remove the apparent inferior general Mortality of Shoreditch. The analysis into which I have entered above is far from complete. It would have been even less so but for the liberality of Mr. Bowring, who has furnished me with copies of his weekly mortality-lists. As his district includes the Workhouse, his returns are of especial value as aids to Sanitary investigations. Tables III. and IV. embrace other facts illustrating the Sickness and Mortality in different districts. They may be usefully compared with similar ones in the first Quarterly Report. 8 TABLE III. Shewing the number of cases of Epidemic diseases admitted under the charge of the District Medical Officers, during the 13 weeks ending 27th September, 1856. DISTRICT. Medical Officer. Small-Pox. Measles. Scarlatina. Hooping Cough. Diarrhcea. Typhus. Total of Epidemics. Total cases of Sickncss Church End North Mr. Greenwood 20 171 36 227 955 Church End South Dr. Burchell 6 6 17 239 84 352 1009 Hoxton Mr. Coward 14 9 8 1 165 13 210 734 Totals 20 15 45 1 575 133 789 2698 Holywell & Moorfields Mr. Collier 3 2 69 74 Workhouse Mr. Clark 23* 658 Mr. Collier's Returns extend to the week ending 2nd August, only. *In this number Three are included in Out-door Medical Officers Returns. The number of cases of the several Epidemics in Workhouse are not given ; cases often arise amongst the resident population of the house. The number 23 of Typhus is the number admitted labouring at the time under that disease. Taking the Three Divisions of which the returns are complete, we find 2698 cases of Sickness of all kinds, of which 789, or considerably more than one fourth were cases of zymotic disease. TABLE IV. Shewing the Mortality from Six Epidemic Diseases in each of the six Registration Sub-Districts, during the 13 weeks ending 27th September, 1856. REGISTRATION SUB-DISTRICT. Small-pox. Measles. Scarlatina. Hooping Cough. | Diarrhoea. Typhus. Total of Epidemics. 1. Holywell 1 1 6 2 10 6 26 2. St. Leonard's 7 4 19 9 39 3. Hoxton New Town Including St. Lukes' Workhouse. 2 4 6 19 16 47 4. Hoxton Old Town 1 2 1 1 18 4 21 5. Haggerstone West Including Shoreditch Workhouse 4 9 2 15 8 38 6. Haggerstone East 1 2 3 11 4 21 Totals 5 7 29 18 92 47 198 9 The following Table exhibits the total number of admissions into the Workhouse, the number of admissions on account of sickness, week by week, and serve to illustrate the relative influence of sickness as a cause of Pauperism. July. August. 5th. 12th. 19th. 26th. 2nd. 9th. 16th. 23rd. 30th. Total Admissions 41 20 46 32 28 38 24 40 54 Admitted Sick 14 7 10 18 10 11 8 21 16 September. 6th. 13th. 20th. 27th. Total Admissions 34 18 47 35 Admitted Sick 7 11 15 10 Hence it appears, that out of 457 admissions, 158 were taken in whilst labouring under sickness ; and it is certain that these persons thus compelled to seek refuge in the Workhouse from sickness draw other members of their families in their train. In many of these instances I am aware from personal knowledge the most obvious cause of disease was destitution; but in many others, the disease, I am equally satisfied, was caused by Malaria. Of the 158 cases of sickness, 23 were cases of Typhus, and 7 of Diarrhoea. Of Typhus, there were 6 males and 17 females. The ages of the six males ranged between 17 and 55; of the females 4 were under 14, and 13 from 17 to 66. These are facts which indicate how severely the Sewer-fever—for that name is more appropriate than Typhus—tells upon those in the productive period of life. During the winter-quarter we may expect Pulmonary and other topical or organic diseases to play a more active part in increasing the Mortality. The influence of heat, cold, and wet—causes which admit of great mitigation under well-devised Sanitary administration—is_ now becoming daily more manifest in the character of the prevailing sickness, although it is scarcely yet traced in the causes of death registered in the Mortuary Returns. 10 SANITARY WORKS. Important progress has been made in improving the Sanitary condition of many parts of the parish where reform was much needed. In pursuance of the recommendations appended to my weekly statements to the Sanitary Committee, works directed specially to remove causes of disease have been ordered, relating primarily to 223 houses. Many of these works will also have a secondary beneficial influence in promoting the salubrity of adjoining dwellings. These works consist chiefly—1st, in purifying the soil, as by filling up cess-pools, repairing drains, paving yards to provide for surface-drainage—2nd, removal of refuse and offensive matter—3rd, lime-washing, cleansing, and repairing dwellings—4th, in improving the water-supply and storeage—5th, in remedying defective ventilation. Your Inspectors, Mr. Ditchman and Mr. Kirkham, have ordered the abolition of about 120 cesspools; the cleansing and repair of 78 drains ; the substitution of 76 water-closets for privies; besides numerous other works. In many cases the owners have willingly executed these works on the simple recommendation of the Inspectors. In others, however, it has been necessary