WHAM 033 County Borough of West Ibam. ANNUAL REPORT on the PUBLIC HEALTH of the County Borough of West Ham, by CHARLES SANDERS, M.B. (Lond.), M.R.C.S. (Eng.), the Medical Officer of Health. LONDON: PRINTED BY SHAW & SONS, FETTER LANE AND CRANE COURT, E.C. 1894. County Borough of West Ham. ANNUAL REPORT Of the Medical Officer of Health for the Year 1893. PUBLIC HEALTH COMMITTEE. Alderman Geo. W. Kidd (Mayor). Alderman F. Smith (Chairman). Alderman R. Fielder. Councillor P. Alden. ,, Fowler. ,, Hunns. ,, Jacobs. ,, Noakes. Councillor Relf. ,, Rippin. ,, Rogerson. ,, Threlford. ,, Wood. To the Town Council of the County Borough of West Ham. Gentlemen, I have the honour to submit to you my Annual Report on the Health Statistics and the general sanitary condition of the Borough during the year 1893, that is to say, a short summary of the matters dealt with by your Committee, and the work done by the Public Health Department during the year. The. chief statistical tables referred to in this report will be found in appendices at the end, as will also a memorandum on hospital accommodation for small-pox patients, which I submitted to you in November, and a complete extract from the final Report of the Registrar-General of the Census Statistics of 1891, so far as they relate to West Ham. In various places throughout the report where it is deemed advisable to compare West Ham with other towns, I have compared it with, in some instances, the thirty-three great towns in England and Wales as a whole, but always with London, the latter being, in my opinion, the most suitable comparison, and one not calculated to err in favour of West Ham. The situation of the Borough being immediately outside the metropolitan area, the climatic variations do not materially differ in the two districts, while the natural arrangement of London as a whole is certainly much more favourable to that district than is the low-lying 2 formation of what used to be Essex Marshes to West Ham district. Another reason why it is advisable to compare West Ham with London arises from the fact that in the weekly death-rate list of the great English towns drawn up by the Registrar-General, and published in the daily press, the death-rate attributed to West Ham is always considerably below that of London, and, being uncorrected, tends to give a very inaccurate impression of the comparative mortality of the two districts. Births.—During the year 1893 1,604 births were registered in the Stratford Ward, 1,580 in Forest Gate Ward, 2,538 in Plaistow Ward, and 2,304 in Canning Town Ward, making a total of 8,026 births in the whole Borough, being 13 more than were registered in 1892, and equivalent to an annual birth-rate of 35.3 per 1,000. Deaths.—During the year, 749 deaths were registered in Stratford Ward, 879 in Forest Gate Ward, 1,194 in Plaistow Ward, and 1,144 in Canning Town Ward. Fifty-one deaths occurred in the Borough Small-pox Hospital, 44 in West Ham Hospital, 30 in the Branch Seamen's Hospital, 11 in the Plaistow Poplar Hospital, 4 in Forest Gate Industrial School, and 237 in the West Ham Workhouse. Besides these, 253 persons died in hospitals and other institutions in the metropolis who previously lived in West Ham, while 31 deaths were registered in the Borough of persons temporarily staying here. The correct number of deaths attributable to West Ham was therefore 4,565, or 546 more than occurred in the year 1892. Taking the Registrar-General's estimate of the population of the Borough at the middle of the year, viz., 227,405, the corrected annual death-rate amounted to 20 per 1,000, whereas the West Ham death-rate published by the Registrar-General was only 18.9, a much more favourable but fallacious figure. As it is, however, it compares favourably with London, the death-rate of which daring the year was 21.3, and with many of the great English towns, which in the aggregate registered an annual death-rate of 21.6. It is a matter of common knowledge that a low death-rate does not by itself necessarily point to a thoroughly sanitary district, and the recurring instances, one might say the almost invariable fact, of the West Ham death-rate being lower than that of the metropolis can, in my opinion, be explained chiefly by the large and constant additions we receive of young lives from without our district. A glance at the census returns on p. 16 will show what a large number of young married people we have in West Ham. The time is not far distant when the whole area of the Borough shall have been built over, and when our phenomenal decennial increases of population shall cease. Then the character of the Borough population, the precarious nature of the work of a large proportion of the inhabitants and the conditions under which they live, will counteract the above-mentioned favourable factor which at the present time induces many to fancy that our hard-working manufacturing town is not only more healthy than London, but nearly as healthy as Brighton. Chief Causes of Death.—In the appendix will be found a tabular statement of all the chief diseases causing death, distributed in various ages, in accordance with the table of the Registrar-General, together with tables of mortality and sickness required by the Local Government Board. The chief zymotic diseases caused 913 deaths, equivalent to an annual zymotic death-rate of 4 per 1,000, which is •9 above the London zymotic death-rate, and .4 above the average West Ham zymotic death-rate during the past eleven years. The increase was due to small-pox and scarlatina. Scarlatina was very prevalent during the whole year, about 500 cases being notified each quarter (vide Appendix, p. 65). In all, 2,184 cases occurred, causing eighty-three deaths. The disease did not attack one district more than any other 3 the cases being fairly distributed throughout the more populous parts of the Borough. Diphtheria, too, proved to be steadily increasing in the Borough. No distinct outbreak occurred which could be traced to a common source, but a general increase throughout the Borough in the number of cases. In all, 470 cases were notified, causing 104 deaths, besides which thirty deaths occurred from membranous croup. In the early months of the year measles, which had been epidemic in 1892, was still very prevalent in the northern half of the borough, while whooping-cough was raging in the southern half. The latter disease caused 143 deaths, nearly every certificate, as is usual in the case of this disease, giving bronchitis as a secondary cause of death. One death occurred from typhus fever; this was in a child aged five years, at Silvertown. I only received information of the case after death, and, as other members of the family occupied the same room, I obtained a magistrate's order for the removal of the body to a mortuary, the bedding and clothes being destroyed prior to disinfection of the premises. No other case of this disease occurred during the year. Cholera.—The precautions taken by the Port Sanitary Authority of London were successful in preventing the escape of cholera into West Ham. One case was notified, but on investigation proved capable of having a simpler explanation. The man had, up to within three days of his illness, been working at the river-side, but not in connection with any foreign boats. The following three days he was without both work and food ; obtaining some money on Saturday, he spent it in a pound and a half of apples in the afternoon, and a pound of hot potatoes in the evening, and was seized in the night with choleraic symptoms, which quickly succumbed to treatment. No less than 201 addresses were visited in response to intimations received that the persons whose addresses were given had left ships or places under the suspicion of having been exposed to the risk of cholera infection. Unfortunately, at most of these addresses the persons named were not known, in many cases the address given was a common lodginghouse or a house of lesser repute, and we naturally lost all trace of the person sought. During the summer the West Ham Board of Guardians granted the use of their hospital at Plaistow to the Council as a cholera hospital in the event of an outbreak, but with the exception of the above case it was not required. Early in September your Committee published throughout the Borough posters descriptive of the mode of infection and precautions to be taken in the case'of cholera. Small-pox.—A severe epidemic of this disease attacked the Borough throughout the year 1893. and has only just ceased. As the Council desired a short history of the epidemic, I have delayed this report until late in 1894, in order to be able to include not only an account of the small-pox statistics for 1893 but also those of the first half of 1894, which may be considered as practically the termination of the epidemic. From the beginning of the year 1893 to the end of June, 1894, 935 cases of small-pox occurred, causing 103 deaths, equivalent to a death-rate of 11 per cent. It is interesting to observe that more than half the cases occurred during the six months of 1894 (448 cases occurred during the whole of 1893, and 487 during the first six months of 1894). The disease was introduced into the Borough in January and February, from three separate sources, into three different parts of the Borough. On January 25th a sailor, who had been visiting some friends at Bow and appeared to have contracted the disease at the West India Docks, developed the disease at the house of a friend in Stratford New Town, and was promptly remove to hospital. On the next day three other cases were removed from the same house. No other case 4 occurred until February 22nd, when a young woman, living at Forest Gate, was removed suffering from Small-pox. She had contracted the disease by visiting her mother who lived at Bow, and who, being ill at the time, was shortly afterwards removed to the hospital ships of the Metropolital Asylums Board. On the same day a tramp was removed from the West Ham Workhouse to the Small-pox Hospital, but not before he had seriously infected the southern end of the Borough. He came from a common lodging-house in Poplar, evidently in an infectious condition, stayed two days in a common lodging-house in Canning Town, and then went to the workhouse, where he was discovered to be suffering from small-pox. The absolute impossibility of tracing and following up the denizens of this lodging-house is apparent, and the disease spread quickly among the unprotected and imperfectly vaccinated members of the population. One good has arisen out of the small-pox epidemic, namely, the fact that our temporary Cottage Small-pox Hospital has been closed, never to be opened again. In the height of the last epidemic of 1885-86, twelve cottages were acquired and hastily fitted for the reception of small-pox cases, and it may have been of some service to the Borough as a whole in dealing with the disease, but it certainly has proved a deadly enemy to the district of Plaistow in which it stood. Dr. Henry Power, Assistant Medical Officer of the Local Government Board, associated this hospital with its neighbour the hospital of the West Ham Guardians as potent factors in the spread of small-pox in Plaistow and Canning Town in 1886, and the circumstances connected with the late epidemic appear to bear out Dr. Power's contention. As noted above, the disease was introduced into the three wards of Stratford, Forest Gate, and Canning Town, but not into Plaistow Ward where the hospital is situate. It was not long, however, before Plaistow became invaded, suffering up till towards the close of the epidemic (as will be noticed presently) much more severely than either of the other wards—a fact very patent to those who have studied the monthly maps which I submitted to you during the period. Again, although the character of the various wards of the Borough (with the exception of one corner) does not materially differ, and although the hospital is situate close to the boundary of the Borough (the area of which is seven square miles), and is consequently only surrounded by population on three sides, yet three-fifths nearly of the whole cases of small-pox occurred within the hospital area formed by a half-mile radius from the hospital. The following table gives the cases occurring within and without the hospital area with their respective percentages during each quarter:— No. of Cases occurring in Percentage of Cases occurring in Hospital area. Rest of Borough. Hospital area. Rest of Borough. 1893. 1st quarter 7 22 .7% 2% 2nd quarter 47 119 5 12 3rd quarter 92 66 9 7 4th quarter 43 52 4 5 1894. 1st quarter 59. 147 6 15 2nd quarter 103 178 11 19 5 The fact mentioned above that Plaistow Ward suffered enormously throughout the epidemic as compared with the other three wards is shown in the table below, which gives the cases occurring monthly distributed to their respective localities. From this it will be seen that out of the 935 cases 557 occurred in Plaistow Ward, and that, while Stratford Ward was responsible for 11 per cent. of the total number, Forest Gate for 12 per cent., and Canning Town for 17 per cent., no less than 59 per cent. of the cases developed in Plaistow, a much larger percentage than is warranted by the population. TABLE shewing monthly attacks of small-pox. Period. Stratford. Forest Gate. Plaistow. Canning Town. 1893.—Feb. 1 7 3 i Mar. 3 3 5 6 Apr. 3 — 19 7 May 9 1 44 12 June 2 5 49 15 July 5 1 43 1 Aug. 1 - 36 2 Sept. 3 - 46 20 Oct. 1 1 23 2 Nov. — 3 22 9 Dec. 6 2 l6 10 1894.