91 WHI 11 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT on The Sanitary Condition of THE WHITECHAPEL DISTRICT, FOR THE THREE MONTHS Ending 28th March, 1863, by JOHN LIDDLE, Medical Officer of Health. READ TO THE BOARD, APRIL 20th, 1863. London PRINTED BY MEAD & POWELL, 101, HIGH STREET, WHITECHAPEL, And 73, Cheapside, 1863. REPORT FOR THE QUARTER TERMINATING 28th MARCH, 1863. Gentlemen, The total mortality in the Whitechapel District, for the quarter ending on the 28th March, 1863, is 761. In the corresponding quarter of last year the total deaths were 640; there is an excess therefore of 121, or an average of 9.3 deaths per week in this quarter above that in the corresponding quarter of last year, and 8.5 deaths per week above the average number in the corresponding quarters of the preceding seven years. This excessive mortality appears to be owing principally to the large number of deaths from epidemic diseases, 182 having died from these causes, while 108 died in the corresponding quarter of 1862. Of the 761 deaths 424 were of males and 337 of females. The total births registered were 723, of which 358 were of males and 365 of females. Thus the births of females are in excess of those of males, which is unusual, the normal proportion of male to female births being as 106 to 100. The deaths during this quarter have exceeded the births by 38, but if we exclude the 45 non-residents who died in the London Hospital then the excess of births over deaths is 7. If we wish to compare the proportionate rate of mortality in this district with that in others we must exclude from the calculation all the deaths in the London Hospital, as patients from all parts of London and from the country are admitted into this institution. The deaths in the London Hospital during this quarter were 100. The 761 deaths, less the 100 which occurred in the London Hospital, are during this quarter at the rate of 34 per 1000 annually of the entire population. The proportion of deaths of children under five years to the total deaths is 40 per cent. In the Whitechapel North Sub-District, where the greatest proportionate mortality of children to the total mortality is usually found, when reckoned separately, the proportion is as high as 62.1 per cent. 4 The 182 deaths from epidemic diseases which have occurred during this quarter are in the proportion of 27.5 per cent, to the total deaths, minus the 100 deaths in the London Hospital.* The deaths from diseases of the respiratory organs, 'which have been 126, are in the proportion of 19 per cent, to the total deaths. The deaths from consumption have been 94 or 11.2 per cent, of the total deaths, less the deaths in the London Hospital. In this district, during the last quarter, the deaths from epidemic diseases have been at the annual rate of 92; from diseases of the respiratory organs, at the annual rate of 62; from consumption, at the annual rate of 45 in every 10,000 of the population. The rate of mortality from these three causes is very high, and indicates a very unhealthy condition of the district. It is true that the mortality from the above specified classes of disease has been unusually great over the entire metropolis; but this fact only serves to show of how great importance it is that those whose duty urges them to investigate the causes of an increased mortality should receive all possible assistance and encouragement in the prosecution of their labors. In country districts the same high rate of mortality as is found in towns does not exist. In large towns the proportionate mortality under 5 years of age is double that which is observed in rural districts, and above 5 years of age the relative proportion of the mortality between a rural and suburban population is about one third greater in the latter than in the former. This is a severe penalty upon those who are compelled to live in towns, and the fact of this excessive mortality deserves our most serious attention. The overcrowding not only of particular rooms, but the massing together of houses without affording sufficient open spaces in the front and back of every house to ensure proper ventilation, together with the want of efficient house drainage, and the accumulation of filth caused by the neglect of cleanliness in the majority of the people who inhabit these confined places are the principal causes of the larger amount of mortality in all large towns when compared with that of country districts. On inspection it is found that many of the rooms tenanted by the poor are so small as to afford a space of less than 100 cubic feet to each inmate (300 cubic feet being considered the smallest space for healthy existence), and, owing to the narrowness of some of the courts, the external air becomes stagnant and contaminated by reason of the want of a current to carry away the impurities surrounding and inseparable from inhabited houses. The most frequent cause of overcrowding, in a single room, is a large family of children, while for the preservation of health a more ample space is requisite; the increased demands » Not a 6ingle death from any epidemic disease occurred in the London Hospital during this quarter. 5 upon the resources of the parents for food and clothing puts it too often beyond their power to pay the requisite rent for increased accommodation. There are many of the houses in this district that have not the smallest open space at the rear, and which have windows only in the front, and where, in some instances, the door of the house and the window of the lower room are close to a public privy. There are others in which there is a back yard, but it is so small that the dust-bin, privy and water-butt occupy its whole space, and are close to the window of the back room in which a family usually lives. There are others again where there is not a back yard, and where the privy is in close proximity to the front rooms of one or two of the houses in the court, which renders these rooms so offensive as to be injurious to the health of the occupants. In my opinion houses so situated ought not to be used for habitation, they should be taken down and the ground on which they stood might be used for building better privy accommodation and other domestic conveniences for the remaining inhabitants. No house is fit for habitation unless there is ample space for all domestic conveniences and provided with an ample supply of water. In spite of all the vigilance of the inspectors, underground rooms, not having the requirements of the Building Act as regards height, size of windows, and extent of area, are continually being occupied as sleeping and sitting rooms; whenever such rooms are found to be inhabited notices are served upon the landlords to remove the occupants. The amended Metropolis Local Management Act, 25 and 26 Vict., c. 102, section 62, requires every District Surveyor to report to the Metropolitan Board, and to every Vestry and District Board in the district in which such surveyor may act, in the months of June and December in each year and at all other times when he shall be required to do so by any such Vestry or District Board, all underground rooms or cellars occupied as dwellings within the meaning of the 103rd section of the 18 and 19 Vict., c. 120, that are not built or constructed in conformity with the rules contained in the said section. A list of all such inhabited underground cellars furnished to the Board twice every year would facilitate the labors of your sanitary officers in bringing such cases more frequently under the notice of your Board. Of the total deaths from epidemic diseases 66 have occurred from scarlet fever and diphtheria. This is an unusually large proportion of deaths from these causes, and the mortality from them has principally occurred among the rate-payers, and not, as is the case in epidemics of fever, among the poor, for the Medical Officers of the Union have only recorded 31 cases of these diseases among the out-door poor of the district. Some families have lost two or three of their number from scarlet fever during the 6 winter quarter. Small-pox was fatal to 31 persons of all ages from 12 days old to between 40 and 60 years. In addition to this number there were 2 deaths in the Small-Fox Hospital out of the 22 persons who were admitted into that institution from this district. Of the 22 cases 18 had been vaccinated. The deaths were among the unvaccinated. Measles has been fatal to 19, hooping cough to 15, diarrhoea to 13, and fever to 37. In the corresponding quarter of the previous year the deaths from small-pox were 3, from measles 10, from scarlet fever and diphtheria 18, from hooping cough 21, from diarrhoea 3, and from fever 53. It appears from the returns of the local registrars that 9 of the deaths from small-pox occurred in children who had not been vaccinated, and that four deaths from this disease occurred in one week at No. 22 Castle Alley. The present epidemic of small-pox has now prevailed during the last six months. During this time there have been registered 48 deaths from this disease and 167 cases have been attended by the Medical Officers of the Union. As early as the 2nd of February last I addressed a letter to the Guardians drawing their attention to the fact that small-pox was very prevalent in the Union. Upon the receipt of my letter the Guardians held a conference with the several Vaccinators of the District upon the subject, and the result of the conference was the issuing of notices calling the attention of all persons to the penalty for neglecting to have their children vaccinated. The issuing of these notices has been the means of extending vaccination among the children residing in the district. If the Public Vaccinators of the District were required not only to perform vaccination at the appointed stations but also to call at every house in their respective districts