99 WHI 13 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT on The Sanitary Conditin of THE WHITECHAPEL DISTRICT, For the Quarter ending 1st April, 1865, by JOHN LIDDLE, Medical Officer of Health. PRESENTED TO THE BOARD, 17th APRIL, 1865. PRINTED BY R. BIRKETT, 27, NORTON FOLGATE. 1865. REPORT For the Quarter ending 1st April, 1865. Gentlemen, During the quarter ending on Saturday, April 1st, there were born in the Whitechapel District 758 children, of whom 405 were boys and 353 girls. In the same period 711 persons died, of whom 430 were males and 311 females. In this number are included 126 deaths which occurred in the London Hospital. In comparing the mortality of this district with that of others, it is necessary to exclude from the calculation all the deaths in this institution. While, however, we deduct all the deaths in the London Hospital from the total mortality, it is necessary also to deduct the number of its inmates (about 420) from the total population of the district. The deaths in the London Hospital may be divided into three classes; viz. those which were caused by accident and were of sudden occurrence, those of persons who resided in the district, and those of non-residents. Of the first class there were 49, of the second 12, and of the third 65. The residences of those who died from accident are not given in the returns. In the corresponding quarter of the previous year the births were 770 and the deaths 767. The births, therefore, show a decrease of 12, and the deaths of 26. The greatest weekly mortality (87) occurred in the week terminating on the 4th February, and the smallest (34) in that terminating on the 18th March. The deaths from epidemic diseases have been 129", viz. 3 from small-pox, 15 from measles, 13 from scarlet fever, 1 from diphtheria, 41 from hoopingcough, 9 from diarrhoea, and 46 from fever. The deaths from this class of diseases are in the proportion to the total deaths of 17.4 per cent. ; but if we exclude the deaths in the London Hospital, where only one death from this.6 class of disease (viz. hooping-cough—a child 7 years of age from Bethual Green) is recorded, then the proportion is increased to 20.9 per cent., or rather more than one-fifth of the total mortality. It must however be borne in mind, that all the fever cases which occur among the poor are treated within the district, either at their own homes or at the workhouse. In the corresponding quarter of last year the deaths from epidemic diseases were only 101, which is 13.1 per cent. of the total deaths; but by deducting the deaths in the London Hospital, it is increased to 15:5 per cent., or 5.4 per cent. less than the proportion during this quarter. 4 The total deaths from zymotic diseases, including those above specified, have been 143, among which are 4 from pyæmia, 1 from carbuncle, and 4 from erysipelas. According to the Registrar General's returns, it appears that the rainfall during this quarter has been 5.84 in. During the corresponding quarter of last year rain fell to the amount of 4.27 in. The increase in the fall of rain has therefore exceeded inches over that of the corresponding quarter of 1864.* The increase of mortality from epidemic diseases is a matter of great regret, and* especially so when the labours of the sanitary officers of your Board are perseveringly continued in endeavouring to improve the sanitary condition of the poor localities in the district; but while so many persons are compelled, owing to the difficulty in obtaining house accommodation, to crowd together in confined places, an increase in the rate of mortality may be anticipated. The difficulty which the poor experience in obtaining house accommodation, and more especially those who have large families, has lately been further increased, owing to the recent demolition of many houses formerly inhabited by the labouring class, for the extension of railways, the formation of new streets, for the erection of warehouses, and for public buildings. The overcrowding of persons in the same house and the crowding together of houses in confined places are evils which at present cannot easily be prevented. There is also considerable difficulty, at all events much time is consumed, in compelling a landlord to thoroughly cleanse and purify a house in which fever has attacked in succession several of the inmates, and in prohibiting him from letting such house for occupation until the same shall have been declared fit for habitation by the Medical Officer of Health. This district is one of the most densely populated in the Metropolis. The average space allotted to each inhabitant is only about 24 square yards,† the total area of the district being 406 acres, of which 23 acres consists of water, and the population is 78,970. If, however, each individual had a space of 24 square yards, including the space on which his house stood, there would not be much cause for complaint upon the subject of density of population, but the inhabitants of some of the courts. in the district have less than 5 square yards •gt.or each. Thus, in Tewksbury Buildings, situated in High Street, Whitechapel, there is a population of 211. This place is a cul-de-sac, having a narrow covered entrance, and is about 67 yards in length by 5 yards in width, with 7 houses on each side two stories in height, without back yards, and with * In the weekly return of the Registrar General ending February 4th is the following note:- An English acre consists of .6,272,640 square inches. An inch deep of rain on an acre yields 6,272,640 cubic inches of water, which at 277.274 cubic inches to the gallon makes 22622.5 gallons; and as a gallon of distilled water weighs 10 lbs., the rainfall on an acre is 226,225 lbs. avoirdupois; but 2,240 lbs. are a ton, and consequently an inch deep of rain weighs 100.993 tons, or nearly 101 tons per acre. For every hundreth of an inch a ton of water falls per acre. † In St. George, Hanover Square, about 78 square yards is the average space allotted to each inhabitant. 5 a basement story to each, which is occasionally occupied as a dwelling, although it is contrary to the terms of the Building Act to be so used. This Act prohibits all such places, unless certain conditions are complied with, from being used as habitable apartments. That portion of the area of this court which is covered by buildings is about 520 square yards, which, if added to the 402 square yards of open space contained in the length and breadth of of the court, and divided by 211, the number of inhabitants, gives little more than 4 square yards to each person! When this place was specially visited by Sir. Coward, one of the Inspectors, in 1861, it contained a population of 136, consisting almost entirely of foreign Jews of the poorer class, among whom numerous instances of indecent occupation were discovered. When visited again, in 1865, the population, which was of the same class as on the former visit, had increased to 211, which number the Inspector considers to be considerably understated, there being great difficulty in obtaining accurate information on the subject. The cases of indecent occupation, although not so numerous as on the previous inspection, were still found to exist. The basements of some of the houses were again occupied as dwellings, and notices were again served on the landlord to remove the occupiers of these underground rooms. The mortality of children under 5 years of age has been 272. This is 36.7 per cent. of the total mortality. In the corresponding quarter of the previous year, the mortality of children under 5 years was in relation to the total deaths 32.8 per cent. The deaths of persons above 80 were 12. One person attained the age of 93, and a widow of a gentleman reached the advanced age of 110 years.* The uncertified deaths have been very few during this quarter, the total number of such being only 3 ; of these, one is registered as convulsions, one as inflammation of the lungs, and one decay of nature. The number of inquests have been 80. Among the records of the Coroner.s Court are 22 deaths caused by burns and scalds, 4 of children who were suffocated in bed, 1 from suffocation from hooping-cough, 1 from rupture of the aorta, 3 from privation, 1 (a child 2 years old) from accidental poisoning, the poison not specified, 1 from exhaustion in childbirth from absence of skilled assistance, and 1 from self-hanging. The deaths in the Workhouse have been 106. Of these 22 were caused by fever, and 1 by erysipelas. In the corresponding quarter of last year the deaths were 115. In the course of the year terminating at Christmas last, the deaths in the workhouse were 417. Of these 210 were in the house for a period under 1 month and 51 under 2 months. The deaths in the Workhouse and Hospital together have been 232, which is 31.3 per cent. of the total deaths in the district. The Medical Officers of the Union have attended 3,929 new cases of disease, * This death is recorded in the week ending January 7th, 1865. From inquiry the Registrar thinks that the age is correctly stated. 6 including 15 of Small-pox, 21 of measles, 23 of scarlet fever, 101 of hoopingcough, 124 of diarrhoea, and 116 of fever. In the corresponding quarter of last year, the total number of cases was 3,569, including 11 of small-pox, 4 of measles, 14 of scarlet fever, 52 of hooping-cough, 153 of diarrhoea, and 148 of fever. The cases of illness in the workhouse have been 861, including 1 of smallpox, 2 of measles, 4 of scarlet fever, 1 of hooping-cough, 42 of diarrhoea, 9 of erysipelas, 1 of carbuncle, 3 of rheumatic fever, 3 of delirium tremens, and 179 of fever; of these latter 22 died. Of the total cases, Mr. Champneys attended 448, and Mr. Richardson 413. In the corresponding quarter of last year the total number of cases of disease in the workhouse was 824, including 145 cases of fever, of which 14 were fatal. The water-waste preventers which have been erected in the district have stood the test of a long and severe winter. They appear to act very satisfactorily, being at the same time economical to the landlords, and highly advantageous to the tenants. From these machines, a glass of pure water, always cool and fresh, can at any time be drawn ; so that the poor who live in those courts in which a water-waste preventer is erected have a better supply of water for drinking purposes than the more wealthy classes who obtain their supply from a cistern within their own houses. I have to report that another of these machines has been erected since my last report, and that there are now eight of them in operation in the district. The mortality, although it has been rather less during this quarter than it was in the corresponding quarter of 1864, is nevertheless very great. The annual rate during this quarter has been, excluding all the deaths in the London Hospital, 31-3 per 1000; and so long as this district continues to be so densely populated, we must expect to find that its rate of mortality will be above that of those districts where the population is spread over a larger area; but as this state of things cannot be prevented, greater attention is demanded on the part of the sanitary officers and those in authority in putting in force the powers intrusted to them to remove the sources of ill-health among the people. In the crowded and ill-ventilated courts in which there is no thoroughfare, the atmosphere contains a considerable amount of decomposing animal matter which is highly prejudicial to the health of the inhabitants. As this decomposing matter, from the want of sunshine and currents of air, does not readily become oxidized, it is of the utmost importance that all practical means should be adopted for producing artificial currents of air through them, which may be effected by flushing them daily with water. Owing to the great traffic which is almost incessantly going on in the streets, it is impossible that the cleansing of them three times a week, even if the cleansing should be well done, can be sufficient to keep the streets clean and free from the injurious emanations which are given off from decomposing animal and vegetable matter. They should therefore be cleansed daily. The public dustbins should be emptied daily, and the dung from stables and cow-yards should also be daily carted away. 7 The importance of thoroughly cleansing the streets has been forcibly dwelt upon by the Registrar General in his last Annual Report upon the Mortality of London. He states that " London has acquired almost as much fame for that highly agglutinative compound, its mud, as for its fogs; and perhaps there is more connexion than is generally supposed between them. It would be a humble but invaluable sanitary work if the streets were subject to a perfect system of purification; if they were frequently and thoroughly cleansed and dried. The attention of Boards of Works may be well directed to this end. The present expedient, by which householders who pay rates for parochial management are expected to clean the pavement in front of their houses, is unjust in principle and futile in practice. The whole width of thoroughfare, from frontage to frontage, should get the benefit of the same brooms and shovels. Old persons, whose avocations compel them to be much out of doors, in feebly urging their steps over filthy streets, waste much of that strength which should be husbanded for the employments by which they live. And how can poor people be expected to keep the inside of their houses free from damp and dirt, when all the adjacent exterior is a . mud-ocean ?. A good scavenger is a practical teacher of that cleanliness which is said to be next to godliness; and if the streets were well kept, the crowds who frequent them would read excellent plain sermons in the stones." The Registrar General concludes his valuable report by expressing a regret that fever in the Metropolis is on the increase. I am, Gentlemen, Your obedient Servant, JOHN LIDDLE. 15, Great Alie Street. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 1st April, 1865. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-cough. Diarrhœa. Continued Fever, Typhus & Typhoid. Cholera. Erysipelas. Pyæmia. 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. Allinson 9 5 1.9 13 32 29 0 14 0 0 0 in 16 0 0 i 3 0 0 1009 1251 Mr. Champneys 3 0 1 8 26 13 0 3 0 0 0 38 8 0 0 0 1 0 0 357 458 Mr. Richardson 0 1 11 10 32 19 0 3 0 0 0 19 0 0 1 0 0 0 0 742 838 Mr. Sequiera 3 15 2 70 34 55 0 4 0 0 0 84 19 0 0 3 0 0 0 1093 1382 Total 15 21 23 101 124 116 0 24 0 0 0 252 43 0 1 4 4 0 0 3201 3929 Corresponding Quarter of previous Year 11 4 14 52 153 148 0 17 0 0 1 267 36 I 5 7 3 0 0 2809 3569 9 TABLE II.