WHI 18 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 1st JANUARY, 1870, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH. Presented to the Board 17th Jan., 1870. London: Printed by T. Penny, 121, Leman Street, Whitechapel, E. 1870. REPORT OF THE MEDICAL OFFICER OF HEALTH, FOR THE Quarter ending lst January, 1370. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, January 1st, 1870, the births registered in the Whitechapel District were 661, viz., 336 males and 325 females. During the same period, the deaths have been 657: of these 379 have been of males and 278 of females. In the corresponding Quarter of the previous year, the births were 639 and the deaths 629. There has been, therefore, an increase of 22 in the number of births, and an increase of 28 in the number of deaths. The deaths in the London Hospital have been 126, viz., 81 males and 45 females. Of the total deaths in this institution, there were 16 of persona resident within the District, 82 of non-residents, and 28 of persons who died from the result of accident and from sudden death. The total mortality of this District is increased by the deaths of residents within the District which have occurred in other hospitals in the Metropolis; but of these I have no record. There were 7 deaths from epidcmic diseases in the London Hospital, viz., 1 from, typhus fever, 1 from typhoid fever, and 5 from scarlet fever. The deaths in the Workhouse have been 75, viz., 41 males and 34 females. There was only 1 death from, epidemic disease in this establishment, viz., diarrhœa. The deaths from epidemic diseases in the entire District have been 139, viz., 24 from measles, 62 from scarlet fever, 2 from diphtheria, 24 from hooping cough, 5 from diarrhoea, 11 from fever, and 1 from cholera. Diseases of the tubercular class have been fatal to 94 persons, viz., 5 from scrofula, 25 from tabes mesenterica, 56 from consumption, and 8 from hydrocephalus. The proportion of deaths from this class of disease to the total deaths is 14.3 per cent. The proportion of deaths from epidemic diseases to the total deaths is 21.1 per cent. 4 The deaths from diseases of the heart were 26, and from aneurism 5. The deaths from diseases of the respiratory organs were 128, viz., 49 from bronchitis, 60 from pneumonia, and 19 from other diseases of the lungs. The deaths caused by child-birth were 2. The deaths from diseases of the urinary organs have been 18; of these, 11 were caused by nephria, or Bright's disease. Convulsions caused the deaths of 18 children; 20 children died from diseases of nutrition—atrophy and debility, 8 from teething, and 5 from premature birth. There were 2 deaths from stricture of the oesophagus. The deaths from the effects of the excessive use of alcoholic drinks were 4. There were 5 deaths from syphilis; of these, 3 were of infants. The deaths from violence, including those from accidents, negligence, and from suicide, have been 46; of these, 3 were of children who were suffocated in bed, 7 of persons who were scalded or burnt, 2 deaths occurred accidentally from drowning, 5 persons committed suicide—one of these was a patient in the London Hospital, who, while unobserved, thrust some medicated wool into his throat, and another, that of a domestic servant, aged 19, who drowned herself in a water-butt. The number of inquests has been 74. In the corresponding quarter of last year the number was 87. Uncertified Deaths. The uncertified deaths were 34; of these, 23 are recorded in the subDistrict of Spitalfields. The proportion of the uncertified to certified deaths is, in the Whitechapel District, unusually large, it being no less than 5.1 per cent. The deaths of children under 5 years of ago have been 271. This is 41.2 per cent. of the total deaths. The deaths of persons above 80 years of age have been 18; 1 of whom had reached the advanced age of 90. and another 92. Patter Illness in the Disteict. The Medical Officers have attended 3832 new cases of illness out of the Workhouse, 56 of measles, 112 of scarlet fever, 54 of hoopingcough, 212 of diarrhcea, 132 of fever, and 27 of erysipelas. In the corresponding quarter of last year, the number of cases of pauper illness was 3891, including 6 of small-pox, 41 of measles, 25 of scarlet fever, 25 of hooping-cough, 145 of diarrhcea, 149 of fever, and 28 of erysipelas. Meteorology of Geeenwich. The returns of the Eegistrar General show that the rain-fall in the Metropolis during the quarter, has been 6.63 inches. During the corresponding quarter of the previous year, the rain-fall was 8.61 inches. The mean temperature of the air has been 42.9°. In the corresponding quarter of last year, the mean temperature of the air was 45.9°. 5 The following Table, taken from the returns of the Registrar General, shows the comparative results during the quarter:— LONDON. Oct. 9th. Oct. 16th. Oct. 23rd. Oct. 30th. Nov. 6th. Nov. 13th. Nov. 20th. Nov. 27th. Dec. 4th. Dec. 11th. Dec. 18th. Dec. 25th. Jan. 1st. Deaths from Diarrhœa 57 51 45 34 29 21 29 20 19 13 14 14 22 Dths. from Scrlt.Fvr. 216 224 233 229 241 218 208 219 245 209 186 123 159 Mean Temperature of the Air 56.7° 51.5° 46.7° 40.0° 46.6° 41.1° 45.8° 41.0° 34.2° 39.2° 44.7° 38.2° 34.2° Rain-fall in inches 0.02 0.25 0.90 0.21 0.27 0.08 0.10 1.16 0.80 0.43 1.23 0.86 0.31 Deaths in London 1867 1305 1476 1536 1772 1689 1859 1676 1705 1759 1566 1357 1996 Deaths in Whitechapel District 53 47 41 60 55 49 48 57 43 66 46 32 57 The deaths in London annually from scarlet fever to 100,000 persons living, were in the 10 years 1851—60, 94; in the 8 years 1801—68, 94; and in the 43 weeks ending October 8th, 1869, the deaths from scarlet fever were in the proportion of 152 to 100,000. In the Whitechapel District, the deaths from scarlct fever during the same periods, were respectively 90, 107, and 247. Sanitary Works performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the quarter ending 1st January, 1870. Number of inspections of houses as shown in the official returns 4469 Houses systematically re-visited 271 Number of cases of indecent occupation discovered 11 Houses ordered to be registered by the Board 2 Certificates and copies prepared for the registration of the above houses 6 Number of special notices served for the registration of houses 12 Preliminary notices served, many of such notices embracing several premises 399 Compulsory orders issued embracing 135 houses and premises 71 Summonses heard at police courts 15 "Workshops specially visited 45 Ditto overcrowded 8 Ditto specially re-visited 23 Copies of the Workshops' Regulation Act distributed 45 Houses in which the rooms or passages have been whitewashed 217 Yentilation of houses improved 16 Yards of houses paved or the pavement repaired 145 Drains in houses improved 119 6 Dust-bins provided 36 Privies limewashed, cleansed, and repaired 139 Water-butts and cisterns provided or repaired 86 Water-waste preventers erected 5 Area-gratings, cellar-flaps, &c., repaired 6 Cellars used as dwellings discontinued for such use 4 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 10 Dung and other offensive matter removed 38 Slaughter-houses specially visited 38 Cow-houses ditto 24 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 Metropolitan Board of "Works several notices of dangerous structures and have also given intimation to the police 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. 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. 45, Lambeth Street, Whitcchapel. In a room in this house the dead body of a man was kept for a period of eleven days before the body was buried. The widow informed tbe Inspector that she could not obtain a coffin for the body of her deceased husband, and when remonstrated with by the Inspector for keeping a body so long in a room used as a living and sleeping room, occupied by herself and another woman, she said that she could not help it, for she belonged to a burial club, and she could not get the money that she was entitled to receive, in consequence of her being three weeks behind in her payments. If the law compelled all persons to bury their dead within a period of three or four days from the time of death, the erection of mortuary houses would not be of so much importance as it is now, when the period of keeping a corpse in an inhabited room is unlimited. Water Supply. The system of constant water supply to the poorer District's 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 th 7 poor localities, are unfit for the purpose of storing water for drinking. They should, therefore, he abolished, and a constant supply of water, direct from the main, without the intervention of either butts or cisterns, should be substituted. As the Water Companies are willing to assist the local Boards in carrying out in this form the constant supply, I trust that water-waste preventers will be erected in all the poor localities of the Metropolis. It is with much pleasure that I am able to report that there are 80 of these machines 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 arc 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 any more attention to the emptying of the public dust bins during this quarter than he gave during the preceding one, as complaints of the non-removal of dust have recently been more numerous. Nuisance in St. Mary Street. The Rector of Whitechapel Parish has made frequent complaints to this Board of the nuisance arising from the smell of urine, caused by hundreds of persons rushing over to this street from the theatre immediately opposite. From the indecency practised by these people, the Rector is almost prohibited from using the large school room for public meetings. Several attempts have been made by the Board to remedy this most disgusting nuisance, and considerable expense has been incurred in their endeavours to suppress it, but hitherto very little success has resulted from their endeavours. Three additional lamps have been recently erected in this street, which, it is to be hoped, will tend to abate the nuisance. Relapsing Fever. From a return which has been kindly furnished to me by Mr. Vallance, the Clerk to the Board of Guardians, and which is appended to this Report, it appears that from the 4th October to 31st December, 113 cases of illness, supposed to be of relapsing fever, have been sent by the Relieving Officers to the London Fever Hospital and to the London Hospital, viz., 106 to the former and 7 to the latter. Of the total cases, there were 59 of males and 54 of females. The majority, viz., 66, were sent from the Registered Common Lodging Houses, 13 from the Workhouse, 1 from the Refuge in Crispin Street, and 33 from other houses in the District. 8 On further analyzing this return, I find that 9 of the cases remained in the Hospital for periods varying from 2 to 10 days, when they were discharged as cured; 23 were kept in the Hospital for periods varying from 11 to 16 days, and were then discharged as cured; 1, a male, aged 30, died either on the same day or the day following his admission. The total mortality of those sent into the Hospital was 6, which is 5.3 per cent. One death, as above stated, took place in 1 day from the date of admission, 1 in 4 days, 1 in 6 days, 1 in 13 days, 1 in 18 days, and 1 in 19 days. Of the 66 patients sent from the lodging houses, 10 were discharged as cured in 15 days, and 1 died on the day after admission. The question may fairly he asked, were all of the 113 patients suffering from typhus, typhoid, or from relapsing fever ? Probably the 32 patients who were discharged as cured after a residence in the Hospital for a period of less than 16 days, were not suffering from either of the above-mentioned forms of fever. All of them, no doubt, presented symptoms common to fever, influenza (a disease now very prevalent) and to some other diseases, when they were first seen by the Medical Officer of the Union, and were, consequently, sent off at once to the Fever Hospital. When relapsing fever, as we are told upon high authority, ''has attacked patients, and when all its acute symptoms are passed, the sufferers remain for a while extremely weak, requiring that food and restoratives should be liberally supplied them, in default of which, the feebleness left by the disease may often be of indefinite duration." Notwithstanding all the care that is given to the patients in the Hospital, it appears from the return, that some have been kept under treatment for upwards of 4 weeks; one patient remained in the Hospital for 47 days. Although fever, according to the returns of the Medical Officers of the Union, has not been so prevalent during this quarter as it was in the corresponding quarter of the previous year, yet, I am glad to find that the public authorities, instigated probably by the public press, have seriously considered the matter, and have adopted the best means of alleviating the sufferings of the patients, and of preventing the spreading of the disease. I sincerely hope that the lesson which has now been taught us by the present epidemic of fever will not be lost, but will induce all persons in authority to pay more attention than has hitherto been done to the abodes of the poor, and especially to the condition of the registered common lodginghouses. The genius, however, of our countrymen still continues to be mainly directed to the cure of sickness, and the ameliorating of cases of distress, as is seen by our numerous charitable institutions, but does not give much attention to the prevention of destitution and misery. 9 Had the public authorities devoted the same amount of attention to the alleviation of the sufferers from fever, in the year 1862, when the deaths from fever in this District were 250, and the cases recorded in the hooks of the Medical Officers of the Union 822, we might have been spared, to some extent, the witnessing of the present outbreak, which, although not very fatal, yet is very extensive; the cases in this quarter being 132, and the deaths 11; and for the year comprising 53 weeks, the cases are 385, and the deaths 95. In the year 1862, the common lodging houses in Spitalfields furnished a large proportion of the cases of fever. In one quarter, the Medical Officer of the Spitalfields District informed me that 40 eases of fever occurred in the common lodging-houses in Flower and Dean Street and the adjacent neighbourhood. The numerous cases of fever which have recently occurred in this District, fully justify the authorities for all the precautions they have taken to mitigate the sufferings of the patients; and although we must regret their shortcomings in 1862, we may be thankful for their exertions in 1869; and if the prevalence of fever in the common lodging houses should lead to amendment of the law relating to the regulation of these places, the visitation of the present epidemic will not have been in vain. Prom the 29th November, to the 1st January, 1870, the police have reported to me 23 cases of fever in the common lodging-houses. All the rooms in which these cases occurred have been visited by the Sanitary Officers, and they have satisfied themselves that the several rooms from which fever patients were removed, had, after being closed for certain periods, been thoroughly disinfected. In consequence of the numerous cases of fever occurring in the registered common lodging-houses in this District, I am desirous of submitting for your information the following report upon these places:— Registered Common Lodging-Houses. I am indebted to the courtesy of the Chief Commissioner of Police for providing me with a list of the common lodging-houses in the District, from which return it appears that there are 188 registered common lodging-houses in the Whitechapel District, which are under the superintendence of the police. These houses are registered to contain 5,337 beds, and there are 12 additional houses progressing towards completion for registration. These beds are chiefly used by single men. Some of the beds are, however, occupied by married couples, and the rooms assigned to them are divided by wooden partitions, so that each married couple may be said to occupy a separate room. In some of the lodging-houses there are rooms set apart for single women. If all the beds in each lodging-house were to be occupied every night, which, I am informed, is seldom or never the case, the population contained in the common lodging-houses in this District would be about 5,400, and when the 12 additional houses are registered, the number of beds in these houses will be about 5,800. 10 From a return of the lodging-houses, which was kindly made to mo by the police in 1861, the number was only 117, in which were 2,620 beds. Since 1861, the number of beds in these houses has been nearly doubled. We may, therefore, presume that the business of a lodging house keeper is of a lucrative nature. Each person pays a sum varying from 3d. to 5d. per night for his lodging, including bed, firing for cooking, hot water, and the use of crockery; and every lodger who remains for 7 days in the same lodging-house is only charged for six days, no payment being required for Sundays. The police pay frequent visits to these houses—occasionally night visits are made, and special attention is given to the cleanliness of the bedding, the floors, passages, and walls, to the condition of the ceilings of the rooms (which arc required to be limewhited twice every year), to the state of the water receptacles, and to the cleanliness of the privies; attention is likewise paid to the pavement of the back yards, and to the airing of the rooms, the police insisting upon the opening of all the windows after tho bed-rooms have been vacated. All this work appears to me to be well done, and the contrast between the present and past condition of these common lodging-houses, as regards their sanitary arrangements, is most striking to those persons who know them before the passing of the Act in 1851, and tells very favorably to the conduct of the police, for the manner in which they carry out their instructions. There are, however, several defects of a sanitary nature which require some attention; and the most important of these is the overcrowding. It appears that the rooms are measured by a surveyor, who fixes the number of persons who may be permitted to sleep in each room; but the space allowed for each bed is too small, for in very few, if any, of these sleeping rooms, is the cubic space more than 250 feet. In one of these common lodging houses, ia a room having the cubic dimensions of about 4,500 feet, there were 21 beds; this allows only a cubic space of 214 feet to each; and in another lodging house the cubic space allotted to each bed was only 200 feet. Now, however competent a surveyor may be to discharge all the duties of his profession, he is not the proper authority to fix the number of persons who can, with a due regard to health, be allowed to pass seven or eight hours at night in a room, the ventilation of which can be at any time so interfered with as to prevent, to a great extent, the entrance of fresh air, and the exit of the foul air which is generated by the congregating together of so many persons in a limited space. In short, a surveyor is legally incompetent to give an opinion upon the matter. This important subject ought to be entirely under the direction of the Medical Officer of Health for the District. But I may here observe that many of the houses which are used as common lodging houses, are totally unfit for that purpose, they are so old, dark, ill-constructed, and slightly built, that the ventilation of them cannot be much improved without endangering the stability of the building. In some of these houses every available space is used for increasing the number of lodgers; the 11 cases are made so narrow and steep that they are difficult to ascend, and dangerous to descend; and the passages in those rooms which are allotted to married couples are extremely narrow, and, in many instances, very dark. The alterations which I would suggest to bo made in these lodginghouses are, 1st, the diminution of the number of persons now occupying them to such an extent as to give to each person a free space of at least 300* cubic feet; 15 additional cubic feet of space should be allowed for each bed. so that the free space for each lodger should be 300 cubic feet. 2nd, the ventilation should be improved, and it should be so arranged, that, if possible, the free entrance and exit of the air cannot be interfered with. Some improvement in the ventilation of the rooms might be effected by causing all the windows to open at the top as well as at the bottom, 3rdly, all those houses in which the ventilation is imperfect and cannot be improved, should be discontinued to be used as common lodging-houses; and lastly, all the water-butts now in use (some of which are old and without covers or taps), should be discontinued, and slate cisterns substituted for them; or, where practicable, the water should be supplied direct from the main, as may be obtained by the use of water-waste preventers, which are now proved to be so beneficial in this District. Where, however, the water is laid on to the lavatories which are in the house, then, and then only, the water-waste preventers as at present in use, will not apply. Before I inspected these common lodging houses, which I have only recently done, I was led to believe, from the extravagant terms that were used in praise of them, that each was, as regarded its sanitary condition, the beau-ideal of perfection, "that no fever case ever occurred in any of them;" and this belief in the supposed exemption of these places from fever has been handed down to us as a fact, ever since they were placed in the hands of the police. The belief in the healthfulness of these houses exists even now in the minds of many persons, and I regret to find in a publication, of a very recent date, the author of which is a medical practitioner of eminence, that the stereotyped opinion respecting the healthy condition of the common lodging houses is continued. The words used are "that from these places, formerly the dens of fever, typhus has been entirely banished !" Now, if overcrowding, defective ventilation, the most abominable smells, arising from the smoking of tobacco, and from the dirty clothes and unwashed bodies of the lodgers, who meet together in large numbers in the kitchens, and by the use of water stored in butts, without covers or taps, and exposed to the contaminating influence of the atmosphere of a crowded neighbourhood, will produce fever; then, it follows, that, where these evils exist, as they unquestionably do, in many of these lodging houses, fever * Although at the present time it would be almost hopeless to insist upon a larger space for a bed than 315 cubic feet, yet, in the course of a few years when sanitary science is better understood, a larger space will be demanded, probably, at least, 400 cubic feet; and as the Poor Law Board has recently demanded a much larger cubic space for each inmate in a workhouse, it cannot be objected to that after twenty years the cubic space for the inmates of a lodging house should be increased. 