where there had been a child born within three months of such call being made and then to offer to vaccinate the child the usual excuses on the part of parents as the want of time, etc., to take the child to the public station could not be made, and the result would be that many more children would be vaccinated. It is no doubt better for the successful performance of vaccination that all children should be taken to the public station, but as all parents cannot be prevailed upon to do so it is absolutely necessary, if vaccination is to be extended to all, that a similar mode to that generally adopted by medical practitioners with their private patients should be acted upon, viz., to vaccinate children at their homes. The benefits resulting from vaccination are not exclusively confined, as is often supposed, to the child successfully vaccinated, but the public generally are benefitted by each successful case of vaccination, for in proportion as the child obtains thereby some amount of security against an attack of small-pox is the public rendered safer from the ravages of the disease by a diminution 7 of the foci of communication. Every endeavour should therefore be made by the public vaccinators to extend vaccination among all classes. The deaths recorded from hereditary syphilis are 4, but this number does not represent the total deaths from this disease, for all the children who die from this disease are not so registered. Such deaths are frequently recorded under the name of some other disease, such as convulsions, etc. A more correct return of deaths from hereditary syphilis would be obtained if medical men always forwarded direct to the local registrar the certificate of death instead of giving it to the parent or guardian of the deceased child. It may be fairly estimated that upwards of 2,000 persons in England and Wales die annually from syphilis (the precise number recorded in 1861 is 1,177); it is also the cause of many children being still-born. There is scarcely room to doubt that this loathsome disease (syphilis) might be greatly mitigated, if not entirelyprevented, by legislative measures. But this is a subject which the public generally are unwilling to discuss. Nevertheless, if the extent of the evil were fully known, as is shown not only by the records of medical practitioners stating the amount of sacrifice of the health and lives of the innocent children who are the offspring of diseased parents but by the enormous expense which is entailed upon the public by the prevalence of this disease among the poor and in our army and navy (the military and naval hospitals always containing a very large number of patients suffering from this disease, thereby incapacitating our soldiers and sailors from effective service) it is not improbable that the subject would receive more attention from the public. The deaths from "teething" are 23. There surely must be some mistake in attributing so many deaths to this cause. Nature does not perform her work in so imperfect a manner as to cause the death of 3 per cent, of all the births. Improper food, the want of fresh air, and general neglect, are the most frequent causes of the death of young children, and not the natural operation of "teething." A female, aged 28. died from lead poisoning. A child, aged 16 days, died from compression of the chest by the use of tight bandages; and a man, aged 78, died from gangrene of the foot occasioned by a cab running over it. An inquest was not held on either of these cases. Twelve deaths were uncertified. One of these uncertified deaths was that of a child, aged 5 months, whose death is thus recorded, " ill from birth, natural causes;" another, of a boy, aged 9 years, "rheumatism and disease of the heart." There are two of these uncertified deaths recorded as having been caused by consumption, one by diarrhoea, and the others by convulsions. The number of inquests was 72 against 69 for the corresponding quarter of last year. Of these 44 were held in the London Hospital. The records of 8 the coroner's inquests show that 2 persons were wilfully murdered, 2 children died from suffocation in bed, 1, an illegitimate child, newly born, died from suffocation through absence of assistance at birth, 1 child, 3½ years old, died from suffocation, produced by the bed taking fire in consequence of a child getting possession of a lucifer match. The death of a man, aged 66, is recorded as having been accelerated by the want of food and other necessaries. Spasm of the glottis was the cause of death in a child aged 6 months. The drinking of water containing phosphoric acid in which certain matches called "Vesuvians" had been floating, caused the death of a child aged 1 year. Two persons, aged respectively 20 and 24, died from the effects of injuries occasioned by the explosion of fire-works. Two men, aged respectively 40 and 63 died in consequence of falls while drunk. A female, aged 33, died from alcoholism or the effects of intoxicating liquors. A boy, aged 16 years, died from the effects of a stab from a knife accidentally given him by a playmate. The deaths in the workhouse were 101, viz., 52 males and 49 females; of these 3 were from small-pox, 3 from diarrhoea, and 13 from fever. Six of the total deaths in the workhouse were of persons who had reached 80 years and upwards. The Medical Officers of the Union have attended 3,607 new cases of sickness among the out-door poor, including 103 of small-pox, 34 of measles, 31 of scarlet fever, 40 of hooping cough, 129 of diarrhoea, and 76 of fever. In the corresponding quarter of the previous year the medical officers attended 3,755 new cases of sickness, including 14 of small-pox, 42 of measles, 9 of scarlet fever, 39 of hooping cough, 140 of diarrhoea, and 199 of fever. The cases of fever have diminished from an average of 15.3 per week to 5'8 per week, while small-pox has increased from an average of 1 to 8 per week. Of the 103 cases of small-pox 33 are said to have been previously vaccinated, 38 unvaccinated, and of the remainder there is no record as regards vaccination. Mr. Sequeira reports that one of the cases of small-pox was that of a boy aged 8 years, who had previously had small-pox. The cases of illness in the Workhouse have been 732, of which number Mr. Champneys attended 381, and Mr. Richardson 351. The cases of epidemic diseases included in the above returns are 28 of small-pox, 3 of scarlet fever, 10 of diarrhoea, and 71 of fever. Of the 28 small-pox cases 17 were attended by Mr. Champneys, and 11 by Mr. Richardson. Mr. Richardson remarks that 5 out of the 11 cases which he attended had been vaccinated, and that the severe cases of the disease were among those patients who had not been vaccinated. 9 The water supply to the poor localities in the district remains very nearly in the same unsatisfactory condition as was stated in my former reports. The mode of supply has in one or two instances been improved by the substitution of a tank containing water enough for the daily use of the inhabitants of the court, instead of the stand pipe from which water flowed for a period of only half an hour daily. Two houses in Frying-pan Alley which, ever since the formation of your Board, had been without any water supply (the same having been cut off many years ago in consequence of the non-payment of the waterrate) have, by notice served upon the landlord, had the water again laid on. I am sorry, however, to have to state that there are several houses in the district which are entirely without any water supply, and that the poor tenants who, of course, must obtain water from some source, are obliged to get it from their neighbours, thereby rendering themselves liable to a penalty of a sum not exceeding ten pounds for each offence, and also rendering the person who supplies them with water liable to the penalty of a sum not exceeding five pounds for each offence. The inspectors have made a return of special visitations to 20 courts, from which it appears that several rooms are overcrowded, and that some of the rooms are not only overcrowded but most indecently occupied. In the course of the inspector's visitations some underground rooms not in accordance with the provisions of the Act of Parliament regulating the dimensions and other sanitary particulars of such rooms were discovered by them. At No. 53, Royal Mint Street, two females were found living in a cellar; and at No. 14, Wellclose Square, a kitchen was found to be unlawfully occupied by a family. In consequence of my attention having been drawn by one of the Relieving Officers of the Union to a room at No. 34, Glass House Street, I visited the house, but I found it to be a matter of such difficulty to enter the room, owing to the narrowness of the ladder leading to a trap-door which opened into it, that I gave up the attempt to do so. However, I looked into the room, where I saw an old woman lying in a bed from which the dead body of her husband had been recently removed. The room, or rather the loft, was less than seven feet high in its highest part. I mention this case to show what kind of places some people will resort to. Any places, whether a loft immediately under the tiles or a cellar under the basement of the house, however unfit for habitation such places may be, will have occupants. The only way to know of such habitations is to inspect periodically all the houses in poor districts. Improvements as regards the pavement have been made by the landlords in Wilson's Place and Bell Court, Spitalfields. The houses in Tuson's Court * 10 still remain closed as the landlord has not yet put them in a proper sanitary condition. By order of your Board I made a special report upon the sanitary condition of Spitalfields Market, in which report I stated that the market was not sufficiently drained, and that the pavement generally was very defective, and that it was only cleansed three times a week. In the course of a few weeks I hope to be able to report that the sanitary condition of the market has been much improved. The refinery premises of Sir A. Rothschild have again been complained of to your Board. The nuisance arising from the escape of the acid fumes from these premises is most annoying to some persons living in the vicinity of the works. These acid vapours are not only injurious to health but they are destructive to clothes. Specimens of clothes, showing the destructive agency of these vapours, have been submitted to me, and I can speak personally of their injurious effects upon respiration. As this nuisance can by proper care be effectually prevented, it is most earnestly to be desired that Sir A. Rothschild will cause such improvements to be effected in the mode of carrying on this business, that complaints from the neighbourhood may entirely cease. I am, Gentlemen, Your obedient Servant, JOHN LIDDLE. 