—Jan. 6 6 24 16 Feb. 16 8 40 12 Mar. 16 22 29 11 Apr. 11 19 91 15 May 16 30 56 20 June 2 8 11 2 Total 101 116 557 161 176 243 269 247 Percentage of Cases 11% 12% 59% 17% Percentage of Population 18.8% 26% 28.8% 26.4% 6 TABLE showing the number of houses newly attacked with small-pox in certain areas of the Borough during each month of 1893, namely: (a) within a zone of a half-mile radius from the hospital, (b) within a zone between half-mile and one mile from the hospital, (c) in the rest of the Borough ; together with the rateds per cent, of the houses, thereby showing that the houses within half-mile of the hospital suffered (three times as much as those between half-mile and one mile of the hospital, and eight times as much as those situated beyond a mile from the hospital 1893. Houses newly attacked with small-pox, of which situate The same in rates per cent, of houses Within half-mile of hospital. Between half-mile and one mile of hospital. In the rest of the Borough. Within half-mile zone. Within half-mile to one mile zone. Within the rest of the Borough. January — - - - - .00 February — — 1 — — .00 March 3 1 9 .07 .01 .04 April 2 9 9 .05 .12 .04 May 14 10 24 .36 .13 .11 June 16 12 14 .41 .16 .06 July 27 4 7 .70 .05 .03 August 17 5 3 .44 .06 .01 September 10 9 2 .26 .12 .00 October 6 8 3 .15 .11 .01 November 8 2 7 .20 .02 .03 December 9 1 8 .23 .01 .03 112 61 88 2.87 79 .36 7 TABLE showing houses newly attacked with small-pox during the six months, January to June, 1894. 1894. Houses newly attacked, of which situate The same in rates per cent, of houses Within half-mile of hospital. Between half-mile and one mile zones. In rest of Borough. Within half-mile zone. Within half-mile to one mile zone. In rest of Borough. January 10 7 18 .26 .09 .08 February 18 9 .47 .12 .07 March 17 31 32 .44 .43 .I5 April 28 2 5 3i .73 .34 -I4 May 15 13 26 .39 .18 .12 June 3 2 7 .07 .02 .03 91 87 129 2.36 1.18 .59 It will be noticed in the tables given above, that the incidence of attack upon the hospital area was most extreme during the third quarter of 1893, and also that with the commencement of 1894 the disease, which up to this time had played havoc in Plaistow, and to a lesser extent in Canning Town, leaving Stratford and Forest Gate comparatively free, became disseminated much more evenly throughout the Borough. In this connection there are some interesting facts which, to some extent, may throw light on the peculiarities of incidence. Down to the end of May our hospital could only accommodate fifty patients. At this period the Mayor, Mr. Alderman Geo. Kidd, took prompt action to increase the accommodation which was rapidly becoming exhausted, and for that purpose he, with the Town Clerk, arranged to rent four additional cottages situated beside and at a right angle to" the existing hospital, together with a neighbouring plot of ground on which were speedily erected two temporary iron wards, which, together with the added cottages raised the accommodation to ninety-five beds. It cannot but suggest itself as highly probable that this increased accommodation, though absolutely necessary and very advantageous to the rest of the Borough, assisted in swelling the number of Plaistow cases. With regard to the second point mentioned, it will be within the recollection of the Council that towards the close of the year the hospital became the centre of a considerable public scandal arising chiefly through the statements of a patient, whose complaints had been previously investigated by the Council without finding confirmatory evidence, and whose conduct in hospital appeared to have been far from regular. In spite of this investigation, a public meeting was held in Plaistow—not to complain of the hospital being situated there, but of the general 8 management of the domestic arrangements—which meeting being fully reported in the press, led to considerable correspondence, From this time I found it increasingly difficult to remove cases into the hospital, with the natural result that many remained at home forming separate centres of infection throughout the Borough. This led to a considerable increase in the number of cases. On April 16th of the present year, at the request of the Town Clerk, I accompanied him to a meeting of the Small-pox Committee of the Metropolitan Asylums Board who undertook to remove cases of small-pox from West Ham to their hospital ships on terms which were reported to and accepted by the Council By this arrangement we were enabled to obtain prompt removal of all cases from the Borough, though not until I had obtained a magistrate's order for removal in four cases. A steady decrease in the cases occurred during the end of May and the month of June, and at the time of writing the epidemic has ceased, and our hospital finally closed. I am indebted to the medical superintendent of the hospital, Dr. Moir, for the following experiences of mortality and vaccination associated with the cases treated in the hospital during the epidemic. Condition as to Vaccination. Percentage of Deaths. Unvaccinated 35 per cent. Said to have been vaccinated, but with no marks 23'57 Imperfectly vaccinated 11 „ Showing good marks 401 „ ,, 2 ,, 2.5 „ „ 3 „ 1.9 „ „4 „ .55 „ Re-vaccinated 0 „ During the epidemic, as will be seen by the list on p. 40, several cases were admitted into our hospital at the request of neighbouring sanitary authorities, until the strain upon the accommodation arising from the spread of the disease in our own Borough rendered it impossible to further relieve outlying districts. Eighty cases were admitted from East Ham, nine from Leyton, and five from Walthamstow. Hospital Accommodation.—The required provision for the isolation of fevers and small-pox received considerable attention during the year. A conference of the Urban Sanitary Authorities comprised in the West Ham Union was invited by the Mayor to meet at the Town Hall. The conference was held on February 17th, when Dr. Barry, of the Local Government Board, attended and gave the Council the benefit of his experience. The object of the Council was primarily to invite the other sanitary authorities to combine for the purpose of treating small-pox, leaving each authority free to deal with the other infectious diseases occurring in its district; but after discussion, a resolution was carried, " That it is desirable to unite in providing a hospital or hospitals for infectious diseases other than small-pox," the desirability to combine for purposes of small-pox having been previously accepted. 9 On June 13th, the Council, having considered the above resolutions, decided to adhere to their previous decision to combine with the adjoining authorities for small-pox purposes only, and to treat other infectious diseases in a separate hospital Jor the Borough. The further action taken by the Council in this question during the year is to be found in the memorandum which I submitted to the Council in November [vide Appendix, p. 32). Early in the summer I was instructed to report upon the Canning Town Pumping Station and the Manhattan Wharf as possible sites for a temporary cholera hospital ; my report being unfavourable in each case, and, as previously mentioned, the Council obtained the use of the Guardian's Hospital for this purpose. Housing of the Working Classes Act, 1890.—Under section 32 of this Act, I reported the undermentioned houses during the year 1893, with the following results:— Nos. 14 to 43 (consecutive) Channelsea Street. (Rendered fit). Nos. 1 to 13 (odd) Prospect Row. (Rendered fit). Nos. 1, 2 and 3, Hayward's Cottages. (Rendered fit). Nos. 7, 9, 10, 11, 14, 16, 24, 26, 27, 29, East Street. (Rendered fit). Nos. 4 to 10 (even) and No. 20, South Street. (Rendered fit1. Nos. 2, 4, 6, 22, 23, 24, 25, 30, 32, Union Street. (Rendered fit). No. 70, Freemason's Road. (Rendered fit). No. 24, Young Street. (Used only as Workshop). Nos. 27, 29, 31, 33, Young Street. (Rendered fit). Nos. 2 to 32 (consecutive) New Street, Stratford. (Rendered fit). No. 165, Balaam Street. (Rendered fit). No. 20, Andrew Street. (Rendered fit). No. 141, Prince Regent's Lane. (Rendered fit). No. 15, Western Road, Plaistow. (Closing order obtained. Council ordered demolition). Nos. 35, 37, 39, 41, Hallesville Road. (Closing order obtained). Nos. 5, 7, 9, Newton Street. (Closed and rendered fit). No. 80, Victoria Dock Road. (Closing order obtained). No. 9, Fulton Street. (Closing order obtained). No. 41, Edward Street. (Rendered fit). No. 11, Newton Street. (Closed). Nos. 11, 13, 15, 19, 27, 29, 37, 39, 41, Brown's Road. (Rendered fit). Nos. 2, 4, 6, 16, 18, Gift Lane. (Demolished by owners). Nos. 2, 4, 6, Caroline Place, Portway. (Demolished by owners). Rear of Carpenter's Arms. (Rendered fit). No. 9, Market Place, Silvertown. (Rendered fit). 10 Food Inspection.—During the year 153 samples were submitted to the Public Analyst under the Sale of Food and Drugs Acts and the Margarine Act. Of these 31, or 20 per cent., were returned as adulterated as follows:— Articles submitted. Number submitted Number adulterated. Milk 56 18 Spirits 4 1 Mustard 11 2 Butter 27 6 Liquorice 2 0 Condensed Milk 2 2 Coffee l6 1 Lard 16 1 Pepper 11 0 Chicory 6 0 Tea 1 0 Cayenne Pepper 1 0 The results of prosecution in the above cases will be found in the table on pages 45, 46 and 47. General Sanitary Work.—In the early part of the year the Public Health Department was reinforced by the appointment of four additional Assistant Inspectors of Nuisances, thereby enabling a much larger amount of sanitary work to be done during the year, and this in much greater proportion than the ratio of increase in staff, as may be gathered from this and my previous reports. Details of the nuisances remedied will be found on p. 43, but it may here be mentioned that among other of their duties the Inspectors have carried out the following:— Number of House-to-house Inspections 4,840 Do. Inspections re Infectious Disease 3>422 Do. Re-inspections 9,680 Do. Inspections of Slaughter-houses 549 Do. do. Bakehouses 33° Do. do. Common Lodging-houses 246 Do. do. Factories 259 Do. Miscellaneous Inspections 1,210 Total 20,536 Gipsy Squatters.—These were a source of constant trouble to the department during the year, and the cause of frequent complaints from burgesses and others. During the greater part of the year the Sanitary Inspectors continued to put in force the method of warning the gipsies off the plots of land on which they were located, and, failing compliance, forcibly removing their vans and tents with a trace-horse into the public roadway, where they came under the notice of the police, and were " moved on." At the end II of the year the Council ordered legal proceedings to be taken against the squatters for infringing the Gipsy bye-laws. The following is a list of forcible removals by the Inspector:— January 5.—5 vans removed from the Ravenhill Estate. ,, 13.—4 vans removed from land in Beckton Road. 2 vans removed from land in Chargeable Lane. 1 van removed from Ravenhill Estate. February 13.—1 van and tent removed from land in Tucker Street. ,, 17.—5 vans and 2 tents removed from Ravenhill Estate. April 20.—3 vans removed from Ravenhill Estate. 7 vans removed from land in Beckton Road. ,, 28.—2 vans removed from Ravenhill Estate. May 12.—3 vans removed from Ravenhill Estate. ,, 18.—7 vans and 3 tents removed from Ravenhill Estate. 2 vans, 5 carts, and 3 tents removed from land in Beckton Road. ,, 30.—1 van and 3 tents removed from Ravenhill Estate. 1 van removed from land in Beckton Road. July 14.—2 vans, 3 carts, and 4 tents removed from Ravenhill Estate. 3 vans and 1 tent removed from land in Beckton Road. September 21.—10 vans, 6 carts, and 4 tents removed from Ravenhill Estate. 1 van and 4 carts from land in Beckton Road. October 3.—Notices to remove served on 4 gipsies on Ravenhill Estate, and on 6 gipsies on land in Beckton Road. November 29.—4 gipsy squatters summoned under bye-laws, and fined 10s., with 7s. costs each. The disappointing character of this work can be seen by the above list. The squatters perambulate a few streets, soon returning to the same or a neighbouring spot, when the process of removal, like the stone of Sisyphus, has to be commenced all over again. Parliamentary.—One of the most important results of the year's work was the passage through Parliament of the West Ham Corporation Act, 1893, an Act fraught with great and lasting benefits to the inhabitants of the Borough in many respects, but mostly, perhaps, from a sanitary point of view. Undoubtedly, the chief hygicnic. provisions of the Act are the clauses authorising the reception and dealing with the sewage of the Borough by the London County Council by means of the northern outfall sewer, which crosses the centre of the Borough. The Act consists of eleven parts, but I need only mention here Parts VI., VII., VIII., dealing with sanitary matters, infectious diseases, and common lodging-houses, respectively. Part VI.—Sanitary. Section 38 extends the definition of nuisances contained in section 91 of the Public Health Act, 1875, include those articles, places, or things which are dangerous to health, as in the Public Health (London) Act, 1891. Section 39 gives additional power to the Corporation in dealing with walls and ceilings which may be broken or dilapidated. 