WHI 17 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 3rd APRIL, 1869, BY JOHN LXDDLE, PRESENTED TO THE BOARD 26TH APRIL, 1869, LONDON. 1 8 6 9, LONDON: printed by e. j. bath, 28, high street, whitechapel. 1869 REPORT of the MEDICAL OFFICER OF HEALTH, for the Quarter ending 3rd April, 1809. TO THE BOARD OF WORKS, WHITECHAPEL DISTRICT, Gentlemen, During the quarter, which terminated on Saturday, 3rd April, a period embracing fourteen weeks, there were registered in the Whitechapel District, 682 births, viz.: 330 males and 352 females; and 721 deaths, viz.; 421 males and 297 females. In the corresponding quarter (13 weeks) of the preceding year, the births were 703 and the deaths G57. The returns of births and deaths in this District for the quarter, will not be found to agree with the returns of the Registrar General, for in the Official Returns issued from Somerset House, the period embraced in the quarter ending on the 3rd April, is only thirteen weeks, an intercalary week having been introduced in the preceding quarter. The births for the week that ended 2nd January, were 64, viz.: 29 males and 35 females; and the deaths 59, viz.: 33 males and 26 females. For the purpose of comparing the returns in this District with those of the Registrar General, the number of births and deaths, for the first week of this year, should be deducted from the returns of this quarter and added to the preceding one. The births for the last thirteen weeks have been 618, and the deaths 662. 4 The deaths in the London Hospital have been 142, viz.: 103 males and 39 females. Of the total deaths in this Institution, there were 16 of residents within the District, 45 of non-residents, and 41 of persons who died from the result of accident and from sudden death. The deaths from epidemic diseases in this Institution were 4; of these, 1 was from measles, 1 from fever, and 2 from scarlet-fever. The deaths in the "Workhouse have been 115, viz.: 71 males and 44 females. The deaths from epidemic diseases in this establishment have been 15, viz.: 14 from fever and 1 from scarlet-fever. Five deaths also occurred from pytemia. The ages at death of persons dying in the Workhouse and in the London Hospital, and the mortality in these Institutions for the corresponding quarter of the previous year, are shown in Table 3 in the Appendix. The deaths from epidemic diseases in the District, have been 109, viz.: 14 from measles, 25 from scarlet-fever, 3 from diphtheria, 20 from hooping-cough, 3 from diarrhoea, and 44 from fever. In the corresponding quarter of the previous year, the deaths from epidemic diseases were 89, viz.: 8 from small-pox, 15 from measles, 9 from scarlet-fever, 3 from diphtheria, 18 from hooping-cough, 7 from diarrhoea, and 29 from fever. From these returns, it appears that while small-pox has entirely subsided, fever and scarlet-fever have considerably increased. Four deaths from choleraic-diarrhoea (children) have been registered in London during this quarter. In the corresponding quarter of last year 7 deaths were registered from this cause. The deaths caused by diseases of the respiratory organs, exclusive ot consumption, have been 154. Consumption was fatal to 81 persons. The deaths from other tubercular diseases were 42, viz.: 23 from mesenteric disease, 6 from scrofula, and 13 from hydrocephalus, or water on the brain. Diseases of the heart were fatal to 35. Three persons died from aneurism. The deaths from diseases of the urinary organs were 20, of these, 5 were caused by nephria, or Bright's disease. Convulsions caused the deaths of 20 children. There were 10 deaths from premature birth, 6 from teething, and 14 from atrophy and debility. The deaths from syphilis were 6. Intemperance was fatal to 4 persons. A man, aged 30, poisoned himself by taking opium. 5 The deaths of 27 persons are attributed to age, and 4 deaths of persons under the age of 70 are thus registered, " premature decay." The deaths of persons above 80 years of age, were 17; 2 of whom reached the age 90 and 91 years respectively, and one the advanced age of 93. There were 26 deaths from mechanical violence: of these, 4 were caused by vehicles in the streets. Burns and scalds were fatal to 12 persons. The deaths of 9 persons are returned as " not certified." Two of these occurred in the London Hospital, but in each of these cases a post •mortem examination of the body was refused. Four children were suffocated in bed. The number of inquests has been 82. In the corresponding quarter of last year, the number was 84. The mortality of children, under 5 years of age, has been 252 ; this is 34.9 per cent, of the total deaths ; but in the Spitalfields sub-District the rate of mortality of children under 5 to the total deaths, was 60.9 per cent. PAUPEE ILLNESS IN THE DISTRICT. The Medical Officers of the Union have attended, during the last fourteen weeks, 3,885 new cases of illness out of the Workhouse, including 2 of small-pox, 30 of measles, 37 of scarlet-fever, 71 of hooping-cough, 105 of diarrhoea, 137 of fever, and 25 of erysipelas. In the corresponding quarter (13 weeks) of the previous year, the number of pauper cases of illness was 4,498, including 52 of small-pox, 88 of measles, 7 of scarlet fever, 34 of hooping-cough, 121 of diarrhoea, 199 of fever, and 17 of erysipelas. There has, therefore, been a marked decrease (about 1,000) in the number of sick paupers during this quarter, when compared with the number returned for the corresponding quarter of last year. METEOROLOGY OF GREENWICH. The returns of the Registrar General show that the rain-fall in the metropolis, during the quarter, has been 8.02 inches. During the corresponding quarter of last year the rain-fall was 6.52 inches. The mean temperature of the air was 41.3°. The lowest temperature was on Sunday, the 24th January, when the thermometer indicated 26.3°, or 5.7° below the freezing point. The highest temperatures were on Thursday, the 28th January, when the thermometer stood at 54.0°, and on Thursday, the 11th February, when it indicated 56.2°. 6 The following Table, taken from the returns of the Registrar General, shows the comparative results during the quarter (14 weeks):— LONDON. Jan. 2nd Jan. 9th Jan. 16th Jan. 23rd Jan. 30th Feb. 6th Feb. 13th Feb. 20th Feb. 27th Mar. 6th Mar. 13 th Mar. 20th Mar. 27th Aprl 3rd Deaths from Diarrhcea. 9 12 12 16 12 9 8 14 9 18 19 13 16 I9 Deaths from Cholera 0 0 0 1 0 0 1 0 1 0 1 0 0 0 Mean Tern peratureo of the Air 41.°0 45.7° 40.4° 36.6° 40.7° 49.2° 47.5° 45.5° 40.9° 39.1° 35.6° 36.9° 38.7° 39.°0 Kain-fall in inches 1.53 1.15 0.23 0.13 1.03 0.65 0.97 0.17 O.70 0.47 0.04 0.57 0.27 0.24 Deaths in London 1629 1501 1490 1578 1737 1631 1426 1491 1419 1487 1519 1549 1590 1670 Deaths in the White- chapel District 59 57 46 44 61 42 52 52 53 58 46 54 49 48 SANITARY WORK PERFORMED DURING THE QUARTER. The following return shows the amount of work done by the Sanitary Inspectors during the quarter:— Number of inspections of houses, as shown in the official returns ...5039 Houses systematically visited and rooms measured to ascertain their cubic capacity 72 Number of cases of indecent occupation discovered 3 Preliminary notices served, many of such notices embracing in each several premises 397 Compulsory orders issued, embracing 50 houses and premises 20 Summonses heard at police courts 5 Houses in which the rooms or passages have been whitewashed 162 Dust-bins provided 55 Privies lime-whited, cleansed, and repaired 86 Water-butts or cisterns provided or repaired 56 Drains in houses improved, &c 60 Cesspools abolished 10 Houses systematically re-visited 41 Cellars used as dwellings discontinued for such use 2 Yards of houses paved or the pavement repaired 72 Number of special noticcs served for registration of 109 houses 95 Slaughter-houses specially visited 36 Cow-houses ditto 24 Animals kept so as to be a nuisance, removed 2 Area gratings, cellar flaps, &c., repaired 9 One case of the prolonged retention of a dead body complained of 1 7 Nuisances caused by the accumulation of dung and other offensive matter, and from stopped privies, are very numerous. These are not recorded in the books of the Inspectors, unless official notices are served. In addition to this return, the Inspectors report that they have forwarded to the police authorities several notices of dangerous structures, and have also given intimation to them of all the rooms which they have found, on a house-to-house visitation, or on private information, to be occupied by more than one family. The Act requires that all rooms so let, must be registered under the Common Lodging House Act. TRADES' NUISANCES. A memorial, signed by 114 inhabitants of Pleasant Row, Mile End New Town, and its vicinity, was presented to the Board on the 11th February last, in which it was stated that a most offensive smell was emitted from the sugar refinery premises of Messrs. Schwartz, situated in Pleasant Row, producing sickness and ill health to the persons living in the vicinity of the factory. The nuisance was said to be caused by the bringing to, and exposing on, the premises, a considerable quantity of "dead oil or creosote," and burning the same in the furnaces, " instead of, or in conjunction with, coal." On the 12th February, the day after the memorial was received, I visited the premises of Messrs. Schwartz, and I was satisfied that the complaint of the memorialists was well founded, not only from the smell of the creosote on the premises, which I experienced, but from the general expression of opinion of the inhabitants, who stated that the effect of the nuisance was to cause headache, nausea, and sickness. Mr. Champneys, the Medical Officer of the Workhouse, stated that the nuisance from Messrs. Schwartz's premises was injurious to health, and it was complained of by the patients in the Workhouse, when the wind blew from the factory towards that building. My second visit was made on the 26th February, in company with Dr. Letheby and Mr. Schwartz, when inquiries were again made of the inhabitants in the neighbourhood as to the injurious effects of the nuisance, and from the information then obtained, the statements made in the memorial were confirmed. So soon as Mr. Schwartz was made acquainted with the complaints of the inhabitants, he expressed his willingness to do anything in his power to abate the nuisance, and he requested Dr. Letheby to make a report to him upon the subject, with which request Dr. Letheby complied. In this report, Dr. Letheby suggested that coke should be used instead of coal. In order to obviate the escape of the vapour from the cistern or tank, in which the creosote is stored, Mr. Schwartz says that he has 8 now so enclosed the cistern as to render it air tight, whereby the escape of the volatile part of the creosote into the neighbourhood is prevented. Notwithstanding, however, the several alterations which have been made, the nuisance is not removed, for complaints still continue to be made by the inhabitants; and Mr. Schwartz has been informed by the Board that, unless the cause of complaint be