15, Great Alie Street. * APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending the 28th March, 1863. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping Cough. Diarrhoea. Continued Fever, (Typhus and Typhoid.) Cholera. Erysipelas. Pyaemia. Puerperal Fever. Carbuncle. AcutePulmonary Inflammations. Croup. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Diphtheria. All other Diseases. Total. Average number of Fever cases per Week Bronchitis and Catarrh. Pleuritis and Pneumonia. Mr. Blackwell 42 10 8 26 39 36 .. 4 .. .. .. 91 21 .. 6 .. .. 1 .. 759 1043 Mr. Champneys 13 1 4 3 25 5 .. 2 .. .. .. 21 4 .. .. 1 1 1 .. 570 651 Mr. Richardson 15 .. 8 3 28 5 .. 2 .. .. .. 24 2 .. 1 .. 1 .. .. 678 767 Mr. Sequeira 33 23 11 8 37 30 .. 4 .. .. .. 30 13 7 .. 2 3 .. .. 945 1146 Total 103 34 31 40 129 76 .. 12 .. .. .. 166 40 7 7 3 5 2 .. 2952 3607 5.8 TABLE II.—Showing the Deaths from Epidemic Diseases for the Three Mouths ending 28th March, 1863. District. Small-pox. Measles. Scarlet Fever. Diphtheria. Hooping-cough. Diarrhoea. Fever. Total. Remarks. Artillery 0 1 7 0 0 0 3 11 Spitalfields 10 3 17 2 2 3 3 40 MileEndN.Town 5 0 11 1 3 3 19 42 Workhouse. Whitechapel, N. 11 10 13 1 1 2 4 42 Whitechapel Ch. 4 1 4 0 2 1 2 14 Hospital. Goodmn's Fields 0 4 5 0 4 0 2 15 Aldgate 1 0 5 0 3 4 6 19 Total 31 19 62 4 15 13 39 183 Death from Epidemics for the corresponding quarter, 1862. 3 10 13 5 21 3 53 108 TABLE III.—Showing the Ages at death in the Workhouse and in the London Hospital. 0 and under 1 1 and under 5 5 and undr20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Total Males 52 Femls. 49 Corresponding Quarter of 1862 Workhouse 10 3 8 22 25 27 6 101 118 L. Hospital 0 7 14 27 39 13 0 Males 69 Femls. 31 100 112 TABLE IV.—Ages at Death in each Registration District for the Three Months ending 28th March, 1863. Districts. 0 and under 1 1 and under 5 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and upwards. Total. Remarks. Artillery 11 15 2 5 6 3 1 43 Spitalfields 26 38 16 16 14 13 2 125 MileEndN.Twn. 35 30 12 34 49 37 6 203 Workhouse. Whitechapel, N. 23 41 11 5 10 11 2 103 Whitechapel Ch. 8 17 16 36 48 18 5 148 Hospital. Goodmn's Fields 14 15 9 4 11 6 2 61 Aldgate 14 21 12 9 12 10 0 78 Totals. 131 177 78 109 150 98 18 761 TABLE V.—The Births and Deaths in each Registration District for the Three Months ending on the 28th March, 1863. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks. M. F. M. F. Artillery 35 39 74 25 18 43 31 — Spitalfields 68 57 125 75 50 125 — — Mile End N. Town 82 96 178 105 98 203 — 25 Workhouse. Whitechapel, N 48 59 107 64 39 103 4 — Whitechapel Ch 41 39 80 88 60 148 — 68 London Hospital. Goodman's Fields 46 39 85 29 32 61 24 — Aldgate 38 36 74 38 40 78 — 45 Non-residents died in Lon. Hosp. Totals 358 365 723 424 337 761 59 97 Excess of births over deaths, deducting the 45 non-residents 7 Population in 1861, 78970. TABLE VI.—Causes of Death at Seven periods of Life, registered in the Whitechapel District, for the Three Months ending 28th March, 1863. Causes of Death. 0 and under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and above. Total. Causes of Death. 0 and under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60, 60 and under 80. 80 and above. Total. 1.—Zymotic. I.—Miasmatic. Small-pox 8 17 2 3 1 ... ... 31 Brought Forward 97 154 59 79 117 72 3 581 IV. — Digestive Organs. Cancrum Oris Measles 2 16 1 ... ... ... ... 19 Scarlatina 7 35 18 2 ... ... ... 6? G-astritis ... ... ... ... 1 ... ... 1 Diphtheria 1 2 ... 1 ... ... ... 4 Enteritis 1 ... ... ... 1 ... ... 2 Quinsy Peritonitis ... ... 1 1 1 ... ... 3 Croup 1 7 ... ... ... ... ... 8 Ascites ... ... ... 3 2 1 ... 6 Hooping - cough 5 10 ... ... ... ... ... 15 Ulc. of Intestines Typhus Fever ... 6 15 6 8 4 39 Hernia (Rupture) ... ... 1 3 ... 1 ... 5 Erysipelas 1 1 ... 1 1 2 ... 6 Ileus Puerperal ... ... ... 1 ... ... ... 1 Intussusception ... ... ... ... 1 ... ... 1 Carbuncle ... ... ... 1 1 ... ... 2 Fistula Influenza Stomach Disease, &c. ... ... ... ... ... 1 ... 1 Dysentery ... ... ... ... 1 ... ... 1 Pancreas Disease, &c. Diarrhoæ 3 4 ... ... 4 2 ... 13 Hepatitis ... ... 1 1 1 ... ... 3 Ague ... 2 ... ... ... ... ... 2 Liver Disease, &c. 2 ... ... 4 3 ... 1 10 Remittent Fever Spleen Disease, &c. Rheumatism ... ... 1 ... 1 ... ... 2 V. — Urinary Organs. Nephritis Pyæmia II.—Enthetic. Syphilis 4 ... 1 ... ... ... ... 5 Disease of Bladder ... ... ... ... 1 ... ... 1 Stricture of Urethra ... ... ... ... ... 1 ... 1 Nephria (Bright's Disease) ... ... 1 3 4 3 ... 11 Hydrophobia III.—Dietic. Privation Diabetes ... ... ... ... ... 1 ... 1 Stone ... ... 1 ... ... ... ... 1 Want of Breast Milk Purpura and Scurvy Alcoholism — Delirium Tremens. ... ... ... 2 ... ... ... 2 Prostate Disease Kidney Disease, &c. ... ... ... ... 1 1 ... 2 Retention ... ... 1 ... ... ... ... 1 VI.—Organs of Generation. Ovarian Disease ... ... ... 1 3 1 ... 5 ,, Intemperance Lead Poisoning ... ... ... 1 ... ... ... 1 IV.—Parasitic Thrush 2 ... ... ... ... ... ... 2 Uterus Disease, &c. VII.—Organs of Locomotion. Joint Disease, &c. Bones, &c. Worms,&c. 2.—Constitutional I.—Diathetic. Gout ... ... ... ... ... 2 ... 2 Spinal Disease ... ... 1 ... ... ... ... 1 VIII. — Integumentary System. Phlegmon Dropsy ... ... ... 1 5 4 ... 10 Cancer ... ... ... ... 2 4 ... 6 Mortification ... ... ... ... ... 4 2 6 Skin Disease, &c. ... ... ... ... ... 1 ... 1 Abscess 2 1 1 ... 1 1 ... 6 Anæmia 4.-Developmental 1.—diseases of Children. II.—Tubercular. Scrofula Tabes Mesanteria 12 9 1 ... ... ... ... 22 Premature Birth 7 ... ... ... ... ... ... 7 Phythisis (Consumtn) 1 3 14 41 30 5 ... 94 Cyanosis 1 ... ... ... ... ... ... 1 Hydrocephalus 1 6 1 ... ... ... ... 8 Spina Bifida 3.—Local. 1.—Nervous System. Other Malformations Teething 10 13 ... ... ... ... ... 23 II.—Diseases of Adults. Paramenia Cephalitis ... ... 1 ... ... ... ... 1 Apoplexy ... ... ... 3 8 6 ... 17 Childbirth ... ... 1 3 ... ... ... 4 Palsy (paralysis) ... ... ... 1 4 4 ... 9 III.—Diseases of Old People. Old Age ... ... ... ... ... 14 14 28 Insanity Tetanus Epilepsy Convulsions 22 8 ... ... ... ... ... 30 IV.—Diseases of Nutrition. Atrophy and Debility 9 ... ... ... ... ... ... 9 Chorea Brain Disease,&c. ... ... ... 2 1 1 ... 4 II.—Organs of Circulation. Pericarditis ... ... ... 1 1 ... ... 2 5.—ViolentDeaths I.—Accidents of Negligence. Aneurism Burns and Scalds ... 6 4 ... ... 1 ... 11 Heart Disease, &c. ... ... ... 7 9 6 ... 22 Poison ... 1 ... ... ... ... ... 1 Philebitis ... ... ... ... 1 ... ... 1 Suffocation 2 2 ... ... ... ... ... 4 Disease of Arteries Violence 1 1 7 10 12 ... ... 31 III.—Respiratory Organs. Laryngismus ... 2 ... ... ... ... ... 2 III.—Homicide. Murder and Manslaughter ... ... ... 1 ... ... ... 1 Laryngitis Bronchitis 1 9 ... 6 1 ... ... 2 1 23 ... 16 ... ... 3 56 PV.—Suicide. Wounds Pleurisy ... ... ... ... 1 ... ... 1 Poison Pneumonia 15 19 2 3 5 1 ... 45 Drowning ... ... ... ... 2 1 ... 3 Lung Disease, &c. ... ... ... ... 8 9 1 18 Hanging Otherwise Not Specified 1 ... ... ... ... ... ... 1 Carried Forward 97 154 59 79 117 72 3 581 Grand Total 131 177 78 109 150 98 18 761 92 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON The Sanitary Condition OF THE WHITECHAPEL DISTRICT, for the THREE MONTHS ENDING 27th JUNE, 1863. BY JOHN LIDDLE Medical Officer of Health Presented to the Board, July 6th, 1863. LONDO: PRINTED BY T. PENNY, 121, LEMAN STREET, WHITECHAPEL, AND 9, LONDON TERRACE, HACKNEY ROAD. 1863. REPORT FOR THE QUARTER ENDING, The 27th JUNE, 1863. Gentlemen, The total deaths in the Whitechapel District during this Quarter, including the deaths of 40 non-residents who died in the London Hospital, have been 639. The mortality still continues to be much in excess of the average for the corresponding periods of the preceding seven years. The excess in the rate of mortality during the first three months of this year was 8.5 per week above that in the corresponding quarters of the preceding seven years, and the mortality during this quarter has been at the rate of 8.2 per week above the average of that in the corresponding quarters of the preceding seven years. From 1856 to 1861 both included, the average mortality in the June Quarter was 519.5. In the June Quarter of 1862, the mortality was 610. The increase of the mortality in this quarter above that of the corresponding quarter of last year is 29, and 107 above the average in the corresponding quarters of 1856-61. The great increase in the number of deaths in this district is much to be deplored, as there is no reason to believe that the population in this district has increased. Judging from the number of houses which have recently been taken down for the Blackwall. Railway extension, the population ought to have decreased, but it is more than probable that those persons who have been displaced by the taking down of their residences have obtained rooms in other