103 WHI 114 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON The Sanitany Dondition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 31st MARCH, 1866, BY JOHN LIDDLE Medical Officer of Health. PRESENTED TO THE BOARD, 16th APRIL, 1 8 6 6. LONDON. 1866 LONDON: PRINTED BY E. J. BATH, 26, HIGH STREET, WHITECHAPEL. REPORT, FOR THE QUARTER ENDING THE 31 st MARCH, 1866. To the Board of Works, Whitechapel District. Gentlemen, During the quarter ending on Saturday, March 31st, there have been registered in the Whitechapel District 738 births and 673 deaths. Of the births, 365 were of males and 373 of females. Of the deaths, there were 388 of males and 285 of females. In the corresponding quarter of the previous year, the births were 758, and the deaths, including 126 which occurred in the London Hospital, were 741. The number of births is less by 20, and the number of deaths by 68, than in the corresponding quarter of 1865. The deaths in.the London Hospital have been 123, of these 58 were of non-residents, 10 of residents within the District, and 55 of persons who died from the result of accident and from sudden death. The greatest weekly mortality (75) occurred in the week ending on the 10th March, and the smallest (35) in that terminating on the 6th January. The deaths from epidemic diseases have been 113, viz.: 15 from smallpox, 13 from measles, 14 from scarlet fever, 1 from diphtheria, 39 from hooping-cough, 2 from diarrhoea, and 29 from fever. 4 It appears from the returns, furnished to me by the relieving officers, through the kindness of Mr. Farr, that 9 deaths from fever occurred in the fever hospital of persons sent from this district, and that one death from small-pox occurred in the small-pox hospital. By adding the 9 deaths from fever and the 1 death from small-pox which occurred in these hospitals of persons belonging to this district, the mortality from epidemic diseases has varied very little in amount from that in the corresponding quarter of last year. The increase in the number of the deaths from smallpox has been very considerable, viz.: from 3 to 15, and including one which occurred in the small-pox hospital, to 16. The deaths from diarrhoea have decreased from 9 to 2. The deaths from fever have decreased from 46 to 29, but to this number must be added 9 deaths which occurred in the fever hospital. During this quarter 3 deaths from fever occurred in the London Hospital, of these, 2 were of non-residents. Deaths from fever have occurred in the following localities : Pelham Street, Pugh's Bow, Metropolitan Buildings, Garden Place, Luke Street, Spicer Street, John Street, Halifax Street, Flower and Dean Street, Fleur de Lis Street, Glass House Street, Mansell Street, Black Lion Yard, Elizabeth Court, Whitechapel Boad, Bell Court, Wilson's Place, Freeman Street, Swan Yard, Whitechapel; and Green Street. The total deaths from zymotic diseases, including those from epidemics, have been 127, among which are 5 from croup, 5 from pyaemia, 1 from carbuncle, 1 from puerperal fever, and 3 from erysipelas. It appears from the Eegistrar General's returns, that the rain-fall during this quarter has been 8.05 inches. During the corresponding quarter of the previous year, the rain-fall was 5.84 inches, and in that of the year 1864 it was 4.27 inches. The mortality of children under 5 years of ago has been 264. This is 39 per cent. of the total mortality; and if we deduct the deaths in the London Hospital, the proportion is raised to 48 per cent. The deaths of persons above 80 have been 16. One person, a female, attained the age of 93, and another reached the advanced age of 105 years. The uncertified deaths are only 3; two of these were said to have been caused by convulsions, and the other was that of a woman whose death is thus registered: "Wife of an eating-house keeper, unknown cause of death" No inquest was held in this case. The number of inquests have been 93, of which 53 were held in the London Hospital. Among the records of the Coroner's Court, are 17 5 deaths caused by burns and scalds, 9 of children who were suffocated in bed, 36 from violence (of these, 6 were the result of injuries caused by vehicles in the public streets), and 1 from hydrophobia, caused by the bite of a dog. In the corresponding quarter of last year, the number of inquests was 80. The deaths in the Workhouse have been 119; of these, 6 were caused by measles, 2 by diarrhoea, and 6 by fever. The deaths in the Workhouse and Hospital together, have been 242, which is 35.9 per cent. of the total mortality in the district. The Medical Officers of the Union have attended 4,174 new cases of disease, including 81 of small-pox, 31 of measles, 46 of scarlet fever, 87 of hooping-cough, 128 of diarrhoea, and 102 of fever. In the corresponding quarter of last year, the total number of cases was 3,929, including 15 of small-pox, 21 of measles, 23 of scarlet-fever, 101 of hooping-cough, 124 of diarrhoea, and 116 of fever. The cases of illness in the Workhouse have been 898, of which number Mr. Champneys attended 465, and Mr. Richardson 433. The cases of zymotic diseases, included in the above returns, are 22 of measles, 1 of scarlet fever, 37 of diarrhoea, 8 of hooping-cough, 53 of fever, 4 of erysipelas, 3 of carbuncle, 6 of rheumatic fever, 3 of ague, and 2 of dysentery; there were also 3 cases of delirium tremens. It is a matter for regret that small-pox should have again visited this district in an epidemic form. The deaths from this disease, and the cases of it attended by the Medical Officers, have greatly increased. From the returns of the Medical Officers, it appears that many of the cases of smallpox occurred in persons who had not been previously vaccinated. The law respecting compulsory vaccination is either not sufficiently stringent, or the best means are not adopted by the authorities to induce or compel parents to have their children vaccinated. Mr. Richardson states that, while attending a child with small-pox, who had not been previously vaccinated, he was anxious to vaccinate another child of the same family, who, likewise, had not been vaccinated, but the father refused to have the operation performed. This child, in the course of about three weeks, was attacked with small-pox. The cow-sheds have several times been visited by the Inspectors. The last time they were inspected was on the 22nd March, when it was ascertained that the total number of cows in the entire district was 155. About 6 two months since, the total number of cows did not exceed 50. Before the cattle plague made its appearance in London, the number of cows in this district was about 400. The rinderpest, in its progress, appears to have been governed by the same law which prevails in the rise, progress, and decline, of the epidemics which affect the human race. This disease appears to have attained its culminating point about the latter end of February. The number of cases increased week by week, up to the week ending on February 17th, when the number of attacks reported to the Privy Council was 13,001, since then, the disease has gradually declined, and we may expect that in the course of a few months it will disappear, or the cases will become so few as not to attract much attention. The poison which produces epidemics seems, after a time, to lose its virulence, and, as I stated publicly in October last, the last regulation issued to arrest the diffusion of the poison, and the latest remedy suggested for the cure of the disease, would obtain undeserved credit, when the abatement of its virulence might more properly be ascribed to its diminished powers of affecting the bodies of animals. Medical science has not as yet discovered a medicine for the cure of any epidemic disease, and the attempts to cure the rinderpest by the use of any specific remedy, will end in disappointment. Since my last Quarterly Eeport, another water-waste preventer has been erected. There are now 15 in operation in the district. The following return shows the amount of sanitary work done by the Inspectors during the quarter:— Houses visited 969 Preliminary Notices served 388 Compulsory Orders issued 114 Summonses heard at Worship Street Police Court 18 Houses in which the rooms and passages have been whitewashed 238 Yards of houses paved or the pavement repaired 151 Lust-bins provided 150 Privies cleansed or repaired 126 Water-butts supplied or repaired 109 Drains in houses improved 114 Cesspools abolished 2 7 The 114 compulsory orders above mentioned contained the particulars of the sanitary improvements required in 316 houses, and the 18 summonses those that were required in 54 houses. In order to make the summonses as little oppressive as possible, it has been the practice to include in the same summons the several sanitary defects which exist in each house. This plan has hitherto answered so well, that in all the cases which have been brought under the notice of the Magistrates, the work required to be done has been carried out by the parties summoned. As the greater or less promptitude which may be displayed by the Sanitary Officers in the removal of nuisances, will affect the health of the public, every facility ought to be afforded to them in the discharge of their duties, so that there may be the least possible delay in carrying into effect the provisions of the Nuisances' Removal Act. The average number of courts visited daily by the Inspectors is 10. Many more than this number of courts could be inspected every day, if so much of the Inspectors' time were not taken up by their being compelled to visit again and again the same houses, in consequence of the great reluctance shown by the owners to comply with the Notices and Orders given for the required sanitary improvements. The over-crowding of tenements, and the inhabitation of under-ground rooms utterly unfit for human habitation, continue to be the greatest obstacles to the improvement of the health of the district. In my Quarterly Report, ending 1st July, 1865, I alluded to the operation of the Sewers' Act for the City of London, in preventing over-crowding. In the "Dublin Improvement Acts Amendment Act, 1864," it is enacted (section 24), "That from and after the commencement of that Act, any and every house, or part of a house, usually or occasionally let in separate floors, rooms or other tenements, for human habitation, for any shorter period than four weeks, at rents not exceeding three shillings per week, should be deemed a public lodging-house, irrespective of the valuation of such house, or part of a house, for assessment to the relief of the destitute poor, And the person in the beneficial receipts of the rents of such house, or part of a house, should be deemed to be the keeper of such public lodging-house, and, as such keeper, liable to the laws, rules, regulations, and penalties in that behalf." 