12 Section 40 provides a penalty not exceeding five pounds for the wilful damage of or the wilful improper use of any drain, water-closet, earth-closet, privy, or ashpit. Section 41 enables the officers of the Corporation to examine any sanitary convenience or fitting, either upon reasonable grounds for believing the existence of a nuisance, or for the purpose of examining the course of the same, without receiving the written complaint mentioned in section 41 of the Public Health Act, 1875. Section 42 gives powers to make bye-laws for securing freedom from pollution of receptacles for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the food of man. Section 43 provides a penalty not exceeding forty shillings, and a daily penalty not exceeding twenty shillings, for non-compliance with an order to close a polluted well under section 70 of the Public Health Act. Section 44. Any dwelling-house without a proper and sufficient water-supply to be deemed unfit for human habitation, and no new dwelling-house to be occupied until provided with such supply. Section 45. The Corporation may require alteration of or removal to a place specified by them of urinals so placed as to be offensive to public decency. Section 46. The Corporation may require urinals to be attached to inns, refreshment-houses, or places of public entertainment. Section 47 provides that sections 96, 97, and 98 of the Public Health (London) Act, 1891, shall extend to and apply within the County Borough. Section 48. The provisions of section 73 of the Public Health Act, 1875, shall extend to persons occupying any cellar-dwelling which does not conform with the requirements of section 72 of that Act, although such cellar-dwelling is not occupied or suffered to be occupied for hire or rent. Section 49 gives further powers in dealing with strayed swine. Section 50 enables the Corporation to employ scavengers for collecting and removing manure, &c., from stables and cow-houses. Section 51 is identical with sub-sections 3 and 4 of section 47 of the Public Health (London) Act, 1891. Section 52 provides for the lighting of common stairs, passages, or courts; and section 53 empowers the Corporation to supply the light and charge the owners. Part VII.—Infectious Diseases. Section 54 empowers the Corporation to require the cleansing, purifying, or destroying of any articles of bed or body clothing in such a filthy or unwholesome condition that health is affected or endangered thereby. Section 55. It shall not be lawful to hold any wake over the body of any person who has died of an infectious disease, and the occupier of any house who permits such wake to take place shall be liable to a penalty not exceeding forty shillings. Section 56. The words "without proper lodging or accommodation" in section 124, of the Public Health Act, 1875, shall be construed to include any person without proper lodging or accommodation, having regard to the danger of infection to other persons in the same house. 13 . Section 57. Dairymen supplying milk within the Borough to notify infectious disease existing among their servants. Section 58. A person who knows himself to be suffering from an infectious disease shall not milk any animal, or pick fruit, or engage in any occupation connected with food intended for the use of man, or carry on any trade or business so as to be likely to spread the disease. Section 59 prohibits the sale of the milk of tuberculous cows. Section 60. Dairymen supplying milk within the Borough to notify all cases of tuberculosis or milk fever to his knowledge occurring in his dairy. Section 62. Dairymen who stop supplying milk at the request of the Corporation to be compensated. Section 63. Midwives and nurses who stop their employment at the request of the Corporation to be compensated. Section 64 provides a penalty on the person having charge of a child, who resides in a house where an infectious disease has existed within six weeks, permitting the said child to attend school without a medical certificate. Section 65 provides a penalty on any person having charge of a school who shall knowingly permit any child to attend school in contravention of the provisions of this Act. Section 66. Whenever a scholar shall be suffering from an infectious disease, the principal of the school shall, at the request of the Corporation, furnish a list of pupils with their addresses. Section 67 enables the Corporation to pay the expenses of maintenance of patients other than paupers received into the Borough Hospital. Part VIII.—Common Lodging-houses. Section 69 requires the keeper or his authorized deputy to reside constantly and remain within his common lodging-house between the hours of 9 p.m. and 6 a.m. Section 70 provides a penalty, not exceeding forty shillings, on every person who keeps a common lodging-house without being registered in accordance with section 77 of the Public Health Act, 1875. Section 71. Notwithstanding anything contained in section 88 of the Public Health Act, 1875, where a common lodging-house keeper has been convicted of any offence against the provisions of the Public Health Act, or of this Act or any other Act in force within the Borough, or of any bye-law made under the authority of any of such Acts in respect of common lodging-houses, the court before whom the conviction takes place may cancel the registration of any such common lodging house keeper. Section 72. The Corporation may refuse to license any person as keeper of a common lodging-house, unless they are satisfied of his character and fitness for the position. Other provisions of a sanitary tendency contained in the Act are section 31, which enables the Corporation to require yards or open spaces in connection with any house to be flagged or paved for at least 100 square feet adjoining the house, and section 34, which deals with licenses for the erection of slaughterhouses and knacker's-yards. 14 It will have been seen that many of the provisions contained in the above Act are similar to those contained in the Public Health (London) Act, 1891, and the Council used every endeavour to obtain the insertion of section 42 of that Act dealing with "bad workmanship" in the repair of water-closets and drains, but were unsuccessful. In the same manner they failed to obtain powers to prevent the opening and carrying on of private hospitals for infectious disease without the license of the Corporation. I am, Gentlemen, Your obedient servant, CHARLES SANDERS. Medical Officer of Health. APPENDIX CONTAINING 1. Census Returns, 1891. 2 Memorandum on Small-pox Hospital Provision. 3. List of Small-pox cases removed to Hospital. 4. List of West Ham Deaths occurring in London Institutions. 5. List of Notices served to abate Nuisances, &c. 6. Table of Prosecutions under various Acts and Bye-laws. 7. Tables of Birth, Death and Zymotic Rates for several years past. 8. Table of Mortality Statistics of large English Towns during 1893. 9. Table of West Ham Deaths at several groups of ages from different causes during 1893. 10. List of Streets in the Borough, distinguishing cases of Infectious Disease notified, Deaths From Infectious Disease, and Deaths from other diseases. 11. Table A required by Local +Government Board. 12. Table B required by Local Government Board. 16 CENSUS RETURNS, 1891. ADMINISTRATIVE. County Borough. Area in Acres. Houses. Population. Inhabited. Uninhabited. Building. Persons. Males. Females. West Ham 4,706 32,066 1,658 334 204,903 102,341 102,562 PARLIAMENTARY. County Borough of West Ham. Area in Acres. 1891. 1881. Inhabited Houses. Population. Population. Males. Females. Persons. Persons. North Division 4706 15,053 44,815 47,308 92,123 66,675 South Division 17,013 57,526 55,254 112,780 62,278 MUNICIPAL. Municipal Borough. Administrative County. Area in Acres. Inhabited Houses. Population Enumerated. Increase of Population between 1881 and 1891. 1881 1891 1881 1891 West Ham County Borough. 4,706 19,167 32,066 128,953 204,903 75.950 17 MUNICIPAL WARDS. West Ham County Borough. Houses. Population. Inhabited. Uninhabited. Building. Persons. Males. Females. Wards—Canning Town 7,715 432 56 54,750 28,716 26,034 Forest Gate 9.103 499 136 53,511 25,600 27,911 Plaistow 9,298 479 132 58,030 28,810 29,220 Stratford 5,950 248 10 38,612 19,215 19,397 ECCLESIASTICAL PARISHES. Ecclesiastical Parish. Date of Formation. Inhabited Houses. Population. Ancient Parish in which situated. Forest Gate, All Saints 1886 1,218 6,821 East Ham and West Ham. Upton Park, St. Stephens 1888 2,478 13,786 East Ham and West Ham. Barking Road, Holy Trinity 1867 2,425 17,069 West Ham. Canning Town, St. Gabriel 1879 1,396 9,790 Forest Gate, Emmanuel 1852 2,764 14,816 Forest Gate, St. James 1881 1,519 10,003 Forest Gate, St. Saviour 1884 1,598 8,780 West Ham, All Saints — 4,061 26,180 Plaistow, St. Andrew 1871 2,569 15,125 Plaistow, St. Mary 1846 3,588 21,393 Stratford, St. John 1844 2,187 13,355 Stratford, St. Paul 1864 2,295 14,378 Stratford, Christchurch 1852 1,546 11,400 Victoria Docks, St. Luke 1875 3,990 29,381 Victoria Docks, St. Mark 1862 1,131 7,676 Wanstead, Harrow Green, Holy Trinity 1879 4,952 29,619 Wanstead, Low Ley ton, and West Ham. 18 *Total Tenements and Tenements with less than Five Rooms, distinguishing those occupied by various numbers of Persons. Sanitary District. Rooms in Tenement. Number of Tenements with less than Five Rooms. Number of Occupants of Tenements. 1 2 3 4 5 6 7 8 9 10 11 12 or more. County Borough of West Ham. 1 2,287 1,003 717 361 148 42 10 2 i 2 — — 1 2 4156 371 1372 1,057 664 402 178 68 32 8 3 — 1 Total T enements= 3 8,291 209 1.577 1730 15I7 1,261 985 567 275 115 43 9 3 42,921 4 9.036 121 1,078 1,369 1517 1,468 1,266 978 671 357 130 55 26 *This Table is to read as follows:—Of the 42,921 tenements in West Ham, 2,287 were tenements of one room, 4,156 were tenements of two rooms, &c., &c.; and of the 2,287 tenements of one room, 1,003 had one occupant each, 717 two occupants, &c., &c. 19 Inmates of Institutions on Census Night. Name of Institution. Total Number of Inmates, including Officers. Number of Special Inmates, such as Paupers, Patients, &c. Persons. Males. Females. Persons Males. Females. West Ham Hospital 36 18 18 24 17 7 Plaistow Fever Hospital 5 2 3 — — — West Ham Small-pox Hospital 6 1 5 1 1 — Cottage Small-pox Hospital 2 1 1 — — — Seamen's Hospital 15 9 6 7 7 — Forest Gate Industrial School (Poplar Union). 586 300 286 536 290 246 Persons enumerated on board Sea-going Vessels and in Inland Barges in Harbours, Rivers, Creeks, and Canals. Registration District. Number of Sea-going Vessels. Number of Inland Barges. Persons. On board Sea-going Vessels. On board Inland Barges. TOTAL British. Foreign or Colonial. British. Foreign or Colonial. StratforD — - 9 — — 18 18 Canning Town 66 1 38 544 4 117 665 20 Ages of Males and Females in County Borough of West Ham. All Ages. Under 1 year. 1— 2— 3- 4— Under 5 years. 5— 10— 15— 20— 25— 30— 35- 40 45 50- 55— 60— 65— 70— 75— 80— 85— 90— 95- 100 and upwards. Persons. Males and Females. 204,903 Males, 102,341 3.067 2,977 2,958 2,960 2,920 14,882 13724 11,849 9,939 8,943 8,174 7,616 6,806 5,682 4.697 3,624 2,325 1,828 1,123 674 307 115 26 6 1 Females, 102,562 3.307 2,856 3,072 2,997 2,906 15.138 13,727 12,047 9,560 8,600 8,298 7,499 6,694 5.532 4,520 3.463 2,394 1977 i,355 979 494 196 76 12 1 Condition as to Marriage, with ages of Males and Females. Urban Sanitary District. All Ages. Under 1 5 years. 15— 20— 25- 35— 45— 55— 65 and upwards. West Ham:— Unmarried Male 63715 40,455 9,880 6,784 4,448 1,25: 621 211 65 Female 59.551 40,912 9,240 4,851 2,739 917 456 238 198 Married Male 36,106 — 59 2,142 11,168 10,802 7,H7 3,328 1,490 Female 37171 — 318 3,721 12,718 10,464 6,265 2,661 1,024 Widowed Male 2,520 — - 17 174 435 583 614 697 Female 5.840 — 2 28 340 845 1,262 1,472 1,891 22 Occupations of Males and Females of Ten Years and Upwards. Males. Females. 73,735 73.697 Total. I.—Professional Class. 546 33 Civil Service (officers and clerks). 228 — Civil Service (messengers). 321 — Police. 84 40 Municipal, parish, union officer. 26 — Other local or county official. 5 — Army officer. 37 — Soldier and non-commissioned officer. 5 — Navy officer. 18 — Seamen, R.N. and Royal Marines. 53 — Clergymen, Established Church. 16 — Roman Catholic priest. 33 — Minister of other religious bodies. 47 36 Missionary, scripture reader, itinerant preacher. — 2 Nun, sister of charity. 32 9 Church, chapel, cemetery officer, servant. 29 — Barrister, solicitor. 216 1 Law clerk. 89 — Physician, surgeon. 13 — Dentist, dental apparatus maker. 4 — Veterinary surgeon. 2 409 Sick nurse, midwife, invalid attendant. 27 4 Subordinate medical service. 331 905 Schoolmaster, teacher, professor. 339 5i3 Student (fifteen years and over). 39 7 School service or concerned in teaching. 18 3 Author, editor, journalist. 17 2 Reporter, shorthand writer. 35 1 Engaged in scientific pursuits. 3 — Literary, scientific institution service. 51 — Civil and mining engineer. 33 — Land, house, ship, surveyor. 37 21 Painter, engraver, sculptor (artist). 43 — Architect. 110 181 Musician, music master. 38 4 Photographer. 23 Males. Females. 17 18 Actor. 10 1 Art, music, theatre service 47 6 Performer, showman, exhibition service. II.—Domestic Class. 92 5,731 Domestic servant (indoors). 30 — Lodge, gate, park-keeper. 493 363 Inn, hotel servant. 12 4 Cottage, club servant. 48 31 Office keeper, caretaker. 59 40 Cook (not domestic). — 435 Charwoman. 65 1,098 Washing and bathing service. 14 [8 Hospital and institution service. 17 14 Others. III.—Commercial Class. 17 — Merchant. 234 4 Broker, agent, factor. 72 3 Auctioneer, house agent, valuer. 67 — Accountant. 44 4 Salesman, buyer (not otherwise described 470 — Commercial traveller. 3.289 149 Commercial clerk. 9 1 Officer of commercial company. 2 — Banker. 137 4 Bank officials and clerks. 7 2 Bill discounter, broker. 256 3 Life, house, ship, &c., insurance service. 537 — Railway engine driver, stoker. 164 — Railway guard. 106 — Railway pointsman. 832 6 Railway porters and servants. 494 — Railway officials and clerks. 38 — Livery stable keeper, cab proprietor. 447 — Coachmen, cabmen, groom, horsebreaker. 1,330 3 Carman, carrier, carter (not farm). 147 1 Tramway service. 12 — Navigation service (not crew). 24 Males. Females. 