houses in the district; and have rendered such houses still more overcrowded. The population in 1861 was found to be nearly the same as it was in 1851, In the official returns, the population of this district is stated to have been in 1851, 79,759, and in 1861, 78,971, or 789 less; but in 1851, the number of persons living on board ship in the Docks and on the River was 979, while in 1861 it was only 264; the population therefore living in houses in 1861 was only 74 less than it was in 1851. The number of inhabited houses in 1851 was 8812, and in 1861 it was 8664. The decrease in the number of houses was 148, while the number of the people living in houses in the district was only reduced by 74. The overcrowding which now probably exists in a greater degree than heretofore may in some measure account for the great increase in the rate of mortality during the last two years. What may be the ultimate result of the present unsatisfactory condition of this district as regards the health of the people cannot be predicted with certainty; but we have reason to believe that the rate of mortality will increase unless improvements are effected, so as to admit currents of air into the most densely populated quarters. Epidemic diseases are constantly among us, and they appear to excite very little alarm; but if Cholera, which is only an occasional 4 visitor, should again prevail, the people will become alarmed, and then, if not hefore, it is to be hoped that increased energy will be put forth by the several local and governmental authorities to stay the ravages of disease, and that amendments will be made in the several acts relating to the health of the people. Of the total deaths, 327 were of males, and 312 of females. The registered births were 700, of which 355 were of males and 345 of females. The deaths in the London Hospital have been 97, of which, 40 were of non-residents, and 47 were the result of accident or were sudden deaths. The total mortality in this district during the last six months has been at the annual rate of 3.5 per cent, of the population. If we exclude the deaths of the non-residents, and include in the general mortality all the sudden deaths, and deaths which occurred in the London Hospital occasioned by violence, the mortality has been at the annual rate of 3.3 per cent., and if we exclude altogether the deaths in the London Hospital, then the mortality has been at the annual rate of 3 per cent. The rate of mortality in London from 1850-9 was 2.36 per cent., from 1859-61, it fell to 2.26 per cent., in 1861 it rose to 2.32 per cent., and in 1862 it was 2.34 per cent. The average number of living to one death annually in London (1860-62) is 41. The average birth rate in London is 3.37 per cent, annually. The mortality in all England from zymotic diseases in 1861 was at the rate of 4.4 in 1000 living. In this district during the same year the mortality from zymotic diseases is 6 in 1000 living. During the last six months, the mortality from zymotic diseases in the Whitechapel District has been at the annual rate of 9.9 in 1000 living. The deaths from epidemic diseases during this quarter have been 165, viz., 21 from Small-pox, 3 from Measles, 82 from Scarlet Fever, 3 from Diphtheria, 15 from Hooping-cough, 13 from Diarrhoea, and 28 from Fever,* including Typhus, Typhinia, and Typhoid or Typhia. Small-pox and Scarlet-fever, as may be seen from the subjoined table have been epidemic for a period of nearly nine months. This table shows the number of deaths in the entire district from Small-pox and from Scarlet-fever which has occurred week by week. It likewise shows the number of cases of these diseases which have been attended by the Medical Officers of the Union, and also the total number of deaths which has occurred weekly in the entire district. * In a letter written by Dr. William Farr, and published in the last Annual Report of the Registrar General, it is stated that Typhus Fever is characterized by blood spots upon the skin (petechiæ), and that the mortality from this disease in the London Fever Hospital is 21 per cent. This form of fever is generated in crowded populations. Typhinia, also called Relapsing Fever and Famine Fever is endemic in times of scarcity and famine. The mortality from this form of fever does not exceed 2½ per cent. It is called Relapsing Fever from the fact that patients, after getting well apparently about the seventh day, are subject to a sudden relapse on the fourteenth day. Typhoid, Typhia or Pythogenie Fever is characterized by an eruption of rose coloured spots on the skin, and by a morbid condition of the glands of the Ilium and Mesentery. This disease is often protracted to the 30th day, and in the Fever Hospital 19 cases in 100 terminated fatally. In the same letter, when writing upon the mortality from Small-pox, Dr. Farr says "that it is impossible to determine in these cases who is to"blame in not procuring for the helpless children the protection which the legislature has provided against Small-pox. The Coroners, by holding a certain number of inquests, might ascertain how the matter really stands, and may prevent acts of negligence which in their consequences are as latal as the ordinary offences of manslaughter." If orders, served upon landlords for removing nuisances injurious to health, are not complied with, such landlords may be rendered liable to a charge of criminal neglect, if death result in consequence of the non-removal of the nuisance. 5 Date 1862 and 1863 Deaths from Small pox, in entire District. Pauper cases of Small-pox. Deaths from Scarlet fever in entire District. Pauper cases of Scarlet-fever. Total deaths in eutire District. Date, 1S63. Deaths from Small pox in entire District. Pauper cases of small - pox. Deaths from Scarlet fever in entire District. Pauper cases of Scarlet-fever. Total deaths in entire District. Oct. 25 3 8 3 8 58 Feb. 28 1 r) 5 3 49 Nov. 1 1 4 3 3 37 Mar. 7 5 6 7 3 65 ,, 8 2 3 0 5 53 ,, 14 5 10 8 4 72 ,, 15 I 4 3 4 65 ,, 21 1 7 4 3 46 ,, 22 1 2 3 1 53 ,, 28 0 6 7 5 75 ,, 29 1 3 1 1 58 April 4 2 7 5 4 44 Dec. 6 0 6 3 7 50 ,, 1 1 1 5 8 8 71 ,, 13 3 7 2 6 48 ,, 18 2 7 5 5 39 ,, 20 2 7 3 8 61 ,, 25 3 10 9 6 53 ,, 27 1 9 4 2 47 May 2 2 14 6 1 66 Jany. 3 2 8 4 0 59 ,, 9 1 7 8 6 47 ,, 10 4 4 4 3 79 ,, 16 2 12 5 5 56 ,, 17 1 7 4 0 59 ,, 23 2 8 9 10 51 ,, 24 0 13 3 1 50 ,, 30 1 6 8 7 54 ,, 31 6 11 2 1 68 June 6 2 15 6 7 41 Feb. 7 0 10 4 5 49 ,, 13 1 2 6 4 34 ,, 14 2 6 7 2 43 ,, 20 1 1 2 13 26 ,, 21 4 10 2 1 41 ,, 27 1 5 5 4 56 It appears from this table that the pauper cases of Small-pox exhibit a much larger proportion to the deaths from this disease than is observed to have been the case with Scarlet-fever. The total deaths from Small-pox since the 25th October, have been 67, and the number of pauper patients attacked have been 255, while the total deaths from Scarlet-fever have been 168, and the cases among the pauper population have been only 156. It therefore appears that Small-pox has prevailed in a greater proportion than Scarlet-fever among the poor ; while Scarlet-fever has been more fatal among the rate-payers generally, and such has been its fatality in this district during the last six months, that the deaths from it have exceeded in number the deaths from Small-pox and Fever combined. The deaths from these two diseases combined having been 119, and the deaths from Scarlet-fever 144. Since the 30th of March last 4 cases of Smallpox from this District have been admitted to the Small-pox Hospital. From an abstract of the returns of the Registrars of Births and Deaths which I have prepared, I find that in 160 separate places in this district one or more deaths have occurred in each from epidemic diseases within the last six months. In some places as many as six or seven deaths have occurred. Thus, in Spitalfields Market there have been 6 deaths from epidemic diseases; in Quaker Street and Grey Eagle Street there have been 11 deaths, in George Street 8 deaths, in Castle Alley 9, in Goulston Street 8, in Swan Court Middlesex Street 9, in Preston Street 5, in Spital Street, 5, in Cobb's Yard 5, in Cox Square 3, in Artillery Passage 3, in Lambeth Street 6, in Leman Street 5, in Royal Mint Street 6, and in Whitechapel Hihg Street and Road Side there have been 9 deaths from this class of diseases. In Jones' Buildings, a place in which the houses are without back yards, and where a public water closet is situated within 18 inches of the window of the lower room of one of the houses, the smell from which water closet is greatly complained of by the tenants, The number of cases of illness which have been attended by one Medical Practitioner, including paupers and private patients, in these "Buildings" from the 14th March to the ,15th June has been 56; of these,, 6 40 have been cases of epidemic diseases, and in the house which is situated so close to the public water closet, there hare been 10 cases of fever, the greater number of which were removed to the "Workhouse. As may be anticipated, from the occurrence of so large a mortality from epidemic diseases, (particularly from Scarlet-fever and Small-pox,) there has been a very large number of deaths of children under 5 years of age. During the previous quarter the proportion of deaths of young children under 5 years to the total mortality in the district was 40 per cent.; whereas during this quarter, the proportion is 43.6 per cent. In the Whitechapel North Sub-district, the deaths of children under 5 years of age are in the proportion to the total deaths of 60 per cent. During this quarter the deaths from diseases of the respiratory organs have been 87. The tubercular class of diseases has been fatal to 98, of which number 59 died of Consumption, 4 from Scrofula, 9 from Hydrocephalus (water on the brain), and 26 from mesenteric disease; 32 died from the effects of violence, 5 destroyed themselves, one of them by inflicting wounds on the throat, 2 by hanging, one by taking poison, and one by throwing himself out of window. The death of a child 4 months old is recorded to have been occasioncd by Erysipelas after vaccination. The number of deaths uncertified by a Medical Practitioner has been 5. One of these uncertified deaths was that of a child aged 3 years, the son of a Captain in the Merchant Service, and the death is recorded in classical terms as . being caused by "Scarlatina Malignaand three are said to have been occasioned by Convulsions, and one is thus recorded "Tuierculers."