WHI 12 94 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT on The Sanitary Condition of THE WHITECHAPEL DISTRICT, For the Year ending 2nd January, 1864, by JOHN LIDDLE, Medical Officer of Health. presented to the board, 1st february, 1864. London: printed by mead & powell, 101, high street, "whiteohapel, And 73, Cheapside. 1864. EIGHTH ANNUAL REPORT, For the Year ending January 2nd, 1864. Gentlemen, The Report which I have now the honor of submitting to you comprises the return of sickness and mortality in the Wliitechapel District for the quarter ending 2nd January, 1864, and also the return of the sickness and mortality during the past year. The year terminated on Saturday, the 2nd January, 1864, and it contained 53 weeks, it being necessary to introduce an intercalary week in about every fifth year in order to compensate for the annual deficiency of l¼ days when reckoning 52 weeks in a year. During the quarter terminating on the 2nd January, 1864, there were born within the Whitechapel District 729 children, of whom 393 were males, and 336 females. In the same period 685 persons died, of whom 392 were males, and 293 females. In the corresponding quarter of the previous year the births were 721, and the deaths 670, but as 14 weeks are reckoned in this quarter, the mortality as compared with that in the corresponding period of 1862, instead of its being greater by 15, as appears from the quarterly returns, is less by 34. The average number of deaths per week is 49. The births have exceeded the deaths by the small number of 44, but if the deaths of the nonresidents are excluded the excess of births over deaths is 98. The greatest weekly mortality (66) occurred in the week ending November 28th, when the mean temperature of the air was 47.9°, which is 6.7° above the average (as determined by Me. Glashier), but in this week the number of deaths was increased by the registration of 19 deaths in the London Hospital. This large mortality was therefore an accidental circumstance in this district, as an excessive mortality did not prevail over the entire metropolis. The mean temperature of the week ending January 2nd, was 37.1°, and the lowest night temperature was on Saturday, the 2nd January, when the thermometer registered 25.2°. In this week the mortality in the Whitechapel District was 41. In the following week, when the lowest night temperature (viz., on Thursday) was 14.3°, and the mean temperature 26.7°, the mortality in that week rose to 66. As was the case in the corresponding period of last year the chief causes of death have been from diseases of the epidemic class, particularly from scarlet fever and from typhus, the former contributing to the total mortality 46, and the latter 52. Although fever has prevailed very generally in the entire district, yet the disease seems to have been especially severe in one or two houses, viz., at No. 29, Little Alie Street, in which 8 cases have recently occurred, 2 of which terminated fatally. As fever prevailed in this house a short time 4 before this severe outbreak of the disease the house was inspected and orders were given for the limewhiting of the rooms, the better drainage of the yard and privy, and for the removal of the occupants of the basement, which was at the time illegally occupied. All these orders were duly complied with. Four persons were laid up at the same time with fever at No. 14, Gun Street, which house was likewise duly inspected and the rooms limewhited. The deaths from small-pox declined from 17 in the corresponding quarter of the previous year to 6; measles from 33 to 4; hooping cough from 15 to 7; and diarrlicea from 22 to 12. Only one death from diphtheria is recorded. This disease is therefore either of rare occurrence in this district or the deaths from this disease are registered under another name. The deaths from diseases of the lungs are 123 against 103 in the corresponding quarter of 1862; the deaths from consumption are 76; from disease of the heart 23. No less than 46 deaths of children are registered under the convenient form of convulsions ! Burns and scalds were fatal to 20 persons. Under this head I suppose must be registered the deaths of two children under two years of age, whose deaths are thus recorded, "violent drinking water accidentally!" In the Aldgate Sub-District the death of a child 14 days old is thus recorded "Phlegmasia." Tetanus or locked jaw was fatal to a man aged 63. The deaths arising from accidents or negligence are 53, of these 17 were from violence, 2 from drowning, 7 from suicide, 1 from manslaughter, and 5 from suffocation, 4 of which were infants under 1 year, and 1, a wine cooper's child, aged 4 years, who died from suffocation, but how produced is not recorded. The number of inquests held during the quarter is 72, of which 47 were held in the London Hospital. No inquest was held on the body of a child, aged 2 years, daughter of a journeyman tailor, residing at No. 5, Gun Street, whose death was caused by burns. My attention has been directed to the fact that several deaths of young children occurred in one week in the neighbourhood of Buck's Bow and Little North Street. There are recorded by the Local Begistrar the death of a child at 28, North Street, aged 1 month, from sloughing of the lower part of the abdomen; and the deaths of 2 children, aged respectively 7 months and 8 months, from abcess in the neck, the one at No. 2, Elizabeth Place and the other at No. 1, Queen Ann Street, both of which places are in the neighbourhood of Buck's Bow. In this neighbourhood, which is now becoming excessively crowded, there are three bone-boiling establishments and a knacker's yard, from all of which most offensive smells, arising from the decomposition of animal matter, are given off, which I need scarcely say are highly prejudicial to health. Much has certainly been done to remedy the nuisance arising from these businesses, and more is promised to be carried out, but so long as large accumulations of bones in a state of decomposition remain on these several premises ill health and premature death will occur in this vicinity. It is true that bone-boiling and other similarly offensive trades have been carried on in this neighbourhood for a great many years and have frequently 5 been causes of complaint, but until the passing of the Metropolis Local Management Act and the Nuisances Removal Act the powers vested in local boards to suppress such nuisances were very limited. Since the passing of the above-named Acts a great deal has been done, as I have just observed, on the part of these manufacturers to mitigate the nuisance arising from their premises, but as there have been about sixty new houses recently erected in the vicinity of their works it is now absolutely necessary for the proprietors to observe greater precautions in preventing the effluvia of decomposed and decomposing animal matter escaping into the neighbourhood. The deaths in the Workhouse are 81 against 69 for the Christmas quarter of 1862 (14 weeks against 13). The deaths from fever in the Workhouse are 16, and from diarrhoea 4. The deaths in the London Hospital are 118. The uncertified deaths are 10. One was recorded as scarlet fever, 1 as hooping cough, 1 in the Spitalfields Sub-District as "hooping-aptha in mouth!'' 1 in the Artillery Sub-District as spasm of the glottis, a child aged 4 months; and the other uncertified deaths are registered as convulsions, debility, and premature birth. The mortality of children in the entire district, under 5 years of age, in relation to the total mortality, is 42.4 per cent. In the Spitalfields Sub-District the mortality under 5 years is 61.8 per cent., and in the Whitechapel North Sub-District 54.6 per cent. The Medical Officers of the Union attended 3803 new cases of sickness, including 13 of small-pox, of which number 6 had been and 7 had not been previously vaccinated. The cases of fever were 161, of scarlet fever 50, and of diarrhœa 166. From the fact of the deaths from scarlet fever having been nearly as numerous (46) as the cases of this disease (50) among the paupers attended by the Medical Officers of the Union it may be inferred that scarlet fever has been proportionately more prevalent among the upper classes than among the poor of the district. The number of cases of sickness in the workhouse was 656, including 5 of small-pox, 2 of measles, 7 of scarlet fever, 3 of hooping cough, 18 of diarrhœa, and 90 of fever. Of these 656 cases Mr. Champneys attended 312, and Mr. Richardson 344. Mr. Richardson remarks that 2 of the small-pox cases attended by him in the workhouse had been vaccinated and were of a modified character. In the corresponding quarter of the previous year the cases of sickness in the workhouse were 657, of which number 121 were of fever. Although no improvement in the water supply in the District has taken place since my last report, I may here state what I omitted to mention in my previous report, that the courts in Blue Anchor Yard have been for upwards of twelve months past supplied with water on Sundays by the New River Company. This liberality on the part of the New River Company is highly appreciated by the inhabitants of this locality. 6 All the courts in the district have been during the last nine months periodically visited by the Inspectors, and a return of the sanitary condition of such places is made to me daily, according to the subjoined form— BOARD OF WORKS—WHITECHAPEL DISTRICT. inspector's return of daily inspections. Date, day, the day of 186 I have this day inspected the undermentioned Courts and Places, and I subjoin the following Remarks upon their General Sanitary Condition. Name of Court or Place and Parish. Number of Houses therein. State of Pavement. State of Privies. Condition of Dust Bins. Nature of Water Supply and condition of the Water Receptacles General Remarks. These returns are preserved and indexed, so that it can be easily ascertained when, and how often, any particular place has been visited. In order to check the nuisance, now so common, of persons throwing dust and rubbish in the public streets proceedings were taken and convictions obtained against two persons so offending. They were respectively fined 1s. and the cost of the summons. These proceedings have already been attended with good result. The number of births registered in the year (53 weeks) was 2,796, of which 1,426 were of males, and 1,370 of females. The deaths were 2,764, viz., 1,513 males, and 2,151 females. In the preceding year the births were 2,813, and the deaths 2,551. The deaths have exceeded the births in the Sub-Districts of Mile End New Town, Whitechapel Church, and Aldgate. It appears that the births in the entire district have exceeded the deaths by 32, but if the deaths of the 181 non-residents are excluded then the births are in excess of the deaths by 213; it is, however, very probable that all the births are not registered, and this neglect on the part of parents to register the birth of their children is likely to continue until the law renders it compulsory upon the parents or guardians of a child to register its birth within a given period (say 21 days) from the time of its birth. In the 27th section of the Act to provide for the better registration of births, deaths, and marriages in Scotland (17 and 18 Vict., c. 80), it is enacted, that "the parents or parent, or in case of the death or inability of the parents, the person in charge of any child born, and the occupier of every house or tenement, in which, to his or her knowledge, any birth shall take place, and the nurse present at such birth; and in case of an illegitimate child, the mother of such child, or in case of the death, illness, or inability of the mother, the person in charge of such child, or the occupier of the house or tenement in which, to his or her knowledge, the child was born, or the nurse present at the birth of such child, shall, within twenty-one days next after the birth of such child, and under a penalty not exceeding twenty-one shillings in case of failure, attend personally and give information 7 to the registrar of the parish or district in which the birth occurred." The 34th section of the same Act enacts, for the still greater security of ensuring a complete registration of births, that "there shall be produced to the Minister or other person officiating in the administration of the Sacrament of Baptism of any child a certificate of the registration of the birth of such child, and failing such production such Minister or other person shall forthwith intimate the baptism of such child, with all the information he may have regarding the birth and parentage of such child, to the registrar of the parish in which the parents of such child reside." By the 60th section of 26 Vict., c. 11, entitled an Act for the registration of births and deaths in Ireland, a penalty not exceeding 20s. may be inflicted on any of the parties who are required to give notice of the birth of a child failing to give such notice to the registrar within 21 days of the birth of such child. Still-born children are not registered in Great Britain. There is no good reason why still-born children are not registered in this country. They are registered in France; and in Paris it appears that the still-births to the living births are 79 to 1000, and in the whole of France there are 41 to every 1000 living births. It will be seen on looking at the Return of Deaths (Table 8) that during the last four years there has been an annual increase in the mortality of the district, and as there is no reason to suppose that the population has increased (the number of houses and the population having diminished between the census of 1851 and 1861, and since the latter period a great many of the then remaining houses have been taken down) it would appear that sickness and death have prevailed to a greater extent among us; thus in the year 1860, the deaths were 2,302, or a weekly average number of 44.2; in 1861, they were 2,331, or a weekly average of 44.8; in 1862, they were 2,551, or a weekly average of 49; and in 1863, they were 2,764, or a weekly average of 52.1. The deaths in 1863 are only 14 less than they were in 1849 when the cholera prevailed. The deaths in London in the above mentioned years were respectively 61,821, or 2.26 per cent. of the population; 65,001, or 2.32 per cent.; 66,950, or 2.34 per cent.; and 72,346, or 2.45 per cent. These calculations are made upon the estimated increase of the population, which in London is 1.73 per cent. annually. The birth rate for this district is 3.54 per cent.; in London it is 3.37 per cent., and for the whole of England it is the same as that for the Whitechapel District, viz., 3.54 per cent. In the City of London it is 2.63 per cent. of the population. The death rate, excluding all the deaths in the London Hospital, is 29.5 in every 1000, or 1 in 34 of the population. If the deaths of the non-residents only are deducted, then the rate of mortality in this district is 32.4 per 1000. The death rate for the whole of England in 1863 was 23.1 in every 1000, in London it was 24.5, and in the City of London it was 25.1 per 1000. The average death rate in England during the preceding 10 years was 22.1, in London 23.3, and in the City of London it was 24.3 per 1000 of the inhabitants. 8 Not only has the total mortality in this district (as is previously stated) annually increased during the last 4 years, but, as may be seen on referring to Table 10, the mortality from epidemic diseases has also increased. Thus in 1860 the total mortality from this class of diseases was 346; in 1861 it was 389; in 1862 it was 658; and in 1863 it was 709. This is 29.2 per cent. of the total mortality. The greatest amount of increase of mortality in this class of diseases is that of scarlet fever and diphtheria,* which in 1861 had conjointly a mortality of 70; in 1862 of 91; and in 1863 of 290. This amount is above that of any return of deaths from these diseases that I have ever had to record. Out of the 290 deaths caused by scarlet fever and diphtheria conjointly there are only 12 attritbuted to diphtheria. In London the deaths from scarlet fever were 5,075, and from diphtheria 724. Scarlet fever has been the prevailing epidemic during the last year. It is generally supposed to be propagated by contagion, but the cause of the disease is involved in mystery. A French writer carries his ideas of contagion so far as to say, that "an epidemic is the effect and not the cause of contagion." "Cleanliness and ventilation," says Dr. Christison, "will extinguish any epidemic." This, I am afraid, is only true to a limited extent; no doubt that when proper ventilation exists the products of putridity become oxidized, and then they are innocuous. The deaths from fever have likewise increased. In 1861 they were 65; in 1862 they were 250; this year, however, they have again declined to 158. The deaths from diseases of the respiratory organs are 388; from tubercular diseases, exclusive of consumption, 139; from consumption 295; from violence and accidents of various kinds 136; from burns and scalds 47; from suffocation 19 (all children under 5 years old); from suicide 20; and from murder and manslaughter 5. The deaths in the Workhouse are 324, or 11.7 per cent. of the total mortality. Of this number 109, or 33.6 per cent., were above 60 years of age. In the City of London 14.5 per cent. of the total deaths occurred in the Workhouses. The mortality in the London Hospital was 418 or 15.1 per cent. of the total deaths. The deaths in these two institutions combined (742) are in the proportion of 26.8 per cent. of the total mortality in the district. The number of inquests held during the year was 291 against 225 in the preceding year. The uncertified deaths are 32 against 42. The absurd manner (as may be seen in this report) in which some of these deaths are registered renders it necessary to make some alteration in the law whereby more correct certificates of death may be obtained. The medical officers of the Union have attended 14,564 cases of illness, exclusive of 2479 in the Workhouse. The cases of small-pox have increased from 115 to 253; of scarlet fever from 118 to 305. A decrease is shown in * Scarlet fever and diphtheria were formerly considered to be similar diseases, but further examination inclines medical men to the belief that the two complaints are specifically different. 