to issue authoritative orders. Great improvements have been made in the surface-drainage of many parts of the district under the direction of your Surveyor, Mr. Freebody. Effective surface-drainage is not only important in an economical point of view, but it is also an essential condition to salubrity. Rain-water fouled by contamination from many sources by soaking into the Pest-Stratum at the surface keeps up constant dampness in the dwellings, and favors the continual generation of malaria. If the Pest-Stratum laden as it is with putrifiable organic matter could be kept absolutely dry, it would be comparatively harmless. Moisture is a necessary element for the evolution of its pestiferous properties. It is gratifying to observe that the applications to the Vestry to connect house-drains with the main sewers increase. The facilities now enjoyed by the inhabitants from the Sewers being under the control of the Yestry begin to be appreciated. The application of the compulsory powers will become less and less called for. Mr. Freebody informs me that the total area still unprovided with Sewerage is probably one-third that of the whole extent of the district. The amount of fever, and other diseases caused by the Sewer-poison is thus largely accounted for. It 11 is a matter of observation that these diseases prevail most extensively in the undrained districts. The diminution of this gigantic evil deservedly occupies the serious attention of your body. Two works alone already in active progress, will accomplish much good in this direction. The works now proceeding in and about Hertford-place will drain an area of three acres and a quarter; those ordered in the Old Street Road will drain an area of nearly four acres. It is useful, however, to bear in mind that 200 acres of ground densely inhabited still need that first of all Sanitary provisions in a site pitched upon for a permanent encampment—the means of getting rid of the excreta attendant upon animal life. Another object that demands to be kept constantly in view is that of opening thoroughfares, by the continuation of streets wherever suitable opportunities occur. It is especially desirable to carry out improvements of this description in the more crowded localities consisting of labyrinths of narrow courts where the sun can rarely shine, where tne air cannot circulate, where the soil cannot be kept dry or clean, and where human beings wither and die. My attention has lately been directed to one spot offering peculiar facilities at this moment for effecting a most useful opening. Some dilapidated houses have been recently pulled down in Duke Street, Long Alley. Were the space thus cleared, thrown into the street, a free communication would be obtained between Market Street, Finsbury, and Long Alley, which would act as a ventilating shaft to this crowded locality, and greatly conduce to increased cleanliness and health. Water Supply and Storeage.—I have become acquainted with several densely-inhabited localities, the insalubrity of which is increased by the objectionable mode in which the water is stored. Underground tanks or reservoirs are constructed to receive the water daily turned on from the main of one of the Water Companies. The common situation of these tanks is the middle of a square or court. It is impossible that they can be so secured as to keep out all penetration of dirty-water and oozings from the pest-stratum in which they are built. Being underground, their condition is not subject to constant inspection, as every receptacle for pure water ought to be. No householder is, or ought to be, satisfied unless he can examine and clean out his own water-butt several times in the year. But it is fortunate if these subterranean tanks being out of sight, exposed though they be to the most dangerous description of contamination—that of sewage water—get cleaned once in five or ten years. I have submitted samples taken from three of these tanks to examination. They abounded in mechanical impurities, exhibiting, under the microscope, quantities of organic debris, such as shreds of cotton, 12 hair, wool, and vegetable cellular tissue; after two or three days exposure to light, multitudes of fungi and animalculas became developed; they contained Nitrates and Ammonia, and unconverted organic matter; and the quantity of inorganic impurity was largely increased. The character of some of these impurities clearly points out the source whence they are derived, viz., from foul washings and sewage. The origin of these underground tanks is no doubt the want of space above ground. In these confined localities every square inch of space is economised in order to squeeze in a greater number of tenements. The remedy is simple, obvious, and effective. Fill up the tanks, and substitute taps furnished on the system of constant supply. Slaughter-Houses.