removed, proceedings will be adopted to compel him to do so. Since the presentation of this Report to the Board, proceedings have been commenced. Dr. Letheby, in his report of the inspection of Mr. Schwartz's premises (a copy of which wras sent to the Board), states, that the material used as fuel is the least volatile portion of coal tar. It has a specific gravity of 1050, and it contains a good deal of crystallizable neutral substance called paranapthaline and a small quantity of carbolic acid, to which lastnamed substance its peculiar odour is chiefly due. Dr. Letheby further says that, he has frequently seen the dead oil used as fuel in London and elsewhere, and he is satisfied that it is a safe and economical method of consuming the oil. It is also, he says, so entirely under the control of the stoker, that the combustion of the oil can be secured so as not to produce smoke or offensive vapour, and that it is the most manageable fuel for furnaces. I have no reason to doubt the correctness of Dr. Letheby's statement as regards the use of creosote in furnaces when a uniform heat is required, but when an increased volume of steam is suddenly required at irregular intervals, it is not so manageable. At all events, as the nuisance still continues in Mr. Schwartz's premises, it is obvious that proper care is not given by that gentleman to the burning of the material in his furnaces. Complaints have also been made of the re-burning of animal charcoal upon the premises of Mr. Bringes, in Back Church Lane, and upon those of Mr. Gadsden, in Chamber Street. VAULTS UNDER THE DANISH CHURCH, WELLCLOSE SQUARE. The Danish church, which was situated in a large open space, in Wellclose Square, and which was built in the year 1694, is now entirely demolished, and the site is about to be used for the erection of schools, in connexion with St. Paul's Church, Bock Street. These schools are intended for the accommodation of 600 children, and they will be under the superintendance of the Rev. Daniel Greatorex, the Incumbent of St Paul's Church. 9 Underneath the church there are several vaults, in which there had been deposited 37 coffins, of which 35 were of lead and 2 of wood. The walls of these vaults are four bricks, or 3 feet in thickness, and the roof is arched in brick-work of 4 rings in thickness. On inspection, I was unable to detect any offensive smell in these vaults, and I found the lead coffins to be in a sound condition. The two wooden coffins had perished, but the bodies were perfectly dry. All the coffins are now covered with earth, of 2 feet in thickness, and above this thick layer of earth there is deposited charcoal, to the extent of 1 ft. 4 inches in depth,'and the vaults are bricked up, so that it is impossible that any danger to health can arise from emanations from the dead bodies in the vaults. SCARLET FEVER. In the returns of the Registrar General for the week ending Saturday, January 9th, 1869, the public is informed that, in London alone, scarletfever has destroyed 15 lives, of children chiefly, every day for the last 13 weeks, or 1,324 lives in the aggregate. The Registrar General calls attention to a Paper by Dr. "WiLliam Budd, M.D., Ed., Consulting Physician to the Bristol Royal Infirmary, on SCARLET FEVER and its PREVENTION. The following is a summary of the precautions recommended by Dr. Budd : " 1. The room, which is occupied by the patient, is to be dismantled of all needless woollen or other draperies which might possibly serve to harbour the poison. "2. Thorough ventilation of the room to be maintained by an open fire and other means added. "3. A basin, charged with chloride or carbolate of lime, or some other convenient disinfectant, is to be kept constantly on the bed for the patient to spit into. "4. A large vessel, containing water impregnated with chlorides or with Condy's fluid, is always to stand in the room for the reception of all bed and body linen, immediately on its removal from the person of the patient. 10 "5. Pocket-handkerchiefs are proscribed, and small pieces of rag are to be used instead, for wiping the mouth and nose. Each piece having been once used is to be immediately burnt. "6. As the hands of nurses of necessity become frequently soiled by the specific excreta, a good supply of towels and two basins, one containing water with Condy's fluid or chlorides, and another, plain soap and water, are always to be at hand for the immediate removal of the taint. "7. All glasses, cups, and other vessels, used by or about the patient, are to be scrupulously cleaned before being used by others. "8. The discharges from the bowel and bladder are to be received on their very first issue from the body, into vessels charged with disinfectants. "9. About the fourth day after the eruption, the surface of the body, scalp included, is to be anointed twice a day with olive oil, slightly impregnated with camphor ; the oiling to be continued until the patient is well enough to take a warm bath, in which the whole skin is to be well scrubbed, disinfecting soap being abundantly used. The bath should be repeated every other day until four have been taken. "10. Ten days after health has been quite re-established, the patient may, in new clothes, without risk, re-enter his family. "11. The children of the poor, who have no means of isolating their children, are to be treated in small model hospitals or houses set apart by towns or parishes for the purpose. "12. The sewers are to be kept in a state of permanent disinfection where the disease prevails. This is done in Bristol, under the direction of the Health Officer." The attention of the Board of Works having been directed to the printed directions of Dr. Budd, upon the subject of preventing the spreading of TYPHOID FEVER,, the Board resolved to distribute a thousand copies of such directions among the poorer inhabitants of the District. These directions are founded on the discovery, that the poison by which this fever spreads, is almost entirely contained in the discharges from the bowels, and hence the importance of disinfecting these discharges so soon as they escape from the body, and BEFORE they are carried from the sick room. 11 As there are many houses in the District so badly constructed, that every room let as a separate tenement has not a communication with the staircase leading either to the privy, the drain, or the ash-pit, except through an inhabited room, the danger of infection from fever or other contagious disease to the occupiers of a room so used, is greatly increased, in consequence of the discharges from the patient, the slops, and other filth of the house being carried through such room to the privy, drain, or ash-pit. Such is the discomfort and danger to the health of persons occupying rooms which are used as thoroughfares, that I have no hesitation in saying that all houses so constructed, if let in separate tenements, are unfit for habitation. Early burial in all cases of infectious diseases, is absolutely necessary, for the protection of the public health, and whenever a death from fever or other contagious disease, occurs in a family who occupy only one room, the corpse should, with as little delay as possible, be removed to a mortuary. The question of providing a mortuary has frequently occupied the attention of the Board, but hitherto without any practical result, although the necessity of erecting one has been repeatedly shown in my Quarterly Reports. I would now again direct the attention of the Board to the subject, as another case of the prolonged retention of a dead body in a room occupied as a living and sleeping room, by a family consisting of seven persons, viz.: a father and his six children. The notice of the Inspector was directed to this case by some persons living in the house, who complained of the nuisance arising from the decomposition of the corpse, which had been kept for several days in the room in which the person had died. The house was tenanted by about 40 persons. The smell from the corpse was said to pervade the whole house. In order that no further time may be lost in discussing the question of the best site for a mortuary, I would suggest that an iron building, similar to any of those now used for temporary churches, be at once provided, and placed either in the burial ground belonging to Spitalfields Church or in that belonging to Whitechapel Church. I am, Gentlemen, Your obedient Servant, 15, Great ALIE Street, JOHN LIDDLE. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute classes, which are recorded in the Books of the Medical Officers of the Union for the three months ending on the 3rd April, 1869 (14 weeks). Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Diphtheria. Continued Fever, Typhus & Typhoid. Pyamia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. Total  Bronchitis and Catarrh. Pleuritis and Pneumonia. Dr. Swyer 0 9 17 22 30 0 30 1 8 1 0 68 59 0 17 1 1 1 3 973 1241 Mr. Chanipneys.. 0 11 11 12 8 1 23 0 3 0 0 35 3 0 0 0 0 0 0 370 476 Dr. Richardson 0 8 0 10 35 0 9 0 3 0 0 82 1 0 5 2 1 0 0 557 713 Mr. Sequiera 2 2 9 27 32 0 75 0 11 0 1 35 13 0 7 7 1 0 1 1231 1454 Total 2 30 37 71 105 1 137 1 25 1 1 220 76 0 29 10 3 1 4 3131 3885 Corresponding Quarter of previous year. 52 88 7 34 121 0 199 0 17 0 1 157 52 0 50 11 5 1 4 3699 4498 TABLE II.—Showing the Deaths from Epidemic Diseases for the Three Months ending 3rd April, 1869 (14 weeks). Districts. Small-Pox Measles Scarlet Fever Diphtheria HoopingCough Diarrhoea Fever Cholera and Choleraic- Diarrhœa. Total Remarks. Artillery 0 1 3 0 2 1 4 0 11 Spitalfields 0 5 5 0 8 1 8 0 27 Mile End N. Twn. 0 3 9 1 4 0 21 0 38 Work house Whitechapel, N.. 0 3 2 1 2 1 5 0 14 Whitechapel Cli.. 0 1 3 0 1 0 2 0 7 Hsptl Goodman's Fields 0 1 1 1 2 0 3 0 8 Aldgate 0 0 2 0 1 0 1 0 4 Totals 0 14 25 3 20 3 44 0 109 Deaths from Epidemics for the corresponding quarter, 1868. 8 15 9 3 18 7 29 0 89 Two deaths from Pyœmia are recorded in the Mile End New Town sub-District and 6 in the Whitechapcl sub-District. TABLE III.— Showing the Ages at Death in the Workhouse, and in the Londoii Hospital, for the Quarter ending 3rd April, 1869 (14 weeks). 0 and underl 1 and under5 5 and undr20 2 20 and under 40 40 and under 60 60 and uuder80 80 and upwards Total Males 71 Femls 44 Corresponding Quarter of 1868. Workhouse 7 2 27 31 37 9 115 101 L. Hospital 4 14 22 41 44 17 0 Malesl03 Femls 39 142 98 TABLE IV.—Ages at Death in each Registration District, for the Three Months ending 3rd April, 1869 (14 weeks). Districts. 0 and under 1 1 and under 5 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Total Remarks. Artillery 12 10 7 3 10 10 1 53 Spitalfields 32 32 6 6 13 14 2 105 Mile E. N. Town 33 23 10 41 44 46 10 207 Workhouse Whitechapel, N. 14 17 3 9 14 9 1 67 Whitechapel Ch. 12 19 26 45 52 23 1 178 Hospital Goodman's Fields 15 10 2 3 14 11 2 57 Aldgate 14 9 2 9 12 8 0 54 Totals 132 120 56 116 159 121 17 721 TABLE V.