9 the number of cases of fever and of measles, the former from 822 to 464 and the latter from 525 to 80. The very large number of sick who are relieved by the Medical Officers of the Union may probably be to some extent accounted for by the migratory character of a considerable number of the population, and also from the fact that members of the same family obtain orders for medical relief more than once in the course of the year. If the same name did not occur more than once in the Medical Officers' books during the year the number of cases would show that 1 in every 5 of the population of this district receives medical advice from the Union Medical Officers. In addition to the annual visitation of the slaughter-houses and cow-houses, all the bakehouses have been inspected, and in each case where it was found necessary to serve an order for the limewhiting of the premises the order on the second visit was found to have been complied with. I notice, with regret, the continuance of the dangerous nuisance (which in one of my former reports I brought before the notice of the Board) arising from the large quantity of hot water which flows into the sewers from some of the manufactories in this district. Not only is the escape of the steam from the ventilating shafts a nuisance to the public, but the fact of so much hot water being sent into the sewers at irregular periods renders it unsafe for persons to enter the sewers for the purpose either of examining or cleansing them. The nuisance arising from the retention of dung in stable yards and in premises where cows are kept until such dung becomes decomposed is a subject of complaint. There can be no doubt of the injurious nature of this nuisance. In order, therefore, to obviate as much as possible the evils arising from those offensive accumulations the Board have issued printed notices to all the cowkeepers in the district, to remove from their premises the dung and other refuse at least three times a week. In conclusion I take leave to thank the Medical Officers of the Union for the valuable suggestions they occasionally insert in their returns of sickness which they make weekly to the Guardians. I am, Gentlemen, Tour obedient Servant, JOHN LIDDLE. 15, Great Alie Steeet. 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 2nd January, 1864 (14 weeks). Names of Medical Officers. Small-Pox. Measels. Scarlatina. Hooping Cough. Diarrhœa. Continued Fever, (Typhus and Typhoid). Cholera. Erysipelas. Pyæmia. Puerperal Fever. Carbuncle. Acute Pulmonary Inflammations. Croup. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Diphtheria. Other Diseases. Total. Average number of Fever Cases per Week. Bronchitis & Catarrh. Pneumonia & Pleuritis. Mr. Blackwell 1 8 9 6 47 47 1 8 .. .. 1 117 12 .. 5 1 1 .. .. 837 1101 Mr. Champneys 1 0 25 2 41 33 .. 4 .. .. 1 30 11 .. .. .. 3 1 .. 526 678 Mr. Richardson 2 4 10 12 38 22 .. 7 .. .. 1 31 1 .. .. .. .. 2 .. 722 852 Mr. Sequeira 9 0 6 3 40 59 .. 7 .. 1 .. 11 11 .. 1 1 .. .. .. 1023 1172 Total 13 12 50 23 166 161 1 26 .. 1 3 189 35 .. 6 2 4 3 .. 3108 3803 11.5 Total for the year ending Jan., 1863. 253 80 305 169 1108 464 1 74 1 1 6 533 134 12 20 11 31 8 .. 11362 14564 8.6 „ year 1862 113 525 118 153 1085 822 1 56 .. .. 4 557 135 9 16 24 21 4 .. 1.0627 14270 15.8 „ „ 1861 86 70 100 388 1418 109 .. 75 1 1 9 803 104 9 5 18 34 2 .. 10492 13724 2.0 „ „ 1860 65 520 93 83 773 190 1 52 .. 1 9 845 141 3 7 41 28 6 .. 8534 11392 3.6 „ „ 1859 242 179 175 146 1209 411 1 73 .. 1 11 609 139 4 .. 14 77 30 1 8379 11701 7.7 „ „ 1858 20 427 146 230 946 590 .. 70 .. 2 16 1411 210 3 6 16 65 39 1 7520 11718 11.3 „ „ 1857 6 266 49 150 1324 1441 16 45 .. 2 1 1727 166 9 .. 9 53 28 .. 5398 10708 27.7 „ „ 1856 115 71 105 98 898 1929 .. .. .. .. .. .. .. .. .. .. .. .. .. 6681 9897 37.1 Total number of cases of Sickness in the Workhouse in 1860 was 1,677 Ditto ditto ditto in 1861 was 2,191 Ditto ditto ditto in 1862 was 2,978 Ditto ditto ditto in 1863 was 2,479 Neither in the Workhouse returns nor in the returns of out-door cases are all the Midwifery cases included. TABLE II.—Showing the Deaths from Epidemic Diseases, for the Three Months ending 2nd January, 1864 (14 weeks). Districts. Small-Pox. Measels. Scarlet Fever. Diphtheria. Hooping-cough Diarrhoea. Fever. Total. Remarks. Artillery 0 0 4 0 0 2 1 7 Spitalfields 0 1 7 0 1 2 10 21 Mile End New Town 1 1 11 0 2 7 20 42 Workhouse. Whitechapel, North 0 0 4 0 1 0 9 14 Whitechapel Church 2 0 4 0 0 0 2 8 Hospital. Goodman's Fields 1 2 12 1 1 1 5 23 Aldgate 2 0 4 0 2 0 5 13 Total 6 4 46 1 7 12 52 128 Death from Epidemics for the corresponding quarter, 1862 17 33 29 2 15 22 51 169 TABLE III.—Showing the Ages at death in the Workhouse, and in the London Hospital, for the Quarter ending 2nd January, 1864 (14 weeks). 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, 52 Females, 29 Corresponding Quarter of 1862. Workhouse 10 1 4 17 24 21 4 81 69 London Hospital 0 13 19 35 37 14 0 Males, 77 Females, 41 118 93 TABLE IV.—The Births and Deaths in each Registration District, for the Three Months ending on the 2nd January, 1864 (14 weeks). Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks. M. F. M. F. Artillery 30 30 60 16 12 28 32 •• Spitalfields 86 59 145 51 59 110 35 .. Mile End New Town 87 80 167 103 69 172 .. 5 Workhouse. Whitechapel, North 53 51 104 52 34 86 18 .. Whitechapel Church 50 34 84 90 62 152 .. 68 London Hospital. Goodman's Fields 48 48 96 42 37 79 17 .. Aldgate 39 34 73 38 20 58 15 .. 54 non-residents died in London Hospital. Totals 393 336 729 392 293 685 117 73 Excess of births over deaths, deducting the 54 non-residents . . 98 TABLE V.—Showing the Births and Deaths in each District, for the Year ending on the 2nd January, 1864 (53 weeks). BIRTHS. DEATHS. Districts. April. July. October. December. Total, April. July. October. December. Total. Excess of Births over Deaths. Excess of Deaths over Births. Artillery 74 61 48 60 243 43 53 40 28 164 79 Spitalfields 125 116 116 145 502 125 94 95 110 424 98 Mile End New Town 178 176 146 167 667 203 154 164 172 693 .. 26 Whitechapel, North 107 121 109 104 441 103 80 71 86 340 101 Whitechapel Church 80 63 73 84 300 148 134 163 152 597 •• 297 Goodman's Fields 85 98 97 96 376 61 64 68 79 272 104 Aldgate 74 65 55 73 267 78 60 78 58 274 .. 7 Totals 723 700 644 729 2796 761 639 679 685 2764 382 330 Excess of births over deaths deducting 181 non- residents 213 TABLE VI.—Ages at Death in each Registration District, for the Three Months, ending 2nd January, 1864 (14 weeks). 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. Population in 1861. Artillery 6 6 4 3 5 4 0 28 Spitalfields 30 38 5 8 13 15 1 110 Mile End New Town 42 23 12 28 33 28 6 172 Whitechapel, North 27 20 10 6 11 11 1 86 78970 Whitechapel Church Goodman's Fields 6 21 21 40 44 20 0 152 12 28 10 14 7 6 2 79 Aldgate 13 11 6 11 9 7 1 58 Totals 136 147 68 110 122 91 11 685 TABLE VII.—Showing the Mortality in the Workhouse and Hospitals in the District during 1856, 1857, 1858, 1859, 1860, 1861, 1862 and 1863. Union Workhouse. London Hospital. Military Hospital. 1856 353 1856 297 1856 0 1857 272 1857 338 1857 2 1858 269 1858 325 1858 5 1859 239 1859 354 1859 3 1860 282 1860 326 1860 2 1861 287 1861 366 1861 0 1862 369 1862 330 1862 2 1863 324 1863 418 1863 2 TABLE VIII.—Showing the total Mortality in the Whitechapel District, without deduction for non-residents, in the undermentioned years. Years 1848 1849 1850 1851 1852 1853 1854 1855 1856 1857 53 wks. 1858 1859 1860 1861 1862 1863 53 wks. Mortality 2648 2778 2061 2377 2286 2444 2878 2453 2237 2360 2444 2321 2302 2331 2551 2764 TABLE IX.—Ages at Death in each Registration District, for the Year ending 2nd January, 1864 (53 weeks). 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. Population in 1861. Mortality percent. under 5. Artillery 42 53 18 16 19 14 2 164 6557 1.44 Spitalfields 102 147 44 42 47 38 4 424 15700 1.58 Mile End New Town 153 162 53 109 137 115 24 693 15392 2.04 Whitechapel, North 79 116 40 22 42 35 6 340 12122 1.60 Whitechapel Church 33 89 67 141 179 77 11 597 8062 1.51 Goodman's Fields 65 83 30 30 34 22 8 272 11166 1.32 Aldgate 61 68 37 39 32 35 2 274 9971 1.49 Totals 535 718 289 399 490 336 57 2764 78970 1.58 For the Year 1862 498 620 182 389 462 350 50 2551 The births during the year were 2,796. This number gives an annual birth rate of 35.4 per 1,000 of the population. The deaths, including all those in the London Hospital (418), were 2,764. This number gives an annual death rate of 35.0 per 1,000. By deducting the deaths of the non-residents (181) the proportion of deaths per 1,000 is reduced to 32.4; and by deducting the total deaths in the London Hospital, which it is requisite to do if we compare the mortality in this district with that in others, the rate of mortality is still further reduced to 29.5 The deaths under 5 years of age were 1,253. This number is at the rate of 44.8 per cent. of the total births, and 45.7 per cent. of the total deaths. As the above calculations are made upon the mortality of 53 weeks, the rate of mortality for this district may be estimated at 34.1 instead of 35.0 per 1000. In the City of London 39 per cent. of the total mortality is of children under 5 years of age. In London the proportion of the deaths of children under 5 years of age to the total mortality is 44 per cent. TABLE X.—Showing the Deaths from Epidemic Diseases in the Whitechapel District, during the Years 1856, 1857, 1858, 1859, 1860, 1861, 1862 and 1863. 1856. 1857 (53 weeks). 1 85 8. Districts. Small-pox. Measles. Scarlet Fever. Hooping-cough. Diarrhœa. Typhus. Total. Small-pox. Measles. Scarlet Fever. Hooping-cough. Diarrhœa. Typhus. Total. Small-pox. Measles. Scarlet Fever. Hooping-cough. Diarrhœa. Typhus. Total. Artillery 0 2 4 3 3 8 20 0 6 4 9 5 3 27 1 4 9 3 5 7 29 Spitalfields 3 1 7 15 10 22 58 0 9 9 19 15 10 62 0 24 22 14 15 18 93 Mile End New Town. 8 1 2 14 18 63 106 0 18 4 6 24 36 88 1 5 24 33 34 38 135 Whitechapel, North 10 3 9 9 11 57 99 1 11 2 20 25 34 93 0 6 18 19 22 22 87 Whitechapel Church 3 2 6 2 8 20 41 1 2 8 10 14 15 50 1 7 6 7 7 11 39 Goodman's Fields 6 1 5 7 12 9 39 0 8 9 15 29 8 69 0 15 6 25 12 4 62 Aldgate 2 2 12 14 19 9 58 1 6 7 10 27 11 62 1 17 2 16 13 4 53 Totals 31 12 45 64 81 188 421 3 60 43 89 139 117 451 4 7887 117 108 104 498 TABLE X.—Continued. 1859. 1860. 1861. Districts. Small-pox. Measles. Scarlet Fever. Hooping-cough. Diarrhœa. Typhus. Total. Small-pox. Measles. Scarlet Fever and Diphtheria. Hooping-cough. Diarrhœa. Typhus. Total. Small-pox. Measles. Scarlet Fever and Diphtheria. Hooping-cough. Diarrhoea. Typhus. Total. Artillery 1 0 8 7 5 4 25 0 2 2 7 1 1 13 0 2 8 7 5 4 26 Spitalfields 20 8 17 8 29 7 89 8 11 17 3 11 11 61 8 6 13 22 19 9 77 Mile End New Town 17 13 8 9 31 33 111 7 8 14 14 23 23 89 7 14 8 18 25 25 97 Whitechapel, North 9 4 15 9 27 9 73 3 16 6 11 9 6 51 0 1 5 16 10 5 37 Whitechapel ChurchGoodman's Fields .. 4 2 13 5 13 16 53 1 4 10 6 5 13 39 3 0 16 5 15 10 49 8 1 26 8 12 12 67 2 17 6 7 12 8 52 1 1 15 17 15 6 55 Aldgate 1 3 9 4 24 12 53 0 23 4 1 6 7 41 9 3 5 13 12 6 48 Totals 60 31 96 50 141 93 471 21 81 59 49 67 69 346 28 27 70 98 101 65 389 TABLE X.—Continued. 186 2. (1863 53 weeks.) Districts. Small-pox. Measles. Scarlet Fever and Diphtheria. Hooping-cough. Diarrhœa. Typhus. Total. Small-pox. Measles. Scarlet Fever and Diphtheria. Hooping-cough. Diarrhœa. Typhus. Total. Artillery 0 11 7 8 2 12 40 2 3 35 3 8 10 61 Spitalfields 4 53 12 15 14 28 126 19 4 60 6 27 21 137 Mile End New Town 15 26 23 11 13 120 208 14 2 56 6 30 67 175 Whitechapel, North 8 23 17 9 14 24 95 17 10 45 7 10 19 108 Whitechapel Church 0 4 10 6 5 19 44 7 1 28 2 11 9 58 Goodman's Fields 0 18 16 7 6 23 70 3 6 40 16 11 12 88 Aldgate 6 18 6 6 15 24 75 7 0 26 12 17 20 82 Totals 33 153 91 62 69 250 658 69 26 290 52 114 158 709 TABLE XI.—Causes of Death at Seven periods of Life, registered in the Whitechapel District, for the Three Months ending January 2nd, 1864. 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. Brought Forward 112 129 57 79 89 63 1 530 IV. — Digestive Organs. Small-pox 1 2 3 … … … … 6 Measles 2 2 … … … … … 4 Cancrum Oris Scarlatina 2 32 14 … … … … 46 Gastritis … 1 … 1 1 … … 3 Diphtheria … 1 … … … … … 1 Enteritis … … … … … 1 … 1 Quinsy Peritonitis … … 1 2 … … … 3 Croup 3 7 1 … … … … 11 Ascites … … 1 … … 2 … 3 Hooping-cough 1 6 … … … … … 7 Ulc. of Intestines … … … 1 1 … … 2 Typhus Fever 1 5 16 12 10 8 … 52 Hernia (Rupture) … … … … 3 … … 3 Erysipelas 1 … 1 1 2 2 … 7 Ileus Puerperal Fever … … … 1 … … … 1 Intussusception … … … … 1 … … 1 Carbuncle Fistula Influenza Stomach Disease, &c. … … … 2 … 2 … 4 Dysentery … … … … 1 … … 1 Pancreas Disease, &c. Diarrhoea 6 4 … 1 1 … … 12 Hepatits … … … … … 2 … 2 Ague Liver Disease, &c. … … … 1 4 … … 5 Remittent Fever Stricture of Rectum. … … … 1 … … … 2 Rheumatism … … 1 1 … … … 2 V.-Urinary Organs. Pvæmia … … 1 … … … … 1 II.—Enthetic. Nephritis … 1 … … … … … 1 Syphilis 3 … … … 1 … … 4 Disease of Bladder … … … … 1 … … 1 Stricture of Urethra Nephria (Bright's Disease) … … … 5 6 … … 11 Hydrophobia III.—Dietic. Diabetes Privation Stone Want of -Breast Milk Purpura and Scurvy Alcoholism —Delirium Tremens. … … … 2 1 1 … 4 Prostate Disease … … … … 2 1 … 3 Kidney Disease, &c. … … 1 … … … … 1 VI.-Organs of Generation. „ Intemperance Ovarian Dropsy … … … … 1 … 1 Lead Poisoning Uterus Disease, &c. … … … 1 … … … 1 IV.—Parasitic Recto-vaginal Fistula … … … 1 … … … 1 Thrush VII.-Organ of Locomotion. Worms, &c. 2.-Constitutional Joint Disease, &c. … … … 1 1 … … 2 Bones, &c. Gout mentary system. Dropsy … 2 1 1 2 2 … 8 Cancer … … 1 3 2 2 … 8 Phlegmon Mortification 1 … … 1 1 2 … 5 Skin Disease, &c. Abscess 2 … … … 3 … … 5 4.-Developmental I.—Diseases of Children. Ulcer … … … … … 1 … 1 II.—Tubercular. Scrofula 2 1 … … … … 3 Premature Birth 2 … … … … … … 2 Tabes Mesenterica 12 12 1 … … … … 25 Cyanosis Phthisis (Consumtn.) 1 3 7 37 20 8 … 76 Spina Bifida Hydrocephalus … 3 … … … … … 3 Other Malformation 6 3 … … … … … 9 3.—Local. 1.—Nervous System. Teething II.-Disease of Adults. Meningitis 1 2 2 2 1 … … 8 Paramenia … … 1 3 … … … 4 Apoplexy … … 1 3 4 7 … 15 childbirth Palsy (Paralysis) … … … 1 2 4 1 8 III.-Disease of Old People. Insanity Tetanus … … … … … 1 … 1 Old Age … … … … … 12 10 22 Epilepsy … … … 1 2 1 … 4 IV.-Disease of Nutrition. Convulsions 37 9 … … … … … 46 Chorea Astrophy and debility 12 1 … … … 1 … 14 Brain Disease, &c. … … 2 2 1 … … 5 5.-violent Deatns I.—Accidents or Negligence. II.—Organs of Circulation. Pericarditis … … 2 … 1 … … 3 Burns and Scalds … 10 5 4 1 … … 20 Aneurism … … … 1 … … … 1 Poison … … … 1 … … … 1 Heart Disease, &c. … 1 5 3 10 4 … 23 Suffocation 4 1 … … … … … 5 Phlebitis Violence … 1 1 4 5 6 … 17 Disease of Arteries Drowning … … … 1 1 … … 2 III.—Respiratory III.—Homicide. Murder and Laryngismus 1 2 … … … … … 3 slaughter … … … … 1 … … 1 Laryngitis IV.—Suicide. Bronchitis 15 5 1 3 13 15 … 52 Wounds … … … 1 1 … … 2 Pleurisy 1 1 … 1 1 … 4 Poison … … … 1 1 … … 2 Pneumonia 21 30 2 2 2 … … 57 Drowning Lung Disease, &c. … … … … 3 4 … 7 Hanging … … 1 … 2 … … 3 Otherwise Not Specified Carried Forward 112 129 57 79 89 63 1 530 Grand Total 136 147 68 110 122 91 11 685 95 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON The Sanitary Condition OF THE WHITECHAPEL DISTRICT FOR THE THREE MONTHS ENDING 2nd APRIL, 1864, BY JOHN LIDDLE, Medical Officer of Health PRESENTED TO THE BOARD, 18th APRIL, 1864. LONDON. 1864. LONDON: printed by e. j. bath, 43, leman street, whitechapel. REPORT, FOE THE QUARTER ENDING 2nd APRIL, 1864. Gentlemen, In the course of the Quarter, ending 2nd April, there were registered in the Whitechapel District 770 births, of which 400 were of males, and 370 of females. The deaths during the same period were 767, of these 424 were of males, and 343 of females. By deducting the deaths of the non-residents (54) the mortality is reduced to 723, and by deducting the total deaths in the London Hospital (117), the mortality is still further reduced to 650. Of the deaths in the London Hospital 50 were the result of accident and of sudden death of persons whose, residences are not given in the returns. Of the remaining 67, there were 13 of persons residing within the District, and 54 non-residents. During the corresponding quarter of last year, the births were 723, and the deaths 761, including 45 of non-residents. The deaths from Epidemic diseases aro 101, which is 13.1 per cent, of the total deaths, whereas, in the corresponding quarter of last year, they were 183, or 24 per cent. If, however, we deduct the total deaths in the London Hospital from the total mortality of the District which occurred in each of the above-named quarters, (for in the London Hospital not a single death from Epidemic disease occurred during the course of either of them,) the proportion of deaths from Epidemic diseases is increased respectively from 13.1 yer cent, to 15.5 per cent., and from 24 per cent, to 28.1 per cent. The proportion of deaths from Epidemic diseases to the total deaths, during the year ending Christmas, 1863, was as high as 25.6 per cent., the total deaths being 2,764, and the deaths from Epidemic diseases, 709. Three deaths from this class of diseases occurred in the London Hospital during the year. If, therefore, we deduct from the total mortality the total deaths in the London Hospital (4.18), and deduct also the three deaths which occurred in that Institution from Epidemic diseases from the total number of such deaths (709), the proportion of deaths from Epidemic diseases is 30 per cent, of the deaths in the District for the year 1863. 