12 and other contagious diseases will occur, notwithstanding all the efforts of the police in removing promptly from the house every person who is reported to he suffering from a contagious disease, and causing the room from which the sick person has been removed to he closed for a certain period, and submitting both the bedding and room to thorough disinfection by means of sulphurous acid vapour. The Act for the well ordering of common lodging-houses, commonly called the Common Lodging-Houses' Act, came into operation in the latter end of the year 1851. This Act has, therefore, now been in force for nearly 20 years, and it has had a very beneficial influence upon the health of those people, who, before the passing of this Act, used to crowd together, regardless of decency and all sanitary laws, in the common lodging-houses in the Metropolis. The provisions of this Act were further extended by the Common Lodging-Houses' Act, 1853. But since that time various Sanitary Acts have been passed, which have been put in operation by the several local Boards in the Metropolis, whereby a great improvement in the public health has been effected. The diffusion of information by the public press and the sanitary reports of the Medical Officers, have so enlightened the public mind, that the various sanitary improvements which were thought so highly of some years ago, are now considered to be very far short of the requirements of the present day. It is, therefore, necessary that the Common Lodging-Houses' Act should be amended, so that the general sanitary condition of these premises may be still further improved. As these Acts were in operation before the passing of the Metropolis Local Management Act, which provided that each District should have a Medical Officer of Health, it would now be desirable so to amend the Common Lodging-Houses' Acts as to place all matters relating to the sanitary condition of them under the charge of the local Boards, so that the Sanitary Officers of the District might assist the police in carrying out the sanitary requirements of these places. I have been induced to draw the attention of the Board to the state of the common lodging-houses in this District, in consequence of the Police Inspectors having recently received instructions to make me acquainted with every case of fever which had occurred in these houses, and to require of me a certificate that every room in which a fever case occurred had been closed for a certain period, and had been thoroughly disinfected. In order to comply with this request, I thought it necessary to inspect the room from which a fever patient had been removed, and to give directions as to the mode in which such room should be disinfected. Upon my observe ing the defective state of the sanitary condition of some of these houses, I wrote to the Chief Commissioner of the Police upon the subject, and I have reason to believe that some of my suggestions for improving the sanitary arrangements of these places will receive clue attention and consideration. I have not, until the recent prevalence of relapsing fever, inspected any of the common lodging-houses in this District; but from a letter which I received 13 from the Medical Officer of the Privy Council, dated 14th of December last, in reply to one that I addressed to the medical department of that office, asking for advice as to the course I should pursue in regard to the requests made to me by the Police Inspectors of common lodging-houses in my District, it would appear "that the Medical Officer of Health is not absolved from his sanitary duties in regard to a house in his District because it is registered as a common lodging-house, and that he is the most proper person to advise the police, acting as local authority under the Common Lodging-Houses' Act, 1853, sec. 7, as to the course to be pursued for preventing the spread of disease and that the Medical Officer of Health "will do well to give every assistance in his power to the Police Inspectors, in regard to common lodging houses in his District, as well, when asked by them, by advising them on sanitary matters, and giving a certificate of satisfactory disinfection, as, without being asked to do so, by calling their attention to any sanitary defects in such houses or their management." Cow-Houses and Slaughter-Houses. All the cow-houses and slaughter-houses in the District have been duly visited by the Sanitary Officers. As regards the cow-houses, I may observe that the proprietors of them having carried out the directions of the Board, as laid down last year, no opposition was made to the renewal of their licenses. The slaughter-houses having been found, upon inspection, to be in a satisfactory condition, both as regards cleanliness and ventilation, the Board offered no objection to the renewal of the annual license. In the course of seven years from this time, according to the provisions of the Building Act, 1844, the slaughtering of cattle in the slaughter-houses in this District will be prohibited. In my opinion, the prohibition of the slaughtering of cattle in crowded neighbourhoods, will greatly benefit the health of the public. It is found that three public slaughter houses are sufficient for Glasgow, a city of about half a million of people, and that this number answers every purpose that slaughter-houses are intended to fulfil; consequently all private slaughter-houses are prohibited in that city. If all the private slaughter-houses were abolished and public slaughterhouses were the only licensed places for slaughtering cattle in London, and if competent officers were appointed to inspect the animals, both before and after slaughter, with power to condemn and order to be destroyed all meat that was unfit for the food of man, then it is probable that much of the bad meat, which now finds its way into some of the butchers' shops in London, would be prevented, and the Sanitary Officers of the local Boards would be saved the trouble, and relieved from the responsibility of inspecting and seizing meat exposed for sale. The slaughtering of cattle, as is now carried on in London, is a nuisance, and the public will hail with delight the approaching period when the numerous slaughter-houses, now scattered all over the Metropolis, will be 14 abolished, and the driving of cattle through the crowded thoroughfares of London will no longer be necessary. There is an evil arising from the existing mode of granting licenses for private slaughter-houses which has not been so prominently brought under the notice of the public as it ought to have been—I mean the lotting out for hire a private slaughter-house to any person who is desirous of slaughtering an animal, which he knows to be in a diseased condition. The improper use of a private slaughter-house has been recently exemplified in this District. The following are the particulars of the case:— On Sunday, the 12th December, 1869, I accompanied the Inspector Mr. Battram, to a butcher's shop in this District, where I saw a large quantity of meat exposed for sale, which, in my opinion, was unfit for the food of man. The meat, amounting to about 7 cwt., was, by my order, removed to the Green Yard, and kept there till the following day, when it was taken to the Thames Police Court for the inspection of the magistrate. Upon the evidence adduced, the magistrate, after inspecting the meat, ordered it to be destroyed. The two owners of the meat in question denied that the meat was unfit for food, and they requested the Magistrate not to order the meat to be destroyed until the following day when they promised to bring forward evidence to show that the meat was good. Upon this statement the magistrate consented to adjourn the further hearing of the case until the next day; but the parties failed to produce any evidence in support of their assertions. The magistrate, therefore, condemned the meat as being unsound, and ordered it to be destroyed, which was accordingly done in the presence of the Inspector. A summons was taken out against the proprietor of the premises on which the meat was found, and also against the two owners of the meat. The several parties were fined £5 each. The object of the legislature in permitting the slaughtering of cattle in private slaughter-houses, was to afford facilities to butchers to carry on their trade with convenience to themselves, but if such privileges are abused, as was the case just described, then the sooner all private slaughterhouses are abolished the better. ANNUAL REPORT. The number of deaths registered in this District, during the year 1869, has been 2675, and the number of births 2571. The deaths in 1868 were 2519 and the births 2611. The deaths, therefore, are in excess of those in 1868 by 156, and the births are less by 40. The return of births and deaths for this year is not very satisfactory. The deaths in the Workhouse have been 328 against 376 for the previous year, and the deaths in the London Hospital 504 against 536. If the population of this District be estimated at 76,000, which is nearly 15 3000 less than when the census was taken in 1861, the rate of mortality has been during this year 35.0 per 1000, or 1 in 28.5 of all living. In making a comparison, however, of the rate of mortality of this District with that of others, the deaths in the London Hospital must be eliminated, which this year amount to 504. Deducting, therefore, the deaths in this institution from the total deaths, the rate of mortality is 28.3 per 1000 or 1 in 35.3 of all living. Pauper Illness in the District. The number of out-door sick paupers who have been attended by the Medical Officers of the Union, has been 14,031. Although it appears from Table VI. that the sick paupers are still very numerous, yet, I have the satisfaction to remark, that during the last year the number has diminished to the extent of 3386. This large number of sick paupers, out of a population of about 76,000, need not surprise us when the condition of the houses in most of the poor localities is considered; for not only are many of the houses without sufficient ventilation, owing to the want of open spaces at the rear, but the rooms are overcrowded. In others, again, the floors, ceilings, and walls are dirty and broken; and in addition to these defects, the roof in some of them is so delapidated that the rain makes its way into the upper, and even, sometimes, into the middle rooms, and the window frames are broken and without any glass in them, so that the poor tenants are compelled, while keeping out the wet, to exclude the light by covering the windows with sacks or old clothes, thereby rendering such rooms unfit for habitation. Moreover, many of the houses are so old that they cannot be extensively repaired, and are only fit to be taken down. Under such circumstances, it cannot be wondered at that ill health and pauperism should prevail so extensively in this District. But how can the state of things, as regards the unfit condition of the existing house accommodation, be remedied? It certainly will not be improved, except to a very limited extent, by local Boards, in consequence of the enormous expense that would fall upon the ratepayers, by any proceeding on a scale sufficiently extended to remedy the evil. The only way, in my opinion, of improving the worst localities in this District, is to encourage the formation of public companies, who should be empowered by the Board of Trade, without compelling such companies to incur the expense of obtaining an Act of Parliament, to purchase, under compulsory powers, such plots of ground as are now covered with houses which are deemed to be unfit for habitation, and to enable such company to clear the ground and to erect on the sites so cleared suitable dwellings for the laboring population. From the rents which are now paid for the existing houses, I believe that a public company, organized for the purpose of improving the dwellings of the poor, would be able to pay its shareholders a fair dividend, even should the present unjust mode of assessing the rental of premises for the poor rate be continued; but if the rate for the poor were to be charged 16 entirely upon the taxes of the country, as it is now partly so charged, then a great encouragement would be given to the formation of such public companies, and London would not only soon become vastly improved in its external appearance, but the health of the people would be greatly benefited. Sanitary Works Performed during the Year 1869. The following return shows the amount of work done by the Sanitary Inspectors during the year 1869. Number of inspections of houses as shown in the official returns 18066 Houses systematically visited and the rooms measured to ascertain their cubic capacity 203 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each person, reckoning 2 children under 10 years of age for one adult 9 Number of cases of indecent occupation discovered 42 Houses systematically re-visited 638 Ditto registered by the order of the Board 41 Certificates and copies prepared for the registration of the above houses 105 Number of special notices served for the registration of houses 237 Preliminary notices served many of such notices embracing several houses 1455 Compulsory orders issued embracing 407 premises 219 Summonses heard at police courts 36 Workshops specially visited 86 Ditto overcrowded 13 Ditto specially re-visited 151 Copies of the Workshops' Regulation Act distributed 45 Houses in which the rooms or passages have been whitewashed 765 Ventilation of houses improved 16 Yards of houses paved or the pavement repaired 427 Drains in houses improved 381 Dust bins provided 197 Privies limewashed, cleansed, and repaired 400 Water-butts and cisterns provided or repaired 334 Water-waste preventers erected 9 Area gratings, cellar flaps, &c., repaired 65 Cellars used as dwellings discontinued for such use 22 Instances where corpses were kept in inhabited rooms for prolonged periods so as to be a nuisance 5 Animals so kept as to be a nuisance removed 17 Dung and other offensive matter removed 38 Cows kept in two unlicensed sheds removed 5 The cow-houses in the District, and the 38 slaughter houses (24 in number) have been visited four times during the year. The bake-houses (83 in number) have been twice specially visited during the same period. I have the honour to be, Gentlemen, Your most obedient Servant, 15, Great Alie Street. JOHN LIDDLE. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 1st January, 1870. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Choleraic Dianl Continued Fever, Typhus & Typhoid. Pyæmia. 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 13 67 24 53 0 73 0 8 0 0 41 64 2 21 0 1 3 1 1044 1415 Mr. Champneys 0 16 14 20 45 0 26 0 10 0 0 81 7 0 0 0 2 0 0 409 630 Dr. Richardson 0 15 6 7 39 0 13 0 2 0 0 89 1 0 2 0 1 0 2 457 634 Mr. Sequiera 0 12 25 3 75 0 30 0 7 0 0 16 10 0 23 7 0 0 0 966 1174 Total 0 56 112 54 212 0 142 0 27 0 0 227 £2 2 46 7 4 3 3 2876 3853 Corresponding Quarter of previous Year. 6 41 25 25 145 0 149 0 28 1 1 153 61 0 38 2 6 2 4 3204 3891 TABLE II. Showing the Deaths from Epidemic Diseases, for the Three Months ending 1st January, 1870. Districts. Small-Pox. Measles. Scarlet-Fever. Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera. Total. Remarks. Artillery 0 1 3 0 5 1 1 0 11 Spitalfields 0 6 15 1 3 2 2 0 29 Mile End New Town 0 7 17 0 5 5 2 0 36 Workhouse. Whitechapel, North 0 4 7 1 3 2 2 0 19 White chapel Church 0 2 6 0 1 2 4 0 15 Hospital. Goodman's Fields 0 1 8 0 1 0 0 l 11 Aldgate 0 3 6 0 6 3 0 0 18 Totals 0 24 62 2 24 15 11 1 139 Deaths from Epidemics for the corresponding Quarter, 1868. 1 13 19 3 6 8 31 0 84 There were 2 deaths from pyaemia in the London Hospital, 1 from typhus fever, 1 from typhoid fever, and 5 from scarlet fever. In the Workhouse there was 1 death from diarrhoea. TABLE III. The Births and Deaths in each Registration District, for the Three Months ending on the 1st January, 1870. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M. F. Artillery 20 25 45 16 18 34 11 0 Spitalfields 70 60 130 50 41 91 39 0 Mile End N. Town 80 96 176 101 86 190 0 14 Workhouse. Whitechapel, N. 53 43 90 38 29 67 29 0 Whitechpel Church 36 25 61 103 60 163 0 102 London Hospital. Goodman's Fields 39 42 81 26 23 49 32 0 82 Non-residents died in the London Hospital. Aldgate 38 34 72 42 21 63 9 0 Totals 336 325 661 379 278 657 120 116 Excess of Births over Deaths, deducting the 82 non-residents, 86. Population in 1801, 78,970. TABLE IV. Ages at Death in each Registration District, for the Three Months ending 1st January, 1870. 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 10 1 3 7 2 0 34 Spitalfields 28 29 8 5 10 8 3 91 Mile E. N. Town 35 50 11 24 28 31 8 190 Workhouse. Whitechapel, N 7 20 2 7 9 10 2 67 Whitechapel Ch 13 9 17 43 41 18 4 163 Hospital. Goodman's Fields 8 15 3 9 9 4 1 49 Aldgate 19 17 2 8 11 6 0 63 Totals 121 150 44 104 108 82 18 657 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 61.7 per cent.; in the Spitalfields it is 62.5 per cent; in the Whitechapel North it is 40.3 per cent.; in the Goodman's Fields it is 46.9 per cent.; in the Aldgate, it is 57.1 per cent; while in the entire District it is 41.2 per cent. In the Whitechapel District the proportion of deaths of infants under 1 year is about one-fifth of the total mortality; in London and other large towns the proportion of these premature deaths is about one-fourth. TABLE V. Showing the Ages at Death iu the Workhouse, aud in the London Hospital for the Quarter ending 1st January, 1870. 0 and under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total Males, 41. Females, 34. Corresponding Quarter of 1868. Workhouse 5 3 1 20 17 24 5 75 103 London Hospital 0 8 14 47 41 12 4 Males, 81. Females, 45. 126 132 TABLE VI. Total number cf the undermentioned Diseases, recorded in the Books of the Medical Officers of the Union, from 1860 to 1869, and the total cases of illness. Year. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea and Dysentery. Fever. Cholera. Erysipelas. Puerperal Fever. Carbuncle. Bronchitis and Catarrh. Pneumonia and Pleuritis. Croup. Rheumatic Fever. Ague. Delirium Tremens. Total Cases. 1860 65 520 93 83 801 100 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 1861 21 482 156 217 1127 295 1 92 1 6 786 95 6 14 13 1 14932 1865 86 51 164 280 1342 573 4 97 2 1 745 123 ... 