8 As the Municipal Council of Dublin have the power of making byelaws, they have issued and directed to be posted in each lodging-house certain rules and regulations to be observed therein, the breaking of any of which rules and regulations renders the parties so doing liable to a penalty of forty shillings. If such a clause as that above quoted were enacted in any Act, having for its object the improvement of the health of London, and if power were to be given to the local authorities to make bye-laws, and to be able to enforce their observance by the infliction of penalties, a vast amount of benefit would soon be experienced by the public Dr. Mapother, the Medical Officer of Health for Dublin, in his Report for the year 1865, whilst speaking of courts and rows of small houses to which there were no privies attached, observes that the owners have been required to discontinue the letting of one house, and to construct upon its site suitable privies, one for males and the other for females. In order to facilitate the better cleansing of the streets, and the removal of dust, arrangements have been made with the Contractors to cleanse the several streets and bye places in each of the four divisions of the district, at certain hours in the day, and to finish the cleansing of the entire district before five o'clock in the afternoon; and, as regards the removal of the dust, it has been arranged that the inhabitants of the principal streets shall be furnished with a card having the letter D upon it, which card is recommended to be placed in a front window of the house, whenever the occupants require the dust to be removed. The dustmen are obliged by the contract to call twice a week at every house in the district, and, if required, they are to remove the dust and house refuse therefrom. All the public dust-bins must be emptied daily. A printed notice is affixed in every court, stating that it is required to be cleansed by the Scavengers three times in every week, and the public dust-bin to be emptied every day, and informing the inhabitants where complaints of neglect are to be made. A printed notice has been extensively circulated, cautioning all persons against the illegality of sweeping the refuse of their shops into the public ways, and intimating that any one committing such offence is liable to a penalty of forty shillings, and that proceedings will be taken to enforce the penalty. I have the honor to be, 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 31st March, 1866. 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. Swyer 51 22 23 22 38 50 2 7 0 0 79 41 0 8 0 1 2 0 979 1325 Mr. Champneys 14 0 2 44 25 23 0 5 0 0 56 6 0 1 0 4 1 0 503 684 Mr. Richardson 12 3 6 14 19 8 0 1 0 0 21 5 0 6 0 0 0 0 747 842 Mr. Sequiera 4 6 15 7 46 21 0 6 0 0 90 15 0 3 2 0 0 0 1108 1323 Total 81 31 46 87 128 102 2 19 0 0 246 67 0 18 2 5 3 0 3347 4178 Corresponding Quarter of previous year. 15 21 23 101 124 148 0 24 0 0 252 43 0 1 4 4 0 0 3201 3929 TABLE II.—Showing the Deaths from Epidemic Diseases for the Three Months ending 31st March, 1866. District. Small-Pox Measles Scarlet Fever Diphtheria HoopingCough Diarrhcea Fever Total Remarks. Artillery 0 0 0 0 2 0 1 3 Spitalfields 4 3 8 0 8 0 3 26 Mile End N. Twn. 9 7 1 0 15 2 14 48 Workhouse Whitechapel, N 1 0 1 0 5 0 3 10 Whitechapel Ch 0 2 2 1 4 0 5 14 Hospital Goodman's Fields 0 1 0 0 3 0 1 5 Aldgate 1 0 2 0 2 0 2 7 Total 15 13 14 1 39 2 29 113 Deaths from Epidemics for the corresponding quarter, 1865. 3 15 3 1 41 9 46 128 There were nine deaths in the Fever Hospital out of the fifty-eight persons who were sent by the Guardians to that Institution, and one death from small-pox out of the seventeen persons sent to the Small-pox Hospital. TABLE III.—Showing the Ages at Death in the Workhouse, and in the London Hospital, for the Quarter ending 31st March, 1866. 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 72 Femls 47 Corresponding Quarter of 1865. Workhouse 11 14 1 18 34 32 9 119 106 L. Hospital 1 12 17 47 32 14 0 Males 82 Femls 41 123 126 TABLE IV. — Ages at Death in each Registration District, tor the Three Months ending 31st March, 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 14 6 0 2 3 6 1 32 Spitalfields 26 17 10 8 12 9 1 83 Mile E. N. Town 38 43 13 25 49 44 8 220 Workhouse Whitechapel, N. 14 14 4 10 14 7 4 67 Whitechapel Ch. 18 23 18 52 43 17 0 171 Hospital Goodman's Fields 13 16 3 4 11 4 2 53 Aldgate 9 13 8 5 9 3 0 47 Totals 132 132 56 106 141 90 16 673 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 32 25 57 17 15 32 25 0 Spitalfields 62 76 138 47 36 83 55 0 Mile End N. Town. 85 96 181 122 98 220 0 39 Workhouse. Whitechapel, N. 63 59 122 39 28 67 55 0 Whitechapl. Church 41 47 88 111 60 171 0 83 London Hospital. Goodman's Fields 52 38 90 28 25 53 37 0 Aldgate 30 32 62 24 23 47 15 0 58 non-residents died in L. Hos. Totals 365 373 738 388 285 673 187 122 Excess of births over deaths, deducting the 58 non-residents 123 Population in 1861, 78,970. TABLE VI.—Causes of Death at Seven Periods of Life, registered in the Whitechapel District, for the Three Months ending 31st March, 1866. 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 i under 80 80 and above Total. Causes of Death. 0 and under 1 1 and under 5 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above. Total. I.—ZYMOTIC. Brought forward. 91 121 38 83 111 59 4 507 Order 1—Miasmatic Order —Digestive Organs. Small-Pox ... 8 5 2 ... ... ... 15 Measles 6 7 ... ... ... ... ... 13 Cancrum Oris Scarlatina 2 8 4 ... ... ... ... 14 Gastritis Diphtheria ... ... ... ... 1 ... ... 1 Enteritis Quinsy Peritonitis ... ... ... ... 2 ... ... 2 Croup 1 4 ... ... ... ... ... 5 Ascites ... ... 1 ... 1 2 ... 4 Hooping-Cough 11 27 1 ... ... ... ... 39 Ulceratn. of Intestns Hernia (Rupture) ... ... ... 1 2 ... ... 3 Typhus Fever ... 3 6 10 7 3 ... 29 Erysipelas ... 1 ... ... 1 1 ... 3 Ilens Puerperal Fever 1 ... ... ... 1 ... ... 2 Carbuncle ... ... ... ... ... 1 ... 1 Fistula Influenza Stomach Disease, &c ... ... ... ... 2 ... ... 2 Dysentery Pancreas Disease, &c Diarrhoea ... 1 ... ... ... 1 ... 2 Hepatitis ... ... ... ... 1 ... ... 1 Ague Liver Disease, &c. ... ... ... ... 2 ... ... 6 Remittent Fever Stricture of Rectum ... ... ... 1 ... ... ... 1 Rheumatism Order 5—Urinary Organs. Pyaemia ... ... 1 3 ... 1 ... 5 Cholera Order 2—Enthetic. Nephritis Syphilis 1 ... ... 5 ... ... ... 6 Disease of Bladder ... ... ... ... ... 2 ... 2 Stricture of Urethra. ... ... ... 1 ... ... ... 1 Nephria. (Bright's Disease) 1 1 1 1 Hydrophobia ... ... ... 1 ... ... ... 1 Diabetes ... ... 1 ... ... 1 ... 2 Order 3—Dietic. Stone ... ... ... ... 2 ... ... 2 Privation 1 ... ... ... ... ... ... 1 Prostrate Disease Want of Breast Milk. 2 ... ... ... ... ... ... 2 Kidney Disease, &c. ... ... ... ... 1 1 ... 2 Purpura and Scurvy. Alcoholism—Delirm. ... ... 1 ... 1 ... ... 2 Order 6- Organs of Generation. Tremens ... ... ... ... 1 ... ... 1 ,, Intemperance. ... ... ... ... 1 1 ... 2 Uterus Disease, &c. ... ... ... 1 2 ... ... 3 Lead Poisoning Ovarian Dropsy Order 4—Parasitic. Order 7—Oroans of Locomotion Thrush Worms, &c. Joint Disease ... ... 2 1 ... ... ... 3 II—CONSTITUTNL Spinal Disease, &c. ... ... ... 1 ... ... ... 1 Order 1—Diathetic. Order 8—Integu- Gout ... ... ... 1 ... ... ... 1 Me Cancer ... ... ... 1 7 3 ... 11 Phlegmon Mortification ... ... ... 1 ... ... 1 2 Skin Disease ... ... ... 1 ... ... ... 1 Abscess 2 2 ... ... ... ... ... 4 IV.—DEVELOP- MENTAL. Noma Order 2—Tubrculr Order 1—Disease of Children. Scrofula ... ... 2 ... ... ... ... 2 Tabes Mesenterica 21 12 ... ... ... ... ... 33 Premature BIRTH 5 ... ... ... ... ... ... 5 Phthisis (Consmptn.) 1 3 7 26 28 4 60 Cyanosis Hydrocephalus 4 8 1 ... ... ... ... 13 Spina Bifida HI.-Local Order 1-LOCAL Other Malformationss 3 ... ... ... ... ... ... 3 Teething 3 2 ... ... ... ... ... 5 System. Order 2—Diseases Cephalitis ... 2 1 ... ... ... ... 3 of Adults. Apoplexy ... ... ... ... 7 1 1 9 Childbirth ... ... ... 2 ... ... ... 2 Palsy (Paralysis) ... ... ... ... 2 7 ... 9 Order 3—Diseases of Old People. Insanity Tetanus Old Age ... ... ... ... ... 12 10 22 Epilepsy ... ... ... 3 ... ... ... 3 Premature Decay ... ... ... ... ... 4 ... 4 Convulsions 17 4 ... ... ... ... ... 21 Order 4—Diseases of Nutrition. Chorea Brain Disease, &c. 1 2 1 2 ... 4 ... 10 Atrophy & Debility.. 17 1 ... ... ... ... 18 Order 2—Organs of Circulation. V.—VIOLENT DEATHS. Anæmia Order 1—Accidents or Negligence. Pericarditis ... ... 1 ... ... ... ... 1 Aneurism ... ... ... 1 ... ... ... 1 Burns and Scalds 2 7 6 2 ... ... ... 17 Heart Disease, &c. ... ... 3 8 12 3 ... 26 Poison Phlebitis Suffocation 9 ... ... ... ... ... ... 9 Disease of Arteries Violence 1 1 7 12 10 4 1 36 Phlegmasia Dolens ... ... ... 1 ... ... ... 1 Drowning Order 3-Respiratory Organs. Order 3—Homicide. Murder & Manslgter. ... ... ... ... 2 ... ... 2 Laryngismus 1 ... ... ... ... ... ... 1 Order 4—Suicide. Laryngitis ... ... ... 1 1 ... ... 2 Wounds Bronchitis 7 9 3 5 27 14 1 66 Poison Pleurisy Hanging Pneumonia 13 20 1 11 12 8 ... 65 Otherwise Lung Disease, &c. ... ... ... ... 3 7 1 11 Not Specified ... ... ... ... 1 ... 1 2 Carried forward.. 91 121 38 83 111 59 4 507 Grand Total 132 132 56 106 141 90 16 673 164 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON The Sanitany Condition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 30th JUNE, 1866, BY JOHN LIDDLE Medical Officer of Health.. PRESENTED TO THE BOARD, 5th JULY, 1866. LONDON. 1866. LONDON: PRINTED BY E. J. BATH, 26, HIGH STREET, WHITECHAPEL. REPORT, FOR THE QUARTER ENDING THE 30th JUNE, 1866. To the Board of Works, Whitechapel District. Gentlemen, The births registered in the Whitechapel District during the quarter ending on Saturday, the 30th June, are 630, of these, 321 are boys and 309 girls. The deaths are 681: of these, 382 are of males and 299 of females. In the corresponding quarter of the previous year, the births were 645, and the deaths 592. The number of births, therefore, during this quarter, are less by 15, and that of deaths, greater by 89. In this quarter, the deaths have exceeded the births by 51. The deaths in the London Hospital have been 98; of these, 49 were of nonresidents, 10 of persons who had resided in this district, and 39 of persons who died from the result of accident and from sudden death. The weekly mortality has varied from 63 to 40; the average number of deaths per week having been 52.3. The deaths from Epidemic diseases have been 165, while, for the corresponding quarter of last year, they were only 99. The great increase in this class of diseases is shown under the 4 heads of Measles and Small-pox; the deaths from the former being 71, and from the latter 12. There have been 12 deaths from Fever in the Fever Hospital, of persons who had been removed from this district to that Institution, and 3 deaths from Small-pox in the Small-pox Hospital. The total deaths, therefore, from Epidemic diseases, have been 180, which is 26.4 per cent. of the total mortality in the district; and excluding from this calculation the deaths in the London Hospital, the proportion is as high as 30.8 per cent. Erom the returns of the Registrar General, it appears that the rain-fall during this quarter has been 8.00 inches. During the corresponding quarter of the previous year, the rain-fall was 7.24 inches. The undermentioned localities are those in which deaths from Fever have occurred, viz:—Pelham Street, Chicksand Street, North Place, Hunt Street, Samuel Court, Spital Street, Brick lane, Charlotte Street, Swan Yard, Fisher's Alley, Frying-pan Alley, Sandy's Row, Wilke Street, Wood Street, Osborn Street, Old Montague Street, Prince's Street, Royal Mint Street, and Queen Street. The deaths caused by diseases of the respiratory organs, exclusive of consumption, are 122. The tubercular class of diseases was fatal to 118, of which, 89 were caused by Phthisis or Consumption. The number of deaths caused by violence has been 28, of these, 5 were caused by vehicles in the public streets. There are recorded 5 deaths from drowning, of which, 4 appear to have been accidental, and the other was that of a young woman aged 16, who was found dead in a water-butt. There have been 4 cases of suicide and 1 of manslaughter. A child, three months old, was suffocated in bed. The death of a child, 9 years of age, is ascribed to the breaking of a crochet needle in the knee, and a boy, 14 years old, died from swallowing a scarlet-bean. The number of inquests has been 73. In the corresponding quarter of last year, the number was 78. A bricklayer's labourer is said to have died from injuries to the head, but, in this case, an inquest was not held. The uncertified deaths have been 10. They relate principally to infants, who are said to have died of convulsions. Inquests should be held in these cases, or some other official inquiry instituted into the cause of death. 