—The Births and Deaths in each Registration District, for the Three Months ending on the 3rd April, 1869 (14 weeks) . Districts, Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks. M. F. M F Artillery 31 36 67 34 19 53 14 0 Spitalfields 68 62 130 52 53 105 25 0 Mile End N. Town, 75 82 157 122 85 207 0 50 Workhouse. Whitechapel, N 50. .60 110 36 31 67 43 0 Whitechapl. Church 41 38 79 120. 58 178 0 99 London Hospital. Goodman's Fields. 44 47 91 26 31 57 34 0 Aldgate 21 27 48 34 20 54 0 6 45 non-residents died in L, Hos. Totals 330 352 682 424 297 721 116 155 Excess of births over deaths, deducting the 45 non-residents 6 Estimated Population in 1869, 76,000. BOARD OF WORKS, WHITECHAPEL DISTRICT. RBPOET ON THE OF THE WHITECHAPEL DISTRICT, FOR TIIE QUARTER ENDING 3rd JULY, 1869, BY JOIIN LIB DIE, MEDICAL OFFICER OF HEALTH. Presented, to the Board 19th July, 1869. London: Printid bt T. Penny, 121, Leman Street, Weiteciiapel, E. 1869. Ax99 R E P O RT of the MEDICAL OFFICER OF HEALTH, foe the Quarter ending' 3rd July, 1863. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, July 3rd, the births registered in the Whitechapel District were 609, viz.: 307 boys and 302 girls. During the same period, the deaths have been 607, viz.: 356 males and 251 females. In the corresponding Quarter of the previous year, the births were 686 and the deat 595. There is, therefore, a diminution in the number of births of 77, and an increase of 12 in the number of deaths. The disproportion, as compared with other Districts, in the number of births and deaths, during this and some previous Quarters, the births exceeding the deaths by 2 only, and for the Quarter ending 3rd April, 1869, the deaths exceeding the births by 39, calls for some attention. The deaths in the "Whitechapel Church District, in which the London Hospital is situated, always, as might be expected, exceeds the births, but why the deaths should exceed the births in the Aldgate District it is not so easy to explain. I am inclined to believe that all the births are not registered in this District, and it may happen that the same neglect takes place in the other Districts. In order to insure a more correct registration of births, it will be necessary to make the registration of births, as in Scotland and Ireland, compulsory. 4 The law, rendering the vaccination of children compulsory, may so operate as to induce some parents to avoid the registration of the births of their children, in the hope of their being enabled to escape the penalty to which they are liable for refusing to have their children vaccinated; and in poor neighbourhoods the registration of births is often neglected in consequence of the parents having been unmindful to register the births of their children at the time when registration can be effected free of expense. The deaths in the London Hospital have been 113, viz.: 86 males and 27 females. Of the total deaths in this Institution, there were 9 of residents within the District, 81 of non-residents, and 23 of persons who died from the result of accident and from sudden death. The deaths from epidemic diseases in this Institution were 3; of these, 1 was from enteric fever, and 2 from typhus. These three deaths were of non-residents. The deaths from pytemia have been 6. The deaths in the "Workhouse have been 75, viz. : 40 males and 35 females. The deaths from epidemic diseases in this establishment have been 2, viz.: 1 from fever and 1 from diarrhoea. The ages at death of persons dying in the "Workhouse and in the London Hospital, and the mortality in these Institutions for the corresponding Quarter of the previous year, are shown in Table 5 in the Appendix. The deaths from epidemic diseases in the District have been 113, viz.: 1 from small-pox, 16 from measles, 33 from scarlet-fever, 30 from hoopingcough, 7 from diarrhoea, 23 from fever, and 3 from cholera and choleraicdiarrhoea. In the corresponding Quarter of the previous year, the deaths from epidemic diseases were 90, viz.: 28 from measles, 1 from scarlet-fever, 1 from diphtheria, 19 from hooping-cough, 22 from diarrhoea, 17 from fever, and 2 from cholera and choleraic-diarrhoea. From these returns, it appears that while only 1 case of small-pox is recorded, fever, scarlet-fever, and hooping-cough have increased. Seveiwleaths from cholera and choleraicdiarrhoea have been registered in London during this Quarter. In the corresponding Quarter of last year 21 deaths were registered from these causes. The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 107 ; of these, 51 were from bronchitis, 54 from pneumonia, and 12 from other diseases of the lungs. Consumption was fatal to 59 persons. The deaths from other tubercular diseases were 36, viz. : 28 from mesenteric disease, 1 from scrofula, and 7 from hydrocephalus, or water on the brain. Diseases of the heart were fatal to 28. Three persons died from aneurism. The death of a male, aged 48, from disease of the arteries, is recorded; this man had undergone amputation of the toe, and, subsequently, amputation of the leg. 5 The deaths from diseases of the urinary organs were 12; of these, 6 were caused by nephria or Bright's diseases. Convulsions caused the deaths of 24 children. The deaths of 6 persons who committed suicide are recorded, and 2 of persons who were accidentally drowned. There were 11 deaths from premature birth, 5 from teething, 15 from atrophy and debility, and 1 death from congenital syphilis. The deaths of 15 persons are attributed to age; 3 deaths of persons under the age of 70 are thus registered, "premature decay," and "senile decay." "This mode of return should only be employed when the cause of death is not traceable to definite disease." The deaths of persons above 80 years of age were 10. There were 22 deaths from mechanical violence: of these, 5 were caused by vehicles in the streets. Burns and scalds wore fatal to 3 persons. Five children were suffocated in bed, and a man, aged 46, was suffocated "whilst drunk." The number of inquests has been 59. In the corresponding Quarter of last year, the number was 57. The mortality of children, under 5 years of age, has been 248 ; this is 40.8 per cent, of the total deaths; but in the Spitalfields sub-District the rate of mortality of children under 5 to the total deaths, is 62.9 per cent. In the corresponding Quarter of the previous year, the rate of mortality of young children to the total deaths was 40.3 per cent. Uncertified Deaths. The number of deaths which have not been certified by a medical practitioner amounts to 14. This is 2.1 per cent, of the total deaths. Four of the "uncertified deaths" were said to have been of children prematurely born. Several of these uncertified deaths are recorded in technical language, viz., "cerebral meningitis," "erysipelas," "epilepsy," and "marasmus." These certificates may have been supplied by persons who have some knowledge of medicine, but who are unqualified to practise as medical men. The subject of uncertified deaths demands more attention than has hitherto been given to it by the public and by those in authority. A loose mode in the registration of deaths affords facilities for secret murder. A certificate of death not duly signed by a registered medical practitioner should not be returned by the registrar, unless the particulars attending the death are investigated by a public officer. In England 2 per cent, of the . total deaths are uncertified. In London rather more than 1 per cent, of the deaths are uncertified. During this Quarter therefore, a larger proportional amount of uncertified deaths has been recorded in this District than in the other districts in the Metropolis. 6 Pauters Illness in the District. The Medical Officers of the Union have attended, during the last Quarter, 3,267 new cases of illness out of the Workhouse, including 1 of small-pox, 72 of measles, 26 of scarlet fever, 93 of hooping-cough, 149 of diarrhcea, 47 of fever, and 10 of erysipelas. In the corresponding Quarter of the previous year, the number of pauper cases of illness was 4,263, including 22 of small-pox, 143 of measles, 5 of scarlet fever, 62 of hooping-cough, 366 of diarrhcea, 125 of fever, and 10 of erysipelas. There has, therefore, been a marked decrease (about 1,000) in the number of sick paupers during this Quarter, when compared with the number returned for the corresponding Quarter of last year. Meteorology oe Greenwich. The returns of the Registrar General show that the rain-fall in the Metropolis during the Quarter has been 4.45 inches. During the corresponding Quarter of last year the rain-fall was 4.22 inches. The mean temperature of the air was 52.5°. In the corresponding Quarter of last year the mean temperature was 55.1°. The hottest days during the Quarter were Sunday, April llth, Wednesday, April 19th, Sunday, June 6th, and Monday, June 7th, when the thermometer in the shade indicated respectively 77.9°, 79.1°, 83.2°, and 87.5°. The following Table, taken from the returns of the Registrar General, shows the comparative results during the Quarter :— LONDON. Aprl 10th Aprl 17th Aprl 24th May 1st May 8th May 15th May 22nd May 29th June June 5th 12th June 19th June 26th July 3rd Deaths from Diar- rhœa 12 21 21 10 19 10 15 5 22 11 17 28 20 Deaths from Choi- 1 0 0 0 2 0 0 0 0 0 4 0 0 Mean Tempera- ture of the air 47.10 55.2° 50.3° 51.9° 50.5° 51.2° 50.0° 51.7° 53.3° 59.0° 51.3° 54.3° 56.9° Rain-fall in inches 0.17 0.46 0.25 0.00 1.28 0.35 0.68 1.12 0.10 0.00 0.84 0.20 0.00 Deaths in London 1550 1595 1377 1288 1421 1279 1281 1276 1355 1305 1236 1381 1231 Deaths in White- chapel District 51 50 42 34 65 40 51 35 59 50 44 40 46 Sanitary Work performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter:— Number of inspections of houses, as shown in the official returns 4856 Houses systematically visited and rooms measured to ascertain their cubic capacity 91 7 Number of rooms found to be overwrowdcd, the space being less than 300 cubic feet for each person, reckoning two children for one adult 2 Number of cases of indecent occupation discovered 11 Preliminary notices served, many of such noticcs embracing several premises 829 Compulsory orders issued embracing 111 houses and premises 56 Summonses heard at police courts 11 Houses in which the rooms or passages have been white-washed 226 Dust-bins provided 48 Privies white-washed, cleansed and repaired 83 Water-butts or cisterns provided or repaired 109 Water-waste preventer erected 1 Drains in houses improved, &c 89 Cesspools abolished 10 Houses systematically re-visited 222 Cellars used as dwellings discontinued for such use 13 Houses closed, the same being unfit for human habitation, the owners preferring' to close them, rather than carry out the necessary requirements 11 Instances where corpses were kept in inhabited rooms for prolonged periods so as to be a nuisance 2 Animals so kept as to be a nuisance, removed 4 Yards of houses paved or the pavement repaired 110 Number of special notices served for the registration of 83 houses 83 Houses registered by order of the Board 21 Certificates and copies prepared thereof for the registration of the above houses 63 Slaughter-houses specially visited 35 Cow-houses ditto 24 Cows kept in an unlicensed shed removed 5 Area