—The time has arrived when the provisions of the "Metropolitan Market Act" (14 and 15 Vic., cap. 61) relative to private SlaughterHouses comes into operation. Under this Act it is provided that all places used as Slaughter-Houses after the 1st of December of the year next following that in which the public Slaughter-Houses attached to the Metropolitan Market are provided shall be licensed at the preceding Michaelmas Quarter Sessions This condition was fulfilled, and official notice thereof given in the London Gazette, in June, 1855. By the 131st section of the " Metropolis Local Management Act," all persons intending to apply for such license are required to give one month's notice to the Vestry. In order that these provisions might be fully known, the Yestry sanctioned the issue of a circular Notice, which has been sent to every butcher within the Parish whose address could be ascertained. 79 butchers have given notice of their intention to apply for licenses. The premises of all these applicants have been examined by your Inspectors, and the Medical Officer has further examined those where doubts existed as to their fitness for slaughtering. In some cases where the drainage or other necessary provision was defective, the approval of your officers has been suspended until the proper alterations shall be carried out. In many other cases, alterations have been voluntarily made, in anticipation of inspection. In other cases, again, of premises that did not admit of being adapted to meet the requirements laid down, the occupiers have wisely abstained form giving notice. The effect of thus bringing the Slaughter-Houses under official inspection has been beneficial. And, since it will be necessary to renew the licenses annually, a continuous supervision will be kept up, the good effect of which will be aided by the natural desire of the butchers to maintain their premises in such order as to ensure that renewal. Considerable difference of opinion exists as to how far, or 13 whether at all, slaughtering should be permitted in crowded localities. By many persons, Slaughter-Houses are regarded as unmitigated nuisances. It is, however, necessary, especially for those Avho are entrusted with the regulation of SlaughterHouses, to consider the question in a practical point of view, and in all its bearings. There are three considerations which demand attention—First, the wants of the community, and the means of supplying them. The suppression, total or partial, of Slaughter-Houses in Shoreditch would, in a degree proportionate to the extent of the suppression, make a population of 125,000 persons dependent for fresh meat upon the railways and upon such supplies as could be brought in carts and at a considerable loss of time from the public abattoirs in the Metropolitan Market. There are some weeks at least in every year during which it would be extremely difficult to bring from a distance a sufficient supply of meat in a fresh and wholesome condition. Unless a certain proportion be allowed to be killed on the spot, we run the risk of having tainted meat, and of increasing the price. Secondly—How far is a Slaughter-House necessarily a nuisance or injurious to health? There is no doubt it may become both in a high degree if not properly constructed and controlled. But I entertain no doubt that if a Slaughter-House be properly adapted for its purpose, and the business be carried on with proper care, it need not prove injurious to health. It will be borne in mind that fresh meat being necessarily concerned, the emanations are, or ought to be, null. Putrescence can only result from retaining too long on the premises offal, blood, and refuse, and from want of cleanliness and ventilation. Against these evils we have this security: the butchers want all available space; it is their interest to allow no accumulation of matter that can be promptly got rid of; and the retention of putrifiable substances, or any neglect of cleanliness is sure to entail a heavy penalty upon them by injury to their stock. The liability to inspection will operate as a further security where self-interest is not sufficient. As regards the question of nuisance, it is not so feasible to remove every cause of inconvenience. But when the most serious annoyances attendant upon slaughtering have been removed, or as much as possible diminished, it may be found that those remaining are inconsiderable when compared with the amount of general public convenience gained. Perhaps the most serious nuisance is the driving of animals, especially horned cattle, through the streets, and acrosss the foot-pavements into the butchers' shops. It is imperative to lessen this nuisance as much as possible. Where a butcher kills many beasts, there ought to be a back entrance to the slaughter-house. No place should be licensed to kill beasts where the animals have to be driven down a long narrow passage, to the danger of the inhabitants. In Shoreditch this evil will be greatly 14 lessened by being spread over a large surface. The 65,000 bullocks, sheep, and pigs, the maximum number killed annually, are not brought to one spot, or through the same streets, but are shared between 78 butchers dispersed in different parts of the parish. No butcher kills a large number in any one week. Thus by subdivision and distribution the nuisance is