5 The mortality of children under 5 years of age, has been 284, which is 41.7 per cent. of the total deaths. The proportion of deaths of young children to the total mortality, varies, however, in the several sub-districts. Thus, in the Whitechapel, North, sub-district, it is 57.7 per cent.; in the Goodman's Fields, it is 64.8 per cent.; and in the Artillery sub-district, it is 58.6 per cent.; while in that of the Whitechapel Church sub-district, it is only 17.2 per cent. of the total deaths. This difference, as regards the last-named sub-district, is accounted for by the deaths in the London Hospital, in which Institution only 3 deaths of children, under 5 years of age, are recorded. The patients in this Institution are for the most part adults. The deaths in the Workhouse have been 89 : of these, 54 were of males and 30 of females. The deaths in the Workhouse and Hospital together, have been 182, which is 26.7 of the total mortality in the district. The deaths from epidemic diseases in the Workhouse, have been 11, viz.: 1 from Small-pox, 6 from Measles, 2 from Diarrhcea, and 2 from Fever. The Medical Officers of the Union have attended 4,209 new cases of disease, including 105 of Small-pox, 359 of Measles, 38 of Scarlet-fever, 78 of Hooping Cough, 215 of Diarrhoea, and 01 of Fever. In the corresponding quarter of the previous year, the total number of cases was 3,076, including 8 of Small-pox, 18 of Measles, 18 of Scarlet-fever, 56 of Hooping Cough, 251 of Diarrhoea, and 108 of Fever. The cases of illness in the Workhouse have been 885 : of which, Mr. Champneys attended 473, and Mr. Richardson 412. The cases of Zymotic disease, included in these returns, are, 5 of Small-pox, 11 of Measles, 3 of Scarlet-fever, 24 of Diarrhoea, 13 of Fever, 4 of Erysipelas, 4 of Carbuncle, 1 of Rheumatic Fever, 3 of Ague, and 4 of Dysentery; there were also 10 cases of Delirium Tremens. The licensed cow-sheds in the district are 32 in number, and on the 7th of July, the number of cows therein was 134. In the Appendix to this Report (Table 6), there is a list of the cow-keepers, the localities of the cow-sheds, and the number of the cows in each cow-shed in the district. In consequence of the severe outbreak of the Cattle Plague during the summer, autumn, and winter of last year, more stringent regulations should before the next licensing day be enforced by the Board, for the better observance 6 cleanliness, of ventilation, and drainage of those places; the more frequent removal of dung should be insisted upon, and the number of cows so reduced, that each cow should have a space of at least 1,000 cubic feet. That no cowhouses should be licensed unless the dung-pit and the place for storing grains are without the walls of the cow-shed. All dung from cow-sheds, slaughter-houses, stables, and lay-stalls, should bo vested in Local Boards, who should be compelled to remove the same every day; for, unless the local authorities are intrusted with the power of removing the dung from the several places in their respective districts where it is accumulated, it will be retained by the owners until it can be sold to the best advantage. No new cow-shed, nor new slaughter-house, should, on any account, be licensed in this district, for these businesses are nuisances and prejudical to health in crowded neighbourhoods. Frequent complaints have been made to this office of the unhealthy condition of Frying-pan Alley and Charlotte Court. In the former, Fever has prevailed to a very great extent; but previous to any outbreak of this disease, the Court was inspected, and orders were served upon the owner to whitewash the rooms and passages of the houses, to improve the drainage, and to re-pave the back yards. While these improvements were in progress, fever made its appearance among some of the inhabitants, and the disease soon spread to others. On personally inspecting these houses, I found that they were, for the most part, inhabited by foreign Jews, and were overcrowded; the back-yards were very small, and the small space of these yards was being further diminished by the addition of two rooms, one of which was occupied by a family, and the other was in the course of erection. It appears that the Building Act does not confer power on any authority to interfere in such a case, so as to prevent the building of additional rooms to houses, which are already too closely packed together, without a sufficient open space at the rear. I referred this case to the Metropolitan Board, who directed the attention of the District Surveyor to the subject. Charlotte Court, in which there has lately been several cases of Measles, Hooping Cough, and Small-pox, was specially inspected by the Inspector, whose report was laid before the Committee of Works, when the Surveyor was directed to examine and report upon the drainage of the locality. It appears, from the report of the Inspector, that the basements of the houses in this Court are about three feet below the surface of the adjoining street. The Court is 345 feet in length and 9 feet in width, and contains 43 houses, each having 3 rooms, a wash-house and small yard at the rear. There were 7 two cases of overcrowding, viz.: one at No. 9, where, in a room, measuring 12 feet x 10 x 7 there was a family of 8 persons, consisting of the father and mother and six children; and the other at No. 15, where, in a room, measuring 10 feet x 8 x 7 a family of 5 persons lived. In the former case, the cubic space for each person was 105 feet, and in the latter 112 feet. Several cases of indecent occupation were also observed. This Court is a cul cle sac, and the want of a free current of air is apparent from the fact, that the dense and offensive vapour from the malt-roasting premises in the New Boad, which, at times, pervades the neighbourhood, remains here for a considerable period before it is dispersed. Proceedings have been taken to abate the overcrowding in two of the houses in this Court. The following return shows the amount of worlc done by the Inspectors during the quarter:— Houses visited 1295 Preliminary Notices served 311 Compulsory Orders issued 97 Summonses heard at Police Courts 18 Houses in which the Rooms and Passages have been whitewashed 156 Yards of Houses Paved or the Pavement repaired 131 Dust-bins provided 99 Privies cleansed or repaired 141 Water-butts supplied or repaired 103 Drains in Houses improved 140 Cesspools abolished 4 Accumulation of Dung and other offensive matter removed 73 Area Gratings, Cellar Flaps, &c., repaired 15 In my first Report for 1856, I enumerated 148 Courts which were so badly paved as to be a nuisance and injurious to health. This number is now reduced to 13, and the owners have again been served with notices to effect the necessary repairs. In some cases, however, when the same Court is held by more than one owner, great delay in carrying out improvements takes place, in consequence of the difficulty of obtaining the joint co-operation of the several owners. If the Board could hold a lien upon the property repaired by them, improvements in the district would be more easily carried out. The undermentioned Courts are those in which the pavement is still very defective, viz.: "Williams's Bents, Brunswick Place, Mundy's Place, Kittleby Court, Frostie Place, John's Place, Hunt Street, Green Dragon Yard, Dale Place, Samuel Court, Ann's Place, Wilson's Place, Harrison's Buildings, Spitalfields, and New Court, Fashion Street. 8 Although a great improvement has been effected in the water supply, it is still far from being in a satisfactory condition. There are at the present time 24 Courts in this district, which are supplied with water from a stand-tap only, from which water flows daily, Sundays excepted, for a period of about twenty minutes, and if the inhabitants are not at home when the water is .turned on, they must either go without a supply or obtain it from their neighbours. The names of the Courts so supplied are Eose Court, Farthing Alley, Three Compasses Court, Vincent's Place, Haye's Back Court, Providence Court, Grower's Place, Little Tongue Yard, Green Dragon Yard, Caroline Place, Bell Place, Montague Court, Eele Place, Castle Alley, Jacob's Court, Samuel Court, Boundary Court, Pope's Head Court, Coburg Court, Yine Yard, Angel Alley, John's Place Chicksand Street, New Court Dorset Street, and Wilke Court. In most of the Courts, where there are butts or cisterns, the receptacles are not sufficiently l&rge to hold what is required for the daily use of the inhabitants ; moreover, when a butt is provided for each house, it is generally found that it is without a cover or tap, and in a very dilapidated and dirty condition. The only proper method of supplying water to the poor localities, is to have it direct from the main, without the intervention of any receptacle, so that the inhabitants can, at all times, procure good and wholesome water for domestic use. All that is required to be done to effect this desirable object, is for the landlords to make arrangements with the Water Companies so that a pipe, having a small bore, might be connected with the main. This pipe shoixld be provided with a well-made screw-tap. All the houses, about 18 in number, in New Gourt, Fashion Street, are supplied with water in the way as above indicated. The taps do not readily get out of order, for, upon inquiry, i was told by a tenant that, during a period of 9 years, it had been necessary to renew the tap only once. The constant supply will not become general until there is an amendment of the Metropolis Water Act (1852). The 15th clause of this Act provides, that when four-fifths of owners or occupiers of the houses supplied by a main, shall, by writing under their hands, have required the Campany to provide a constant supply of water, then the Company shall be bound to provide a supply in that manner, This clause is practically inoperative, in consequence of the difficulty of obtaining the desire, in writing, of four-fifths of the owners and occupiers of the houses. It should be made compulsory upon the Companies to supply water on the high pressure system to every locality that the Local Board shall require to be thus supplied. There is now considerable difficulty of obtaining a proper supply of water to the poor localities; and if landlords are contumacious, and refuse to lay on a proper service for a due supply of water to their tenants, then, the only way of 9 compelling them to do so, is by taking proceedings for overcrowding, in the manner provided by the Nuisances' Removal Act for England (1855). It is probable that there would be very little difficulty of procuring an adequate supply of water for every house, if it were enacted that the word "Nuisances," in the 8th section of the Nuisances' Removal Act included any house not having a sufficient water supply. The Public Health Bill, now before the House of Commons, provides in the 22nd clause, that the word "Nuisances" shall include any house or part of a house, so overcrowded as to be dangerous or prejudicial to the health of the inmates. But the word "Nuisances" should also include any house not provided with a privy or water-closet, so constructed as not to be offensive; and it should also include any house not provided with a proper dust-bin. The sanitary laws, in short, require to be simplified. The overcrowding of houses will not be prevented until the owners of small houses, let to weekly tenants, are compelled to register such houses as lodging-houses, and the Local Boards be empowered to make such laws, rules, and regulations, as they deem necessary for the preservation of the health of the occupiers. I have the honor to be, 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 June, 1866. 