14 12 4 15594 1866 261 679 197 217 1664 343 58 62 7 546 244 7 66 12 13 16502 1867 254 155 60 219 1471 308 5 65 1 5 642 228 5 183 10 10 17181 1868 93 323 54 144 1626 586 8 80 2 5 450 208 3 157 18 10 17417 1869 5 212 311 308 1033 385 1 75 1 6 6320 258 1 100 35 11 14031 In the Annual Report for the last year, the following note was appended:— "On perusing the above Table, it will be seen, that the cases of illness among the pauper population had been annually increasing from 1860 to 1868, and, on referring to my Reports for the years 1857 and 1858, I find that the cases of illness, which were attended by the Medical Officers of the Union, were 10,708 and 11,718 respectively, while in 1856 they were only 9897. The great annual increase, as is shown in the above returns, cannot be explained on the supposition that there has been an increase of the population, for the census returns show that the population of this District, so far from having increased, is less by two or three thousand than it was in 1857." The number of cases of illness among the pauper population has been for this year less by 3387. TABLE VII. Showing the Births, Deaths, Deaths of Non-residents, Deaths in the London Hospital and in the Workhouse, in each Year, from 1857 to 1869. Year. Total Births. Total Deaths. Deaths of NonBesidents. Total Deaths in the London Hospital. Total Deaths in the Workhouse. 1857 (53 weeks) 2868 2360 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 1867 2686 2331 241 445 331 1868 2611 2519 324 536 376 1869 (53 weeks) 2571 2675 283 504 328 The number of inquests which have been held this year in this District has been 256. In the year 1868 the number was 306. TABLE VIII. Showing the Deaths from Epidemic Diseases in the Whitechapel District during the last 14 years. Name of Disease. 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868* 1869* Small Pox 31 3 4 60 21 28 33 69 5 22 44 40 11 1 Measles 12 60 78 31 81 27 153 26 137 28 139 33 69 71 Scarlet Fever and Diphtheria 45 43 87 96 59 70 91 200 50 80 76 26 48 208 Hooping Cough 64 89 117 50 49 98 62 52 74 97 94 72 55 113 Diarrhœa 81 139 108 141 67 101 69 114 109 122 119 100 138 97 Fever 188 117 104 93 69 65 250 158 170 167 100 82 109 95 Cholera and Choleraic Diarrhoea 0 10 6 5 1 4 5 5 2 4 904 9 10 7 Totals 421 461 504 476 347 393 663 714 547 520 1476 362 440 592 London Fever 2674 2203 1902 1796 1302 1754 3635 2802 3689 3232 2681 2174 2483 2211 Scarlta.&Diphta 1795 1587 4118 4197 2457 3058 4194 5799 3806 2614 2316 1836 3418 6162 * The year 1868, in the returns for London, comprises 371 days. In the Whitechapel District, the year 1869 comprises 371 days. TABLE IX. Showing the cases of Epidemic Diseases among the pauper population in the Whitechapel District during the last 14 years. Name of Disease. 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 Small Pox 115 6 20 242 65 86 113 253 21 86 261 254 93 5 Measles 71 266 427 179 520 70 525 80 482 51 679 155 323 212 Scarlet Fever and Diphtheria 105 49 146 175 93 109 118 305 156 164 197 60 54 311 Hooping Cough 98 150 230 146 83 388 153 169 217 280 217 219 144 308 Diarrhœa 898 1324 946 209 773 1418 1085 1108 1127 1342 1664 1471 1631 1033 Fever 1929 1441 590 411 190 109 822 464 295 573 343 308 586 385 Cholera and Choleraic Diarrhœa 0 16 0 1 1 0 1 1 4 58 5 8 1 Totals 2216 3252 2359 1363 1725 2180 2817 2380 2302 2500 3419 2469 2839 2255 RETURN OF FEVER CASES, Sent from the Whitechapel Union to the London Fever Hospital and to the London Hospital, between October 1, 1869, and December 31, 1869. Those which were sent to the London Hospital are distinguished from the others by the letters L. H. Date. Sex. Age. Residence. Whether Residence is or is not a Registered Lodging House. Length of time in Hospital. Results. Oct. 4 th. F. 41 15, Flower and Dean Street Yes. 20 days. Cured. .. .. M. IS 17, Thrawl Street Yes. 7 days. Cured. .. 5th. M. 39 11, Flower and Dean Street Yes. 11 days. Cured. .. .. M. 20 1, Lower Keate Street Yes. 20 days. Cured. .. .. F. 32 7, Wilson Place No. 11 days. Cured. .. .. M. 13 7, Wilson Place No. 23 days. Cured. .. .. F. 8 7, Wilson Place No. 14 days. Cured. .. .. F. 5 7, Wilson Place No. 14 days Cured. .. .. M. 2 7, Wilson Place No. 15 days. Cured. .. 7th. F. 40 36, Flower and Dean Street Yes. 25 days. Cured. .. .. M. 18 9, Flower and Dean Street Yes. 22 days. Cured. .. 11th. F. 20 10, Lower Keate Street Yes. 21 days. Cured. .. .. F. 18 9, Flower and Dean Street Yes. 23 days. Cured .. 12th. M. 18 40, Duke Street No. 28 days. Cured. .. .. F. 32 5, Dale's Place No. 24 days. Cured. .. .. F. 8 5, Dale's Place No. 20 days. Cured. .. .. M. 10 8, Bell Court No. 26 days. Cured .. .. F. 15 20, Flower and Dean Street Yes. 22 days. Cured. .. .. M. 35 19, Flower and Dean Street Yes. 22 days. Cured. .. 14th. F. 23 9, Lower Keate Street Yes. 20 days. Cured. .. .. M. 60 60, Wentworth Street Yes. 16 days. Cured. .. 20th. M. 20 11, Flower and Dean Street Yes. 24 days. Cured .. .. M. 58 17, Thrawl Street Yes. 47 days. Cured. .. .. M. 27 17, Thrawl Street Yes. 24 days. Cured .. 21 st. M. 20 5, Little Halifax Street No. 19 days. Cured. .. 22nd. F. 16 Goulston Square No. 21 days. Cured. .. .. M. 14 Workhouse 24 days. Cured. .. .. M 19 9, Flower and Dean Street Yes. 22 days. Cured. .. 27th. M. 18 36, Flower and Dean Street Yes. 20 days. Cured. .. 29th. M. 7 40, Fashion Street No. 17 days. Cured. Nov. 1st. F. 18 6, Wilson Place No. 22 days. Cured. .. .. M. 30 15, Flower and Dean Street Yes. 23 days. Cured. .. .. M. 25 5, Flower and Dean Street Yes. 22 days. Cured. .. .. F. 19 36, Flower and Dean Street Yes. 25 days. Cured. .. .. M. 30 36, Flower and Dean Street Yes. 12 days. Cured. .. 2nd. F. 22 6, Thrawl Street No. 14 days. Cured. .. .. F. 36 4, Tenter Street No. 27 days Cured. .. 3rd. F. 17 5, Dunk Street No. 18 days. Cured. .. .. F. 21 2, Farthing Hill No. 20 days. Cured. .. .. M. 45 5, Flower and Dean Street Yes. 21 days. Cured. .. .. F. 15 19, Flower and Dean Street Yes. 21 days. Cured. .. 5th. F. 50 11, John Street No. 23 days. Cured. .. .. F. 14 5, Brace's Buildings No. 18 days. Cured. .. 6th. M. 22 7, Flower and Dean Street Yes. 23 days. Cured. .. .. M. 30 9, Lower Keate Street Yes. 1 day. Dead. .. .. F. 40 4, Upper Keate Street Yes. 17 days. Cured. .. .. M. 33 19, George Street Yes. 20 days. Cured. .. .. M. 7 40, Fashion Street No. 22 days. Cured. .. 9th. F. 54 4, Flower and Dean Street Yes. 17 days. Cured. .. 10th. F. 4 2, King Street, Aldgate No. 37 days. Cured. .. 11th. M. 19 81, Wentworth Street No. 18 days. Cured. .. 13th. F. 20 9, Lower Keate Street Yes. 24 days. Cured. .. 15th. F. 20 36, Flower and Dean Street Yes. 22 days. Cured. .. .. F. 40 26, Mount Street, W.C. No. 34 days. Cured. .. 18th. M. 44 4, Montague Street Yes. 33 days. Cured. .. .. F. 52 Crispin Street Refuge. 19 days. Cured. .. .. F. 17 1, George Street Yes. 17 days. Cured. .. 19 th. M. 16 4, Flower and Dean Street Yes. 40 days. Cured. .. .. F. 43 1, Bull Stake Court No. 18 days. Cured. .. 23rd. F. 38 6, Spital Street No. 15 days. Cured. .. .. M. 18 9, Lower Keate Street Yes. 22 days. Cured. .. .. M. 19 17, Thrawl Street Yes. 18 days. Cured. Return of Fever Cases—(continued). Date. Sex. Age. Residence. Whether Residence is or is not a Registered Lodging House. Length of time in Hospital. Results. Nov. 24th. M. 45 12, Thrawl Street Yes. 20 days. Cured. .. 26th. F. 19 11, Flower and Dean Street Yes. 10 days. Cured. .. .. M. 45 27, Castle Alley No. 16 days. Cured. .. 29th. M. 19 Workhouse 14 days. Cured. .. .. M. 21 65, Wentworth Street Yes. 18 days. Cured. .. .. M. 39 Workhouse 20 days. Cured. .. .. M. 15 2, Black Horse Court No. 20 days. Cured. .. .. F. 7 2, Black Horse Court No. 2 days. Cured. .. .. F. 2 2, Black Horse Court No. 2 days. Cured. .. .. M. 21 16, George Street Yes. 20 days. Cured. Dec. 3rd. M. 22 30, Dorset Street Yes. 21 days. Cured. .. 6th. M. 44 15, Flower and Dean Street Yes. 25 days. Cured. .. .. M. 19 5, Dowson Place No. 16 days. Cured. .. 8th. M. 24 Workhouse 22 days. Cured. .. .. M. 22 19, George Street Yes. 19 days. Cured. .. .. M. 25 9, Lower Keate Street Yes. 14 days. Cured. .. .. M. 30 9, Lower Keate Street Yes. 18 days. Cured. .. .. M. 25 9, Lower Keate Street Yes. 18 days. Cured. .. 9th. F. 49 3, Keate Court No. 26 days. Cured. .. .. M. 36 14, Easington Buildings No. 14 days. Cured. .. .. F. 7 14, Easington Buildings No. 14 days. Cured. .. 10th. M. 19 1, George Street Yes. 9 days. Cured. .. 11th. M. 30 34, Flower and Dean Street Yes. 24 days. Cured. .. .. F. 21 36, Flower and Dean Street Yes. 20 days. Cured. .. .. F. 26 36, Flower and Dean Street Yes. 13 days. Cured. .. 13th. M. 17 4, Thomas Street No. 23 days. Cured. .. 14th. M. 11 5, Garden Place No. 13 days. Dead. .. 16th. M. 40 56, Fashion Street No. 13 days. Cured. .. .. M. 40 12, Thrawl Street Yes. 8 days. Cured. .. .. M. 30 12, Thrawl Street Yes. 15 days. Cured. 17th. F. 25 7, Nelson Court No. 15 days. Cured. .. .. F. 19 4, Wilson Place No. 29 days. Cured. .. 18th M. 19 Workhouse 17 days. Cured. .. 20th. F. 35 Workhouse 26 days. Cured. .. .. F. 13 5, King Street No. 26 days. Cured. .. .. M. 14 48, Grey Eagle Street No. 18 days. Cured. .. .. M. 12 48, Grey Eagle Street No. 18 days. Cured. .. .. M. 22 60, Wentworth Street Yes. 28 days. Cured. .. .. M. 14 36, Flower and Dean Street Yes. 18 days. Cured. .. .. F. 55 31, Wheeler Street No. 6 days. Dead .. 21st. F. 20 65, High Street No. 10 days. Cured. .. 22nd. M. 21 Workhouse 20 days. Cured. .. .. F. 36 Workhouse 30 days. In Hsptl. .. .. M. 35 36, Flower and Dean Street Yes. 12 days. Cured. .. 23rd. M. 23 12, Thrawl Street Yes. 19 days. Cured. .. 24th. M. 60 Workhouse 13 days. Cured. .. .. M. 56 Workhouse 14 days. Cured. .. .. F. 19 4, Buck's Row No. 18 days. Deal. .. 25th. F. 30 54½, Flower and Dean Street Yes. 27 days. In Hsptl. F. 1 54½, Flower and Dean Street Yes. 27 days. In Hsptl. .. 27th. M. 23 10, Lower Keate Street Yes. 7 days. Cured. .. .. F. 18 1, George Street Yes. 25 days. In Hsptl. LH .. .. F. 27 48, Flower and Dean Street Yes. 19 days. Dead. LH .. .. F. 46 48, Flower and Dean Street Yes. 25 days. In Hsptl. LH .. .. M. 34, Flower and Dean Street Yes. 25 days. 8 days. In Hsptl. .. 28th. M. 22 Workhouse Yes. Cured. .. 29th. M. 22 9, Rose Court No. 23 days. In Hsptl. .. .. F. 23 13, Grey Eagle Street No. 20 days. Cured. .. .. F. 32 4, Upper Keate Street No. 23 days. In Hsptl. LH .. .. M. 5, Flower and Dean Street Yes. 23 days. In Hsptl. LH .. .. F. 1, George Street Yes. 23 days. In Ilsptl. .. 30th. M. 28 Workhouse 22 days. In Hsptl. .. .. M. 22 19, George Street Yes. 17 days. Cured. LH .. .. M. 58 6, Little Pearl Street No. 22 days. In Hsptl. .. 31st. M. 49 Workhouse 4 days. Dead. LH .. .. M. 23 7, Flower and Dean Street Yes. 21 days. In Hsptl. 21st January, 1870. W. YALLANCE. BOARD OP WORKS, WHITECHAPEL DISTRICT. REPORT on the Sanitary Condition of the WHITECHAPEL DISTRICT, for the QUARTER ENDING 2nd APRIL, 1870, BY JOHN LIDDIE, MEDICAL OFFICER OF HEALTH. Presented to the Board 25th April., 1870. London: Printed by T. Penny, 121, Leman Street, Whitechapel, E. 1870. REPORT of the MEDICAL OFFICER OF HEALTH, for the Quarter ending 2nd April, 1870. To the Board of "Works, Whitechapel District. Gentlemen, During the thirteen weeks terminating on Saturday, the 2nd April, the official returns show that there were registered in the "Whitechapel District the deaths of 616 persons, of whom 349 were males and 267 females. During the same period, the births have been 725, viz., 366 males and 359 females. In the corresponding quarter of the previous year (14 weeks), the births were 682 and the deaths 721. The deaths in the London Hospital have been 128, viz., 88 males and 40 females. Of the total deaths 9 were of residents within the District, 87 of non-residents, and 32 of persons who died from the result of accident and from sudden death. Five deaths from pyaemia, 1 from diphtheria, 1 from scarlet-fever, and 1 from diarrhoea, occurred in this Institution. The deaths in the Workhouse have been 115, viz., 72 males and 43 females. The deaths from epidemic diseases in this Establishment have been 7, viz., 4 from measles, 2 from diarrhoea, and 1 from fever. The ages at death in the London Hospital and in the "Workhouse are shown in Table III. of the Appendix. Epidemic diseases have been fatal to 43. Measles occasioned 12 deaths, scarlet-fever 8, diphtheria 2, hooping-cough 8, diarrhoea 5, and fever 8. 4 In the corresponding quarter of the previous year the deaths from epidemic diseases were 109, viz., 14 from measles, 25 from scarlet-fever, 3 from diphtheria, 20 from hooping-cough, 3 from diarrhoea, and 44 from fever. The deaths caused by diseases of the respiratory organs, exclusive of consumption, have heen 139; of these, 71 were caused by bronchitis, 47 by pneumonia, 2 by laryngismus, 2 by laryngitis, 2 by spasm of the glottis, and 15 by other affections of the lungs. Consumption was fatal to 82 persons. The deaths from other tubercular diseases were 27, viz., 20 from mesenteric disease, 1 from scrofula, and 6 from hydrocephalus, or water on the brain. Diseases of the organs of circulation were fatal to 38 persons; of these 28 died from disease of the heart, 3 from pericarditis, 6 from aneurism, and 1 from phlegmasia dolens. The deaths from diseases of the urinary organs were 23; of these, 10 were caused by nephria or Bright's disease, 2 by diabetes, 9 by other diseases of the kidneys, and 2 by disease of the bladder. Convulsions caused the deaths of 24 children. There were 5 deaths from premature birth, 9 from teething, and 19 from atrophy and debility. The deaths by syphilis were 6; of these, 4 were of children under one year of age. Intemperance was fatal to 3 persons, and 11 died from privation. The deaths of 30 persons are attributed to old age; of these, 21 were above 80 years of age; one of these, a female, reached the advanced age of 98. Six persons died from premature decay under the age of 70 years. There were 25 deaths from mechanical violence; of these, 2 were caused by horses and vehicles in the streets. Burns and scalds were fatal to 11 persons. Three children were suffocated in bed. A child, aged 5 years, died from inflammation caused by putting a stone in her ear whilst at play. The number of inquests held has been 80. In the corresponding quarter of last year the number was 82. The deaths from epidemic diseases to the total mortality are in the proportion of 7 per cent. In the corresponding quarter of last year the proportion was 15.1 per cent. From consumption the proportion is 13.3 per cent.; and from old age and premature decay, 6.0 per cent. The deaths of children under 5 years of age are 193. This is 31.3 per cent, of the total mortality. In the previous quarter of last year the rate of mortality of children under 5 was 34.9. In the Artillery sub-district the rate is 33.3 per cent.; in the Spitalfields, 50.0 per cent.; in the Mile End New Town, 24.5 per cent.; in the Whitechapel North, 42.4 per cent.; in the Whitechapel Church, 15.2 per cent.; in the Goodman's Fields, 40.0 per cent.; and the Aldgate, 51.8 per cent. The number of deaths which have not been certified by a medical 5 tioner has been 20; of these, 12 were recorded in the Spitalfiolds sub-district. The Eegistrar 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 mcdical practitioner. Two deaths occurred in the London Hospital which are recorded as being uncertified in consequence of a post mortem examination having been disallowed. Pauper Illness in the District. The Medical Officers of the Union have attended, during the last quarter, 3647 new cases of illness out of the Workhouse, including 3 of small-pox, 34 of measles, 27 of scarlet-fever, 2 of diphtheria, 32 of hooping-cough, 109 of diarrhoea, 61 of fever, and 18 of erysipelas. In the corresponding quarter (14 weeks) of the previous year the number of pauper cases of illness was 3885, 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. Meteorology of Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis during the quarter has been 3.97 inches. During the corresponding quarter of last year the rain-fall was 8.02 inches. The mean temperature of the air was 36.8°. In the corresponding quarter of last year the mean temperature was 41.3°. The coldest days during the quarter were Friday, the 11th, and Friday, the 18th February, when the thermometer indicated respectively 19.4° and 19.6°. The following Table, taken from the returns of the Registrar-General, shows the compartive results during the quarter:— LONDON. Jan. 8th. Jan. 15th. Jan. 22nd. Jan. 29th. Feb. 5th. Feb. 12th. Feb. 19th. Feb. 26th. Mar. 5th. Mar. 12th. Mar. 19th. Mar. 26th. April 2nd. Deaths from rhœa 19 13 15 8 17 11 20 15 16 14 11 9 18 Dths. from Scrlt.Fvr. 134 114 143 118 107 103 104 111 78 69 81 56 78 Mean Temperature of the Air 39.5° 39.3° 36.1° 31.6° 42.0° 32.4° 30.7° 36.9° 45.8° 38.4° 41.0° 38.1° 37.2° Rain-fall in inches 0.79 0.48 0.05 0.00 0.25 0.25 0.05 0.05 1.22 0.02 0.44 0.37 0.00 Deaths in London 1697 1664 1652 1613 1828 1568 1716 1861 1673 1499 1532 1478 1625 Deaths in Whitechapel District 51 56 45 40 53 48 46 63 43 37 52 38 44 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 6 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. Three additional water-waste preventers have been erected since my last Report, making now 83 in this District, whereby a constant supply of water is afforded to about 6500 poor people. East London Water Supply. The Board of Works having had their attention directed to a Report made by Professor Frankland upon the condition of the water supply to the Eastern part of the Metropolis, which. Report occasioned suck a feeling of anxiety on the part of the Board that the Clerk was directed to write to the Board of Trade, directing that Honourable Board's attention to the report made by Captain Tyler in 1867, in reference to (he sufficiency and purity of the water supply to this part of the Metropolis, and respectfully requesting that Honourable Board to ascertain whether the alterations which the Company had engaged to perform had been carried out, and further requesting their attention to the Report of Professor Frankland before alluded to, and dated January 24th, and published in the Weekly Return of the Registrar-General, for the week ending January 22nd. In this Report of Professor Frankland it is stated that the water supplied by the East London Company was very turbid, owing to the presence of muck suspended brown matter full of living organisms. Amongst the latter vibrios were found. The Professor states that this is the first time since he had examined the London waters microscopically that these organisms, which are abundant in putrid sewage, have been met with in these waters. The sample which contained these impurities was taken from one of the Company's mains on the 10th January, and on the 19th of the same month a second sample was obtained from the same main, which sample was perfectly clear and transparent, but in other respects, so far as the analysis proceeded, the matters in solution are present in substantially the same proportion. At a Meeting of the Board of Works held on the 4th of April, the Clerk reported that a communication had been received by him from Captain Tyler on the part of the Board of Trade on the subject of the Works of the East London Water Company appointing a time when he would attend at the Works at Old Eord to inspect them. Two members of the Board and the Medical Officer of Health met Captain Tyler at Old Ford at the time appointed. The following is a copy of Captain Tyler's Report of his Inspection of the East London Company's Works at Old Ford, made to the Board of Trade: 7 Old Ford. 4th April, 1870. I have this day visited the Old Ford Works of the East London Waterworks Company, with Mr. Liddle, the Medical Officer of Health for the Whitechapel District, Messrs. Gladding and Jacobs, Members of the Board of Works for the Whitechapel District, and Mr. Greaves, the Engineer of the Waterworks Company. The covered reservoirs at Old Ford which were referred to in my Report of the 27th day of May, 1867 are now out of use, and are in process of being—the Eastern reservoir filled up altogether—and the Western reservoir filled up with ballast and gravel to the height of 2 feet G inches, and covered with a concrete floor with an additional thickness of eighteen inches. This concrete is being mixed with lias lime. The water is not again to be admitted until the Western reservoir has been made completely tight from leakage or soakage. It is stated that these reservoirs have not been used since July, 1869. By that time the Company had completed their arrangements for a sufficient extra supply of engine power at Lea Bridge to enable them temporarily to do without the covered reservoirs at Old Ford. They expect to have the Western reservoir ready to work again early in the coming autumn. The open ponds referred to in the same Report have now been nearly filled up. The Company have been increasing the size of their storage reservoirs at Waltliamstow by sixty additional acres with a depth of water of 10 feet, and they have employed portions of the material excavated from the