reduced to a point at which it is hoped no serious inconvenience or danger to the Public will be felt. Should, however, just cause of complaint arise, it wrill be remembered, that the licenses remain in force only from year to year, and that in any particular case where a nuisance is substantiated, cause may be shown against the renewal of the licence. I take the opportunity of stating in this place that there is no Knackers' Yard or place for slaughtering horses in the parish, or that if such exists or should be established it will be illegal, since no Notice has been given to the Yestry of intention to apply for a license for such purpose. Thirdly—We have to consider the rights of Trade. No useful occupation should be interfered with except to the extent that may be necessary in order to guard the greater rights of the Public, and to protect individuals from injury. It is hoped that the Vestry will, on these grounds, approve the principles which have actuated their officers in the discharge of this responsible duty. It would have been easy to lay down a code of conditions with which very few butchers could have complied, and the adherence to which would have had the effect of closing almost every Slaughter-house in the Parish. The endeavour has been to interpret the Acts in a just and liberal spirit. I have the Honour to be, Gentlemen, Your faithful Servant, ROBERT BARNES, M.D. 13, Devonshire Square, l'Ath October, 1856. ANDREW T. ROBERTS, PRINTER, OPPOSITE SHOREDITCH CHURCH. SHOR 4 Third Quarterly Report ON THE HEALTH AND SANITARY CONDITION OF SHOREDITCH, BY ROBERT BARNES, M.D., L.R.C.P., F.S.S, &c, senior physician to the seamen's hospital, dreadnought; medical officer of health to shoreditch. For QUARTER ENDING 27th DECEMBER, 1856. PRINTED IN PURSUANCE OF A RESOLUTION OF THE VESTRY PASSED 1st JUNE, 1856. METROPOLIS LOCAL MANAGEMENT ACT, Vestry of St. Leonard's, Shoreditch. THIRD QUARTERLY REPORT OF THE MEDICAL OFFICER OF HEALTH. TO THE Vestry of Saint Leonard's Shoreditch. GENTLEMEN, I have the honour to lay before you my Third Quarterly Report on the Health of the population of Shoreditch, and the Sanitary condition of the district. It refers to the thirteen weeks ending on the 27th December, 1856. This period has not been marked by the excessive prevalence of any epidemic disease, nor by an unusual amount of sickness and mortality from diseases of other kinds. The following summaries and analyses of the sickness and death returns which it is my duty to present to you, are nevertheless not deficient in interest and instruction. Independently of immediate applications directed to the improvement of the health standard of the inhabitants, which is of course the direct and paramount object to be kept steadily in view, these summaries and analyses constituting as they do parts of a series, will, in proportion as they accumulate, acquire a constantly increasing value. I have much satisfaction in being able to state, that the want of full information as to the causes of death, which has hitherto impeded the prosecution of sanitary inspection and improvement, and deprived me of most essential materials for statistical analysis and comparison, will be henceforth supplied. From the commencement of the present year, every Metropolitan Medical Officer of Health will, by the liberal aid of the Registrar-General, be regularly furnished with the Registrars' weekly mortality returns. Any future Reports which I may have the honour of submitting, will, I trust, through this aid, be more complete in information, and more satisfactory as records of sanitary improvements accomplished. These returns will, by continually pointing out the disease-producing localities, entail more labour on your Medical Officer and Inspectors, but this I am sure will be cheerfully undertaken. TABLE I. Shewing the Weekly Meteorological Phenomena, and the total Deaths in Shoreditch and all London; the deaths from Epidemics in Shoreditch and all London; and the proportions borne by Shoreditch. Week Ending Average Temperature. Barometer. Difference between Dew-point Temperature and Air-Temperature. WIND. Rain in Inches. TOTAL DEATHS. Proportion of deaths from all causes in Shoreditch to all London. DEATHS FROM EPIDEMICS Proportion of Deaths from Epidemics in Shoreditch to all London. General Direction. Amount of Horizontal Movement. In Shoreditch. In all London. In Shoreditch. In all London. Oct. 4 55°.3 in. 29.439 5°.2 S.W. Miles. 565 0.54 57 1071 1/19 15 216 1/14 „ 11 54°.3 29.883 1.9 Shifting & Calms. 230 0.00 60 939 1/16 11 201 1/18 „ 18 53.0 29.937 2.5 ditto 435 0.36 46 960 1/24 12 164 1/14 „ 25 51.2 30.208 3.2 Easterly & Calm. 5 days 185 0.00 37 974 1/26 8 182 1/23 Nov. 1 44.7 30.165 1.0 Calm. 245 0.34 49 969 1/19 6 143 1/24 „ 8 43.4 30 236 3.6 N.E. 160 0.23 31 1006 1/32 8 189 1/23 „ 15 38.3 29.649 5.1 N. 1075 0.12 56 1090 1/19 13 179 1/14 „ 22 42.3 30.025 2.2 N.W. 545 0.15 77 1261 1/16 15 199 1/14 „ 29 39.3 29.677 4.7 N.W. 865 0.52 41 1158 1/28 12 200 1/16 Dec. 6 35.5 29.675 3.3 Westerly Calm. 1045 0.30 59 1318 1/24 8 201 1/25 „ 13 51.3 29.219 5.1 S.W. 1755 0.78 54 1243 1/23 9 194 1/21 „ 20 38.8 30.128 2.3 N.N. E. 520 0.03 50 1060 1/24 11 159 1/14 „ 27 35.7 29.419 2.8 w. 530 0.13 52 1069 1/20 9 168 1/18 Totals 8155 4.30 669 14118 1/21 137 2395 1/17 No. of Column 1 2 3 4 5 6 7 8 9 10 11 12 Total mortality in St. Luke's Workhouse 40, from epidemics 12. Deducting; St. Luke's mortality the proportion of Shoreditch to all London, is only; from epidemics 1/19. 