gratings, cellar flaps, &e., repaired 11 Workshops specially visited 38 Bitto overcrowded 4 Ditto specially revisited 114 Nuisances caused by the accumulations of dung and other offensive matter, and from stopped privies, are very numerous. These arc not recorded in the books of the Inspectors, unless official notices are served. In addition to this return, the Inspectors report that they have forwarded to the police authorities several notices of dangerous structures, and have also given intimation to them of all the rooms which they have found on a house-to-house visitation, or on private information, to be occupied by more than one family. The Act requires that all rooms, so let, must be registered under the Common Lodging House Act. 8 Water Supply. The system of constant water supply to the poorer Districts of the Metropolis, ought to he insisted on by the several local Boards, for it is the only plan which will give the poor a sufficient quantity of wholesome water for domestic use. All, or nearly all, the existing water-receptacles in the poor localities are unfit for the purpose of storing water for drinking. They should therefore be abolished, and a constant supply of water, direct from the main, without the intervention of either butts or cisterns, should be substituted. It is with much pleasure that I am able to report that there are 72 water-waste preventers in this District, which afford a constant supply to about 6000 pcor people. Public Dust Bins. There are about 160 public dust bins in this District, all of which the contractor is bound to empty daily. The importance of the daily emptying of the public dust bins cannot be overestimated, and it slioulJ be rigidly enforced, for the smell of the contents of these receptacles, when they are allowed to remain unomptied for a period longer than 24 or 30 hours, is sometimes intolerable, and is a cause of ill health to persons living in the vicinity of them. This is not to be wondered at when we find that the public dust bins are made the receptacles of all sorts of refuse, such as stinking fish, dead dogs and cats, poultices, pieces of filthy rags, and sometimes even the contents of privies. Workshop Regulation Act. The Inspectors have inspected 38 workshops: Of these, 6 were found to be overcrowded, 28 were in a dirty and unwholesome condition, and in no case was there any other provision made for ventilation than by the windows, which, in the winter, will probably bo kept closed. On revisiting the workshops, it was found that the overcrowding had ceased, and the rooms had been cleansed. The greater number of the workshops recently visited are occupied by Jews, who employ several hands as tailors. The occupiers of these workshops are for the most part willing to comply with the sanitary regulations of the Workshop Act, but they strongly object to that portion of the Act which prohibits them from working on Sundays. It will be necessary, however, notwithstanding the dislike of the Jewish population to this enactment, to enforce it. In my opinion, all the provisions of this Act, which are not of a sanitary nature, should be enforced by the police, and the duties of the Sanitary Inspectors ought to be confined to the carrying into effect the provisions relating to the want of cleanliness, overcrowding, defective ventilation, and insufficient privy accommodation. 9 Prolonged Retention of Dead Bodies. In the detail of the sanitary work performed during the Quarter, two cases of the prolonged retention of the dead in inhabited rooms are recorded, and on looking over the quarterly tabulated statements of the sanitary work performed during the last two years, it will be observed, that such cases are of frequent occurrence, and as the Board has now put in force that portion of the Sanitary Act of 1866, relating to the Registration of Houses, it is probable that a greater number of similar cases will be brought under the notice of the Sanitary Officers; for the keeper of every house which has been registered under the provisions of the Sanitary Act, is required to give notice to the Board of any case of infectious or contageous disease which is in such house, and he is also responsible for keeping the house in a cleanly and wholesome condition. The two cases of the keeping of dead bodies in rooms occupied by families were brought under the notice of the Sanitary Officers in a letter addressed to the Medical Officer of Health, stating that his immediate attention should be given to the dangerous state of the house next door to the Jews' Infant School in Rose Court, Commercial Street, in consequence of two children there lying dead, and of " fever being very bad in that house." It was ascertained on inspection that the house complained of consisted of eight rooms, each being occupied by a separate family. There were two dead bodies in the house, and the smell from one of them was very offensive. The parents of these children were remonstrated with upon the impropriety and danger of keeping for so long a time a corpse in a room occupied by several members of the family. This is all that the officers can do in such cases until the resolution of the Board is carried into effect respecting the necessity of erecting a Mortuary House. The question of providing a Mortuary has been repeatedly brought under the notice of the Board has been fully discussed, and a resolution passed upwards of two years ago, to the following effect, viz., that a public mortuary ought to be erected. The last time this subject was discussed was in May, 1869, when a Committee for the second time was appointed to consider the most eligible site for the erection of a mortuary, and the Committee, after having duly considered the several sites spoken of, agreed to recommend, for the approval of the Board, as the most eligible site for that purpose, the piece of ground adjoining the old Parish Dead House, an access to which can be obtained through Eagle place, Princes Street. At a Meeting of the Board held on the 24th of May, the report of the Committee was discussed; but it having been stated that the Poplar Board of Works had made satisfactory arrangements with the proprietors of the Bow Cemetery for a mortuary 10 within the boundary of that Cemetery, it was resolved that the Surveyor be instructed to ascertain if any and what arrangements had been made at the Bow Cemetery for mortuary purposes. It is also necessary to provide, in accordance with the 28th Section of the Sanitary Act, 1866, a " Place fob the Reception of Dead Bodies dubing the Time keotiked fob post mobtem examination." The inconvenience arising from the want of a proper building for conducting post mortem examinations has been felt in some districts, and the subject has been freely commented on by the public press in a manner not creditable to the local authorities. A similar inconvenience may arise in any District in which there is not a convenient place, properly furnished with all necessary appliances for conducting a post mortem examination, and more especially when such examination has been ordered by the Coroner. The same room might be made applicable for the reception of the body of any person found dead in the public streets, or of the body of a person found drowned in the Docks, or in the River. The impprtance of the precept, " Let all things be done decently and in order," is not fully appreciated by the public. Disinfecting Establishment. The question of erecting an establishment for the disinfecting of clothes, bedding, &c., was brought under the notice of the Board in my Quarterly Report for September, 1867, and I would again most respectfully beg to direct your attention to this important matter. The disinfecting of clothes and bedding which have been used by persons attacked with contagious or infectious diseases would certainly tend to prevent the spreading of such diseases, and hence the cost of erecting a disinfecting establishment would soon bo repaid. Two disinfecting apparatuses have been established in the Borough of Liverpool, and they have been, for three years and upwards, in operation. The clothes and bedding are gratuitously disinfected, and, it appears from the Report of Dr. Tbench, the Medical Officer of Health, that they are becoming more fully appreciated by the people. The number of articles sent to them during the year 1867 was 4603, and in 1868 the number was 16,639, showing an increase of 12,036 in one year. Dr. Trench, however, expresses regret at the lukewarmness in the matter of the use of these disinfecting apparatuses, "on the part of those who generally interest themselves in the well-being of society and in the care and protection of the poor and the sick." 11 Trades' Nuisances. In my last Quarterly Report, I gave a somewhat detailed account of the nuisance arising from the burning of creosote in the sugar refinery of Mr. Schwartz, in Mile End New Town, and I am now able to inform the Board that Mr. Schwartz has discontinued to use creosote as fuel, and the neighbourhood is, consequently, relieved from the nuisance which they had so long complained of. Complaints have been made of a nuisance caused by the fumes of burning coke in open iron baskets, at a paper-stainer's in Prince's Street, Spitalfields. These open baskets of red hot coke are used in several parts of the building for the purpose of drying the paper, and the suffocating fumes arising from the combustion of the coke in this manner is a nuisance dangerous to health, and must therefore be suppressed. On my pointing out to the proprietor the danger of so using coke, he promised to adopt such measures as would prevent all further cause of complaint. The nuisance is now satisfactorily abated. A memorial, signed by seven inhabitants of Norton Eolgate, was sent to the Board, complaining of a nuisance arising from the melting of lead on the premises of Messrs. Chuck & Lockett. Upon receipt of this memorial I inspected the premises complained of, and I reported that while old lead was being melted, there was a disagreeable smell, which was no doubt a source of annoyance to the immediate neighbourhood. As the shaft, through which the vapours escaped into the neighbourhood, was not sufficiently high, I suggested to Messrs. Chuck & Lockett the raising of the chimney-shaft to a height of a few feet above the roofs of the adjacent houses. This suggestion Mr. Lockett most readily consented to carry into effect. The chimney has been raised, and no further complaints have been made to this Board respecting the nuisance. Complaints have again been made of the nuisance from the re-burning of animal charcoal on the premises of Mr. Bhinjes, in Back Church Lane, and on those of Mr. Gadsden, in Chamber Street. The proprietors of each of these premises have made efforts, attended with considerable expense, to abate the nuisance, but their efforts, hitherto, have not proved successful. Further alterations will, consequently, be necessary. The nuisance, I firmly believe, can be effectually abated. Unless, therefore, more efficient means are adopted, it will be necessary to take proceedings to compel an abatement of the nuisance. Complaints are occasionally made of the nuisanec arising from the premises of "marine store dealers," which is caused by the accumulation of offensive fat, bones, skins, old rags, &c. Several parties have been cautioned respecting the nuisance, which caution, if not attended to, will be followed by the adoption of legal proceedings. All such premises should be licensed, as well as stables, and sheds or other buildings in crowded neighbourhoods where cattle or sheep arc detained. 