Walthamstow reservoirs to fill up the open ponds in question. The work is still going on. The ponds will bo completely filled up in the course of a few months, and the parts which are not yet filled up are those which are farthest from the river and from the covered reservoirs. The vibrios detected by Dr. Frankland in the sample taken from Mr. Slater's Lampblack Works, Old Ford, on the 10th January, 1870, as referred to in the Registrar General's Report for the week ending 22nd January, 1870, could not have been drawn from the Old Ford reservoirs. Neither those nor any other underground reservoirs were in use by the Company, and they had not been used for six months previously. The only explanation that has yet been given in regard to the appearance of these vibrios, and to the general condition of the sample of water on the 10th January from Slater's Works, is to the efEect that, great additions having been made to the Company's mains from Lea Bridge, within the last two years, a deposit of sediment in an old main which had been laid for more than fifty years, was disturbed by alterations of current and pressure, and certain impurities which would otherwise have been dormant were thus stirred up. It is possible that such may have been the case, and as no further complaint of the same description has been made, it seems probable that the instance was exceptional. If such complaints should again be made it will be necessary to make a more detailed inquiry, and to ascertain definitely the causes to which they may be due. The Gentlemen of the Whiteehapel Board of Works, finding that the time allowed by the Company's Act of July, 1867, for the completion of their Works has not yet expired, and will not expire until July, 1870, consider the present inspection to be somewhat premature, and they would prefer that a definite report be not made until after the Works have been finally completed, and then inspected previously to their being brought into use. (Signed) H.W.TYLER. From Captain Tiler's Report the public may feel satisfied that every thing is being done by the East London Water Company to supply the inhabitants of the East of London with pure water, so far at least as any contamination of the water, supplied from the "Works, by soakage from the River or otherwise, in the vicinity of the reservoir at Old Eord is concerned. I am glad to have this opportunity of expressing my sense of the courtesy shown by Mr. Greaves, the Engineer of the Company, to us at the time of 8 our visit, and to thank him for his frank manner in answering the several questions which were put to him. The time probably is not far distant when the recommendation of the Select Committee of the House of Commons on East London "Water Bills, &c., will he carried into effect, viz., to compel each Town to intercept its sewage and apply it to some adjacent land, which could be done at small cost and with great agricultural profit. "By these means each town would bear the cost and enjoy the advantages resulting from its own sewage; and, as the quantity of sewage would be in proportion to the population, each place would be treated with an equal measure of justice." Overcrowding. The question of overcrowding in the houses occupied by the poor is one of the most important that can engage the attention of the public. From the experience that the Sanitary Officers have gained in this District, by daily visitations, and, on two or three occasions by nightly visits, they are fully aware that the great evil of the overcrowding of the tenements of the poor prevails very extensively; and they believe, if a similar system of visitation of other Districts in the East of London were to be carried out, that similar results would be obtained. On the 7th April the Inspectors having received information that the following premises, viz., No. 6, Goulston Street; No. 6, Inkhorn Court; No. 3, Marlborough Court; and No. 1, Castle Alley; were overcrowded and indecently occupied, they proceeded together to make a night inspection of them. The following results were obtained: In the front room of the first floor of No. 6, Goulston Street, which has a cubic space of 1408 feet, there were four men, one woman, and a child, and in the room above, which is of the same size, there were eight persons, viz., four men, three women and a child. On the same night the Inspectors visited No. 6, Inkhorn Court, and on the third floor of this house they saw three women, a man, and a child. The Inspectors were not allowed to enter the ground floor room. On the following night, Tuesday, the 5th of April, the Inspectors visited the house No. 3, Marlborough Court, and on the second floor they discovered three women, two men, and a child. At 6 o'clock on the morning of the 9th April, they again visited No. 6, Inkhorn Court, and on entering the room on the ground floor, where they were refused admittance on the night of the 4th, they found three men and three women. These were the same persons who had been compelled to remove from No. 1, Castle Alley, a house belonging to the same owner as that of No. 6, Inkhorn Court; so that when the indecent occupation of one house was ordered to be discontinued, the same parties removed to another house belonging to the same landlord. The smell of the rooms inspected on these occasions was, in the words of the Inspectors, "most offensive and 9 overpowering." The owner of these houses is a foreign Jew, and the rooms are occupied by foreign Jews of the lowest class. Night visits have been made to some workshops, and young persons have been found at work in them contrary to the Statute. No. 1, Old Eose Lane, is a house registered under the regulations of the Board of Works, which, from information received concerning its overcrowded condition, the Inspector made an inspection of it on Wednesday night, the 23rd February. The report of such inspection is as follows: The house consists of eight rooms, all of which, with the exception of one, were occupied by a larger number of persons than is allowed by the regulations. In room No. 2, which is registered for the occupation of four persons only, six were found, viz., two men and one woman, who were in bed together, and three children lying on the floor. In room No. 3, registered for the occupation of four persons, there were five men, all of whom were lying on the floor. In room No. 5, registered for the occupation of three, there were seven persons, viz., three women, one man, and three children. In room No. 6, registered for the occupation of three, there were six men and one woman. In room No. 7, registered for three persons, there were two women and one man; and in room No. 8, which is also registered for three persons, there were two men, one woman, and five children. The smell of each room was most offensive. From the facts brought to light by the Inspectors, it cannot excite the least surprise that ill health and consequent pauperism prevails so extensivly in this District. The Inspectors further report that of the thirty-five houses which they visited at night, eighteen of them were registered under the Sanitary Act, and no case of overcrowding or of indecent occupation was discovered with the exception of those rooms in No. 1, Old Rose Lane, before mentioned, but all of which on the second visit were found to bo in accordance with the regulations. Of the seventeen houses which are not registered, seven cases of indecent occupation and six of overcrowding were discovered. Metropolitan Buildings and Management Bill. A Bill to Consolidate and Amend the Building Acts relating to the Metropolis; the formation of streets and of sewers and drains in the Metropolis; and for other purposes relating thereto, has been prepared and brought in by Sir Wm. Tite, Mr. BENTINCK, and Mr. Bowring, and ordered by the House of Commons to be printed, 18th March, 1870. It is proposed by this Bill, which consists of 132 clauses, to repeal 7 & 8 Vict. c. 84, 18 & 19 Vict. c. 120, in part, viz., so much of Section 103 as relates to reports by District Surveyors, 18 & 19 Vict. c. 122, better known as the Metropolitan Building Act 1855, 23 & 21 Vict. c. 52, 24 & 25 10 Vict. c. 87, 25 & 26 Vict. c. 102, better known as the Metropolis Management Amendment Act 1862, in part, viz., Section 46, so much of Sections 47 & 48 as relates to a sewer vested in the Board, Section 49, so much of Section 62 as relates to reports by District Surveyors, Sections 98 & 99, and The Metropolitan Building Act 1869. I have on several occasions directed the attention of the Board to the Sanitary Clauses of the two preceding Metropolitan Building Bills, which had been prepared by the Metropolitan Board of Works; and as some alterations appear to have been made in those Clauses in the Amended Bill, I have deemed it advisable to bring them again under the notice of the Board. The most important of those Clauses are those relating to light and ventilation, the height of rooms, and the walls and foundations of houses intended to be inhabited. The Seventh Schedule in the Bill enacts that all rooms constructed to be inhabited shall be lighted and ventilated directly from the outside, and unless all the rooms in a dwelling house above the ground or entrance storey can be lighted and ventilated directly from a street or public place or from ground adjoining and appropriated to the Building or TO IT IN COMMON WITH OTHEES, shall at all times have in the rear or on one side thereof, or partly in the rear and partly on one side thereof, an open space belonging to such building to the extent of one hundred square feet at least, and the distance across such open space between such building and the opposite building or ground at the rear or side shall in all cases be ten feet throughout its whole height. The words "in common with others" are very ambiguous. The words ought to be "exclusively belonging to such building." Although this Clause may satisfactorily provide for an open space at the rear or side of a dwelling house, it does not enact that a window in every storey of such house shall open into such open space. Neither does it provide for the thorough ventilation of a house when the rooms of such house can be lighted from the front, or in other words it does not prohibit the building of houses back to back. Neither does it provide for the ventilation of the stair-cases and passages of a dwelling house. It is most earnestly to be desired that the words "at all times" in this Clause will effectually prevent such additions from being made to houses as may incroach upon the open space of 100 square feet provided at the rear or side of the house. As regards the height of rooms, an additional foot in height is provided in the Amended Bill. In the Bill of 1867 seven feet only were deemed as being sufficient for an inhabited room, but in the present Bill a height of 8 feet at least is required. In my opinion no room in a house should be less than 8 feet in height. 11 As regards the WALLS and foundations of houses it is proposed that all walls sliall be constructed of bricks, well burnt, hard and sound; or of stone or other hard and incombustible substances. That the footings of every wall shall rest on the "solid ground" or on concrete, or on other solid substructure as a foundation. The words "solid ground" appear to be objectionable and ought to be omitted from the Clause, inasmuch as all the walls of a house should rest on concrete or on other solid substructure, and not on the unprotected ground however solid it might be. In the Amended Building Bill it is provided by the 44th Section that a penalty not exceeding twenty shillings may be inflicted on any person who suffers any room to be inhabited which has not been built in conformity with the 7th Schedule of the Bill, which Schedule lays down rules for the construction of rooms intended for habitation. But it surely would be better to prohibit tha building of any room, and especially rooms in the basement, unless they are so constructed as to be in conformity with the provisions laid down in the Building Act, and in the Metropolis Local Management Act, as to the occupation of such rooms as dwellings. It is true that by such an enactment some trifling additional expense would be incurred in building a house; but the house, if let out in tenements, would be of more value to the owner, and therefore there can be no good reason why such a Clause should not be inserted in the Bill. While the Building Bill provides that certain restrictions be placed on carrying on noxious businesses—matters which ought to be transferred to the Nuisances' Removal Act—it is entirely silent upon some important subjects connected with the healthy condition of dwelling houses; for instance, not a word is said upon the proper drainage of houses, nor upon the necessity of every dwelling house being provided with a proper water-closet and dust-bin within the curtilage of such house. But the sanitary defects of the new Building Bill might be remedied if a Clause to the following effect were inserted therein, viz., "That before the building of any new dwelling house be commenced, or any old dwelling house rebuilt, all the plans relating to the drainage and to the sanitary arrangements of such houses should be submitted for approval to the Local Board, and the Surveyor to the Board should be required to examine the nature of the ground on which such houses are about to be laid, the course and efficiency of the drains, the domestic offices, and all other sanitary arrangements, and to report in writing his opinion to the Board of the fitness or otherwise of such houses for habitation; and if the Local Board be satisfied that such houses are fit for habitation, then the Local Board shall direct the Surveyor to give a certificate to the owner to that effect; and if any newly built house be occupied before such certificate be obtained, then the person letting such house shall be liable to a penalty not exceeding twenty shillings for each day such house or any part thereof shall be occupied. 12 Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending 2nd April, 1870:— Number of inspections of houses as shown in the official returns 4692 Houses systematically visited and the rooms measured to ascertain their cubic capacity 15 Houses specially visited at night 35 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each person, reckoning 2 children under 10 years of age for one adult 10 Number of cases of indecent occupation discovered 15 Houses systematically re-visited 250 Ditto registered by the order of the Board 13 Certificates and copies prepared for the registration of the above houses 33 Number of special notices served for the registration of houses 37 Preliminary notices served, many of such notices embracing several houses 469 Compulsory orders issued, embracing 109 premises 50 Summonses heard at police courts 3 Workshops specially visited 8 Ditto overcrowded 4 Ditto specially re-visited 15 Houses in which the rooms' or passages have been whitewashed .... 138 Cesspools abolished 22 Yards of houses paved, or the pavement repaired 161 Drains in houses improved 101 Dust bins provided 53 Privies limewashed, cleansed, and repaired 154 Water-butts and cisterns provided or repaired 125 Water-waste preventers erected 3 Area gratings, cellar flaps, &c., repaired 5 Cellars used as dwellings discontinued for such use 12 Instances where corpses were hept in inhabited rooms for prolonged periods so as to be a nuisance 1 Dung and other offensive matter removed 12 The cow-houses in the District, 24, and the slaughter-houses, 38 in number have been visited during the quarter. The bake-houses (83 in number) have been specially visited during the same period. 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 Metropolitan Board of Works several notices of dangerous structures, which notices the Metropolitan Board has promptly attended to. I am, Gentlemen, Your obedient Servant, JOHN LIDDIE. 15, Geeat 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 April, 1870. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Choleraic-Diarrœa. Continued Fever, Typhus & Typhoid. Diphtheria. 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 14 10 9 27 0 43 1 4 0 0 51 37 0 13 1 4 1 0 1088 1304 Mr. Champneys 0 13 2 9 17 0 3 0 6 0 0 69 0 0 1 0 2 0 0 324 448 Dr. Richardson 0 0 7 5 22 0 5 1 1 0 0 47 0 0 2 1 2 0 0 500 593 Mr. Sequiera 2 5 8 9 43 0 10 0 7 0 0 10 4 0 21 4 0 0 1 1178 1302 Total 3 34 27 32 109 0 61 2 18 0 0 177 41 0 37 6 8 1 1 3090 3647 Corresponding Quarter of previous Year. 2 30 37 71 105 1 137 1 25 1 1 220 76 0 29 10 3 1 4 3131 3885 TABLE IT. Showing the Deaths from Epidemic Diseases, for the Three Months ending 2nd April, 1870. Districts. Small-Pox. Measles. Scarlet-Fever. Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera. Total. Remarks. Artillery 0 1 0 0 0 0 1 0 2 Spitalfields 0 4 1 0 1 0 1 0 7 Mile End New Town 0 6 0 0 1 3 4 0 14 Workhouse Whitechapel, North 0 1 2 1 1 0 0 0 5 Whitechapel Church 0 0 1 1 0 1 0 0 3 Hospital. Goodman's Fields 0 0 2 0 2 0 1 0 5 Aldgate 0 0 2 0 3 1 1 0 7 Totals 0 12 8 2 8 5 8 0 43 Deaths from Epidemics for the corresponding Quarter, 1869. (14 weeks.) 1 14 25 3 20 8 44 0 109 Five cases of Pyaemia occurred in the Whitechapel Church sub-District. TABLE III. Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 2nd April, 1870. 0 and under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. j 80 and upwards. Total Males, 72 Females, 43 Corresponding j Quarter of 1869. Workhouse 6 11 5 20 32 34 7 115 115 London Hospital 0 10 18 41 40 18 1 Males, 88 142 Females, 40 128 TABLE IV. Ages at Death in each Registration District, for the Three Months ending 2nd April, 1870. Districts. 0 and under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total. Remarks. Artillery 7 2 1 1 5 10 1 27 Spitalfields 29 11 5 9 12 12 2 80 Mile E. N. Town 23 20 9 30 43 43 7 175 Workhouse. Whitechapel, N 12 16 4 7 13 12 2 66 Whitechapel Ch. 11 14 18 47 47 24 3 164 Hospital. Goodman's Fields 10 10 5 6 8 8 3 50 Aldgate 14 14 2 7 8 6 3 54 Totals 106 87 44 107 136 115 21 616 TABLE V. The Births and Deaths in each Registration District, for the Three Months ending on the 2nd April, 1870. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M. F. Artillery 33 33 66 14 13 27 39 0 Spitalfields 72 76 148 32 48 80 68 0 Mile End N.Town 84 97 181 101 74 175 6 0 Workhouse. Whitechapel, N. 58 52 110 42 24 66 44 0 Whitechpl Church 45 34 79 106 58 164 0 85 London Hospital. Goodman's Fields 52 42 94 27 23 50 44 0 87 Non-residents died in the London Hospital. Aldgate 22 25 47 27 27 54 0 7 Totals 366 359 725 349 267 616 201 92 Excess of Births over Deaths, deducting the 87 non-residents, 196 Estimated Population in 1869, 76,000. BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 2ND JULY, 1870, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH. Presented to the Board 17th July, 1870. London: Printed by T. Penny, 121, Leman Street, WhiteChapel, E. 1870. REPORT of the MEDICAL OFFICER OF HEALTH, for the Quarter ending 2nd July, 1870. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, July 2nd, 1870, the births registered in the Whitechapel District were 664, viz., 341 males and 323 females. During the same period, the deaths have been 585: of these, 336 have been of males and 249 of females. In the corresponding Quarter of the previous year, the births were 609 and the deaths 607. There has been, therefore, an increase of 55 in the number of births, and a decrease of 22 in the number of deaths. The deaths in the London Hospital have been 157, viz., 108 males and 49 females. Of the total deaths in this institution, there were 21 of persons resident within the District, 81 of non-residents, and 55 of persons who died from the result of accident and from sudden death. The total mortality of this District is increased by the deaths of residents within the District which have occurred in other hospitals in the Metropolis; but of those I have no record. There were 3 deaths from epidemic diseases in the London Hospital, viz., 1 from diarrhoea, 1 from typhoid fever, and 1 from scarletfever. The deaths in the Workhouse have been 85, viz., 50 males and 35 females. There was only 1 death from epidemic disease in this establishment, viz., measles. The deaths from epidemic diseases in the entire district have been 66, viz., 12 from measles, 6 from scarlet fever, 1 from diphtheria, 20 from hooping-cough, 12 from diarrhoea, and 15 from fever, 4 In the corresponding Quarter of the previous year, the deaths from epidemic diseases were 113, viz., 1 from small-pox, 16 from measles, 33 from scarlet-fever, 30 from hooping-cough, 7 from diarrhoea, 23 from fever, and 3 from cholera and choleraic-diarrhoea. Diseases of the tubercular class have been fatal to 100 persons, viz., 1 from scrofula, 26 from tabes mesenterica, 62 from consumption, and 11 from hydrocephalus. The proportion of deaths from this class of disease to the total deaths is 17.0 per cent. The proportion of deaths from epidemic diseases to the total deaths is 11.2 per cent. In the corresponding quarter of the previous year the proportion was 18.6 per cent. The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 98; of these, 45 were caused by bronchitis, 31 by pneumonia, 1 by laryngismus, 1 by laryngitis, 1 by spasm of the glottis, and 19 by other affections of the lungs. Consumption was fatal to 62 persons. The proportion of deaths from this disease to the total deaths is 10.6 per cent., and nearly equals the proportion of that of the epidemic class of diseases. Diseases of the organs of circulation were fatal to 27 persons; of these, 23 died from disease of the heart, and 4 from aneurism. The deaths from diseases of the urinary organs were 16; of these, 10 were caused by nephria or Bright's disease, 1 by nephritis, and 5 by other diseases of the kidneys. Convulsions caused the deaths of 14 children. There were 10 deaths from premature birth, 9 from teething, and 14 from atrophy and debility. The deaths by syphilis were 4; of these, 3 were of children under one year of age. Three persons died in child-birth. Intemperance was fatal to 2 persons, 2 died from privation, and 2 from want of breast-milk. The deaths of 16 persons are attributed to old age; of these, 11 were above 80 years of age; one of these, a female, reached the advanced age of 97. Five persons died from premature decay under the age of 70 years. There were 43 deaths from mechanical violence; of these, 9 were caused by horses and vehicles in the streets. Burns and scalds were fatal to 6 persons. Five children were suffocated in bed. The number of inquests held has been 88. In the corresponding quarter of last year the number was 59. Six persons committed suicide, and 5 persons were accidentally drowned. The deaths of children under five years of age are 129. This is 34.7 per cent, of the total mortality. In the previous quarter of last year the rate of mortality of children under five was 40.8. In the Artillery sub-district the rate is 64.2 per cent.; in the Spitalfields, 43.3 per cent.; in the Mile End New Town, 33.1 per cent.; in the Whitechapel North, 47.7 per cent.; in th 5 Whitechapel Church, 16.4 per cent.; in the Goodman's Fields, 64.0 per cent.; and the Aldgate, 41.1 per cent. In the Aldgate sub-district the deaths during the last two quarters have exceeded the births; in this quarter by 13, and in the previous quarter by 7. The question may be asked, Are all the births which take place in this District duly registered ? The number of deaths which have not been certified by a medical practitioner has been 19; of these, 10 are recorded in the Spitalfields subdistrict. 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. One death occurred in the London Hospital which is recorded as being uncertified in consequence of a post mortem examination having been disallowed. In all doubtful cases as to the cause of death occurring in a hospital, a post mortem examination should be made, unless the same is strictly forbidden by the relatives or friends of the deceased. Pauper Illness in the District. The Medical Officers of the Union have attended, during the last quarter, 3393 new cases of illness out of the Workhouse, including 21 of small-pox, 143 of measles, 21 of scarlet-fever, 37 of hooping-cough, 235 of diarrhoea, 27 of fever, and 9 of erysipelas. In the corresponding quarter of the previous year the number of pauper cases of illness was 3267, including 1 of small-pox, 72 of measles, 26 of scarlet-fever, 93 of hoopingcough, 149 of diarrhoea, 47 of fever, and 10 of erysipelas. Although no deaths from small-pox have been recorded in the mortality returns of this quarter, yet, as several cases of this disease have recently come under the notice of the Medical Officers of the Union, it behoves the authorities to be especially vigilant as regards the carrying out of the Vaccination Act. Meteorology at Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 1.29 inches. During the corresponding Quarter of last year the rain-fall was 4.45 inches. The mean temperature of the air was 54.7°. In the corresponding quarter of last year the mean temperature was 52.5°. The hottest days during the Quarter were Saturday, May 21st, Sunday, June 19th, Thursday, June 16th, and Wednesday, June 22nd, when the thermometer in the shade indicated respectively, 85.4°, 83.2°, 86.2°, and 90.2°. The rain-fall in the corresponding Quarter of 1869 was 4.22 inches, and the mean temperature of the air was 55.1°. The highest reading of the thermometer in the shade was 88.6° 6 The following Table, taken from the returns of the Registrar-General, shows the comparative results during the Quarter:— LONDON. Aprl 9th. Aprl 16th Aprl 23rd Aprl 30th May 7th May 14th May 21st May 28th June 4th June 11th June 18th June 25th July 2nd Deaths from Diarrhœa 16 18 17 13 14 14 17 13 22 24 56 86 192 Deaths from Scarlet Fever 71 70 77 68 74 76 81 90 91 103 100 95 80 Mean Temperature of the air 45.5º 50.1° 55.0° 47.7° 45.6° 49.3° 59.8° 50.6° 58.1° 58.0° 61.6° 63.8° 57.7° Bain - fall in inches 0.07 0.07 0.00 0.13 0.02 0.37 0.04 0.00 0.16 0.00 0.15 0.12 0.16 Deaths in London 1631 1475 1487 1394 1314 1426 1313 1239 1232 1273 1292 1282 1363 Deaths in Whitechapel District 49 34 45 53 47 41 41 44 48 46 42 46 49 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. The Water Companies are willing to assist the Local Boards in carrying into effect this important sanitary improvement; and I am able to report that there are 92 water-waste preventers in this District, which afford a constant supply to more than 7,000 poor people. Besides these water-waste preventers, there are several houses occupied by the poor which are supplied with water direct from the main. In this way, the 15 houses in New Court, Fashion Street, are supplied. Each house in this Court is furnished with a small pipe, which is in connection with the main, and is provided with an ordinary tap; so that, with the least possible trouble, an ample supply of water at all times can be obtained. The houses in this Court have been supplied with water in this most simple manner for the last thirteen years and upwards to the great comfort of the tenants, and without waste of water to the detriment of the Water Company. Three houses in Spital Street, three in Spital Court, eighteen in Easington Buildings, fourteen in Crawford's Court, two houses in Finch Street, both of which are occupied by several families, seven in Great Tongue Yard, and several of the common lodging houses, which are under the supervision of the Police, are supplied with water direct from the main. 7 The undermentioned places are provided with water-waste preventers. Angel Alley Jones Buildings, Bracey's Buildings, North, Jacob's Court, „ „ South, John's Place, Bond's Buildings, John's Court, Boundary Court, Keate Court, Castle Alley, (4.) Kettleby Court, Charlotte Court, M. E. N. T. Landsdown Cottages, Christopher Court, Marlborough Court, Cooper's Court, Montague Court, W. C. Cobourg Court, Maria Court, Caroline Place, Miller's Court, Crown Court, Wentworth Street, Neatsby Court, Crown Court, Quaker Street, New Court, Great Pearl Street, Crown Court, Little Pearl Street, New Court, George Yard, Devonshire Place (2) New Square, Dinah's Buildings, Norwich Court, Diamond Court, Norton Folgate, in lieu of public Duke Street, pump, Eele place, Osbom Court, Fann Court, Pratt's A1ley, Farthing Alley, Providence Court, Garden Place, Pool's Square, Green Dragon Yard, Pope's Head Court, Gower's Place, Pearl Street (Great) 2 Garden Court, Queen's Place. Goodman's Buildings, Rama Place, Goulston Court, (2) Russell Court, George Street, C. C. (3) Samuel Court, George Yard (3) Shorter's Rents, Goulston Street, (3) Slater's Court, Half Wilk Court, Sun Court (2) Hobson's Court, Swan Court, Middlesex Street, Hobson's Place, Tewkesbury Buildings, Hayes Court, Union Court, Wheeler Street, Hum's Buildings, Union Place, Fashion Street' Hunt Court, Vine Yard, C. C. Holloway Court, Vincent's Place, Harriet Place, Well's Yard, Hanover Court, White Bear Court, Inkhorn Court, Wilk Court, Total 92 8 Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending 2nd July, 1870, Number of inspections of houses as shown in the official returns 4624 Houses systematically visited and the rooms measured to ascertain their cubic capacity 36 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each person, reckoning 2 children under 10 12 years of age for one adult Number of cases of indecent occupation discovered 20 Houses specially visited 352 Houses specially revisited 1560 Ditto registered by order of the Board 14 Certificates and copies prepared for the registration of the above houses 28 Number of special notices served for the registration of houses 79 Preliminary notices served many of such notices embracing several houses 549 Compulsory orders issued embracing 151 premises 69 Summonses heard at police courts 1 Workshops specially visited 11 Ditto overcrowded 4 Ditto specially re-visited 13 Copies of the Workshops' Regulation Act distributed 11 Houses in which the rooms or passages have been whitewashed 381 Ventilation of houses improved 2 Yards of houses paved or the pavement repaired 253 Drains in houses improved 232 Dust bins provided 185 Privies limewashed, cleansed, and repaired 199 Water-butts and cisterns provided or repaired 234 Water-waste preventers erected 7 Area gratings, cellar flaps, &c., repaired 10 Cellars used as dwellings discontinued for such use 14 Instances where corpses were kept in inhabited rooms for prolonged 3 periods so as to be a nuisance Animals so kept as to be a nuisance removed 1 Dung and other offensive matter removed 25 Trades nuisances abated 2 The cow-houses in the District, 24, and the slaughter-houses, 38 in number, have been visited during the quarter. 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. 9 In addition to this return the Inspectors report that they have forwarded to the Metropolitan Board of Works several notices of dangerous structures, which notices the Metropolitan Board has promptly attended to. It appears from the above return of the sanitary work carried out by the Inspectors, that no less that 1560 re-visits have been made to houses. This large number is accounted for in consequence of the Inspectors having to repeatedly call upon the owners of property to induce them to carry out the sanitary work required. Many of the owners of property, after they have received notices to do certain repairs—to provide better drainage— water supply — to cleanse the houses; instead of doing the most important works in the first instance, they begin to whitewash a room or two; then they do nothing more until they are reminded of their neglect; then something else is done, and after another visit, perhaps something more, and so long as something is being done to the houses, legal proceedings are not usually taken. A similar labour devolves upon the Inspectors when houses are brought up for registration; as the Board, in order to afford ample time for the owners of property to complete the improvements ordered to be carried out, defer the consideration of the cases; and it is only when the parties are contumacious that the houses are ordered to be registered. I may observe that nearly the whole work above specified has been carried out without the aid of the Magistrate (it having been necessary in one instance only to take out a summons). It is true that, by abstaining from taking out summonses, much more labour devolves upon the Inspectors, but it is infinitely better and more satisfactory to get the work done, if possible, without carrying the case before the Magistrate, and obtaining his order to compel the owner to perform the work. Although a great number of houses have been brought up for registration, only 56 have been registered by the Board; the owners, rather than their houses should be registered, prefer carrying out the necessaiy sanitaiy improvements. A great improvement has been made in some houses belonging to Mr. Freeman, in George Yard, Whitechapel, numbered 9, 10, 11, 12, 21, 22 and 23. These houses have been cleansed; the yards, which were in a very bad condition, have been well paved and drained, and are made to communicate with each other, thereby giving a freer circulation of air at the rear of the houses. The water-butts, which were old and in a filthy condition, have been taken away and three water-waste preventers erected in their stead. Nos. 21, 22, and 23, Spital Street, and the houses in Spital Court, belonging to Mr. Field, have also been greatly improved. The said houses in Spital Street have been, until lately, without either privy accommodation or a water supply, the tenants having been compelled to make use of the public privies in Spital Court, which is some distance from the above-named houses; 10 they had also to get water for their domestic use from the same Court. Each house is uow provided with privy accommodation and a constant supply of water direct from the main. The public privies in Spital Court, which were a continual nuisance, have been abolished, and a water supply is now provided direct from the main. The stinking public privies in this Court were frequently occupied at night by vagrants as sleeping places. Prolonged Retention of Dead Bodies. There have been three cases of prolonged retention of the dead in rooms occupied as living and sleeping rooms. One of these cases was that of a child who died of diarrhoea at No. 26, King Street, Spitalfields, and whose body was retained for nine days, the parents stating that they were unable to raise sufficient money to bury it. During the time the body was kept it became so offensive that it was necessary to remove it to a shed at the rear of the house. Eventually the father applied to the Relieving Officer and obtained an order for the burial of the body. Another case was that of a young man who died of consumption at 120, Royal Mint Street. The body of this young man was kept for eight days in the room in which his father and mother lived and slept. The third case was that of a child three weeks old who died at No. 5, Devonshire Place, Whitechapel. The body of this child was kept in the room occupied by its parents for a period of twelve days, and at the time of the visit of the Inspector the smell from it was most offensive. Although in each of these cases every thing was done by the Officers of this Board and by the Relieving Officer to induce the respective parties to bury their dead before a nuisance was occasioned, yet to a certain extent, their efforts were unavailing. As such cases are of frequent occurrence, it is certainly full time that power was given to Magistrates to order the burial without delay of every corpse which is certified to be a nuisance or dangerous to the public health. 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 happy to be able to state that the present contractor has done his work during this quarter in a very satisfactory manner, for very few complaints have been made respecting the non-removal of dust from private houses, and the public dust bins have beeu duly attended to. 11 Trades' Nuisances. Complaints have been made at the office of the Board of several nuisances arising from the defective mode in carrying on certain businesses, viz., the Refinery premises of Sir Anthony Rothschild, in Royal Mint Street, the premises of Mrs. Flexon, Fellmonger, in Buxton Street, the Chemical works of Messrs. Womersley and Son, in EInch Street, and the Malt-roasting premises of Messrs. Walmsley, in Booth Street. The nuisance arising from the Refinery premises of Sir Anthony Rothschild has been more or less complained of by the inhabitants of the neighbourhood during the last 13 years, and notwithstanding that the injurious effects of the acid vapours which are given off from those premises have been repeatedly brought under the notice of Sir A. Rothschild, yet the nuisance is allowed to continue. Unfortunately for the neighbourhood proceedings to obtain an abatement of the nuisance cannot be taken under the provisions of the Nuisances' Removal Act. I am decidedly of opinion that the nuisance can be prevented. The nuisance from the premises of the Fellmonger has been complained of in a memorial signed by 133 persons living in the vicinity of them, and proceedings will be taken under the Nuisances' Removal Act to compel the abatement of this nuisance. The nuisance from the Chemical works in Finch Street was occasioned by the escape of nitrous acid fumes, which produced great discomfort to the neighbourhood. I wrote to Messrs. Womersley and Son upon the subject, and since the date of my letter no further complaint has been made to me respecting the nuisance. As regards the nuisance arising from the malt-roasting premises of Messrs. Walmsley, the complaints have been very numerous. On the llth April a memorial was presented to the Board, signed by 20 of the men employed in building a chemicai factory for Mr. Bishop, in Samuel Street, Spitalfields, which is nearly opposite to the premises of Messrs. Walmsley, complaining of this nuisance, by whom it was stated that the annoyance caused by the smoke, and offensive smell from the roasting of the malt, produced in them a nauseating and suffocating sensation; and that it interfered with the enjoyment of their food. The memorialists urged the Board to take measures to cause the nuisance to be abated. Another memorial, signed by 68 of the inhabitants in the vicinity of the said premises, complaining of the same nuisance, was presented to the Board on the 5th May. In addition to these two memorials, several letters have been addressed to the Board by gentlemen living in the neighbourhood, complaining of the nuisance, and requesting the Board's interference in the matter. I have called repeatedly upon the Messrs. Walmsley, and informed them of the great inconvenience and suffering that their neighbours experienced from 12 the mode in which their business is carried on; and I have expressed to them my opinion that, from the dilapidated state of their premises, it was impossible to carry on therein such a business without occasioning a nuisance injurious to the health of the neighbourhood. The nuisance still continues unabated, but the adoption of legal proceedings has been delayed in consequence of the Messrs. Walmsley having promised that immediate steps would be taken to provide more suitable premises in the country for carrying on their business, and that every possible means would be adopted by them to prevent any cause of complaint while they continued to work in their present premises. Registered Common Lodging Houses. In my report for the quarter ending 1st January, 1870, I drew attention to the overcrowding of some of the Registered Common Lodging Houses, and I suggested that a space of not less than 300 cubic feet should be allowed for each bed. Since the publication of my report, I have been informed that the rooms in all the lodging-houses which are under the supervision of the Police have been re-measured, and that in most of them a cubic space of 300 feet has been allotted to each bed; and I am further informed, that on every new application for the registration of a lodging-house, a space of 300 cubic feet for each bed will be insisted on. Offensive Streets and Places. In consequence of the offensive smell in some of the narrow and overcrowded streets, occasioned by the dirty habits of the people, who, instead of conveying the slops and refuse of their houses to proper drains and receptacles, throw them into the roadways, I have given directions to have such places watered with a weak solution of carbolic acid, and have intimated, by public notice, that all persons detected in throwing filth upon the public way will be prosecuted. These proceedings have been attended with very good results. The following streets, viz., Goulston-street, Wontworth-street, and Middlesex-street, arc watered twice daily with the carbolic acid solution; Fashion-street and Plower and Dean-street are thus watered once daily; the Railway Arches and Phoenix-street three times a week; and some other streets, viz., Glasshouse-street, Blue Anchor yard, Cartwright-street, and Darby street, are watered every Saturday with the same solution. 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 July, 1870. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Choleraic-Diarrhœa. Continued Fever, Typhus & Typhoid. Pyaemia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. Eheumatic Fever. Ague. Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Dr. Swyer 11 50 7 4 64 0 17 0 1 0 0 34 36 0 17 4 0 0 0 704 949 Mr. Champneys 2 26 0 19 » 37 0 1 0 3 0 0 34 2 0 0 0 3 1 0 396 524 Dr. Richardson 0 36 3 5 49 0 0 0 1 0 0 28 6 0 7 2 0 0 0 513 650 Mr. Sequiera 8 21 11 9 85 0 9 1 4 0 0 3 4 0 14 18 0 0 2 1091 1270 Total 21 143 21 37 235 0 27 1 9 0 0 99 48 0 38 24 3 1 2 2704 3393 Corresponding Quarter of previous Year. 1 72 26 93 149 0 47 1 10 0 0 117 52 2 10 12 2 2 2 2669 3267 TABLE IT. Showing the Deaths from Epidemic Diseases, for the Three Months ending 2nd July, 1870. Districts. Small-Pox. Measles. Scarlet-Fever. Diphtheria. HoopingCough. Diarrhoea. Fever. Cholera &Choleraic-Diarha. Total. Remarks. Artilery 0 3 1 1 0 2 0 0 7 Spitalfields 0 3 1 0 3 1 4 0 12 Mile End New Town 0 3 0 0 4 1 4 0 12 Workhouse. Whitechapel, North 0 0 0 0 1 2 2 0 5 Whitechapel Church 0 0 1 1 2 2 2 0 7 Hospital. Goodman's Fields 0 3 0 0 9 2 2 0 16 Aldgate 0 0 3 0 1 2 1 0 7 Totals 0 12 6 1 20 12 15 0 66 Deaths from Epidemics for the corresponding Quarter, 1869. 1 16 33 0 30 7 23 3 113 There was one death from Scarlatina, one from Typhoid Fever, one from Diarrhœa, and three from Pyæmia, in the London Hospital. TABLE III. Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 2nd July, 1870. 0 and under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total Males, 50 Females, 35 Corresponding Quarter of 1869. 12 0 2 12 13 31 7 85 75 London Hospital 3 5 22 63 45 18 1 Males, 108 113 Females, 49 157 TABLE IV. Ages at Death in each Registration District, for the Three Months ending 2nd July, 1870. 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. Artllery 12 6 1 5 2 2 0 28 Spitalfields 19 7 4 7 11 9 3 60 Mile E. N. Town 27 21 7 18 25 40 7 145 Workhouse. Whitechapel, N 18 3 0 7 8 8 0 44 Whitechapel Ch 18 14 23 71 46 22 1 195 Hospital. Goodman's Fields 21 11 3 2 10 3 0 50 Aldgate 14 12 6 13 15 3 0 63 Totals 129 74 44 123 117 87 11 585 TABLE V. The Births and Deaths in each Registration District, for the Three Months ending on the 2nd July, 1870. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M. F. Artillery 28 31 59 13. .15 28 31 0 Spitalfields 51 64 115 30. .30 60 55 0 Mile End N. Town 82 76 158 84. .61 145 13 0 Workhouse. Whitechapel, N. 69 50 119 23. .21 44 75 0 WhiteciiplChurch 37 32 69 126. .69 195 0 126 London Hospital. Goodman's Fields 51 43 94 14 96 50 44 0 Aldgate 23 27 50 36. .27 63 0 13 81 Non-residents died in the London Hospital. Totals 341 323 664 336 249 585 218 139 Excess of Births over Deaths( deducting the 81 non-residents, 160 Population in 1861, 78,970. Estimated Population in 1870, 76,000. BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE Saintary Condition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 1ST OCTOBER, 1870, BY JOHN LIBBLE, MEDICAL OFFICER OF HEALTH. Presented to the Board 7tli November, 1870. Honijon: Phinted br T. Penny & Co., 121, Leman Sibeet, Whitechapel, E. 1870. REPORT OF THE MEDICAL OFFICER OF HEALTH, FOR THE Quarter ending \st October, 1870. To the Board of "Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, October 1st, 1870, the births registered in the Whitechapel District were 631, viz., 321 males and 310 females. During the same period, the deaths have been 609 : of these, 342 have been of males and 267 of females. In the corresponding Quarter of the previous year, the births were 619 and the deaths 690. There has been, therefore, an increase of 12 in the number of births, and a decrease of 81 in the number of deaths. The mortality in this District during the Quarter has been at the rate of 32 per 1000, while for the whole of London the rate of mortality has been about 24 per 1000. This, however, refers to the rate of mortality for the entire District; but if we were able to calculate the rate of mortality in particular localities, where overcrowding, defective ventilation, and other sanitary defects exist, the rate of mortality would be found to be greatly in excess of 32 per 1000; but it is difficult to obtain accurate returns from these bye places, inasmuch as the parties, when sick, go into the hospitals, or are removed to the Workhouse, where, when they die, their deaths are recorded. The deaths in the London Hospital have been 159, viz., 112 males and 47 females. Of the total deaths in this institution, there were 15 of persons resident within the District, 110 of non-residents, and 34 of persons who died from the result of accident and from sudden death. The total mortality of this District is increased by the deaths of residents within the District which have occurred in other hospitals in the Metropolis; but of those I have no record. There were 5 deaths from epidemic diseases in the London Hospital, viz., 3 from diarrhoea, 1 from enteric fever, and 1 from diphtheria. All of these deaths, with the exception of one from diarrhoea, were of nonresidents. The deaths from pycemia were 3. 4 The deaths in the Workhouse have been 66, viz., 32 males and 34 females. There were 3 deaths from epidemic diseases in this establishment, viz., 2 from diarrhoea and 1 from fever. There was 1 death from pyaemia and 1 from erysipelas. The deaths from epidemic diseases in the entire District have been 133, viz., 6 from small-pox, 7 from measles, 13 from scarlet-fever, 1 from diphtheria, 12 from hooping-cough, 78 from diarrhoea, 10 from fever, and 6 from choleraic-diarrhoea. In the corresponding Quarter of the previous year, the deaths from epidemic diseases were 231, viz., 17 from measles, 82 from scarlet-fever, 1 from diphtheria, 39 from hooping-cough, 72 from diarrhoea, 17 from fever^ and 3 from choleraic-diarrhœa. The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 51; of these, 21 were caused by bronchitis, 22 by pneumonia, 1 by laryngismus, 2 by laryngitis, 1 by pleuritis, and 4 by other affections of the lungs. Consumption was fatal to 76 persons. The deaths from other tubercular diseases were 32, viz., 23 from mesenteric disease, 4 from tubercular meningitis, and 5 from hydrocephalus, or water on the brain. Diseases of the organs of circulation were fatal to 35 persons; of these, 33 died from disease of the heart, 1 from aneurism, and 1 from disease of the arteries. The deaths from diseases of the urinary organs were 16 : of these, 8 Were caused by nephria or Bright's disease, 2 by diabetes, 2 by morbus Addisonii, 2 by disease of the bladder, and 2 by other diseases of the urinary organs. Convulsions caused the deaths of 13 children. There were 11 deaths from premature birth, 1 from teething, and 26 from atrophy and debility. The deaths from syphilis were 9; of these, 4 were children under 1 year of age. Intemperance was fatal to 2 persons, and 2 died from privation. The deaths of 18 persons are attributed to old age: of these, 10 were above 80 years of age; one of these, a female, reached the advanced age of 94. Four persons died from premature decay under the age of 70 years. There were 29 deaths from mechanical violence; of these, 5 were caused by horses and vehicles in the streets. Burns and scalds were fatal to 3 persons. Two persons were accidentally drowned, 2 were poisoned accidentally, and 5 committed suicide. Five children were suffocated in bed. The number of inquests has been 64. In the corresponding Quarter of last year the number was 59. 5 The deaths from epidemic diseases to the total mortality are in the proportion of 21.8 per cent. In the corresponding Quarter of last year the proportion was 33.4 per cent. From consumption the proportion is 12.4 per cent.; and from old age and premature decay, 3.6 per cent. The deaths of children under 5 years of age are 250. This is 41.0 per cent, of the total mortality. In the previous quarter of last year the rate of mortality of children under 5 was 49.2 per cent. In the Artillery sub-District the rate is 70.0 per cent.; in the Spitalfields, 56.9 per cent.; in the Mile End New Town, 41.2 per cent.; in the Whitechapel North, 56.6 per cent.; in the Whitechapel Church, 18.1 per cent.; in the Goodman's Fields, 69.2 per cent.; and the Aldgate, 51.8 per cent. The number of deaths which have not been certified by a medical practitioner has been 17; of these, 10 were recorded in the Spitalfields subDistrict. Three deaths occurred in the London Hospital, which are recorded as being uncertified, in consequence of a jjost mortem, examination having been disallowed. One of these was that of a labourer aged 30, who was admitted with constipation and vomiting, and died in a state of collapse. Pauper Illness in the District. The Medical Officers of the Union have attended, during the last Quarter, 3585 new cases of illness out of the Workhouse, including 33 of small-pox, 75 of measles, 27 of scarlet-fever, 39 of hooping-cough, 646 of diarrhoea, 66 of fever, 4 of choleraic-diarrhoea, and 19 of erysipelas. In the corresponding Quarter of the previous year, the number of pauper cases of illness was 3525, including 2 of small-pox, 54 of measles, 135 of scarlet-fever, 90 of hooping-cough, 560 of diarrhoea, 1 of choleraic-diarrhoea, 72 of fever, and 13 of erysipelas. Meteorology of Greenwich. The Returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 4.50 inches. During the corresponding Quarter of last year the rain-fall was 4.40 inches. The mean temperature of the air was 68.8° In the corresponding Quarter of last year the mean temperature was 61.5° The hottest days during the Quarter were Friday, the 8th, and Monday, the 25th July, and Thursday, the 21st August, when the thermometer indicated respectively 89.7°, 88.8°, and 88.1°. In the week ending September 10th, the rain-fall was 1.33 inches. 6 The following Table, taken from the returns of the Registrar-General, shows the comparative results during the Quarter:— LONDON. July 9 th July 16th J uly 23rd July 30th Aug. 6th Aug 13th Aug. 20 th Aug 27th Sept. 3rd Sept. 10th Sept. 17th Sept. 24th Oct 1st Deatha from Diar- rhœa 258 259 385 371 385 289 248 202 156 130 73 46 37 Deaths from Scar- let Fever 104 85 130 100 114 118 126 108 129 165 157 167 171 Mean Temperature of the air 65.0° 65.1° 68.5° 61.8° 65.3° 61.5° 62.9° 57.3° 57.7° 57.0° 54.0° 54.5° 55.7° Rain-fall in inches 0.12 0.80 o.oo 0.93 0.15 0.62 0.00 0.70 0.64 1.33 0.21 0.00 0.00 Deaths in London 1497 1498 1754 1700 1648 1494 1398 1393 1426 1322 1197 1212 1275 Deaths in White- chapel District 50 55 57 54 38 43 40 60 51 48 39 28 46 Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending 1st October, 1870:— Number of inspections of houses as shown in the official returns 4016 Houses systematically visited and the rooms measured to ascertain their cubic capacity 22 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each person, reckoning 2 children under 10 9 years of age for one adult, nuisance abated Number of cases of indecent occupation discovered 27 Houses specially visited 266 Ditto specially re-visited 1064 Ditto registered by order of the Board 3 Certificates and copies of same prepared for the registration of the 9 above houses Number of special notices served for the registration of houses 52 Preliminary notices served, many of such notices embracing several houses 353 Compulsory orders issued embracing 112 premises 38 Summonses heard at police courts 6 Workshops specially visited 13 Ditto specially re-visited 9 Copies of the Workshops' Regulation Act distributed 13 Houses in which the rooms or passages have been whitewashed 282 Yards of houses paved or the pavement repaired 118 Drains in houses improved 93 Dust bins provided 67 Privies limewashed, cleansed, and repaired 105 Water-butts and cisterns provided or repaired 119 7 Water-waste preventers erected 1 Area gratings, cellar flaps, &c., repaired 12 Cellars used as dwellings discontinued for such use 13 Animals kept in four premises so as to be a nuisance—removed 26 Dung and other offensive matter removed 8 Trades-nuisances abated 2 The cow-houses in the District, 24, the slaughter-houses, 39, and the bake-houses, 94 ia number, have been visited during the Quarter. House Accommodation for the Poor. I have shown in the first page of this Report, that the rate of mortality in this District, including all the deaths in the London Hospital, and excluding those of residents dying in the other hospitals in London and elsewhere, is at the rate of 32 per 1,000, estimating the population at 76,000. This is a very large mortality, and is considerably above that of the whole Metropolis, which is about 24 per 1,000 annually. This high rate of mortality is a question of very great importance, and is one which, more or less, engages the attention of all persons who hold those public appointments which have for their object the amelioration of pauperism, and sickness, and the carrying out of the sanitary laws for the suppression of nuisances. It is well known that much has been done by Guardians, by Vestries, and by District Boards, to improve the localities of the poor, as regards their sanitary condition—in organizing a regular and systematic inspection of the poorer class of houses, in endeavouring to abate the overcrowding of rooms, and in obtaining for the poorer inhabitants cleaner and better ventilated dwellings, and better drainage. Such, however, is the wretched condition of many of the tenements in some parts of Loudon—and especially in this District—that the mere white-washing of walls and ceilings, improving the water supply, providing better drainage, laying down good pavement in the fronts and backs of the houses, and diminishing the overcrowding of the rooms, are not sufficient to render a large class of the houses, now, as it were, jammed together, and without proper ventilatior, fit for habitation. The only thing, therefore, that can be done to improve the sanitary and physical condition of the people who inhabit these dens, is to pull them down, and so compel the inhabitants to move into more healthy localities; and, from my experience, I can state that little or no inconvenience to the poor will be the result of such a proceeding. It has been well and truly said that the question of human habitations is the greatest problem that sanitarians and statesmen have to solve; for it is in these close, filthy, and ill-ventilated places, that disease, crime, and pauperism are generated and maintained. Money, in large amounts, is annually spent in widening thoroughfares, and in adding to the splendour of this vast city, but as yet nothing has been done on a scale commensurate with its necessity to improve the dwellings of the poor. 8 It may, perhaps, be thought that as laws have been passed to prohibit the occupation of houses unfit for habitation, and for the pulling down of such houses as cannot be improved by any structural alterations, that such laws are sufficient to effect all the improvements as regards the lowest class of house property, and that it is only necessary for the several local Boards to put in force the existing sanitary laws regarding house property of this description. Now, if the experience of all the Medical Officers of Health in London coincides with mine (and I believe it does so), in regard to the benefit which the public health would derive from the permanent closing of houses unfit for habitation, or from the demolition of such houses, it will ^be found that, on attempting to enforce the laws relating thereto, they are not sufficient for the purpose. It has often been a matter of surprise to me that the subject of the prevention of pauperism, of sickness, of crime, and of the physical inability of the lower class of labourers to work, has not taken a stronger hold on the public mind than it has hitherto done. All persons who have spoken of the causes of ill health among the labouring population, have dwelt strongly upon the injurious effects of the wretched condition of the houses in which the poor are compelled to dwell; yet few, if any, practical suggestions for their improvement, have been put forth by this class of speakers—the evils are pointed out and deplored — and there the matter ends. The time, however, for talking, I hope, is now past, and action, I trust, will be taken to remove the evils which are so well known and deplored. It is probable that, owing to the enormous increase in local taxation which is now telliug upon the ratepayers, occasioned by the ample provisions which the authorities are compelled to make for the cure of sickness among our paupers, in the shape of improved workhouse accommodation, additional medical attendance, the purchase of drags, the formation of dispensaries, and the erection of hospitals, that these heavy burdens will soon be so severely felt, that the ratepayers will be compelled, in order to save themselves from additional expense, to inquire very seriously whether the large amount of sickness, now so prevalent, may not be diminished; and whether it would not be cheaper to spend a little money in preventing disease, than to continue to spend so much in curing it, and in providing for the relief of the numerous widows and orphans, and of those so prostrated by the effects of disease, as to be physically unable to maintain themselves by their labour. If in addition to the rates now imposed upon the several parishes for the relief of pauper sickness, a special tax were to be levied for the support of the sick in the public hospitals (the levying of such a tax being by no means of unlikely occurrence, owing to the depressed state of the funds of many of the public hospitals, which, otherwise, must be partially closed), the inducement to direct public attention to the prevention of disease would be further stimulated. 9 But it may be fairly asked, how are the numerous unhealthy tenements before spoken of to be dealt with ? The Legislature has long felt the importance of affording facilities for providing better habitations for the poor, and has passed several Acts for that purpose. In 1851, the Labouring Classes Lodging Houses Act was passed, which vested powers in certain local authorities, for the purpose of facilitating the erection of lodging houses for the labouring classes. In 1866, an Act was passed to enable the Public Works Loan Commissioners to make advances towards the erection of dwellings for the labouring classes. These two Acts are to be read and construed together, as if they were one Act. In 1867, an Act was passed to amend the above recited Acts; and, finally, in 1868, the Artizans and Labourers Dwellings Act was passed. The three former mentioned Acts, being only of a permissive character, are, consequently, of little or no use; and the latter, although containing apparently stringent and compulsory clauses, has, as yet, been of comparatively little benefit in clearing away property unfit for human habitation, or in causing the unhealthy dwellings occupied by working men and their families to be improved. The Nuisance Removal Act of 1855, imperfect as it is, is the only Act which is put in force to obtain an order from the magistrate to compel the owner to close a house, which, in the judgment of the magistrate, upon proof being adduced, is unfit for habitation. But the order for compelling the owner to close a house is rarely applied for. Few persons, and especially the owners of house property, will believe that a house is unfit for habitation; and it is difficult, nay, it is almost impossible, to convince them on the subject, owing to their unwillingness to be instructed in any matter which is at variance with their pecuniary interests. Several plans for improving the dwellings of the labouring classes have been laid before the public. The first that I shall mention is that recommended by some philanthropists to form additional voluntary societies for the building of healthy and cheap habitations for the working classes. Two of these societies have been in existence for about twenty-six years, and although some good has doubtlessly been afforded by their benevolent exertions, yet, their work has been carried on with insufficient means to effect any material improvement in this vast Metropolis. The next plan which has been in operation for a few years, on a very limited scale, is that of building houses of a cheap yet healthy character, in the suburbs of London, and in obtaining facilities from a railway company to provide cheap trains at certain hours for the special accommodation of the artizan class who reside in these newly-erected houses. The third plan which has been put forward for improving the habitations of the poor, is that the local authority should have the power of expending the public rates, in converting privies into waterclosets. Such a 10 proceeding would no doubt tend to promote the public health, particularly in crowded neighbourhoods. But I apprehend that the proposition to improve private property at the public expense, will not commend itself to the favorable consideration of local Boards. The poorer class of ratepayers will strongly object that any portion of the rates shall be applied for the special benefit of landlords. The next plan is one upon a much larger scale than that last mentioned, and is to the following effect, viz.: that the Government should lend money to the amount of fifty