—Showing the Deaths from Epidemic Diseases, for the Three Months ending 1st April, 1865. Districts. Small.Pox. Measels. Scarlet Fever. Diphtheria. HoopingCough. Diarrhoea. Fever. Total. Remarks. Artillery 0 3 0 0 0 0 1 4 Spitalfields 0 5 4 0 2 0 4 15 Mile End New Town 1 0 2 0 2 3 30 38 Workhouse. Whitechapel, North 1 4 2 0 3 2 4 16 Whitechapel Church 0 1 2 0 9 1 3 16 Hospital. Goodman.s Fields 0 1 3 0 13 1 2 20 Aldgate 1 1 0 1 12 2 2 19 Total 3 15 13 1 41 9 46 128 Deaths from Epidemics for the corresponding Quarter, 1864 4 25 5 0 19 4 44 101 TABLE III.—Showing the Ages at Death in the Workhouse, and in the London Hospital, for the Quarter ending 1st April, 1865. 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, 58 Females, 48 Corresponding Quarter of 1864. Workhouse 10 6 1 14 30 40 5 106 115 London Hospital 3 12 13 41 40 16 1 Males, 91 Females, 35 126 117 10 TABLE IV.—Ages at Death in each Registration District, for the Three Months ending 1st April, 1865. 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 7 9 2 1 12 12 i 44 Sipitalfields 20 25 6 7 16 15 3 92 Mile E.N. Town 35 23 8 20 41 53 7 187 Workhouse. Whitechapel, N. 12 27 5 4 19 12 0 69 Whitechapel Ch. 24 24 17 50 45 24 6 190 Hospital. Goodman's Fields 21 20 9 7 12 7 3 79 Aldgate 21 21 6 7 12 10 3 80 Totals 140 139 53 96 157 133 23 741 TABLE V.—The Births and Deaths in each Registration District, for the Three Months ending on the 1st April, 1865. Districts. Births. Total. Deaths. Total. Excess of Births oyer Deaths. Excess of Deaths over Births. Remarks. M. F. M. F. Artillery 25 26 51 27 17 44 7 0 Spitalfields 60 73 133 49 43 92 41 0 Mile End N. Town 110 79 189 101 86 187 2 0 Workhouse. Whitechapel, N 70 67 137 37 32 69 68 0 Whitechapl. Church 48 35 83 126 64 190 0 107 London Hospital. Goodman's Fields 61 41 102 47 32 79 23 0 Aldgate 31 32 63 43 37 80 0 17 65 non.residents died in L. Hos. Totals 405 353 758 430 311 741 141 124 Excess of births over deaths, deducting the 65 non.residents . 82 Population in 1861, 78,970. 11 TABLE VI.—Causes of Death at Seven Periods of Life, registered in the Whitechapel District, for the Three Months ending April 1st, 1865. 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. Totalj 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. Brought Forward 103 121 40 70 125 98 8 565 I—Miasmatic. IV.—Digestive Organs. Small.Pox ... I 2 ... ... ... ... 3 Measles 3 11 1 ... ... ... ... 15 Cancrum Oris Scaarlatina ... 9 4 ... ... ... ... 13 Gastritis ... ... ... 1 ... ... ... 1 Diphtheria ... 1 ... ... ... ... 1 Enteritis Quinsy Peritonitis Group ... 5 3 ... ...... ... ... 8 Ascites ... ... ... 1 3 1 ... 5 Hooping.Cough 14 24 ... ... ... ... 41 Ulc.of Intestines Typhus Fever 1 4 3 7 18 13 ... 46 Hernia (Rupture) ... ... ... 2 2 ... 1 5 Erysipelas 1 ... 3 ... ... 4 Ilens ... ... ... ... 1 ... ... 1 Puerperal Fever ... Intussusception 1 ... ... ... ... ... ... 1 Carbuncle ... ... ... ... 1 ... ... 1 Fistula Influenza Stomach Disease, &c. Dysentery Pancreas Disease, &c. ... ... ... ...... 1 ...... ... 1 Diarrhœa 3 1 ... ... 3 2 ... 9 Hepatitis Ague Liver Diseases, &c ... ... 1 l 5 2 ... y Remittent Fever Spleen Disease, &c Rheumatism ... ... ... 1 1 ... ... 2 V.—Urinary Organs. Pyæmia ... ... ... 1 2 1 ... 4 II.—Enthetic. Nephritis ... ... 1 ... ... ... ...... l Syphilis 1 1 ... 2 ... ... ... 4 Disease of Bladder Stricture of Urethra ... ... ... ... 2 1 ... 3 Nephria (Bright's Disease) ... ... 1 3 5 2 ... 11 Hydrophobia Glanders Diabetes III.—Dietic. Stone Privation ... ... ... 2 1 ... ... 3 Prostate Disease Want of Breast Milk 1 ... ... ... ... ... ... 1 Kidney Disease, &c. ... ...... ... ... 1 ... ... l Purpura and Scurvy. ... 1 1 ... ... ... ... 2 VI.—Organs of Generation. Alcoholism—DeL Tremens ... ... ... 1 ... ... ... 1 Ovarian Dropsy ... ... ... ... I ... ... l „ Intemperance Uterus Disease, &c ... ... ... ... 1 ... ... 1 Lead Poisoning VII.—Organs of Locomotion. IV.—Parasitic. Thrush 3 ... ... ... ... ... ... 3 Joint Disease, &c. ... ... ... 3 1 ... ... 4 Worms, &c Bones, &c. ... 1 1 1 ... ... ... 3 2.—Constitutional VIII. — IntegumentarySystem Gout ... ... ... ... ... 1 ... 1 Skin Disease, &c Dropsy ... 1 1 ... 2 4 ... 8 Cancer ... ... ... 2 1 ... 6 4.—Developments Mortification ... ... ... 1 ... ... 1 2 I. — Diseases of Children. Abscess 1 1 ... 3 ... ... ... 5 II.—Tubercular. Premature Birth 5 ... ... ... ...... ... ... 5 Scrofula Cyanosis Tabes Mescnterica 19 16 1 ... ... ... ... 36 Spina Bifida Phthisis (Consumpn.) ... 3 5 25 22 4 ... 59 Other Malformations 1 ... ... ... ... ... ... 1 Hydrocephalus 2 7 2 ... ... ... 11 Teething 7 6 ... ... ... ... ... 13 3—Local. II.—Diseases of Adults. I.—Nervous TEM Paramenia 1 1 ... ... ... ... ... 2 Childbirth ... ... ... 1 1 ... ... 2 Apoplexy ... 1 1 3 4 1 10 III.—Diseases of Palsy (Paralysis) ... ... ... 2 10 1 13 OLD PEOPLE Old Age ... ... ... ... ... 22 13 35 Insanity ... IV.—Diseases of Nutrition. Epilepsy 1 ... 1 1 1 ... 1 3 Convulsions 26 ... ... ... ... ... 32 Atrophy and Debility ... ... ... ... ... ... Chorea ... ... 1 ... ... ... 1 5.—Violent Deaths Brain Disease, Ac. 1 3 4 2 1 I ... 12 I.—Accidents or Negligence. II.—Organs of Circulation. Burns and Scalds 2 10 6 1 ... 2 1 22 Pericarditis ... 1 1 1 ... ... 3 Poison ... 1 ... ... ... ... ... 1 Aneurism ... ... 1 ... ... ... 1 Suffocation 4 ... ... ... ... ... ... 4 Heart Disease, &c ... ... 6 11 7 ... 24 Violence 1 ... 3 11 9 5 ... 2y Phlebitis ... ... 1 ... ... ... 1 Drowning ... ... ... 1 ... ... ... i Disease of Arteries ... ... ... ... 1 ... 1 III.—Homicide. Murder and Manslaughter III.—Respiratory Organs. Laryugismus 1 ... ... ... ... ... 1 IV.—Suicide. Laryngitis Wounds Bronchitis 9 9 1 4 29 34 5 91 Poison Pleurisy Drowning Pneumonia 15 17 6 6 12 2 ... 58 Hanging ... ... ... ... 1 ... ... l Lung Disease, &c. ... l 7 11 ... 19 Otherwise Not Specified 1 ... ... ... ... ... ... 1 Carried Forward 103 121 40 70 125 98 8 565 Grand Total 140 139 53 96 157 133 23 741 100 BOARD OF WORKS. WHITECHAPEL DISTRICT. REPORT on The Sanitary Condition of THE WHITECHAPEL DISTRICT, For the Quarter ending 1st Judy, 1865, b y JOHN LIDDLE, Medical Officer of Health. PRESENTED TO THE BOARD, 10th JULY, 1805. foKton: PRINTED BY R. BIRKETT, 27, NORTON FOLGATE. 1865. REPORT For the Quarter ending 1 si July, 1865. Gentlemen, During the quarter ending on Saturday, July 1st, there have been registered in the Whitechapel District 645 births, of which 331 were of males and 314 of females. The deaths during the same period have been 592; of these 331 were of males and 261 of females. In the corresponding quarter of the previous year the births were 729 and the deaths 631. The deaths in the London Hospital have been 99; of these 44 were of non.residents, 10 of persons who had resided in this district, and 45 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 local Registrar. The deaths from epidemic diseases have been 99, viz. 1 from small.pox, 12 from scarlet fever, 1 from diphtheria, 23 from hooping.cough, 26 from diarrhoea, and 36 from fever. The following are the localities where the deaths from fever occurred:—Pelham Street, Brick Lane, Luntley Place, Spital Street, King Edward Street, Little Halifax Street, Queen Street (Aldgate), Crown Court (Blue Anchor Yard), Wellclose Square, Lambeth Street, Royal Mint Street, Sandy.s Row, Chapel Street, Little North Street, Swan Court (Middlesex Street), Wentworth Street, Wood.s Yard, Emery.s Court, and Charlotte Court. In the corresponding quarter of last year, the deaths from epidemic diseases were 132; of these 40 were from measles, 3 from scarlet fever, 2 from diphtheria, 26 from hooping.cough, 18 from diarrhoea, and 43 from fever. On comparing the mortality from epidemic diseases in the corresponding quarters of 1864 and 1865, it will be observed that in the former period 40 deaths occurred from measles, whereas not one death from this disease is recorded in the latter; while, on the other hand, the mortality from scarlet fever has increased from 3 to 12. The deaths from fever have decreased from 43 to 36. In the week ending June 17th there were 7 deaths from fever in the district, and in the following week 12 deaths occurred from diarrhoea. In the corresponding quarter of each year from 1859 to 1865, the deaths from epidemic diseases were respectively 68, 64, 74, 172, 165, 132, and 99, and the total deaths respectively were 418, 523, 526, 610, 639, and 631. The reasons why epidemic diseases prevail more or less extensively at certain periods are not known; but when they do occur, it is found that the weak, the half.starved, the badly.housed, the over.worked, and the mentally.depressed are the most numerous sufferers. 4 The following table, which is compiled from the weekly returns of the Registrar General, may be found interesting. It shows during each week the rainfall in inches, the range of temperature, the mean temperature, and whether the temperature has been above or below the average for the corresponding week in the last 50 years, as determined by Mr. Glaisher. Week ending Rainfall. Range of Temperature. Mean Temperature. Above the Average. Below the Average. Remarks. April 8 0.08 71.5° to 31.9° 48.9° 3.7° — „ 15 0 15 72.0 „ 37.4 52.4 73 — „ 22 0.13 76.7 „ 39.2 56.0 9.0 — „ 29 o.oo 81.5 „ 36.1 54.2 6.2 — May 6 0.16 74.0 „ 31.4 54.1 3.5 — „ 13 2.69 70.0 „ 38.9 50.7 — 0.7° Rain fell on 5 days in this week. „ 20 0.16 72.8 „ 39.2 53.7 1.1 — „ 27 1.35 78.5 „ 42.3 61.7 7.1 — On the 23rd, 1*03 inches fell. June 3 1.11 73.8 „ 47.2 58.3 1.7 — Rain fell during 4 days in this week. „ 10 o.oo 82.0 „ 50.9 63.6 0.3 — „ 17 000 77.0 „ 41.2 57.8 — 1.0° „ 24 0.00 87.6 „ 42.4 61.1 1.2 — On Thursday 29th rain fell to the extent of 0.02 inches, and on Friday 30th to 1.39 inches. July 1 1.41 77.0 „ 47.0 59.5 1.9° An unusally long drought prevailed in the month of June. No rain appears to have fallen in London for 25 days, viz. from the 3rd to 29th. The total amount of rainfall during this month was T51 inches. In the four weeks from the 10th of June to the 1st of July the mortality in this district was 183. The average mortality during the corresponding weeks in the previous ten years was 146*8. The mortality therefore in these four weeks has been 30.2 above the average. The mortality of children under 5 years of age has been 245, which is 41.2 per cent. of the total deaths. The mortality of children under 5 years in relation to the total deaths in each of the registration districts may be seen on referring to table No. 4. In the Whitechapel North Sub.district it is as usual very high, viz. 57*5 per cent.; and in the Aldgate Sub.district it is 58 per cent. In the corresponding quarter of the previous year the proportion of deaths under 5 was 44.6 per cent. of the total mortality. The deaths in the Aldgate Sub.district are 25 in excess of the births. If the registration of births were made compulsory, it is probable that more births would be registered. 5 The deaths from diseases of the respiratory organs, exclusive of those of consumption, have been 92. Consumption and the other diseases of the tubercular class were fatal to 106, which is nearly 18 per cent. of the total deaths. Convulsions proved fatal to 16 children under 5 years of age. Every three months I have to record the fact, that several children, only a few months old, are said to have been accidentally suffocated in bed. The repeated warnings given at the inquests held upon these cases appear to have little effect in diminishing their number. During the last three months 4 deaths from this cause are recorded. The number of inquests has been 78, against 71 for the corresponding quarter of the previous year. It appears from the record of these legal inquiries that 6 persons died from injuries caused by vehicles running over them. In the whole of London 50 of such deaths occurred. The deaths show but a small proportion of those persons who are injured by the recklessness of many of the drivers. The attention of the police is especially required to check the furious and careless driving in London, whereby so many persons are daily injured. The death of a man aged 35 occurred in the London Hospital from the effects of drinking spirits of wine. A man aged 50 died from eating unwholesome mackerel. A child 13 months old died from obstruction of the bowels caused by accidentally swallowing a bone-button. Five deaths occurred from & drowning. A lad 17 years of age died in the London Hospital from pyaemia, the result of yellow fever acquired at Berbice. A child aged 1 year died from injury to the head, but there is no record of an inquest having been held in this case. Two deaths occurred from choleraic diarrhoea. The number of deaths uncertified by a Medical Practitioner is 3. These deaths are said to have been caused by convulsions. For the protection of the public against the crime of murder, some official inquiry should be instituted in every case where a medical certificate stating the cause of death has not been obtained. The deaths in the Workhouse have been 79, against 118 in the corresponding quarter of the previous year. Of the 79 deaths 13 were caused by fever. In one instance the disease appears to have originated in the Workhouse; while all the other deaths were of persons brought from the under-mentioned localities,—1 from Windmill Court, 1 from Sharp.s Buildings, 1 from Osborn Place, 1 from Plough Street, 1 from High Street (Mile End New Town), 1 from Well.s Place, 1 from Queen Street (Aldgate), 2 from George Street, and 3 from Flower and Dean Street. The mortality in the Workhouse under 5 years has been 16, which is 20 per cent. of the total deaths. The mortality under 1 year has been 11, or about one-seventh of the deaths. About 30 per cent. of the total mortality in the district occuired in the Workhouse and in the London Hospital. The Medical Officers of the Union have attended 3,676 new cases of disease, including 8 of small-pox, 18 of measles, 18 of scarlet fever, 56 of 6 hooping-cough, 251 of diarrhoea, and 108 of fever. In the corresponding quarter of last year the total number of new cases was 3,362. The new cases of disease in the Workhouse have been 818. Of these Mr. Champnkys attended 411, and Mr. Richardson 407. Included in the total number are 3 of scarlet fever, 2 of hooping-cough, 54 of diarrhoea, and 117 of fever. There are also 2 of carbuncle, 2 of eiysipelas, 6 of rheumatic fever, 3 of dysentery, and 4 of delirium tremens. Two additional water-waste preventers have been erected since my last report. Ten of these machines are now in operation in the district. They continue to give satisfaction. On comparing the present mortality of the district during this quarter with that of the corresponding quarters of the years 1856 to 1861, it will be seen that the