12 Registkation of Deaths. The Registrar General asks, "Why is life cut short? Why do the people of England live only a mean life-time of41 years?" These are important questions, and are interesting to all men, hut especially so to the members of the medical profession; and it is to them that we must look for a solution of the questions. The Government has taken an interest in this matter, for it has forwarded, free of expense, to each medical practitioner in United Kingdom, a copy of the new nomenclature of diseases, which was prepared hy a joint committee of some of the most eminent members of the medical profession, appointed by the Royal College of Physicians of London. By the universal adoption of this nomenclature, which contains synonymes in the Latin, French, Italian, and German languages, it is to be hoped that the vague terms now so commonly used in the registration of the causes of death will cease, and that more definite words will be substituted, and that we shall no longer see in the returns the mere symptoms of disease recorded as being the cause of death. In some cases it may be necessary to record the most prominent symptoms of the disease as the cause of death, when a post mortem examination cannot be obtained. It is certainly most desirable for statistical purposes that the several kinds of fever, which are now better understood, should be distinguished in the certificates of death—that the words fever, bilious fever, gastric fever, and such like indefinite terms should be discontinued, and that the present standard nomenclature should be adopted. It is also desirable that the cause of death should be plainly written in each certificate of death, so that the registrars, who for the most part are not medical men, may be able to transmit a true copy of the certificate to the Registrar General. I am, Gentlemen, Your obedient Servant, 15, Great Alie Street. JOHN LIDDLE. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 3rd July, 1869. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhcea. Choleraic-Diarrhoea. Continued Fever, Typhus & Typhoid. Pyaemia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Dr. Swyer 1 38 11 28 47 0 16 1 3 0 0 31 36 1 8 1 1 1 0 809 1013 Mr. Champneys 0 15 3 18 16 0 9 0 3 0 0 16 3 0 0 0 1 0 0 355 439 Dr. Richardson 0 17 0 3 45 0 7 0 0 0 0 61 1 1 1 0 0 0 1 500 637 Mr. Sequiera 0 22 12 44 41 0 15 0 4 0 0 9 12 0 1 11 0 1 1 1005 1178 Total 1 72 26 93 149 0 47 1 10 0 0 117 52 2 10 12 2 2 2 2669 3267 Corresponding Quarter of previous Year. 22 143 5 62 366 1 125 0 10 1 1 80 51 3 43 1 5 4 7 3393 4263 TABLE II. Showing the Deaths from Epidemic Diseases, for the Three Months ending 3rd July, 1869. Districts. Small-Pox. Measles. Scarlet-Fever. Diphtheria. HoopingCough. Cholera & Choleraic Diarrhea. Fever. Cholera. Total. Remarks. Artillery 0 0 4 0 1 0 0 0 5 Spitalfields 1 4 7 0 11 0 1 0 24 Mile End New Town 0 4 9 0 5 5 4 3 30 Workhouse. Whitechapel, North 0 4 3 0 6 0 5 0 18 Whitechapel Church 0 0 1 0 1 0 6 0 8 Hospital. Goodmanp's Fiedlds 0 2 4 0 5 1 5 0 17 Aldgate 0 2 5 0 1 1 2 0 11 Totals 1 16 33 0 30 7 23 3 113 Deaths from Epidemics for the corresponding Quarter, 1868. 0 28 1 1 19 22 17 2 90 There were 6 deaths from pyaemia in the London Hospital. One death from fever occurred in in the Fever Hospital, and not a single death from small-pox is recorded in the Small-pox Hospital of any person belonging to this District. Three deaths from fever occurred in the London Hospital, all of which were of non-residents. TABLE III. The Births and Deaths in each Registration District, for the Three Months ending on the 3rd July, 1869. Districts. Bir hs. Total. Dea ths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M, F. Artillery 28 26 54 9 15 24 30 0 Spitalfields 63 38 101 40 41 81 20 0 MileEndN.Town 70 80 150 91 78 169 0 19 Workhouse. Whitechapel, N. 43 54 97 50 24 74 23 0 Wliitechpl Church 26 32 58 103 42 145 0 87 London Hospital. Goodman's Fields 53 47 100 35 29 64 36 0 81 Kon-residents died in the London Hospital. Aldgate 24 25 49 28 22 50 0 1 Totals 307 302 609 356 251 607 109 107 Excess of Deaths over Births, deducting the 81 non-residents, 73. population in 1861, 78,970. TABLE IV. Ages at Death in each Registration District, for the Three Months ending 3rd July, 1869. Districts. 0 and under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total. Remarks. Artillery 7 5 3 2 0 6 1 24 Spitalfields 22 29 2 5 15 7 1 81 Mile E. N. Town 31 31 4 23 39 37 4 169 Workhouse. Whitechapel, N. 25 17 9 7 12 4 0 74 Whitechapel Ch. 10 15 8 46 47 17 2 145 Hospital. Goodman's Fields 8 15 3 6 10 7 1 50 18 15 3 7 13 7 1 61 121 127 32 96 136 85 10 607 It appears, on the perusal of the above Table, that the rate of mortality of children under 5 years of age, in relation to the total deaths, varies in the several sub-districts. Thus, in the Artillery sub-district it is 50.0 per cent.; in the Spitalfields it is 62.9 per cent ; in the Whitechapel North it is 56.4 per cent.; in the Aldgate, 54.0 per cent ; while in the entire District it is 40.8 per cent. TABLE V. Showing the Ages at Death in the Workhouse, and in the London Hospital ior the Quarter ending 3rd July, 1869. 0 and under 1. 1 and under 5. 5 and under 20. j 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total Males, 40. Females, 35. Corresponding Quarter of 1868. 6 1 0 18 26 21 3 75 93 London Hospital. 0 7 3 40 45 13 0 Males, 86. Females, 27. 113 117 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE SANITARDS cONDITION OF THE WHITECHAPEL DISTKICT, FOR THE QUARTER ENDING 2nd OCTOBER, 1869, BY JOHN LIDDLB, Spiral <M«r nf iraltlj. PRESENTED TO THE BOARD 8th NOVEMBER, 1869. london: printed by e. j. bath, 26, high street, whitechapel. 1869. REPORT of the MEDICAL OFFICER OF HEALTH, foe the Quarter ending 2nd October, 1869. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended 2nd October, 619 births and 690 deaths were registered in the Whitechapel District; of the births there were 307 of boys and 312 of girls. In the corresponding Quarter of the previous year, the births were 583 and the deaths 638. In each of these Quarterly returns, the deaths in the London Hospital are included. The deaths in this Quarter have exceeded the births by 71, but deducting the deaths of 75 non-residents the births have exceeded the deaths by 4. The deaths in the London Hospital have been 123, viz.: 79 males and 44 females. Of the total deaths in this Institution there were 14 of residents within the District, 75 of non-residents, and 37 of persons who died from the result of accident or from sudden death. The deaths from epidemic diseases in the Hospital were 10; of these, 6 were from scarlet fever, 2 from typhoid fever, and 2 from diarrhoea. The deaths from pyaemia were 4. The deaths in the Workhouse have been 63, viz.: 28 males and 35 females. The deaths from epidemic diseases in this establishment have been 4, all from diarrhcea. The ages at death of persons dying in the Workhouse and in the London Hospital, and the mortality in these Institutions for the corresponding Quarter of the previous year, are shown in Table 3 in the Appendix. 4 The deaths from epidemic diseases in this District have been 231, viz.: 17 from measles, 82 from scarlet-fever, 1 from diphtheria, 39 from hoopingcough, 72 from diarrhoea, 3 from choleraic-diarrhoea, and 17 from fever. In the corresponding Quarter of the previous year, the deaths from epidemic diseases were 177, viz.: 2 from small-pox, 13 from measles, 11 from scarlet-fever, 1 from diphtheria, 12 from hooping-cough, 101 from diarrhoea, 29 from fever, and 8 from cholera and choleraic-diarrhoea. The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 65; of these 15 were caused by bronchitis, 38 by pneumonia, and 12 by other affections of the lungs. Consumption was fatal to 77 persons. The deaths from other tubercular diseases were 33, viz.: 27 from mesenteric disease, 1 from scrofula, and 5 from hydrocephalus, or water on the brain. Diseases of the heart were fatal to 24 persons. The deaths from diseases of the urinary organs were 18; of these, 8 were caused by nephria or Bright's disease, 1 by diabetes, and 9 by other diseases of the kidneys. Convulsions caused the deaths of 10 children. There were 9 deaths from premature birth, 7 from teething, and 25 from atrophy and debility. The deaths from syphilis were 2. Intemperance was fatal to 5 persons, and 1 child, aged 6 years, was aocidently poisoned, but the particular poison is not specified. The deaths of 13 persons are attributed to old age ; of these, 10 were above 80 years of age. Three persons died from premature decay, under the age of 70 years. There were 25 deaths from mechanical violence; of these, 9 were caused by horses and vehicles in the streets. In one of these cases a verdict of manslaughter was returned. Burns and scalds were fatal to 4 persons. Three children were suffocated in bed. One death occurred from drowning The number of inquests has been 59. In the corresponding Quarter of last year, the number was 80. The deaths from epidemic diseases to the total mortality were in the proportion of 33.4 per cent.; from consumption the proportion was 11.1 per cent.; from violence, 3.6 per cent.; and from old age and premature decay, 2.3 per cent. The deaths of children, under o years of age, are 340. This is 49.2 per cent, of the total mortality. In the previous Quarter of last year, the rate of mortality of children under 5 was 44.8. This increase in the rate of mortality of young persons is accounted for by the large mortality from scarlet-fever, a disease chiefly attacking young persons. This disease in t'he October Quarter of 1868 was fatal to 11, whereas during this Quarter the deaths have been 82. In the Artillery Sub-District the rate is 78.5 per cent.; in the Spitalfields, 65.0 per cent.; in the Mile End New Town 45.0 per cent.; in the Whitechapel North, 63.1 per cent.; in the Whitechapel Church, 1S.8 per cent.; in the Goodman's Fields, 63.6 per cent.; and the Aldgate, 68.0 per cent. 5 The number of deaths which have not been certified by a medioal practitioner has been 19; of these 15 were recorded in the Spitalfields sub-District. The Registrar for this sub-District makes a note to the effect that the majority of the certificates are informal, that is to say, the certificate of death has not been given in accordance with the form prescribed by the Registrar-General, although the certificates were signed by a duly qualified medical practitioner. The form of certificate as now used is faulty, and it ought to be amended. Unless