5 TABLE I. Has been constructed on the same plan as a similar one in preceding reports. In order to have a clearer idea of the proportional mortality of Shoreditch, it is necessary to bear in mind, that the population of Shoreditch is estimated to be as nearly as possible one-twentieth part of that of the whole metropolis; it is obvious therefore, that whenever the mortality of Shoreditch exceeds one-twentieth part of the gross metropolitan mortality, the health-balance turns against this district. I abstain at present from making any deductions from the meteorological columns, in connection with the sickness and mortality returns. It will be seen that, while Shoreditch contributed 1/24 only of the gross metropolitan mortality, or somewhat less than its proportion, the deaths from zymotic diseases amounted to 1/17, or considerably more than the due proportion. A similar discrepancy has been pointed out in my previous Reports. If we subtract 12 deaths from fever which took place in St. Luke's Workhouse, but which are included in the mortality returns of Shoreditch, we reduce the proportional zymotic mortality to 1/19; this rate approaches more nearly to the average rate of the metropolis, but still leaves a marked discrepancy between the general death-rate, and the special death-rate from zymotics. This circumstance has led me to pursue the analysis into the deaths from zymotic diseases more minutely. Tables II and III have been constructed for this purpose. TABLE II. Shewing the Mortality from six Epidemic diseases in each of the six Registration Sub-districts, during the 13 weeks ending 27th December, 1856. REGISTRATION SUB-DISTRICT. Small-pox. Measles. Scarlatina. Hooping Cough. Diarrhoea. Typhus. Total of Epidemics. 1. Holywell ... 2 4 6 ... 4 16 2. St, Leonard's 1 5 8 4 2 8 28 3. Hoxton New Town Including St. Luke's Workhouse ... 1 4 11 1 *21 38 4. Hoxton Old Town ... 5 7 6 ... 4 22 5. Haggerstone West Including Shoreditch Workhouse ... 1 7 6 3 12 29 6. Haggerstone East ... •• 1 1 1 1 4 Totals 1 1 14 13 34 7 50 137 *This includes 12 cases in St. Luke's Workhouse. 6 TABLE III. Shewing the absolute and relative mortality from six Zymotic Diseases in Shoreditch during the Quarter ending 27th December, 1856. SMALL POX. MEASLES. SCARLATINA. Mortality in Proportion to Mortality in Proportion to Mortality in Proportion to Sh. Lond. EastD. Lond. EastD. Sh. Lond. EastD Lond. EastD. Sh. Lond. East D. Lond. EastD. 1 74 6 .014 .17 14 372 50 04 .28 31 556 141 .06 .23 HOOPING-COUGH. DIAKRHCEA. TYPHUS. Mortality in Proportion to Mortality in Proportion to Mortality in Proportion to Sh. Lond. EastD. Lond. EastD. Sh. Lond. EastD. Lond. EastD. Sh. Lond. EastD. Lond. EastD. 34 466 118 .07 .33 7 316 65 .02 .10 50 611 194 .08 .25 ALL SIX EPIDEMICS. Mortality in Proportion to Sh. Lond. EastD. Lond. EastD. 137 2395 574 .06 .24 The proportionate population of Shoreditch, is for London "05 ; for East Districts .22. In Table II, the mortality from small-pox, measles, scarlatina, hooping cough, diarrhoea, and fever, is given separately for each registration Sub-district. I have not inserted the population of each Sub-district. We possess no ennumeration since 1851; and since this period the relative distribution of the aggregate population of the district has much changed: thus, between 1841 and 1851, the rate of increase of Shoreditch was 2.790 per cent. annually. If we assume that the like rate has been maintained to the present time, we must estimate the actual entire population at not less than 125,000; whilst, at the census of 1851, it was 109,257 only, It is certain that this immense increase of 15,000 persons has taken place almost exclusively in the Hoxton and Haggerstone Sub-districts; but I am unable to apportion this increase accurately between the several sub-districts; and to record the figures of 1851 would only suggest erroneous inferences. In reading this Table it will of course be borne in j 7 mind that the Hoxton New Town Sub-district, includes St. Luke's Workhouse; a deduction of 12 must be made from fever-deaths on this occount. No deaths from any of the other five zymotic diseases took place in this Workhouse. The Haggerstone West Sub-district containing Shoreditch Workhouse, in which is situated the fever hospital, includes some deaths that ought to be distributed amongst the Sub-districts where fatal sickness was contracted. It is shown in the last quarterly summary of the Registrar-general, that the fever mortality was greatest in the Eastern division of the metropolis, of which Shoreditch forms a part. I have therefore constructed Table III, for the purpose of showing not only what proportion the Shoreditch mortality from each