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. Swyer 33 72 19 23 55 19 0 2 0 0 19 37 0 8 0 1 3 0 812 1103 Mr. Champneys 21 55 8 22 31 22 0 8 0 1 22 5 0 1 2 1 0 0 545 745 Mr. Richardson 43 81 5 14 42 7 0 0 0 0 14 3 0 2 1 0 0 0 697 909 Mr. Sequiera 8 151 6 19 87 13 0 4 0 0 34 7 0 1 2 0 1 0 1119 1452 Total 105 359 38 78 215 61 0 14 0 1 89 52 0 12 5 2 4 0 3173 4209 Corresponding Quarter of previous year. 8 18 18 56 251 108 1 15 1 0 136 25 3 5 2 7 1 2 3019 3676 TABLE II.—Showing the Deaths from Epidemic Diseases for the Three Months ending 30th Jane, 1866. District. Small-Pox Measles Scarlet Fever Diphtheria HoopingCough Diarrhœa Fever Total Remarks. Artillery 0 5 6 0 5 0 4 20 Spitalfields 2 8 0 0 2 1 2 15 Mile End N. Twn 5 16 6 0 4 2 13 46 Workhouse Whitechapel, N 2 15 1 0 4 4 3 29 Whitechapel Ch 1 6 1 1 0 1 3 13 Hospital Goodman's Fields 1 13 4 0 5 2 1 26 Aldgate 1 8 3 0 2 1 1 16 Total 12 71 21 1 22 11 27 165 Deaths from Epidemics for the corresponding quarter, 1865. 1 0 12 1 23 26 36 99 One case of Cholera occurred in the sub-District of Mile End New Town. Six deaths from Pyæfmia are recorded, and three from Erysipelas. Sixty.eight cases of Fever were sent to the Fever Hospital, of which twelve died, and twenty-two were sent to the Small Pox Hospital, of which three died. TABLE III.-—Showing the Ages at Death in the Workhouse, and in the London Hospital, for the Quarter ending 30th June, 1866. 0 and under l 1 and under5 5 and undr20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Total Males 54 Femls 36 Corresponding Quarter of 1865. Workhouse 7 8 3 20 21 22 3 84 79 Males 56 L. Hospital 0 3 18 29 33 15 0 Femls 42 97 98 TABLE IV. —Ages at Death in each Registration District, tor the Three Months ending 30th June, 1866. Districts. 0 and under 1 1 and under 5 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Total Remarks. Artillery 11 16 3 4 9 2 1 46 Spitalfields 16 27 7 11 17 6 1 85 Mile E. N. Town 30 40 14 36 39 30 5 194 Workhouse Whitechapel, N. 19 22 7 6 12 4 1 71 Whitechapel Ch. 11 13 22 32 38 21 2 139 Hospital Goodman's Fields 19 29 5 8 10 3 0 74 Aldgate 10 21 4 14 16 4 3 72 Totals 116 168 62 111 141 70 13 681 TABLE V.—The Births and Deaths in each Registration District, for the Three Months ending on the 30th June, 1866. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks. M. F. M. F. Artillery 23 26 49 22 24 46 3 0 Spitalfields 65 56 121 56 29 85 36 0 Mile End N. Town. 71 80 151 109 85 194 0 43 Workhouse. Whitechapel, IT 64 47 111 41 30 71 40 0 Whitechapl. Church 32 31 63 74 65 139 0 76 London Hospital. Goodman's Fields 39 45 84 48 26 74 10 0 Aldgate 27 24 51 32 40 72 0 21 49 non-residents died in L. Hos. Totals 321 309 630 382 299 681 89 140 Excess of deaths over hirths, deducting the 49 non-residents 2 Population in 1861, 78,970. Table VI—Cow Keepers in the Whitechapel District. July the 7th, 1866. NAMES. ADDRESSES. NUMBER OF COWS. Ayres, James 59, Back Church Lane None. Ayres, Thomas 2, Gower's Walk Five. Bird, William Gower's Walk. None, Brown, Walter Preston Street Two. Base, Henry 19, Charles Street None. Brown, Frederick Old Montague Street Seven. Barker, Daniel Saw Yard Four. Bates, Levi King Edward Street None. Davis, John Black Lion Yard Two. Davis, Elizabeth Royal Mint Street One. Dewson, John Lambeth Street Five. Foster, Edward 27, Pelham Street Fourteen. Griffith, David Bell Lane None. Gilbert, John 63, Royal Mint Street None. Green, William Sharter's Rents Passage None. Hurley, John Crispin Street Eleven. Johnson, Archibald Boar's Head Yard None. Le Beau, G Cartwright Street None. Le Beau 127, Royal Mint Street Two. Lee, Charles 58, Goulston Street Eleven. May, Robert 29, White Lion Street Six. McAvoy, Thomas 8, Colchester Street Four. McAvoy, Phillip Spital Street None. Moore, John Darby Street None. Neill, Thomas Brown's Lane One. Pool, Marcus White's Row Twenty-six. Sole, Isaac Weaver's Arms Yard Twenty. Williams, Elizabeth 19, Brown's Lane Four. Williams, Thomas White's Row Two. Watson, Thomas Old Montague Street Two. Webb, John Grey Eagle Street Four. Young, George Whitechapel Road One. TABLE VII. — Causes of Death at Seven Periods of Life, registered in the Whitechapel District, for the Three Months ending 30th June, 1866. 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 1 5 and under 20 1 20 and under 40 40 and under 60 60 and under 80 80 and above. Total. I.—ZYMOTIC. Order 1—Miasmatic Brought forward 85 162 44 85 103 50 1 530 Small-Pox 2 5 2 3 ... ... ... 12 ORGANS. Measles 29 47 2 ... ... ... ... 71 Cancrum Oris Scarlatina ... 18 2 1 ... ... ... 21 Gastritis ... ... ... ... 1 ... ... 1 Diphtheria 1 ... ... ... ... ... ... 1 Enteritis Quinsy Peritonitis ... ... 1 ... 2 1 ... 4 Croup 1 6 ... ... ... ... ... 7 Ascites ... ... 2 1 1 1 ... 5 Hooping-Cough 9 10 3 22 Ulceratn of Inestns ... ... ... ... ... ... ... ... Typhus Fever ... 2 7 3 14 1 ... 27 Hernia (Rupture) ... 1 ... 2 1 1 ... 5 Erysipelas ... ... ... 3 1 1 ... 5 Ileus Puerperal Fever ... ... ... ... 1 ... ... 1 Intussusception Carbuncle Fistula Infiuenza Stomach Disease,&c ... ... ... 3 1 ... ... 4 Dysentery Pancreas Disease,&c Diarrhœa 3 2 3 1 ... 1 1 11 Hepatitis Agne Liver Disease,&c ... ... ... 1 5 ... ... 6 Remittent Fever Stricture of Rectum ... ... ... 2 ... ... ... 2 Rheumatism ... ... ... ... ... 1 ... 1 Order 5—Urinary Organs Pyæmia ... ... 2 2 2 ... ... 6 Cholera 1 ... ... ... ... ... ... l Nephria ... ... 1 1 ... ... ... 2 Order 2—Enthetic. Disease of Bladder... Nephria. (Bright's disease) ... ... ... 3 6 1 ... 10 Syphilis 3 ... ... 3 1 ... ... 7 Stricture of Urethra. Hydrophobia Diabetes Order 3—JDietic. Stone Privation Prostrate Disease Want of Breast Milk. Kidney Disease, &c. ... ... ... 1 1 ... ... 2 Purpura and Scurvy. Order 6—Organs of Generation. Alcoholism-Delirm Tremens ... ... ... ... 1 ... ... 1 Uterus Disease, &c. ... ... ... 1 ... 1 ... 2 ,, Intemperance. Ovarian Dropsy Lead Poisoning Ovariotomy Order 4—Parasitic. Order 7—Organs of Locomotion. Thrus Worms, &c. Joint Disease ... ... 1 ... ... ... ... 1 II—CONSTITUTNL Spinal Disease, &c ... ... ... ... 1 ... ... 1 Order1-Diathetic Order 8—Integumentary System. Dropsy ... ... 1 ... ... 3 ... 4 Cancer ... ... ... 3 3 1 ... 7 Phlegmon Mortification ... ... ... ... ... 2 ... 0 Skin Disease Abscess or Tumour 1 1 ... ... ... ... ... 2 IV.—DEVELOPMENTAL. Order 2—Tubrculr. Order 1—Disease of Tabes Mesenterica 6 10 1 1 ... ... ... 18 Premature Birth 10 ... ... ... ... ... ... 10 Phthisis (Consmptn.) ... ... 7 46 29 4 ... 86 Cyanosis 4 6 ... ... ... ... ... 10 Spina Birth 10 ... ... ... ... ... ... 10 III.—LOCAL. Other Malformations 2 1 ... ... ... ... ... 3 Teething 4 2 ... ... ... ... ... 6 Order 1—Nervous Order 2—Diseases Cephalitis ... 3 1 1 ... ... ... 5 Childbirth ... ... ... 2 ... ... ... 2 Apoplexy ... 2 ... 5 1 ... 8 Order 3—Diseases of Old People. Palsy(Paralysis) ... ... 3 2 1 5 ... 11 Insanity Old Age ... ... ... ... ... 7 12 19 Tetanus ... ... ... ... 1 1 ... 2 Premature Decay Epilepsy ... ... ... ... ... 1 1 2 Convulsions 15 8 1 ... ... ... ... 24 Order 4—Diseases of Nutrition. Chorea Brain Disease, &c ... 2 1 ... 1 ... ... 4 Atrophy & Debility 14 ... ... 1 ... ... ... 15 Order 2—Organs of Circulation. V.—VIOLENT DEATHS. Anæmia Order 1—Accidents or Negligence. Pericarditis ... ... 1 ... ... ... ... 1 Aneurism ... ... ... ... 1 ... ... 1 Burns and Scalds ... 1 6 1 1 ... ... 9 Heart Disease, &c ... ... 1 6 13 5 ... 25 Poison Suffocation 1 ... ... ... ... ... ... 1 Epistaxis ... ... ... ... ... ... ... ... Disease of Arteries Violence ... 1 6 3 13 5 ... ... Phlegmasia Dolens Drowning ... ... ... 2 1 1 ... 4 Order 3—Homicide. Order 3—Respiratory Organs. Murder & Manslgter. ... ... ... 1 ... ... ... ... L arynismus 1 ... ... ... ... ... ... 1 Order 4—Suicide. Laryngitis 1 1 ... ... ... ... ... 2 Wounds ... ... ... 1 1 ... ... ... Bronchitis 1 8 1 4 21 20 ... 55 Poison ... ... ... ... 2 ... ... 2 Pleurisy Hanging ... ... ... ... ... 1 ... 1 Pneumonia 14 32 3 55 4 ... ... 58 Drowning ... ... 1 ... ... ... ... 1 Lung Disease, &c ... ... ... ... 4 3 ... 1 Not Specified ... ... ... ... 1 ... ... 1 Carried forward 85 162 44 85 103 50 1 530 Grand Total 116 168 62 111 141 70 13 681 105 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT The sanitatg Condition OF THE WHITECHAPEL DISTRICT, FOR THE Quarter ending 29th September, 1866, BY JOHN LIDDLE, Medical Office of Health. LONDON: PRINTED BY T. PENNY, 121, LEMAN STREET, WHITECHAPEL. REPORT OF THE MEDICAL OFFICER OF HEALTH, FOR THE QUARTER ENDING 29th SEPTEMBER, 1866. To the Board of Works, Whitechapel District. Gentlemen, In the quarter that ended on Saturday, September 29th, the births registered in the Whitechapel District were 582, viz: 310 boys, and 272 girls. The deaths during the same period were 1479; of these, there were 774 of males and 705 of females. In the corresponding quarter of last year, the total births were 632, and the deaths 579. The increase in the mortality, therefore, during this quarter has been 900, or 39 per cent. The increase in the number of deaths in the London Hospital over that of the corresponding quarter of the previous year has been 309. The total deaths in the London Hospital have been 393; of these, there have been 304 from cholera, of which 225 were of non-residents, and 79 of residents within the district. In the temporary Cholera Hospital in Commercial Street, there have been 87 deaths from the 20th of August to the 30th of September; of these, 61 were of non-residents, and 26 of persons belonging to this district. The deaths from Epidemic diseases have been 1026, viz.: 8 from Small Pox, 49 from Measles, 19 from Scarlet Fever, 1 from Diphtheria, 17 from Hooping Cough, 98 from Diarrhœa, 25 from Fever, and 809 from Cholera. The proportion of deaths from Epidemic diseases to the total deaths is 69 per cent. It appears from the returns of the Registrar General, that the rain-fall during this quarter has been 7.84 inches. During the corresponding quarter 4 of the previous year, the rain-fall was 6.41 inches. During the five weeks from the week ending July 7th, to that ending August 4th, the rain-fall was only 1.69 inches, whereas in the corresponding weeks of 1865, the rainfall was 3.19 inches. From Friday, the 6th of July, to Saturday, the 28th, no rain fell in London. During the last three weeks of July, the temperature in the shade was above the average for that period of the year; and on Friday, the 13th, the temperature was 87.2°. For the week ending July 21st, the deaths from Cholera in London were 308. The deaths in the "Workhouse have been 129; of these, 2 were caused by Diarrhoea, 1 by Fever, and 60 by Cholera. The Medical Officers of the Union have attended 4547 new cases of disease, including 34 of Small-pox, 244 of Measles, 55 of Scarlet Fever, 41 of Hooping Cough, 1021 of Diarrhœa, 80 of Fever, 26 of Choleraic Diarrhœa, and 50 of Cholera. These returns give but a very imperfect idea of the cases of sickness which have occurred during the quarter, for it became necessary to appoint 11 additional Medical Practitioners to attend to the numerous cases of Diarrhoea