the death of a patient is expected by the medical practitioner in attendance at the date of the last visit speedily to take place, it is questionable whether a medical man is justified in stating that his patient died on such a day, and more especially when he has not verified the fact that his patient is actually dead; all that he can correctly say in the certificate of death is, that he was informed of the day when the patient died, and in his opinion the cause of death was , unless a post mortem, examination of the body has been made by him, when he can then speak with more certainty as to the cause of death. Paupers' Illness in the District. The Medical Officers of the Union have attended, during the last Quarter, 3,526 new cases of illness out of the Workhouse, including 2 of small-pox, 54 of measles, 135 of scarlet-fever, 90 of hooping-cough, 560 of diarrhoea, 72 of fever, and 13 of erysipelas. In the corresponding Quarter of the previous year, the number of pauper Cases of illness was 4, 765, including 13 of small-pox. 51 of measles, 17 of scarlet-fever, 23 of hooping-cough, 1,041 of diarrhoea, 7 of cholera and choleraic-diarrhoea, 113 of fever, and 25 of erysipelas. There has, therefore, been a marked decrease in the number of sick paupers during this Quarter, when compared with the number returned for the corresponding Quarter of last year. Scarlet-fever, however, has been extremely prevalent among the paupers in this District, the disease having increased from 17, in the corresponding of last year, to 135 in this Quarter. Upon the extensive and still existing prevalence of scarlet-fever, the RegistrarGeneral remarks:—" This highly contagious disease finds in the crowded quarters of our large towns all the conditions favourable to its extension. The skill and energy of the medical profession, and more particularly of the Officers of Health, are taxed to the utmost in dealing with the disease. in endeavouring, when possible, to separate the sick and the dying, and in making generally known the precautions most needful; their humane efforts are, however, beset with difficulties Until better habitations are within reach of the labouring and poorer classes, until decent public mortuaries are provided in all populous towns, and, perhaps also, until the rudiments of physiology are included in the education of our youth, so that all who read may know something of the laws by which we live and have our being. We cannot extinguish with needful rapidity the oft recurring visitations of epidemics like that we are now suffering from ; for ignorance is the fostermother of disease as well as of crime." There are some places in this District (particularly those large blocks of buildings bounded by Castle Street and Castle Alley on the east, and by the east side of Middlesex Street on the west, and bounded on the north by Union Street), where the houses are so old, ill-constructed, and confined, that from the want of efficient ventilation and of proper privy accommodation persons occupying them cannot enjoy good health; and as it is impossible to improve these houses they ought to be taken down. They would soon be demolished if the same anxiety were displayed by the public authorities for the improvement of the health of the people as such authorities now manifest in improving the traffic and embellishing the 6 Metropolis. Upwards of six millions have been expended in ornamentation and in traffic convenience, whereby the wealthy are principally benefitted, but not one single street, court, or alley, where the poor are compelled to dwell, has been improved at the public expense in order to advance the physical condition of the people. In the densely crowded streets in London, fever and other contagious or infectious diseases are very seldom or never absent, and such diseases extend over the whole metropolis when they prevail epidemically; the whole community, rich and poor, then suffer alike from their influence. It is surely time that public attention should now be directed to this matter, so that something effectual may be done to improve the existing state of things. I may further add, that a great number of the houses in this District are used as common lodging-houses, which are under the inspection of the police, and are principally occupied by tramps and persons of the lowest class. There are also many of the houses, which, from their almost inaccessable situations, afford shelter to thieves and vagrants, who make their way into London from all parts of the country ; the former to (obtain a larger field to carry on their depredations, and the latter to live upon the charity which is so indiscriminately bestowed by the unthinking members of the community. Almost the only persons who enter these abodes of wretchedness are the police officers, the relieving and sanitary officers, and the medical officers of ihe Union. Publication of Returns of Sickness. The information respecting the state of the public health that would be afforded by a weekly publication of all the cases of sickness which are treated by the medical officers of the Unions, by the Hospital and Dispensary medical officers, and by the medical attendants of large establishments, such as schools, asylums, factories, &c., might prove of great importance by showing the prevalence or otherwise of epidemic diseases. The deaths which are published regularly every week by the Registrar-General, valuable as such publication undoubtedly is, does not give full information respecting the public health, for it sometimes happens that the deaths are very numerous, owing to the fatal nature of disease; while, at the same time, cases of disease are comparatively few in number ; and, on the other hand, the cases of illness may be very numerous while the number of deaths is of small amount, owing to the mildness of the prevailing diseases. If the deaths and the cases of illness among the population were published together, a more correct opinion of the public health would be obtained. Ever since your Board has been established, I have published quarterly the returns of sickness which are made weekly to the Guardians by the medical officers of the Union, and in the years 1857 and 1858 the Metropolitan Association of the Officers of Health collected the returns of the cases of sickness occurring among the pauper population and those in the several charitable Institutions and Workhouses in London. These returns were submitted to a member of the Association, who prepared them for publication weekly. Mr. Simon, the Medical Officer of the Privy Council, in his last annual report expresses an opinion that, for the purposes of promoting medical science and health administration, periodical reports of sickness treated by the medical and surgical staffs of all the medical charities should be obtained and published. These reports might be sent to the Medical Officers of Health for the respective districts, who should transmit them to the medical officer of a central authority having the supervision of the public health. 7 In a letter addressed to the Editor of the Journal of Public Health, and published in the number for July, 1848, I drew public attention to this important subject, and urged the desirability of furnishing the Eegistrar-General with a weekly return of the cases of sickness occurring in the metropolis, so that he might be able to publish it with the weekly returns of death. Such a publication would acquaint the public authorities and their officers with the actual state of the health of the people. If such returns had been published, the numerous cases of relapsing fever, a disease fatal in the proportion only of about 5 per cent, of persons attacked would have called, at an early period, the attention of the public to the subj ect, whereas public attention was only drawn to the prevalence of this disease by the publication in the Lancet of the return of oases admitted into the Fever Hospital. If the returns of sickness furnished to the Guardians by the medical officers of the Unions were utilized by the Medical Officers of Health, and presented to their respective Boards at their weekly or fortnightly Meetings, such returns would be published in the local journals, and so the public generally would be informed of the health of each District. Meteorology op Greenwich. The returns of the Eegistrar-General show that the rain-fall in the Metropolis during the Quarter has been 5.23 inches. During the corresponding Quarter of last year the rain-fall was 4.40 inches. The mean temperature of the air was 01.5°. In the corresponding Quarter of last year the mean temperature was G3.9". The hottest days during the Quarter were Sunday, July 18th, Thursday, July 22nd, and Saturday, August 28th, when the thermometer in the shade indicated respectively 88.8°, 90.9°, and 89.0°. The following Table, taken from the returns of the Eegistrar-General shows the comparative results during the Quarter :— LONDON. July 10th July 17th July 24th July 31st Aug. 7th Aug. 14 th Aug. 21st Aug. 28th Sept 4th Sept 11th Sept 18th Sept 25th Oct. 2nd. Deaths from Diarrhcea 50 102 253 3S4 394 346 264 195 161 185 139 115 76 Deaths fromCholera Choleraic Diarrhœa 4 11 33 29 33 29 17 14 6 8 5 2 3 Mean Temperature of the Air 64.2° 66.9° 66.0° 64.0° 59.8° 58.5° 58.7° 68.4° 56.1° 63.5° 58.1° 56.8° 58.8° Rain-fall in iuches 0.00 0.14 0.00 0.41 0.47 0.73 0.01 0.00 0.00 0 69 1.85 0.12 0.81 Deaths in London 1279 1313 1600 1640 1630 1591 1587 1463 1388 1601 1409 1362 1395 Deaths in theWhitechapel District 45 56 52 55 55 42 54 62 51 53 59 42 64 Sanitary Work performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter:— Number of inspections of houses, as shown in the official returns 3702 8 Houses systematically visited and rooms measured to ascertain their cubic capacity 40 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each person, reckoning two children for one adult 7 Number of cases of indecent occupation discovered 17 Preliminary notices served, many of such notices embracing several premises 330 Compulsory orders issued embracing 111 houses and premises 72 Summonses heard at police courts 5 Houses in which the rooms or passages have been white-washed 160 Dust-bins provided 48 Privies white-washed, cleansed, and repaired 92 Water-butts or cisterns provided or repaired 83 Water-waste preventers erected 3 Drains in houses improved, &c 113 Houses systematically re-visited 134 Cellars used as dwellings discontinued for such use 3 Instances where corpses were kept in inhabited rooms for prolonged periods so as to be a nuisance 1 Animals so kept as to be a nuisance, removed 1 Yards of houses paved or the pavement repaired 100 Number of special notices served for the registration of houses 48 Houses registered by order of the Board 18 Certificates and copies prepared for the registration of the above houses 36 Bake-houses specially visited 76 Slaughter-houses ditto 35 Cow-houses ditto 24 Cows kept in 2 unlicensed sheds, removed 4 Area gratings, cellar flaps, &c., repaired 39 Workshops specially visited 3 Ditto overcrowded 1 Ditto specially revisited 15 Trades nuisances abated 1 Nuisances caused by the accumulations of dung and other offensive matter, and from stopped privies, are very numerous. These are not recorded in the books of the Inspectors, unless official notices are served. In addition to this return, the Inspectors report that they have forwarded to the police authorities* several notices of dangerous structures, and have also given intimation to them of ah the rooms which they have found on a house-to-house visitation, or on private information, to be occupied by more than one family. The Act requires that all rooms, so let, must be registered under the Common Lodging-House Act, *The amended Metropolitan Building Act, 1869, which came into operation on the 1st Octobel, transfers the power of the Commissioners of Police over dangerous structures to the Metropolitan Board of Works. 