number of deaths is now much greater, although we have not any direct evidence to show that the population has increased. During the years 1851 to 1861 the population slightly decreased, and since 1861 a great many houses, chiefly occupied by the poor, and for the most part overcrowded, have been pulled down. This fact might lead us to suppose that the population had decreased; but from inspection of the houses in the district generally, there is good reason to believe that the population has actually increased ; for as many houses which were formerly occupied by single families are let out in separate tenements, and every room now contains a distinct family,—and to such an extent is this separate letting of rooms carried out that, from information given to me, there is not a single street in the Parish of Whitechapel that is not more or less a nursery of pauperism in consequence of this sub-division of tenements. From this it may be inferred, that not only are the houses in the district more crowded, but that the population is of a poorer class, amongst whom disease and death are of more frequent occurrence than among the upper classes. The increase of mortality may therefore be to some extent accounted for; and to strengthen this supposition, it appears that an annual increase in the number of paupers has taken place, as is shown by the subjoined return, which has been kindly given to me by Mr. Farr, jun. Thus, from Lady-day 1861 to Lady-day 1862, the number of in-door paupers, exclusive of the class of casual poor, was 4,403, and of out-door 20,217; in 1863 the number of in-door was 4,970, and of out-door 20,461; in 1864, 4,746 in-door, and 21,270 out-door; and in 1865 the number of in-door was 4,772, and of out-door 23,137,—the in-door and out-door for this year making together 28,909. As the population is 78,970, no less than 36*6 per cent. or more than one-third have received relief either as in-door or out-door paupers. If the name of each person relieved appeared only once in the return, the number of paupers in this district would be most startling. In the year terminating December 31st, 1864, the number of out-door and in-door sick poor together (as is shown by the returns of the Medical Officers of the Union) was 18,044. It may not perhaps be difficult to a certain extent to account for this 7 increase of pauperism, notwithstanding that the rateable value of the several parishes has considerably increased by the erection of spacious warehouses and other large buildings. I have just stated that a change has taken place in the class of the occupants of numerous houses in the district. This change has been occasioned by the demolition of an immense number of the houses occupied by the poorer classes, not only in this but in the surrounding districts, which has compelled the occupants to seek lodgings in other localities; and as the labouring class must, if possible, live in the vicinity of their places of work, an empty house soon becomes occupied by those who have been compelled to remove, and thus an inferior class becomes located in a street which was recently tenanted by respectable mechanics and tradesmen. These latter, in consequence of the new comers, leave the neighbourhood, and the entire street soon becomes tenanted by the same class of persons as those who took possession of the first empty house, and thus the neighbourhood becomes rapidly deteriorated. Such is the demand for houses among the working classes that rents are rapidly rising; and as it is almost impossible for the labouring poor to pay a higher rent than they paid for their rooms that they formerly occupied, each house soon becomes overcrowded. This overcrowding, for the sake of the public health, must be prevented. It is very probable that the districts adjoining the City of London suffer more from overcrowding than remoter districts, in consequence of the local authorities there being empowered to institute a regular and systematic inspection of all the rooms in any house in the City of London (the same not being a licensed victualling house) let or any part of which is let at a daily or weekly rent not exceeding the rate of 3s. Gd. per week, or in which persons are harboured or lodged for hire for a single night or for less than a week at one time, and to issue regulations from time to time to be observed by the owners of such houses; and if any keeper of such lodging house shall offend against any of the regulations respecting these houses made by the Commissioners of Sewers, he shall be liable to a penalty not exceeding five pounds, and the like penalty for any day after the first upon which anysuch offence shall be continued. I am informed that this Act, known as the Sewers Act for the City of London, (14th & 15th Vict., c. 91,) is of immense service in that district in preventing overcrowding; but what must be the effects of such a systematic visitation upon the neighbouring districts, where the authorities have not the same powers to prevent overcrowding? In selfdefence, therefore, similar powers to regulate the number of persons who should be allowed to occupy a single room should be granted to all Vestries and District Boards, so that the same kind of inspection of the rooms in all such houses (as defined by the Sewers Act) might be adopted in all the Metropolitan districts. Unless effectual means be taken to prevent overcrowding, disease will extend, and the rate of mortality increase, and consequently the burdens of the ratepayers will become augmented. This district consists of 406 statute acres, or rather less than two-thirds of of a square mile. Included in this area there are 23 acres covered with water. t 8 The district comprises 415 streets and bye-places, the length of which is upwards of 21 miles. Of these streets and bye-places, 228 are on the north side and 187 on the south side of the district. At the last census the number of houses which were inhabited was 8,664; of those uninhabited the number was 292, and there were 33 in the course of erection. If all these houses were now occupied, the number would be above 9,000. Of these it may be fairly estimated that 5,000 are let out in separate tenements, and each house may be estimated to contain on an average 3^ rooms. If such a system of supervision were to be carried out, as in my opinion would be desirable, about 17,500 rooms would require a periodical inspection; for unless a regular inspection, at very short intervals, be adopted, overcrowding will exist, and wherever overcrowding is found nuisances will be of continual recurrence. The public dustbins (about 160 in number) must be inspected twice at least every week, so that they may be emptied before the vegetable and animal matter in them putrifies. Every street should also be inspected on the day that the scavengers are bound to cleanse it. Besides this, it is absolutely necessary for all the rooms in which fever has recently existed to be inspected, so that orders may be served upon the owners to have them lime-washed. All the cow-houses (37 in number) should be inspected at least twice a week, in order to see that they are properly kept, and that the dung is regularly removed every second day. The same regular inspection of all lay-stalls and dungpits is required. The physical labour which such an inspection requires is more than can be given by two Inspectors ; a third Inspector should therefore be appointed.* The overcrowding in this district is of two kinds, viz. that of the houses, and of the people occupying the houses. Many of the houses are built back to back, and consequently cannot have a current of air through them, and the spaces at the rear of others are so small that they are inadequately ventilated. The former can only be prevented by proper provisions being introduced into a new Building Act, and the latter by the frequent inspection and putting rigidly in force the powers entrusted to Local Boards. There can be but little doubt that density of population exercises a powerful influence in increasing the rate of mortality. Cases of fever have been caused by overcrowding, and by the emanations from cesspools. But it cannot be said that overcrowding is either the sole cause of an increased rate of mortality or of fever. The poverty of the people, their occupations, their ages, the means of cleanliness at their command, the state of the drainage, the ventilation, and the existence or otherwise of efficient sanitary conditions, will produce a difference in the rate of mortality in any district. The knowledge of the fact that the want of sanitary arrangements causes * Since this report was presented to the Board an additional Inspector has been engaged, whose duty at the present time is to inspect every house where diarrhcea has occurred, and to report to me the sanitary state of such house. For the week ending 22nd July, 85 cases of diarrhoea were attended by the Medical Officers of the Union, and for the following week the number of cases was 88, 9 ill-health shows the importance of inculcating upon the public generally, and of the poor in particular, the benefits as regards health which arise from personal and household cleanliness, ventilation, &c. Much might be done in spreading information, if the educated class would have more frequent intercourse among the poor, and impress upon their minds the importance of practising the laws of health, and of observing a proper sense of decency and self-respect. District visitors might do a great deal to improve the social condition of the people; and landlords, when they collect their rents, should inspect each room, examine the water-closets, and the water supply, and give such instructions to their tenants as shall compel them upon pain of removal to observe cleanliness, and avoid the wilful destruction of property—now so much complained of by the owners and agents of small tenements. Poor people cannot now as formerly leave their habitations, however bad such habitations may be, and readily obtain others; for such is the demand for rooms that rents are rising in all poor localities. The same houses of two rooms each which two years ago were let at 3s. per week now fetch 4s. 6d. per week. If it were not for the vigilance of the Inspectors in visiting the houses of the poor, nuisances would remain altogether unattended to; for very few of the poor dare to make a complaint, from fear of being compelled to quit their tenements. The proper cleansing of the streets is a matter of the greatest importance in relation to the public health. It is obvious that the greater is the traffic in a street the more frequently such street requires cleansing. The great thoroughfares should therefore be cleansed daily. But it is equally, or perhaps even more important for the public health, that the poorer localities, where nuisances are daily recurring, should also be daily cleansed. Owing to the want of proper receptacles for house refuse among the poor, they are in the habit of throwing it into the public thoroughfares, where it is allowed to remain until the scavengers remove it. In order to put a stop to this practice, the Board issued printed notices cautioning the inhabitants against the practice of placing filth and rubbish upon the carriageway or footway of any street or other public place, and offering a reward of 5s. for such information as should lead to the conviction of any person so offending. Convictions have been obtained and fines inflicted. Now, some excuse may be found for the poor transgressing the law in this particular; but what can be said in extenuation of those tradesmen living in the principal thoroughfares, who, shortly after the streets have been cleansed, sweep the refuse of their shops upon the public ways, thus giving the street the appearance of not having been cleansed? The great thoroughfares must be cleansed early in the morning, before the traffic of the day commences; for at midday, when the traffic is great, it is next to impossible to thoroughly cleanse the streets, and it is dangerous for the men employed to attempt it. In contracting with the scavengers, it would be desirable to have all the main thoroughfares cleansed by ten o'clock in the morning; and if the cleansing of the principal streets be not completed by a given time, a fine should be inflicted. By adopting this plan, not only would 10 the public be benefitted, but the time of the Inspectors would be economized. A mutter even of still greater importance as regards the public health is the cleansing daily of the public dustbins. Into these receptables all sorts of refuse are thrown, such as stinking fish, dead dogs and cats, the contents of privies, &c.; so that the inhabitants of the houses in the immediate vicinity of these dustbins are not only greatly annoyed, but their health suffers in consequence of the offensive smell. Owing to the want of back-yards, it is impossible to do away with public dustbins; and the only way of remedying the evil of them is to have their entire contents removed every day. I am, Gentlemen, Your obedient Servant, JOHN LIDDLE. 15, Great Alie Street. appendix. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 1st July, 1865. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhœa. Continued Fever, Typhus & Typhoid. Cholera. Erysipelas. Pysemia. 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. Allinson 3 0 8 10 75 51 2 8 0 1 1 48 12 0 4 0 3 1 1 996 1224 Mr. Champneys 1 0 1 10 48 23 1 2 0 0 0 21 1 0 0 0 2 0 1 326 437 Mr. Richardson 0 1 8 8 54 16 0 3 0 0 0 21 2 0 1 0 2 0 0 762 878 Mr. Sequiera 4 17 1 28 74 18 0 2 0 0 0 46 10 0 0 2 0 0 0 935 1137 Total 8 18 18 56 251 108 3 15 0 1 1 136 25 0 5 2 7 1 2 3019 3676 Corresponding Quarter of previous Year 3 189 27 79 236 75 0 17 0 0 1 147 14 1 2 3 2 0 0 2566 3362 12 TABLE II.—Showing the Deaths from Epidemic Diseases, for the Three Months ending 1st July, 1865. Districts. Small-Pox. Measels. ScarletFever. Diphtheria. HoopingCough. Diarrhœa. Fever. Total. Remarks. Artillery 0 0 0 0 1 2 2 5 Spitalfields 0 0 5 0 2 6 4 17 0 0 1 o 9 6 19 35 Workhouse Whitechapel, North 1 0 4 0 2 3 3 13 Whitechapel Church 0 0 0 0 1 3 2 6 Hospital. Goodman's Fields 0 0 0 1 3 1 3 8 Aldgate 0 0 2 0 5 5 3 15 Total 1 0 12 1 23 26 36 99 Deaths from Epidemics for the corresponding Quarter, 1864 0 40 3 2 26 18 43 132 TABLE III.—Showing the Ages at Death in the Workhouse, and in the London Hospital, for the Quarter ending 1st July, 1865. 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, 42 Females, 37 Corresponding Quarter of 1864. Workhouse 11 5 1 12 25 21 4 79 118 London Hospital 2 5 25 29 25 12 I Males, 67 97 Females, 32 99 13 TABLE IV.—Ages at Death in each Registration District, for the Three Months ending 1st July, 1865. 