zymotic disease bore to that of all London, but also to that of the Eastern division. It need not be said that the Eastern division is composed to a greater extent than any other of the great metropolitan divisions, of those classes which have always furnished the greatest contingent to the mortality lists. The Eastern division, it is well known, bears not only the weight of its own pauperism, but also an enormous proportion of that pauperism which on every principle of justice, it belongs to other districts to support. The concentration of the poorer classes of the London community in the East, seems to be constantly increasing ; depreciating property, crushing industry, burdening the ratepayers, and perpetuating the diseases which spring from immorality, destitution, and over crowding. It is no matter for surprise, if, under these circumstances, the fever mortality of the Eastern division is greater than that of the aristocratic districts of the West, whose comparative healthfulness is maintained at our expense. The population of Shoreditch may be estimated to be .22, or somewhat less than one-fourth that of the Eastern division of the metropolis. The mortalitv should of course bear the same proportion. Table III shows that from small-pox we have suffered very little, only one death having occurred from this cause in the parish ; and Mr. Ross, the relieving officer, informs me that no case of small pox has been sent to the Small Pox Hospital during the quarter. From measles, our loss was less than the London average, and more than that of the Eastern division. From scarlatina we lost rather more than the London average, and less than the Eastern average. From hooping cough our relative loss was in excess; from diarrhoea, in deficiency compared with both all London, and with the East. From typhus, our loss was much in excess relatively to all London, and about the same as in the Eastern division. 8 TABLE IV. Shewing the number of cases of Epidemic diseases admitted under the care of th< District Medical Officers, during the thirteen weeks ending 27th December, 1856. DISTRICT. MEDICAL OFFICER Small-pox. Measles. Scarlatina. Hooping Cough, Diarrhoea. Typhus. Total of Epidemics. Total Cases of Sickness of all kinds. Church End North Mr. Greenwood ... 19 11 ... ... 53 83 552 Church End South Dr. Burchell 5 5 12 ... 24 54 101 718 Iloxton Mr. Coward 1 18 25 ... 15 25 84 628 Workhouse Mr. Clark .. ... ... ... 3 21 24 719 Holywell & Moorfields Mr. Collier ... ... ... No Return. ... ... 6 42 48 ... 43 153 292 2617 The facts aggregated in this Table shew the sickness from zymotic diseases observed by the District Medical Officers, and the proportion of cases of this character to the cases of all kinds which came under their care. The following Table V. exhibits the total number of admissions into the Workhouse, with the number of admissions on account of sickness week by week. October. November. 4th. 11th. 18th. 25th. 1st. 8th. 15 th. 22nd. 29th. Total Admissions 41 25 42 37 40 38 19 44 23 Admissions from Sickness 13 19 18 21 13 17 16 19 10 December. 6th. 13th. 20th. 27th. Total Admissions 29 26 15 38 Admissions from Sickness 14 14 7 16 These admissions include 30 cases of zymotic diseases, and 20 cases of insanity. 9 This Table forcibly illustrates the influence of disease as a cause of pauperism. The total admissions into the Workhouse during the quarter were 407 ; the admissions from sickness — each case of which is regularly reported to me, together with the locality whence it was brought—were 197, or as nearly as possible one-half. It would be an inquiry full of practical interest, to trace out the various causes of the diseases which are the immediate causes of pauperism, and their relative proportions. Whilst intemperance, idleness, immorality, unwholesome food, and destitution, operate powerfully, there can be no doubt as to the far greater influence of evils which it is in our power to mitigate or remove. A large proportion of our population lives under conditions which render the preservation of health almost impossible. These conditions are centred in the dwellings of the poorer classes. An atmosphere empoisoned by exhalations from cess-pools, privies, sewers, and the pest-stratum, which is charged with every element of foulness, forms the air supply from without. Within, new sources of infection are added from dirt and animal excretions. The air, thus doubly empoisoned, is pent up in ill-constructed rooms destitute of all efficient means of ventilation. I refer to this great source of disease, because howsoever obvious and certain, its importance is underrated. It is held with great pertinacity in some quarters, that the great preventive remedy of fever, is the diversion of sewage from the Thames. That th e dwellings immediately exposed to the exhalations from the mud-banks, left at every ebb, are especially unwholesome, is indeed amply proved. But we have seen from the preceding statistical analyses, that the deaths from fever in the East division, including Shoreditch, which was high and far removed from the river, were