6 Since the publication of my last Annual Report, the Registrar General has issued the Weekly Returns of Births, Deaths, and Causes of Death in London during the year 1863, from which it appears that the deaths in the Metropolis from small-pox were 2,012, from measles 1,698, from scarlet-fever 5,075, from diphtheria 724, from hooping-cough 2,229, from diarrhcea 2,448, and from typhus 2,892. Total 17,078. The total deaths in London from all causes for the year were 72,346. The proportion of deaths from epidemics to the total deaths is therefore 23.6 per cent., which is two per cent, below that in the Whitechapel District. It further appears from these weekly returns, that the annual rate of mortality per cent, of the population in the West Districts of London is 2.324, in the South Districts 2.337, in the North Districts 2.381, in the East Districts 2.655, and in the Central Districts 2.664. The diminution of the number of deaths from epidemics during the last quarter, is due chiefly to the abatement of scarlet-fever and small-pox, the former being less by 58 and the latter by 27. The deaths from fever have slightly increased, viz. from 39 to 44, while the deaths from diarrhcea have decreased from 13 to 4. The rise, culminating point, and decline of the several epidemic diseases continue to be involved in mystery. The phrase "Epidemic constitution of the Atmosphere" is frequently used, but as Dr. [Holland observes, “it is merely a phrase which wraps ignorance in the garb of scientific language.” The deaths from diseases of the respiratory organs have been 193. Consumption has been fatal to 66, and the other scrofulous diseases to 38. The excessive indulgence in intoxicating drinks proved fatal to 4 persons. Burns and scalds proved fatal to 18 persons, one of whom was a widow 89 years of age, and 10 were children under 5 years of age. In one week, viz.: that ending February 6th, there were 10 deaths in the London Hospital from burns and scalds. The operation of ovariotomy was fatal in one instance. Three persons committed suicide, one by taking poison whilst intoxicated, and two by hanging ; in each case during an attack of temporary insanity. One case of manslaughter is recorded. Rheumatism was fatal to two young women, domestic servants, aged respectively 16 and 17 years. Pyemia, abscess, mortification, and erysipelas, were fatal to 14 persons. This is a large number, and the prevalence of these diseases showed that a very unhealthy condition of the atmosphere existed. A child newly born was found dead, death having boen caused by suffocation, but how, or by whom the suffocation was produced, there was not any evidence. The death of a man aged 55 is registered as being the result of inflammation of the brain occasioned by blow; in this case an inquest was not held. One death was occasioned by privation and exposure to cold. Four children were suffocated in bed. An infant two weeks old is recorded as having died from being bandaged too tightly. There are also among the records of the causes of death the following, viz.: a widow, aged 68, from “ ulcerated breast with hydatids and hemorrhage, 12 months, bronchitis 6 months ” —two children aged respectively 5 years and 14 months, from skin disease “eczema”—a child aged 3 weeks from “phlegmasia doleus.” The uncertified deaths, or those registered without a certificate from a qualified medical practitioner, have been six, viz.: two from measles (children), one from consumption (an adult), one from “ old age ” a man aged 82 and the others from convulsions (children). The deaths of children under 5 years of age are 252. This number is in the proportion of 32.8 per cent, of the total deaths, and the deaths of persons above the age of 60 are 165, which is 22.8 per cent, of the total deaths. The average annual number of deaths of children under 5 during the last 5 years—1859-64, lias been, in relation to the total mortality, at the rate of 47.5 per cent. ; and the deaths of persons above 60 have been at the rate of 16 per cent. In the quarter ending October, 1860, the deaths of children under 5 were 50 per cent, of the total deaths, and the deaths of persons above 60 were 15 per cent. It therefore appears, that during the quarter now under consideration, the rate of mortality of children has been in proportion to the total mortality much more favorable. The deathrate of those above 60 has increased. 7 From a Table prepared by the Registrar General, and ordered by the House of Commons to be printed, 5th February, 1864, entitled " Return of the average annual proportion of deaths from specified causes, at specified ages, in England generally, and in each Registration Division and Registration District of England, during the decennial period 1851-60, it appears that the District of Whitechapel, as regards its rate of mortality, is very high, (the highest but one in the whole Metropolis,) the deaths in 100,000 being on an average 3,041 annually, or 3.041 per cent. ; but from a Table corrected by the Registrar General for the deaths in Hospitals, and distributing them proportionally over the several Districts, it appears that the average number of deaths per 100,000 in the "Whitechapel District is 2,841 annually. This mode of calculation may be the best that can be adopted upon the data furnished to the Registrar General, but it probably tells unfavorably upon all the Districts in London ; for a great many patients from the country are admitted into the London Hospitals, and the fatal eases are registered among the deaths in the Metropolis. In the London Hospital, during the last year, there were 21 deaths of persons whose residences were in the country, of which, 16 were of patients from Essex. As regards the mortality of the Whitechapel District, when compared with that of other districts, I may state, that while the neighbouring districts sent a great many of their fever cases to the Fever Hospital, (St. George in the East having sent 140 patients during the year 1863,) Whitechapel did not send one case. The rate of mortality in the Fever Hospital of patients admitted with typhus fever was 16.02 per cent., the rate of mortality among the female patients being 14,5 per cent., and among the male patients 17.8 per cent. Deducting 23 cases, fatal within 24 hours, and 28 other cases, fatal within 48 hours of admission, the mortality was only 12.5 per cent. The rate of mortality of patients admitted with typhoid or enteric fever was 14.2 per cent.; that among the male patients having been 21.60 per cent., and among the female patients only 11.76 per cent. The number of Inquests has been 90, of which 48 were held at the London Hospital. In the corresponding quarter of the previous year, the total number of Inquests held in this District was 72. The deaths in the workhouse have been 115, viz.: 64 of males and 51 of females, of which deaths, 14 were caused by feyer, 2 by diarrhoea, and 1 by measles. Three of the deaths in the workhouse were of persons above 80 years of age ; one of these, a female, had reached the extreme age of 96. In the corresponding quarter of last year the deaths in the workhouse were 101. The Medical Officers of the Union have attended 3,569 new cases of disease among the pauper population; of which 11 /were of small-pox, 45 of measles, 14 of scarlet-fever, 54 of hooping-cough, 142 of diarrhoea, and 141 of fever. In the corresponding quarter of 1863, the total number of cases was 3,607, of which 103 were of small-pox, 34 of measles, 31 of scarlet-fever, 40 of hooping-cough, 129 of diarrhoea, aud 76 of fever. The cases of illness in the workhouse have been 824, of which Mr. Champneys attended 439, and Mr. Richardson 385. The cases of epidemic disease, included in the above returns, have been 4 of small-pox, 2 of measles, 8 of scarlet-fever, 28 of diarrhoea, and 145 of fever. Mr. Champneys states that three cases of gangrene occurred in the workhouse during the last quarter, one of which proved fatal. The Inspectors have, in addition to their visitations to, and reports upon, an average number of 10 courts daily, specially inspected and given in a report upon the sanitary condition of each room, and of the number of persons living therein, in the 14 undermentioned courts: New Court, George Yard ; Hairbrain Court; Harrison's Court; Pope's Head Court; Luntley Place ; Jacob's Court, which is an enclosed part of Castle Alley, in which are four houses badly constructed and without sufficient domestic conveniences, so that this locality is always in a filthy condition ; King's Head Court; Queen's Place, High Street, Whitechapel ; Inkhorn Court; Buckle Street; Plough Square ; Plough Street; Plough Court; 8 Parson's Court; Russell Court; and Rose Court, Blue Anelior Yard. In these .visitations, the Inspectors found that some of the rooms were overcrowded, and several cases of indecent occupation were ascertained to exist; such as, a man sleeping in the same room with his adult niece and 3 children—a man and wife, and an adult female, said to he acting as a servant—a mother with three adult daughters and two adult sons. The above account of the manner in which the population of many in the poor localities live is given merely as an example, it being unnecessary to particularize all the cases of indecent occupation of rooms which came under the notice of the Inspectors. Where overcrowding exists, the law gives power to the local authorities to take proceedings before the magistrates to obtain a diminution of the number of occupants in a room, but it gives no power to interfere in the cases of indecent occupation. The Inspectors have also inspected every house where fever has existed, and in every case where requisite, orders have been given to the landlord to limewhite the house ; but notwithstanding this necessary proceeding, cases of fever are found frequently to recur in the same house and in the same room. Thus, at No. 4, Garden Court, Glasshouse Street, a house consisting of three rooms, there have been within the last three months, 8 cases of fever. This house has been, by order of the Inspector, limewashed on several occasions, yet, fever continued to prevail. At last, the landlord reduced the number of inmates in the house, got rid of the family occupying the lower room in which cases of fever had been of such frequent occurrence, and closed the room. The removal of the inmates—the shutting up of the room for a period, and the thoroughly cleansing of the same, is the only effectual plan of preventing the spread of fever and other epidemic diseases. The practice of keeping swine is of common occurrence, and it is difficult to entirely prevent it. Proceedings have been taken, and convictions obtained under the provisions of Michael Angelo Taylor's Act against persons keeping swine within 40 yards of any public place. This Act does not appear to have been repealed by any recent enactment. The authorities in St. George, Hanover Square, have recently taken proceedings under this Act, and obtained a conviction. The penalty is 40s. and forfeiture of the swine. The periodical inspection of the bakehouses will now form a portion of the duty of your Sanitary Officers. During the last two quarters, all the bakehouses, where bread and confectionary are baked, have been inspected by myself and the Inspectors. The following is the result of these inspections. There are 84 bakers, including confectioners, in the Whitechapel District. In order to facilitate the inspection of these premises, 1 caused to be prepared a tabular form, showing 1st, the names and addresses of the owners; 2nd, whether the bakery was underground or otherwise; 3rd, whether the premises were clean or dirty; 4th, whether they were or were not properly ventilated; 5th, whether or not the drainage was good ; 6th, whether any persons under the age of 18 years were employed between the hours of 9 at night and 5 in the morning ; and 7th, whether any portion of the bakery was used as a sleeping apartment. In seven instances it was found that the premises required limewashing ; two required improvement in the ventilation; in one a cesspool was found to exist in the rear of the premises ; in one instance, an offensive, and untrapped drain was discovered in the bakery. In no instance was it ascertained that the bakehouse was used as a sleeping place, neither was it discovered that lads under 18 years of age were employed between the hours of 9 o'clock in the evening and 5 in the morning. Information respecting some of these particulars could only be obtained from the owners of the premises. It would be very desirable that a copy of the rules and regulations for bakehouses, in accordance with the provisions of the "Bakehouse Regulation Act," should be posted in every bakery. Official inquiries having been made of me respecting the state of work-rooms, the mode of life, where young females are employed at needlework and at the sewing machines, the number of hours of work, and the ages of those so employed, I visited, in company with the inspectors, several of these establishments within this District, The 9 result of my investigations is— that some of the rooms are overcrowded and badly ventilated— that the mode of life of the workers is not calculated to sustain health, particularly in the case of growing girls, the hours of labour being too long, viz.: from 10 to 12 hours daily, ahd the employment being entirely sedentary—that as young men and young women in some establishments work together in the same room for 12 hours daily, with an interval of one hour only for dinner, and, in some instances, half an hour for tea, not only the health but the morals of the young are likely to suffer from the long hours of working in a badly ventilated room, and the familiarity likely to be engendered by the constant association of the young people so employed. In one establishment, I found that it was customary for the young women to bring with them their dinners. In this case there was no interval allowed for change of air. During the busy period, the hours of labour exceed twelve hours daily; At present no provision exists for placing such work-rooms under periodical inspection. I am, Gentlemen, your obedient Servant, 15,Grear 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 on the 2nd April, 1864. Names of Medical Officers, Small-Pox. Measles. Scarlatina. Hooping- Cough. Diarrhoea. Continued Fever, Typhus & Typhoid. Cholera. Erysipelas. Pyaemia. Puerperal Fever. Carbuncle. Acute Pulmonary Inflammation. Croup. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Diphtheria. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Mr. Blackwell 0 13 0 7 49 68 — 5 — — 1 148 18 1 4 0 1 — — 673 988 Mr. Champneys 0 0 5 6 41 29 — 5 — — 0 74 6 0 0 0 1 — — 457 624 Mr. Richardson 1 3 5 21 32 10 — 3 — — 0 11 0 0 1 0 0 — — 725 812 Mr. Sequiera 10 29 4 18 31 41 — 4 — — 0 34 12 0 0 7 1 — — 954 1145 Total 11 4 14 52 153 148 — 17 — 1 267 36 1 5 7 3 — — 2809 3569 11 TABLE II.— Showing the Deaths from Epidemic Diseases for the Three Months ending 2nd April, 1864. District. Small-Pox Measles Scarlet Fever Diphtheria HoopingCough Diarrhoea Fever Total Remarks. Artillery 0 0 0 — 1 0 3 4 Spitalftelds 1 5 0 — 1 0 3 10 Mile End N. Twn. 0 6 1 — 6 3 20 36 Workhouse Whitechapel, N 0 11 2 — 8 1 5 27 Whitechapel Ch 0 2 0 — 0 0 3 5 Hospital Goodman's Fields 2 1 2 — 2 0 5 12 Aldgate 1 0 0 — 1 0 5 7 Total 4 25 5 — 19 4 44 101 Deaths from Epidemics for the corresponding quarter, 1863. 31 19 62 4 19 13 39 183 TABLE III.— Showing the Ages at Death in the Workhouse, and in the London Hospital, for the Quarter ending 2nd April, 1864. 0 and underl 1 and under5 5 and undr20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Total Males 64 Femls51 Corresponding Quarter of 1863. Workhouse 5 2 1 23 36 45 3 115 101 L. Hospital 2 8 14 30 49 13 1 Males 80 Femls37 117 100 12 TABLE IV.— Ages at Death in each Registration District, for the Three Months ending 2nd April, 1864. 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 6 5 3 3 9 9 1 36 Spitalfields 26 21 4 7 23 20 3 104 Mile E. N. Town. 27 27 9 26 60 61 6 216 Workhouse Whitechapel, N 26 30 7 5 17 12 4 101 Whitechapel Ch. 9 22 15 36 62 23 6 173 Hospital Goodman's Fields 19 11 7 13 10 12 1 73 Aldgate 10 13 4 13 17 6 1 64 Totals 123 129 49 103 198 143 22 767 TABLE V.— The Births and Deaths in each Registration District, for the Three Months ending on the 2nd April, 1864. Districts. Births. Total. Deaths. Total. Excess of Births oyer Deaths. Excess of Deaths over Births. Remarks. M. F. M. F. Artillery 81 25 56 19 17 36 20 0 Spitalfields 65 53 118 48 56 104 14 0 Mile End N. Town. 101 86 187 115 101 216 0 29 Workhouse. Whitechapel, N 55 64 119 53 48 101 18 0 Whitechapl. Church 44 48 92 109 64 173 0 81 London Hospital. Goodman's Fields 69 56 125 45 28 73 52 0 Aldgate 35 38 73 35 29 64 9 0 54 non-residents died in L. Hos. Totals 400 370 770 424 343 767 113 110 Excess of births over deaths, deducting the 54 non-residents..57 Population in 1861, 78,970. TABLE VI. — Causes of Death at Seven Periods of Life, registered in the Whitechapel District, for the Three Months ending 2nd April, 1864. 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. o 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. Brought forward 82 116 36 78 146 99 5 562 Order 1—Miasmatic Order 4,—Digestive Small-Pox … … 3 1 … … … 4 Measles 4 21 … … … … … 25 Cancrum Oris Scarlatina … 2 3 … … … … 5 Gastritis 1 … 1 … 1 … … 3 Diphtheria Enteritis 1 … … 2 … 2 … 5 Quinsy Peritonitis Group 1 7 … … … … … 8 Ascites … … … … 2 1 … 3 Hooping-Cough 1 17 1 … … … … 11) Ulceratn. of Intestns Hernia (Rupture) … … … … 2 1 … 3 Typhus Fever … 5 6 10 17 6 … 44 Erysipelas … … … 2 2 … … 4 Ileus … … … 1 1 … … 2 Puerperal Fever … … … 1 … … … 1 Intussusception … … … 1 1 … … 2 Carbuncle Fistula Influenza Stomach Disease, Ac- … … … … 3 … … 3 Dysentery Pancreas Disease, &c Diarrhoea 1 1 … … 1 1 … 4 Hepatitis … … … 1 … … … 1 Ague Liver Disease, &c … … … 3 5 … … 10 Remittent Fever … 1 … … … … … 1 Spleen Disease, &c. Rheumatism … … 2 … 1 … … 3 Order 5—Urinary Organs. Nephritis Pyaemia … … … 2 … … … 2 Order 2—Enthetic. Syphilis 1 … … … … … … 1 Disease of Bladder 1 … … … … 2 … 3 Stricture of Urethra. 1 1 Nephria. (Bright's disease) … … … 2 5 2 … 9 Hydrophobia Order 3—Dietic. Diabetes Stone … … … … … 1 … 1 Privation … … … … … 1 … 1 Prostrate Disease Want of Breast Milk. Kiclney Disease, &c. … … 1 … 1 1 … 3 Purpura and Scurvy. •Alcoholism—Delirm. Tremens … … … 1 1 … … 2 Order 6 —Organs of Generation. Ovarian Dropsy „ Intemperance … … … 1 1 … … 2 Lead Poisoning … … … … … … … … Uterus Disease, &c … … … 1 2 … … 3 Order 4—Parasitic. Ovariotomy … … … … 1 … … 1 Order 7—Organs of Locomotion. Thrush Joint Disease, &c … … 1 1 1 … … 3 II—CONSTITUTNL Bones, &c … … 2 1 … … … 3 Order 1—Diathetic. Order 8—Integumentary System. Gout … … … … 1 … … 1 Dropsy … … 3 3 6 6 … 18 Phlegmon Cancer … … … … 3 4 … 7 Skin Disease, &c 1 … 1 … … … … 2 Mortification … … 1 2 … … … 3 IV.—DEVELOPMENTAL. Abscess 1 … … 1 3 1 … 6 Order 2— Tubrculr. Order 1—Disease of Children. Scrofula 3 … … … … … … 3 Tabes Mesenterica 16 8 … … … … … 24 Premature Birth 8 … … … … … … 8 Phthisis (Consmptn.) 2 7 30 23 4 66 Cyanosis Hydrocephalus 3 8 … … … … … 11 Spina Bifida III.— LOCAL. Order 1—Nervous System. Other Malformations Teething 5 4 … … … … … 9 Order 2—Diseases of Adults. Meningitis … 3 … … 2 … … 5 Apoplexy … … … 3 5 8 … 16 Paramenia Palsy (Paralysis.) … … … 1 5 4 … 10 Childbirth Insanity Order 3—Diseases of Old People. … … … … 4 27 14 45 Tetanus Epilepsy Old Age Convulsions 20 6 1 … 1 … … 28 Order 4—Diseases of Nutrition. Chorea Brain Disease, &c 1 2 2 1 3 1 … 10 Atrophy & Debility.. 16 … … … 3 … … 19 Order 2—Organs of Circulation. V.