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 7 2 4 5 2 4 1 25 Sipitalfields 21 19 2 7 15 6 2 72 Mile E.N. Town 48 31 5 21 39 29 5 170 Workhouse. Whitechapel, N. 18 20 4 9 9 6 0 66 Whitechapel Ch. 12 9 26 34 34 15 3 133 Hospital. Goodman's Fields 15 11 2 6 12 11 0 57 Aldgate 19 21 6 10 5 5 3 69 Totals 132 113 49 92 116 76 14 592 TABLE V.—The Births and Deaths in each Registration District, for the Three Months ending on the 1st July, 1865. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks. M. F. M. F. Artillery 37 21 58 11 14 25 33 0 Spitalfields 63 54 117 43 29 72 45 0 Mile End N. Town 69 79 148 91 79 170 0 22 Workhouse. Whitechapel, N. 61 63 124 33 33 66 58 0 Whitechapl. Church 38 29 67 80 53 133 0 66 London Hospital. Goodman's Fields 46 45 91 31 26 57 34 0 Aldgate 19 25 44 42 27 69 0 25 44 non-residents died in Lon. Hos. Totals 333 316 649 331 261 592 170 113 Excess of births over deaths, deducting the 44 non-residents - 101 Population in 1861, 78,970. 14 TABLE VI.—Causes of Death at Seven Periods of Life, registered in the Whitechapel District, for the Three Months ending July 1st, 1865. 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. Brought Forward 93 99 28 67 84 48 5 424 I.—Miasmatic. IV.—Digestive Organs. Small-Pox ... 1 ... ... ... ... ... 1 Measles Cancrum Oris Scarlatina 3 7 2 ... ... ... ... 12 Gasttritis ... ... ... 1 ... ... 1 Diphtheria ... 1 ... ... ... ... ... 1 Enteritis ... ... 1 ... ... ... 1 Quinsy Peritonitis ... ... 3 2 ... ... ... 5 Croup ... 6 ... ... ... ... ... 6 Ascites ... ... ... 1 1 2 ... 4 Hooping-Cough 8 15 ... ... ... ... 28 Ulc. of Intestines Typhus Fever 1 5 5 6 13 ... ... 86 Hernia (Rupture) 1 ... ... 1 2 ... ... 4 Erysipelas ... ... 2 3 1 ... ... 10 Ileus ... ... ... 1 ... 1 ... 2 Puerperal Fever ... ... 3 ... ... ... 8 Intussusception Carbuncle ... ... ... ... 1 ... ... 1 Eistula Influenza Stomach 1 1 Dysentery ... ... ... 2 ... ... ... 2 Pancreas Disease, &c. Diarrhoæa 16 7 ... 1 1 1 26 Hepatitis Ague Liver Disease, &c. ... ... ... 1 8 2 ... 11 Remittent Fever Spleen Disease, &c. Rheumatism ... ... 1 1 ... ... ... 2 Stric. of Esophagus.. ... ... ... ... ... 1 ... 1 Paæmia ... 1 3 ... ... ... ... 4 V.—Urinary Organs. Cholera ... 1 1 ... ... ... ... 2 II.-Enthetic Nephritis ... ... ... ... ... 1 ... 1 Syphilis 3 ... ... ... 1 ... ... 4 Disease of Bladder ... ... 1 ... ... ... ... 1 Stricture of Urethra ... ... ... ... ... 2 ... 2 Nephria (Bright's Disease) ... ... ... 3 2 ... ... 5 Hydrophobia III.-Dietic Diabetes Privation ... 1 ... ... ... ... ... 1 Stone Want of Breast Milk. 1 ... ... ... ... ... ... 1 Prostate Disease ... ... ... ... ... 1 ... 1 Purpura and Scurvy.. 1 ... ... ... 1 Kidney Disease, &c. ... ... ... ... 1 ... ... 1 Alcoholism—Del.Tremens ... ... ... 1 ... ... ... 1 VI.—Organs of Generation. „ Intemperance Ovarian Dropsy Uterus Disease, &c. IV.—Parasitic. 1 ... ... ... ... 1 VII.—Organs of Locomotion. Worms, &c. Joint Disease, &c. ... 1 2 1 1 1 ... 6 2Constituional Bones, &c. ... ... 1 ... 1 ... ... 2 I.—Diathetic. VIII. — IntegumentarySystem. Gout ... ... ... ... 1 ... ... 1 Dropsy ... ... 2 1 ... ... ... 3 Phlegmon Cancer ... ... ... 2 4 2 ... 8 Skin Disease, &c. 1 ... ... ... ... ... ... 1 Mortification ... ... ... 1 ... ... 1 3 Developmental Abscess ... ... ... 1 ... ... ... 1 1. — Diseases of Children. II.—Tubercular. Scrofula Premature Birth 3 ... ... ... ... ... ... 3 Tabes Mesenterica 18 20 ... 1 ... ... ... 39 Cyanosis 1 ... ... ... ... ... ... 1 Phthisis (Consumpn.) 2 1 2 28 23 2 ... 58 Spina Bifida Hydrocephalus 4 4 ... 1 ... ... ... 9 Other Malformations Teething 6 3 ... ... ... ... ... 9 3.-Local. I.—Nervous tem II.—Diseases of Adults. Cephalitis ... 1 ... ... ... ... ... 1 Paramenia Apoplexy ... ... ... ... 2 4 ... 6 Childbirth ... ... ... ... ... ... ... 1 Palsy (Paralysis) ... 1 ... ... 3 2 ... 6 III.-Disease of Old People. Insanity Old Age ... ... ... ... ... 14 8 22 Tetanus IV.—Diseases of Nutrition. Epilepsy ... ... ... ... 1 ... ... I Convulsions 13 3 ... ... ... ... ... 16 Chorea Atrophy and Debility 20 ... ... ... ... ... ... 20 Brain Disease, &c. ... 5 ... 3 1 ... ... 9 5.—Violent Deaths II.—Organs of Circulation. I.—Accidents or Negligence. Pericarditis Burns and Scalds ... 3 2 2 2 ... ... 9 Aneurism ... ... ... 1 ... ... ... 1 Poison ... ... ... ... 1 ... ... 1 Heart Disease, &c. ... ... 6 5 10 8 ... 29 Suffoceation 4 ... ... ... ... ... ... 4 Phlebitis Violence 1 7 10 8 7 4 1 38 Disease of Arteries ... ... ... ... 1 ... ... 1 Drowning ... ... 1 3 1 ... ... 5 III.—Respiratory Organs. III.—Homicide. Murder and Manslaughter ... ... ... 1 ... ... ... 1 Laryngismus 1 ... ... ... ... ... ... 1 Laryngitis IV.-Sucide. Bronchitis 8 11 ... 6 11 13 2 51 Wounds ... ... ... ... 3 ... ... 3 Pleurisy Drowning Pneumonia 14 8 1 1 4 4 ... 3? Hanging ... ... ... ... 1 ... ... 1 Lung Disease, &c. ... ... ... ... 6 2 ... 8 Otherwise Not Specified 2 ... ... ... ... ... ... 2 Carried Forward 93 99 28 67 84 48 5 424 Grand Total 132 113 49 92 116 76 14 592 ■1 101 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON The Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOR THE THREE MONTHS ENDING 30th SEPTEMBER, 1865, BY JOHN LIDDLE, Medical Officer Of Wealth. PRESENTED TO THE BOARD, 23RD OCTOBER, 1865. LONDON. 1 8 6 5. LONDON: PRINTED BY E. J. BATH, 26, HIGH STREET, WHITECHAPEL. REPORT, For the Quarter ending 30th September, 1865. Gentlemen, The Births registered in the Whitechapel District during the thirteen weeks ending on Saturday, the 30th September, are 632, of these 318 are boys and 314 girls. The Deaths are 579, viz. 326 males and 253 females. In the corresponding quarter of the previous year the births were 648 and the deaths 740. The deaths, therefore, are less by 161, which is an average of 12.4 per week. The deaths in the London Hospital, which were 129 in the corresponding quarter of 1864, have been only 84, thus showing a decrease of 44. So far, therefore, as the general mortality of the district is concerned, we have cause for congratulation. Of the deaths in the London Hospital, there have been 39 of non-residents, 16 of persons belonging to this district, and 29 of persons who died from the result of accident and from sudden death. The greatest weekly mortality (57) occurred in the week terminating 8th July, and the smallest (30) in that ending September 16th. Epidemic diseases have been fatal to 144, which is one-fourth of the total mortality. Four deaths are recorded as having been caused by Cholera. In the corresponding quarter of the previous year, the deaths from Epidemic Diseases were 219. The deaths from this class of diseases have therefore been less by 75. The principal diminution is in Measles— 1 against 57. The deaths from Diarrhœa are 64 against 71, and of Fever 42 against 52. 4 The deaths caused by diseases of the respiratory organs, exclusive of consumption, are 43, of these 17 were attributed to Pneumonia or inflammation of the substance of the lungs, and 23 to Bronchitis or inflammation of the bronchial or air tubes, 2 to Laryngitis, and 1 to Asthma. The tubercular class of diseases was fatal to 99, of which 52 were caused by consumption. Thirty-five deaths were caused by violence, 2 by poison, one of these, the wife of a clothier, having mistaken white precipitate for arrow-root, 2 from wounds on the throat, 4 from burns and scalds, 3 by drowning, one of which was that of a child who accidentally fell in a tub of water, and another, that of a man aged 60, who was accidentally drowned in a bath. A child residing at Little Pearl Street, was wilfully murdered. There were 3 cases of manslaughter and 5 of children suffocated in bed. A man aged 23 years of age was killed by a sun-stroke on the 26th July; a child aged 8 years, died of hydrophobia from the bite of a dog, and 5 deaths were caused by carriage accidents in the streets. A man aged 60 was killed by a fall, occasioned by his leg getting entangled in a lady's crinoline in the street, and 2 men were killed by the bursting of boilers. The deaths of children under 5 years of age, have been 283, which is 48.8 per cent. of the total mortality. In the Whitechapel North sub-district, the deaths of children under 5, in proportion to the total deaths, is 63.3 per cent. The fact that so large a proportion of deaths of young children, which I have had every quarter to record, speaks very unfavourably of the general condition of this district. From a Supplement to the last Annual Report of the Registrar General, it appears that in 1861, the number of males living in the Whitechapel District, under 5 years of age, was 5,101, and of females 5,117, making together 10,718, which is 12.9 per cent. or about one-eighth of the total population. The average amount of mortality per cent. of children under 5 years of age, in the ten years 1851-60, was 10.246; of boys, it was 10.669, and of females, 9.822 per cent. This high rate of mortality is above that of any of the districts in the Metropolis, with the exception of that in St. Giles, where the rate of mortality of children under 5 years is 10.852 per cent., that of males being 11.691, and of females 10.043 percent. The rate of mortality of children under 5 is, however, higher by two per cent. in Leeds, Wolverhampton, and Liverpool, than in Whitechapel. From the Registrar General's returns, we learn that, in 1861, the number of males in London was 1,307,781, and of females 1,496,208—total 2,803,989; of these there were 361,296 under 5—above 5 and under 10— 300,259; above 10 and under 15—264,349; above 15 and under 20— 259,155. The number of females living at the time when the last census was taken, who were above 80, was 6,958, and of males 3,710—total 10,668; of these 152 were 9.5 years of age and upwards, of which 42 were males and 110 females. 5 The deaths from old age are 21, of which 9 were of persons above 80 years. Uncertified deaths are becoming less in number. During this quarter they are only 4. The number of Inquests have been 80. In the corresponding quarter of last year they were 94. The deaths in the Workhouse have been 71 against 90 in the corresponding quarter of the previous year. Of the total deaths, 18 were caused by fever. The localities in which the patients who died of Fever in the Workhouse had formerly resided, were George St., Thomas St., North St., Pelham Street, Osborn Place, Moor's Gardens, High Street, Spicer Street, Church Street, Walton's Court, Thrawle Street, and Back Church Lane. Two deaths from Fever appear to have occurred among the inmates of the Workhouse, as no address of the previous residence of either of the patients is given in the returns. The mortality in the workhouse of children under 5 years of age, has been 11, and the mortality under 1 has been 9. The combined mortality in the workhouse and in the London Hospital, has been 155, which is 26.7 per cent, of the total mortality in the District, The medical officers of the Union have attended 4,286 new cases of disease, including 15 of Small-pox, 3 of Measles, 62 of Scarlet-fever, 72 of Hooping-cough, 709 of Diarrhoea, and 108 of Fever. The cases of Diarrhoea and Fever show an increase of 110 and 25 respectively over those of the corresponding quarter of 1864. The new cases of disease in the workhouse have been 922. Of these Mr Champneys attended 491, and Mr. Richardson 431. Included in the total number are 2 of Small-pox, 3 of Scarlet-fever, 53 of Diarrhoea, 120 of Fever, 9 of Erysipelas, 3 of Eheumatic Fever, and of 4 Delirium Tremens. In the corresponding quarter of last year, the total number of cases was 751, including 39 of Diarrhoea and 103 of Fever, Two additional water-waste preventers have been recently erected; there are, therefore, now 12 of these machines in use in this district. The importance of supplying the poor with water direct from the main, uncontaminated by atmospheric and other impurities, cannot be over-estimated, and this mode of supply should be enforced throughout the Metropolis. The impure water which is to be seen in the uncovered butts in many of the houses of the poor must, if drank, prove injurious to them. It is therefore not to be wondered at that recourse is so frequently had to the public house by those persons who can only obtain water from such receptacles A water-waste preventer, at the cost of about twenty-four shillings, can be fixed in every room in each house. The work of the Inspectors would be much lessened, and the staff might probably be diminished, if landlords, so soon as they receive a notice 6 pavement to be laid down in the court and in the back yards, an improved drainage, and a thorough lime-washing of the houses, would at once carry out the orders in their entirety, and not merely white-wash a room, as is now too frequently the case, thereby occasioning not only great delay, to the injury of the health of the tenants, but involving the necessity of repeated inspections on the part of the sanitary officers, and hindering them from proceeding with other cases. If the landlord pleads that the works are in progress, legal action is usually postponed, and thus from continued delay, it sometimes becomes necessary to re-commence the whole proceedings. The duty and interest of landlords appear to be at variance, as regards their doing to their houses what is absolutely necessary for the wellbeing of their tenants. It is unquestionably the duty of landlords to keep the houses which they let out in separate tenements to the poor in a healthy condition; but this is not always done, and even if compulsory orders are signed at the Board and summonses issued, the work is imperfectly performed, thereby involving the necessity of fresh proceedings; whereas, by keeping their tenements in a clean and healthy condition, they would find that their duty and interest would not be antagonistic to each other. Besides, by so doing, they could readily obtain a better class of tenants, and receive higher rents, whereby they would not only benefit themselves, but the whole district would be improved, and the poor-rate become diminished. The time of the inspectors would be greatly economized if, as is the case in some districts, proceedings were to be taken to obtain the removal of nuisances under the Metropolis Local Management Act, instead of under the Nuisances Removal Act. It might, under certain circumstances, be desirable to take proceedings under the Metropolis Local Management Act, as we were advised to do by Mr. Cooke, one of the Police Magistrates at Worship Street. By so doing, nuisances which are dangerous to the health of a crowded locality, can be more promptly removed; for, if the order made by the Board upon the owner to remove a nuisance upon his property