451 2 Bargeman, lighterman, waterman. 2,203 7 Merchant service, seaman, pilot. 3,307 — Dock and wharf labourer. 430 9 Harbour, dock, wharf officials. 254 5 Warehouseman. 28 — Meter, weigher. 1,404 9 Messenger, porter (not railway or government). 123 31 Telegraph, telephone service. IV.—Agricultural and Fishing Class. 7 1 Farmer, grazier. 4 — Farm bailiff. 81 12 Agricultural labourer, farm servant. 2 — Shepherd. 5 — Others connected with agriculture. 2 — Woodman. 228 18 Gardener, nurseryman. 11 — Cattle, sheep, pig dealer, salesman. 8 — Drover. 1 — Gamekeeper. 2 — Dog, bird, animal keeper, dealer. 26 7 Knacker, cats'-meat dealer. 5 — Fisherman. V.—Industrial Class. 68 6 Publisher, bookseller, librarian. 97 76 Bookbinder. 658 14 Printer. 55 24 Newspaper agent. 60 3 Lithographer. 2 2 Map and print colourer, seller. 881 13 Engine and machine maker. 69 — Millwright. 1,373 — Fitter and turner (engine and machine). 1,106 — Boiler maker. 10 1 Spinning, agricultural, domestic implement maker. 18 1 Tool maker. 18 — Cutler and scissors maker. 15 — Saw and file maker. 122 9 Watch, clock maker. 25 Males. Females. 59 5 Philosophical instrument maker. 310 17 Electrical apparatus maker. 17 1 Weighing and measuring apparatus maker. 6 8 Surgical instrument maker. 31 — Gunsmith. 38 1 Musical instrument maker. 7 — Type-cutter, founder. 8 — Die, seal, coin maker. 25 24 Fishing-tackle, toy maker, dealer. 327 — Builder. 1,718 3 Carpenter, joiner. 1,217 1 Bricklayer. 242 1 Mason. 45 — Slater, tiler. 280 1 Paperhanger, plasterer, whitewasher. 442 2 Plumber. 1,167 1 Painter, glazier. 361 50 Cabinet maker, French polisher, upholsterer. 164 1 Locksmith, bellhanger, gasfitter. 37 4 House and shop fittings maker, dealer. 43 4 Undertaker, funeral furniture maker. 9 — Wood carver. 29 — Carver and gilder. 3 1 Dealer in works of art. 2 — Figure, image maker, dealer. 1 2 Animal, bird, &c., preserver. 1 17 Artificial flower maker. 598 3 Coach, carriage maker. 126 — Wheelwright. 75 — Bicycle, tricycle maker. 20 3 Others. 81 6 Saddler, harness maker. 115 — Shipwright, barge builder (wood). 944 1 Shipwright, ship and barge builder (iron). 49 — Ship-rigger, fitter. 24 1 Sail maker. 25 — Ship chandler. 62 5 Dye, paint, ink, blacking manufacture. 49 211 Fireworks, explosive articles manufacture. 133 11 Chemist and druggist. 578 14 Manufacturing chemist, alkali, &c. 26 Males. Females. 4 — Drysalter. 121 68 Tobacconist, tobacco manufacturer. 9 5 Tobacco-pipe and snuff-box maker. 172 21 Innkeeper, publican. 13 77 Lodging-house keeper. 108 35 Coffee, eating-house keeper. 6 — Hop merchant, dealer. 12 — Maltster. 88 — Brewer. 137 28 Beerseller, ale, porter, cider. 89 2 Cellarman. 46 1 Wine, spirit merchant, agent. 366 31 Milkseller, dairyman. 91 3 Cheesemonger, butterman. 624 33 Butcher, meat salesman. 80 16 Provision curer, dealer. 298 24 Fishmonger, poulterer. 110 11 Corn, flour, seed merchant, dealer. 52 1 Corn miller. 582 52 Baker. 176 367 Confectioner, pastrycook. 380 61 Greengrocer, fruiterer. 7 2 Mustard, pickle, spice maker, dealer. 690 9 Sugar refiner. 732 136 Grocer, tea, coffee, chocolate maker, dealer. 21 5 Mineral water manufacturer, dealer. 19 4 Wool, worsted, flannel worker. 15 — Dealer in wool and worsted. 19 50 Silk, satin, velvet worker. 3 1 Silk merchant, dealer. 64 242 Cotton, linen, lace manufacture. 3 — Cotton, linen, lace dealer. 81 347 Hemp, jute manufacture. 28 27 Rope, twine, cord maker. 39 29 Mat maker. 6 66 Canvas, sailcloth, sacking maker. 3 2 Others working in hemp. 8 — Dealers in hemp. 5 65 Weaver (undefined). 28 5 Dyer, bleacher, calenderer (undefined). 11 42 Textile factory hand (undefined). 11 1 Carpet, rug manufacture. 27 Males. Females. 432 432 Ltnen draper, mercer. 32 86 Fancy goods worker, dealer. 11 — Other dealers. 45 14 Hatter, hat manufacture (with straw plait) 405 596 Tailor. 34 2,302 Milliner, dressmaker, staymaker. 27 385 Shirtmaker, seamstress. 86 98 Hosier, glover. 656 74 Shoemaker. 212 6 Wigmaker, hairdresser. 47 31 Umbrella stick maker. 14 25 Others working and dealing in clothes. 126 11 Tallow chandler, candle maker. 177 5 Soap boiler, maker. 63 3 Manure manufacture. 9 — Bone, horn, ivory, tortoise shell worker. 22 — Others working in similar industries. 96 38 Furrier, skinner. 69 11 Currier, leather goods maker, dealer. 87 52 Brush, broom maker, dealer. 10 20 Quill, feather dresser, dealer. 173 24 Oil and colourman. 41 4 Floorcloth manufacture. 259 107 India rubber, water proof goods, worker. 95 2 Others in similar industries. 21 7 Basket makers, hay and straw cutters. 4 — Cane, rush, straw dealer. 73 1 Timber, cork, bark merchant, dealer. 175 — Sawyer. 66 38 Wood turner, wooden box maker. 362 — Cooper. 131 20 Others working in wood, cork, bark. 18 3 Paper manufacture. 128 49 Stationer. 22 11 Ticket, label writer. 3 14 Envelope maker. 40 87 Others working in paper. 95 6 Coal, coke, &c., dealer. 858 — Coalheaver, labourer. 1,288 3 Gasworks service and mine service. 547 — Platelayer, railway navvy. 109 — Paviour, road labourer. 28 Males. Females. 32 — Stone cutter, dresser. 116 — Others working in stone, clay, and road making. 148 4 Glass manufacture, earthenware, and china. 30 22 Glass, earthenware, and china dealer. 3 — Salt maker, dealer. 30 — Waterworks service. 94 4 Goldsmith, silversmith, jeweller. 980 2 Blacksmith, whitesmith. 641 — Other iron and steel manufacture. 105 2 Ironmonger, hardware dealer. 94 — Copper goods manufacturer, worker. 143 38 Tin goods manufacturer, worker. 29 — Zinc goods manufacturer, worker. 10 2 Leaden goods manufacturer, worker. 327 8 Workers in other, mixed, or unspecified metals. 264 203 General shopkeeper. 139 4 Pawnbroker. 276 75 Costermonger, hawker. 123 10 Contractor, manufacturer, manager (undefined). 7,670 23 General labourer. 938 — Engine driver, stoker, fireman (not railway or marine). 407 26 Artizan, mechanic, apprentice (undefined). 359 135 Factory labourer (undefined). 192 320 Machinist (undefined). 28 1 Town drainage service. 28 — Chimney-sweep. 36 — Scavenger, crossing-sweeper. 12 5 Rag dealer. VI.—Unoccupied Class. 529 138 Retired from business (not army, navy, church, medicine). 150 15 Pensioner. 468 1,801 Living on own means. 11,679 53,675 Others (over ten years). 29 Birthplaces of Male and Female Inhabitants of West Ham. Males. Females. 102,341 102,562 Total of inhabitants. 30,287 33,044 born in London. 41,519 41,097 „ Essex (including West Ham). 4,067 3,778 ,, Norfolk and Suffolk (2). 6,089 6,177 ,, South-Eastern Counties (5). 5,192 5,095 ,, South Midland „ (8). 2,584 2,664 „ South Western „ (5). 2,094 1,942 ,, West Midland ,, (6). 887 851 „ North Midland „ (5). 1,278 1,137 ,, North Western ,, (2). 952 822 ,, Yorkshire ... ... (1). 731 713 ,, Northern Counties (4). 412 469 ,, Monmouthshire and Wales (13). 349 273 „ England (County not stated). 2,146 1,872 ,, Scotland. 1,568 1,254 ,, Ireland. 756 536 ,, Other parts of British Empire. 188 115 ,, Foreign Countries (British subjects). 1,134 796 „ „ ,, (Foreigners). 28 17 ,, At sea. 30 Country of Birth of Foreigners Inhabiting West Ham. Males. Females. 31 14 born in Russia. 78 51 „ Poland. 29 3 ,, Sweden. 14 4 „ Norway. 22 8 ,, Denmark. 32 35 „ Holland. 20 19 „ Belgium. 59 60 „ France. 620 356 ,, Germany. 19 11 „ Austria. 3 2 „ Hungary. 16 7 ,, Switzerland. 7 5 ,, Spain. 3 2 ,, Portugal. 57 28 „ Italy. 2 1 „ Greece. 5 8 „ Turkey. 13 1 „ China. 5 3 ,, Other parts of Asia. 5 3 Egypt. — 2 „ Other parts of Africa. 73 51 „ United States. — 1 „ Mexico. 3 5 „ Brazil. 18 19 ,, Other parts of America. BOROUGH OF WEST HAM. Memorandum. ON THE PROVISION OF HOSPITAL ACCOMMODATION FOR SMALL-POX, BY THE Medical Officer of health November, 1893. 32 MEMORANDUM on the PROVISION OF HOSPITAL ACCOMMODATION FOR SMALL-POX, by the MEDICAL OFFICER OF HEALTH. The resolution passed by the Council on the 24th day of October, referring back to the Public Health Committee the question of the provision of hospital accommodation for small-pox, with instructions to prepare a statement of the comparison as regards cost between a land hospital and a ship hospital, suggests to me the advisability of putting into writing some facts which may appear to be pertinent to the question or calculated to assist the Committee. This course is rendered the more necessary, owing to the fact that the provision of hospital accommodation is interwoven with the larger question of the provision of hospital accommodation for other infectious diseases, to the lengthened period over which the discussion has unavoidably been spread, and consequently to the somewhat altered "personnel" of the Council since the earlier stages of this most debateable question. It would render this memorandum very tedious and scarcely entertaining to give a history of the discussions, deputations, resolutions, &c., which have been forced upon the Council in this matter during the past four years, but it is only fair to myself to state that until the Council Meeting of October 24th I had never been asked the question whether I preferred a land hospital or a ship hospital for small-pox, or I should, as I did then, unhesitatingly have advised a land hospital. Four years ago, when the scheme for fever hospital provision, contained in my report dated October, 1890, was adopted by the Council, I was asked what could be done with small-pox cases if the Small-pox Cottage Hospital were closed, and I replied, "Take them down the river, or any where, provided they are removed from the crowded district of West Ham." It is possible that some members of the Council may have been led into the belief that I was in favour of West Ham having a hospital ship of its own, which is a very different thing. At this time, 1890, I felt that an arrangement could be made between the Council and the Metropolitan Asylums Board, whereby the Board's steamers could call at the Council's Wharf, and take the Borough cases to the hospital ship of the Metropolitan Asylums Board in Long Reach. This was no unreasonable belief, for local authorities outside the metropolis are empowered by section 131, Public Health Act, to combine for the purpose of providing hospitals, and I was aware of no legal disability on the part of the Metropolitan Asylums Board should they see fit to enter into such an arrangement; indeed, many things appear to suggest it. Small-pox in West Ham is almost as great a danger to the metropolis as small-pox in the metropolis -itself. The Metropolitan Asylums Board hospitals contain accommodation sufficient to take West Ham cases, and owing to the extent of their land at Darenth, can be quickly enlarged if necessary. Moreover, during the 1884-5 epidemic the Metropolitan Asylums Board entered into an arrangement for the hire of a hospital, situate in West Ham, and filled it with small-pox cases. On the other hand, on the part of 33 the Council, it did appear, looking to all the surrounding facts of the case, that this arrangement would be the most simple, advantageous, and economical. On enquiry, however, I soon discovered that the Metropolitan Asylums Board could not entertain such a proposal, since when I have ceased to consider it practicable at present, although for reasons which will become more evident towards the end of my report, I am still of opinion that in the treatment of this one disease only, looking to the increasing populations of the extra-metropolitan districts, an arrangement such as is suggested above would be the most efficient, even if more costly than a land hospital, for the districts of West Ham, East Ham, and Leyton. The treatment of small-pox from a municipal point of view may be considered under five headings:— (1.) Efficient vaccination. (2.) Prompt removal from home. (3.) Complete isolation from crowded districts. (4.) Ample accommodation for patients and staff. (5.) Strictest economy of cost, compatible with thorough performance of the previous four. Under these headings I propose to compare ship and land hospitals. (1.) Vaccination. All sanitarians are agreed that small-pox epidemics are more quickly controlled by efficient vaccination than by removal to hospital or by any other treatment, and it is to be hoped that in the near future local authorities may be in a better position to control this most important preventive measure than they are at present, but as this subject does not affect the question at issue between ship and land hospital, it may be left with a mere mention. (2.) Small-pox being highly infectious from its very commencement, prompt removal from home becomes at first essential. On receipt by the local authority of notice of the existence of a case of smallpox, the patient should be on the way to hospital within a few hours. It is evident that for this purpose not only must the hospital be ever in readiness to receive patients, but also that the ambulance or other means of conveyance to the hospital must be ever in readiness. In the case of a land hospital the prompt removal is simple, our ambulance being ever ready for use. In the case of a ship hospital, beside the ambulance journey from home to the landing-stage, the patient will require the constant readiness of a steamer for removal from landing-stage to ship hospital. In the communications made to the Council by Mr. Hudson, the naval architect, whose advice the Council obtained in connection with the question of converting a ship into a small-pox hospital, certain figures (which will appear later) being the salaries of officials (captain, mate, &c.) appointed to the River Transit Service are given, and it was suggested that when no small-pox existed in West Ham, a shipkeeper could supervise, cleanse, and maintain the steamer. Such an arrangement, however, strikes at the foundation of successful hospital provision. The varied