—VIOLENT DEATHS. Ansemia … … … … 1 … … 1 Order 1—Accidents or Negligence. Pericartidis Aneurism … … … 1 … … … 1 Burns and Scalds 2 9 3 1 1 1 1 18 Heart Disease, &c … 1 2 6 14 8 … 31 Poison Phlebitis Suffocation 4 … … … … … … 4 Disease of Arteries Violence 2 4 8 16 4 2 36 Phlegmasia Dolens 1 … … … … ... … 1 Order 3—Homicide. Murder & Manslgter. … … … 1 … … … 1 Order 3— Respiratory Organs. Order 4—Suicide. Laryngismus 1 l … … … … … 2 Wounds Larynggitis … 1 1 1 … … … 3 Poison … … … 1 … … … 1 Bronchitis 5 8 2 6 31 43 5 100 Drowning … … … 1 1 … … 2 Pleurisy … … … … 4 1 … 5 Hanging … … … … 2 … … 2 Pneumonia 23 22 2 4 13 2 … 66 Otherwise Lung Disease, &c … … … 1 8 8 … 17 Not Specified … … … 1 … … 1 Carried forward 82 116 36 78 146 99 5 562 Grand Total 123 129 49 103 198 143 22 767 96 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON The Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOR THE THREE MONTHS ENDING 2nd JULY, 1864, BY JOHN LIDDLE, Medical Officer of Health. PRESENTED TO THE BOARD, 4TH JULY, 1864. LONDON. 1 8 6 4. LONDON: PRINTED BY E. J. BATH, 43, LEMAN STREET, WHITECHAPEL REPORT, FOR THE QUARTER ENDING JULY the 2nd, 1864. Gentlemen, The deaths in the district during the quarter ending on Saturday, July 2nd, have been 631, of which 341 were of males and 290 of females. The births have been 729, of which 376 were of males and 353 of females. In the corresponding quarter of last year the deaths were 639 and the births 700. The deaths from Epidemic diseases have been 132, viz., 40 from Measles, 3 from Scarlet-fever, 2 from Diphtheria. 26 from Hooping-cough, 18 from Diarrhoea, and 43 from Fever. During the corresponding quarter of 1863, the deaths from Epidemic diseases were 165, of which 21 were from Small-pox, 3 from Measles, 82 from Scarlet-fever, 15 from Hooping-cough, 13 from Diarrhoea, and 28 from Fever. Although the total number of deaths from this class of disease has not very much diminished, yet, a great difference has taken place in the mortality of the several Epidemic diseases. Thus, not a single death from Small-pox is recorded against 28 in the June quarter of last year; the deaths from Measles have increased from 3 to 40; Scarlet-fever, on the other hand, has diminished from 82 to 3. The deaths from Fever have increased from 28 to 43. The health of the district during this quarter has not been in a satisfactory state, neither as regards the total number of deaths nor the number of deaths caused by Epidemic diseases. In the June quarter of 1862, the total mortality was 620, and the deaths from Epidemics were 172; in 1863, the total mortality was 639, and that from Epidemic diseases 165, and in this quarter the deaths are 631, including 132 from Epidemic diseases, while in June, 1858, the total deaths were 538, including 106 from Epidemic diseases; in June, 1859, the total deaths were 488, and those from Epidemic diseases 68 ; in 1860, the total deaths were 523, and the mortality from Epidemic diseases was only 64; and in 1861, the total mortality was 526, including 74 deaths from Epidemic diseases. The average mortality in the June quarter, for the four years 1858-61, was annually at the rate of 26.2 per 1,000 of the population, while in the three years from 1862-64, the rate of mortality has been 31.6 per 1,000 The deaths from Epidemic diseases have increased from an average of 78 annually in the first-named period—1858-61, to 156 annually in the last—1862-64. 4 It is probable that the influence of the weather may, to some extent, account for the increase of mortality. By the Registrar-General's returns, it appears that during the spring months of the last three years, the variations in the temperature of the air have been very considerable. The days and nights in April have been warm, while the nights in May and the days in June have been generally cold. The lowest night-temperature during the quarter occurred in the week ending June 4th, 1864, when it was 33.4°, and and the highest day-temperature was in the week ending May 21st, when the thermometer stood at 81°. The mortality of children under 5 years of age has been 282, which is 44.6 per cent, of the total deaths. During the corresponding quarter of the previous year the proportion was 43.5 per cent. In the Whitechapel North Sub-District, where 18 fatal cases of Measles occurred, the proportion of deaths of children under 5 years to the total [mortality of that Sub-District, has been as high as 75.2 per cent. The deaths from diseases of the respiratory organs, exclusive of Consumption, have been 102. Consumption and the other diseases of the tubercular class, were fatal to 118, of which 54 were under 5 years of age. Twenty children under 5 years old died from Convulsions, 14 from Atrophy and Debility, 9 from Teething, and 5 from Premature birth. Eight children under 1 year were suffocated in bed. The number of inquests has been 71 against 69 for the corresponding quarter of the previous year. An inquest was held on the body of a child whose death is thus recorded “ Exhaustion from Absence of Breast Milk.” Two inquests were held on the bodies of children who died from Convulsions, the disease in one case was said to have been occasioned by Dentition, and in the other, death was said to have occurred from Convulsions during the night. In the records of the 71 inquests, it is stated that a child 5 years of age died from violent inflammation of the brain from a pea lodging in the ear, and also that a Ginger-beer Manufacturer died from “ Suffocation by getting a soda-water bottle stuck in his throat unintentionally.” _ The death of a female servant aged 30 years, was caused by Elephantiasis, succeeded by Erysipelas. The death of a young man aged 27 years was caused by ulceration of the larynx. The number of deaths uncertified by a Medical Practitioner has been 4; they are all recorded as having been caused by Convulsions. It may he asked why inquests were not held in all these cases; as it appears from the records that an inquest in two instances was held oil children who had died from convulsions. Convulsions may be the result of poison, of suffocation, and of many other causes. Unless, therefore, an inquiry is instituted by the Coroner, or by a properly qualified Medical Practitioner into all cases of death not properly certified, the public is not sufficiently protected against murder. 5 The deaths in the Workhouse have been 118 against 70 for the corresponding quarter of the previous year. Of these deaths, there were 4 from Measles, 2 from Erysipelas, 2 from Diarrhoea, 22 from Fever, and 4 from Gangrene. Respecting these 4 deaths from Gangrene, it appears that one of the patients, a female aged 51 years, was admitted into the workhouse on June 25th, 1863; after a long illness, she had bed sores, which assumed a gangrenous character; she died June 7th, 1864. The next case was that of a man 65 years of age, who, when admitted on the 12th of February, was suifering from a bad leg. An abscess subsequently occurred in the foot which was followed by Gangrene. He died on the 24th May. The next case was that of a child 1 year old,.who was admitted on the 13th February, suffering from Secondary Syphilis which resulted in a gangrenous ulcer. This child died on the 21st April. The fourth case was that of a woman who was admitted on the 18th of March, and died on the 31st of the same month from Gangrene, the result of ossification of the arteries. On looking over a return of the deaths in the Workhouse which was recently given to me by one of the Guardians, it appears that out of the 321 deaths which occurred in that institution during the year ending March, 1864, there were 65 deaths of persons who had been only five days in the house; 111 of persons who had been there for a period varying from 6 days to a month ; 109 of persons who had been in the house from 1 to 12 months, and 36 who had been there for a longer period. The Medical Officers of the Union attended 3,362 new cases of illness, including 3 of Small-pox, 189 of Measles, 27 of Scarlet-fever, 79 of Hoopingcough, 236 of Diarrhoea, and 75 of Fever. The number of cases of illness in the Workhouse has been 733, including 2 of Small-pox, 11 of Measles, 8 of Scarlet-fever, 25 of Diarrhoea, and 111 of Fever. Of the total number, Mr. Champneys attended 372 and Ma. Richardson 361. By the daily and systematic inspection of the Courts by the Inspectors, instances are repeatedly found of the overcrowding and indecent occupation of rooms, and occasionally of the sub-letting of them. In these latter instances, notice of the fact is always given to the Police. I desire to conclude this Report by making a few observations On the WATER SUPPLY. During the last six months I have again directed my attention to the very inadequate supply of water to the poor of this district. It appears from the returns of the Inspectors, that 66 courts within this district, are supplied with water from a stand-tap only, from which the water flows for the short period of about 20 minutes daily on six days of the week, while on Sundays there is no supply at all, except in the few instances which are mentioned in a former Report. 6 During the time the water is running, the inhabitants of the court and sometimes the inhabitants of other courts, where the water supply is equally scanty, crowd round the stand-tap, with jugs, buckets, and such other vessels as they have for holding water. At these stand-taps scones of quarrelling often occur, and in most cases where the supply is very short, the strongest only get their vessels filled, the water being shut off before the weaker can get near to the stand-post. What water is not required for immediate use they keep in their rooms (which are used both as sleeping and day-rooms, and in which cooking and washing are carried on), until the next day, when the water is again turned on, and they can obtain a fresh supply. The water thus preserved in their ill-ventilated rooms (frequently the sleeping-place of a large family) soon becomes unfit for drinking or even culinary purposes, and can be used for washing and cleansing only. Under these circumstances there can be but little doubt that the poor suffer great privations, and we ought to regard with charitable feelings the absence of personal and household cleanliness among them ; more especially, when we reflect upon the labour which, is entailed upon a poor woman, living in a garret two or three stories high, who has to fetch every pail of water either from the cellar of the house, or from the source of the supply in the court or alley, and also to carry down that portion of it which has been used in washing and other cleansing purposes. It was a matter of comparatively rare occurrence, when water was supplied only three or four times a week, to hear complaints from the poor of the want of water. An ample supply of water, like education, appears to be appreciated just in proportion as the people are in possession of it. The less the mind is educated, the less is the want of education felt; and the more dirty the people are, and consequently the greater necessity for cleanliness, the less is the demand for water. It is stated by some landlords that the inhabitants of those courts, where the supply of water is very scanty and intermittent, that they do not desire any additional supply; and this is given as a reason why they do not afford their tenants facilities for obtaining water at all times. But I am happy to be able to say that few persons are now found with such a low state of their mental faculties as not to desire the comforts and advantages of cleanliness; and I have no hesitation in saying that if water were at all times as readily accessible as it ought to be, habits of cleanliness would soon be acquired. On the contrary, unless means are at hand of removing, by an ample supply of water, the dirt from their persons and the filth from their habitations, the reverse of cleanly habits will prevail among the poorer classes. I may here observe that I have had my attention directed upon more than one occasion by a Lady, moving in the upper ranks of society, to the want of a proper supply of water to some of the localities in this District, inhabited by Jews of the poorer class. This is undoubtedly true; hut although at present, comparatively little has been done, owing to the reluc- 7 tance of landlords to incur expense, to improve the water supply, I hope, ere long, to be able to report that some, if not all, the localities where, the water supply is now defective, have been provided with means of supplying water at all times. In order to get this existing deficiency of the water supply remedied, I have obtained an interview with the Engineer of the East London Water Company, and with the Inspector of the New River Company, and also with Mr. Beggs, of 37, Southampton Street, Strand, who is Agent for Messrs. Guest & Grimes, of Rotherham, where all sorts of sanitary appliances are manufactured, and have conferred with each of them upon the best mode of supplying water to the districts inhabited by the poor, and I have much pleasure in stating that the officers of the Water Companies expressed their willingness to render the Landlords of courts and alleys every reasonable assistance in the matter. The Engineer of the East London Company recommended the adoption of the "Patent Absolute Water Waste Preventer." This machine ''consists of two parts: 1st, a Two-way Cock; 2nd, a Cast-iron Vessel. Its action is as follows: The two-way cock is fixed at the bottom of the vessel. One of the water-ways of the plug of the cock admits water into the vessel, and the other allows it to run out, but both cannot be open at the same time, so that a continuous flow of water beyond the contents of the vessel is impossible." Water being connected 'with the machine by a pipe from the main fills the vessel up to the compressed air line, and which compression will vary in height, according to the pressure of the water works' supply. The quantity of water which this vessel is capable of holding is always ready for use, and no sooner is it drawn off, then, by reversing the handle of the cock, the vessel will be again filled and ready for use, as may be required. He stated, also, that every court in the District could be supplied with water from the main; but, upon further inquiry, I found that although this could be done, yet, the expense of laying on the water from the main, in some cases, would be so great, owing to the distance of the main from the court to be supplied, that many landlords would refuse to incur it. The Inspector of the New Eiver Company suggested that a cistern should be erected in each court, and that a pipe leading therefrom should be supplied to every house in the court, and provided with a self-closing tap, so that no one could carelessly waste the water, perhaps empty the cistern, and thus inconvenience the other inhabitants. This plan would certainly prevent the theft of water, a matter which the New River Company think of such importance that they will not permit an " Absolute Water Waste Preventer " to be erected in a court where permission to erect one was recently required, but will only allow one " to be placed within a house, and be properly protected."* The objection made by the Company of the inhabitants of the neighbouring courts taking water from one of these * In most of the courts where cisterns are used, any person can now obtain water, for the cisterns are not protected. 8 machines, might, some years ago, have been valid, but now that all the courts in the District are supplied with water, the objection has little or no weight, for, as the inhabitants of all the courts pay for water, it can make no difference to the Company where they obtain the supply, as only the amount which they require for use will be drawn. A tap from the main, without the intervention of some machine to prevent waste, will not be permitted by the Water Companies, unless a meter is used. MR. Wicksteed, formerly Engineer to the East London Water Company, in his evidence before the Commissioners for Inquiring into the state of large Towns and Populous Districts, states that, " the best mode of supplying water to the poor would be by a common stand-cock so constructed that when the water was required it would be necessary to hold up the valve to keep it open, and when the supply was obtained, the valve would shut itself and remain closed until water was again required—this would prevent a waste of water.” There can be no doubt that, for many reasons, the constant supply from the main would the best mode of supplying water to the Courts and Alleys in the District. By providing a constant supply from the main without the intervention of a tank or butt, the water when required for use would always be fresh and cool. The water which is retained in butts soon becomes contaminated and unfit for drinking, owing, in the first place, to the butt itself being, in many instances, partially decayed. Secondly, as the greater number of the butts in use are uncovered, there is always a film of dust on the surface of the water, and if the butts are not placed sufficiently high from the ground to prevent persons from dipping all sorts of vessels into them, and washing vegetables, &c., therein, the water soon becomes so filthy that it cannot be used. Covers to the butts, unless well secured and placed beyond reach, are soon destroyed by the tenants. Thirdly, the butt is generally so placed as to be exposed to the heat of the sun in summer, in those courts where the sun's rays penetrate, thereby rendering the water warm and disagreeable to the taste. Slate or iron cisterns are a great improvement upon the wooden butts, but even to these there is an objection, for however carefully they may be covered, the water will, in the course of time, become contaminated, unless they are cleansed out thoroughly once in every three or four weeks. But as neither the landlords nor any of the tenants are likely to perform so frequently this necessary work, the cistern will soon become dirty.* Besides, unless the Companies will allow the water to flow for a longer period than they do at present, the cistern will not be washed out. The properly cleansing of a cistern can only be performed while the water is flowing; therefore, if the inhabitants of the court cleanse the cistern, they must, under the present arrangements, go without water for that day. The very short supply of water which is given by the Water Companies to the poor localities in this district has, to a great extent, frustrated my endeavours to ameliorate the condition of the poor as regards personal and household * In private houses the cistern should be cleansed once a month at the least. 