be not complied with in a given time, then the Board is empowered to perform the work without the necessity of applying to a police magistrate, as it is necessary to do under the Nuisances Removal Act. The objections, however, to the Board performing the work are great. In some cases the proceedings would be deemed very arbitrary, and in others the Board would not be able to recover from the owners of the property the expenses incurred by effecting the necessary improvements. In the several instances in which the work has been done by the Board, their expenses have not been recovered. However, as it has been deemed by the Board to be more expedient to proceed under the Nuisances Removal Act, it would not be advisable to diminish the number of Inspectors; and when we consider the great prevalence of fever and diarrhœa, and the fact that the Cholera has been for some time committing great ravages in Paris and 7 in other great cities and towns on the Continent, it is absolutely necessary for the safety of the public that, instead of spasmodic efforts being made through fear, when a severe epidemic arrives, a repeated inspection of all the poor localities should at all times be carried out, so that the nuisances which are so frequently recurring may be promptly removed. Here, I would remark, that a uniform system of inspection of all the houses in the several districts in London, which are let out in separate tenements, should be repeatedly and systematically adopted; for if all the Vestries and local Boards do not act together in this important matter, hot-beds of epidemic diseases will remain undiscovered, which will serve as centres from whence such diseases may emanate, and extend over the entire Metropolis. The whole population of London, therefore, is interested in the prompt removal of nuisances. As a further precaution against the anticipated advent of Cholera, I suggested that certain sewers which were offensive should be cleansed under the direction of the Surveyor, and the Board gave instructions to that effect. From a return furnished to mo by Mr. Mundy, it appears that several of the small sewers were flushed, that the deposit was removed from 9 of the large sewers, of which 3 were main sewers, and that a great many of the Courts were flushed; all of which operations, I believe, were attended with benefit to the public health. I may add that the flushing operations of sewers is still being continued. It is true that the Cholera has not this year taken its usual course in its progress from the East towards Europe. On former occasions, it travelled Northwards through Russia, and it then took a South-westerly course, and attacked the cities and towns on the Baltic, from whence it came to England and commenced its ravages in the towns situated on the North-eastern Coast, from whence it soon spread to Edinburgh and to London, and subsequently it attacked the City of Paris; whereas, on this occasion, it has travelled from the East along the shores of the Mediterranean, attacked the inhabitants of Marseilles and Toulon, and then made its appearance in Paris. We have, therefore, some reason to hope that we may escape its ravages, for although several cases of Cholera have appeared in Southampton, also in a village near Epping, and at Woolwich, yet it has not visited the Metropolis in the form of an epidemic. We do not, however, feel secure against its attacking the population of London. The Epidemic may fall upon us without any further warning, and it behoves us to take such preventive measures against its obtaining a footing here as science and experience have pointed out. If we wait until the disease commences its ravages, our preventive measures against its spreading will be hastily adopted and imperfectly carried out, and the Government may interfere and do for us what we ought to have done for ourselves. We have now a staff of officers; and it is only necessary to keep up its efficiency so that the sanitary state of the district may be continually brought to your notice. By the aid of an additional inspector, we have 8 been enabled, during the last three months, to repeatedly inspect most of the worst places in the District, and to obtain a speedy removal of the frequently recurring nuisances in them. In consequence of the existence of the Cattle Plague, the inspectors and myself have paid repeated visits to the several cow-sheds in the district, and we have endeavoured to enforce the observance of the utmost possible cleanliness and the use of disinfectants, yet, I am sorry to say, that notwithstanding our efforts, the cattle plague has extensively prevailed, and has attacked every cow-shed, with one exception, in the district, Regardless of the great loss of property occasioned by this disease, nearly all the cow-keepers have made application for the renewal of the annual license, a circumstance to be regretted, inasmuch as it is highly probable that, in the course of a few years, no cow-shed will be permitted to exist in any of the crowded districts in London. In my Report for October, 1856, I classed cow-sheds among the principal causes of ill-health, and the high rate of mortality in crowded districts; and in the next following Report, I stated that cows cannot be kept in London without occasioning more or less nuisance to persons living in their immediate vicinity. I also stated that the smell arising from the manure, urine, brewers' grains and distillers' wash, is very offensive, and injurious to the public health, and that the atmosphere of a cow-shed, as ordinarily conducted in London, is injurious to the health of the cows. I further added that it would be most desirable to prohibit the keeping of cows in all densely-populated cities and towns. I see no reason, from the experience I have gained since that time, now nine years ago, to alter that opinion. While, however, cow-sheds do exist, it is most desirable to limit the number of cows in each shed, so that 1,000 cubic feet of space should be allowed for each cow, and that neither a dung-pit nor a grain-pit should be placed within the cow-shed. Where there is no space for a dung-pit, except within the cow-shed, then the manure should be collected twice or oftener Eevery day, put into covered casks, and removed off the premises. In my last Report on the subject of cow-sheds (1864), I stated that I had informed all the cow-keepers, that unless the whole of the dung were removed regularly, at least three times every week, in conformity with the printed instructions of the Board, I should advise the Board to oppose the granting of the annual license. This order of the Board has, in several instances, not been carried out, and some of the cow-keepers have also so misconducted their business, that their premises have been a nuisance to the neighbourhood. I have therefore advised that the application for certain licenses should be opposed. The object of an annual license for the carrying on the business of a cow-keeper, and also that of a slaughterer of cattle is, that during the holding of the license, the premises should be kept in as good a sanitary condition as the nature of the businesses will permit, and if not so conducted, then the license should be withheld, for it is manifestly a sham if the license is to be granted merely because immediately before the licensing day, the premises are white-washed. Before any 9 license is granted either for the keeping of cows or the slaughtering of cattle, the magistrates should, in every case, take the best evidence that can he obtained, both as regards the fitness of the premises, and the mode in which the applicant has conducted his business during the preceding year; and not to grant a license, as a matter of course, because the local board does not oppose, and if the evidence is very conflicting, then they should be respectfully requested to view the premises, and give sentence concerning their fitness or otherwise, according to their own judgment. This might entail a good deal of trouble upon all parties concerned in the matter, but the result would be highly advantageous to the public, for it would have the effect of compelling the applicants for a license to use the utmost care in carrying on their businesses. If cow-sheds and slaughter-houses are permitted to continue in London, then, the dung from these places, and also that from stables and lay-stalls, should be vested in the local boards, in a similar manner to the dust in private houses, and it should bo removed daily by their own contractor; for if the dung be allowed, as it is at present, to be a source of profit to the owners, it will be retained by them until the best price can be obtained for it, notwithstanding the vigilance of the inspectors and the complaints of the neighbourhood. The dust-bins of private houses ought to be emptied at least once in every week, and in hot weather more frequently, for vegetable and animal refuse is thrown into them, which occasions offensive smells, and when these receptacles are placed near to the dwelling houses, they are frequently the cause of ill-health to those who are exposed to their emanations. All the slaughter-houses, 37 in number, have heen inspected, and where required, orders were given to cleanse the premises, trap the drains, and repair the pavement. The bake-houses, 85 in number, have likewise been inspected, and in some instances, it was deemed necessary to order the premises to be white-washed. My attention has recently been directed to a nuisance, not only very disgusting, but likewise injurious to the public health, arising from the keeping of large numbers of pigs and cattle in some of the densely populated localities in the district. As premises used for this purpose do not require an annual license, the only way of getting rid of the nuisance is to take proceedings under the Nuisances Removal Act, for keeping animals so as to be a nuisance or injurious to health. I have written to the proprietor of one of these premises, informing him that they are not fit for the purpose of keeping pigs, and that he must discontinue the practice. This is only one of the evils arising from the existence of slaughter-houses in the Metropolis. That all such places in large cities and towns should be abolished is now universally admitted; they are nuisances, and injurious to health. It is expected that in the course of about nine years from this date, no slaughter-house will be permitted to exist in London. 10 The following Table is compiled from the weekly returns of the Registrar General. It shows during each week the rainfall in inches, the range of temperature, the mean temperature, and whether the temperature has been above or below the average for the corresponding week in the last 50 years, as determined by Mr. Glaisher. Week ending Rainfall Range of Temperature. Mean temperature. Above the Average. Below the Average. Remarks. July 8 0.89 84.2° to 48.9° 66.1° 4.5° — Rain fell on 2 days in this week. „ 15 0.10 85.0 „ 47.0 61.4 — 0.7° Rain fell on 3 days in this week. „ 22 0.35 78.8 „ 51.2 63.6 1.8 — Rain fell on 4 days in this week. „ 29 0.15 85.0 „ 51.4 66.0 4.1 — Rain fell on 1 day in this week. Aug. 5 1.70 75.8 „ 43.2 55.9 — 6.5 Rain fell on 5 days in this week. „ 12 0.78 76.5 „ 47.5 62.0 — 0.1 Rain fell on 4 days in this week. „ 19 0.29 73.2 „ 46 6 60.0 — 1.3 Rain fell on 4 days in this week. „ 26 1.96 77.4 „ 50.7 61.7 11 — Rain fell on 5 days in this week. Sep. 2 0.03 80.1 „ 45.7 61.4 20 — Rain fell on 1 day in this week. „ 9 0.00 86 .0 „ 53.3 67.4 9.4 — No rain. „ 16 0.00 85.3 „ 52.3 67.8 10.5 — No rain. „ 23 0.16 81.2 „ 40.2 60.9 4.9 — Rain fell on 1 day in this week. „ 30 0.00 76.0 „ 43.5 59.3 4.9 1.9 No rain. Rain fell on 25 days during this quarter, to the amount of 6.41 inches. The total amount of rainfall in September, was only 1.49 inches. On Saturday, the 16th September, the thermometer at Greenwich stood at 85.3°, and on the 8th of the same month, it stood at 86°, which was the hottest day during the quarter. 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 30tlh September, 1865. Names of Medical Officers, Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhœa. Continued Fever, Typhus & Typhoid. Carbuncle. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Cholera. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Diphtheria. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Mr. Allinson., 1 1 17 17 247 31 0 19 0 2 66 3 0 0 0 2 0 0 1053 1459 Mr. Champneys 0 0 14 24 145 23 0 6 0 0 22 5 0 0 1 5 0 0 440 685 Mr. Richardson 6 2 24 16 146 34 0 1 0 0 14 3 1 0 0 1 1 0 716 965 Mr. Sequiera. 8 0 7 15 171 20 0 4 0 0 28 13 0 0 1 0 0 0 910 1177 Total 15 3 62 72 709 108 0 30 0 2 130 24 1 0 2 8 1 0 3119 4286 Corresponding Quarter of previous year. 1 199 59 28 599 83 2 27 0 0 166 16 1 0 1 10 0 0 2898 4090 12 TABLE II.—Showing the Deaths from Epidemic Diseases for the Three Months ending 30th September, 1865. District. Small-Pox Measles Scarlet Fever Diphtheria HoopingCough Diarrhœa Fever Total Remarks. Artillery — 0 1 0 0 2 2 5 Spitalfields — 0 4 0 4 11 6 25 Mile End N. Twn. 1 0 11 0 3 18 23 46 Workhouse Whitechapel, N. 2 1 1 1 4 12 1 22 Whitechapel Ch. — 0 1 0 0 5 5 11 Hospital Goodman's Fields — 0 11 0 2 7 2 22 Aldgate — 0 1 0 0 9 3 13 Total 3 1 30 1 13 64 42 144 Deaths from Epidemics for the corresponding quarter, 1864. 0 57 22 1 16 71 52 219 Four Cases of Cholera occurred in the District, one in Mile End New Town, one in Spitalfields, and two in Whitechapel Church sub-Districts. TABLE III.—Showing the Ages at Death in the Workhouse, and in the London Hospital, for the Quarter ending 30th September, 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 42 Femls 48 Corresponding Quarter of 1864. Workhouse 9 2 4 9 29 14 4 71 90 L. Hospital 0 9 11 27 24 13 0 Males 66 Femls 18 84 103 13 TABLE IV.—Ages at Death in each Registration District, tor the Three Months ending 30th September, 1865. 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 upwirds Total Remarks. Artillery 9 7 2 2 2 2 0 24 Spitalfields 42 24 3 6 7 15 1 98 Mile E. N. Town 38 33 10 13 36 21 6 157 Workhouse Whitechapel, N. 30 15 4 8 9 5 0 71 Whitechapel Ch. 11 20 12 34 28 18 0 123 Hospital Goodman's Fields 14 16 8 7 7 3 2 57 Aldgate 14 10 1 7 7 8 2 49 Totals 158 125 40 77 96 72 11 579 TABLE V.—The Births and Deaths in each Registration District, for the Three Months ending on the 30th September, 1865. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M. F. Artillery 34 32 66 12 12 24 42 0 Spitalfields 62 48 110 55 43 98 12 0 Mile End N. Town. 67 74 141 86 71 157 0 16 Workhouse. Whitechapel, N 53 43 96 39 32 71 25 0 Whitechapl. Church 40 38 78 88 35 123 0 45 London Hospital. Goodman's Fields 41 51 92 25 32 57 35 0 Aldgate 21 28 49 21 28 49 0 0 39 non-residents died in L. Hos. Totals 318 314 632 326 253 579 114 61 Excess of births over deaths, deducting the 39 non-residents, 92 Population in 1861, 78,970. TABLE VI.