officials to man the river service could not be obtained at a moment's notice, and unless they are in constant attendance, and ready to remove isolated cases at any time, the hospital will be robbed of a great part of its value. This point must be borne in mind in considering the question of maintenance, as it tends largely to increase the cost of a ship hospital as compared with a land hospital. One other point under this heading for consideration, is the risk of spreading infection in transit. The ambulance can be driven direct from the patient's home to the land hospital without stoppage, but to reach the landing-stage at Manhattan Wharf, which is the only available place of embarkation in West Ham, there are two routes. On both these routes the ambulance may be delayed for a quarter of an hour at two places, namely, the Tidal Basin Railway crossing, the Tidal Basin 34 swing bridge, the Connaught Road swing bridge, and the Silvertown railway crossing. The Tidal Basin crossing is situate in one of the poorest, busiest, and most crowded parts of the Borough, while there is frequently a stationary crowd at all the other places mentioned, and it will consequently not be denied that an ambulance with one or two small-pox patients would be a very undesirable addition to the localities mentioned, to say nothing of positive menace to the health of the population. (3.) Complete isolation from crowded districts. What is complete isolation from a practical point of view ? It is easy to take an alarmist's view, and in the matter of infectious disease there is a great tendency on the part of the public to do this. Since the issue of Dr. Power's Report to the Local Government Board on the Fulham Hospital in 1881, and Dr. Barry's Report on the Sheffield Small-pox Epidemic of 1888, many persons have been inclined to credit small-pox with an even greater virulence than it has; but I would remind the Council that, although these reports show definitely that a small-pox hospital situated in a crowded district is a grave danger to the population immediately surrounding the hospital, the investigations referred to therein were limited to zones around the respective hospitals of varying length, showing that the incidence of attack varied inversely with the distance from the hospital. Indeed, this diminished danger with increased distance from hospital, is apparently sufficiently uniform to suggest to the thoughtful reader conclusions of practical utility. For a thorough knowledge of this point the reports themselves must be read, but I append below two extracts of tables from the reports which will serve to illustrate the argument. Dr. Power, in his investigation of the Fulham Hospital, took four circles with the hospital as a centre, the radius of these circles being respectively ¼ mile, ½ mile, ¾ mile, and 1 mile. An examination of columns 10, 11, 12 and 13 of the table below, extracted from his report, shows diminished incidence of attack before mentioned. EPIDEMIC PERIOD (January to August, 1878). Small-pox Cases from all sources received into Fulham Hospital during period. PERIOD. Within one mile of the Hospital. Houses becoming newly invaded. The same in Rates per cent. of Houses. Total such Houses. Of which situated. Rate on total Houses. | Rate on Houses 0-¼ mile. Rate on Houses ¼-½ mile. Rate on Houses ½-¾ mil. Rate on Houses ¾- mile. Acute Cases. Convalescent Cases. Under ¼ mile from Hospital. In ring ¼-½ mile from Hospital. In ring ½-¾ mile from Hospital. In ring ¾-1 mile from Hospital. 714 344 January, 1878, to August, 1878. 211 20 89 78 24 1.80 4.62 2.55 1.84 .67 1 2 3 4 5 6 7 8 9 10 11 12 13 Again, Dr. Barry, in his investigation of the Sheffield epidemic, 1888, took four circles with the hospital as a centre, the radius of the circles being respectively 1,000 feet, 2,000 feet, 3,000 feet, and 35 4,000 feet, and an examination of columns 11, 12, 13, and 14 of the table below, extracted from his report, leads to the same conclusion as that derived from Dr. Power's report, although to a less extent in consequence of the area under examination being smaller. Showing for the thirteen months from February, 1887, to March 17th, 1888, the number of acute cases of small-pox received into the Borough Hospital, Winter Street, and the extent to which houses in the special areas within 4,000 feet of the hospital, and houses in the rest of the Borough oi Sheffield, were newly infected by small-pox. Total Acute Small-pox Cases received into Hospitals within the Borough of Sheffield. Average Daily Number of Small-pox Patients under Treatment in Borough Hospital, Winter Street. Acute Cases of Small-pox admitted to Borough Hospital, Winter Street. PERIODS. Within 4,000 feet of the Hospital Houses becoming newly infected, of which situate In the Borough of Sheffield, Houses becoming newly infected. The same in Rates per cent. of Houses. Under 1000 ft. from Hospital. . In Zone 1000-2000 ft. from Hospital. In Zone 2000-3000 ft. from Hospital. In Zone 3000-4000 ft. from Hospital. In special area within 4000 ft. of Hospital. In the rest of the Borough. 0-1000 ft. Circle. 1000-2000 ft. Zone. 2000-3000 ft. Zone. 3000-4000 ft. Zone. In the Special Area. In the rest of the Borough. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1,775 — 1,144 Whole Period from commencement of Epidemic to 17th March, 1888. 225 599 595 811 2,230 2,866 19.74 17.55 10.46 10.19 12.26 6.37 18.10 10.29 The foregoing tables suggest that small-pox hospitals should not, if possible, be erected within about one mile of a crowded district. (4.) Ample accommodation for patients and staff. It is an impossibility to accurately estimate the amount of accommodation which will be just enough for the wants of West Ham, and yet it is highly desirable to form such an estimate, as if the accommodation be insufficient the Council will be unable to cope with an epidemic of small-pox, while if the accommodation provided be too large the annual cost of maintaining a large building which is only occasionally used, but which, as I said before, must be kept ever in readiness, would be a standing thorn in the side of the Finance Committee. It will be within the recollection of the Public Health Committee that the question of the (very small) annual outlay in maintaining our present Cottage Hospital, the salaries of officials, their maintenance, &c., came up for discussion just prior to the outbreak of the present small-pox epidemic. Another reason for limiting so far 36 as possible the accommodation required for the treatment of small-pox is the fact that the fever hospital for the treatment of other infectious diseases, which the Council shortly hopes to open, will be in constant use at all times, and will cause a considerable financial outlay annually. The accommodation provided by the Metropolitan Asylums Board for small pox consists of 350 beds for acute cases on the ships at Long Reach, and 800 convalescent beds in the hospital on land, making a total of 1,150, and giving one bed to each 3,774 persons according to the last census. The Borough of Sheffield has lately commenced erecting a small-pox hospital to contain 100 beds, situate four miles from the borough, to replace the Borough Hospital in Winter Street, which was so unfavourably reported upon by Dr. Barry. This provision gives one small-pox bed for each 3,330 persons. To equal the provision made in the case of London and Sheffield, the Borough would require some sixty beds. It is true that this number has been exceeded in the present epidemic, but as my periodical maps issued to the Public Health Committee have shown, the epidemic has been almost limited to the district in which our hospital is situated, and I am strongly of opinion that the fifty beds at the command of the Council at the commencement of the epidemic would have been sufficient if the hospital had been some miles away. In the case of a land hospital, should the accommodation be insufficient, additional accommodation of a temporary character could be quickly erected. On the other hand, in the case of a ship hospital, the accommodation to be provided must be equal to the largest possible demand likely to be made upon it, as additional accommodation could not easily be acquired in the height of an epidemic. (5.) Cost.—In order to estimate the relative cost of a ship hospital compared with that of a land hospital, I have obtained information of the working of the hospitals under the Metropolitan Asylums Board, kindly supplied me by T. Duncombe Mann, Esq. I have also quoted below an extract from a paper by Deputy-Surgeon-General Bostock, C.B., and Sir Vincent K. Barrington, contained in the Transactions of the Seventh International Congress of Hygiene and Demography, dealing with this subject. The experience of the Metropolitan Asylums Board in dealing with scarlet fever in land hospitals leads them to estimate the cost of treating and maintaining an individual case (excluding the capital charges of the cost of buildings, etc.), at £15. The average stay in hospital of scarlet fever cases from the East End of London is from nine to ten weeks. Now the average stay of a small-pox case in hospital is not more than six weeks, and consequently the average cost of treatment of a case of small-pox in a land hospital would be less. As will be seen from the paper quoted below, the cost of each case of small-pox treated in the hospital ships during the 1884-5 epidemic is estimated at £23 5s., that is, at least one-third more than it would have cost if treated in a land hospital. Extract of Paper on the Metropolitan Infectious Hospital and Ambulancc Organization. The question is often asked, what is the cost of an epidemic, and what price do the ratepayers pay for the means provided by the Metropolitan Asylums Board to limit, if not to prevent, the spread of infectious disease in their midst ? The epidemic of small-pox described above may be taken as an example. Great difficulty is experienced in answering this question correctly. All the hospitals in London received both fever and small-pox patients in 1884-5, and no separate accounts of the expenditure on each disease were kept, but an approximate estimate may be arrived at by (i) setting down the expenditure on the establishments specially devoted to the reception of small-pox cases,. 37 and (2) by calculating what proportion of the expenditure on the land hospitals and land ambulance service should be charged to this disease. £ 1.—a. The floating hospital total cost during 1884-5 was £ 68,631, from which may be deducted £24,000, being the average nominal cost of maintaining the ships when without patients for two years 44,631 b. The camp for 1,000 convalescent patients at Darenth, maintenance and administrative charges 81,112 c. Plaistow Hospital, rent for one and a half years, with maintenance, &c., &c. 8,882 d. River ambulance service 16,860 2.—e. At the beginning of the epidemic three-fourths of all the patients admitted into the land hospitals in London were suffering from small-pox, but as has been explained, convalescents were at an early period transferred to the ships, mild cases were soon afterwards removed from their homes to the wharves, and at last all cases, with few exceptions, were so treated, and the land hospitals admitted fever cases only. Under these circumstances the total expense may be fairly divided between the two diseases. The total expense of the land hospitals during the period was £171,759. Deducting one-half, it leaves £85,880 to be added to the cost of the epidemic 85,880 f. A similar deduction can be made from the total expenditure on the land ambulance service, but in this case one-quarter only should be deducted, as three-quarters of all the patients were suffering from small-pox, and were carried either to the hospitals or the wharves, and the expense must be debited in either case to small-pox 19,800 Total £257,165 As 11,060 cases were admitted during the period, it follows that each case cost £23 5s. This is exclusive of the capital expenditure on the sites and buildings of the hospitals, wharves, and ambulance stations and steamboats. The sums thus expended are raised on loan from the London County Council, at 3½ per cent. interest, and are repayable in an average of fifty years. The cost of the epidemic was defrayed from the current account of the managers, and was a charge on the rates of the several parishes of the district. For the purpose of estimating the comparative cost of ship and land hospitals, the question may be considered under three heads—(a) cost of buildings and site, (b) ambulance service or apparatus for conveying patients, (c) annual cost of maintenance; and in doing so I shall quote the figures given by Mr. Hudson to the Council as the estimated cost in providing a ship hospital, and figures suggested by consideration of Dr. Thorne Thorne's report to the Local Government Board, together with the experience gained in West Ham itself. Many items may be left without consideration, as they would entail the same expense in both ship and land hospital, such as furnishing, cost of nursing, and medical attendance. (a) Estimated Cost of Site and Buildings. Ship. Land. Site—Mooring Fee at £200 per annum, capitalized £6,000 Site—Fifty acres of Land,at £60 per acre £3,000 Building and Fitting Hospital of Fifty Beds 12,500 Buildings—Pontoon 9.45o Fitting ditto 14,000 Steam Disinfecting Chamber 200 £29,450 £15,700 38 (b) Estimated Cost of Ambulance Service. Ship. Land. Launch for 8 or 10 Patients £700 Land Ambulance (already in use) Land Ambulance and horse (already in use) — Extra Horse, at £50 £50 Weekly Expense in Removing Patients. Ship. Land. £ S. d. £ s. d. Captain of Launch 2 1O 