and of Cholera; but I must defer giving the details of the cases of sickness which were attended by the increased staff, until the time arrives for presenting my Annual Report, when I hope to be able to lay before you a full account of the rise, progress, and decline of the present Epidemic of Cholera; and also, to record the several proceedings that were adopted in this district to endeavour to mitigate the sufferings of the afflicted, and to prevent the spread of the disease. The cases of illness amongst the female inmates in the Workhouse attended by Mr. Eichardson have been 462; of these, 74 were of Cholera and Choleraic Diarrhoea, 2 of Fever, 2 of Small-pox, and 2 of Erysipelas. The return of Mr. Champneys has not been received. From the notices sent to the Office of the Board, it appears that there were 38 applications for the renewal of the license for slaughter-houses; in each case the license was granted. For the renewal of the license for cowsheds, there were 27 applications; of these, two have been withdrawn, and eight have been adjourned until the 19th October, in order that the necessary alterations in the premises may be completed. All the slaughter-houses and cow-houses were inspected by myself and the Inspectors. As regards the former, they are in a similar condition to that of last year, when the license was granted, and they are generally in as good a condition as such places can possibly be in such densely populated districts as that of Whitechapel : and as regards the latter, I have, in order to guard against the 5 recurrence of the ravages of the rinderpest, recommended that the number of cows in each cow-shed should be limited to the amount of cubic space therein; and I have advised the Board to oppose the renewal of any license, where provision is not made for affording to each cow a breathing* space of 1000 cubic feet. This minimum space for each cow has been determined by competent authority, and it is now generally enforced throughout the whole metropolis. Unless this regulation, which has been proposed, not only for the benefit of the public, but also of the cow-keeper himself, be rigidly adhered to, it is to be hoped that, on the next application, the license will be refused. In the Appendix to this Report I have given the measurement of all the cow-sheds in the district. In some of the cow-sheds, pumps are used for the purpose of cleanliness, and also for the dilution of the milk. The use of these pumps ought to be discontinued, and the supply of water should be obtained from the Water Company. The water in all the superficial wells in London is more or less contaminated, and in the cow-houses, the water is in constant danger of being still further polluted by the soaking into the wells of the fluid filth of the premises. Milk diluted with the impure water from these pumps is unwholesome, and may, at times, be poisonous. Since my last quarterly report was issued, four additional water waste preventers have been erected for the use of the inhabitants of the following places, viz.: Jones' Buildings, Montague Court, Inkhorn Court, and Angel Alley. Twenty-one of these machines are now in use in this district, and they continue to give great satisfaction, not only to the poor, but to the Water Companies. There are two or three Courts in this district that have been supplied with water, for some years past, from cisterns placed underneath the pavement, from which water is drawn by means of a pump. This plan has recently been advocated by Mr. Quick, the engineer for the Yauxhall Water Company. It is, however,. objectionable, for the cistern cannot be cleansed without a great deal of trouble and some expense, and consequently it is seldom or never cleansed. The best plan of supplying water to the poor, is by means of a pipe in direct communication with the main, without the intervention of any receptacle. The pipe could be furnished with an ordinary tap, so that pure water may at all times be obtained by the poor without labour and loss of time. This plan, as mentioned in my last report, has been carried out with success in one of the Courts in this district, in which there are 18 houses. The following return shows the amount of work done by the Inspectors during the quarter:— 6 Preliminary Notices served 1178 Compulsory Orders issued 144 Summonses heard at the Police Courts 27 Houses in which the Rooms and Passages have been whitewashed 566 Yards of Houses Paved, or the Pavement repaired. 248 Dust-bins provided 150 Privies cleansed or repaired 202 Water-butts or Cisterns supplied or repaired 286 Drains in Houses improved 178 Cesspools abolished 8 Accumulation of Dung and other offensive matter removed 136 Area Gratings, Cellar Flaps, &c., repaired 32 Ventilation of Houses improved 29 Houses closed, being unfit for human habitation 2 Rooms overcrowded abated 10 Animals so kept as to be a nuisance 11 Notices given to Police of Rooms sub-let 5 The 144 compulsory orders mentioned contained the particulars of the sanitary improvements required in 353 houses, and the 27 summonses those that were required in several houses. One summons was taken out at the Worship Street Police Court, under the Public Health Act, 1866. During the quarter, it has been necessary to take legal proceedings against several manufacturers for not conducting their businesses in such a manner as to prevent the escape of noxious effluvia. In the two cases of bone boiling and the storing of bones heard at Worship Street Police Court, the Magistrate ordered the bones to be removed daily ; and he ordered that the business should be suspended during the prevalence of the Cholera,, or at all events during the next two months. This order has been attended to, and the neighbourhood has been entirely freed from the nuisance arising from these noxious businesses ; but I am afraid that as the two months have now expired, the nuisance will be again repeated; but if so, the most stringent measures must be put in force to abate it. A nuisance of another kind, but equally as injurious to health by its tendency to produce disease of the respiratory organs, has repeatedly been brought to the notice of your Board. I allude to the refinery premises of Sir Anthony Rothschild, in Royal Mint Street. It appears that, in consequence of numerous complaints made to your Board during the last eight or nine years, Sir Anthony has incurred considerable expense in endeavouring to condense the sulphuric acid vapour which escapes from the process adopted in refining the precious 7 metals. To a certain extent, success has attended these endeavours, but the business is frequently so carelessly conducted that the greater part of the acid vapour escapes into the neighbourhood. Not only is this vapour injurious to the health of the neighbourhood, but it is likewise destructive to property, and complaints of many persons who have had their clothes destroyed have been made. The nuisance, I believe, may be entirely abated; it is merely a question of cost. After the numerous complaints which have been made, and of which Sir Anthony has had notice, it is most earnestly hoped that the cost of suppressing this injurious nuisance will not be considered, but that Sir Anthony will adopt means whereby the inhabitants may breathe an atmosphere uncontaminated by the deleterous gases that are given off from his premises. If Sir Anthony Rothschild cannot obtain the additional space by the side of the Royal Mint which he thinks would tend to mitigate the nuisance, he can certainly procure almost any amount of space on the East-side of the existing premises. I may hero express a feeling of regret that the proposal I made personally to Sir Anthony to allow me to obtain the assistance of a skilled and practical chemist to inspect the premises with myself and his surveyor to ascertain what means might be adopted to prevent the escape of the acid vapour into the neighbourhood, was not agreed to. I have also to record the fact of another nuisance arising from the mode in which a Malleable Iron Foundry, situated in Back Church Lane, is conducted. A short time ago, a memorial signed by 63 inhabitants, was sent to your Board, complaining of the offensive black smoke and the quantity of black and white dust which are emitted from the factory. The black and white "dust is stated to get into the rooms of the memorialists and to be injurious to their eyes. It is further stated, that the said dust is often to be found lying in the ground to the depth of the thickness of a half-penny. Not only do the memorialists [complain of the smoke and dust, but they state that the noise from the machinery is so loud that they cannot hear each other speak distinctly, and this noise is accompanied with rumbling and shaking of the houses. On visiting the premises complained of, I ascertained that the dust spoken of arose from the escape of portions of oyster-shells which are used in the process of melting the iron, to free it from slugs or rubbish. The smoke is occasioned by the chimney being too low, and the want of a proper smoke-consuming apparatus in the furnace. The noise is caused by the use of a fan to produce a blast in the upright cylinders in which the iron is melted. A notice has been served upon the proprietor to abate the nuisance complained of, which I have no doubt will be promptly attended to. In addition to your powers under the Nuisances Removal Act, and the Metropolis Local Management Acts, you have recently been entrusted with 8 further authority to carry into effect several most important provisions for regulating houses that are let out to more than one family. The want of this power has been frequently alluded to in my Quarterly Reports ; but you can now frame such rules and regulations with regard to Lodging-houses occupied by the poor, as will bring them more effectually under your control. You can, by the provisions of the New Act, determine the number of Lodgers that each room shall contain; and not only have you been entrusted with this power, but you have authority to determine that the present indiscriminate herding together of adults of different sexes shall cease. It is true, that the carrying out the rules and regulations which you may adopt as regards these Lodging-houses, will entail a vast amount of labour upon your Sanitary Officers; but, nevertheless, the existing evils of overcrowding and indecent occupation are so greaf that stringent measures must be adopted to lessen them. If the rules and regulations as regards Lodginghouses which are-absolutely necessary to be put in force by all the Vestries and District Begirds in the metropolis, and also the other provisions in the Public Health Act, it will be necessary for the Medical Officer of Health to devote his whole time to the duties of his office. In short, such is the importance that I attach to the duties of Public Officers, whether Sanitary Officers, or Medical Officers of Unions, that the performance of any work beyond their public duties should not be recognized. Having brought the subject of Lodging-houses under your notice, I was directed to prepare such rules and regulations thereto as I thought would be suitable for the better maintenance of the health of the district, and in accordance with such direction, I prepared the following code for the consideration of the Board. Rides and Regulations (proposed by the Medical Officer of Health) to le observed and enforced upon the Owners of all Houses which are let to more than one family. 1. No owner of any house which is let out to more than one family, shall admit or suffer to remain in such house, or in any room thereof, a greater number of Lodgers or other persons than shall be fixed by the Board of "Works. 