9 cleanliness. In some of the courts where Landlords have erected cisterns, whereby the inhabitants expected to have a better supply of water, there is a general- complaint that the water is turned off before the cistern is filled, and in these instances, the inhabitants have been in no way benefitted as regards an increased quantity of water, although considerable expense has been incurred by the landlords in the erection of the cisterns. It is stated by the inhabitants of Hurn's Buildings, where a large cistern has been erected, that the supply is so short that the cistern is never filled, and that on Sundays they are always without water. On the 18th June, I wrote to the Secretary of the Company respecting this short supply, but as yet I have received no answer. This short supply of water by the Companies is an important question, and is one that should be well considered by the Local Boards and the public, so that Parliament may be petitioned, and thereby induced to pass such laws as will compel the Companies to supply a larger quantity of wrater daily to the poor localities of the Metropolis. The poor have long suffered from the want of an adequate supply of water, and it is greatly to be desired that an energetic movement should be made on the part of those in authority to get this evil remedied. As the Companies do not supply water on Sundays (except in a few instances), which, in my opinion, they ought to do, the daily supplying of water being a work of necessity, it is almost a matter of impossibility for landlords to erect tanks of sufficient size to hold the quantity which the last amended Metropolis Local Management Act gives power to Vestries and District Boards to enforce, viz., 30 gallons to each inhabitant per day. So large a quantity as 30 gallons daily to each inhabitant of a court containing 100 persons, would, unless the water were supplied every day without exception, require a tank capable of holding 6,000 gallons, the dimensions of which would be (allowing 6 gallons and 2 pints to a cubic foot) about 960 cubic feet. It would be impossible in many of the courts in this District to find space for so large a tank ; and even if it were possible, it would not be desirable to erect so large a vessel. The Legislature merely intended by the 68th section of the Act that the inhabitants of courts should have a proper supply of water. I have long held the opinion that there is a great want of economy in watering the roads, in supplying manufactories, in extinguishing fires, in flushing sewers, &c., with filtered water, as is now practised, owing to the circumstance of the Water Companies having only one set of mains. The large quantity of water required for the above purposes has a tendency to render the supply to the poor inadequate to their wants. But still the Companies have it in their power to increase the quantity of water to the Courts, and they ought to do so; for I am persuaded that an ample supply to the poor, will do more to promote habits of decency and self-respect, and foster a disposition to personal cleanliness among them, than any injunction 10 ever ably or forcibly delivered. The want of pure water for drinking purposes, has, to a certain extent, been ameliorated by the erection of drinking fountains. The nearer these fountains are placed to the dwellings of the poor the greater will be the advantage to that class for whose special benefit they are erected. I am happy to be able to report that my endeavours to obtain a better supply of water to the poor of this district have not been altogether fruitless. In addition to the several courts mentioned in a former Report* where cisterns have been erected, I may mention that a cistern has been fixed in Garden Court, in New Court Brown's Lane, in Kittleby Court, in New Court George Yard, in Holloway Court, in Cooper's Court, in Russell Court, and in Slater's Court. In Pool's Place, the landlady, Mrs. Hubie, has erected a “ Patent Absolute Water Waste Preventer,” which appears to answer in a very satisfactory manner, and other landlords have promised to erect a similar apparatus. Those landlords who hold property in the District where the water supply is inadequate to the wants of their tenants, and who have neither complied nor promised to comply with my request, as regards the erection of a suitable apparatus for the affording of an additional supply, I shall leave to be dealt with by the Board in such manner as the Clerk may advise, in order to compel them to give their tenants such a supply as is necessary for the promotion of their health and for cleanliness. There are a few houses in the District which are entirely without any water supply. The tenants of these houses obtain water for their.domestic use surreptitiously from their more fortunate neighbours. In order to compel a landlord who refuses to have a proper supply of water to any house let out in tenements, the Legislature should prohibit under adequate penalties the occupation of such house. The penalties might be enforced by the Police Magistrates. Any house in London let out in tenements, not having a supply of water, is unfit for human habitation. As the Parish Engine is now of very little use for the extinguishing of fires, and is soon likely to be superseded by a properly organized brigade of firemen, under the authority of the Metropolitan Board, it might be advantageously used for washing out, daily, several of the confined courts in the district. The flushing of courts with a copious supply of water imparts a coolness to the atmosphere which is refreshing, and I believe that such a proceeding would be found to prove not only beneficial to the health of the inhabitants, but would be an inducement to them to keep the interior of their houses clean. People daily accustomed to witness filth exterior to their houses, are not likely to acquire habits of cleanliness. * See Report for December, 1862. 11 I have observed at the commencement of this Report, that the rate of mortality in this district, in the June quarter, during the last three years, has considerably increased. Any plan, therefore, that is suggested on competent authority, to promote the health of the population, is worthy of attention. In the City of London the courts are daily flushed during the hot weather. When the Cholera first became epidemic in this country, very many of the Courts in Whitechapel Parish were daily washed by means of the fire-engine. In conclusion, I am desirous of suggesting, as an additional sanitary measure, that all the courts in Petticoat Lane, Rosemary Lane, and in Upper East Smithfield, should be cleansed daily by the scavengers, and also Goulston Street and Baker's Row. I am, Gentlemen, Your obedient Servant, 15, Great Alie Street. JOHN LIDDLE. A P P E M D 1 X. 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 on the 2nd July, 1864. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Continued Fever, Typhus & Typhoid. Cholera. Erysipelas. Puerperal Fever. Carbuncle. Acute Pulmonary Inflammation. 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 0 45 8 8 70 28 — 4 — 0 81 4 0 2 0 0 — — 592 842 Mr. Champneys 1 12 1 20 57 22 - 7 - 1 38 2 0 0 0 2 - - 379 542 Mr. Richardson 1 56 18 19 51 8 — 4 — 0 16 3 0 0 0 0 — — 699 875 Mr. Sequiera 1 76 0 32 58 17 — 2 - 0 12 5 1 0 3 0 — — 896 1103 Total 3 189 27 79 236 75 — 17 — 1 147 14 1 2 3 2 - — 2566 3362 6 13 TABLE II.—Showing the Deaths from Epidemic Diseases for the Three Months ending 2nd July, 1864. District. Small-Pox Measles Scarlet Fever Diphtheria HoopingCough Diarrhoea Fever Total Remarks. Artillery - 0 0 1 4 0 2 7 Spitalfields — 4 0 0 1 2 6 12 Mile End N. Twu. — 6 0 0 6 7 27 46 Workhouse Whitechapel, N — 18 3 0 6 4 0 31 Whitechapel Ch - 0 0 0 6 1 2 9 Hospital Goodman's Fields - 4 0 1 3 3 3 14 Aldgate — 8 0 0 0 1 4 13 Total - 40 3 2 26 18 43 132 Deaths from Epidemics for the corresponding quarter, 1863. 21 3 82 3 15 13 28 165 TABLE III.—Showing the Ages at Death in the Workhouse, and in the London: Hospital, for the Quarter ending 2nd July, 1864. 0 and underl 1 and under5 5 and undr20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Total Males 62 Femls56 Corresponding Quarter of 1863. Workhouse 13 12 2 30 34 31 6 118 70 L. Hospital 0 5 14 29 32 16 1 Males 62 Femls35 97 97 14 TABLE IV.— Ages at Death in each Registration District, for the Three Months ending 2nd July, 1864. 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 upw.irds Total Remarks. Artillery 3 11 1 2 3 2 0 22 Spitalfields 18 25 3 10 9 7 0 72 Mile E. N. Town. 38 31 6 30 43 47 8 193 Workhouse Whitechapel, N 29 39 2 4 8 7 0 89 Whitechapel Ch. 8 17 17 31 36 20 2 131 Hospital Goodman's Fields 19 18 3 6 14 10 0 70 Aldgate 15 11 7 9 9 3 0 54 Totals 130 152 39 92 122 96 10 631 TABLE V.— The Births and Deaths in each Registration District, for the Three Months ending on the 2nd July, 1864. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks- M. F. M. F. Artillery 29 38 57 11 11 22 35 * 0 Spitalfields 75 62 137 43. 29 72 65 0 Mile End N. Town. 98 89 187 101 92 193 0 6 Workhouse. Whitechapel, N 52 51 103 45 44 89 14 0 Whitechap]. Church 36 42 78 77 54 131 0 53 London Hospital Goodman's Fields 60 41 101 34 36 70 31 0 Aldgate 26 40 66 30 24 54 12 0 46 non-residents died in L. Hos. Totals 376 353 729 311 290 631 157 59 Excess of births over deaths, deducting the 46 non-residents 144 Population in 1861, 78,970. TABLE VI. —Causes of Death at Seven Periods of Life, registered in the Whitecliapel District, for the Three Months ending 2nd July, 1864. 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... Order 4.—Digestive Organs. 94 141 25 68 93 58 2 481 Small-Pox Measles 5 33 2 … … … … 40 Cancrum Oris Scarlatina … 8 … … … … … 3 Gastritis … … … 1 1 … … 2 Diphtheria … 2 … … … … … … Enteritis 1 … … 1 … 1 … 3 Quinsy Peritonitis … … 1 … 1 … … 2 Croup … 8 … … … … … 8 Ascites … … 1 2 … 1 … 4 Hooping-Cough 12 12 2 … … … … 16 Ulceratn. of Intestns Hernia (Rupture) … … … … 4 … … 4 Typhus Fever … 3 3 11 14 12 … 43 Erysipelas … … ... 1 1 6 … 5 Ileus … … … 1 … … … 1 Puerperal Fever … … … 1 … … … 1 Intussusception 1 … … … … … 1 Carbuncle Fistula Influenza Stomach Disease &c … … … 1 2 … … 3 Dysentery Pancreas Disease &c Diarrhcea 11 3 … 2 1 1 … 18 Hepatitis … … … … 2 … … 2 Ague LiverDisease &c 1 … … 2 1 1 … 5 Remittent Fever … 1 … … … … 1 Spleen Disease, &c. … … … … 1 … … 1 Rheumatism … … … 2 … … … 2 Order 5—Urinary Pyaemia Order 2—Enthetic. Nephritis … … … … 1 … … 1 Syphilis 3 2 … … … … … 5 Disease of Bladder … … … … 1 … … 1 Stricture of Urethra. Hydrophobia Nephria. (Brighfs disease) … … … … 1 2 … 3 Order 3—Dietic. Diabetes … … … 2 … … … 2 Stone Privation 1 … … … … … … 1 Retention of Urine … … … 1 … … … 1 Want of Breast Milk 2 … … … … … … … Kidney Disease, &c Purpura ancl Scurvy. … … … 2 … … … 2 Order 6 - Organs of Generation. Alcoholism—Delirra. ,, Intemperance Ovarian Dropsy Uterus Disease, &c. … … … 2 1 … … 3 Lead Poisoning Ovariotomy Order 4-Parasitic Thrush 1 … … … … … … 1 Order 7-Organs of Worms, &e Joint Disease, &c … … 2 … … … … 2 II—CONSTITUTNL Bones, &c Order 1—Diathetic. Oout Order 8—Integumentary System. Dropsy … … 3 1 2 3 9 Phlegmon Cancer … … … … 4 2 … 6 Skin Disease, &c … … … 1 … 1 … 2 Mortification 1 1 … … 2 4 … 8 IV.—DEVELOPMENTAL. Order 1—Disease of Children. Abscess … … 1 2 3 … … 6 Order 2-Tubrculr Scrofula 1 2 … … … … … 3 Tabes Mesenterica 15 22 … … … … … 37 Premature Birth 5 … … … … … … 5 Phthisis (Consmptn) 1 1 3 33 2b 1 … 65 Cyanosis Hydrocephalus 5 7 1 … … … … 13 Spina Bilida III.—LOCAL. Order 1—Nervous Other Malformations 1 … … … … … … 1 Teething 4 5 … … … … … 9 Order 2—Diseases of Aduits. Cephalitis … 1 … 2 … … … 8 … … 1 2 2 1 fi Paramenia Palsy (Paralysis) … … … … 4 3 1 8 Childbirth Insanity Order 3—Diseases of Old People. Tetanus Epilepsy Old Age … … … … … 17 7 24 Convulsions 16 5 … … … … … 20 Order 4—Diseases of Nutrition. Chorea Brain Disease, &c. … 2 1 … 2 … … 5 Atrophy & Debility.. 14 … 1 … 1 … … 16 Order 2—Organs of Circulation. V.—VIOLENT DEATHS. Order 1—Accidents Anfemia . Pericarditis or Negligence. Aneurism … … … … 1 … … 1 Burns and Scalds … 5 2 … … … … 7 Heart Disease, &c … … 6 3 11 9 … 29 Poison Phlebitis Suffocation 8 … … … 1 … … 9 Disease of Arteries Violence … 1 6 9 9 4 1 30 Phlegmasia Dolens Drowning … … 1 … 1 … … 2 Order 3—Respiratory Organs. Order 3—Homicide. Murder & Manslgter. … … … 1 … 1 … 2 Laryngismus Order 4—Suicide. Laryngitis . 1 … 1 … 1 … … 3 Wounds Bronchitis 4 i14 … 3 12 8 1 42 Poison … … … … 1 … … 1 Pleurisy Hanging Pneumonia 16 19 1 3 4 4 … 47 Otherwise Lung Disease,&c … … … … 3 7 … 10 Not Specified 1 … … … … … … 1 Carried forward 94 141 25 6S 93 58 2 481 Grand Total 130 152 39 92 122 86 10 631 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON The Sanitary Condition THE WHITECHAPEL DISTRICT, FOR THE THREE MONTHS ENDING 1st OCTOBER, 1864, BY JOHN LIDDLE, Medical Officer of Health. PRESENTED TO THE BOARD, 31st OCTOBER, 1864. LONDON. 1 8 6 4. LONDON: PRINTED BY E. J. BATH, 20, HIGH STREET WHITECHAPEL. REPORT FOR. THE QUARTER ENDING OCTOBER the 1st, 1864. Gentlemen, During the quarter which ended on Saturday, October 1st, 740 persons died in this district, of whom, 405 were males and 335 females. In the corresponding quarter of the previous year, the deaths were 679. The increase of the mortality, therefore, as compared with that of the previous year, has been 61. The deaths in the London Hospital have been 129 against 103, so that, if we deduct the total number of deaths in the London Hospital in each instance, the mortality of this quarter shows an increase of 35 only, over that of the corresponding quarter of 1863. If, however, we compare the mortality in this quarter with that in the corresponding quarters of the preceding seven years, it will be found, that the number of deaths has greatly increased. Thus, in 1858, the deaths were 547, in 1859—624, in 1860—515, in 1861—549, in 1862—613, in 1863—670, and in 1864—740. Of the deaths in the London Hospital, there were 60 of non-residents, 9 of persons belonging to this District, and 60 were the result of accident. The births have been 648 : of these, 367 were of males, and 281 of females. The deaths have exceeded the births by 92, but if we deduct the 129 deaths in the London Hospital, which it is always necessary to do, in comparing the mortality in this district with that in others, then it appears that the births have exceeded the deaths by 37. But as probably more than 37 persons belonging to this distriet have died during the quarter in the several charitable institutions in London (of which, however, we have no return), the deaths will be found to have exceeded the births. Epidemic diseases were fatal to 219 persons, and the whole class of zymotic diseases was fatal to 235. This is 31.7 per cent, of the total mortality. Noma, Abscess, and Mortification, which are nearly allied t the zymotic class of diseases, were fatal to 17. In one of the casts. 4 Noma, on a post mortem examination, “ a clot of blood was found in the heart.” In the corresponding quarter of last year, the deaths from epidemic diseases were 233, and the entire class of zymotic diseases 258. Diseases of the tubercular class were fatal to 124, of these, 66 died from consumption. Diseases of the respiratory organs were fatal to 73. Two persons died of cancer of the stomach, one from cancer of the oesophagus, and another from cancer of the tongue. Two children were suffocated in bed. In one of these instances, the mother was drunk. A man, aged 41 years, residing in Osborn Street, was " accidentally drowned by falling into a cistern." Two persons, one the wife of a gentleman, and the other, the widow of a musician, both residing at 21, Albert Cottages, died from " poisoning—how, not proven." Although a post mortem examination was made in each of these cases, no further information respecting them, than that above given, is recorded. Four persons died from accidents which occurred whilst the parties were under the influence of intoxicating liquors. A death occurred in the London Hospital from abdominal obstruction caused by a band of organized lymph encircling the intestine. Tha mortality under 5 years of age is 350. This is 47.2 per cent, of the total deaths, but in some of the sub-districts, the proportion of the deaths of children under 5 years is much larger—thus, in the Aldgate sub-district, the proportion is 54.0 per cent.; in the Whitechapel, North, it is 64.2 per cent.; in the Goodman's Fields, it is 64.1 per cent. ; and in the Spitalfields sub-district, it is 72.7 per cent. Measles, Convulsions, and Diarrhoea, were very fatal in the Spitalfields sub-district during the last quarter. The number of Inquests held in the district have been 94; of these> 60 were held in the London Hospital. Two newly-born children were found dead, upon whose bodies inquests were held. The verdict in one of these investigations was " wilful murder against some person or persons unknown," and in the other, it wan " Found dead, but whether the child was born alive, or if so, how death was occasioned, the body was too much decomposed to prove." Four persons destroyed themselves, one by wounds in the throat, one by wounds from a gun, one by taking poison, and one by hanging. The uncertified deaths were 11; of these, 9 were said to have been caused by convulsions, one from disease of the heart, and the other from inflammation of the lungs. The deaths in the Workhouse have been 90. Of these deaths, 2 were caused by Diarrhoea, and 19 by Fever. In the corresponding quarter of last year the deaths were 70. The Medical Officers of the Union attended 4,090 new cases of illness, including 1 of Small-pox, 199 of Measles, 59 of Scarlet-fever, 28 of Hooping-cough, 599 of Diarrhoea, and 83 of Fever. The number of cases of illness in the Workhouse has been 751. Of these, Mr. Champneys attended 384, and Mr. Eichardson 367. Included 5 in the total number there were 3 cases of Measles, 39 of Diarrhoea, and 103 of Fever. In the corresponding quarter of last year, the number of cases of illness in the Workhouse was 528, including 50 cases of Fever, and 15 of Diarrhoea. Since my last Report, the Water Supply to the district has been improved by the erection of four additional Water-waste Preventers. There are now five of these machines in operation, so that the poor in all these localities Jhave a constant instead of as formerly an intermittent supply. Besides these, there are two other machines of a similar