9 Mortuary House. The necessity of providing a Mortuary has again been strikingly shown in a case of prolonged retention of a dead body at No. 6, Princes Street, Whitechapel. In a room in this house, about 8 feet square and about 7 feet high, occupied by three persons, the dead body of a child, seven years of age, who died of fever, was kept for a period of nine days. Since the death of the child, the parents were obliged to take another room in the house, in consequence of the offensive smell arising from the body. The parents informed the Inspector that the reason why they could not bury the child at an earlier period was, that they could not obtain the means to do so. They further stated that they would have gladly deposited the body of their child in a building set apart for the reception of the dead, had there been suoh a place in the District. Water Supply. The system of constant water supply to the poorer Districts of the Metropolis, ought to be insisted on by the several local Boards, for it is the only plan which will give the poor a sufficient quantity of wholesome water for domestic use. All, or nearly all, the existing water receptacles in the poor localities are unfit for the purpose of storing water for drinking. They should therefore be abolished, and a constant supply of water, direct from the main, without the intervention of either butts or cisterns, should be substituted. It is with much pleasure that I am able to report that there are 75 water-waste preventers in this District, which afford a constant supply to more than 6,000 poor people. Public Dust Bins. There are about 160 public dust bins in this District, all of which the contractor is bound to empty daily. The importance of the daily emptying of the public dust bins cannot be over estimated, and it should be rigidly enforced, for the smell of the contents of these receptacles, when they are allowed to remain unemptied for a period longer than 24 or 30 hours, is sometimes intolerable, and is a cause of ill health to persons living in the vicinity of them. I am sorry to say that the contractor has not given sufficient attention to the emptying of the public dust-bins during this quarter. Sanitary Requirements. In order that the duties of the Sanitary Officers may be carried out in a more efficient manner, it is necessary: 1st. To build a Mortuary suitable to receive the bodies of all persons who have died in this District of any contagious or infectious disease, and a dead body from any room occupied by several persons. The Mortuary should be so built as to have nothing of a repulsive character, but it should be so constructed as to present certain architectural and ecclesiastical ornaments. 2nd. To provide means of disinfection by erecting a proper building where the disinfection of clothing and bedding may be carried out. 3rd. To provide a carriage for the conveyance of infected persons to Hospitals. 4th. To provide a place suitable for the 10 reception of dead bodies during tbe time required for making post mortem examinations. 5th. To provide a House of Refuge for the reception of persons living in a room where infectious or contagious disease exists, and: 6th. To provide a house which might be used as a Hospital for the reception and treatment of persons suffering from fever or other infectious disease. Disinfection. I have thought it advisible to append to my report the subjoined extract from a Memorandum on Disinfection, prepared by Mr. Simon, the Medical Officer to the Privy Council, and published in 1866. "1, During the emptying of privies and cesspools, and whenever else temporary disinfection is required for them, carbolic acid,* or sulphate of ironf, or perchloride of iron, or chloride of manganese‡, or chloride of zinc§, will bo found available. A dilute solution of one of those agents should be poured into the privy or cesspool, from a quart to a pailful at a time, till the desired effect is obtained. Especially where cholera or typhoid fever is present, privies and cesspools ought to be very frequently flooded in this manner. The best test of their being adequately disinfected, is the entire absence of faecal or ammoniacal odour. "2. Heaps of manure or other filth, if it be for the time impracticable or inexpedient to remove them, should be covered, to the depth of two or three inches, with a layer of freshly burnt vegetable charcoal in powder. Freshly burnt lime may be used in the same way, but is less effective than charcoal. If neither charcoal nor lime be at hand, the filth should be covered with a layer, soma inches thick, of clean dry earth. For a privy which has only solid contents, the same sort of treatment is applicable. Earth near dwellings, if it has become offensive or foul by the soakage of decaying animal or vegetable matter, should be treated on the same plan. "3. If running sewage, about to be used in agriculture, require to be disinfected, the chloride of manganese or perchloride of iron may be best used ; but if the sewage is to pass into a river, or into any pond or canal, where it might again become offensive, chloride of lime is to be preferred; and in this case a pound of good chloride of lime will generally suffice to disinfect 1,000 gallons of the sewage. For foul ditches and other stagnant drainage, chloride of lime is also the proper disinfectant. "4. Where it is desirable to disinfect, before throwing away, the evacuations from the bowels of persons suffering from cholera or typhoid fever, some of the disinfectant (which here may best be chloride of lime) should be put *Carbolic Acid (in the fluid form in which it is commonly sold) should bo diluted with about eighty times its volume of water. +Sulphate of Iron should be dissolved in ten times its weight of water. tPerchloride of Iron, or Chloride of Manganese (the common concentrated solutions may be used), diluted with twelve times their bulk of water. §Chloride of Zinc, the common concentrated solution may be diluted with eight or ten times its bulk of water. ||Chloride of Lime may be mixed in the proportion of about ono pound to a gallon of water. Sulphate of Zinc may l e dissolved in about ten times its weight of warm water. 11 into the bed-pan or other vessel before it is used by the patient, and some more should be added immediately after. Its thorough mixture with the evacuation should be ensured. Care should also be taken that portions of the discharges do not remain about the patient's body, or in his dress. "5. Linen and washing apparel requiring to be disinfected may bo set to soak in water containing per gallon about an ounce either of the common clear solution of chloride of lime, or of that of chloride of soda Or the articles in question may be plunged into boiling water, and afterwards, when at wash, be actually boiled in the washing-water. "6, Woollens, bedding or clothing, which cannot be washed, may be disinfected by exposure for two or more hours, in chambers constructed for the purpose, to a temperature of F. 210°—250°. When this cannot be done, the natural disinfecting process of prolonged exposure to air, sun, and rain, ought to be had recourse to. "7. For the disinfection of the interior of houses, the ceilings and walls should be washed with warm quick-lime water. The wood-work should be cleansed with soap and water, and subsequently washed with water containing in each gallon about two ounces of the clear solution of either chloride of lime or chloride of soda. "8. A room, no longer occupied may be disinfected by chlorine gas, or nitrous acid gas, or sulphurous acid gas. And for this purpose the gases may be produced in the room as follows:—Chlorine gas, by pouring over a quarter of a pound of finely powdered black oxide of manganese, contained in a jar, half a pint of muriatic acid previously mixed with a quarter of a pint of water, or by pouring over a quarter of a pound of chloride of lime, contained in a jar, a quarter of a pint of muriatic or dilute sulphuric acid;—Nitrous acid gas, by pouring over an ounce of copper shavings or turnings, contained in a deep jar, three ounces of concentrated nitric acid; — Sulphurous acid gas, by burning an ounce or two of flower of sulphur in a pipkin. The process of disinfecting a room by any of these gases requires several hours ; and while it is going on, all doors, chimneys, and windows of the room must be kept carefully closed. Precautions to this effect should have been taken before the chemicals are mixed, as the person who starts the process (having to avoid the gases) must not afterwards loiter in the room. When the process is at an end, doors and windows should be fully opened." In a Memorandum on Disinfection, by the Medical Officers of Health, it is recommended that for fumigating infected rooms and their contents, a quarter of a pound of brimstone, broken into small pieces, should be put into an iron dish (or the lid of an iron saucepan, turned upside down), supported by a pair of tongs over a bucket of water. The chimney and other openings are then to be closed with paper pasted on, and a shovel of live coals put upon the brimstone. The door must then be quickly shut, the crevices outside covered with paper and paste, and the room kept closed for five or six hours. After this, a thorough cleansing should be effected ; everything washable should be washed, and all other things cleansed by proper means. Chlorine gas may likewise be used. It may be prepared by mixing two table spoonfuls of common salt, two teaspoonfuls of red lead (or oxide of manganese), half a wine glassful of sulphuris acid (oil of vitrol), and a pint of water. 12 Since this report was presented to the Board, I have received a return of the cases of relapsing fever admitted into the London Fever Hospital from this District. Up to August 31st, 9 cases, September, 14 cases, October, 7 cases, November 1—9, inclusive, 14 cases. The greater number of these cases were removed from the registered lodging houses, which are under the care of the police. Relapsing fever appears now to be on the decrease, the return of cases for the week ending November 13th, being 4, and for that ending 20th Nov. 3. For the purpose of showing the present condition of the District as regards the prevalence of fever, and its condition during the corresponding six weeks of the previous year, I laid before the Board at its meeting on Monday, the 22nd November, the following returns:— 1868. Cases of Fever attended by the Medical Officers of the Union during the weeks ending 1868. Deaths from Fever, in the entire District during the same weeks. Oct. 10th 5 Oct. 31st 18 Oct. 10th 2 Oct. 30th 4 „ 17th 7 Nov. 7th 17 „ 17th 2 Nov. 7th 5 „ 24th 5 „ 14th 14 ,, 24th 2 14th 4 Total Cases 66 Total Deaths 19 1869. 