—Vaccination Extension Act—"Whitechapel Union—for the Year ending September 29th, 1865. 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. Mr. J. Allinson Christchurch 71 7 78 71 7 78 508 Mr. James Edmunds Old Artillery Ground 123 3 126 123 3 126 220 Mr. Alex. M. Champneys Mile End New Town 171 26 197 171 26 197 637 Mr. Edward Richardson Whitechapel North 239 29 268 239 29 268 464 Mr. C. T. Blackmail Whitechapel Church 255 29 284 255 29 284 395 Mr. J. S. Se,queira Goodman's Fields 339 67 406 339 67 406 358 Mr. John Wells Aldgate 31 2 33 31 2 33 214 Totals 1229 163 1392 1229 163 1392 2696 For the year ended September 1862 1690 166 1856 1671 164 1835 2757 Ditto ditto 1863 1913 3563 5476 1912 3561 5473 2788 Ditto ditto 1864 1288 147 1357 1228 147 1375 2876 TABLE VII.—Causes of Death at Seven Periods of Life, registered in the Whitechapel District, for the Three Months ending 30th September, 1865 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 49 40 and under 60 60 and under 80 80 and above. Total. I.—ZYMOTIC, Brought forward 118 111 29 55 72 44 2 431 Order 1—Miasmatic Order 4.—Digestive Small-Pox 1 1 1 ... ... ... ... 3 Measles ... ... 1 ... ... ... ... 1 Cancrum Oris ... 1 ... ... ... ... ... 1 Scarlatina 2 25 3 ... ... ... ... 30 Gastritis Diphtheria 1 ... ... ... ... ... ... 1 Enteritis 1 ... ... ... ... ... ... 1 Quinsy Peritonitis ... ... 3 2 ... ... ... 5 Croup ... 8 ... ... ... ... ... 8 Ascites ... ... ... ... 1 1 ... 2 Hoopmg-Cough 6 7 ... ... ... ... ... 13 Ulceratn. of Intestns Typhus Fever ... 5 8 9 10 10 ... 42 Hernia (Rupture) ... ... ... ... 2 2 ... 4 Erysipelas 2 ... ... ... ... 1 ... 3 Ileus Puerperal Fever Intussusception ... ... ... ... 1 1 ... 2 Carbuncle Fistula Influenza Stomach Disease, &c. ... ... ... ... ... 1 ... 1 Dysentery 1 ... ... ... ... ... ... 1 Pancreas Disease, &c. Diarrhœa 38 23 1 1 1 ... ... 64 Hepatitis ... ... ... 1 ... ... ... 1 Ague ... ... ... ... ... 2 ... 2 Liver Disease, &c. ... ... ... 1 1 ... ... 2 Remittent Fever ... 1 ... ... ... ... ... 1 Cancerof Œsophagus Rheumatism ... ... ... 2 ... ... ... 2 Order 6—Urinary Organs. Pyaemia ... 1 ... 1 ... ... ... 2 Cholera 1 2 ... 1 ... ... ... 4 Nephritis Order 2-Enthetic Syphilis 2 ... ... ... ... 2 ... 4 Disease of BladderNephria. (Bright's disease) Stricture of Urethra. ... ... ... ... 1 ... ... 1 Hydrophobia ... ... 1 ... ... ... ... 1 Diabetes ... ... ... 1 ... 1 ... 2 Order 3—Dietic. Retention ... ... ... ... 1 1 ... 2 Privation Prostrate Disease ... ... ... ... 1 1 ... 2 Want of Breast Mill 1 ... ... ... ... ... ... 1 Kidney Disease, &c. ... ... ... 1 3 ... ... 4 Purpura and Scurvy. 1 ... ... ... 1 ... ... 2 Order 6 —Organs of Generation. Alcoholism—Delirm. Tremens ... ... ... 1 1 ... ... 2 ,, Intemperance ... ... ... ... ... 1 ... 1 Ovarian Dropsy ... ... ... ... 1 ... ... 1 Lead Poisoning Uterus Disease, &c. Ovariotomy Order 4 —Parasitic. Thrush 1 ... ... ... ... ... ... 1 Order 7—Organs of Locomotion. Worms, &c. Spinal Disease, &c. ... ... 1 ... ... ... ... 1 II—CONSTITUTNL Bones, &c. ... ... ... 1 ... ... ... 1 Order 1—Diathetic. Order 8—Integumentary System. Dropsy ... ... ... ... 1 2 ... 3 Cancer ... 1 ... 4 4 1 ... 10 Phlegmon Mortification 1 1 ... 1 ... ... 1 4 Nœvus ... ... ... 1 ... ... ... 1 Abscess 1 ... 1 ... 1 ... ... 3 IV.—DEVELOPMENTAL. Noma Order 2 -Tubrculr Order 1—Disease of Children. Scrofula ... 1 ... ... ... ... ... 1 Tabes Mesenterica 22 16 1 ... ... ... ... 39 Premature Birth 12 ... ... ... ... ... ... 12 Phthisis (Consmptn) 1 1 7 16 22 5 ... 52 Cyanosis Hydrocephalus 4 3 ... ... ... ... ... 7 Spina Bifida III.-LOCAL. Other Malformations 1 ... ... ... ... ... ... 1 Order 1—Nervous System. Teething 8 5 ... ... ... ... ... 13 Order 2—Diseases of Adults. Cephalitis Apoplexy ... ... 1 2 10 7 ... 20 Paramenia Palsy (Paralysis) ... ... ... ... 2 1 ... 3 Childbirth ... ... ... 1 ... ... ... 1 Insanity ... ... ... 2 ... ... ... 2 Order 3-Diseases of Old People. Tetanus Epilepsy ... ... ... ... 1 ... ... 1 Old Age ... ... ... ... ... 12 9 21 Convulsions 22 6 ... ... ... ... ... 25 Order 4—Diseases Chorea of Nutrition. Atrophy & Debility 7 1 ... ... ... ... ... 8 Brain Disease, &c. 1 ... 1 ... 3 ... ... 5 Order 2—Organs of Circulation. V.—VIOLENT DEATHS. Anæmia Order 1—Accidents or Negligence. Pericarditis Aneurism ... ... ... 2 ... ... ... 2 Burns and Scalds ... 4 ... ... ... ... ... 4 Heart Disease, &c. ... 1 2 7 7 4 ... 21 Posison ... ... ... ... 1 ... ... 1 Phlebitis Suffocation 5 ... ... ... ... ... ... 5 Disease of Arteries Volence 1 3 6 11 7 7 ... 35 Phlegmasia Dolens Drowning 1 ... ... 1 ... 1 ... 3 Order 3 - Respiratory Organs. Order 3—Homicide. Murder & Manslgter 1 ... ... ... 3 ... ... 4 Laryngismus Order 4-Suicide. Laryngitis ... 1 ... 1 ... ... ... 2 Wounds ... ... ... 1 1 ... ... 2 Bronchitis 3 6 ... 2 4 7 1 23 Poison ... ... 1 ... ... ... ... 1 Pleurisy Hanging Pneumonia 6 4 1 2 4 ... ... 17 Otherwise Lung Disease, &c. ... ... ... ... ... 1 ... 1 Not Specified 3 ... ... ... ... ... ... 3 Carried forward 118 111 29 55 72 44 2 431 Grand Total 158 125 40 77 96 72 11 579 162 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT on The Sanitarg Tondition of THE WHITECHAPEL DISTRICT, For the Year ending 30th December, 1865, by JOHN LIDDLE, Medical Officer of Health. presented to the board 22nd january, 1866. London: PRINTED BY R. BIRKETT, 27, NORTON FOLGATE. 1866. TENTH ANNUAL REPORT, For the Year ending 30th December, 1865. Gentlemen, The deaths in the Whitechapel District during the quarter ending on Saturday, the 30th December, including those in the London Hospital C107), have been 620, of which 344 are of males and 276 of females. The births have been 645; of these 334 are boys and 311 girls. In the corresponding quarter of the previous year the births were 656, and the deaths 654. The births therefore are less by 11, and the deaths are less by 34. Of the deaths in the London Hospital, there have been 60 of non-residents, 9 of persons belonging to this district, and 38 of persons who died from the result of accident and from sudden death. Epidemic diseases have been fatal to 124; of these deaths 43 were caused by fever, 23 by diarrhoea, 21 by scarlet fever, 19 by hooping-cough, 15 by small-pox, 2 by measles, and 1 by diphtheria. These numbers contrast very unfavorably with those for the corresponding quarter of last year, when the total deaths from epidemic diseases were only 93. Two deaths from fever occurred in the London Hospital, one of which is thus registered—"Typhus followed by typhoid fever." The deaths caused by diseases of the respiratory organs, exclusive of consumption, are 113 ; of these 47 were caused by pneumonia, 52 by bronchitis, and 14 by other diseases of the lungs. The tubercular class of diseases was fatal to 112, of which 61 were caused by consumption. The deaths registered as occasioned by violence are 33 ; of these no less than 7 were caused by vehicles in the public streets; 6 children died from the effects of burns and scalds; 2 infants were suffocated in bed; 6 persons committed suicide. There was 1 case of manslaughter; 1 person was killed by the shock from an explosion, and 1 from injury to the eye from the cork of a bottle of lemonade. A boy aged 12 years killed himself by drinking a large quantity of " raw spirit." The deaths of children under 5 years are 236, which is 38 per cent, of the total mortality. The deaths of persons above 80 years of age are 15 ; one of whom, a female residing in Frying-pan Alley, had attained the advanced age of 101 years ; and 7 died in the Workhouse, whose ages were from 84 to 88 years; and a man died in the London Hospital at the age of 91 years. Four deaths were uncertified. The number of inqueets have been 76. In the corresponding quarter of last year the number was 83. The deaths in the Workhouse have been 106, against 91 in the corresponding quarter of the previous year. Of the total deaths 15 were caused by fever and 4 by diarrhoea. The Medical Officers of the Union have attended 3,703 new cases of illness, including 48 of small-pox, 247 of diarrhoea, and 241 of fever. In the corresponding quarter of the previous year the total cases were 3,911, including 6 of small-pox, 119 of diarrhoea, and 89 of fever. From these returns it appears, that although there have been fewer cases of illness, yet the number of cases of small-pox, diarrhoea, and fever have increased respectively from 6 to 48, 119 4 to 247, 89 to 241. Small-pox lias prevailed very extensively in King Street, Spitalfields, and the courts adjacent; and in the neighbourhood of Grey Eagle Street and Fashion Street numerous cases of fever have occurred. Five of the cases of small-pox occurred after vaccination; one of these was that of a child aged 5 years, who was vaccinated in the week previous to the attack of this disease; and although the child had six good vesicles, yet this child had smallpox very severely. Seven of the cases were of children who had not been vaccinated, and of the remainder (26) there is no record as regards vaccination. The new cases of illness in the Workhouse have been 934. Of these Mr. Champneys attended 409, and Mr. Richardson 525. Included in the total number are 2 of small-pox, 5 of scarlet fever, 2 of hooping-cough, 29 of diarrhoea, 7 of erysipelas, 3 of rheumatic fever, 3 of ague, 3 of delirium tremens, and 119 of fever. In the corresponding quarter of last year the total number of cases was 804, including 1 of small-pox, 4 of measles, 17 of diarrhoea, 3 of rheumatic fever, 1 of carbuncle, 4 of erysipelas, and 127 of fever. Two additional water-waste preventers have been erected since my last report. There are now 14 of these machines in use in this district. They continue to give general satisfaction to the poor inhabitants. A large cistern lias been erected in Eagle Place, whereby the tenants have a constant supply of water, instead of as formerly an intermitting one from a stand-tap. In three houses in New Montague Street, let out in separate tenements, slate cisterns have been erected in lieu of water-butts; and in 66 instances new water-butts have been supplied, or the old ones efficiently repaired. It would certainly be most desirable that a constant supply of water from the main should be supplied to all houses occupied by the poor; and this is what I am endeavouring to accomplish. Butts and cisterns are decidedly better than the daily half-hour supply from a stand-pipe, but these should be superseded by a supply of water direct from the main. From the returns given to me by Mr. Battram, one of the Inspectors, it appears that, from the 26th July to the 30th December, he has inspected 1,960 houses, containing about 7,840 rooms, all of which he reports that he has inspected. For the several sanitary defects in these houses, 560 notices have been served, and in 280 instances the necessary work has been completed. In the other cases the works are in progress. From the 14th September to the 30th December, 78 compulsory orders have been served for sanitary improvements to be effected in 155 houses. From Mr. James' returns, it appears that he served during the last six months 411 preliminary notices; and from Mr. Coward's returns, 354 have been served. During the same period 27 summonses have been heard at Worship Street Police Court. In these summonses there were included 149 houses. The number of births registered during the year 1865 was 2,684, viz. 1,390 males and 1,294 females. The deaths have been 2,532, viz. 1,431 males and 1,101 females. In the preceding year the births were 2,803, and the deaths 2,792. The deaths are therefore less by 260, and the births are less by 119. The deaths in the London Hospital have been 416 ; of these there were 208 of residents; and the total deaths in the Workhouse have been 362. The deaths in these two institutions are 30 per cent, of the total mortality in the district. Of the deaths in the Workhouse, there were 181 of persons who had been there for a period of less than one month, 130 for a period of less than a year, and 51 for a longer period. During the past year 314 inquests have been held. In the previous year the number was 338. The number of uncertified deaths is annually 5 ing. During this year only 14 deaths were uncertified by a medical practitioner ; while during the preceding year the number of such deaths was 25, and in 1863 the number was 32. The Medical Officers of the Union have attended 15,594 new cases of illness, including 573 cases of fever. In the preceding year the total number of cases was 14,932, including 395 cases of fever. In the Workhouse the total number of new cases of illness has been 3,535, including 535 of fever. From these returns, it appears that fever has prevailed very extensively in this district during the year 1865. The number of deaths from this disease has been 167, exclusive of the deaths which occurred in the Fever Hospital of those belonging to this district. The practice of sending cases to the Fever Hospital has only prevailed during the last three or four months; all the cases of fever occurring in the district before that time having been treated either at the residences of the patients or in the Workhouse. From table No. 8, it appears that fever has been epidemic since 1862, in which year the number of deaths from it was 250 ; in 1863 the number was 158, and in 1864 it was 170. This melancholy fact clearly indicates that our sanitary arrangements are very imperfect, and that much greater exertion must be made, and further scientific inquiries must be instituted, if this plague is to be checked. The deaths from fever during the last four years have been in proportion to the total mortality as 1 in 14, or 7 per cent.; and if we exclude from this calculation the deaths in the London Hospital, where very few cases of this disease are admitted, the proportion will be much greater. It may be fairly asked by any ratepayer how it happens, that after the Metropolis has been heavily taxed for sanitary improvements, fever should still so extensively prevail ? It is true that great improvements in drainage have taken place in this district since the passing of the Metropolis Management Act. Between 3,000 and 4,000 cesspools have been abolished, and about £10,000 has been expended in the formation of new sewers; and at the present time, with few exceptions, all the houses in the district communicate by drains with the main sewers ; and as two or three new sewers will probably be soon constructed, the owners of the few houses now undrained will be