considerably more than in the South, which is within its immediate influence. It is therefore in strictly local conditions that we must seek for the disease-producing causes. Disease must be pursued in its abiding-places; it can only be expelled by the vigorous application of sanitary remedies at the very spot where it takes its rise. That the sewage-matter received into the stream of the Thames is not in itself, and so long as it is not deposited on the banks, a fertile source of fever, is further proved by the following facts. The population actually living on the bosom of the Thames, whose every breath is a distillation from its waters, is not especially liable to fever ; not so much so, indeed, as the population whose dwellings 10 skirt the banks. And this littoral population, it must be borne in mind, is exposed not only to the malaria arising from the banks, but also to that same class of pernicious influences attached to bad sites and badly constructed houses, which are found alone sufficient to generate fever elsewhere. Few of the seamen who fill the medical deck of the Dreadnought have contracted their illness on the river under circumstances which can be connected with the state of its waters; and of these few, it will be found that the illness of most can be traced to cold, wet, exhaustion, bad food, and over-crowding in the close ill-ventilated forecastles of unhealthy ships. Most erroneous assumptions still continue to guide the exertions of those who are most earnest in favour of the present scheme for what is called the dispollution of the Thames, within the metropolitan boundary ; and very exaggerated sanitary results are anticipated from the execution of this scheme. A misapprehension of the true meaning of an expression used by Professor Faraday has led to much confusion. When this celebrated chemist described in an often-quoted letter to the Times, the " clouds of feculence" rolling in the river, and dilated in graphic language upon the opaque turbidity of the stream, he was too hastily understood to mean that these " clouds" and this turbidity, were nothing more nor less than sewage-matter. So far is this inference from being true, those clouds of so-called " feculence" are important agents in the purification of the Thames. Almost the whole of that matter which renders the river turbid, is earthy detritus—clay and silex, washed down from its banks and water-shed; or raised from its bed, and suspended in the mass of flowing waters in fine particles. This inorganic matter attracts and entangles the sewage-substances as these mingle with the stream. It thus exerts a powerful disinfecting and decomposing action on the organic matter. A series of observations, as yet incomplete, which I have made upon the waters of the Thames, taken at different periods of the tide, from alongside the Dreadnought, affords sufficient proof of the accuracy of these statements. The Thames is never so muddy, so turbid, or so opaque, as during the flood and high-water, precisely when it contains the minimum of sewage-matter; during the flood, the water contains a large quantity of inorganic mud, much common salt, and sulphates, and but a small proportion of organic matter, either in an unconverted form or in the form of animalcules and protophytes; at lowwater, on the other hand, when there is the maximum of sewage, the water is often almost bright, yielding comparatively little earthy deposit. At this time, even at 11 Greenwich, it is rare to find more than a trace of common salt or sulphates; we find traces of nitric acid, and a greater abundance of animalcules, especially of the Paramecium, of protophyt.es, and of unconverted organic matter. But I think it has not been proved by distinct evidence that this unconverted organic matter exists in a form which is capable of producing disease, so long, that is, as it is not deposited on the banks. The conditions under which the sewage at present flows into the river, are the most favourable for rapid conversion and disinfection; flowing constantly by thousands of natural out-falls and sewers into the Thames, along many miles of its course, the sewage is so sub-divided that speedy and perfect admixture with the stream is ensured. Very different are the conditions for the reception of the sewage by the Thames, in the plan adopted by the Metropolitan Board of Works, and very different would be the results. Concentrated in enormous masses, and discharged intermittingly by two points of out-fall only, the entire sewage of London would be propelled in a stream of great velocity. Under these circumstances the sewage would not instantly mix with, and be diluted by the whole volume of the river, as has been unaccountably assumed. Like the Gulf-stream which flows across the Atlantic; like the Plata which carries its stream of fresh water unmingled many miles into the ocean; like the confluence of the Rhine and the Main, whose streams, one coloured red, the other green, run on side by side, two rivers in one bed; so would the great Sewage-stream hold itscourse, a concentration of pollution, undiluted