2. A ticket, signed by the Clerk to the Board of Works, stating the number of Lodgers allowed to sleep in each such house, will be supplied to the owner of each such house, which ticket must be fixed either on the inside of the street-door or passage, so that the same may be readily seen by any person entering the house. 3. In every room of each such house shall be put up in a conspicuous place a ticket, signed by the Clerk to the Board, stating the number of Lodgers allowed to sleep in such room, and this ticket, which will be supplied by the Board, shall be kept at all times visible and legible. 9 4. Two children, under ten years of age, to be counted as one Lodger.* 5 Persons of different sexes shall not occupy the same sleeping room, except married couples, or parents with their children under ten years of age, or any children under ten years of age. 6. The.owner of every such house shall cause the walls and ceilings of every room, and of the staircases and passages of such house, to be thoroughly cleansed, and well and sufficiently limewashed three times at least in every year. 7. The owner of every such house shall cause every room, and the passages therein, to be ventilated to the satisfaction of the Medical Officer of Health. 8. Such a supply of water for the use of the tenants, and the means of storage thereof, as shall be satisfactory to the Medical Officer of Health, shall be provided. 9. Every such house shall be kept in tenantable repair, and shall be furnished with a dust bin of proper size, which shall be provided with a cover. 10. Every such house shall be provided with a water-closet, or a privy properly panned and trapped, for every 20 persons living in the house; if there are more than 20 persons in a house, then an additional privy or water-closet shall be provided. Each privy or water-closet must be kept in good repair, and provided with a door. 11. The drains and sinks shall be trapped so as to prevent effluvia coming up from the Sewers or Cesspools. 12. The water-closet or privy seat, floor and walls, shall be kept free from filth, and clean in all respects. 13. The yards and areas of every such house shall be properly paved and drained, so that all waste water shall readily flow off. 14. The owner of every such house to be responsible for obeying all such Rules as the Board may deem proper from time to time to enact, and if the owner be not resident within the District, then it shall be necessary for him to appoint an agent to see that all the regulations are obeyed. The above Rules and Regulations were referred to a Committee for further consideration. Any Rules and Regulations as regards Lodginghouses that may be adopted by the Board after they shall have received the sanction of the "Secretary of State, may be enforce'd by penalties to the amount of forty shillings for any one offence ; but in order to carry into effect Rules and Regulations as regards houses let out in tenements to the poor, care must be taken not to act oppressively in any case, but to proceed cautiously and gradually, for in attempting to do too much at once, we may fail in doing any thing effectually. It may be observed that these Rules and Regulations are taken from those issued and enforced by the Police with * This regulation of the Poiice is, upon physiological principles, incorrect; for young persons requiro a larger amount of air, in proportion to their size, than adults. In the young the respiration is more rapid, and in order to maintain the system during the growth of the body, an abundaiace of pure air is absolutely necessary. 10 respcct to the Registered Common Lodging-houses, and have been in operation since 1851. The benefit that the public has derived from the Common Lodging-houses' Act of 1851, has been so great, that the legislature has at length given similar authority to the Local Boards of the Metropolis to make such regulations for the better conducting of houses and rooms let to the poor, which they may think fit; and after such Rules and Regulations shall have been made by the Board, and shall have been approved by the Secretary of State, they have the same force as any clause in the Act. In framing the above Regulations, I have endeavoured to keep in view what is practicable, and I have not proposed for adoption such stringent measures as the present state of sanitary science might indicate as being necessary for the public health. Whatever laws are enforced with regard to Lodginghouses, some inconvenience must necessarily result to the poor, but the public health and public morality demand that the tenements of the poor, as regards their sanitary condition, should be placed under the control of proper officers. The space which each inhabitant of a room should have allotted to him, should be at least 300 cubic feet, and in order to sufficiently provide for the health of the occupants, it is absolutely necessary when so small a space is permitted to each tenant, that the room should be properly ventilated. The condition of many of the houses let out in tenements to the poor is so bad, owing to their original faulty construction, that they cannot be improved; and all that can be done with them, is to pull them down and retain the several sites as open spaces. There are very few of the houses in this district occupied by the poor, in which there is a sink, (except perhaps in the basement of some of them), which is available for carrying away the waste water. Some of the houses are three storeys in height without any open space at the back, and consequently they are without proper ventilation; and the unhealthiness is increased by the privy and water butt being placed in the cellar. Every pail of water which is required for the use of the occupants of the top room must be carried up four flights of stairs, and the waste .water carried down again, when it is thrown, either into the public way, or down the drain in the cellar, thereby entailing such an immense amount of labour, that it is not to be wondered at if the rooms are dirty. There are also many Courts occupied by the poor which are so narrow and confined that the sun's rays never penetrate, and are, moreover, so badly ventilated that the air is almost stagnant, so that it is impossible for persons living in them to enjoy health. Some of the property as above described belongs to the Trustees of the Whitechapel Parish Estates, and is, I believe, let on lease. The sooner, however, that such property as Bell Court and Bell Place, Princes Street, is pulled down, the better it will be for the health of the district, for it is totally unfit for human habitation. 11 The attention of the Clerk to the Parish Estates has been drawn to the unhealthiness of the locality, but as the lease of this property has not expired, it appears that he can do nothing with it. Our legislature has not been sufficiently mindful of the public health by their having permitted such unhealthy houses to have been built as are to be found in every district in London, where every available space has been occupied by houses that are so closely packed together as to render them mere nurseries of fever and other Epidemic diseases. The attention of the legislature has upon many occasions within these few years been forcibly directed to the unhealthiness of the dwellings of the poor, and it is now manifest that laws must be enacted to prohibit houses from being built unless plans of the proposed buildings are submitted to, and approved of, by the Local Board, not only as regards the drainage, but as regards the sanitary arrangements. Large sums of public, money are annually spent in purchasing property for the purpose of improving the means of traffic in the principal thoroughfares of the metropolis, but hitherto, no part of the public money has been expended for the purpose of taking down such houses occupied by the poor as are unfit for habitation, and throwing open the site on which the unhealthy houses stand. But if I read correctly, the 46th and 47th Clause of the New Public Health Act, Local Boards have now the power of purchasing lands for any purposes of the Local Government Act, (1858), the Public Health Act, (1848), and the Lands Consolidation Act, (1845). It is, therefore, most desirable that the attention of the Board should be directed to the powers conferred upon them, whereby they can now carry out the twenty-second recommendation of the Health of Town Commissioners who were appointed by Her Majesty in 1844, to inquire into the sanitary condition of large towns and populous districts in England and Wales. This recommendation is as follows:—That, subject to proper control, the Local Administrative Body be empowered to raise money for the purchase of property for the purpose of Opening Thoroughfares and Widening Streets, Courts and Alleys, so as to improve the ventilation of the densely crowded districts of towns, as well as to increase the general conveniences of traffic. The Reports of this Royal Commission are most valuable, and the attentive perusal of them will amply repay any person feeling an interest in this important subject. If, however, there be not sufficient power given by the "New Health Act to the Local Board to effect the improvements, then additional powers ought to be granted to them. There are other most important provisions in the Public Health Act which demands your most serious attention, such as the 24th, 25th, 26th, 27th, 28th, 29th, 30th, 31st, 32nd, 37th, 38th and 39th Clauses. All these Clauses are most important as bearing upon the public health, but in 12 ing them into effect a large outlay of money will be neccssary. The carrying into effect the 53rd Clause, which relates to the periodical removal of the dung, will not be attended with much difficulty, inasmuch as, several persons who keep horses and cows, have expressed their desire to have the dung removed daily by the Board; and as the Board is empowered by the 95th Clause of the Amended Metropolis Local Management Act, 25th and 26th, c. 132, to employ a sufficient number of persons, or to contract with any Company or persons, for collecting and removing the manure and refuse straw from such stables and cow-houses, within their parish or district, there will be no difficulty in effecting such an arrangement as will be beneficial to all parties. 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 29th September, 1866. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhœa. Continued Fever, Typhus & Typhoid. Cholera. Choleraic Diarrhœa. Erysipelas. Puerperal Fever. Carbuncle. Acute Pulmonary Inflammation. Croup. Rheumatic Fever. Ague. Dysentry. Delirium Tremens. Diphtheria. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Dr. Swyer 13 107 22 15 301 37 3 7 3 0 0 14 23 1 0 0 0 0 0 815 1361 Mr. Champneys 2 32 7 1 200 12 12 12 3 0 0 9 4 1 3 0 4 3 0 410 715 Mr. Richardson 8 34 17 9 235 7 15 6 3 0 2 10 0 2 0 0 2 0 0 680 1030 Mr. Sequiera 11 71 9 16 285 24 20 1 4 0 1 18 10 2 0 l 0 1 0 977 1441 Total 34 244 55 41 1021 80 50 26 13 0 3 51 37 6 3 1 6 4 0 2882 4547 Corresponding Quarter of previous Year. 15 3 62 72 709 108 1 0 30 0 0 130 24 2 0 2 8 1 0 3119 4286 TABLE II.—Showing the Deaths from Epidemic Diseases, for the Three Months ending 29th September, 1866. Districts. Small-Pox. Measles. Scarlet Fever. Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera. Total. Remarks. Artillery 0 3 4 0 1 4 2 19 33 Spitalfields 2 14 3 0 2 16 3 179 219 Mile End New Town 3 8 2 1 2 19 9 149 193 Workhouse. Whitechapel, North 2 6 3 0 7 13 3 39 73 Whitechapel church 0 3 1 0 2 21 4 329 360 Hospital. Goodman;s Church 0 6 2 0 2 13 1 57 81 Aldgate 1 9 4 0 1 12 3 37 67 Total 8 49 19 1 17 98 25 809 1026 Deaths from Epidemics for the corresponding Quarter, 1865. 