! The number of inquests has been 69. In the records of these inquests it is stated that the death of a child 4 years of age was occasioned by a bean getting into the windpipe. The following deaths are also recorded, viz., five by suicide, one from the effects of blows at a prize fight at Hackney, one from the effects of excessive drinking, one from a fall, the deceased having trod upon a piece of orange peel on the pavement, one, a labourer's wife aged 28, from "burns through wearing crinoline," one, a child newly born, from violence wilfully inflicted; three children aged respectively 6 weeks, 6 weeks, and 9 weeks, from suffocation in bed, the last of which occurred at night "whilst the parents were under the influence of drink"; one, a female aged 37 from "Eupture of the Bladder from Natural Causes," one from syncope from too great use of opium, one, a boy aged 9 years, " from eating largely of raw sugar cane, and disease of the kidneys from suppressed Scarlatina"; one from suffocation from a piece of meat sticking in his throat; and one, a child aged 6 months, from the effects of violence, the mother while in a state of insanity having thrown the child out of the window. An inquest was not held on the body of a child aged 5 years whose death occurred from the effects of burns received 10 weeks since. The deaths in the "Workhouse have been 70 against 120 for the corresponding quarter of the previous year. Of these deaths, there were 2 from Smallpox, one from Measles, and 11 from Fever. The Medical Officers of the Union attended 3462 new cases of sickness, including 100 of Small-pox, 26 of Measles, 80 of Scarlet-fever, 66 of Hooping cough, 167 of Diarrhoea, and 123 of Fever. Of the Small-pox cases 56 had been previously vaccinated, 29 had not been vaccinated, and of the remaining 15 cases there is no record as regards vaccination. 7 The number of cases of sickness in the "Workhouse has been 563, including 48 of Small-pox, one of Hooping Cough, 2 of Erysipelas, 4 of Diarrhoea, and 45 of Fever. Of the total number Mb. Champneys attended 298, and Mr.. Richardson 265. In the corresponding quarter of the previous year the total number of cases of sickness in the Workhouse was 876. The undermentioned Courts and Places have been specially visited by the Inspectors during the last three months: Cobb's Yard, Jefferies' Buildings, Easington Buildings, Vine Yard, Hanover Court, Crown Court Whitechapel Road, Sarah Place, C.C., Corbett's Court, Goulston Court, George Court, Unanimous Row, Adelaide Place, and Hunt Court: Providence Place Back Church Lane, Munday's Place, Conant's Place, Leman Row, Baker's Arms Alley, Bracey's Buildings, White Horse Court, Compasses Court, Cherubim Court, Brunswick Place Back Church Lane, and Williams Rents. The rooms in many of these places were found to be overcrowded, and some of the rooms were not only overcrowded but indecently occupied. Thus, at No. 7, Leman Row, the Inspector found that a man and his wife, the wife's sister 25 years of age, and a daughter 13 years of age, slept in the same room. In the same house, on the second floor there slept in one room a man and his wife, son aged 15 years, daughter 18 years, and three children. Similar instances of the indecent occupation of rooms were found at Nos. 8 and 9 in the same place, at Nos. 4 and 5, Baker's Arms Alley, and at Nos. 1, 3, 4, 5, 8, and 9, Bracey's Buildings, at 1, 2, 11, and 18, Williams Rents, at 1, 4, and 12, Brunswick Place. In one room, at No. 12, having only one bed, an uncle and adult neice slept. In some of these places, the closets were found to be very offensive, and large accumulations of dust and house refuse were not only found in the yards but in the cellars. In some of the rooms, the space, supposing the room to be void of furniture, for each occupant was only 125 cubic feet. The Inspectors now regularly inspect a certain number of Courts and bye places daily. By steadily pursuing this plan, all the worst places where sanitary remedies are most required, and where nuisances are frequently recurring are repeatedly brought under notice. The daily reports of these visits are preserved and indexed, so that it can be easily ascertained what number of times each place has been visited. The result of these daily inspections has been very satisfactory—the public dust bins are more frequently emptied, and the public privies are kept in a cleaner condition. Considerable difficulty is found in preventing persons occupying cellars. Whenever it is discovered that any cellar is occupied as a sleeping room, notice is immediately served upon the landlord of the house to remove the occupants, but they soon return to the same place, or others get possession of it. The police are the only parties who could effectually deal with such cases. In the month of May last, information was given at the Office of the Board that bodies of still-born children were lying at an undertaker's premises in the district, and it was said, that these dead bodies had been kept there for a considerable time, and that the smell from them was very offensive. Upon inquiry, the undertaker admitted the fact, but stated that it was owing to the neglect of his foreman, who had kept them on the premises for his own benefit. When the premises were visited, the Inspector was informed that the bodies had been buried. I am, Gentlemen, Your obedient Servant, 15, Great Alie Street. JOHN LIDDLE. TABLE I.—Cases of Sickness of the Zymotic and Acute classes, which are recorded in the Books of the Medical Officers of the Union for the Three Months ending the 27th June, 1863. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Continued Fever (Typhus and Typhoid.) Carbuncle. Erysipelas. Acute Pulmonary Inflammations. Croup. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. All other Diseases. Total. Average number of Fever cases per Week. Bronchitis and Catarrh. Pneumonia and Pleuritis. Mr. Blackwell 33 7 29 13 44 45 1 4 78 8 0 2 1 1 0 695 961 Mr. Champneys 16 1 13 12 29 44 — 6 14 16 1 0 0 16 0 508 676 Mr. Richardson 27 2 30 4 33 4 — 3 4 1 1 0 0 0 0 667 776 Mr. Sequiera 24 16 8 37 61 30 — 3 10 2 0 0 5 1 0 852 1049 Total 100 26 80 66 167 123 1 16 106 27 2 2 6 18 0 2722 3462 94 Of the 100 cases of Small pox 58 are recorded as having been previously vaccinated, 29 as not having been vaccinated and of the remainder there is no record as regards vaccination. TABLE II.—Showing the Deaths from Epidemic Diseases for the Three Months ending 27th June, 1863. District. Small-pox. Measles. Scarlet Fever. Diphtheria. Hooping-cough. Diarrhoea. Fever. Total. Remarks. Artillery 2 2 10 0 3 1 2 20 Spitalfields 7 0 16 0 2 2 4 31 Mile End N.Town 6 1 17 1 1 2 16 44 Workhouse. Whitechapel, N 6 0 19 0 1 0 1 27 Whitechapel Church 0 0 8 1 0 3 2 14 Hospital. Goodman's Fields 0 0 10 1 4 2 1 18 Aldgate 0 0 2 0 4 3 2 11 Total 21 3 82 3 15 13 28 165 Deaths from Epidemics fur the corresponding quarter, 1861. 6 44 12 3 15 8 84 172 TABLE III.—Showing the Ages at Death in the Workhouse, and iu the London Hospital. 0 and under 1 1 and under 5 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Total Males 43 Femls. 27 Corresponding Quarter of 1862. Workhouse 11 2 1 15 19 18 4 72 120 L. Hospital 0 6 12 24 41 13 1 Males 73 Femls.24 97 69 TABLE IV.—Ages at Death in eaeh Registration District, for the Three Months ending 27th June, 1863. Districts. 0 and under 1 1 and under 5 5 and ^under 20 20 and under 40 40 and under 80 60 and under 80 80 and upwards. Total. Remaks. Artillery 10 19 9 4 6 4 1 53 Spitaltields 23 29 13 9 13 6 1 94 Mile End N. Town 41 78 16 25 28 21 5 154 Workhouse. Whitechapel, N 16 32 8 7 9 7 1 80 Whitechapel Church 3 19 16 28 45 20 3 134 Hospital. Goodman's Fields 18 19 5 6 9 3 4 61 Aldgate 19 12 3 11 5 10 0 60 Totals 130 148 70 90 115 71 15 639 TABLE V.—The Births and Deaths in each Registration District, for the Three Months ending on the 27th June, 1863. Districts. Births. Total. Deaths Total Excess of Births over Deaths Excess of Deaths over Births. Remarks. M. F. M. F Artillery 31 30 61 29 24 53 8 — Spitalfields 61 55 116 39 55 94 22 — Mile End New Town 82 94 176 76 78 154 22 — Workhouse. Whitechapel, N 61 60 121 38 42 80 41 — Whitechapel Church 35 28 63 89 45 134 — 71 London Hospital. Goodman's Fields 43 50 98 28 36 64 34 — Aldgate 37 28 65 28 32 60 5 40 Non - residents died in Lon. Hos. Totals 355 345 700 327 212 639 132 71 Excess of births over deaths, deducting the 40 non-residents 101 Population in 1861, 78,970. In 1801 the population was 79,759. which number included 979 persons being on board ship in the River and in the Docks, while in 1861 the number living on board ship was only 261 the population therefore in 1861 living in houses within the district was only 74 less than it was in 1851. TABLE VI.—Causes of Death at Seven Periods of Life, registered in the Whitechapel District, for the Three Months ending 27th June, 1863. Causes of Death. 0 and under 1 1 and under 5 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above. Total. Causes of Death. 0 and under 1. 1 and under 5 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above Total. I.-Zymotic:— Order 1—Miasmatic Brought forward 98 134 58 76 83 40 2 482 Small-Pox 4 7 5 4 1 ... ... 21 Order 4—Digestive Organs. Measles 2 1 ... ... ... ... ... 