by the waters of the Thames. Other objections against this scheme have been well urged in the able report of your chief surveyor, Mr. Freebody. I advert to the subject here, because I deeply feel the importance of not suffering ourselves to be diverted from those practical sanitary duties which cannot be neglected without entailing incalculable cost of money and health. During the past quarter 217 houses have been specially reported on by myself or the inspectors. In the East division 298 notices, and in the West division 319 have been issued for the removal of nuisances, the abolition of cess-pools, the repair of drains, and the ventilation and cleansing of dwellings. The sewerage accommodation has, under your order, and the superintendence of the Surveyor, been extending; but I wish to take this opportunity of urging that measures be adopted to hasten the communication of houses with the new sewers in all cases where the occupiers have not yet availed themselves of the benefit now within their reach. A great sanitary as well as pecuniary capital is now lying comparatively idle. It is eminently desirable that as much of this work as possible should be accomplished before the summer, when the disturbance and exposure of foecal matter are seldom unattended with danger. The Gas-Supply—During the winter months especially, a large portion of town populations lives for several hours every day in an atmosphere exposed to deterioration and empoisonment by the combustion of gas. As the injurious properties of air so altered are more or less due to the greater or less impurity of the gas, as supplied to the public, I have felt it desirable to institute an examination of the gas consumed in Shoreditch. This is supplied by the Independent Gas-Works, at Haggerstone; I have at various times lately, tested the gas both at the Works, and elsewhere, for the ordinary impurities. The result is, upon the whole, satisfactory. On no occasion have I found a trace of carbonic acid, or sulphuretted hydrogen; there was however, a certain amount of ammonia. This impurity is objectionable because it is apt to carry with it certain tarry compounds, I have not however, obtained any tarry film on the surface of water through which the gas was made to pass even for a considerable time. The presence of ammonia induced me to examine in a similar manner the gas supplied by three other companies. The first of these gave no trace of carbonic acid or sulphuretted hydrogen, but like the gas of the Independent company, it yielded ammonia; the second gas yielded ammonia likewise, and, to my surprise, a very large amount of carbonic acid, and a distinct film of tarry matter; the third gas, derived from Cannel-coal, and supplied at six shillings the thousand cubic feet, also yielded ammonia. In an elaborate examination of the gas of six different companies, by Dr. Letheby, in 1854, ammonia was found in every instance; it must therefore be inferred that the purifying processes commonly in use, are not sufficient to ensure the separation of this ingredient. I am however, assured that efforts that promise to be successful will be made immediately in order to effect this separation. The illuminating-power was considerably greater than the standard required to be maintained by the Great Central Company: The pressure is 2.50 inches after day-light. In reference to this subject, I wish to advert to the fact, that the purest gas which it is possible to manufacture, must always be injurious to health if burnt in rooms where there is not a free escape for the products 13 of combustion, or a free circulation of air to dilute them. It is possible as we have seen, to supply gas free from carbonic acid, but it is not possible, notwithstanding the pretensions of patent stove makers, to burn it without creating that poison in volumes exactly proportioned to the extent of the combustion. Besides carbonic acid, during the burning of gas, a great and injurious quantity of sulphuric acid is also evolved. Many striking examples of the destruction of books, furniture, and goods from this cause, are given in Dr. Letheby's Report. It cannot be enforced too emphatically, that it is quite as rational and dangerous to burn gas in a close inhabited room without providing a vent for the vitiated air, and means for the supply of fresh air, as it would be to burn a coal - fire in a room without a chimney. There are invisible vapours far more poisonous than smoke. Gas, it must be remembered, is an article subject to great and sudden fluctuations in the quantity required. It may be expected, therefore, that occasional variations will be observed in the quality. If it be further remembered that some of the most pernicious contaminations are those necessarily produced in the act of burning, it will be obvious that, as regards protective measures, more rests with the consumer than with the manufacturer. I have the honour to be, Gentlemen, Your faithful Servant, ROBERT BARNES, 13, Devonshire Square, 17 th January, 1857. andrew t. roberts, printer, opposite shoreditch church, ' '''if '• ■> ■ > ' ~ ' .