enabled to abolish the existing cesspools, and form drains to communicate with the public sewers. But when all this is done, I am afraid that fever will still continue to prevail among us, unless all those sewers, in which large deposits are continually taking place, are reconstructed. We have, it is true, removed the filth from cesspools, which formerly festered in close proximity to our houses, to the public sewers ; but if these are little, if any better, than cesspools, not much has been gained by transferring the filth from the rear of our houses to the front of them; for the public Sewers, for the most part, pass along the centres of our streets. Out from the ventilating openings of some of these sewers the most abominable emanations are given forth, whereby disease and death are spread through many families living in their viciuity. The smell is at times so bad that the inhabitants complain of it; and they have recourse to the covering of them with pieces of matting, to prevent the nuisance from making its way into their houses. Such is the faulty construction of some of these sewers that they cannot be cleansed by flushing them; and it is dangerous, owing to the large quantity of decomposing animal matter lodged in them, for any one to enter them. The only way that the offensive deposit can be got rid of is to open the sewer from the road, remove the filth to the surface, and then cart it away through the crowded streets of London, thereby occasioning an additional nuisance to the inhabitants. It would certainly be most desirable that the Surveyor should make a return to the Board of all those sewers in which deposits are continually 6 taking place, and from which offensive emanations are constantly being given off, so that all such sewers might be reconstructed. There are other causes in operation which tend to spread fever among the inhabitants of London. The first I shall mention is that of overcrowding. This evil is annually increasing; and if means be not adopted to check it, the overcrowding will soon become of an alarming extent. In order to lessen this source of danger, it has been proposed to build houses for the working classes in the suburbs of London, who, by means of cheap railway tickets, might be carried daily to and from their places of work. This plan would only benefit the people to a very limited extent; for very many of the labouring population depend for subsistance on their being, during all hours of the day, at their present places of abode; and if they were not found there, when wanted, they would lose their usual work, and be compelled to seek other occupations. Besides, the liting together in large numbers of persons of the same class would not tend to raise them in the social scale of society; for in order to improve a lower class, it is absolutely necessary that it should be mingled and associated with the class above, so that the example and superior intelligence of the upper class may influence and elevate the lower one. Not only therefore would the herding together of the working classes in a suburb be a social wrong, but it might in a time of excitement prove to be a political mistake. It is true that the labouring population now live very much by themselves, but this is no reason why they should continue to do so. The evil of the present state of overcrowding might be ameliorated to a very great extent, and the labouring class still be able to reside near to their present places of work, if most of the houses now tenanted by them were pulled down, and more commodious dwellings built upon the sites, after the best model of those which have been erected for the working classes by some of the Philanthropic Societies. There is plenty of space in this district, and in other parts of London, where there are houses of only one stoiy in height, and which have back yards of some extent, thereby affording a tolerably extensive area for the erection of new buildings. These yards are, for the most part, instead of being a benefit to the occupants, a source of nuisance, discomfort, and ill-health to them, arising from their defective drainage and the accumulation of filth which is deposited upon them. Many of these small houses of two rooms each are let at a weekly rent of 4s. 6c?. or 5s. The ground now occupied by such tenements might be purchased (under compulsory powers similar to those possessed by Railway Companies) by Public Companies incorporated by Act of Parliament, who might raise money by shares to be called up as occasion may require to clear the land of the existing hovels, and erect on the site suitable habitations for the working classes. In order to carry out this plan effectually, it will be necessary for the Company to have a prospective capital of at least £2,000,000. I feel satisfied, from what I know of the high rents that are now paid in this district for very wretched lodgings, that the Company, if judiciously managed, would give a good return in the shape of interest to the shareholders. In carrying into effect such a plan, it is quite possible, without adding to the area of the Metropolis, to provide healthy house accommodation for another 1,000,000 inhabitants.* Some persons are of opinion, that whenever a Railway Company should demolish houses in London occupied by the working classes for making a new line of Railway, that it should be compelled to purchase adjoining sites of land, and build thereon houses for all those persons whom they have dispossessed of their homes. There may be practical difficulties in the way of * The Registrar General, in his weekly returns, informs us that in the Metropolis there are 39'3 persons to an acre, in Edinburgh 39'6, in Birmingham 42'9, in Manchester 80*0, in Glasgow 85'4, and in Liverpool 94'8. In the Whitechapel District there are 194-5 persons to an acre. 7 carrying out such a scheme; but if a Railway Company could not obtain permission to demolish houses where the poor are lodged, unless they provided other houses for them, means would soon be devised to accomplish this object. The fragmentary manner in which the important subject of providing better house accommodation for the working classes has hitherto been dealt with has done but little toward its accomplishment; neither will the existing Freehold Land Societies be able to do much in this matter, nor will the extension of any of the Philanthropic Societies be of much avail. The undertaking is gigantic, and it can only be properly carried out by one or more Chartered Public Companies with large capital as above mentioned. Before, however, any further steps are taken to improve the habitations of the poor, a new Building Act must be obtained, so as to prevent the erection of houses on improper sites. In many districts in London there are numerous houses, built back to back, with no open space in the rear, so that they cannot be ventilated, and which stand on a narrow slip of ground in a confined alley, where the privy, water-closet, and dust-bin are in close proximity in the cellar, which is always damp, and from which foul emanations ascend to every room in the house. As it cannot be expected that any Public Company, with a view to profit, will buy such houses, they should be purchased by the Local Boards, and pulled down, and the ground thrown open to the public. The demolition of all such houses that admit of no sanitary improvement, and where fever is of frequent occurrence, will benefit not only the particular district where they are situated, but the whole Metropolis will reap the advantage of such a proceeding ; for it is well known that fever and other contagious diseases do not confine their ravages to the district where they originate, but they prove more or less destructive to the public health in all parts of the Metropolis. Under these circumstances, the Metropolitan Board of "Works might with fairness be called upon to contribute a certain portion of the expense. I believe that, under the provisions of the 14th and 15th Vict., c. 34, (an Act to which I drew your attention in the first report that I submitted to you,) Local Boards can purchase, under compulsory powers, such pestilential places as I have mentioned. A great deal might be done to mitigate the evils of overcrowding, if it were enacted that all houses let out in separate tenements, below a certain annual value, should be required to be registered as lodging houses; and the number of persons who should be permitted by the local authority to occupy any given room should be legibly affixed to one or more places in such room; and if this regulation were found to be transgressed, by permitting a larger number of persons to occupy it, then the person so letting the room should incur a pecuniary penalty; and any person letting an underground room for habitation, contrary to the statute, should, on conviction before a magistrate, be fined. The drinking of impure water is another source of ill-health to the community; but as this subject has been so frequently mentioned in my reports, I need not now further allude to it. I may however state, that as very impure water is drawn from the public pumps, in consequence of their being connected with shallow wells, which receive the surface drainage of the streets, and into which other abominations find their way, they should be removed. Another cause of fever and of other epidemic diseases is the prolonged retention of the dead in rooms occupied by families as day and sleeping rooms. This fruitful source of the spread of epidemic and contagious diseases has more than once been brought to your notice ; and upon one occasion, viz. so far back as July 1859, a letter, under your direction, was written by Mr. Turner, the Clerk to your Board, and forwarded to the late Sir G. Lewis, the then Secretary of 8 State of thc Home Department, setting forth the nuisance and danger to the public health from this cause in crowded neighbourhoods. The receipt of this letter was acknowledged, stating that it had been forwarded to the President of the Council of Health, and there the matter terminated. In order to meet this evil, it has been suggested that an Act might be passed forbidding the retention of a dead body in any dwelling house for a longer period than four or five days, according to the period of the year, unless such dead body should be inclosed in a well cemented leaden coffin, and not kept in a room occupied as a sleeping room. Another prolific cause of the spread of fever is the treating of a case of this disease in the room in which 'several members of a family reside. The rooms occupied by the poor are, for the most part, from the want of proper ventilation, and from other defects, unfitted for the treatment of a person suffering from so prolonged and dangerous disease. At present, however, persons in destitute circumstances, suffering from fever, are usually removed to the London Fever Hospital, the general Hospitals, or to the Workhouses. The London Fever Hospital, which is situated at Islington, will not accommodate more than 280 or 300 patients; and the deaths from fever in the Metropolis average 70 per week, the total number for 1864 being 3,689, which number multiplied by 7, the mortality being 14 per cent., will show the number of cases to be provided for in the course of the year. From this it is manifest that the present building is inadequate for the reception of all the fever cases which occur in London ; and even if it were to be enlarged to three times its present size, it would not be expedient to remove thereto patients living at a distance of several miles from the locality. The danger of removing patients suffering from fever to a distance is very great, and ought, if possible, to be avoided. If patients therefore, are to be treated away from their homes, several fever Hospitals must be erected in different parts of the Metropolis, for it appears to have been deemed objectionable to send patients ill of fever to the Workhouses. The last cause of ill-health among the population of London that I shall mention is the dirty state of our public streets, and the accumulation of house refuse in the dust-bins. These are matters which I have on former occasions brought to your notice; and as the present contracts for scavengering the districts will soon expire, I have thought it expedient again to mention the subject. It is indeed a great luxury, as well as a matter most important to the public health, to have clean streets; but this cannot be enjoyed without considerable expense being incurred. It has been considered proper, in a sanitary point of view, that all the streets in London should be cleansed every day, and that the public dust-bins should be emptied daily. For the comfort and convenience of the public, all the main thoroughfares should be cleansed before 10 o'clock in the morning, and the bye-streets and courts before 11 o'clock, or at a later hour in the day to be determined by the Board; and in order to accomplish this desirable object, it would be necessary that a very much larger staff of scavengers should be employed, and a considerably larger number of horses and carts engaged, in order that the filth of the streets, instead of being, as it is at present, suffered to remain for hours in the channels, might be carted away immediately after it has been collected. If it were ordered that all the streets should be cleansed daily before a certain hour in the day, there would be no difficulty in seeing that the contractors did their duty; but no supervision that can be devised of a practicable nature will insure the effective cleansing of the streets so long the contractor is allowed to cleanse them at any hour of the day or night. It might be expedient to engage other contractors to remove the dust than those engaged to cleange the streets. The thorough cleansing of the streets throughout the Metropolis would have an excellent moral effect upon the inhabitants of the poor localities, who would then have a great inducement to keep the 9 interior of their houses clean; for at present, from the dirty state of the public ways, the poor, who live in houses let out in separate tenements, cannot be induced to remove the dirt from the passages and stairs which is continually being trod in by each tenant. No accumulation of dust should be allowed to remain in the areas or back yards of any house for a period longer than a week. In order to obtain a thorough removal of the dust throughout the district, the contractor must be compelled to call once a week at each house to take away the dust and house refuse; and if any housekeeper should refuse to allow the dustman, when he called, to take away the dust, the Board should have the power of