3 1 30 1 13 64 42 4 148 TABLE III—The Births and Deaths in each Registration District, for the Three Months ending on the 29th September, 1866. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M F. Artillery 22 26 48 29 26 55 0 7 *Spitalfields 61 50 111 118 145 263 0 152 Chol. Hospital. Mile End N. Town 89 50 139 166 161 327 0 188 Workhouse. Whitechape l, N. 45 41 86 66 58 124 0 38 *WhitechplChurch 26 23 49 282 189 471 0 422 London Hospital. Goodman's Fields 30 46 76 57 76 133 0 57 Aldgate 37 36 73 56 50 106 0 33 Totals 310 272 582 774 705 1479 0 897 Population in 1861, 78,970. * The total Deaths of non-residents have been 316. The excess of Deaths over Births is therefore 581. TABLE IV. Return of Cow-Houses in the Whitechapel District sought to be Licensed. October, 1866. NAMES. ADDRESSES. Dimensions of Cow Houses. r of Cows allowed. Length. Breadth. Height. Cubic Spaces. Ayres, Thomas 2, Gower's Walk Feet. Feet. Feet. 5520 6 46 10 12 Anderton, J. 2, Old Montague St. 46 14 8 5152 6 Brown, Walter* Preston Street 38 19 8 5336 6 Brown, Frederick Old Montague Street 34 13 12 5304 6 No. 1 shed ,, 2shed Barker, Daniel Saw Yard 30 17 11 5610 6 12 8 12 1152 2 Davis, John Black Lion Yard 71 17 10 12070 12 Davis, Elizabeth Royal Mint Street 42 20 17 14280 15 No. l shed Foster Edward ,, 2 shed0 27, Pelham Street 27 26 14 9828 10 19 12 8 1824 2 Griffith, David Bell Lane 39 14 18 9823 10 Green, William Shorter's Rents 13 12 12 1872 2 Hurley, John Crispin Street 58 14½ 10 8410 9 Le Beau, G Cartwright Street 41 25 14 14350 15 Le Beau, G 127, Royal Mint St. 28 10 14½ 4060 5 Lee, Charles 58, Goulston Street 54 16 25 21600 22 May, Robert 29, White Lion St. 34 15 15 7650 8 McAvoy, Robert 8, Colchester Street 20 32 22 14080 14 McAvoy, Philip Spital Street 65 12 8 6240 7 No. 1 shed Moore, John ,, 2 shed Darby Street 23 16 15 5528 6 18 15 11 2970 3 Neill, Thomas Brown's Lane 13 13 8 1352 2 Pool Marcus Two sheds White's Row - - - 14321 21 6240 Sole, Isaac Three sheds Weaver's Arms Yard - - - 28182 28 Taylor, Jonathan Mill Yard - - - 17516 18 Williams, Elizabeth 19, Brown's Lane 54 20 14 15120 15 Williams, Thomas White's Row 40 12½ 8½ 4250 5 Webb, John Grey Eagle Street 31 14 11 4774 5 * A portion only of these Premises has bee Licensed. 106 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT 0N OF THE WHITECHAPEL DISTRICT, FOR The Year ending 29th December, 1866, BY JOHN LIDDLE, Medical officer of health. PRESENTED TO THE BOARD 21st JANUARY, 1867. LONDON. 1 8 6 7 . London PRINTED BY T. PENNY, 121, LEMAN STREET, WHITECHAPEL. ELEVENTH ANNUAL REPORT, Foe the Year ending 29th December, 1866. To the Board of Works, Whitechapel District. Gentlemen, The total mortality in the Whitechapel District during the Quarter ending on Saturday, the 29th December, was 657, viz., 344 males, and 313 females. In the corresponding Quarter of the previous year, the deaths were 620. The deaths in the London Hospital have been 119, while in the corresponding quarter of last year the mortality was 107. Of the deaths in this Institution, there were 56 of non-residents, 15 of persons belonging to this District, and 48 of persons who died from the result of accident and from sudden death. The deaths from Epidemic diseases have been 172, viz., 9 from Smallpox, 6 from Measles, 18 from Scarlet Fever, 1 from Diphtheria, 16 from Hooping Cough, 8 from Diarrhoea, 19 from Fever, and 95 from Cholera. In the corresponding quarter of last year, the deaths from Epidemic diseases were 124, viz., 15 from Small-pox, 2 from Measles, 21 from Scarlet Fever, 1 from Diphtheria, 19 from Hooping Cough, 23 from Diarrhcea, and 43 from Eever. The deaths from Cholera in the London Hospital have been 15, of these 10 were of non-residents, and 5 of persons who had resided within the District. The deaths in the Temporary Cholera Hospital in Commercial Street have been 51, of which 42 were of non-residents. The deaths in the Workhouse have been 81, viz., 45 males and 36 females. In the corresponding quarter of the previous year the deaths were 106. The deaths from Epidemic diseases in the Workhouse have been 3, of these 2 were from Cholera and one from Fever. The Medical Officers of the Union have attended 3568 new cases of illness, including 41 of Small-pox, 45 of Measles, 58 of Scarlet Fever, 11 of Hooping Cough, 261 of Diarrhcea, and 100 of Fever. In the corresponding quarter of the previous year, the total number of cases attended by the Medical Officers was 3911; of these .6 were of Small-pox, 90 of Measles, 56 of Scarlet Fever, 58 of Hooping Cough, 119 of Diarrhcea, and 89 of 4 Fever. On comparing these returns, it appears that Small-pox, Diarrhoea and Fever have increased respectively from 6 to 41, from 119 to 261, and from 89 to 100. The cases of Cholera returned are 8, while in the corresponding quarter of 1865 there was not a single case of this disease. From the returns of the Registrar General, it appears that the rainfall during the quarter has been 5.36 inches. In the corresponding quarter of the previous year the rain-fall was 9.2 inches. The following return shows the amount of sanitary work done by the Inspectors during the quarter:— Preliminary Notices served 473 Compulsory Orders issued for 210 Premises 66 Summonses heard at the Police Courts 5 Houses in which the Booms and Passages have) been whitewashed 324 Yards of Houses Paved, or the Pavement repaired. 296 Dust-bins provided 282 Privies cleansed or repaired 219 "Water-butts or Cisterns supplied or repaired 219 Drains in Houses improved 231 Cesspools abolished,. 8 Accumulation of Dung and other offensive matter removed 47 Area Gratings, Cellar Flaps, &c., repaired 56 Trades Nuisances abated 6 Cellars used as dwellings discontinued for such use 19 Houses closed, the same being unfit for human habitation 10 Several cases of indecent occupation have been discovered on making a house to house visitation; but as the Board has not issued a code of rules and regulations to be observed by the Lodging House Keepers, the Officers are almost powerless to abate this evil. The danger to the public health from overcrowding is very great, and vigorous measures to abate it must be adopted. A record of all the houses in which overcrowding has been discovered is kept by the Inspectors. A code of rules, however, has reeently been issued by the Board, which, if sanctioned by the Secretary of State, will, it is to behoped, enable the Inspectors to take legal proceedings to abate the immoral practice, now so common, of adults of different sexes occupying the same sleeping apartment. Numerous cases of gross immorality have been published from time to time in my quarterly reports, such as adult brothers and sisters, fathers and adult daughters, mothers and adult sons, uncles and neices, sleeping together in the same room, but as we had no legal power to deal with such cases, I ceased to record them. On a recent occasion one man and five women were found to occupy the same room. 5 As the District for cleansing purposes has been divided into four parts, and as there are now four Inspectors of Nuisances, I have assigned an Inspector to each of them, who will be removed from one Division to another as often as it may be deemed necessary. Each Inspector will be required to visit the courts and houses in the worst localities, of his division to inspect each room of every house, and make a return to me daily, according to a printed form, of the size of each room, the number of occupants, specifying whether children or adults, the general sanitary condition of the rooms and premises, the supply of water as regards the quantity, the condition of the receptacles for storing water, and other matters in relation to the public health. These returns will be preserved in a book prepared for that purpose, which will be indexed so that it may be of easy reference. During the quarter a few cases of overcrowding have been abated. Several animals which were so kept as to be a nuisance have been removed. Numerous notices have been sent to the police of dangerous structures, also of rooms sub-let. All the bakehouses, 79 in number, have been inspected, and 51 notices have been served for cleansing the same. The cow-houses and slaughter-houses have likewise been inspected. Three additional water waste preventers have been erected in the District since my last report. There are now 22 of these machines in use, two of which are supplied with water by the New River Company, and the others by the East London. Of these 22 machines, 20 are of one kind, and 2 of another. This mode of constant water supply is economical, and very satisfactory to the inhabitants. The number of births registered in this District during the year 1866 has been 2561, and the number of deaths 3492. The deaths are greatly in excess of any year since 1848. The total deaths in this District for the year 1849, when the severe epidemic of Cholera occurred, was only 2778 in a population of 71,879, whereas, in 1866, in an estimated population of about 78,000, the mortality has been greater by 714. In both of these years the deaths in the London Hospital are included. In 1866 the death rate has been 4.45 per cent., while in 1849 it was 3.86 per cent. The deaths in the "Workhouse have been 413 against 362 for the previous year, and in the London Hospital 703 against 416. The total deaths from Epidemic diseases have been 1476, viz., 44 from Small-pox, 139 from Measles, 72 from Scarlet Fever, 4 from Diphtheria, 94 from Hooping Cough, 119 from Diarrhcea, 100 from Fever, and 904 from Cholera. 6 The mortality from Epidemic diseases in each year since 1860 is shown in Table No. 7. Estimating the population at 78,000, the rate of mortality from Epidemic diseases has been l.89 per cent., and from Cholera alone it has been at the rate of 1.15 per cent. But by deducting the deaths of non-residents, the rate of mortality from Cholera is reduced to 0.72 per cent. The following return shows the amount of work done by the Sanitary Officers during the year:- Preliminary notices served 2530 Compulsory orders, signed by the Chairman of the Board 421 Summonses heard at the Police Courts 68 Rooms and passages cleansed and limewashed 1284 Yards of houses paved, or the pavement repaired 826 Dust-bins provided or repaired 683 Privies cleansed or repaired 688 Water butts supplied or repaired 717 Drains to houses repaired and improved 663 Cesspools abolished 22 Accumulation of dung and other offensive matter removed 297 Area gratings, cellar flaps, &c., repaired 123 Trades' nuisances abated 8 Cellars used as dwellings discontinued for such use 34 Houses closed, the same being unfit for human habitation 12 Deaths from Pyæmia are of frequent occurrence in the London Hospital. In the last volume of Clinical Lectures and Reports published in 1866, and prepared by the medical and surgical staff of the Hospital, it appears that in 20 cases of amputation of the thigh, 7 died from Pyæmia, and two more deaths are recorded from the same disease after other operations. The frequency of this disease is a matter which calls for the serious attention, not only of the medical staff, but also of the governing body of the Hospital. As this disease, when occurring in hospitals, is generally supposed to be caused by some defect in the sanitary arrangements of those institutions, I take leave to urge the consideration of this important matter upon all the parties interested in the welfare of the sick admitted within their walls. I am certain, from my personal knowledge of the members of the Medical Staff and of the Committee of the London Hospital, that all are actuated by the most humane feelings to those poor persons who are entrusted to their care, and that every thing that can be suggested by the Medical Officers to improve the sanitary condition of the Hospital, so as to diminish the amount of mortality from any cause, will be readily carried out by the Committee. In order to accomplish this object, it would be desirable that a Report be prepared by the . whole Medical Staff, assisted by the Lecturer on Chemistry, pointing out where sanitary defects exist, and in what manner they can be remedied, and lay the joint Report before the Committee of the Hospital. 