1869. Oct. 9th 12 Oct. 30th 11 Oct. 9th 0 Oct. 30th 2 ,, 16th 21 Nov. 6 th 17 „ 16th 2 Nov. 6th 1 „ 23rd 7 ,, 13th 10 ,, 23rd 2 13th 0 Total Cases 78 Total Deaths 7 By the above comparative statement it will be seen that the number of deaths from fever has been less in the six weeks terminating on November 14th, 1869, than in 1868; but the number of cases has been greater, thereby showing that although the cases have been more numerous the disease has been of a milder type. Of the cases returned during the above-mentioned period for this year, 13 are of relapsing fever. As the presence of this fever is indicative of unusual destitution, it will be desirable to make the best possible provision to contend with the existing want. It has been suggested, in a letter forwarded to this Board by Dr. Buchanan, that some increase of the staff of your Board should be made, and as it is highly important that the habitations of persons suffering from fever and from scarletfever, which is now very prevalent, should be disinfected, I think it would be a wise precaution if the Board would employ some person for that purpose during the present period. The above recommendation was acceded to, and a person has accordingly been appointed. 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 2nd Oct., 1869. Names of Medical Officers, Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhcea. Cholera and Choleraic-Diarrhoea. Continued Fever, Typhus & Typhoid. Cholera. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. Rheumatic Fever. Ague, Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Dr. Swyer 1 17 63 16 173 0 39 0 1 0 0 17 28 0 13 0 1 5 1 1054 1134 Mr. Champneys 0 6 15 17 112 1 18 0 6 0 0 18 1 0 1 0 1 0 0 556 567 Dr. Richardson 0 7 17 8 119 0 4 0 3 0 0 26 1 0 1 3 0 0 2 562 658 Mr.Sequiera 1 24 40 49 156 0 11 0 3 0 0 5 10 2 0 3 0 0 0 1156 1167 2 54 135 90 560 1 72 0 13 0 0 66 38 2 15 6 2 5 3 3328 3526 Corresponding Quarter of previous year. 13 51 17 23 1041 7 113 0 25 0 0 60 44 2 26 4 3 3 5 3328 4765 Of the 18 cases of Fever attended by Mr. Champneys, one is recorded as Relapsing Fever. TABLE II.—Showing the Deaths from Epidemic Diseases for the Three Months ending 2nd October, 1869. Districts. Small-Pox Measles Scarlet Fever Diphtheria HoopingCough Diarrhcea Fever Cholera and Choleraic- Diarrhcea. Total Remarks. Artillery 0 0 6 0 3 4 0 1 14 Spitalfields , 0 2 22 0 12 18 5 1 60 Mile End N. Twn. 0 3 20 0 6 14 5 0 48 Work house Whitechapel, N.. 0 6 9 0 4 5 2 1 27 Whitechapel Ch.. 0 0 7 1 2 5 2 0 17 Hsptl Goodman's Fields 0 3 6 0 1 13 1 0 24 Aldgate 0 3 12 0 11 13 2 0 41 Totals 0 17 82 1 39 72 17 3 231 Deaths from Epidemics for the corresponding quarter, 1868. 2 13 11 1 12 101 29 8 177 There were four deaths from Scarlatina, one from Typhoid Fever,"and one from Diarrhoea in the London Hospital, all of which cases were of non-residents. Six deaths must therefore be deducted from the total of 231, thereby reducing the mortality from Epidemic Diseases to 225. TABLE III. - Showing the Ages at Death in the Workhouse, and in the London Hospital, for the Quarter ending 2nd October, 1869. 0 and underl 1 and under5 5 and undr20 20 and under40 40 and under 60 60 and under 80 80 and upwards Total Males 28 Femls 35 Corresponding Quarter of 1868. Workhouse 7 1 1 13 21 18 2 63 70 L. Hospital 2 10 18 36 38 19 0 Males 79 Femls 44 123 137 TABLE IV.—Ages at Death in each Registration District, for the Three Months ending 2nd October, 1869. 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 9 5 5 4 5 0 42 Spitalfields 32 47 9 9 14 7 5 123 Mile E. N. Town 29 44 6 25 29 26 3 162 Workhouse "Whitechapel, N. 17 19 5 6 4 5 1 57 Whitechapel Ch. 10 19 19 40 44 22 0 154 Hospital Goodman's Fields 30 19 7 9 9 3 0 77 Aldgate 20 31 9 6 5 3 1 75 Totals 152 188 60 100 109 71 10 690 TABLE V.—The Births and Deaths in each Registratio District, for the Three Months ending on the 2nd October, 1869. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks. Artillery M. 23 F. 25 48 M. 20 F. 22 42 6 0 Spitalfields 69 64 133 56 67 123 10 0 Mile End N. Town. 64 71 135 73 89 162 0 27 Workhouse. Whitechapel, N. 43 58 101 21 36 57 44 0 Whitechapl. Church 37 24 61 92 62 154 0 93 London Hospital. Goodman's Fields . 43 42 85 38 39 77 8 0 Aldgate 28 28 56 43 32 75 0 19 75 non-residents died in L. Hos. Totals 307 312 619 343 47 690 68 139 Excess of deaths over births, deducting the 75 non-residents 4 Estimated Population in 1869, 76,000. BOARD OF WORKS, WHITECHAPEL DISTRICT. DR. BHDD'S DIRECTIONS HOW TO PREVENT TYPHOID FEVER AN D SCARLET FEVER FROM SPREADING. LONDON t.penny & co., printers, 121, leman street, whitechapel. 1869. DR. BUDD'S DIRECTIONS. TYPHOID FEVER. The means by which Typhoid Fever may be prevented from spreading are very simple, very sure, and their cost next to nothing. They are founded on the discovery that the poison by which this Fever spreads is almost entirely contained in the discharges from the Bowels. These discharges infect— 1. The Air of the Sick Room. 2. The Bed and Body Linen of the Patient. 3. The Privy and the Cesspool, or the Drains proceeding from them. From the Privy or Drain the poison often soaks into the well, and infects the drinking water. This last, when it happens, is, of all forms of Feverpoisoning, the most deadly. In these various ways the infection proceeding from the Bowel Discharges often spreads the Fever far and wide. The one great thing to aim at, therefore, is to disinfect these discharges on their very escape from the body, and BEFORE they are carried from the Sick Room. This may be perfectly done hy the use of Disinfectants. One of the best is made of GREEN COPPERAS. This substance, which is used by all Shoemakers, is VERY CHEAP, and may be had everywhere. 4 A pound and a half of Green Copperas to a gallon of Water is the proper strength. A Teacupful of tliis Liquid, put into the Night-Pan every time before it is used by the Patient, renders the Bowel Discharge perfectly harmless. To disinfect the Bed and Body Linen, and Bedding generally, CHLORIDE OE LIME or M''DOUGAL L' S POWDER is more convenient. These Powders should be sprinked, by means of a common dredger, on soiled spots on the Linen, and about the Room, to purify the air. All articles of Bed and Body Linen should be plunged, immediately on their removal from the Bed, into a bucket of Water containing a Tablespoonful of Chloride of Lime or M'Dougall's Powder, and should be boiled before being washed. The Privy, or Closet, and all Drains communicating with it, should he flushed TWICE DAILY with the Green Copperas Liquid or Carbolic Acid, diluted with water. In Towns and Villages where the Fever is already prevalent, the last Rule should he put in force for all Houses, whether there be Fever in them or not, and for all Public Drains. In the event of death, the body should be placed, as soon as possible, in a Coffin, sprinkled with Disinfectants. Early burial is, on all accounts, desirable. As the HANDS of those attending on the Sick often become unavoidably soiled by the discharges from the Bowels, they SHOULD BE FREQUENTLY WASHED. The Sick Hoom should be kept well ventilated, day and night. The greatest Possible care should be taken with regard to the Drinking Water. Where there is the slightest risk of its having become tainted with Fever-Poison, Water should be got from a pure source, or should at least be boiled before being drunk. 5 Immediately after the ILLNESS is over, whether ending in death or recovery, the DRESSES worn by the Nurses should be Washed or Destroyed, and the Bed and Room occupied by the Sick should he thoroughly disinfected. These are Golden Rules. Where they are neglected, the Eever may become a deadly scourge. Where they are strictly carried out, it seldom spreads beyond the person first attacked. SCARLET FEVER. 1. The room, which is occupied by the patient, is to be dismantled of all needless woollen or other draperies, which might possibly serve to harbour the poison. 2. Thorough ventilation of the room to be maintained by an open fire and other means added. 3. A basin, charged with chloride or carbolate of lime, or some other convenient disinfectant, is to be kept constantly on the bed for the patient to spit into. 4. A large vessel, containing water, impregnated with chlorides or with Condy's fluid, is always to stand in the roomjor the reception of all bed and body linen, immediately on its removal from the person of the patient. 5. Pocket-handkerchiefs are proscribed, and small pieces of rag are to be used instead, for wiping the mouth and nose. Each piece having been once used is to be immediately burnt. 6. As the hands of nurses of necessity become frequently soiled by the specific excreta, a good supply of towels and two basins, one containing water with Condy's fluid or chlorides, and another, plain soap and water, are always to be at hand for the immediate removal of the taint. 6 7. All glasses, cups, and other vessels, used by or about the patient, are to be scrupulously cleaned before being used by others. 8. The discharges from the bowels and bladder are to be received on their very first issue from the lody, into vessels charged with disinfectants. 9. About the fourth day after the eruption, the surface of the body, scalp included, is to be anointed twice a day with olive oil, slightly impregnated with camphor; the oiling to he continued until the patient is well enough to take a warm bath, in which the whole skin is to be well scrubbed, disinfecting soap being abundantly used. The bath should be repeated every other day until four have been taken. 10. Ten days after health has been quite re-established, the patient may, in new clothes, without risk, re-enter his family. 11. The children of the poor, who have no means of isolating their children, are to be treated in small model hospitals or houses set apart by towns or parishes for the purpose. 12. The sewers are to be kept in a state of permanent disinfection where the disease prevails. This is done in Bristol, under the direction of the Health Officer. PUBLIC ATTENTION To the preceding Directions of Dr. Budd, as to the best means of preventing the spreading of Scarlet Fever, is this moment, of the utmost importance, for in the returns of the Registrar General for the week ending on Saturday, October 30th, 1869, it appeared that in London alone Scarlet Fever had destroyed during the previous 13 weeks, 2,317 lives, and for the week ending Nov. 6th, the deaths from Scarlet Fever in London were 241. Board of Works, Wnitechapel District, November 10 th, 1869.