construction, so far as relates to the affording a constant supply of water without occasioning waste, which have been in operation for several years. They appear to answer the desired purpose in a very satisfactory manner. I have mentioned at the commencement of this Report, that the mortality in the district is in excess of that of the corresponding quarter of last year, and I regret to add that this excess is increasing year by year. The state of the public health is certainly very unsatisfactory, whether we regard the increased mortality, the large number of deaths from zymotic diseases, or the fact of the deaths exceeding in number the births. If we estimate the number of houses which now exists, and compare it with that at the last census, it will be found that, owing to the extension of railways, the number of them is less. If, therefore, the population has increased, the inciease is owing to a greater number of persons living together in the same house, a state of things, which from the reports of the Inspectors, I find in some instances, is actually the case. Thus, in Inkhorn Court, which is a cul de sac, about 54 yards in length and yards in width, and has houses on each side of this narrow space, there were in October, 1859, 117 inhabitants. In October, 1861, the number of inhabitants was 138, and on a visit recently made, the number was ascertained to be 156. This over-crowding in houses, I believe to be very general throughout the district. The fact of over-crowding is one very difficult to detect, and if detected, still more difficult to prevent; for, many of the houses in poor neighbourhoods become over-crowded in consequence of some of the tenants under-letting their rooms to lodgers for single nights, so that, when the Inspector makes his visit in the day time, he only learns the number of tenants who rent the house from the landlord, and it is only from information obtained from the inhabitants of the adjoining houses, that he learns the fact of there being many more occupants at night. The police have the power of dealing with such cases, and when informed, they take measures to remedy them. My attention has been recently directed to two buildings now in the course of erection, one in Diamond Court, and the other in Osborn Place, both of which the respective owners intend to let out in separate tenements. On inspecting the house in Diamond Court, I found that the already too narrow open space in this Court had been considerably encroached upon 6 by the new building,* the rooms in which are under 7 feet in height, and are without sufficient ventilation. The building in Osborn Place is intended to consist of ten rooms, and is approached by a narrow passage of only two feet in width. This narrow passage will be the only means of affording light and air to several of the rooms. The respective owners of these buildings have been officially informed by me, that, if the houses are completed in the manner contemplated, and let out in tenements, it will be my duty to advise the Board to take proceedings under the Nuisances Removal Act to prevent their being occupied, as the rooms will be unfitted for human habitation, owing to the want of sufficient light and ventilation. I have on two previous occasions, viz. : in my Eeport for the quarter ending October 1st, 1859, and again in my Report for the quarter following, directed the attention of the Board to the sanitary defects in the Building Act, and as it is probable that a new Building Act will be passed during the ensuing Session of Parliament, I have again very briefly brought the subject under your notice. The most important defect in the present Building Act, is that which relates to the requirement of providing an open space of at least 100 square feet at the rear or sides of those houses, in which all the rooms cannot be lighted and ventilated from the street or alley adjoining. But as nothing is said about the arrangement of such open space, it may consist of a slip of ground, being only one foot in width and 100 feet in length, or it may be of any other shape, if only the 100 square feet, required by the act, has been provided. Not a word is said in the act respecting the necessity of there being a window opening into this space. The act is also silent upon the size of the windows in any of the rooms in a house, and of the height of the rooms, except those in the basement and attic, when these rooms are let as separate tenements. Every room, used as a sleeping-room, should be at the least 8 feet in height. To show how the spirit of this act nas been evaded in this district, I may, in addition to the instance in Osborn Place above-mentioned, bring to your recollection the fact, that in 1861, four new houses were erected in Bear's Head Yard, upon a space of ground, on which only two houses should have been allowed. One of these houses, No. 2, has a narrow passage by the side of it, in addition to the open space forming the Court in front, so that all the rooms in this house are said to be lighted and ventilated, and therefore an open space at the rear is not required. The yard at the rear of this house is apparently common to it, and to No. 1, but as No. 2 does not, according to the Act of Parliament, require an open space in the rear, the yard, which is exactly 100 square feet, is said to belong exclusively to No. 1. As it was found to be impossible, by any contrivance, to give to ths house No. 3, which was intended to contain • As this Court is not a public way, but is private property the Board cannot prevent the Landlord from building upon it. It is much to be desired that the open spaces in all the Courts were placed under the jurisdiction of the Board, for then, encroachments upon them could be pro vented. 7 two rooms on a floor, a space of 100 square feet at the rear, the builder was compelled to make only one room on a floor, whereby all the rooms could then be said to be lighted and ventilated in front, consequently it was not necessary to provide any space at the rear of this house. The yard, therefore, which ought to be common to it and the next house, is said to belong exclusively to No. 4. Again, in Queen's Place, Whitechapel, two dwelling-houses of six rooms in each, have been erected, with a space at the rear of only 50 feet to each. It was obvious, in this case, that the buildings were not in accordance with the requirements of the Building Act, and on a complaint being made of the want of sufficient space at the rear of these houses, the owner caused a door-way to be made in the party-wall, between these houses. This arrangement was said to be legally sufficient to convert these two houses into a single house, whereby the entire space at the rear, which is 100 square feet, is all that the act requires. Upon the same principle, half a dozen or more houses may be converted into a single house, while the open space in the rear for lighting and ventilating the back rooms may not exceed one foot in width, provided that the building extends 100 feet. In Inkhorn Court, three dwelling-houses, of six rooms each, have recently been erected on a narrow slip of ground, where a warehouse formerly stood. All the rooms are in front, having only the open space of the Court (about 13 feet) for the purposes of light and ventilation. The privy accommodation for these three houses, containing about 80 inhabitants, consists of three exposed privies, situated at the so 1th end of the Court, and adjoining one of the newly erected houses. They are within 12 feet of the entrance-door and window of the house opposite. The permission for erecting public privies in confined and populous Courts is another defect of the Building Act. Every house ought to be provided with a water-closet within the curtilage of the same. The following case will further show how the provisions of the Building Act have been evaded. The landlord of some old houses in a Court in Spitalfields, thought it expedient to re-build and enlarge them; but instead of pulling them down at once, as he ought to have done, he first took down the front walls only, and re-built them. He then took down the back walls, and re-built them. He subsequently took off the roof, and re-placed it with a new one. By these proceedings he evaded the requirements of the act relating to the structural arrangements of new houses; besides which, he was enabled to "build 2 small rooms 6 feet only in height; at the back of each house, without his being under the necessity of complying with the 29th clause of the act, which relates to the providing of an open space of 100 square feet for the purposes of light and ventilation. The width of all Courts in which houses are to be built, should be regulated by Act of Parliament. It appears that in old Courts, in which perhaps a warehouse, stable, or shed has existed for a few years, the 8 owner may erect upon the sites of these buildings dwelling-houses, and may let them out'in tenements, without any regard being had to the width of the Court, because it is said to be an old Court, and no power is given to any authority to limit the height of the houses built thereon, but in a new Court, a bye-law of the Metropolitan Board provides, that an open space of 20 feet shall exist between the houses on each side of it. The present Building Act does not require a parapet-wall to be made. The want of such a protection to the public may be productive of danger to life. A tile, slate, or a quantity of frozen snow may fall from the roof and injure persons in the public streets. Neither is there any provision made to afford safety to the public in enabling them to make a speedy exit from places of public entertainment in case of an alarm of fire. The law relating to the building of houses, appears to be in this anomalous state, viz.: That houses can be built without suitable provision being made for the proper ventilation and height of the rooms; but after such houses are completed and let out in tenements, then, by virtue of another act, the local authority may institute proceedings before a magistrate to prevent the occupation of any room, which, in the opinion of the medical officer, is unfitted for the health of the occupants. It surely would be much better to prevent houses being built, unless every arrangement suitable for preserving the health of the occupants be first made, than to allow houses to be completed, and then to prevent the landlord from letting them. At the present time large sums of money are being expended by some philanthropists in erecting improved dwellings for the labouring classes, in the hope that such dwellings will not only directly benefit the occupants themselves, hut will contribute indirectly to the general welfare of the whole 'community; but, unless the provisions of a new Building Act forbid the extension of buildings in unsuitable localities, and at the same time enact that all the rooms in dwelling-houses shall be sufficiently lighted and ventilated, the labour, time, and property of such kind-hearted persons will be, to a certain extent, thrown away. All the cow-houses and slaughter-houses have been inspected, and the Board has not offered any opposition to the annual grant of the necessary license in any one case. There is, I am sorry to say, great difficulty in compelling the cow-keepers to observe the regulations of the Board respecting the regular removal of the dung three times every week. I intimated to all the keepers of cows, where these necessary regulations were not obeyed, that I should advise the Board to oppose the license on the next licensing day. I stated in a former Report that 1,000 cubic feet of space should be allowed to each cow kept within a cow-house. This important regulation was insisted upon by the Vestry of St. James', Westminster, and in every case it appears to have been disregarded ; whereupon, the Vestry opposed the further granting of the annual license, and the magistrates consequently 9 refused it. Dr. Lankester, the Medical Officer of Health, remarks, “ hat there is now no longer a cow-house in the Parish.”He further states “ That the result has been beneficial in a high degree. The property in the neighbourhood of the cow-houses has already improved, a better class of tenants occupy the houses, and no complaints are heard of the quality or quantity of the milk to be obtained in the Parish.” In conclusion, I am desirous of stating, that as no periodical account of the cases of illness in the Metropolis is published, but only a record of the deaths, it would be most desirable, in any amended sanitary act, to introduce a clause giving power to the Metropolitan Board of Works to publish weekly a return of all the cases of illness from the several public Hospitals, Dispensaries, and Workhouses, as well as of those cases which are attended by the Union Medical Officers. Such returns, in addition to those of the deaths, would be of great value, as showing the state of the the public health, which the publication of the deaths only does not accomplish. For this purpose, it would be necessary for the Metropolitan Board of Works to obtain power to appoint a Medical Officer of Health, whose duty, amongst other things, it should be, not only to prepare for publication such weekly returns, but also to prepare a digest of the reports of the several Medical Officers of Health. I am, 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 on the 1st October, 1864. Names of Medical Officers, Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Continued Fever, Typhus & Typhoid. Carbuncle. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Cholera. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Diphtheria. I All other Diseases. Total. Average number of Fever Cases per Week. Bronchitis and Catarrh. Pleuritis and Pneumonia. Mr. Allinson 0 37 22 3 178 23 0 13 0 0 121 7 0 0 0 9 0 0 796 1209 Mr. Champneys 0 69 9 4 123 34 2 3 0 0 14 2 1 0 0 1 0 0 424 686 Mr. Kichardson 1 66 23 18 119 8 0 7 0 0 26 1 0 0 0 0 0 0 762 1031 Mr. Sequiera 0 27 5 3 179 18 0 4 0 0 5 6 0 0 1 0 0 0 916 1164 Total 1 199 59 28 599 83 2 27 0 0 166 16 1 0 1 10 0 — 2898 4090 6.3 11 TABLE II.—Showing the Deaths from Epidemic Diseases for the Three Months ending 1st October, 1864. District. Small-Pox Measles Scarlet Fever Diphtheria HoopingCough Diarrhoea Fever Total Remarks. Artillery — 1 1 0 0 4 2 8 Spitaliields — 19 5 0 2 10 7 43 Mile End N.Twn. — 7 4 0 3 17 28 59 Workhouse Whitechapel, N — 14 3 0 3 14 5 39 Whitechapel Ch — 5 7 1 3 9 2 27 Hospital Goodman's Fields - 10 2 0 5 10 5 32 Aldgate — 1 0 0 0 7 3 11 Total — 57 22 1 16 71 52 219 Deaths from Epidemics for the corresponding quarter, 1863. 11 0 88 4 15 76 39 233 Two .Cases of Cholera occurred in the District, one in Mile End New Town, the other in Aldgate. A case of Small-pox, removed from Mr. Richardson's District, died in the Small-pox Hospital. The patient had not been vaccinated. TABLE III.—Showing the Ages at Death in the "Workhouse, and in the London Hospital, for the Quarter ending 1st October, 1864. 0 and under 1 1 and onder 5 5 and undr 20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Total Males 42 Femls 48 Corresponding Quarter of 1863. Workhouse 6 5 8 16 26 32 2 90 70 L. Hospital 1 11 18 35 48 16 0 Males 100 Femls 29 129 103 12 TABLE IV.—Ages at Death in each Registration District, for the Thres Months ending 1st October, 1864. 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 5 4 3 3 6 5 1 27 Spitalfields 43 45 9 9 9 5 1 121 Mile E. N. Town. 41 39 7 28 41 44 2 202 Workhouse Whitechapel, N 36 27 9 9 6 7 4 98 Whitechapel Ch. 12 27 25 36 52 22 1 175 Hospital Goodman's Fields 21 22 4 10 8 1 1 67 Aldgate 20 7 3 9 6 3 2 50 Totals 178 171 60 104 128 87 12 740 TABLE V.—The Births and Deaths in each Registration District, for the Three Months ending on the 1st October, 1864. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks. M. F. M. F. Artillery 29 26 55 12 15 27 28 0 Spitalfields 85 49 134 65 56 121 13 0 Mile End N. Town. 77 59 136 99 103 202 0 66 Workhouse. Whitechapel, N 39 48 87 48 50 98 0 11 Whitechapl. Church 45 23 68 128 47 175 0 107 London Hospital. Goodman's Fields 58 47 105 30 37 67 38 0 Aldgate 34 29 63 23 27 50 13 0 60 non-residents died in L. Hos. Totals 367 281 648 405 335 740 92 184 Excess of deaths over irths, doducting the 60 non-residents, 32 Population in 1861, 78,970. In 1851 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 264, the population therefore in 1861 living in houses within the district was only 71 less than it was in 1851. TABLE VI.—Vaccination Extension Act—Whitechapel Union—for the Year ending September 29 The, 1864. 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 Rgistered Births of all classes during the year, including the Workhouse and the whole of the Parishes in the Union. Under One Year. Above One Year. Total. Under One Year. Above One Year. Total. Thomas. S. Blackwell Christchurch 114 4 118 114 4 118 534 James Edmunds Old Artillery Ground 96 48 144 96 48 144 228 Alex. M. Champneys Mile End New Town 123 10 133 123 10 133 677 Edward Richardson Whitechapel North 277 27 304 277 27 304 413 C. T. Blackmail Whitechapel Church 281 23 304 281 23 304 322 J. S. Sequeira Goodman's Fields 311 32 343 311 32 343 427 John Wells Aldgate 26 3 29 26 3 29 265 Totals 1288 147 1375 1228 147 1375 2876 For the year ended September 29th, 1861 1956 243 2199 1933 235 2168 2717 Ditto ditto 1862 1690 166 1856 1671 164 1835 2757 Ditto ditto 1863 1913 3563 5476 1912 3561 5473 2788 13 The disproportion in the number of births in the Artillery and Aldgate Districts in relation to the population in each, is very striking. In the former, the population is 6557, and the births are 228. In the latter, the population is 9971, and the births are only 265. TABLE VII.—Causes of Death at Seren Periods of Life, registered in the Whitechapel District, for the Three Months ending 1st October, 1864. Causes of Death. Oand under 1 1 1 and under 5 5 and j under 20 | 20 and under 40 | 40 and under 60 60 and under80 80 and above Total. Causes of Death. 0 and under 1 1 and under 5 5 and under 20 20 and under 4® 40 and under 60 60 and under 80 80 and ' above. Total. I.—ZYMOTIC. Order I—Miasmatic Brought forward... 