3 Scarlatina 8 49 25 ... ... ... ... 82 Cancrum Oris Diphtheria ... 2 1 ... ... ... ... 3 Gastritis Quinsy ... 1 ... ... ... ... ... 1 Enteritis ... ... 1 2 1 1 ... 5 Croup 2 5 1 ... ... ... ... 8 Peritonitis ... ... ... ... ... 1 ... 2 Hooping-Cough 4 11 ... ... ... ... ... 15 Ascites ... ... ... ... 4 3 ... 7 Typhus Fever 1 1 9 9 6 2 ... 28 Ulc. of Intestines Erysipelas 3 ... 2 1 2 ... ... 8 Hernia (Rupture) ... ... ... ... 2 2 1 5 Puerperal Fever Ileus Carbuncle Intussusception Influenza Fistula Dysentery ... ... ... ... 1 ... ... 1 Stomach Disease, &c. Diarrhoea 5 3 2 ... 1 1 1 13 Pancreas Disease, &c. Ague Hepatitis ... ... ... 1 2 ... ... 3 Remittent Fever ... ... 1 ... ... ... ... 1 Liver Disease, &c. ... ... ... 2 3 2 ... 7 Rheumatism ... ... 1 ... ... ... ... 1 Stricture of (Esophagus) ... ... ... ... 1 ... ... 1 Pyæmia Order 5 — Urinary Organs. Varicella ... 1 ... ... ... ... ... 1 Order 2—Enthetic. Morbus Addisonii Syphilis ... ... ... ... 1 ... ... 1 Rupture of Bladder ... ... ... 1 ... ... ... 1 Stricture of Urethra ... ... ... 2 2 ... ... 4 Nephria (Bright's disease) ... ... ... 2 2 1 ... 5 Hydrophobia Order 3—Dietic. Diabetes ... ... ... ... 1 ... ... 1 Privation Prostate Disease ... ... ... ... ... 1 1 2 Want of Breast Milk Kidney Disease, &c. ... ... 1 ... ... ... ... 1 Purpura and Scurvy Order 6—Organs of Generation. Alcoholism—Delirium Tremens ... ... ... 3 1 ... ... 4 Ovarian Dropsy ... ... ... ... 1 ... ... 1 „ Intemperance Uterus Disease, &c. lead Poisoning Order 7—Organs of Locomotion. Order 4—Parasitic. Thrush Joint Disease, &c. ... ... ... 1 ... ... ... 1 Worms, &c. ... 1 ... ... ... ... ... 1 Bones, &c. ... ... ... ... 1 ... ... 1 II.—Constitutional. Order 1—Diathetic Disease of Spine ... 1 ... ... ... ... ... l Order 8 — Integumentary System. Gout Dropsy ... 2 1 ... 1 2 ... 6 Phlegmon Cancer ... ... ... 2 8 4 ... 14 Skin Disease, &c. ... 1 ... ... ... ... ... 1 Mortification ... ... ... ... 1 3 ... 4 IV.—Developmental Order 1 —Diseases Abscess ... ... 1 ... ... 1 ... 2 Anæmia ... 1 ... ... ... ... ... 1 of Children. Order 2—Tubrclr. Premature Birth 5 ... ... ... ... ... ... 5 Scrofula 2 ... 2 ... ... ... ... 4 Cyanosis Tabes Mesenterica 18 7 ... ... 1 ... ... 26 Spina Bifida Phthisis(Consumptn 4 3 4 33 15 ... ... 59 Other Malformations 1 1 ... ... ... ... ... 2 Hydrocephalus 4 4 1 ... ... ... ... 9 Teething 5 2 ... ... ... ... ... 7 III.—Local. Order 1—Nervous System. Order 2 — Diseases of Adults. Paramenia Cephalitis Childbirth ... ... ... 2 1 ... ... 3 Apoplexy ... ... ... ... 3 1 ... 4 Order 3—Diseases of Old People. Palsy (Paralysis) ... 1 ... ... 5 3 1 10 Tetanus ... ... ... ... 1 ... ... 1 Old Age ... ... ... ... ... 9 11 20 Epilepsy ... ... ... 1 2 ... ... 3 Order 4 —Diseases of Nutrition. Convulsions 24 5 ... ... ... ... ... 29 Neuralgia Atrophy and Debility 14 1 ... ... ... 3 ... 18 Brain Disease, &c. ... 1 1 2 3 ... ... 7 V.—Violent Deaths. Order 1—Accidents or Negligence. Softeng, of Spinal Cord ... ... ... 1 ... ... ... 1 Order 2—Organs of Circulation. Burns and Scalds ... 3 4 1 ... 1 ... 9 Pericarditis Poison ... ... ... ... ... 1 ... 1 Aneurism ... ... ... ... 1 ... ... 1 Suffocation 4 1 ... ... ... 1 ... 6 Heart Disease, &c. 1 ... 1 2 8 5 ... 18 Violence 3 6 7 11 4 ... 32 Phlebitis Drowning ... ... ... 1 ... ... ... 1 Disease of Arteries Order 3—Homicide. Order 3— Respiratory Organs. Murder & Manslaghtr. 1 ... ... l ... ... ... 2 Order 4—Suicide. Laryngismus ... 2 ... ... ... ... ... 2 Wounds ... ... ... ... 1 ... ... 1 Laryngitis ... 1 ... ... ... ... ... 1 Poison ... ... ... 1 ... ... ... 1 Bronchitis 3 9 ... 1 12 12 ... 37 Drowning Pleurisy ... ... ... 1 ... ... 1 Hanging ... ... ... 1 ... 1 ... 2 Pneumonia 12 17 ... 4 4 1 ... 38 Otherwise ... ... ... ... 1 ... ... 1 Lung Disease ... ... ... 2 2 4 ... 8 Not Specified 1 ... ... ... ... ... ... 1 Carried Forward 98 134 58 67 83 40 2 482 Grand Total 130 148 70 90 115 71 15 639 93 BOARD OF WORKS, WHITECHAPEL DISTRICT. R E P 0 R T ON The Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOR THE THREE MONTHS ENDING 26th SEPTEMBER, 1863. BY JOHN LIDDLE, Medical Officer of health. Presented to the Board, October 26th, 1863. LONDO: 1863. LONDON: PRINTED BY T. PENNY, 121, LEMAN STREET, WHITECHAPEL, and 9, london terrace, hackney road. REPORT, FOR THE QUARTER ENDING 26th SEPTEMBER, 1863. Gentlemen, During the thirteen weeks terminating on Saturday, the 26th September, the official returns show, that there were registered in the "Whitechapel District the deaths of 679 persons, of whom 370 were males and 309 females. There were also registered the births of 644 children, of whom 320 were males, and 324 females. From these returns it appears that, the deaths have exceeded the births by 35. But then it must be borne in mind that there were 103 deaths in the London Hospital, of which deaths there were only 11 of persons belonging to this District, and of the other deaths 42 were of nonresidents, and 50 were the result of accident. If therefore, we deduct the deaths of the non-residents and those which were occasioncd by accident, then the returns of the births and deaths in this District will read thus:—births 644, deaths 587, but to this number ought to be added the deaths of all those residents who died in the several charitable institutions in the Metropolis; Of these however we have no return. The total mortality in the corresponding quarters of the last seven years has averaged 585. The deaths in the corresponding quarter of each year from 1857, have been as follows, viz., in 1857—551, in 1858—547, in 1859—624, in 1860—515, in 1861—549, in 1862—631, and in 1863—679. The mortality therefore during this quarter is 94 above the average of the corresponding quarters of the last seven years. In the comparatively healthy summer (July, August, September,) of 1860, the mean temperature of the air was 56.8°; in 1859 it was 62.9°, and in the summer quarter of the present year the mean temperature of the air was 59.2°. The deaths from Epidemic diseases have been 233. This number is in the proportion of 34.3 per cent. of the total mortality and is greatly in excess of that of any previous quarter. The deaths from Scarlet Fever and Diphtheria have been 92, from Small-pox 11, from Hooping Cough 15, from Diarrhoea 76 and from Eever 39. The subjoined Table, which is a continuation of that on page 5 of my last Quarterly Report, shows the weekly return of cases of Small-pox and Scarlet Eever attended by the Medical Officers of the Union, and the deaths from these two diseases in the entire District. To the number of cases of Small-pox and deaths from this disease recorded in this Table there must be added seven cases which were sent from the Whitechapel District to the Smallpox Hospital; of these; one died; The total number of deaths in the District is therefore 12; the total number of cases attended the Medical Officers of the Union is 37. 6 Date 1863. Deaths from Small pox in entire District. Pauper cases of Small-pox. Deaths from ScaTlet fever in entire District. Pauper cases of Scarlet-fever. Total deaths from all causes in entire District. Date 1863. Deaths from Small pox in entire District. Pauper cases of Small-pox. Deaths from Scarlet lever in entire District. Pauper cases of Scarlet-fever. Total deaths from all causes in entire District. July 4 1 3 3 4 43 Aug. 15 0 3 7 17 42 „ 11 0 0 8 17 50 „ 22 1 5 11 1 65 „ 18 2 3 5 15 44 „ 29 0 3 5 11 45 Sep. 5 0 8 3 11 45 „ 25 1 0 6 18 66 „ 12 1 2 9 6 57 Aug. 1 1 3 7 24 55 „ 19 3 5 7 1 65 „ 8 1 1 9 8 42 „ 26 0 2 8 9 52 There are no available means of obtaining a return of diseases which occur in the practice of private Medical Practitioners, but an approximation to the number of cases of Small-pox may be arrived at by multiplying the deaths from this disease by the rate of its mortality which is about 1 in 8. The cases of this disease have therefore been about 96. Typhus Fever has been epidemic in this District since September 1861, when 27 deaths from it were registered in the quarter ending the following Christmas. In the succeeding quarter the deaths were 53. In the quarters ending June, September and December, 1862, March, June and September, 1863, the deaths were respectively 84, 62, 39, 28, and 39. Scarlet Fever has been epidemic since June, 1862, and Small-pox since December, 1862. The mortality from Fever having gradually declined from 84 in the quarter ending June 1862 to 28 in the quarter ending the following June there was reason to hope that the epidemic was about to subside; but as the mortality has again increased during the present quarter our hopes may not be realized. If the coming winter be severe, and the people unemployed, we may anticipate a considerable increase in the mortality from this disease. Overcrowding, the want of ventilation, and insufficient food and clothing predispose persons to attacks of Typhus Fever. From the records of the Fever Hospital recently published, it appears that, from January 1863, to the middle of October, the City of London sent 34 patients to the Fever Hospital, Bethnal Green sent 32, Limehouse 24, Stepney 41, St. George's East 103, while during the same period not one was sent from Whitechapel. In drawing comparisons therefore between Whitechapel and the neighbouring districts, the fact of the adjoining districts sending so many patients to the Fever Hospital must be borne in mind. The mortality of children under 5 years of age is 324, or 47.6 per cent. of the total mortality of the District. In the Artillery Sub-district the proportion of deaths of children under 5 years to the total deaths is 70 per cent.; in the Spitalfields Sub-district it is 68.4, and in the Goodman's-fields Sub-district, it is 61.7 per cent. The deaths of persons above 80 years of age are 13; one of these had reached the advanced age of 89 years. Five deaths were uncertified by any Medical Practitioner. 