millions, at 3½ per cent., to local authorities, on security of the rates, to improve dwelling houses, to sewer, drain, construct waterworks, markets, &c.; and to effect street, road, and other town improvements. This is certainly the boldest scheme which has ever been put forward, and is one which, if carried out, would soon be productive of good results, as would be shown in the improvement of the health of the people, and in the diminution of pauperism and crime. But the same objection holds good to this scheme as to the preceding one, viz., the taking of money out of the rates to improve private property. The fifth plan is one which I brought under your notice in my Report for the Quarter ending 30th December, 1865, and which has been advocated by others, is to the following effect, viz.: That public companies, having for their object the improvement of the dwellings of the poor, should, under certain restrictions, to be imposed by the Board of Trade, or by the Privy Council, obtain compulsory powers for the purchase of land, on fair compensation being made to the owners, and to erect suitable habitations for the working classes. If encouragement were to be given to the formation of such public companies, without compelling them to incur the expense of obtaining Acts of Parliament, but by simply enabling them to obtain such powers from a Government Board (after [such Board had approved of their plans), as would be conferred upon them by an Act of Parliament, viz., to purchase, under compulsory powers, plots of ground upon which houses unfit for habitation are found to exist, to pull such houses down, and to erect in their stead others fit for the occupation of the working classes, I believe that public companies would readily be formed, having for their object the building of suitable habitations for the labouring classes, and that the good results of the labours of such companies would soon become apparent, not only in the improved condition of the houses and localities of the poor, but in the improvement of the moral and physical condition of the people. The last scheme proposed for obtaining a better class of house accommodation for the working people—and it is the one which meets my views upon this subject—is to the following effect, viz., that the Legislature should invest the Home Secretary or the Privy Council with power to appoint a certain number of skilled medical men as inspectors who should be required 11 to inspect the unhealthy localities in each District, and to determine what houses are unfit for habitation; and, upon their report, the Home Secretary or the Privy Council, as the case may be, who shall appoint the inspectors, shall take the necessary steps, either to cause the owners to put such houses in a state fit for habitation, or to cause them to be demolished. But in every case in which the demolition of property is concerned a power of appeal to a court of law should be given. In order to render this plan effectual, it would be necessary to afford compulsory power of purchase to the local authority, who might either throw open to the public the plots of ground rendered vacant by the demolition of the houses thereon, or they might have the power of selling the ground. In order to prevent hardship or inconvenience to the poor inhabitants of such places, by dispossessing them of their homes, this plan must be carried out gradually, so that the poor residents might, without difficulty, find other houses, either in London or in its suburbs, as they now readily do when a multitude of houses are at one time demolished, for the carrying out of im provements, or for railway extensions. The hardship in dispossessing a large number of the persons who occupy these densely-crowded and unhealthy dwellings in the Metropolis, is not so great as it may appear to be, for the more hidden from public view, and the more unfit for habitation the places are, the more they are sought after by vagrants and thieves, who seek refuge in them, in order to carry on, without observation, their depredations upon the public. The numerous charitable institutions in London attract a large number of the idle and profligate class from the country, where the police are, perhaps, vigilant, and they take refuge in the infamous dens which exist in this vast Metropolis. The better class of artizans and labourers may be induced to reside a few miles from London, if they can obtain cheap railway conveyances ; but that is not the class who inhabit these wretched localities; and nothingshort of pulling such places down will benefit the public health, and so diminish pauperism. The condemning of houses which, upon competent authority, are considered as unfit for human habitation, cannot be an injury to any person, inasmuch as, a house unfit for habitation, ceases to be property, and, of course, the owner when called upon to close such house, is not entitled to compensation. The ground and the materials of the house will, of course^ be the property of the owner, which he may dispose of to his own advantage. As the law now stands, no compensation is given to a landlord when a magistrate, upon sufficient proof being given as to the unfitness of a house for habitation, orders the same to be closed, and the owners of all such houses may deem themselves as fortunate in not having to pay a 12 penalty for letting unwholesome houses. Many of the landlords of small house property fully uuderstand and practise the rights of ownership, but fail to carry out the duties which are enjoined upon them as owners. One of the errors of the existing laws, in relation to unhealthy houses, is the placing of the power of determining as to the unfitness of a house for habitation upon a single Medical Officer of Health; and so long as such power is intrusted to one man, the law will not be satisfactorily carried out; and there will always be great difficulty in inducing magistrates to order houses to be closed on the evidence of one witness; but if evidence were adduced, and supported by two or three competent Medical Officers, appointed by the government, as to the unfitness of houses for habitation, orders for the closing of such houses would more readily be made. A great deal of the worst class of house property is now in the hands of poor people; the richer class of owners, finding that property of this description occasioned them so much trouble and expense, have sold it, and the result has been that a poor class of persons have purchased it who are not able to fulfil the duties of ownership; who, when pressed to do the necessary work to render their property fit for habitation, plead their poverty, and so excite the sympathy of the public. But the plea of poverty is not allowed to prevail in mitigating the penalty incurred by persons selling or exposing for sale unwholesome food, although the injury to public health, arising from the eating of such food, is not nearly so great as the letting of houses unfit for habitation. In the one case, the injury is confined to the persons who eat the unwholesome food; but in the other, the injury to health by the propagation of fever, which is engendered in unhealthy houses, may extend over a large area, and attack a numerous population. In the latter case, the owner of the unhealthy house is liable to no penalty, while, in the former, the seller of unwholesome meat is liable, and very justly so, not only to a severe penalty, but to a term of imprisonment. Both parties are, in my opinion, equally guilty of a serious offence against the public health, and they ought to be made liable to similar punishments. As a proof that the existing laws relating to the closing or the pulling down of houses unfit for habitation require some amendment, in order that they may be better carried into effect, we find that, in London, where there are so many houses unfit for habitation, very few have either been closed or demolished ; and it is only in two or three Districts that the Artizans and Labourers Dwellings Act has been successfully, but only on a very limited scale, put in force. I am, Gentlemen, Your obedient Servant, JOHN LIDDLE. 15, Great Alie Street. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 1st October, 1870. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Cholera and Choleraic-Diarrhoea. Continued Fever, Typhus & Typhoid. Pyaemia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. Eheumatic Fever. Ague. Dysenteiy. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Dr. Swyer 23 16 10 8 193 3 18 0 9 0 0 46 23 0 17 1 0 3 1 723 1094 Mr. Champneys 5 27 4 8 122 0 20 0 6 0 0 36 2 0 0 0 6 0 0 438 674 Dr. Richardson 1 15 10 8 128 1 10 0 0 0 0 28 0 0 0 1 1 0 0 507 710 Mr. Sequiera 4 17 3 15 203 0 18 0 4 0 0 23 7 0 4 5 1 0 4 799 1107 Total 33 75 27 39 646 4 66 0 19 0 0 133 32 0 21 7 8 3 5 2467 3585 Corresponding Quarter of previous Year. 2 54 135 90 560 1 72 0 13 0 0 66 38 2 15 6 2 5 3 3328 3526 TABLE II. Ages at Death in each Registration District, for the Three Months ending 1st October, 1870. 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. Artilley 14 5 2 3 2 1 0. 27 Spitalfields 25 12 5 5 8 7 3 65 Mile E. N. Town 41 23 6 24 23 31 7 155 Workhouse. Whitechapel, N 18 12 3 5 7 7 1 53 Whitechapel Ch 21 16 24 53 62 27 2 205 Hospital. Goodman's Fields 27 9 3 5 6 2 0 52 Aldgate 16 11 2 12 6 4 1 52 Totals 162 88 45 107 124 79 14 609 It appears, on perusal of the above Table, that the rate of mortality of children under 5 years of age, in relation to the total deaths in the entire'District is 41.0 per cent. It varies, however, in the several sub-districts. Thus, in the Artillery sub-district, it is 70 0 per cent.; in the Whitechapel North, it is 56.6 per cent.; in the Goodman's Fields it is 69 2 per cent.; and in the Spitalfields it is 56-9 per cent. TABLE III. The Births and Deaths in each Registration District, for the Three Months ending on the 1st October, 1870. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M, F. Artilley 20 22 42 13. 14 27 15 0 Spitalfields 62 63 125 43. 22 65 60 0 Mile EndN. Town 74 76 150 76. 79 155 0 5 Workhouse. Whitechapel, N. 58 38 96 25. 28 53 43 0 WhitechplChurch 51 30 81 132. 73 205 0 124 London Hospital. Goodman's Fields 38 46 81 27 52 32 0 Aldgate 18 35 53 28. 24 52 1 0 110 Non-residents died in the London Hospital. Total 321 310 631 342 267 609 151 129 Excess of Births over Deaths, deducting the 110 non-residents, 132 Population in 1861, 78,970. Estimated Population in 1870, 76,000. table iv. Showing the Deaths from Epidemic Diseases, for the Three Months ending 1st October, 1870. Districts. Small-Pox. Measles. Scarlet-Fever. Diphtheria. HoopingCough. Diarrhoea. , Fever. Cholera &Choleraic-Diarha. Total. Remarks. Artillery 0 0 2 0 2 5 0 0 9 Spitalfields 2 2 2 0 1 9 1 2 19 Mile End New Town 4 2 2 0 2 21 5 3 39 Workhouse. Whitechapel, North 0 2 3 0 1 10 1 0 17 Whitechapel Church 0 1 2 1 1 5 2 0 12 Hospital. Goodman's Fields 0 0 1 0 2 16 0 1 20 Aldgate 0 0 1 0 3 12 1 0 17 Totals 6 7 13 1 12 78 10 6 133 Deaths from Epidemics for the corresponding Quarter, 1869. 0 17 82 1 39 72 17 3 231 TABLE V. Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 1st October, 1870. 0 and under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total Males, 32 Females, 34 Corresponding Quarter of 1869. Workhouse 9 1 1 12 13 25 5 66 63 London Hospital 1 11 18 52 50 26 1 Males, 112 123 Females, 47 159 BOARD OF Works, WHITECHAPEL DISTRICT. REPORT] on the Sanitarg Condition of the WHITECHAPEL DISTRICT, foe the QUARTER ENDING 31st DECEMBER, 1870, BY JOHN LIBDLF., medical officer of health. London: Printed by T. Penny & Co., 121, Leman Street, "Whitechapet, E. 1871, R E PORT of the MEDICAL OFFICER OF HEALTH, for the Quarter ending 31st December, 1870. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, December 31st, 1870, the births registered in the Whitechapel District were 670, viz., 331 males and 339 females. During the same period, the deaths have been 655 : of these, 368 have been of males and 287 of females. In the corresponding Quarter of the previous year, the births were 661 and the deaths 657. There lias been, therefore, an increase of 9 in the number of births, and a diminution of 2 in the number of deaths. The deaths in the London Hospital have been 155, viz., 98 males and 57 females. Of the total deaths in this institution, there were 21 of persons resident within the District, 96 of non-residents, and 38 of persons who died from the result of accident and from sudden death. The total mortality of this District is increased by the deaths of residents within the District which have occurred in other hospitals in the Metropolis; but of those I have no record. There were 7 deaths from epidemic diseases in the London Hospital, viz., 4 from scarlet fever, 2 from small pox, and 1 from diarrhoea. The deaths in the Workhouse have been 76, viz., 39 males and 37 females. There were 9 deaths from epidemic diseases in this establishment, viz., 5 from small pox and 4 from diarrhoea. Two deaths were caused by erysipelas. 4 The deaths from epidemic diseases in the entire District have been 124, viz., 50 from small pox, 5 from measles, 28 from scarlet fever, 10 from hooping cough, 12 from diarrhoea, and 19 from fever. The deaths from pyaemia were 10, from erysipelas 16, and from puerperal fever 1. Diseases of the tubercular class have been fatal to 106 persons, viz., 3 from scrofula, 15 from tabes mesenterica, 76 from consumption, and 12 from hydrocephalus. The proportion of deaths from this class of disease to the total deaths is 1C-1 percent. The proportion of deaths from epidemic diseases to the total deaths is 18*9 per cent. The deaths from diseases of the organs of circulation were 42, viz., 1 from aneurism, 1 from pericarditis, 1 from disease of the veins, 1 from anaemia, and 38 from disease of the heart. Two persons died from spinal meningitis. The deaths from diseases of the respiratory organs were 128, viz., 68 from bronchitis, 46 from pneumonia, 1 from spasm of the glottis, 2 from laryngismus, and 11 from other diseases of the lungs. The deaths from diseases of the urinary organs have been 16; of these, 5 were caused by nephria, or Bright's disease, 2 by diabetes, 2 by nephritis, and 7 from other diseases of the kidneys. Convulsions caused the deaths of 28 children; 12 children died from diseases of nutrition—atrophy and debility; 7 from teething, and 8 from premature birth. There were 5 deaths from syphilis; of these, 3 were of infants. The deaths from violence, including those fiom accidents, negligencc, aid from suicide, have been 45; of these, 8 were of children who were suffocated in bed, 6 of persons who were scalded or burnt, 1 death occurred from the inhalation of chloroform, 2 persons committed suicide, and a child three years of age, was poisoned " by eating root of German white bean by misadventure." The number of inquests has been 79; of these, 7 were held on persons who were killed by horses or vehicles in the streets. The total number of fatal street accidents, from horses or vehicles, registered in London during the year, is 198. In the corresponding Quarter of last year the number of inquests was 74. Uncertified Deaths. The uncertified deaths were 17; all of these are recorded in the subDistrict of Spitalfields. The deaths of children under 5 years of age have been 231. This is 35.2 per cent, of the total deaths. The deaths of persons above 80 years of age have been 8. 5 Pauper Illness in the District. The Medical Officers have attended 3523 new cases of illness out of the Workhouse, viz., 245 of small pox, 7 of measles, 19 of scarlet fever, 32 hooping cough, 107 of diarrhoea, 171 of fever, and 36 of erysipelas. In the corresponding Quarter of last year, the number of cases of pauper illness was 3853, including 56 of measles, 112 of scarlet fever, 54 of hooping cough, 212 of diarrhoea, 142 of fever, and 27 of erysipelas. Meteorology of Greenwich. The returns of the Registrar General show that the rain-fall in the Metropolis during the Quarter, has been 7'66 inches The total rain-fall (including melted snow) at Greenwich, during the month of December, was 3-1 inches, or 1-2 inches above the average. During the corresponding Quarter of the previous year, the rain-fall was 6.63 inches. The mean temperature of the air has been 41.8°. The coldest day during the Quarter was Sunday, the 25th December, when the thermometer indicated 9.8°, or 22.2 below the freezing point. In the corresponding Quarter of last year, the mean temperature of the air was 42.9°. "The total rain-fall during the year was 18-6 inches, showing a deficiency of 6-8 inches, as compared with the average fall during 54 previous years." lhe followmg lable, taken from the returns oi the Registrar-General, shows the comparative results during the Quarter:— LONDON. Oct. 8th Oct. 15th Oct. 22nd Oct. Nov. 29th 5th Nov. 12th Nov. Nov. 19th 26th Dec. 3rd Dec. 10th Dec. 17 th Dec. 24th Dec. 31st Deaths from Small Pox 27 13 17 21 23 40 45 41 60 61 44 82 110 Deaths from Scarlet Fever 192 198 192 167 174 150 162 122 130 116 135 104 110 Mean Tempera- ture of the air 54.1° 47.1° 49.7° 48.2° 41.1° 39.1° 37.6° 46.8° 38.9° 32.5° 42.8° 38.0° 25.7° Rain - fall in inches 0.20 0.14 1.38 1.16 0.47 0.04 0.18 0.95 0.01 0.84 1.70 0.17 0.42 Deaths in London 1279 1416 1331 1206 1343 1468 1639 1652 1482 1586 1737 1377 1760 Deaths in Whitechapel District 49 35 51 40 45 50 58 68 40 55 49 49 66 Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending 31st December, 1870:— Number of inspections of houses as shown in the official returns 4143 Houses systematically visited and the rooms measured to ascertain their cubic capacity 33 Houses specially visited at night 15 6 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each person, reckoning 2 children under 10 87 years of age for one adult, nuisance abated Number of cases of indecent occupation discovered 31 Houses specially visited 115 Ditto specially re-visited 460 Ditto registered by order of the Board 13 Certificates and copies of same prepared for the registration of the above houses 39 Number of special notices served for the registration of houses 24 Preliminary notices served, many of such notices embracing several houses 311 Compulsory orders issued embracing 75 premises 45 Summonses heard at police courts 2 Workshops specially visited 42 Ditto specially re-visited 2 7 Copies of the Workshops' Regulation Act distributed 47 Houses in which the rooms or passages have been whitewashed 304 Ventilation of houses improved 4 Yards of houses paved or the pavement repaired 127 Drains in houses unproved 119 Dustbins provided 23 Privies limewashed, cleansed, and repaired 139 Water-butts and cisterns provided or repaired 77 Water-waste preventers erected 11 Area gratings, cellar flaps, &c., repaired 6 Nuisances from dung and other offensive matter removed 12 The cow-houses iu the District, 24, and the slaughter-houses, 39 in number, have been visited during the Quarter. 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. Water Supply. The question of an improved system of water supply is now engaging public attention, and it is probable that in the course of the ensuing session it will receive due attention from Parliament. The most important point for discussion is how far it is advantageous and practicable to supply all the houses in London with water on the constant service, instead of the present system, which is partly on the constant and partly on the intermittent service. It has been most satisfactorily proved in this District, that the poorer class of houses can be supplied with water on the constant service, without the use of either butts or cisterns. There are now in this District 7 104 water-waste preventers, by means of which upwards of 7,000 poor people have a constant supply. Now, if so large a number of poor persons can be supplied by means of these machines, which are not so costly as either butts or cisterns, there is no reason why all the houses in the poor localities in London cannot be supplied in a similar manner; and as such a mode of supply is obviously so advantageous to the health, comfort, and well-being of the poor, it ought to be made compulsory upon landlords to adopt it. How far it would be desirable to extend the constant service to the whole community is a question well worthy of consideration. Some objections might, perhaps, be raised to its universal adoption by the owners or occupiers of those houses where the cistern is very large, and furnished with a filtering apparatus and other expensive appliances. The question, however, of making the constant supply compulsory, might, in particular instances, be left to the discretion of the local Board; but in all houses below a certain rental, the constant supply should bo enforced. Overcrowding. I have, on several occasions, directed the attention of the Board to the fact that overcrowding exists to a very great extent in this District; and no doubt the same evil prevails in most of the poor localities in London, but the fact cannot be fully known to the authorities of the District, unless the Sanitary Officers make night visits to those places where it is suspected that overcrowding exists. In a joint Report, dated December 1st, the Inspectors state "that they paid a midnight visit to the undermentioned registered houses, viz., No. 1, Old Rose Lane, No. 1, Castle Alley, and Nos. 5, 8, 9 and 10, Inkhorn Court. Nos. 8, 9 and 10, Inkhcrn Court were overcrowded, and indecently occupied. At No. 8, in room No. 6, registered for the occupation of four persons, three men, one woman, and four children were found. At No. 9, in room No. 1, registered for the occupation of three persons, two men, two women, and one child were found. In room No. 2, registered for the occupation of three persons, one man, two women, and two children were found. In room No. 3, registered for the occupation of three persons, one woman and her two adult sons were found. In room No. 5, registered for the occupation of two persons, two men and one woman were found. At No. 10, in room No. 1, registered for the occupation of three persons, two men, one woman, and one child were found. In room No. 2, registered for the occupation of three persons, three men, one woman, and one child were found; and in room No. 5, registered for the occupation of two persons, four men and two women were found. In each case the parties were in their beds. The smell arising from the filthy habits of the people living in these rooms was most offensive." 