levying a fine upon the person so refusing, unless he can show good cause why at that particular time he could not have the dust removed. This proceeding would not perhaps be of such importance, if the nuisance arising from the prolonged retention of house refuse was confined to the inmates of the particular house; but the evil effects of decomposing animal and vegetable refuse extend to a considerable distance, and may produce ill-health among a large number of people. The poor localities will always be neglected by the dustmen so long as the practice prevails among the upper class of giving them beer-money. In justice therefore to the poor the giving of gratuities for the removal of dust should bo discontinued. Under the terms of the present contract, the dustmen are bound to call at every house in the district once a week and remove the house refuse; and any inhabitant who can prove to the Board that the dustmen have not called at his or her house once in seven days, the Board has the power of inflicting a penalty for the negligence of the contractor. If this clause of the contract be rigidly acted upon, complaints for the non-removal of dust will soon cease. So far as the cleansing of the streets is concerned, London should be regarded as one district; not that it should be managed by one Board, but that each Board should adopt a uniform system of scavengering. Unless the daily cleansing of the streets is carried out by each District Board, the public generally will not derive much advantage by the activity and liberality displayed in this matter by one or two districts only; for if the daily cleansing of the streets be not general throughout London, the dirt of the neglected districts will be carried by the traffic into the adjoining clean ones, and thus give to all of them the appearance of not having been cleansed. Only sixty-four complaints have been entered in the public complaint-book during the past year. Some of these complaints relate to the defective state of of the pavement, and others to stopped gullies and the neglect of scavengers. A separate book is kept for complaints of the non-removal of dust. The complaints concerning nuisances have been only thirty-three. If therefore nuisances were not sought for by the Sanitary Officers of the Board, they would have scarcely anything to do, and very little sanitary improvement would be effected. It is well known to the Officers of the Board that the poor will seldom complain of anything that will affect the pocket of the landlord. They are afraid to do so, although every facility is afforded to them to make their complaints known. Notice boards are placed in conspicuous parts of the district directing the public where to apply; and from the numerous complaints which are daily made at the office for the non-removal of dust, the public very well know where to obtain redress. In order still further to facilitate the obtaining information respecting nuisances, anonymous communications are always attended to. The preparations which the Board has made during the last six months to meet the probable advent of cholera among us during this year, by the appointment of an additional Inspector, and by the flushing of several of the public sewers, will be of great service in mitigating the ravages of those epidemic diseases which are more or less constantly among us, even if the much dreaded 10 cholera should not again visit us; for the same precautions which will tend to mitigate the severity of one of this class of diseases will be equally available in lessening the mortality of all the others. Under any circumstances, we are now much better prepared to deal with any extensively prevailing epidemic than we were before the formation of your Board, inasmuch as we have a staff of Sanitary Officers. In conclusion, I have to thank the Board for the promptitude with which they have carried into effect my several proposals to improve the health of the district. I am, Gentlemen, Your obedient Servant, JOHN LIDDLE. 15, Great Alie Street. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 30th December, 1865. 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. Bronchitis and Catarrh. Pleuritis and Pneumonia. Mr. Allinson 32 4 23 6 80 112 0 11 0 0 91 4 0 3 1 0 0 0 760 1127 Mr. Champneys 2 1 8 17 39 49 0 5 0 0 42 8 0 1 0 0 1 0 456 629 Mr. Richardson 7 0 11 13 41 43 0 3 0 0 15 6 0 1 1 0 0 0 608 749 Mr. Sequiera 7 4 19 15 37 37 0 9 1 0 79 13 0 3 2 0 0 0 922 1198 Total 48 9 61 51 247 241 0 28 1 0 227 31 0 8 4 0 1 0 2746 3703 Corresponding Quarter of 1864. 6 90 56 58 119 89 2 31 1 4 206 29 0 7 2 5 1 0 3206 3911 12 TABLE II.—Total number of the under-mentioned Diseases, recorded in the Books of the Medical Officers of the Union, from 1860 to 1865. 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. . 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 1865 86 51 164 280 1342 573 4 97 2 1 745 123 0 14 12 3 15594 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 Ditto ditto ditto in 1865 3535 TABLE III.—Showing the Deaths from Epidemic Diseases, for the Three Months ending 30th December, 1865. Districts. Small-Pox. Measels. Scarlet Fever. Diphtheria. HoopingCough. Diarrhoea. Fever. Total. Remarks. Artillery 1 0 0 0 0 0 0 1 Spitalfields 10 0 4 0 2 1 8 25 Mile End New Town 2 0 6 0 7 8 22 45 Workhouse. Whitechapel, North 0 1 2 0 3 6 6 18 Whitechapel Church 0 0 7 0 3 1 2 13 Hospital. Goodman's Fields 2 0 0 0 1 4 3 10 Aldgate 0 1 2 1 3 3 2 12 Total 15 2 21 1 19 23 43 124 Deaths from Epidemics for the corresponding Quarter, 1864 1 15 16 1 13 16 31 93 TABLE IV.—Showing the Ages at Death in the Workhouse, and in the London Hospital, for the Quarter ending 30th December, 1865. 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, 54 Females, 52 Corresponding Quarter of 1864. Workhouse 10 4 4 19 28 34 7 106 91 London Hospital 0 7 14 37 34 14 1 Males, 79 Females, 28 107 110 13 TABLE V.—Showing the Births, Deaths, Deaths of Non-residents, Deaths in the London Hospital and in the Workhouse, in each Year from 1857 to 1865. Year. Total Births. Total Deaths. Deaths of NonResidents. Total Deaths in the London Hospital. Total Deaths in the Workhouse. 1857 (53 weeks) 2868 2350 147 338 272 1858 2712 2444 140 325 269 1859 2826 2321 189 354 239 1860 2748 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 1865 2681 2532 208 416 362 The deaths of persons resident in the district which occurred in the London Hospital during tho year 1865 were only 47. The residences of those persons whose death was the result of accident are not given in the Registrar's returns. TABLE VI.—Ages at Death in each Registration District, for the Three Months ending 30th December, 1865. Districts. j 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 7 3 1 5 4 3 29 Workhouse. Spitalfields 22 20 8 12 6 9 1 78 Mile E. N. Town 34 29 9 36 31 41 7 187 Whitechapel, N. 18 14 6 5 8 10 1 62 Whitechapel Ch. 11 16 18 41 42 19 2 149 Hospital. Goodman'sFields 19 13 6 7 6 13 0 64 Aldgate 9 18 2 7 8 6 1 51 Totals 119 117 52 109 106 102 15 620 TABLE VII.—The Births and Deaths in each Registration District, for the Three Months ending on the 30th December, 1865. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks. M. F. M. F. Artillery 23 20 43 16 13 29 14 0 Spitalfields 68 56 124 42 36 78 46 0 Mile End N. Town 75 67 142 99 88 187 0 45 Workhouse. Whitechapel, N. 53 53 106 34 28 62 44 0 Whitechapl. Church 33 42 75 100 49 149 0 74 London Hospital. Goodman's Fields 50 45 95 28 36 64 31 0 Aldgate 32 28 60 25 26 51 9 0 60 non-residents died in Lon. Hos. Totals 334 311 645 344 276 620 144 109 Excess of births over deaths, deducting the 68 non-residents - 85 Population in 1861, 78,970. 14 TABLE VIII.—Showing the Deaths from Epidemic Diseases in the Whitechapel District, during the Years 1857,1858,1859,1860, 1861, 1862, 1863, 1864, and 1865. 1857 (53 weeks). 1858. 1859. Districts. Small-Pox. Measles. Scarlet Fever. Hooping-cough. Diarrhoea. Typhus. Total. Small-Pox. Measles. Scarlet Fever. Hooping-Cough. j Diarrhoea. Typhus. Total. Small-Pox. Measles. Scarlet Fever. Hooping-Cough. Diarrhoea. Typhus. Total. Artillery 0 6 4 9 5 3 27 1 4 9 3 5 7 29 1 0 8 7 5 4 25 Spitalfields 0 9 9 19 15 10 62 0 24 22 14 15 18 93 20 8 17 8 29 7 89 Mile End New Town 0 18 4 6 24 36 88 1 5 24 33 34 38 135 17 13 8 9 31 33 111 Whitechapel, North 1 11 2 20 25 34 93 0 6 18 19 22 22 87 9 4 15 9 27 9 73 Whitechapel Church 1 2 8 10 14 15 50 1 7 6 7 7 11 39 4 2 13 5 13 16 53 Goodman's Fields 0 8 9 15 29 8 69 0 15 6 25 12 4 62 8 1 26 8 12 12 67 Aldgate 1 6 7 10 27 11 62 1 17 2 16 13 4 53 1 3 9 4 24 12 53 Totals 3 60 43 89 139 117 451 4 78 87 117 108 104 498 60 31 96 50 141 93 471 TABLE Till.—Continued. 1860. 1861. 1862. Districts. | Small-Pox. | Measles. Scarlet Fever and Diptheria. Hooping-Cough. Diarrhoea. | Typhus. Total. | Small-Pox. Measles. Scarlet Fever and Diphtheria. Hooping-Cough. | Diarrhoea. Typhus. Total. Small-Pox. Measles. Scarlet Fever and Diphtheria. | Hooping-Cough. ] Diarrhoea. Typhus. | Total. Artillery 0 2 2 7 1 1 13 0 2 8 7 5 4 26 0 11 7 8 2 12 40 Spitalfields 8 11 17 3 11 11 61 8 6 13 22 19 9 77 4 53 12 15 14 28 126 Mile End New Town 7 8 14 14 23 23 89 7 14 8 18 25 25 97 15 26 23 11 13 120 208 Whitechapel, North 3 16 6 11 9 6 51 0 1 5 16 10 5 37 8 23 17 9 14 24 95 Whitechapel Church. 1 4 10 6 5 13 39 3 0 16 5 15 10 49 0 4 10 6 5 19 44 Goodman's Fields 2 17 6 7 12 8 52 1 1 15 17 15 6 55 0 18 16 7 6 23 70 Aldgate 0 23 4 1 6 7 41 9 3 5 13 12 6 48 6 18 6 6 15 24 75 Totals 21 81 59 49 67 69 346 28 27 70 98 101 65 389 33 153 91 62 69 250 658 TABLE VIII.—Continued. 1863 (53 weeks). 1864. 1865. Districts. Small-Pox.* Measles. Scarlet Fever and Diphtheria. Hooping-Cough. | Diarrhoea. Typhus. Total. Small-Pox. Measles. Scarlet Fever and Diphtheria. Hooping-Cough. | Diarrhoea. Typhus. Total. Small-Pox. Measles. Scarlet Fever and Diphtheria. Hooping-Cough. Diarrhcea. J Typhus. Total. Artillery 2 3 35 3 8 10 61 0 2 2 6 4 9 23 1 3 1 1 4 5 15 Spitalfields 19 4 60 6 27 21 137 1 30 14 6 12 22 85 10 15 17 10 18 22 92 Mile End New Town 14 2 56 6 30 67 175 1 21 6 15 33 89 165 4 0 20 21 35 94 174 Whitechapel, North 17 10 45 7 10 19 108 0 45 12 20 25 11 113 4 6 10 12 23 14 6SI Whitechapel Church 7 1 28 2 11 9 58 0 10 9 10 11 9 49 0 1 10 13 10 12 46 Goodman's Fields 3 6 40 16 11 12 88 2 16 -7 14 15 15 69 2 1 15 19 13 10 60 60 Aldgate 7 0 26 12 17 20 82 1 13 0 3 9 15 41 1 2 7 21 19 10 Totals 69 26 290 52 114 158 709 5 137 50 74 109 170 545 22 28 80 97 122 167 516 * In the Report of tho Small-Pox 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 anu fatality, commenced In November 1862, and reached its point of culmination in May and June 1863. 15 TABLE IX.—Causes of Death at Seven Periods of Life, registered in the Whitechapel District, for the Three Months ending 30th December, 1865. 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. Brought Forward 92 109 36 87 85 61 4 474 I.—Miasmatic. IV.—Digestive Organs. Small-Pox 1 9 5 ... ... ... ... 15 Measles 1 1 ... ... ... ... ... 2 Cancrum Oris 1 ... ... ... ... ... ... 1 Scarlatina 3 10 7 1 ... ... ... 21 Gastritis ... ... ... ... ... 1 ... 1 Diphtheria ... 1 ... ... ... ... ... 1 Enteritis ... ... 1 ... ... ... 1 Quinsy Peritonitis ... ... 1 ... ... ... ... 1 Croup 1 2 ... ... ... ... ... 3 Ascites ... ... 1 1 2 3 ... 7 Hooping-Cough 4 14 ... 1 ... ... ... 19 Ulc. of Intestines ... ... ... ... ... 1 ... 1 Typhus Fever ... 3 9 16 9 6 ... 43 Hernia (Rupture) ... ... ... ... ... 1 ... 1 Erysipelas 1 ... ... ... 1 ... ... 2 Ileus ... ... ... 1 ... ... ... 1 Puerperal Fever ... ... ... ... 1 ... ... 1 Intussusception ... 1 ... ... ... ... ... 1 Carbuncle Fistula Influenza Stomach Disease, &e. Dysentery Pancreas Disease, &c. Diarrhœa 9 7 ... 1 4 2 ... 23 Hepatitis ... ... 1 ... ... ... ... 1 Ague Liver Disease, &c. ... ... 1 1 3 3 ... 8 Remittent Fever V.—Urinary Organs. Rheumatism ... ... 2 2 1 ... ... 5 Pyaemia ... ... ... 2 1 1 ... 4 Nephritis Parotitis ... 1 ... ... ... ... ... 1 Disease of Bladder II.—Enthetic. Nephria (Bright's Disease) ... ... ... ... ... 1 ... 1 Syphilis ... 1 ... ... ... ... ... 1 Stricture of Urethra Diabetes Hydrophobia Retention III.—Dietic. Prostate Disease Privation Kidney Disease, &c ... ... 1 ... 2 ... ... 4 Want of Breast Milk. 2 ... ... ... ... ... ... 2 VI.—Organs of Generation. Purpura and Scurvy- ... ... ... 1 ... ... ... 1 Alcoholism—Delirm. Tremens ... ... ... ... ... 1 ... 1 Ovarian Dropsy ... ... ... ... ... ... ... ... Uterus Disease, &c ... ... ... 1 1 1 ... 3 „ Intemperance Lead Poisoning VII.—Organs of Locomotion. ... ... ... ... ... ... ... ... IV.—Pakasitic. Joint Disease, &c. ... ... ... 1 ... 1 ... 2 Thrush 1 ... ... ... ... ... ... 1 Bones, &c ... ... ... 1 ... ... ... 1 Worms, &c. Spinal Disease ... ... ... 2 1 ... ... 3 2.—Constitutional VIII. — IntegumentarySystem. I. Diathetic. Gout Phlegmon Dropsy ... 1 1 1 1 1 ... 5 Skin Disease, &c 1 ... ... ... ... ... ... 1 Cancer ... ... ... 1 2 2 ... 5 4.—Developmental Mortification ... ... ... ... ... ... 2 2 I. — Diseases of Children. Abscess or Tumour ... 1 ... 2 1 ... ... 4 II.—Tubercular. Premature Birth 6 ... ... ... ... ... ... 6 Scrofula ... 1 ... 1 ... 1 ... 3 Cyanosis Tabes Mesenterica 17 19 ... ... ... 1 ... 37 Spina Bifida 1 ... ... ... ... ... ... 1 Phthisis (Consumpn.) 1 ... 3 33 19 5 ... 61 Other Malformations Teething 3 2 ... ... ... ... ... 5 Hydrocephalus 2 9 ... ... ... ... ... 11 3—Local. II.—Diseases of Adults. I.—Nervous System. Paramenia Cephalitis Childbirth ... ... ... ... 1 ... ... 1 Apoplexy ... 1 1 1 6 8 ... 17 III.—Diseases of Old People. Palsy (Paralysis) ... ... ... 2 6 4 1 13 Insanity Old Age ... ... ... ... ... 16 11 27 Tetanus Premature Decay ... ... ... ... ... 5 ... 5 Epilepsy ... ... ... ... ... 2 ... 2 IV.—Diseases of Nutrition. Convulsions 15 3 ... ... ... ... ... 18 Chorea 12 ... ... ... ... ... ... 12 Brain Disease, Ac. 1 3 1 ... 2 2 ... 9 5.—Violent Deaths II.—Organs of Circulation. I.—Accidents or Negligence. Pericarditis Burns and Scalds ... 4 2 ... ... ... ... 6 Aneurism ... ... ... 1 1 ... ... 2 Suffocation 2 ... ... ... ... ... ... 2 Heart Disease, &c. ... ... 1 13 6 5 I 26 Violence ... 1 6 10 10 5 ... 33 Phlebitis Drowning ... ... 1 ... ... ... ... 1 Disease of Arteries III.-Homicide. III.—Respiratory Organs. Murder and Manslaughter ... ... ... ... ... 1 ... 1 Laryngismus IV.—Suicide. Laryngitis Wounds ... ... ... 1 1 1 ... 3 Bronchitis 11 10 1 4 16 10 ... 52 Poison ... ... 1 1 ... ... ... 2 Pleurisy ... ... ... 1 1 ... ... 2 Drowning ... ... 1 ... ... ... ... 1 Pneumonia 22 12 4 2 5 2 ... 47 Hanging Lung Disease, &c. ... ... 1 1 2 8 12 Otherwise Not Specified 1 ... ... ... ... ... ... 1 Carried Forward 92 109 36 87 85 61 4 474 Grand Total 119 117 52 109 106 102 15 620