7 It is 110 argument in favor of the sanitary arrangements of this Institution to say that Pyæmia exists in other Hospitals, for this only proves, that these hospitals also are defective in theirsanitary arrangements, if such be the cause of the disease, while it forcibly suggests that all institutions set apart for the treatment of the sick and wounded, where Pyæmia is of frequent occurrence, demand the strictest investigation into their general sanitary condition. It has hitherto been a rule, in ventilating public buildings, to let the architect have his own way, and the opinions of medical men, who are most competent to advise upon this matter, are seldom asked, and still more rarely acted upon. Hence the frequent mistakes that are made in the ventilation of public buildings. In my last Quarterly Report I brought under the notice of the Board certain clauses in the Sanitary Act of 1866, which, in my opinion, demand your attentive consideration, and particularly the 53rd clause, that relates to the periodical removal of dung and refuse which are allowed to accumulate in stables, cow-sheds, and other places, until decomposition has taken place. The stirring up and carting away of this offensive matter is a nuisance to the neighbourhood, and is injurious to the health of those persons who are compelled to inhale the noxious effluvium. The ill effects from these accumulations are increased in proportion to the length of time they are retained upon the premises. Manure and other refuse should not be allowed to remain on any premises situated within this populous District for a longer period than two days. As the period is nearly at hand when a new contract for cleansing the District will be considered, I have again to urge upon your notice the great advantage that will accrue to the public by contracting for the daily cleansing of all the streets and bye places ; for unless the streets are daily cleansed in this crowded District, where persons have been so long accustomed to throw all sorts of refuse in the public thoroughfares, it will be impossible to keep them clean if only swept three times a week. The streets being clean will act as a stimulus upon the poorer inhabitants to keep the interior of their dwellings in a cleaner state than most of them are in at the present time. I am, Gentlemen, Your obedient Servant, JOHN LIDDLE. 15, Gbeat 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 29th December, 1866. 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. Dr. Swyer 32 14 30 1 97 36 0 5 0 2 32 45 4 10 0 0 2 0 679 989 Mr. Champneya 2 23 8 0 60 34 0 5 0 0 33 3 0 7 0 0 0 0 428 603 Mr. Richardson 1 7 6 2 31 10 2 3 0 0 52 3 0 5 0 0 0 0 504 626 Mr. Sequiera 6 1 14 8 73 20 0 3 0 0 43 15 4 11 4 0 0 0 1148 1350 Total 41 45 58 11 261 100 2 16 0 2 160 68 8 33 4 0 2 0 2759 3568 Corresponding Quarter of previous Year. 6 90 56 58 119 89 2 31 1 4 206 29 0 7 2 5 1 0 3206 3911 Numerous slight cases of Fever and of Febricaia are recorded in the books of the Medical Officers, but those cases only appear in my returns which are visited at the residences of the patients. TABLE II.- - Showing the Deaths from Epidemic Diseases, for the Three Months ending 29th December, 1866. Districts. Small-Pox. Measles. Scarlet Fever. Diphtheria. HoopingCough. Diarrhœa. Fever* Cholera. Total. Remarks. Artiller 0 9 0 0 1 0 1 2 6 Spitafields 7 3 7 0 0 0 3 61 3 81 Mile End New Town 1 1 5 0 4 1 6 21 Workhouse. Whitechapel,North 1 0 3 1 2 0 4 4 17 White chapel Church 0 0 1 0 1 1 1 24 28 Hospital. Goodman's Fields 0 0 1 0 7 3 9 0 13 Aldgate 0 0 1 0 1 1 2 1 6 Total 9 6 18 1 16 8 19 95 172 Deaths from Epidemics for the corresponding Quarter, 1865. 15 2 21 1 19 23 43 0 124 * fever cases are not now taken into the Workhouse, but are sent to the Fever Hospital. TABLE III —The Births and Deaths in each Registration District, for the Three Months ending on the 29th December, 1866. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M F. Artillery 24 21 45 16 19 35 10 0 *Spitalfields 62 44 106 71 72 143 0 37 Chol. Hospital. MileEndN.Town 73 66 144 72 80 152 0 8 Workhouse. Whitechapel, N. 47 50 97 33 35 68 29 0 *WhitechplChurch 31 33 64 95 57 152 0 88 London Hospital. Goodman's Fields 45 58 103 30 27 57 46 0 Aldgate 26 26 52 30 25 55 0 3 Totals 313 298 611 347 315 662 85 136 Population, as enumerated in 1861, was, 78,970; in 1866, as estimated by the Registrar General, it is 76,386. * The total Deaths of non-residents have been 98; of these 56 occurred in the London Hospital and 42 in the Cholera Hospital in Commercial Street. The deaths from Cholera in the London Hospital were 15; of these 10 were of non-residents. The deaths from Cholera in the Workhouse were 2, one of these occurred on the 2nd November, and was removed from 11, Flower and Dean Street, the other on the 7th November from the same house. TABLE IV.—Total number cf the undermentioned Diseases, recorded in the Books of the Medical Officers of the Union, from 1860 to 1866. Year. Small-Pox. Measels. Scarlatina. Hooping-Cough. Diarrhœa and Dysentery. Fever. Cholera. Erysipelas. Puerperal Fever. Carbuncle. Bronchitis and Cattarrh. Pneumonia and Pleuritis. Croup. Rheumatic Fever. Ague. Delirium Tremens. Total. 1860 65 520 93 83 801 190 1 52 1 9 845 141 3 7 41 6 11392 1861 86 70 100 388 1452 109 ... 75 1 9 803 104 9 5 18 2 13724 1862 113 525 118 153 1106 822 1 56 ... 4 557 135 9 16 24 4 14270 1863 253 80 305 169 1139 464 1 74 1 6 533 134 12 20 11 8 14564 1864 21 489 156 217 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 ... 14 12 4 15594 1866 261 679 197 217 1664 343 58 62 ... 7 546 244 7 66 12 13 16502 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 2742 2444 140 325 269 1859 2826 2321 189 354 239 1860 2746 2302 163 326 282 1861 2686 2331 179 366 287 1862 2813 2551 187 330 369 1863 (53 weeks) 2796 2764 181 418 324 1864 2803 2792 212 453 414 1865 2684 2532 208 416 362 1866 2561 3495 432 733 413 The deaths of persons resident in the district which occurred in the London Hospital during the year 1866 were 115. The residences of those persons whose death was the result of accident, are not given in the Registrar's returns. The deaths of non-residents in the temporary Cholera Hospital were 103, and of residents within the district 31. Total deaths 134. TABLE VI.—Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 29th December, 1866. 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 end upwards. Total Males, 45. Females, 36. Corresponding Quarter of 1865. Workhouse 7 1 5 23 25 18 2 81 106 London Hospital 0 14 19 38 35 12 1 Males, 78. Females, 41. 119 107 TABLE VII. 1860. 1861. 1862. Districts. Small-Pox. Measles. Scarlet Fever & Diphtheria. Hooping-Cough. | Diarrhœa. Typhus. Total. Small-Pox. Measles. Scarlet Fever & Diphtheria.| Hooping-Cough, Diarrhœa. Typhus. Total. Small-Pox. Measels. Scarlet Fever & Diphtheria. Hooping-Cough. Diarrhœea. Typhus. Total. Artiller 0 2 2 7 1 1 13 0 2 8 7 5 4 26 0 11 7 8 2 12 40 Spitalfield 8 11 17 3 11 11 61 8 6 13 22 19 9 77 4 53 12 1 5 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 Chnrch l 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 VII.— Continued. 1863. (53 weeks.) 1864. 1865. Districts. Small-Pox Measles. Scarlet Fever & Diphtheria. Hooping-Cough. Diarrhœa. Typhus. Total. Small-Pox. Measles. Scarlet Fever & Diphtheria. Hooping-Cough. Diarrhœa. Typhus. Total. Small-pox. Measels. Scarlet Ferer & tSiphtheria. Hooping-Cough. Diarrhœa. Typhus. Total. Artillery 9 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 69 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 Aldgate 7 0 26 12 17 20 82 1 13 0 3 9 15 41 1 2 7 21 19 10 60 Totals 69 26 290 52 114 158 709 5 137 50 74 109 170 545 22 28 80 97 122 167 516 TABLE VII.—Continued. 1866. Districts. Small-Pox.* [ Measles. Scarlet Fever and Diphtheria. Hooping-Cough. | Diarrhœa. Typhus. Cholera. Total. Remarks. Artillery 0 10 10 9 4 8 21 62 Cholera Hospital Workhouse. Spitalfields 17 28 18 12 17 11 240 343 Mile End New Town 17 32 15 25 24 42 152 307 Whitechapel, North 6 21 9 18 19 13 43 129 London Hospital. Whitechapel Church 1 11 7 7 23 13 353 415 Goodman's Fields 1 20 7 17 18 5 57 125 Aldgate 2 17 10 6 14 8 38 95 Total 44 139 76 94 119 100 904 1476 In the Report of the 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 and fatality, commenced in November, 1832, and reached its point of culmination in May and June, 1863. Great as was the mortality from Small-pox in 1863, it has been much greater in 1866. In the last Report of the Small-pox Hospital it is stated that 2,069 cases have been admitted, which is an excess of 25 per cent, over those admitted in 1863. Fever and Small-Pox cases which occur in this District are now generally sent to the Hospitals, whereas, until the last 18 months, comparatively few of such cases wore removed. Table VIII. The following Table, prepared - from the Returns of the Registrar General for the week ending December 8th, shows the Elevation, Persons to an Acre, Annual Value of House and Shop room to each Person in the £, Poor Rate in the £ of House Rent, Annual Mortality in each of the Ten Years 1841-50, from all Causes, and Number of Deaths in Twenty -three Weeks ending 1st December, 1866, to 10,000 persons living, from all causes, from Cholera, and from Diarrhœa. Districts. Elevation in feet above Trinity High Water Mark. Persons to an acre in 1866. Annual value of Houses, year • ending April, 1843. Annual value of House and shop room to each person in £. Poor rate in the £ of House Rent. Annual Mortality from all causes. Number of deaths iN 23 weeks, to 10,000 living. Deaths to 1000 living. All causes. Cholera.* Diarrhoea. Cholera and Diarrhœa. 1841-50 1851-60 London 39 39.0 £ 40 £ 5.589 .064 25 24 119.9 18.3 8.9 27.2 Whitechapel London Hospital, Temporary Cholera Hospital 32 188.1 26 3.388 .075 29 28 223.1 77.5 14.4 91.9 TABLE IX. The following Table, prepared from the same Return, shows the Area in Acres, the Number of Inhabitants in 1861, Population in 1851, 1861 and 1866, and Deaths registered in Twentythree Weeks ending 1st December, 1866, from all Causes, from Cholera, and from Diarrhœa. District. Area in Statute acres. Number of inhabited houses enumerated in 1861. Population Deaths registered in 23 weeks ending 1st December, 1866. 1851 enumerated. 1861 enumerated. 1866 estimated. All Causes. Cholera. Diarrhœa Cholera and Diarrhœa London 77,997 359,421 2,362,236 2,803,989 3,037,991 36,423 5,548 2,692 8,240 Whitechapel 406 8,664 79,759 78,970 76,386† 1,704 592* 110 702 * The deaths from Cholera in the London Hospital not belonging to this District were 235, and those in the Temporary Cholera Hospital were 103.- The deaths, exclusive of those of non-residents, have been 566, instead of 592, as above estimated; consequently the rate of mortality in this District has been 70 per 10,000. † The population in this District may be more properly estimated at 78,000.