7 The deaths caused by diseases of the respiratory organs were 51; Toy disease of the heart 22; by consumption 65, and by the other diseases of the tubercular class 39. Death was caused in two instances from the abase of alcoholic liquors. Croup was fatal to 11 young persons. Cholera was fatal to 5 children under 5 years of age. Four young children were suffocated in bed. It is difficult to ascertain whether these deaths were accidental or otherwise. Six persons died from suffocation by drowning; one of these was a child 3 months old, who fell out of bed into a pail of water. A man aged 44 died from the effeets of chloroform administered before the performance of a surgical operation. The death of a child aged 21 months occurred from the effect of laudanum administered by its mother to cause sleep. The deaths from violence were 42; of these, one was the result of laceration of the intestine caused by a blow (the man while drunk knocking himself against a lamp post), and another was the result of a full which happened to a man while in a state of intoxication. Five persons committed suicide, two by cutting the throat, two by banging, and one from taking poison. The deaths from consumption, as above stated, have been 65. Many of the deaths from this disease are caused by breathing the impure air of crowded rooms, and more especially of rooms where gas or other artificial lights are used, and where the ventilation is bad. Schools, churches, workshops and other places where persons assemble in great numbers are for the most part badly ventilated. It is estimated that an adult consumes 14 cubic feet of air per hour, and that an argand gas burner consumes as much of the vital portion of the air as 8 or 9 adults. The importance therefore of efficient ventilation is obvious to every person who reflects upon the subject. I have visited work-rooms and crowded school-rooms where the closeness of the places was almost unbearable. In a school-room in this District, having the dimensions of about 1952 cubic feet, 110 children have been congregated, each child having only 18 cubic feet of space, or the space contained in a box 3-ft. long, 3-ft. wide, and 2-ft. high! I have no doubt whatever that the seeds of consumption are sown by persons frequenting and working in badly ventilated and overcrowded rooms, and! it is with a view of mitigating the evils from these causes that I have thus; deemed it necessary to direct your attention to them. The number of inquests held during the quarter was 75, of these, 49 were held on persons who died in the London Hospital. In seven instances, death was caused from burns; of these; one was a policeman's wife, aged 35, whose dress took fire through wearing crinoline; and another,, a mariner's wife, aged 21, whose death occurred from a similar cause. In August and September last, several bodies, apparently of still-born children, and of one, supposed to be about three or four months old, were found in the belfry and in the roof of Whitechapel Church, upon two of which bodies an inquest was held. From the evidence taken at this inquest it was found that the laws relating to the burial of still-born children required amendment—that undertakers received the bodies of children said to be still-bom, without a certificate from a qualified Medical Practitioner—that a certificate- signed by any person stating herself to be a midwife was all that an undertaker required to justify him in burying the child—that the undertaker took no pains to ascertains whether the child was still-born or not—that still-boras were occasionally kept for several days in the premises of the undertaker before they were removed, or until a sufficient number was obtained to remancrate the undertaker for the expense meurred by conveying the bodies to a cemetery for interment. The expense 8 incurred for the removal of one is said to be as great as for the removal of several when carried by the same conveyance. In the cases under consideration however, it was evidently more remunerative to the undertakers to deposit the bodies in the roof of the Church than to convey them to a cemetery. The Jury in their verdict animadverted strongly on the practice of undertakers receiving certificates for the burial of still-born children from unqualified midwifes, as such a practice afforded facilities of escape to the perpetrators of abortion and infanticide; and the Jury expressed an opinion that any person who should bury or assist in burying a still-bom child without receiving, before the period of interment, a certificate signed by a qualified Medical Practitioner, should be liable to the penalty of a misdemeanour. It is not an uncommon practice with a certain class of undertakers to place a still-born child in the coffin used for the body of an adult, so as to avoid expense. This practice is so highly reprehensible from the facility it affords for the commission of crime, that in all cases where a stillborn child, or one said to be still-born shall be interred with the body of an adult, the parties engaged in such practice should be liable to a fine or imprisonment upon information laid before a magistrate. The only exception to this rule should be where the mother has died in giving birth to a still-born child, when in such a case the mother and child might be interred in the same coffin. If the law required that the burial of a still-born child should be prohibited unless the undertaker charged with the burial of such still-bom child had obtained a certificate from a Medical Practitioner stating that such child was still-born, the dreadful, and I believe increasing crime of infanticide might be checked. As there would probably be some difficulty in every instance of a still-birth, in obtaining a medical certificate, the local authority should appoint a Medical Man to inspect the body of every child and indeed of every adult where a certificate of death has not been obtained from a Medical Practitioner, and that the Medical Officer so appointed by the local authority should be required to give the necessary certificate; but if in his opinion there were any suspicious circumstances respecting the cause of death, then it should be the duty of such Medical Officer to give information to the Coroner upon the matter, and leave it to him to deal with the case in such way as he may deem necessary. Although numerous bodies of children are found in the public streets and elsewhere, it must not be inferred that in all these cases, the children have been murdered, for in some instances the bodies may be deposited in the public way to avoid the expense of burial. The deaths in the "Workhouse have been 70. In this number are included 8 deaths from Fever, 3 from Diarrhoea, and 1 from Small-pox, (a child aged 4 years who had not been vaccinated). The Medical Officers of this Union attended 3692 new cases of sickness, including 37 of Small-pox, of which number 19 had not been vaccinated, 10 had been previously vaccinated, of 7 there is no record whether they had or had not been vaccinated, and in Mr. Seqtteiea's District a severe case of Small-pox occurred in a patient who had had a previous attack of that disease. As, from the concurrent testimony of the Medical Profession, it appears that Small-pox may be greatly mitigated in its effects, if not. entirely prevented by vaccination when properly performed, it has been thought right by the Coroner of the Central Division of Middlesex to hold an inquest upon the body of a child who had died from Small-pox, in order to ascertain whether there had been criminal neglect on the part of the parents. The parents of the child, it appeared, had neglected to have it vaccinated, notwithstanding that they had received the usual notice, informing them of the law respecting vaccination, and who in refusing to comply 9 with the terms of the notice had broken the law. The verdict of the Jury was that the death had resulted from an attack of Small-pox, and that the said death was accelerated by the deceased not having been vaccinated, and not having had proper Medical attendance. Inquests may very properly be held in any case when death ensues from neglect of official orders served upon owners of property to improve its sanitary condition, where such property is in so bad a state as to be injurious to health. The number of eases of illness in the "Workhouse was 528, including 13 of Small-pox, 1 of Measles, 3 of Scarlet Fever, 15 of Diarrhoea, and 50 of Fever. Of these 528 cases, Mr. Champneys attended 303 and Mr. Richardson 325. Mr. Richardson remarks that of the 7 cases of Small-pox attended by him in the Workhouse, 3 had been vaccinated, and the disease in each of these cases was very mild. The undermentioned Courts and Places have been specially visited by the Inspectors during the last three months, Goodwin's Buildings, Well's Yard Gower's Walk, Wells Place, Green's Place, Princes Place, John's Place, Webb's Place, Davies' Buildings, Mill Court, Castle Alley, Charles Court, Walton's Court, Queen Place, Swan Court, Garden Court, and Chicksand Place. It was, found that many of the rooms inspected on these special visitations were not only overcrowded but indecently occupied, adult males and females occupying the the same sleeping room. Several instances of families occupying underground rooms not in accordance with the provisions of the Act of Parliament have been discovered by the Inspectors in the course of their visitations. In all of such oases, the usual notices have been served requiring the landlords to remove the tenants and not to permit such places to be again occupied. The water supply in the District is very defective, inasmuch as, many of the houses are entirely without any water supply. In those instances only where the water is supplied direct from the main, or where there is an efficient tank can the poor obtain water on Sunday, the day above all others when water is most needed, for on that day the labouring man is generally at home with his family. I have had an interview with the Directors and with the Engineer of the East London "Water Company upon the defective supply of water to this District, but I regret to state that neither the Directors nor the Engineer have done anything to assist me in obtaining a better supply of water for the poor. In conclusion, I have to draw the attention of the Board to the inconvenience occasioned by so many streets and places in the District having the same name. Thus, there are no less than six John Streets, four John's Places, six Crown Courts, four Swan Yards, four Ann's Places, eight New Courts, five Union Courts, three Garden Courts, three Rose Courts, five Providence Courts or Places, and several others having the same name which may be seen on referring to the Street-list recently published by the Guardians. I may further add that facilities for the finding of places would be afforded to persons visiting the District, if the houses were to be renumbered in all those Streets where the numbers are irregular; and if the name of each Street and Court were conspicuously attached to one of the corner houses of every Street or Place in the District. I have the honor to be, Gentlemen, Your obedient Servant, 15, Great Alie Street, JOHN LIDDLE. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute classes, which are. recorded in the Books of the Medical Officers of the Union for the Three Months ending the 26th September, 1863. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhœa. Continued Fever (Typhus and Typhoid.) Erysipelas. Pyaemia Carbuncle. Acute Pulmonary Inflammations. Croup. Rheumatic Fever. Dysentery. Delirium Tremens. All other Diseases. Total. Bronchitis and Catarrh. Pneumonia and Pleuritis. Mr. Blackwell 4 4 34 12 212 28 8 0 0 53 8 1 1 1 0 631 987 Average number of Fever cases per Week Mr. Champneys 8 0 36 9 160 24 4 1 3 12 11 2 0 1 2 427 699 Mr. Richardson 6 2 40 2 140 11 4 0 1 5 1 0 3 0 0 625 840 Mr. Sequiera 19 2 34 17 134 41 4 0 0 3 9 0 1 2 1 907 1166 Total 37 8 144 40 646 104 20 1 3 72 22 3 5 4 3 2580 3692 8 TABLE II.—Showing the Deaths from Epidemic Diseases for the Three Months ending 26th September, 1863. District. Small-pox. Measles. Scarlet Fever. Diphtheria. Hooping-cough. Diarrhoea. Fever. Total. Remarks. Artillery 0 0 13 1 0 5 4 23 Spitalfields 2 0 18 0 1 20 4 45 Mile End N. Town 2 0 14 1 0 18 12 47 Workhouse. Whitechapel, N 0 0 8 0 4 8 5 25 Whitechapel Church 1 0 9 2 0 7 3 22 Hospital. Goodman's Fields 2 0 11 0 7 8 4 32 Aldgate 4 0 15 0 3 10 7 39 Total 11* 0 88 4 15 76 39 233 Deaths from Epidemics for the corresponding quarter, 1862. 7 66 23 4 11 36 62 209 * One death occurred in the Small-pox Hospital out of the seven which were sent into that Institution from this District. TABLE III.—Showing the Ages at Death in the Workhouse, and in the London Hospital. 0 and under 1 1 and under 5 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Total Males 38 Femls. 32 Corresponding Quarter of 1862. Workhouse 5 1 1 13 21 23 6 70 72 L. Hospital 1 9 10 37 33 12 1 Males 72 Femls. 31 103 70 TABLE IV.—Ages at Death in each Registration District, for the Three Months ending 26th September, 1863. Districts. 0 and under 1 1 and under 5 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and upwards. Total. Remarks. Artillery 15 13 3 4 2 3 0 40 Spitalfields 23 42 10 9 7 4 0 95 Mile End N. Town 35 31 13 22 27 29 7 164 Workhouse. Whitechapel, N 13 23 11 4 12 6 2 71 WhitechapelChurch 16 32 14 37 42 39 3 163 Hospital. Goodman's Fields 21 20 6 6 7 7 0 68 Aldgate 15 24 16 8 6 8 1 78 Totals 138 186 73 90 103 76 13 679 TABLE V.—The Births and Deaths in each Registration District, for the Three Months ending on the 26th September, 1863. Districts. Births. Total. Deaths Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks. M. F. M. F. Artillery 26 22 48 18 22 40 8 — Spitalfields 61 55 116 42 53 95 21 — Mile End New Town 61 85 146 81 83 164 2 — Workhouse. Whitechapel, N. 59 50 109 39 32 71 38 — Whitechapel Church 33 40 73 114 43 163 — 90 London Hospital. Goodman's Fields 53 44 97 37 31 68 29 — Aldgate 27 28 55 39 39 78 — 53 42 Non-residents died in Lon. Hos. Totals 320 324 644 370 309 679 99 113 Excess of births over deaths, deducting the 42 non-residents 7 Population in 1861, 78,970; TABLE VI.—Vaccination Extension Act—Whitechapel Union—for the Year ending 29th September, 1863. Names of the whole of the Public Vaccinators of the Union. Vaccination Districts. Number and Ages of Persons Vaccinated by the Public Vaccinators. Number of such cases successfully Vaccinated. Number of Registered Births of all classes during the Year, including the Workhouse and the whole of the Parishes in the Union. Unsuccessful Cases Under One Year. Above One Year. Total. Under One Year. Above One Year. Total. Thomas S. Blackwell Christchurch 188 671 859 188 671 859 500 0 James Edmunds Old Artillery Ground 295 1019 1314 295 1019 1314 237 0 Alex. M. Champneys Mile End New Town 319 654 973 319 654 973 669 0 Edward Richardson Whitechapel North 353 282 635 353 282 635 453 0 C. T. Blackmail Whitechapel Church 342 371 713 341 371 712 278 1 H. L. Sequeira Goodman's Fields 352 433 785 352 431 783 396 2 C. E. Jenkins Aldgate -64 133 197 64 133 197 255 0 Totals 1913 3563 5476 1912 3561 5473 2788 3 For the Year ending 29th September, 1862 1690 166 1856 1671 164 1835 2757 21 „ „ 1861 1956 243 2199 1933 235 2168 2717 31 „ „ 1860 2015 400 2415 2004 898 2402 2754 13 TABLE VI.—Causes of Death at Seven Periods of Life, registered in the Whitechapel District, for the Three Months ending 29th September, 1863. Causes of Death. 0 and under 1 l and under 5 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above. Total. Causes of Death. 0 and under 1. 1 and under 5 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above Total. I.—Zymotic:— Order 1—Miasmatic Brought forward 108 170 62 61 73 41 1 516 Order 4—Digestive Organs. Small-Pox 1 7 3 ... ... ... ... 11 Measles Scarlatina 7 54 26 1 ... ... ... 88 Cancrnm Oris Diphtheria 1 2 ... ... 1 ... ... 4 Gastritis ... ... ... 1 ... ... ... 1 Quinsy ... ... ... 1 ... ... ... 1 Enteritis ... ... ... 1 ... 1 ... 2 Croup 1 10 ... ... ... ... ... 11 Peritonitis ... ... 1 3 2 3 ... 9 Hooping-Cough 3 11 1 ... ... ... ... 15 Ascites Typhus Fever 1 10 13 5 6 4 ... 39 Ulc. of Intestines Erysipelas 2 1 ... ... 1 1 ... 5 Hernia (Rupture) ... ... ... 1 2 ... ... 3 Puerperal Fever ... ... ... 1 ... ... ... 1 Ileus ... ... ... ... ... 1 ... 1 Carbuncle Intussusception Influenza Fistula ... ... ... 1 ... ... ... 1 Dysentery ... 1 ... ... ... ... ... 1 Stomach Disease, &c. ... ... ... ... ... 2 ... 2 Diarrhœa 38 39 1 2 3 3 ... 76 Pancreas Disease, &c. Ague Hepatitis Remittent Fever Liver Disease, &c. ... ... ... 2 2 3 ... 7 Rheumatism ... ... 1 ... ... ... ... 1 Stricture of (Esophagus) Pyaemia Order 5-Urinary Organs. Cholera 3 2 ... ... ... ... ... 5 Order 2—Enthetic. Morbus Addisonii Syphilis 1 ... ... ... ... ... ... l Rupture of Bladder Stricture of Urethra.. Hydrophobia Nephria(Bright's ease) ... ... ... 3 1 1 ... 5 Order 3—Dietic. Stone ... 1 ... ... 1 ... ... 2 Privation Prostrate Disease ... ... ... ... 2 2 ... 4 Want of Breast Milk Kindey Diesease, &c. ... ... ... ... 1 1 ... 2 Purpura and Scurvy ... ... ... 2 ... ... ... 2 Order 6—Organs of Generation. Alcoholism—Delirium Tremens ... ... ... ... 1 1 ... 2 Ovarian Dropsy „ Intemperance Uterus Disease, &c. ... ... ... ... ... 2 ... 1 Lead Poisoning Order 7-Organs of Locomotion. Order 4—Parasitic. Thrush Joint Disease, &c. ... ... ... 1 ... ... ... 1 Worms, &c. Bones, &c. II.—Constitutional. Order 1—Diathetic Disease of Spine ... 1 1 ... ... ... ... 2 Order 8 — integumentary System. Gout Dropsy ... 3 2 2 1 2 ... 10 Phlegmon Cancer ... ... ... 2 4 2 ... 8 Skin Disease, &c. 1 ... ... ... ... ... ... 1 Mortification ... ... ... ... ... 2 ... 2 IV.—developmental Order 1 —Diseases of Children. Abscess ... ... ... 2 1 ... ... 3 Ulcer ... ... ... ... ... 1 ... 1 Order 2—Tubrclr. Premature Birth 5 ... ... ... ... ... ... 5 Scrofula ... 1 1 ... ... ... ... 2 Cyanosis Tabes Mesenterica 19 10 2 ... ... ... ... 31 Spina Bifida 1 ... ... ... ... ... ... 1 Phthisis(Consumptn) 2 4 7 27 22 3 ... 65 Other Malformations Hydrocephalus 1 5 ... ... ... ... ... ... Teething 4 3 ... ... ... ... ... 7 III.—local. Order l—Nervous System. Order 4-Disease of Adults. Paramenia Cephalitis 1 ... 1 ... 3 ... ... 5 Childbirth ... ... 1 ... ... ... ... 1 Apoplexy ... ... ... ... 4 1 1 6 Order 3—Diseases of Old People. Palsy (Paralysis) ... ... ... 1 5 4 ... 10 Tetanus Old Age ... ... ... ... ... 10 11 21 Epilepsy ... ... 1 1 1 ... ... 3 Order 4-Disease of Nutrition. Convulsions 13 4 ... ... ... ... ... 17 Neuralgia Atrophy and Debility 13 1 ... ... ... 1 ... 15 Brain Disease, &c 1 1 ... 3 1 3 ... 9 V.—Violent Deaths. Order l— Accidents or Negligence. Softeng, of Spinal Cord Order 2—Organs of Circulation. Burns and Scalds ... 1 ... 5 1 ... ... 7 Pericarditis Poison ... 1 ... ... ... ... ... 1 Aneurism ... ... ... 1 ... ... ... 1 Suffocation 4 ... ... ... ... ... ... 4 Heart Disease, &c. ... ... 1 5 13 3 ... 22 Violence ... 6 6 10 12 7 1 42 Phlebitis Drowning 1 2 2 ... 1 ... ... 6 Disease of Arteries Chloroform ... ... ... ... 1 ... ... 1 Order 3—Respiratory Organs. Order 3—Homicide. Murder Manslaghtr. ... ... ... ... 1 ... ... 1 Laryngismus Order 4—Suicide. Laryngitis ... 2 ... ... ... ... ... 2 Wounds ... ... ... ... 2 ... ... 2 Bronchitis 2 4 2 1 3 10 ... 22 Poison ... ... ... 1 ... ... ... 1 Pleurisy ... ... ... 1 ... ... ... 1 Hanging ... ... ... ... 1 1 ... 2 Pneumonia 11 8 ... 1 2 1 ... 23 Otherwise Lung Disease ... ... ... 2 1 ... ... 3 Not Specified 1 ... ... ... ... ... ... 1 Carried Forward 108 170 62 61 73 41 1 516 Grand Total 138 186 73 90 103 76 13 679