0 Driver 1 10 0 Mate 2 0 0 Keep of two Horses, &c. 1 10 0 Youth 0 l6 0 Incidentals 0 10 0 Engineer 2 5 0 Coals and Stores 3 0 0 Incidentals for Doctor and Nurse 2 0 0 Driver of Ambulance 1 10 0 Keep of Horse, &c. 0 15 0 14 16 0 3 10 0 (c) The annual cost of maintenance in either case will vary in accordance with the decision of the Council as to whether the hospital shall be kept ever in readiness to receive cases or not. If, during interepidemic periods, when no small-pox cases exist, the hospital is to remain in the hands of caretakers simply, there will doubtless be no great difference between the annual expenditure of ship and land hospital; but if, as I submit should be the case, the hospital is to be kept in readiness to receive any case suddenly arising in the shortest possible time, then the heavy outlay incurred in connection with the river service militates strongly against the adoption of a ship hospital. In conclusion, I respectfully submit that the facts cited in this memorandum suggest—(i) the advisability of erecting a land hospital in preference to converting a ship for that purpose, (2) that a hospital of 50 beds, with an administrative block capable of dealing with double that number of beds, would be sufficient accommodation for the requirements of the Borough at present, (3) that the hospital should be within, if possible, five or six miles from the Borough, and situate a mile from a populated district. In connection with the last paragraph, I may state that your Public Health Committee have, at the instance of your chairman, visited and inspected a large site at Dagenham, the only drawback to which is the close proximity of the village of Dagenham itself. I have no grounds for stating so, other than a consideration of the reports of Drs. Power and Barry before referred to, but I suggest that the Local Government Board might raise objection to this site in consequence of this close proximity of population. The Council has recently acquired land at Chadwell Heath for the purpose of erecting a Borough Asylum. This latter site is more isolated than that at Dagenham, and would be, in my opinion, much more suitable or a Borough small-pox hospital, as the distance is not so great, a consideration of much greater moment 39 in removing persons dangerously ill than in conveying persons of unsound mind who are not physically diseased, while in the event of an epidemic, the shorter journey would add materially to the prompt removal of cases. Opposition will have to be met wherever the small-pox hospital shall be placed, and will probably not be greater in one case than in the other, although there are good grounds for greater and more successful opposition to the Dagenham site than at Chadwell Heath. I respectfully submit it would, in my opinion, be advantageous to the Borough to use the latter site for the small-pox, and the former for asylum purposes, for the following reasons:— (1) The Chadwell Heath site is more easily accessible from West Ham, and consequently the journey not so dangerous to the patient. (2) More journeys could be made each day, with consequent diminished cost of removal. (3) Should East Ham and Leyton engage to send their cases to our Hospital, this site would be much more central. (4) The Local Government Board, in my opinion, will not be so likely to object to this site as to the Dagenham site. (5) The Dagenham site is much larger, and the land offers greater advantages to the Council from the employment of capable lunatics, than from the establishment of a small-pox hospital. (6) The Dagenham site is admirably fitted for dealing with the sewage of an asylum by the irrigation process—a process unsuitable for sewage from a small-pox hospital. CHARLES SANDERS, Medical Officer of Health. 4° Small-pox Cases removed to Hospital. Period ending. No of Cases notified in Borough. No. of Cases removed to Hospital from No. of Cases removed from Borough to Hospital Ships of Metropolitan Asylums Board. Borough. East Ham. Leyton. Walthamstow. 1893. Feb. 4 ... 4 4 18 I I' — I — Mar. 4 ... 6 6 — — — 18 11 10 — — — Apr. 1 9 11 — 2 — .. 15 15 11 — — — 3° 16 13 — — — —- May 13 ... 32 31 — I — June 3 39 35 — — — .. 17 48 42 — — — — July 1 3i 28 — — .. 15 44 38 — — — Sept. 6 ... 78 68 6 — — » 3° 16 15 7 — Oct. 14 9 8 1 — — Nov. 18 ... 40 23 1 — — Dec. 2 16 13 7 I — — » 3° 33 28 12 I — 1894. Jan- J7 25 17 *3 I 3 Feb. 3 37 30 5 — 1 — .. 21 28 20 18 — — Mar. 3 ... 46 35 10 2 1 — .. 3i n4 82 — — — — Apr. 14 ... 61 44 — — — 4 28 60 — — — 44 May 19 ... 67 — — — — 57 June 2 ... 2 5 — — — 22 16 17 — — — — 11 3° 7 5 41 West Ham Deaths occurring in London Institutions. 12 in St. Bartholomew's Hospital. 101 ,, London Hospital. 36 ,, Shadwell Children's Hospital. 10 „ Poplar Hospital. 2 ,, Poplar Workhouse. 9 „ German Hospital. 3 ,, North Eastern Hospital. 4 ,, Homerton Fever Hospital. 3 ,, Mile End Infirmary. 4 ,, River Thames and Docks. 4 „ Brompton Hospital. 1 „ Wormwood Scrubbs Prison. 2 „ London Temperance Hospital. 6 ,, Guy's Hospital. 1 ,, Royal Hospital (Lambeth). 1 „ Stepney Workhouse. 1 ,, Metropolitan Asylums Board Hospital Ships. 2 „ Great Northern Hospital. 2 ,, Middlesex Hospital. 1 ,, Middlesex Asylum (Wandsworth), 10 ,, City of London Chest Hospital, Victoria Park. 1 „ Bethnal House Asylum. 2 „ Mildmay House. 3 ,, University College Hospital. 1 ,, London Fever Hospital. 1 „ Grove Hall Asylum. 1 ,, City of London Infirmary. 1 ,, St. Thomas's Hospital. 1 „ Chelsea Hospital for Women. 1 ,, Dr. Brownfield's, East India Road. 3 „ Friedenheim, Hampstead. 1 ,, Shadwell Railway Station. 1 ,, Poplar and Stepney Sick Asylum. 1 „ Royal Free Hospital. 1 ,, Lock Hospital, Soho. 1 ,, Hospital for Women, Euston Road. 1 ,, Metropolitan Hospital. 1 „ St. Peter's Hospital. Carried forward 237 42 Brought forward 237 1 in St. Pelagia's Creche. 1 ,, Islington Infirmary. 2 ,, Seamen's Hospital. 2 „ King's College Hospital. 1 „ St. George's Hospital. 1 ,, Convent Hospital. 2 „ Metropolitan Asylums Board North Western Hospital. 1 „ Cancer Hospital. i „ Refrigeration Company's Works, Shadwell. 1 ,, Alexandra Hospital. 1 „ North London Consumption Hospital. 1 ,, Heart Hospital, Soho. 1 at 7, Marshall Grove, Woolwich. 253 Total. 43 Notices to abate Nuisances, or remedy Defects, served during the year 1893. Drains choked 851 To cleanse w.c. pans 90 To lay drains bare for inspection 217 To furnish new pans to w.c.'s 236 Stack pipes connected to drains 476 Sink do. do. do. 356 To relay drains 105 Drains defective 299 W.C. pans do. 150 Flushing apparatus defective 577 Stack pipes defective 190 Sink pipes do. 155 Gutters do. 359 Water fittings do. 120 Walls and ceilings dirty or defective 1926 Floors defective 314 Roofs do. 479 Doors do. 52 Water tanks do. 71 Seats of w.c.'s do. 121 W.C.'s dilapidated 13 Offensive accumulations 166 Animals improperly kept 41 To abate over crowding 48 To pave and drain yards 483 To drain stables 15 Houses without proper water-supply 298 To cleanse water tanks 174 To cover do. do. 450 To furnish new gullies 645 To render premises fit for human habitation 26 To cleanse walls and ceilings of bakehouse 28 W.C. traps defective 103 Gullies do. 121 Stairs do. 34 Windows do. 54 To ventilate drains 86 To disconnect disused w.c. from drain 3 Smoke nuisance 4 To abate nuisance from factories 2 Carried forward 9,938 44 Brought forward 9,938 Fire grates defective 43 Stables dilapidated 2 To provide water tank 3 To connect drains to sewer 45 Washing copper defective 2 To cleanse and fill up cesspools 57 To furnish new guttering 14 Insufficient ventilation 21 T o provide dung pits 4 To furnish an intercepting trap 1 To remove soil pipes 24 To cleanse yard 1 To prevent shooting house refuse 4 To close and cover inspection chamber 10 To alter soil pipes 48 To abate nuisance from offensive urinal 2 Cases of no flushing apparatus to w.c. reported to town clerk 202 Gipsy notices served 20 Total 10,441 1,397 rooms in 1,277 houses were disinfected. 45 PROSECUTIONS. Date. Name. Address. Cause of Prosecution. Result. 1893. 18th Jan. Charles Gibbons "Two Brewers," High Street, Stratford. Selling whisky, 350under proof Fined £5, and 17s. 6d. costs. 8th Feb. Henry Murch 352, Romford Road Selling milk, one-fifth of cream abstracted. Dismissed with costs. Do. Wm. Ed. Phillips 11, Jamiston Road, Stratford. Selling milk, one-fifth of cream abstracted. Dismissed with costs. Do. Herbert Dean 12. Cruikshank Road, Stratford. Selling milk, 22 per cent. added water Fined £3, and 17s. 6d. costs. 29th March Henry G. Berry 10, Tate Road, Silvertown Selling mustard, adulterated with 20 per cent. wheaten flour. Fined 5s., and 17s. 6d. costs. Do. Henry G. Berry 10, Tate Road, Silvertown Selling butter, 90 per cent. margarine Fined £3, and 17s. 6d. costs. Do. Fred. Jno. Wesley 294, Romford Road Non-compliance with terms of notice to remedy sanitary defects at Nos. 42 and 44, Studley Road. Fined £1, and £1 10s. 6d. costs. Do. Charles Living 125, Broadway, Plaistow Non-compliance with terms of notice to remedy sanitary defects at 23, Chargeable Street, Canning Town. Ordered to pay costs, £1 10s. 6d. Do. D. C. Simpson Graydon Villa, Woodford Road, Forest Gate. Non-compliance with terms of notices to render the premises Nos. 132 and 134, Barking Road, fit for human habitation under Housing of Working Classes Act. Ordered to pay costs, 7s. 6d.; closing order made. Do. — Smith 39, Alexandra Street, Canning Town. Non-compliance with terms of notice to remedy sanitary defects at No. 25, Sydney Street. Ordered to pay costs, £1 10s. 6d. Do. Rachel Birchall 11, Tate Road, Silvertown Selling condensed milk, 85 per cent. original cream abstracted. Summons dismissed; case stated afterwards withdrawn. 19th April Charles Keyer 9, Lawson Terrace, Albert Road, Silvertown. Selling mustard, adulterated with 30 per cent. wheaten flour coloured with turmeric. Fined 3s. 6d., and 17s. 6d. costs. Do. Charles Keyer 9, Lawson Terrace, Albert Road, Silvertown. Selling coffee, 45 per cent. chicory. Fined 2s. 6d., and 17s. 6d. costs. Do. Charles Keyer 9, Lawson Terrace, Albert Road, Silvertown. Selling condensed milk, one half of its cream abstracted. Fined 2s. 6d., and £2. 6s. costs. 24th April Alexander Burr Mountnessing Hall, Ingatestone. Consigning milk wholesale, with 7 per cent. added water. Four days taken in serving summons; case not heard. 46 Date. Name. Address; Cause of Prosecution. Result. 24th April George Bish 211, High Street, Stratford. Non-compliance with terms of notice to remedy sanitary defects at 211, High Street, Stratford. Fined is., and 8s. costs, and an order made to prevent a recurrence of the nuisance. Do. Mrs. Randall Melrose House, Romford Road. Non-compliance with terms of notice to remedy sanitary defects at 63, Water Lane, Stratford. Case withdrawn through inability to prove ownership. 24th May Charles Hall 2, Paul Street, West Ham. Exposing for sale 2 lbs. brawn unfit for human food. Fined £1, and 17s. 6d. costs. Do. Thomas Young 20, Broadway, Barking Non-compliance with terms of notices to remedy sanitary defects at Nos. 4, 8, 10, and 12, Agate Street, 7, Randolph Road, and 28, Tucker Street, Canning Town. Fined £2, and £3 5s. 6d. cost. 5th July George Douglas Prince Regent's Lane, Canning Town. Selling milk, 11 per cent. added water. Fined £1, and 19s. 6d. costs. Do. Sarah Ann Bye 33, Randolph Road, Custom House. Selling milk, 17 per cent. added water. Fined £2, and 19s. 6d. costs. Do. Henry Davis 7, Kelland Road, Plaistow Selling milk 7 per cent. added water Fined £2, and 19s. 6d. costs. Do. Henry Hooker 73, High Street, Plaistow Selling milk 25 per cent. added water Fined £3, and 19s. 6d. costs. 12th July Henry Wagstaff 68, Victoria Dock Road, Canning Town. Exposing for sale four pieces of beef, and six pieces of mutton, unfit for human food. Fined £2 10s., and £1 18s. 6d. costs. 4th Oct. Frederick John Folkard 50, Stratford Road, Plaistow. Selling margarine which was not duly branded or durably marked. Fined £5, and costs. Do. William Marshall 78, Stratford Road, Plaistow. Selling margarine which was not duly branded or durably marked. Fined £3, and £1 is. costs. Do. Benjamin Swan 72, Chargeable Street, f laistow. Non-compliance with terms of notice to abate nuisance at 72, Chargeable Street. Fined £2, and costs. Do. George Allard Laurel Farm, East Ham Fish offal van passing along Barking Road during prohibited hours. Find £2, and 7s. costs. 18th Oct. Joseph Smith 219, Barking Road, Canning Town. Exposing for sale beef unfit for human food. Fined £5, and 10s. costs. Do. Henry Hudson 20, Clarence Terrace, Becton Road. Exposing for sale grapes, unfit for human food, on a stall in Victoria Dock Road. Fined £1 is., and 10s. costs. 47 2gth Nov. David Lee On land, Ravenhill Estate Squatting on land known as the Ravenhill Estate, Barking Road (failing to comply with gipsy notice). Fined 10s., and 7s. costs. Do. Samuel Cooper On land, Ravenhill Estate Squatting on land known as the Ravenhill Estate, Barking Road (failing to comply with gipsy notice). Fined 10s., and 8s. costs. Do. Joseph Smith On land, Ravenhill Estate Squatting on land known as the Ravenhill Estate, Barking Road (failing to comply with gipsy notice). Fined 10s., and 7 s. costs. Do. James Lee On land, Ravenhill Estate Squatting on land known as the Ravenhill Estate, Barking Road (failing to comply with gipsy notice). Fined 10s., and 7s. costs. 