144 160 42 73 81 65 3 558 Small-Pox Organs. Measles 13 48 2 … … … … 57 Cancrum Oris 1 Scarlatina 1 14 7 … … … … 22 Gastritis 1 1 Diphtheria … 1 … … … … … 1 Enteritis 1 l 1 Quinsy Peritonitis I 2 1 Croup 1 5 … … … … … 6 Ascites 2 Hooping-Cough 5 10 1 … … … … 16 Ulceratn. of Intestns Typhus Fever … 4 12 12 13 11 … 52 Hernia (Rupture) 1 2 Erysipelas … … … … 4 … … 3 Ileus 1 Puerperal Fever … … … 1 … … … 1 Intussusception Carbuncle 1 Influenza Stomach Disease, &c 2 2 Dysentery Pancreas Disease, &c Diarrhoea 42 20 2 l 1 4 1 71 Hepatitis l 4 1 Ague Liver Disease, &c I 4 1 Remittent Fever Cancerof (Esophagus 1 Rheumatism … … … 1 1 … … 2 Order 5—Urinary Organs Pyaemia … … 1 … 1 … … 2 Cholera Nephritis Order 2—Enthetic. Disease of Bladder Syphilis 1 … … … … … … 3 Nephria. (Bright's disease) 3 2 1 6 Stricture of Urethra. … … … … 1 … … 1 Hydrophodia Diabetes 1 Order 3—Dietic. Stone 1 i 2 Privation Prostrate Diseaso 1 4 Want of Breast Milk. 1 … … … … … … … Kidney Disease, &c. I A1 coholism—Delirm. Order 6 - Organs of Generation. Tremens ... … … … 1 … … 1 2 » ,, Intemperance. 1 1 Order 4—Parasitic. Thrush 1 … … … … … … 1 Ovariotomy Order 7—Organs of Worms, &c 2 2 II—CONST1TUTNL Bones, &c Dropsy … … 1 2 1 4 … 8 mentary system. Cancer … … … … 4 4 … 8 Phlegmon Mortification … 1 … … 1 1 … 3 Skin Disease, &c 1 Abscess 1 2 … 4 1 6 … 12 IV.—DEVELOP- Noma … 2 … … … … … 2 Order 2—Tubrculr. Scrofula … … … 1 … … … 1 Order 1—Disease of Children. Tabes Mesenterica 25 18 … … 1 … … 44 Premature Birth 5 ... Phthisis (Consmptn.) 1 … 10 28 22 5 … 66 Cyanosis Hydrocephalus 8 5 … … … … … 13 Spina Bifida III.—LOCAL. Order 1—Nervous Other Malformations Teething 5 3 … 8 Order 2—Diseases of Adults. Cephalitis … … … … 1 … … 1 Apoplexy … … … 6 4 3 … 13 Palsy ( Paralysis) … … … … 2 3 … 5 Childbirth Insanity Order 3—Diseases Tetanus of Old People. Epilepsy … … l … … … … 1 Old Age 1 17 Convulsions 30 5 … … … … … 35 Order 4—Diseases of Nutrition. Atrophy & Debility.. 17 17 Brain Disease, &c 1 2 1 1 … … … 5 Order 2—Organs of Circulation V.—VIOLENT DEATHS. Aneemia Order 1—Accidents or Negligence. Pericarditis Aneurism … … … 2 … … … 2 Burns and Scalds 1 2 2 Heart Disease &c … … 1 7 9 6 … 23 Poison 1 1 Phlebitis Suffocation 2 2 Disease of Arteries violence 16 16 4 Phlegmasia Dolens Drowning 1 1 Order 3—Respiratory Organs. Order 3—Homicide. Murder & Manslgter. 1 1 Laryngismus Order 4—Suicide. Laryngitis Wounds 1 1 2 Bronchitis 5 8 … … … … 1 … Poison 1 Pleurisy … … … l … … … Hanging 1 1 Pneumonia 6 21 2 6 3 3 1 49 Otherwise Lung Disease, &c … … … 1 5 … … 6 Not Specified 1 1 Carried forward 144 160 42 73 81 55 3 588 Grand Total 178 171 60 104 123 87 12 40 98 BOARD OF WORKS, WHITECHAPEL DISTRICT REPORT ON The Sanitarn Condition OF THE WHITECHAPEL DISTRICT, FOR the Year ending 31st December, 1864, BY JOHN LIDDLE, Medical Officer of Health presented to the board, 23RD january, 1865 London: PRINTED BY R BIRKETT, 27, NORTON FOLGATE 1865 NINTH ANNUAL REPORT, For the Year ending 31st December, 1864 Gentlemen, The total number of deaths registered in the Whitechapel District during the quarter ending on Saturday, the 31st December, including those in the London Hospital (110), were 654, of which 361 were of males and 293 of females The average number of deaths for this quarter during the preceding eight years is 610 The excess of deaths, therefore, is 44 above the average The mortality during this quarter has been at the annual rate of 33 in 1,000, or 1 in 30 of the population In the more healthy districts in England, the rate of mortality is only 15 in 1,000, or 1 in 66 of the population The births have been 656, of which 330 were of males and 326 of females The births have exceeded the deaths by 11 only; but if the deaths of the 52 nonresidents are excluded, then the excess of births over deaths is 63 The average number of deaths per week has been 503 Of the 110 deaths in the London Hospital, 56 were of persons who died from the result of accident and from sudden death (The residences of these are not given in the returns) Of the remaining 54, 2 were of persons residing in the district, and 52 of nonresidents The greatest weekly mortality (71) occurrcd in the week ending November 19th During this week, although the mean temperature was 28° above the average, the variations in the temperature of the air had been very considerable In October the mean temperature had been 51° In the first week in November it fell to 424°; in the next week to 375°; and in the following week it rose again to 455", when the total mortality in London was 1742, which is 331 above "the average number of deaths for the fortysixth week of ten years 185463,—the average number of deaths being, with a correction for increase of population, 1,411" The deaths from epidemic diseases have been 93, from puerperal fever 3, from erysipelas 6 (of which 2 were of infants aged respectively 3 weeks and 14 days), from pysemia 1, from diseases of the respiratory organs 1 66, from diseases of the heart 20, from tubercular diseases 97 ("of which 65 were from consumption) Two persons, aged respectively 74 and 35, residents in Bethnal Green, died in the London Hospital from urasmic poisoning, and 1 (a cab proprietor), residing in Spitalfields, from acute farcy glanders The deaths arising from accidents or negligence were 51, of which 14 were caused by burns and scalds, 4 from suffocation (of which 1 was that of a man aged 61 who was suffocated from a piece of beef lodging in the windpipe), 1 from a gunshot wound, 1 from the bite of a dog, and 1 from drowning Two persons destroyed themselves by hanging, whilst under temporary derangement 4 Although the deaths from epidemic diseases (93) form a large proportion, viz 113 per cent, or oneseventh of the total deaths, yet this class of diseases has not been so fatal during this quarter as it was in the corresponding quarter of the previous year, when the deaths from epidemic diseases were 128 The deaths from fever have diminished from 52 to 31 This is certainly satisfactory ; but notwithstanding the regular and systematic visitation by the Inspectors of all the places in the district, fever has been found to occur and attack severely the inhabitants of certain localities Thus, at No 8, Court Street, there were 8 cases of fever within two months The Medical Officer of the Union states that the disease spread from one to another, and, notwithstanding his urgent entreaties, the persons first attacked refused to be removed Again, at No 82, Wentworth Street, 9 cases of fever occurred in the course of about 5 weeks Also, at 9, George Yard, there were 10 cases within a month All these places were duly visited, and orders served upon the landlords to lime white the several rooms At No 82, Wentworth Street, it was found that the basement (in which 2 cases of fever occurred) was not fit for human habitation An order to close this room was served upon the landlord, and it is now unoccupied The mortality under 5 years of age has been 251 This is 383 per cent, of the total deaths In the corresponding quarter of the previous year, the mortality of children under 5 years was, in relation to the total deaths, 424 per cent In the Spitalfields SubDistrict, however, the mortality of children is 556 per cent During the preceding quarter it was 72l per cent The deaths of persons above 80 years of age have been 15, of which 1 had arrived at the advanced age of 95 There has been a large mortality, viz 224 (which is above onethird of the total deaths), among persons in the prime of life,—that is, between the ages of 20 and 60 The number of inquests held on the bodies of those who died suddenly, or whose death was occasioned by violence, lias been 83 Of these sudden and violent deaths, 10 were occasioncd by the abuse of ardent spirits,—a number larger than has in any previous quarter been recorded The deaths uncertified by a member of the medical profession are less in number than heretofore; they amount to 4 One of these deaths is recorded in the following terms:—" Atalectasis, female, ten hours" The deaths in the Workhouse have been 91, including 11 from fever, 1 from smallpox, 1 from measles, and 2 from diarrhoea The Medical Officers of the Union have attended 3,911 new cases of illness, including 6 of smallpox, 90 of measles, 56 of scarlet fever, 58 of hooping cough, 119 of diarrhoea, and 89 of fever In addition to these, 3 or 4 cases of leadpoisoning are recorded In the corresponding quarter of last year, the total number of cases was 3,803, including 161 of fever and 13 of smallpox The cases of illness in the Workhouse have been 804 Of these Mr Champneys attended 426, and Mr Richardson 378 Included in the total 5 number are 1 of smallpox, 4 of measles, 17 of diarrhoea, 127 of fever, 3 of rheumatic fever, 1 of carbuncle, 4 of erysipelas, and 3 of delirium tremens In the corresponding quarter of last year the total number of cases was 656, including 90 of fever The waterwaste preventers which have been in use in the district during the last nine months appears to work very satisfactorily Since my last report two additional ones have been erected, one in the district supplied by the New River Company, the other in that of the East London There are now seven of these machines in operation, and no complaint has as yet been made to me respecting them in their failing to give a constant supply of water without waste The number of births registered during the year 1864 was 2,803, viz 1,473 males and 1,330 females The deaths were 2,792, viz 1,531 males and 1,261 females The deaths in the London Hospital of nonresidents, exclusive of those whpse death was occasioned by accident, were 225 The excess of births over deaths has been only 11; but if the deaths of the nonresidents are excluded, the excess of births over deaths is 236 In the preceding year the excess of births over deaths was 32 ; excluding the deaths of the nonresidents it was 213 During the past year 338 inquests were held against 291 in the previous year The uncertified deaths are 25 against 32 When such facilities exist for all persons obtaining gratuitous medical assistance, as is the case in this district, it is to be lamented that so many people die without having been attended by a qualified member of the medical profession The Medical Officers of the Union have attended 14,932 new cases of illness, exclusive of 3,112 in the Workhouse Last year the Medical Officers returned 14,564 cases among the outdoor poor, and 2,479 in the Workhouse On reviewing the sanitary condition of the district, as indicated by the annual increase of the number of deaths and cases of illness among the pauper population, I regret to have to report that the public health is very far from being in a satisfactory state, although great improvements have been effected in the drainage of the houses, particularly of those occupied by the poor,—the more prompt removal of nuisances which is brought about by the regular and systematic inspection of all the poor localities,—the improvement which has taken place in the water supply, and the better pavement which has been laid down in several of the courts and byeplaces In 1860 the mortality returns were 2,302, and the cases of illness among the pauper population 11,392; in 1861 the deaths were 2,331, and the cases of illness 13,724; in 1863 the deaths were 2,551, cases of illness 14,270 ; in 1863 (53 weeks), deaths 2,764, cases of illness 14,564; while in 1864 the deaths were 2,792, and the cases of illness 14,932 These returns are very significant, and they ought to engage our serious attention, with a view of accounting for this annual increase in the deaths Upwards of 3,400 cesspools have been destroyed since the formation of your Board 6 and in the number of cases of illness in the district, so that, if possible, remedies may be used to mitigate these calamities I have on former occasions stated, and I now repeat it, that we have no evidence to show that our population is increasing It is true that there has been an excess annually in the births over the deaths, which in eight years, from 1857 to 1864, has amounted to 2,425 This is at the average rate of annual increase of about 300 During the last three years, however, the excess of births over deaths has been only 305, which is at the rate of about 100 annually But in a migrating population, such as exists in this district, the excess of births over deaths will not be found to indicate that the population has increased; for, in 1857, I estimated, by adopting this mode of calculation, that our population was at that time upwards of 84,000, which, when the census papers were published, was found to be greatly in excess of the actual amount The population in 1841 was 71,879; in 1851 it increased to 79,756, which is at the rate of about 11 per 1,000 annually; while in 1861 the population decreased to 78,970, notwithstanding that the excess of births during the decennary had been annually much greater than it has been during the last four years The annual increase in the rate of mortality has not been confined to this district, but it prevailed over the entire metropolis Thus, in 1860 the deaths in London were 226 percent of the population; in 1861 they were 232; in 1862, 234; in 1863, 245; *and in 1864, 266 During the last twelve months very little rain has fallen; but how far this deficiency of moisture has been the cause of the increased mortality, it is, perhaps, impossible to assert with confidence Although the atmosphere was, by the long drought of last summer, deprived of the purifying influence of rain, which may, perhaps, in some measure account for the increase of mortality during this year, it will not account for the annual increase of the rate of mortality during the last four years It would be exceedingly gratifying to myself were I able to satisfactorily account for this annual increase in the number of deaths and cases of illness, but I must candidly confess my inability to do so I may, however, venture to offer a few conjectures upon the subject The first one that I would put forth as a not improbable cause of this increase of mortality is, that either the type of diseases has changed, or that a change has taken place in the constitution of the people, so that they are now less able to bear the effects of disease than formerly Those inflammatory diseases, for the cure of which large and frequent bleedings were practised, do not now come under the notice of medical men; or, if similar inflammatory diseases do occur, the patients are now unable to bear those depleting remedies formerly used Stimulating remedies, such as wine, brandy, and nutritious food, are now found to be absolutely necessary for the cure of a very large proportion of the diseases which attack the inhabitants of towns These remedies the mass of the people are unable to procure If, as is very probably the case, a change has The fall of rain in the year was only 167 in The average yearly fall is 253 in each of the years 1858 and 1847 the rain fall was 178 in 7 taken place in the physical condition of the people, so that they are now less able to bear up against the ravages of disease, they require for their well being a larger amount of nutritious food, fire, and clothing than formerly; and unless the weekly wages of the labouring classes have increased, they are unable to procure these necessaries in sufficient quantities The best kind of nutritious food, such as meat of good quality, has lately been so dear that many of the working classes are unable to purchase it Besides, much of the food, such as bread, oatmeal, &c, which is purchased by the poor, is largely adulterated with substances containing a very small amount of nutritious properties Milk, the chief, or at least that should be the chief article of food for children, is rarely to be purchased in its genuine state, being usually adulterated with half its weight of water Here then is a fertile source of disease in children The majority of children of the poor, and many of those belonging to the more wealthy classes, are not only underfed, but they are not sufficiently clothed There is very little danger to the health of a child by overfeeding, provided that plain food only be given to it Nature sets a limit to the quantity of food a child requires for its support by the withdrawal of the stimulus of appetite Many skin and parasitical diseases are frequently caused by a diet not sufficiently nutritious, and such diseases attack the children of the rich, although not so frequently as the children of the poor, but in both the cause is the same It is of the utmost importance to the well being of a child, both as regards its mental capacity and physical condition, that it should be not only fed with animal food twice a day, and be well clothed, but that it should breathe pure air; for, by providing it with these necessaries, we shall find that the fatality of the tubercular class of diseases will be greatly diminished, and a more robust race of men and women will grow up, thereby increasing the strength, and consequently the wealth of the nation Secondly, the hours of labour in certain businesses are too long, and more especially so where the rooms in which many of the young men and women employed in tailoring and similar occupations are overcrowded, badly ventilated, and lighted with gas Thirdly, the exposure of infants to the cold, and the administering to them of opium and other narcotics Fourthly, the increased mental labour which so many men engaged in business appear now to impose upon themselves, and the increased anxiety which attends the carrying on their mercantile transactions Various other causes are in operation, which I need not here particularize, whereby the health of the people is deteriorated I may, however, mention one more, viz, the breathing of the tainted atmosphere in the several places of entertainment, caused by their being charged with the products of the burning of an unnecessary large quantity of gas, and of the respiration of crowded audiences The atmosphere of many of the churches where gas is used has a very pernicious effect upon many persons The same remark applies to the injurious effect of burning gas in every room of a dwellinghouse, where adequate means are not provided for carrying away the vitiated air In conclusion, I may be permitted to remark, that we have much reason for 8 congratulating ourselves upon the sanitary improvements which have been effected in this district; for had a similar state of things existed now as it did formerly, instead of my having to record an increase of the death rate during the last three or four years of about 4 in 1,000 annually, a death rate of treble that amount might have taken place For the information of those members of the Board who were not acquainted with the physical condition of the district twenty years ago, I subjoin a description of the state of Blue Anchor Yard in 1846; and I may state, from my own personal