13th Dec. John E. Ford 42, Ford's Park Road, Canning Town. Non-compliance with terms of notice to remedy sanitary defects at 4, Queensland Terrace. Case withdrawn. Do. John E. Ford 42, Ford's Park Road, Canning Town. Non-compliance with terms of notice to remedy sanitary defects at 21, Granville Road. Fined 5s., and ns. 6d. costs. Do. John E. Ford 42, Ford's Park Road, Canning Town. Non-compliance with terms of notice to remedy sanitary defects at No. 3, Queensland Terrace. Fined 5s., and us. 6d. costs. Do. D. C. Simpson Graydon Villa, Woodford Road, Forest Gate. Non-compliance with terms of notices to remedy sanitary defects at Nos. 48, 50, and 52, Marten Road, Custom House. Fined 40s., and us. 6d. costs, and an order made to do work. Do. J. Heath 142, Grange Road, Bermondsey. Non-compliance with terms of notice to remedy sanitary defects at 18, Francis Street. Fined 5s., and costs, and an order made to do work. Do. O. E. Cash 52, Wrotham Road, Camden Square, N.W. Non-compliance with terms of notice to remedy sanitary defects at 75, Vincent Street. Fined 20s., and 10s. costs, and an order made to do work. Do. O. E. Cash 52, Wrotham Road, Camden Square, N.W. Non-compliance with terms of notice to remedy sanitary defects at 77, Vincent Street. Fined 20s., and 10s. costs, and an order made to do work. Do. D. C. Simpson Graydon Villa, Woodford Road, Forest Gate. Non-compliance with terms of notices to render the premises Nos. 35, 37, 39, and 41, Hallsville Road, fit for human habitation under Housing of Working Classes Act. Ordered to pay £ 1 costs; closing orders made. 48 The following Table shows West Ham Births and Deaths with their respective rates during the past 11 years. Year. Births. Birth-rate per 1,000. Deaths. Death-rate, per 1,000. 1883 6,014 42 2,693 19 1884 6,563 43.7 3,057 20 1885 6,547 41.9 3,503 22 1886 7,075 41.6 3,151 18.5 1887 6,865 39.1 3,286 18.7 1888 6,867 38.5 2,848 l8 1889 6,947 33.5 2,883 18 1890 7,063 38.5 3,977 21.7 1891 7,911 38.2 3,952 19.1 1892 8,013 36.9 4,019 18.6 1893 8,026 35.3 4,565 20 Chief Zymotic Deaths and Zymotic Death-rate during past 11 years. Year. No. of Deaths from chief Zymotic Diseases. Zymotic Death-rate, per 1,000. Remarks 1883 420 2.9 1884 696 4.6 Small-pox epidemic. 1885 1,014 6.3 Small-pox epidemic. 1886 563 3.3 1887 460 5.2 Half-year only. 1888 466 2.6 Notification introduced. 1889 352 1.9 1890 752 4.1 Measles epidemic. 1891 489 2.3 1892 721 3.3 Scarlatina epidemic. 1893 913 4 Small-pox & Whooping-cough. 49 Notified Cases and Percentage of Deaths to Attacks during the past five years. Disease. Year. No. of Cases notified. No. of Deaths. Percentage of Deaths to Attacks. Scarlatina 1889 806 78 9 per cent. 1890 921 49 5 ,, 1891 742 29 4 ,, 1892 2,023 70 3 ,, 1893 2,184 83 3 ,, Diphtheria 1889 145 32 23 ,, 1890 232 50 21 ,, 1891 179 55 30 ,, 1892 401 100 24 ,, 1893 470 104 22 ,, Enteric Fever 1889 171 39 22 ,, 1890 254 43 17 ,, 1891 248 49 19 ,, 1892 138 23 17 ,, 1893 359 68 18 „ 52 West Ham Deaths at several groups of Ages from different Causes during 1893. 0-1 1-5 5-20 20-40 40-60 60-80 80 Small-pox Vaccinated — 2 4 5 3 Unvaccinated 3 10 4 2 1 No statement 4 4 4 8 — 1 Measles 11 21 Scarlet fever 5 37 33 5 Typhus — — 1 Relapsing fever Influenza 4 4 7 17 14 17 1 Whooping-cough 56 82 10 1 Diphtheria 8 70 28 2 1 Simple continued fever — Enteric fever — 3 36 28 2 1 Cholera and choleraic diarrhœa 4 2 — 1 2 Diarrhoea, dysentery 195 39 1 3 2 9 1 Remittent fever Hydrophobia Glanders Cow-pox and effects of vaccination Venereal affections 17 — — 4 2 Erysipelas 14 — — 2 7 4 1 Pyaemia and septicaemia 2 — — 5 2 3 Puerperal fever — —0 1 19 2 Other zymotic diseases 1 Thrush Worms and other parasitic diseases Starvation, want of breast milk 45 Alcoholism — — — 4 2 1 Rheumatic fever — 1 7 12 2 Rheumatism — — 3 1 2 2 Gout — — — — 2 1 1 Rickets 6 2 Cancer — — 1 18 67 45 3 Tabes mesenterica 61 26 6 1 Tubercular meningitis 8 19 8 1 1 Phthisis 1 6 44 153 76 12 Scrofula, tuberculosis 18 22 13 8 5 1 Other constitutional diseases 134 7 3 3 4 3 53  0-1 1-5 5-20 20-40 40-60 60-80 80 Premature birth 158 — 1 Atelectasis 13 Congenital malformations 14 Old age — — — — 2 76 66 Apoplexy — — 1 3 40 56 6 Epilepsy — 1 2 2 3 1 Convulsions 130 39 3 2 Other diseases of brain and nervous system 17 33 21 16 30 46 2 Diseases of organs of special sense 1 — 1 1 Diseases of circulatory system 5 1 29 32 75 90 6 Croup 4 20 6 1 Bronchitis 170 113 17 14 92 175 20 Pneumonia 45 80 32 50 60 35 3 Pleurisy — 3 — 7 3 5 1 Other diseases of respiratory organs 4 11 2 9 7 6 1 Dentition 34 16 Quinsy, sore throat — 4 1 1 Enteritis 63 10 5 4 5 3 1 Peritonitis 2 1 7 12 5 4 Diseases of liver 3 — 1 9 25 18 Other diseases of digestive system 12 3 3 9 15 13 1 Diseases of lymphatic system and ductless glands. 2 1 2 — 2 Diseases of urinary system 1 2 2 15 20 18 2 Diseases of generative system — — — 3 3 Accidents of child-birth 1 — — 17 3 1 Diseases of locomotive system 2 2 6 1 3 2 Diseases of integumentary system 10 3 — — 1 2 54  0-1 1-5 5-20 20-40 40-60 60-80 80 Violent deaths— By railways 13 — — 4 8 — 1 By vehicles or horses 9 1 2 — 2 4 By ships, docks (not drowning) 8 — — 1 2 4 1 In building operations 3 — — — 1 1 1 In conflagrations By burns, scalds, explosions 25 2 9 3 3 4 4 By drowning 16 — — 5 7 4 By suffocation in bed 23 23 By poisons or poisonous vapours 6 — — 2 2 2 Other or not stated causes 23 1 4 3 3 8 3 1 Homicide 4 — — — 3 1 Suicide 10 — — — 4 5 1 Other causes 1ll 5 6 5 15 17 55 TABLE showing No. of Cases of Infectious Disease notified, with No. of Deaths from Infectious Disease, and No. of Deaths from other Diseases, occurring in the several streets of the Borough. Streets. Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases. Streets. Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases. Abbey Lane 14 1 15 Ascot Street 7 2 2 Abbey Road 4 — 8 Ashlin Road 8 2 4 Abbey Street 10 1 4 Ashton Street 3 1 3 Adamson Road 14 9 10 Atherton Road 1 — 1 Addison Road — 1 1 Aubrey Street 1 — 1 Adine Road 9 — 2 Aviary Street — — 1 Agate Street 3 1 12 Avenons Road 6 1 3 Agnes Street 3 — 1 Avenue Road 4 1 2 Ailwyn Road 10 1 — 1st Avenue 5 — 3 Albany Road — — — 2nd Avenue 6 1 3 Albert Road, Forest Gate 8 1 3 3rd Avenue 1 — 5 Albert Road, Plaistow 5 4 5 Albert Square 4 — 9 Albion Street — — — Bailey Street 1 1 1 Aldwortn Road 1 — — Bakers Row 6 2 — Alethia Avenue — — — Balaam Street 19 2 11 Alexandra Street 4 2 9 Barking Road 58 10 47 Alfred Road — — 1 Barnby Place 2 — 2 Alfred Street — — 2 Barnby Street 2 1 9 Alice Road 1 — 3 Barnwood Road 6 2 8 Alice Street 13 2 7 Baron Road 16 2 5 Alma Terrace — — 1 Barrow Road — — — Almshouses, West Ham — — 1 Baxter Road 1 — — Alnwick Road 11 — 4 Beaconsfield Road 1 — 2 Amber Street 4 2 1 Beale Street 2 — 6 Amelia Street 6 1 3 Beatrice Street 8 — 6 Amity Road 19 — 13 Beauchamp Road 7 1 3 Andrew Street — — 6 Beaufoy Road 2 1 8 Angel Lane 3 1 9 Beaumont Road 8 — 1 Ann Street — — — Beck Road 10 4 3 Anne Street 1 2 2 Beckton Road 10 — 2 Argyle Road, Forest Gate — — — Bective Road 1 — 5 Argyle Road, Canning Town 10 2 10 Beddingfield Street 7 1 2 Arkwright Street — — — Beech wood Road — — — Arrow Street — 1 5 Belton Road 7 — 1 Arthingworth Street 14 3 3 Bengeo Road 6 3 5 Arthur Street, Stratford — — — Berwick Road — — — Arthur Street, Silvertown 5 1 2 Bett's Road 3 — — 56 Streets. Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases Streets Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases. Bidder Street 8 3 11 Catherine Street, Canning Town. 4 — 6 Biggerstaff Road 13 1 2 Bignold Road 3 1 2 Catherine Street, Silvertown. 3 2 4 Bishop Road — 1 — Blanche Road 5 — 7 Cave Road 1 — 1 Blythe Road 14 4 21 Cecil Road, West Ham 4 — 5 Boleyn Road 10 4 12 Cecil Road, Upton 4 — Bolton Road, Stratford 1 — 3 Cedars Road 6 2 8 Bond Street 2 — — Cemetery Road 9 1 6 Boulton Road, Plaistow 2 1 5 Chadd Street — — 4 Bow Street — — 2 Chandos Road 13 9 17 Boyd Road 4 5 9 Channelsea Road 6 4 9 Bradley Street 8 1 2 Channelsea Street 3 — 1 Braemar Road 8 4 7 Chant Square — 2 4 Bridge Road 10 1 6 Chapel Street, Forest Gate 1 — 1 Brighton Road 1 2 2 Chapel Street, Stratford 5 3 5 Broad Street — — 8 Chaplin Road 2 — 1 Broadway, Plaistow 5 — 2 Chapman Road 2 — 1 Broadway, Stratford 4 — 2 Chargeable Street 12 1 8 Brooks Road 6 1 8 Charles Street, Plaistow 6 — 2 Brownlow Road 4 1 4 Charles Street, Silvertown 3 — 1 Brown's Road 4 1 5 Charlotte Street, Canning Town. 7 — 9 Brunei Street 5 2 4 Bryant Street — — 1 Charlotte Street, Old Canning Town. — — 3 Brydges Road — — — Buckingham Road 3 1 8 Charlton Road 3 1 3 Burford Road 1 — 4 Chatsworth Road 5 4 5 Burgess Road 2 — 2 Chauntler Road 7 2 6 Burke Street 1 — 8 Chaucer Road 8 2 3 Burleigh Road 3 2 1 Chesterton Crescent 2 1 — Burnham Street 3 1 10 Chesterton Road 2 2 2 Burrard Road 9 2 0 Chesterton Terrace 4 1 6 Buxton Road 3 1 15 Chesnut Avenue 2 1 7 Chobham Road 9 2 12 Church Street, West Ham 13 1 6 Caistor Park Road 7 1 4 Church Street, Plaistow 3 1 — Campbell Road 2 2 I Church Street, Barking Road 2 — 4 Canning Road — — I Church Street Buildings — — 2 Capel Road 3 — 7 Churchill Road 3 1 1 Carlton Street 7 2 2 Clare Road 5 — 4 Carnarvon Road — 1 2 Clarence Road 9 3 6 Carpenters Road 24 5 11 Claremont Road 11 — 3 Carter Road — — — Clarkson Street 7 5 11 Castle Street 1 — 5 Clever Road 17 6 14 57 Streets. Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases. Streets. Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases. Clifford Road 1 1 6 Disraeli Road 7 — 2 Clifton Road 5 6 9 Dongola Road 22 1 6 Clova Road 1 — — Drew Road — — — Clyde Road 2 — 2 Dunbar Road 1 — 3 Cobbold Road 3 2 4 Dunmow Road 5 2 1 Colegrave Road 15 7 24 Columbia Road — — 2 Connaught Road — — 2 Earl Street 2 2 1 Constance Street, Plaistow 5 1 3 Earlham Grove 10 1 12 Constance Street, Silvertown 1 2 8 East Road 9 2 5 Cook's Road 2 — — East Street — — 4 Coolfin Road 3 1 5 Eastbourne Road 4 2 10 Cooper Street 8 — 7 Eastern Road, Stratford — — — Corner Street 1 — — Eastern Road, Plaistow 1 — — Cranmer Road 3 1 4 Eastwood Road 1 3 4 Crawford Street — 1 1 Eaton Place — — 1 Cranbrook Road 3 1 3 Edith Road — — 4 Creek Street — — 1 Edward Street, Barking Road 7 2 7 Crescent Road 2 — 4 Edward Street, Canning Town 2 — 2 Cross Street, Stratford 2 — 2 Edwin Street 1 — 1 Cross Street, Canning Town 1 — 1 Eleanor Road 6 1 1 Crown Street 3 — 4 Elm Road — — 1 Crownfield Road 1 — — Elmhurst Road 3 — 7 Croydon Road 12 4 15 Elphick Street 2 4 3 Crosby Road 1 — 1 Emily Street 1 2 1 Cruickshank Road — 1 6 Emma Road 2 — 2 Cullum Street 4 4 11 Emma Street 3 1 7 Cundy Road 32 6 6 Ernest Road, Forest Gate 4 1 1 Curtis Street — — 1 Ernest Road, Plaistow 4 1 4 Custom Street 1 1 2 Essex Street 1 — 5 Ethel Road, Barking Road 7 — 1 Ethel Road, Canning Town — 3 — Dacre Road 5 2 5 Eve Road 8 — 4 Dale Road 23 1 12 Evelyn Road 4 1 3 Dames Road 7 — 13 Evesham Road 18 4 6 David Street 6 4 4 Exning Street — — — Davis Street 5 — 1 Dean Street — — 3 Deanery Road 1 1 1 Factory Road — — 1 Denmark Street 5 3 13 Fairland Road 5 2 1 Derby Street 16 1 6 Falmouth Street — — 1 Devonshire Road 1 — — Faulkner Street 2 2 1 Dirleton Place — 1 2 Falkland Road — — 1 Dirleton Road — 1 3 Feltham Gardens 1 1 1 58 Streets. Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases. Streets. Cases of infectious diseases notified. Deaths from infectious disease. Deaths from other diseases. Fentons Avenue 2 — 5 Godsell Street — — — Ferndale Road — — 2 Godwin Road 3 2 12 Ferns Road — — 1 Goodman Row 1 1 — Field Road 7 1 7 Gordon Street 9 — 12 Firwood Road — — — Gough Road 1 1 — Fisher Street 18 5 11 Gowar Road 2 — 1 Florence Road 10 1 4 Grace Road 5 1 7 Florence Street 5 2 5 Grafton Road North 9 1 9 Folkstone Road 7 1 4 Grafton Road South 4 3 5 Ford Street 4 2 1 Graham Road — — 2 Fords Market — — — Grange Road 45 6 31 Fords Park Road 19 5 10 Granville Road 2 2 — Forest Lane 15 2 7 Gray Street 2 2 3 Forest Road — 1 3 Great Eastern Road 2 3 10 Forest Street 4 3 5 Green Street 7 1 2 Forty Acre Lane 6 7 11 Greengate Street 3 1 6 Foster Road — — — Greenville Street 1 2 7 Fowler Road — — 3 Gregory Road 6 1 — Fox Street 7 1 10 Grove Crescent Road. 5 — 1 Francis Street, Stratford 3 — 5 Gurney Road 7 1 9 Francis Street, Canning Town. 16 1 10 Frank Street 3 1 5 Hack Road 5 1 6 Frederick Road 7 5 2 Hallsville Road 7 1 1 Fredericks Street 1 — 1 Ham Road — — — Freemason Road 13 3 4 Ham Park Road 8 1 8 Fulton Street 3 — 6 Hamfrith Road 2 — 4 Hampton Road 9 — 8 Harold Road 5 4 8 Garfield Road 2 1 — Hartington Road 4 — 5 Garvery Road 4 4 10 Hartland Road 8 — 5 Geere Road 16 3 7 Hastings Road 5 — 2 George Street, Canning Town 3 — — Hazelmere Road 2 — — George Street, Plaistow — 3 1 Hearn Street 5 1 6 George Street, Silvertown 6 — — Helena Street 3 2 4 Gift Lane 1 — 2 Hemsworth Street 8 5 8 Gibbins Road 8 2 6 Henniker Road 9 4 10 Gipsy Lane 2 — 1 Hermit Road 16 3 12 Gladstone Road 2 — — Herbert Road 6 3 6 Glenparke Road 3 1 5 Hey worth Road 3 1 2 Gilbert Street — — — High Street, Plaistow 4 3 7 Globe Crescent Road — — 1 High Street, Stratford 25 5 20 Globe Road — — 2 Hill Street — 1 6 Godfrey Street 4 — 3 Hollybush Street 11 3 4 59 Streets. Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases. Streets. Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases. Holness Road 1 — 1 Keogh Road 9 2 7 Holtum Place — 1 2 Khartoum Road 7 — 3 Hooper Road 22 3 11 Khedive Road 9 — 3 Horace Road 2 4 King Street, Canning Town 8 2 7 Hospital, West Ham 3 3 42 King Street, Plaistow 18 2 9 Hospital, Poplar Board of Works. — — 13 King Street, Stratford 1 — 1 Kingsley Road 1 — 1 Hospital, Cottage Small-pox — 50 — Knight's Road 2 — 1 Hospital, West Ham Guardians. — — — Knox Road — — 1 Hospital, Seamen's 2 4 26 Hospital, St. Mary Day Nursery. — 3 — Lady well Street — — — Lancaster Road — — — Hospital, St. Mary Cottage — 2 6 Langthorne Street 5 3 11 Hotham Street 15 — 3 Lansdown Road 11 2 11 Howard Road, Forest Gate 6 2 3 Latimer Road 3 — 5 Howard Road, Plaistow 17 1 6 Lavender Street — — — Hoy Street 20 3 8 Lawrence Street 17 3 15 Hubbard Street 7 2 3 Lea Street 3 1 1 Huddleston Road 1 — — Leabon Street 1 1 3 Hudson Road 2 1 2 Lee Street 1 — 1 Hughan Road 2 4 — Leonard Road 1 — 6 Huntingdon Street 4 1 6 Leslie Road 1 1 1 Lett Road 14 2 8 Idmiston Road 2 — 2 Leyes Road 14 3 13 Ingal Road 5 1 2 Leyton Road 19 6 17 Ingestre Road — — 1 Leytonstone Road 5 1 10 Invicta Road — — — Libra Road 2 1 2 Ismailia Road — — 3 Liddington Road 6 2 10 Industrial School, Forest Gate — 1 3 Liddon Road 5 1 2 Lincoln Road — — — James Place 1 1 1 Liston Street — — 2 James Street 1 — 4 Liverpool Road 15 4 6 Janson Road 5 1 3 Livingstone Road 10 1 16 Jedburgh Road 3 2 2 London Road 4 — 3 John Street, Canning Town 1 1 2 Lome Road 2 — 2 John Street, Plaistow 6 — 3 Louise Road 1 — 5 Junction Road, Plaistow 3 — 2 Lovatt Road — — 2 Junction Road, Old Canning Town. — 1 6 Lower Road 12 3 8 Lucas Road 8 3 8 Jupp Road 4 3 5 Luton Road 3 — — Kelland Road 5 1 5 Kent Street 11 2 9 Major Road 7 2 8 60 Streets. Cases of infectious disease notified Deaths from infectious disease. Deaths from other diseases. Streets. Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases. Malmesbury Road 19 8 18 Nelson Street 1 1 8 Manbey Grove — — 1 Neville Road 15 — 10 Manbey Park 2 1 2 New Road, Old Canning Town 5 — 2 Manbey Road 1 — 1 New Road, Plaistow 3 — — Manbey Street 4 1 4 New Street, Stratford 4 — 7 Manor Road 11 1 4 Newland Street 3 — 2 Marcus Street 7 2 9 New Barn Street 6 3 8 Margery Park Road 3 — 3 New City Road 15 1 4 Mark Street 8 — 14 New Providence Street — — 1 Marshgate Lane 2 — 2 Newman Road 5 1 4 Martha Road — — — Newman Street 2 — — Marten Road 5 5 7 Newton Street 1 1 1 Martin Street 6 1 7 Norfolk Street 4 2 1 Martindale Road 9 3 15 North Street, Plaistow 2 — 2 Mary Street 10 2 5 North Street, Stratford — — — Maryland Park 4 1 5 Northern Road 8 2 8 Maryland Road 7 5 13 North Woolwich Road 10 2 7 Maryland Square — — 4 Norwich Road 4 — 1 Maryland Street — 1 3 Nursery Lane 1 — 1 Mason Road — — — Maud Road 18 1 6 Maud Street — — 6 Oak Road 2 3 4 Mayfield Road 4 — 4 Oakdale Road — — 1 May's Buildings 1 — — Odessa Road 12 3 6 Macdonald Road 2 — 4 Ohio Road 3 2 — Meeson Road 6 5 9 Ordnance Road 8 5 7 Melford Road 7 3 3 Oriental Road 2 1 10 Meredith Street — 1 1 Osborne Road 9 2 6 Merton Road — — — Outram Street — — 1 Middle Road — — 1 Milton Road 1 2 3 Milton Street Pacific Road 1 1 1 Montague Street — — 1 Pallmerston Road 1 — 5 Montesquieu Street 3 — 5 Park Avenue 1 — 1 Morecambe Street — — 1 Park Grove — 2 6 Morgan Street 7 — 10 Park Place — — 4 Mortham Street 7 1 7 Park Road 1 — 5 Morton Road 2 — 1 Parker Street 8 — 2 Mount Street 1 — 3 Paul Street 9 3 16 Muir Street 1 — 3 Pelly Road 1 4 6 Myra Street 2 2 2 Percy Road, Forest Gate — — 2 - Percy Road, Upton — — 3 Percy Road, Canning Town 6 1 4 Napier Road 10 — 3 Peterborough Road — — — 61 Streets. Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases. Streets. Cases of infectious disease notified. Deaths from infectious disease. Deaths from other diseases. Peter Street 8 3 7 Ridley Road 1 — 5 Peto Street — — — Riles Road 3 — 3 Phillip Street, Canning Town 2 1 2 River Lea — — — Phillip Street, Plaistow — — 2 River Thames — — 4 Pitchford Street 9 1 3 River Street 2 1 2 Pit Street 5 2 4 Rivett Street 1 — 4 Plaistow Grove 5 1 8 Roberts Road 8 4 4 Plaistow Road 20 4 12 Robertson Street 2 — 1 Plaistow Park Road 5 — 5 Rochester Avenue 1 — 1 Plashet Road 4 — 8 Rokeby Street 6 — 6 Pleasant Place — — — Romford Road 27 4 20 Poplar Street 5 — 4 Roscoe Street 6 1 9 Portland Road 8 1 10 Rosetta Road — — — Portway 14 3 13 Rosher Road 10 1 17 Pragell Street 13 3 3 Ross Road — — 2 Preston Road 5 1 5 Royal Road 5 3 1 Prince Regents Lane 6 2 4 Russell Street 3 — 1 Prince of Wales Road 6 2 2 Ruth Street 3 — 1 Prospect Row 5 1 — Sabberton Street — — 3 Quadrant Street 1 — 5 Salisbury Road 4 — 1 Queens Road, Canning Town 14 1 7 Salmen Road 11 1 3 Queens Road Plaistow 31 9 25 Salway Road 4 — 3 Queen Street, Stratford 1 2 8 Samson Street 2 — — Queen Street, Stratford New Town 3 Sandal Street 6 — 4 Sandford Street — 1 2 Sarah Street 11 3 8 Scott Street 6 2 13 Radnor Street — — 1 Seaton Street 4 3 3 Railway Cottages — — 2 Sebert Road 14 2 18 Randall Street — — — Selwyn Road 8 1 3 Randolph Road 16 2 6 Sewell Street 2 — — Ranelagh Road 5 — 5 Shaftesbury Avenue 12 — 3 Rathbone Street 8 — 11 Shepheard Street 5 2 2 Ravenstone Road — — — Ship Street 1 — 4 Raymond Road 4 1 2 Shipwright Street 1 — 6 Redriff Road 6 1 4 Shirley Avenue — 2 1 Reginald Road 1 — 2 Shirley Street 7 1 9 Rendel Road 6 4 11 Short Street — — 1 Reynolds Road — — 2 Sidney Street 15 6 4 Richard Street 3 — 1 Skelton Road 3 1 3 Richford Road 5 1 5 Skiers Street 2 3 7 Richmond Street 3 — 3 Smeaton Street 1 — — 62 Streets. Cases of infectious disease notified. Deaths from infectious diseases. Deaths from other diseases. Streets. Cases of infectious diseases notified. Deaths from infectious disease. Deaths from other diseases. Smith Street 1 — 3 Sutton Road 1 1 3 Solomon Road — — — Swanscomb Street 2 2 8 Sophia Road 2 2 2 Swete Street 9 — — South Street, Stratford South Street, Stratford New Town 1 — 1 Sylvan Road 4 — — Tabernacle Avenue — — — Southern Road 4 — 2 Talbot Road — 2 5 Spray's Buildings — — 3 Tate Road 4 3 3 Sprowston Road 2 — 1 Tavistock Road 7 — 6 Stanley Road 19 4 15 Temple Mill Lane 2 3 6 Stanley Street 8 8 13 Tenby Road 10 2 15 Star Lane 14 5 17 Terrace Road 6 1 6 Station Road, Forest Gate 11 1 4 The Crescent — — — Station Road, Plaistow 1 — 3 The Green 6 1 — Station Street 3 — 3 The Grove 3 1 3 Station Works — — 3 Thomas Road — 3 1 Steele Road 6 — 4 Thornham Grove 3 1 — Stephens Road 15 2 10 Thorpe Road — — — Stephenson Street 6 1 5 Three Mills 1 — — Stock Street 11 1 1 Tidal Basin Road 1 2 3 Stopford Road 9 3 2 Tower Hamlets Road 14 2 12 Store Street — 1 1 Tree-in-pound Road — — — Stork Road 6 3 2 Trevelyan Road 8 5 5 Stracey Road 3 — 5 Trinity Gardens — 1 1 Stratford Road 14 1 4 Trinity Street 6 — 8 Stratford Street 3 1 5 Tucker Street 2 4 4 Strode Road 9 — 3 Tunmarsh Lane 4 3 Studley Road 15 2 11 Twyford Street 3 — — Stukeley Road 2 — — Tyas Road 2 2 3 St. Andrew's Road 5 1 2 Tylney Road 1 — 4 St. George's Avenue 1 — 3 St. George's Road 1 — — Union Cottages — — 1 St. George's Square — — 2 Union Road, Plaistow 3 3 2 St. James Road 11 3 7 Union Road, Stratford 1 — 3 St. John's Avenue — — — Union Street, High Street 7 1 7 St. John's Road 5 2 4 Union Street Marsh 4 St. Luke's Square 2 1 3 Upper Road 16 — 5 St. Mary's Road 17 3 18 Upton Lane 16 2 5 St. Thomas' Road 5 3 2 Upton Park Road 13 1 6 Suffolk Road 10 4 2 Ursuline Convent — — 1 Suffolk Street 1 — 1 Sugar House Lane 1 — 5 Valetta Grove 15 2 — Surrey Street 6 1 2 Vansittart Road 9 2 6 Sussex Street 6 2 2 Vaughan Road 1 1 — 63 Streets. Cases of infectious diseases notified. Deaths from infectious disease. Deaths from other diseases. Streets. ' Cases of infectious diseases notified. Deaths from infectious disease. Deaths from other diseases. Vicarage Gardens — — 1 Westbury Road 3 1 5 Vicarage Lane 19 5 13 Westwood Road — — — Vicarage Road 7 — 6 Whalebone Lane — — — Victoria Place 1 — 2 Wharf Road — — — Victoria Road, Plaistow 6 — 4 Wharf Street — 1 1 Victoria Street, Stratford 14 1 13 Wharton Road 3 — 6 Victoria Dock Road 32 8 22 White Road 2 1 4 Victoria Docks 1 — 19 Whitehall Place — — 1 Village Street 1 — 2 Whitwell Road 9 — 8 Vincent Street 8 6 13 Whyteville Road 5 — 6 Vine Road 1 — 2 Widdin Street 4 — 1 Wightman Street 10 1 2 Wilberforce Street 1 2 3 William Street 6 — 7 Waddington Road 4 3 10 William Street Waddington Street 1 1 6 Willow Grove 12 2 6 Walter Street 6 2 3 Wilson Street — — 5 Wrard Road 6 — 1 Wilton Street 2 — 1 Warmington Street 8 — 3 Winchester Street — — 1 Wrarrington Street — 1 4 Windmill Lane 7 1 11 Warwick Road 6 — 5 Windsor Road 4 — 3 Water Lane 3 — 5 Wiingfield Road 4 — 9 Watson Street 13 — 1 Winkfield Road 3 2 1 Webb Street 3 1 1 Wolseley Road 5 1 — Well Street — — 3 Wood Street — — — Wellington Place 1 1 1 Woodford Road 7 i 6 Wellington Road 19 2 7 Woodgrange Road 7 5 6 Wellington Street 2 1 — Woodstock Street 10 1 10 West Ham Lane 3 — 8 Worland Road — 1 1 West Road, Canning Town 7 — 2 Wouldham Street 11 1 9 West Road, Plaistow 8 3 15 Wyatt Road 3 1 2 West Street, Forest Gate 1 2 6 Wycliff Road — — 2 West Street, Stratford 1 Western Road 21 2 6 Western Street, CanningTown — 1 1 York Street 3 1 6 Western Street, Stratford 7 1 3 Young Street 5 1 3 64 Ages, ??? Localities. Names of Localities adopted for the purpose of these Statistics public institutions being shown as separate localities. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Tears of Age. At all Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Small-pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping-cough. Diarrhoea & Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis,Pneumonia and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. Typhus. Enteric of Typhoid Continued. Relapsing. Puerperal. (a) (b) (C) (d) (e) (f) (g) (h) (i) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Stratford Ward 749 254 133 41 32 170 119 Under 5 ... 3 28 4 ... ... ... ... ... ... ... 4 18 36 ... ... 32 73 5 6 178 387 5 upwds. ... 5 3 1 ... 12 ... ... 2 ... 2 2 3 5 4 ... 62 106 44 7 104 362 Forest Gate Ward 879 269 109 50 30 199 222 Under 5 ... 7 13 5 ... 2 ... ... ... ... 2 11 25 52 ... ... 30 76 2 7 146 378 5 upwds. ... 9 10 1 ... 8 ... ... 5 ... 2 3 1 4 5 ... 65 128 60 2 198 501 Plaistow Ward 1194 409 215 63 61 257 189 Under 5 1 19 18 7 ... ... ... ... ... ... 4 7 46 100 ... ... 33 133 5 11 240 624 5 upwds. 1 11 7 3 ... 16 ... ... 8 ... 7 ... 2 9 11 ... 78 161 52 15 189 570 Canning Town Ward 1144 422 222 73 46 246 135 Under 5 ... 14 7 8 ... 1 ... ... ... ... 4 7 46 103 2 ... 50 132 2 12 256 644 5 upwds. 1 13 6 1 1 22 ... ... 4 ... 3 1 2 11 2 ... 67 134 44 23 165 500 Borough Hospital 51 7 15 10 6 12 1 Under 5 22 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 5 upwds. 29 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 29 West Ham Hospital 44 3 11 6 6 15 3 Under 5 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 3 ... 7 2 14 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 1 15 9 30 Seamen's Hospital 30 ... 1 ... 3 23 3 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... ... 4 6 1 7 6 29 Poplar Hospital 11 ... ... ... ... 2 9 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... 7 11 Forest Gate Industrial School. 4 ... 1 3 ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... 3 West Ham Workhouse. 237 23 9 1 9 78 117 Under 5 ... ... ... ... ... ... ... ... ... ... 1 ... ... 8 ... ... 6 4 ... ... 13 32 5 upwds. ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... ... 30 47 17 2 106 205 Totals 4343 1387 716 247 193 1002 798 Under 5 23 43 67 24 ... 3 ... ... ... ... 11 30 135 300 2 ... 151 421 14 44 835 2103 5 upwds. 31 38 27 6 1 60 ... ... 19 ... 14 6 8 35 22 ... 312 584 220 73 784 2240 The subjoined numbers have also to be taken into account in judging of the above records of Mortality. Deaths occurring outside the District among persons belonging thereto 253 22 26 27 23 123 32 Under 5 1 1 7 ... ... ... ... ... ... ... ??? ... ... 8 ... ... 6 5 2 1 16 48 5 upwds. ... 1 3 ... ... 5 ... ... ... ... ... ... ... 5 ... ... 27 21 22 33 88 205 Deaths occurring within the District among persons not belonging thereto. 31 ... 1 3 3 15 9 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... ... 6 4 3 6 6 30 65 (B.)— Table of Population, Births, and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1893, in the Urban Sanitary District of West Ham; classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of those Statistics: Public Institutions being shown as separate localities. Population at all ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Number of such Cases Removed from their Homes in the several localities for treatment in Isolation Hospital. Census 1891. Estimated to middle of 1893. Small-pox. Scarlatina. Diphtheria. Membranous croup. Fevers. Cholera, English. Erysipelas. Small-pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a.) (b.) (c.) (d..) (e.) 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11 12 13 Stratford 38,612 43,237 1,604 Under 5 12 196 71 4 ... 7 ... ... ... ... ... ... ... 9 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 49 425 97 1 ... 91 6 ... 3 ... 2 ... ... 39 ... ... ... ... ... ... ... ... ... ... ... ... Forest Gate 53.511 58,636 1,580 Under 5 4 128 33 Not notifiable 5 ... 6 ... ... ... ... Not notifiable 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 19 233 52 1 ... 29 1 ... 1 ... 2 ... ... 9 ... ... ... ... ... ... ... ... ... ... ... ... Plaistow—H. 58,030 64,657 2,538 Under 5 48 203 45 7 ... 5 ... ... ... ... 4 ... ... 44 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 185 356 46 3 ... 51 ... ... 1 ... 7 ... ... 174 ... ... ... ... ... ... ... ... ... ... ... ... Canning Town 54,75° 60,875 2,304 Under 5 35 249 33 8 ... 22 1 ... ... 1 4 ... ... 34 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 79 394 116 1 1 148 3 ... 5 2 3 ... ... 74 ... ... ... ... ... ... ... ... ... ... ... ... West Ham Hospital ... ... ... Under 5 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... Totals 204,903 227,405 8,026 Under 5 99 776 183 24 ... 40 1 ... ... 1 10 ... ... 89 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 332 1,408 312 6 1 319 10 ... 10 2 14 ... ... 296 ... ... ... ... ... ... ... ... ... ... ... ... State here whether "Notification of Infectious Disease" is compulsory in the District—Yes. Since when?—1888. Besides the above-mentioned Diseases, insert in the columns with blank headings the names of any that are notifiable in the District, and fill the columns accordingly. State here the name of the isolation hospital used by sick of the district. Mark (H) the ??? which such Hospital is situated; and if not within the district, state where it is