knowledge, that some of the courts in Essex Street, now the site of Commercial Street, were in equally as bad a condition before the new street was formed I quote from a copy of my petition to the House of Lords, which was presented by the late Marquis of Normanby After alluding to the bad physical condition of several of the localities in Whitechapel Parish, and stating that not only had nothing been done to improve the condition of these places, but that they had been progressively getting worse and worse, it goes on to state, that in "Blue Anchor Yard, which is a street abounding with narrow courts, which it is scarcely possible for any one to penetrate, there being in the centre of the street an open gutter which is almost always full of putri fying matter, there are now, in addition, large holes, which, as well as the gutter, are constantly filled with all sorts of refuse and filth There is no footpath, and the houses, which are dilapidated, are filthy to the last degree— without drainage, without water, and without privies That among the houses in one of the small courts in this street, Cooper's Court, one was in such a dilapidated condition that it was necessary to take it down some time ago, and the site is now occupied by a large dunghill, formed of every description of refuse matter, mixed with the contents of privies, and the filth of adjoining pigsties, several of the rooms in the immediate neighbourhood of the court being inhabited by pigs Again, in Rose Court, another court in this street, some old dilapidated wooden houses, which formed one side of this court, have been recently pulled down Into the vacant space the contents of the privies of Crown Court empty themselves, forming a large reservoir of most filthy fluid, composed of the contents of the privies and rainwater, from which a noisome stench exhales, and into which the children, many of whom are always found at play near this dangerous spot, may readily fall, and perish instantaneously from suffocation" After the publication of this petition in some of the daily newspapers, the Trustees of Whitechapel Parish offered to the Ratcliff Commission, to which this street was adjacent, the sum of £250 to take it under their jurisdiction This offer was accepted, and the Ratcliff Commission paved the street, and those courts which their respective landlords were willing to place under the control of the Board A sewer was soon after constructed in this street by the Tower Hamlets Commission of Sewers As regards the sanitary work performed during the year, I may state, among other things done, that all the courts in the district have been visited and reported upon by the Inspectors about once in every three weeks, by which 9 means nuisances have been discovered which had not, and perhaps never would have been complained of; and the consequence is that the sanitary defects which the Inspectors found in the several houses and localities have been for the most part remedied All the houses where fever cases were recorded in the books of the Medical Officers of the Union have likewise been inspected, and in nearly every case notice has been served upon the landlord to limewhite the room, and in some instances the entire house There are 170 public dustbins in the district, all of which are periodically examined by the Inspectors For neglect in not emptying these public dustbins twice every week the contractors are liable to a fine The slaughterhouses, cowhouses, and bakehouses have been several times inspected As regards slaughterhouses, I may here observe, that the clause of the Building Act relating to the prohibiting the opening of a new slaughterhouse has not been acted upon in this district since the first licensing day after the passing of the Metropolis Local Management Act, when the Board successfully opposed the granting of a license to one of the applicants upon the ground that it was a new application, and consequently contrary to the provisions of the Building Act Since then the Board has not deemed it advisable to oppose under that section any further application In St Pancras Parish, however, according to Dr Hillier's last Annual Report, the application for a license for a new slaughterhouse was refused by the Justices on the ground that the premises were within 50 feet of a dwellinghouse, and therefore, as a new application, was contrary to the provisions of the Building Act It was no doubt contemplated by the Legislature, when this clause of the Building Act was passed, that the privilege of slaughtering cattle in London should gradually be abolished The bakehouses, on inspection, were for the most part found to be clean ; and in no instance was there discovered to be one used contrary to the provisions of the Act Many of them are underground, which in a sanitary point of view is exceedingly objectionable, from the large quantity of carbonic acid which is evolved from the dough while undergoing the necessary fermentation, and from the gases equally destructible to health which frequently escape from the fires which heat the ovens These gases cannot readily escape, owing to the difficulty of properly ventilating those bakehouses which are situated underground I am sorry to say, that in only one instance in this district is the bread made by machinery The objectionable plan of kneading with the hands and arms is still practised I am, Gentlemen, Your obedient Servant, JOHN LIDDLE 15, GBKAT 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 on the 31st December, 1864 Names of Medical Officers Small-Pox Measles Scarlatina Hooping -Cough Diarrhoea Continued Fever, Typhus & Typhoid Carbuncle Erysipelas Puerperal Fever Croup Acute Pulmonary Inflammation Cholera 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 Allinson 4 27 24 11 46 12 1 18 1 3 137 15 0 5 2 3 1 0 985 1295 Mr Champneys 0 27 10 5 19 23 1 7 0 0 35 7 0 1 0 1 0 0 428 564 Mr Richardson 1 15 14 25 24 14 0 0 0 0 15 2 0 1 0 1 0 0 799 910 Mr Sequiera 1 21 8 17 30 40 0 6 0 1 19 5 0 0 0 0 0 0 994 1142 Total 6 90 56 58 119 89 2 31 1 4 206 29 0 7 2 5 1 0 3206 3911 68 Corresponding Quarter of 1863 13 12 50 23 166 161 3 26 1 0 189 35 1 6 2 4 3 0 3108 3803 115 11 TABLE II—Showing the Deaths from Epidemic Diseases, for the Three Months ending 31st December, 1864 Districts SmallPox Measels Scarlet Fever Diphtheria Hooping Cough Diarrhoea Fever Total Remarks Artillery 0 1 0 0 1 0 2 4 Spitalfields 0 2 9 0 2 0 7 20 Mile End New Town 1 2 1 0 0 6 14 24 Workhouse Whitechapel, North 0 2 4 0 3 6 1 16 Whitechapel Church 0 3 1 0 1 1 2 8 Hospital Goodman's Fields 0 1 1 1 4 2 2 11 Aldgate 0 4 0 0 2 1 3 10 Total 1 15 16 1 13 16 31 93 Deaths from Epidemics for the corresponding quarter, 1863 6 4 46 1 7 12 52 128 TABLE III—Showing the Ages at Death in the Workhouse, and in the London Hospital, for the Quarter ending 31st December, 1864 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, 50 Females, 41 Corresponding Quarter of 1863 Workhouse 12 1 2 18 25 29 4 91 81 London Hospital 0 11 18 29 35 17 0 Males, 75 Females, 35 110 118 12 TABLE IV—Ages at Death in each Registration District, for the Three Months ending 31st December, 1864. 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 8 7 2 2 5 9 4 37 Sipitalfields 20 23 4 8 11 14 2 88 Mile E.N Town 30 31 10 21 37 40 4 173 Workhouse. Whitechapel, N. 21 19 8 11 15 11 2 87 Whitechapel Ch. 9 23 20 34 42 23 0 151 Hospital. Goodman's Fields 19 9 3 13 7 9 1 61 Aldgate 11 14 3 9 9 8 2 57 Totals 125 126 50 98 126 114 15 654 TABLE V—The Births and Deaths in each Registration District, for the Three Months ending on the 31st December, 1864 Districts. Births. Total. Deaths. Total. Excess of Births oyer Deaths. Excess of Deaths over Births. Remarks. M F M F Artillery 25 20 45 21 16 37 8 0 Spitalfields 77 71 148 49 39 88 60 0 Mile End N Town 79 79 158 88 85 173 0 15 Workhouse. Whitechapel, N 51 56 107 44 43 87 20 0 Whitechapl Church 34 33 67 95 56 151 0 56 London Hospital. Goodman's Fields 37 36 73 30 31 61 12 0 Aldgate 27 31 58 34 23 57 1 0 52 non-residents died in L. Hos. Totals 330 326 656 361 293 654 101 71 Excess of births over deaths, deducting the 52 non-residents - 04 Population in 1861, 78,970 In 1851 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 264; the population therefore in 1861 living in houses within the district was only 74 less than it was in 1851 TABLE VI.—Total number of the under-mentioned Diseases, recorded in the Books of the Medical Officers of the Union, from 1860 to 1864. Year. Small-Pox. Measles. Scarlatina. Hooping-Cough Diarrhoea and Dysentery. Fever. Cholera. Erysipelas. Puerperal Fever Carbuncle. Bronchitis and Cattarrh. Pneumonia and Pleuritis. Croup. Rheumatic Fever. Ague. Delirium Tremens. Total. 1860 65 520 93 83 801 190 1 52 1 9 845 141 3 7 41 6 11392 1861 86 70 100 388 1452 109 ... 75 1 9 803 104 9 5 18 2 13724 1862 113 525 118 153 1106 822 1 56 ... 4 557 135 9 16 24 4 14270 1863 253 80 305 169 1139 464 1 74 1 6 533 134 12 20 11 8 14564 1864 21 482 156 217 1127 295 1 92 1 6 786 95 6 14 13 1 14932 Total number of cases of Illness in the Workhouse in 1860 1677 Ditto ditto ditto in 1861 2911 Ditto ditto ditto in 1862 2987 Ditto ditto ditto in 1863 2479 Ditto ditto ditto in 1864 3112 13 TABLE VII.—Showing the Births and Deaths in each District for the Year ending 31st December, 1864. BIRTHS. DEATHS. Districts. M. F. Total. M. F. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks. Artillery 114 99 213 63 59 122 91 ... Spitalfields 302 235 537 205 180 385 152 ... Mile End New Town 355 313 668 403 381 784 ... 116 Workhouse. Whitechapel, North 197 219 410 190 185 375 41 ... Whitechapel Church 224 146 305 409 221 630 ... 325 Hospital. Goodman's Fields 180 404 139 132 271 133 ... Aldgate 122 138 260 122 103 225 35 ... Totals 1473 1330 2803 1531 1261 2792 452 441 The excess of Births over Deaths in 1864 is 11 TABLE VIII—Showing the Births, Deaths, Deaths of Nonresidents, Deaths in the London Hospital and in the Workhouse, in each Year from 1857 to 1864 Year. Total Births. Total Deaths. Deaths of Non Residents. Total Deaths in the London Hospital. Total Deaths in the Workhouse. 1857 (53 weeks) 2868 2350 147 338 272 1858 2742 2444 140 325 269 1859 2826 2321 189 354 239 1860 2746 2302 163 326 282 1861 2686 2331 179 366 287 1862 2813 2551 187 330 369 1863 (53 weeks) 2796 2764 181 418 324 1864 2803 2792 212 453 414 The deaths of persons resident in the district which occurred in the London Hospital during the year 1864 were only 30 The residences of those persons whose death was the result of accident are not given in the Registrar's returns TABLE IX —Showing the Ages at Death in each Registration District, for the Year ending 31st December, 1864 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 Population in 1861 Artillery 22 27 9 10 23 25 6 122 6557 Spitalfields 113 114 20 34 52 46 6 385 15700 Mile End New Town 136 128 32 105 171 192 20 784 15392 Whitechapel, North 112 115 26 29 46 37 10 375 12122 Whitechapel Church 38 89 77 137 192 88 9 630 8062 Goodman's Fields 78 60 17 42 39 32 3 271 11166 Aldgate 57 45 17 40 41 20 5 225 9971 Totals 556 578 198 397 564 440 59 2792 78970 For the Year 1863 535 718 289 399 490 336 57 2264 The births during the year have been 2,803 This number gives an annual birth rate of 354 per 1,000 of the population The deaths, including all in the London Hospital (453), have been 2,792 This gives an annual death rate of 35 3 per 1,000 By deducting the deaths of the nonresidents (212), the proportion of deaths per 1,000 is reduced to 326; and by deducting the total deaths in the London Hospital, which it is requisite to do if we compare the mortality in this district with that in others, the rate of mortality is still further reduced to 296 The deaths under 5 years of age have been 1,134 This number is at the rate of 404 per cent. of the total births, and 406 per cent. of the total deaths 14 TABLE X.—Showing the Deaths from Epidemic Diseases in the Whitechapel District, during the Years 1856, 1857, 1858, 1859, 1860, 1861, 1862, 1863, and 1864. 1859. 1857 (53 weeks). 1858. Districts. Small-Pox. Measles. Scarlet Fever. Hooping-Cough. Diarrhoea. Typhus. Total. Small-Pox. Measles. Scarlet Fever. Hooping-cough. Diarrhoea. Typhus. Total. Small-Pox. Measles. Scarlet Fever. Hooping-Cough. Diarrhoea. Typhus. Total. Artillery 0 2 4 3 3 8 20 0 6 4 9 5 3 27 i 4 9 3 5 7 29 Spitalfields 3 1 7 15 10 22 58 0 9 9 19 15 10 62 0 24 22 14 15 18 93 Mile End New Town 8 1 2 14 18 s3 106 0 18 4 6 24 36 88 1 5 24 33 34 38 135 Whitechapel, North 10 3 9 9 11 57 99 1 11 2 20 25 34 93 0 6 18 19 22 22 87 Whitechapel Church 3 2 6 2 8 20 41 1 2 8 10 14 15 50 1 7 g 7 7 11 39 Goodman's Fields 5 1 5 7 12 9 39 0 6 9 15 29 8 69 0 15 6 25 12 4 62 Aldgate 2 2 12 14 19 9 58 1 6 7 10 27 11 62 1 17 2 16 13 4 53 Totals 31 12 45 64 81 188 421 3 60 43 89 139 117 451 4 78 87 117 108 101 498 T AB LE X.- -C TINU ED 1859. 1860. 1861. Districts. | Small-Pox. | Measles. | Scarlet Fever. | Hooping-Cough. Diarrhœa. Typhus. Total. Small-Pox. |Measles. Scarlet Fever and Diptheria. Hooping-Cough. Diarrhœa. Typhus. Total. Small-Pox. |Measles. Scarlet Fever and Diphtheria. Hooping-Cough. Diarrhœa. Typhus. Total. Artillery 1 0 8 7 5 4 25 0 2 2 7 1 1 13 0 2 8 7 5 4 26 Spitalfields 20 8 17 8 29 7 89 8 11 17 3 11 11 61 8 6 13 22 19 9 77 Mile End New Town 17 13 8 9 31 33 111 7 8 14 14 23 23 89 7 14 8 18 25 25 97 Whitechapel, North 9 4 15 9 27 9 73 3 16 6 11 9 6 51 0 1 5 16 10 5 37 Whitechapel Church 4 2 13 5 13 16 53 1 4 10 6 5 13 39 3 0 16 5 15 10 49 Goodman's Fields 8 1 26 8 12 12 67 2 1? 6 7 12 8 52 1 1 15 17 15 6 55 Aldgate 1 3 9 4 24 12 53 0 23 4 I 6 7 41 9 3 5 13 12 6 48 Totals 60 31 96 50 141 93 471 21 81 59 49 67 69 346 28 27 70 98 101 65 389 table x —continued. 1862 1863 (53 tfeeks). 1864. Districts. Small-Pox. Measles. Scarlet Fever and Diphtheria. Hooping-Cough. Diarrhœa. Typhus. Total. Small-Pox.* Measles. Scarlet Fever and Diphtheria. Hooping-Cough. Diarrhœa. Typhus. Total. Small-Pox. Measles. Scarlet Fever and Diphtheria. Hooping-Cough. Diarrhœa. Typhus. Total. 0 11 7 8 2 12 401 2 3 35 3 8 10 61 0 2 3 6 4 9 23 4 53 12 15 14 28 12fil 19 4 60 6 27 21 137 1 30 14 6 12 22 85 Mile End New Town 15 2 6 23 11 13 120 206 14 2 56 6 30 67 175 1 21 6 15 33 89 165 Whitechapel, North 8 23 17 9 14 24 95 17 10 45 7 10 19 108 0 45 12 20 25 11 113 Whitechapel Church n 4 10 6 5 19 44 7 1 28 2 11 9 58 0 10 9 10 11 9 49 Goodman's Fields 0 18 16 7 6 23 70 3 6 40 16 11 12 88 2 16 7 14 15 15 BU Aldgate 6 18 6 6 15 24 75 7 0 26 12 17 20 82 1 13 0 3 9 15 41 Totals 33 153 91 62 69 658 250 69 26 290 52 114 158 709 5 137 50 74 109 170 .545 In the Report of the SmallPox Hospital for 1864, it is stated that the epidemic, the severest known within the memory of the present generation, both as regards the number of persons attacked, and its severity and fatality, commenced in November 1862, and reached its point of culmination in May and June 1863 15 TABLE XI—Causes of Death at Seven Periods of Life, registered in the Whitechapel District, for the Three Months ending December 31st, 1864 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 l.-Zymotic Brought Forward 99 107 30 77 101 73 5 492 I,—Miasmatic IV—Digestive Organs SmallPox ... ... ... 1 ... ... ... 1 Measles 1 13 1 ... ... ... ... 15 Cancrum Oris Scarlatina 1 10 5 16 Gastritis ... ... ... ... 1 ... ... 1 Diphtheria ... ... 1 ... ... ... ... 1 Enteritis ... ... ... ... 1 ... ... 2 Quinsy ... ... ... ... ... ... ... Peritonitis ... ... ... ... ... 1 ... 1 Croup 3 11 ... ... ... ... ... 14 Ascites ... ... ... 1 2 1 ... 4 HoopingCough ... 7 1 ... ... ... ... 13 UlC.of Intestines ... Typhus Fever 2 3 3 9 7 7 ... 31 Hernia (Rupture) ... ... ... ... 1 1 ... 2 Erysipelas 3 ... ... 1 2 ... ... 6 Ileus ... ... ... 1 ... ... 1 Puerperal Fever ... ... ... 3 ... ... ... 3 Intussusception Carbuncle Fistula ... ... ... ... 1 ... 1 Influenza Stomach Diseases,&c ... ... 2 2 » ... 6 Dysentery Pancreas Diseases,&c Diarrhœa 3 4 1 ... 2 6 ... 16 Hepatitis Ague Liver Disease, &c ... ... ... 1 2 3 ... 6 Remittent Fever 1 ... ... ... ... ... ... 1 Spleen Disease, &c Rheumatic Fever ... ... 3 1 1 1 6 V—Urinary Organs Pyræmia ... 1 ... 1 ... 1 ... 3 II—Enthetic Nephritis Syphilis 2 ... ... 2 ... ... ... 4 Diseases of Bladder ... ... ... ... ... 1 ... 1 Stricture of Urethra ... ... ... ... 1 ... ... 1 Nephria (Bright's Disease) ... ... ... ... 1 2 ... 3 Hydrophobia Glander ... ... ... ... 1 ... ... 1 Diabetes IIL—Dietic Stone ... ... ... ... 1 ... 1 Privation Prostate Disease Want of Breast Milk Kidney Disease, &c ... ... ... 1 2 1 ... 4 Purpura and Scurvy Alcoholism—DeL Tremens ... ... ... ... 1 ... ... 1 VI—Organs of Ovarian Dropsy ... ... ... ... 1 ... 1 „ Intemperance ... ... ... 3 3 3 ... 9 Uterus Disease, &c Lead Poisoning IV—Parasitic VII—Organs of Thrush Joint Diseases,&c ... ... 3 1 ... ... 4 Worms, &c Bones, &c ... 1 3 2 1 ... 7 2Constitutional VIII — Integu mentarySystem I—Diathetic Gout Phlegmon Dropsy ... ... ... 1 1 4 ... 6 Skin Disease, &c Cancer ... ... ... ... 3 1 ... 4 4—Developmental Mortification 1 ... ... ... ... ... ... 1 I — Diseases of Children Abscess ... ... ... ... 2 ... ... 2 II—Tubercular Premature Birth 5 ... ... ... ... ... 5 Scrofula Cvanosis Tabes Mesenterica 17 8 ... 1 ... ... ... 26 Spina Bifida Phthisis (Consumpn) 2 1 4 32 20 5 1 65 Other Malformations 2 ... ... ... ... ... 2 Hydrocephalus ... 6 ... ... ... ... ... 6 Teethin 4 10 ... ... ... ... 14 3—Local II—Diseases of Adults L—Nervous Sys Paramenia Cephalitis ... ... 3 ... ... ... ... 3 Childbirth ... ... 1 1 ... ... 2 Apoplexy ... ... ... 2 4 6 ... 12 III—Diseases of Old People Palsy (Paralysis) ... ... 1 1 3 7 1 13 Insanity Old Age ... ... ... ... ... 15 10 25 Tetanus IV—Diseases of Nutrition Epilepsy ... ... ... 3 ... 1 ... 4 Convulsions 16 3 ... ... ... ... ... 19 Atrophy and Debility 13 ... ... 1 ... ... 14 Chorea 5—Violent Deaths Brain Disease, & c 1 1 1 3 I—Accidents or Negligence II—Organs of Circulation Burns and Scalds ... 8 4 ... ... 2 ... 14 Pericarditis 1 1 9, Poison Aneurism 1 1 Suffocation 2 ... ... ... 1 1 ... 4 Heart Disease,& c ... ... 1 2 11 2 1 17 Violence ... ... 7 8 9 0 ... 32 Drowing ... 1 ... 1 Disease of Arteries III. Homeicide ... ... ... III—Respiratory Organs Murder and Man ... ... ... 1 ... 1 ... 2 Laryngismus IV—Suicide Laryngitis ... 1 ... ... ... ... ... 1 Wounds Bronchitis 16 11 ... 4 25 21 2 79 Poison 1 ... 1 1 ... ... 3 Drowing Pneumonia ... 26 4 3 8 3 ... 69 Hanging ... ... ... 1 ... 1 ... 2 Lung Disease, Acc ... ... ... 5 5 4 14 Otherwise Not Specified Carried Forward 99 107 30 77 101 73 5 492 Grand Total 125 126 50 98 106 114 15 654