8 On the 15th December, the Inspectors further reported that they made two special night visits to the same houses in Inkhorn Court. They state that on the 9th instant, they found no abatement of the overcrowding or indecent occupation; but, on their visit last night (the 14th instant), at 11.30, and again at G a.m. the following morning, they found the overcrowding and indecent occupation abated, with the exception of two cases, viz., at No. 9, where in room No. 5, there were two men, one woman, and a child; and at No. 10, in room No. 2, there were one man, two women, and three children. The owner of the above-named houses, Mr. castleberg, upon being informed that the Board would institute proceedings against him for the infringement of their regulations respecting registered lodging houses, promised that, for the future, there should be no cause for complaint. It appears, from the Reports of the Inspectors, that Mr. castleberg is the owner of several houses in Castle Alley, as well as in Inkhorn Court, and that the parties occupying one set of rooms in one of these courts, when threatened with proceedings removed to the houses in the other court, and then, when discovered there, moved back to the houses in the court which they had just left. Registered Common Lodging Houses. My attention having recently been directed to a Report of the Chief Commissioner of Police of the Metropolis, which contained, inter alia, a statement respecting the general condition of the common lodging houses, I deemed it to be my duty, in my fortnightly statement, dated 24th Oct., 1870, to draw the attention of your Board to the following paragraph in the Report, and to make a few comments upon it. " In consequence of the prevalence of famine or relapsing fever during the past year, particularly in the Parishes of St. Giles-in-the-Fields, and Christ Church, Spitalfields, and other Districts of the Metropolis, which created considerable alarm, it was deemed expedient to make some alteration in the cubical space allowed for each lodger. Hitherto the space allotted did not, in some cases, exceed 200 cubical feet; the alteration adopted increased it to 300. In new houses, or houses to be re-opened, this is easily accomplished, but to alter the numbers (at a great pecuniary loss to the keepers) in the registered houses at first seemed an insurmountable difficulty. I am, however, gratified to state that out of 410 houses and rooms remeasured and re-apportioned, the new scale has been adopted without opposition." On inspecting some of the registered lodging houses, I found that out of the 93 rooms which have been recently measured by the Inspectors and myself, 53 had less than 300 cubic feet allotted for each lodger. In eleven of these rooms, the cubical space for each bed was respectively 206, 208, 212, 213, 218, 219, 224, 226, 227, and 234 feet. 9 I learn that great dissatisfaction exists among some of the lodging house keepers, in consequence of a distinction being made between the space allowed for each bed in the old and in the new lodging houses ; but I thought, on first reading the Report, that the increased space applied to all registered lodging houses indiscriminately; and surely such ought to have been the case; for, it is either necessary for health that 300 cubic feet be allotted for each bed, or it is unnecessary; and if such a space be necessary (as I hold it to be), it should surely be applied in all cases, whether it be in a new house or an old one. A discussion followed upon the reading of this Report, when several members freely expressed their opinions upon the subject, and it was unanimously resolved that, in the opinion of this Board, a space of 300 cubic feet, at least, should be allowed for each lodger admitted to the registered common lodging houses, both old and new, and that a communication be addressed to the Commissioner of Police, to urge that not less 300 cubic feet should be allowed to each such lodger. The pecuniary loss to the lodging house keepers, who allow a less space than 300 cubic feet to each bed, ought not to be considered, when the public health is concerned. From a circular letter of the Poor Law Board, dated 29th September, 1870, it appears that the Poor Law Board has adopted, as a general rule, the following scale, recommended by the "Cubic Space Committee," subject only to such modifications as the peculiar construction of wards sometimes demanded. Amount of space in dormitories# Sick 850 cubic feet. Lying-in woman 1200 do. Infirm persons occupying the same room day and night 700 do. Infirm persons able to leave their dor- mitories during the day 500 do. Healthy persons 300 do. For the last two classes day room accommodation is required, in addition to the amount of 500 and 300 cubic feet allotted to them as sleeping accommodation. The instructions given in this circular letter to the Poor Law Guardians are not strictly in accordance with the recommendations of Dr. E. Smith, the Poor Law Inspector, who not only advises for ordinary wards occupied by day and night a cubic space of 500 feet, but that the floor space be from 54 to GO feet, and 6 feet across the bed, and that the height of the ward be from 10 to 12 feet, and the space between the beds should not be less than 3 feet. Dr. E. Smitii further says "that a cubic space of 500 feet is far less useful in a room 14 feet high than in one 10 feet high; and it follows' that if the great height exists, a larger cubical space must be allowed. In a very lofty 10 room, unless the windows reach the ceiling, and remain open, the interchange of the higher stratum of air is incomparably less than that on the level of the doors. In the circular of the Poor Law Board above quoted, not a word is said about the ventilation of each ward, but reliance upon the healthy condition of each ward is placed entirely upon the cubical space allotted to each inmate, whereas, in Dr. Smith's suggestions, it is strongly insisted on that the ventilation must be efficient. The above-mentioned regulations respecting the cubic space to be allotted to each inmate of a workhouse, and the suggestions of Dr. E. Smith as regards floor space and ventilation, are highly important in determining the cubic space which is necessary to be allowed to each lodger in a registered common lodging house. Seizure of Bacon unfit fob the Food of Man. On September 3rd, the Inspector, from information received, accompanied by the Medical Officer of Health, visited the premises of a provision merchant in Royal Mint Street, and there found a large quantity of bacon (about 5 tons) exposed for sale in the shop, all of which, being unfit for the food of man, was seized and taken to the Thames Police Court, and on the following day the same was condemned by tho sitting magistrate as being unfit for the food of man. Tho bacon was then conveyed by the Inspector to the premises of a soap maker at King's Cross, and was there so destroyed by pouring carbolic acid over it, as to render it impossible to bo used for food. Small Pox. From the weekly returns of death by the Registrar General, and from tho weekly returns of sickness, which are furnished to the Guardians, by the Medical Officers of the Union, it is evident that small pox has prevailed during the last four months very extensively, and I believe to a greater extent than has been known since the formation of your Board. The returns of death from small pox for the Quarter ending on December 31st, 1870, have been 50, to which number we must add the two deaths which occurred among the patients who were sent from this District to the Small Pox Hospital. The largest number of deaths which has hitherto been registered in any Quarter in this District from small pox, since 1856, occurred in that ending 28th March, 18G3, when the number amounted to 31, and the cases attended by the Medical Officers of the Union were 103. The years when small pox has been epidemic, during the last 17 years, are 1854, 1855, and a portion of 1856, 1859,1863,1866, and the last five months of 1870; and the epidemic continues to the present time, 4th February, 1871, when, for each week since 11 December 30th, the number of deaths has been as follows: For the week ending on Saturday, the 7 th January, the deaths from small-pox in the Whitechapel District, were 3, and in the entire Metropolis 79. In the following week, the deaths in this District, and in the Metropolis, were respectively 6 and 135, in the week ending 21st January, they were respectively 8 and 188, in the week following they were 5 and 153, and in the week ending 4th February the deaths from small-pox were respectively 8 and 196. The cases returned by the Medical Officers of the Union for the same weeks, were 20, 33, 19, 30, and 32. The locality principally affected in this District, for the present Quarter, has been that which has been entrusted to the care of Dr. Swyer, and embraces the Northern and Western parts of Spitalfields Parish. The number of cases of small pox returned by Dr. wyer, for this Quarter, is 123, while in the four other Medical Districts, the number is 122, or only the half of the total cases. During the first two Quarters of the present year, not a single death was recorded in this District from small pox, and only 24 cases of the disease were recorded by the Medical Officers. As this disease is apt to recur periodically, it is clearly the duty of the several local authorities, at all times, to be prepared to meet the emergency. For this purpose, it will be necessary for the Guardians to have always ready for immediate use, an appropriate building, for the reception of cases of small pox; and the Medical Officers of the Union should have power to use it at discretion, and to compel persons suffering from this disease to be removed to it, or to any other hospital in London which may be appropriated for small pox cases. It seems to me most desirable, that whenever small pox, or any other contagious or infectious disease, is extensively prevalent in any District in London, the local authority of such infected District, should have power to apply, at their discretion, the 6th clause of the 18th and 19th Vic., c. 116, so that it might be empowered to provide for "the speedy interment of the dead, for house to house visitation, and for affording to persons afflicted by, or threatened with, such epidemic disease, such accommodation as may be required." As it is impossible thoroughly to disinfect a house unless all the inmates are removed therefrom, the Board of Works should always have at their immediate disposal a certain number of rooms, to which the tenants of any house in which cases of epidemic disease exists, might resort during the time required for the disinfection of those rooms in which any person or persons have been attacked with such disease. The clothing, bedding, and all articles likely to retain infection, should be at once removed in a covered vehicle set apart for the purpose, to a convenient place where a proper disinfecting apparatus has been erected; and, as there is not, in this District, a proper disinfecting apparatus, one should be immediately provided. 12 The bodies of all persons dying of small pox in any hospital or workhouse, should be buried direct from such establishments, and should not be given up to the friends of the deceased. as much mischief may arise by the friends bringing the body to their rooms in crowded neighbourhoods, and there keeping it for several days previous to interment. Great pains have been taken by the guardians of this District to promote the extension of vaccination, and to carry out the provisions of the Vaccination Act. The Guardians, soon after the Vaccination Act, 1867, came into operation, issued Notices, informing parents that they had not received certificates of the vaccination of their children, and intimating to such defaulting parents that legal proceedings would be taken against them for their neglect. If this Notice be not duly attended to, a second Notice is sent, requiring, within fourteen days, the children to be vaccinated' and a certificate of such vaccination transmitted to the Registrar, by. whom the birth of such child was registered, otherwise a summons will be issued requiring such parents' attendance, to answer a complaint which will be made to the Justices. Then in case of any parent not complying with the provisions of the Act, in not producing the children after vaccination to the Public Vaccinator for inspection, the penalty incurred by such neglect will be sought to be enforced; a final Notice being sent, intimating that, unless a reasonable excuse for such non-vaccination, and non-transmission of certificate of vaccination respectively, be forthwith rendered, a summons will bo issued, &c. In addition to these several Notices to the parents of children, who have not been duly reported as having been vaccinated, the Guardians have requested the Medical Officers of the Union to fill up a printed Form, duly stamped for transmission by post, and send it to the Clerk of the Board. In the Form required to be filled up, there is a column for the name and address of the person suffering from small pox, another for the names and ages of the members of the family of the patient, and for a statement whether the members of such family have been vaccinated or not, and for the number of cicatrices on each vaccinated person which were found on examination. The Guardians, in making known the provisions of the Act, and in enforcing the penalties for non-compliance therewith, have found that very many of the children in this District, had not been vaccinated. In order to induce all the poorer class of persons to take their children to the Public Vaccinator, it would be most desirable that no private practitioner should vaccinate gratuitously. But if medical practitioners will continue to vaccinate gratuitously, then it is clearly their duty to see that the operation has succeeded. For this purpose, every medical practitioner so vaccinating 13 should see the case on the eighth day after the operation has been performed, and, if successful, give to each patient a certificate to that effect. As many parents will not bring their children for inspection to a privato medical practitioner on the eighth day after vaccination, then, in all such cases, the patient ought to be seen by the vaccinator at the residence of the parents. Unless the patients are duly inspected after vaccination many cases of imperfect vaccination are likely to occur. I know from my own experience, that many children who have been vaccinated are not adequately protected from small pox. It is most satisfactory to find that the Privy Council has taken the very best course to obtain for all classes a more efficient way for their protection against small-pox by limiting the number of vaccinators so that an adequate supply of good lymph may be kept up for distribution to medical practitioners, who wish to vaccinate their private patients, and where persons, living in the district assigned to a public vaccinator, may take their children for vaccination, and there have the operation performed with lymph taken direct from the arm of a healthy child. It is, however, a question, and one well worthy of consideration, whether it would not be better to have two vaccine stations in a district so populous as that of Whitechapel, but if there should be two such stations there should be only one vaccinator, who should set apart two days instead of as at present only one, for the purpose of vaccinating the children residing in the district. It is also a question how far it might be desirable to appoint one vaccinator who should not be engaged in private practice, and pay him such a salary as would ensure to more than one Union, the entire services of an efficient officer. Such an arrangement would remove all feeling of jealousy so often expressed by medical men in respect to their patients being vaccinated by the public vaccinator, who, like themselves, is engaged in private practice. It is doubtless attended with inconvenience to many parents to carry their children any considerable distance from their homes for vaccination and for subsequent inspection. In order to meet the exigences of the present outbreak of small-pox the Guardians have provided a detached building for the reception of cases of this disease, and they have appointed an officer to visit the localities where small-pox prevails with a view of ascertaining whether all the children in the infected neighbourhoods have been vaccinated or otherwise, and of compelling the parents of unvaccinated children to have them forthwith vaccinated under the penalty of a prosecution. The two Inspectors to this Board likewise visit every house where a case of small-pox has occurred, and when practicable disinfect the rooms, and give such instructions as will tend to prevent the spreading of the disease ; and they are further required to take down the names of all "unvaccinated children in the localities they visit and transmit the same to the Clerk of the Guardians. 14 The action taken by the several local authorities in endeavouring to prevent the extension of disease daring the prevalence of an epidemic is no doubt very praiseworthy, but instead of their acting as it were spasmodically under the influence of fear, I would suggest that the carrying out of all the Sanitary Laws should be done systematically; and in all the districts in the Metropolis a similar mode of proceeding should be adopted, so that when an epidemic appears among a dense population all appliances to mitigate the severity of the outbreak should be in readiness. In carrying out regulations for the prevention of disease no distinction should be made between the rich and the poor; and as now, under the regulations of this Board, all keepers of lodging-houses registered under the Sanitary Act, 1866, are compelled, under a penalty of forty shillings, to give notice to the Board of the existence of any contagious or infectious disease, so should it be made compulsory upon the head of every family where either cholera, fever, small-pox, or scarlet-fever exists in the house, to give notice of the same to the Medical Officer of Health of the District, so that the said Medical Officer might not only be made acquainted with the locality of every case of epidemic disease, but might have the opportunity of conferring with the medical attendant of the particular case. It is hardly necessary to say that if such a plan is carried out the Medical Officer of Health should not be in private practice. For many reasons, which need not be specified here, it would be desirable to restrict from private practice the medical officers of all the Metropolitan Unions. The following observations, marked by inverted commas, were published in my Quarterly Report for April, 1859:— "When small-pox prevails, no age appears to be exempt from its ravages; for the infant of a week old, and the very aged, have not escaped its fatal influence. The prejudice against vaccination is generally strongly manifested in a poor neighbourhood, whenever a child has suffered from an eruptive disease after vaccination. The eruption, whether syphilitic, eczematous, or of any other kind common to children at the time of teething, is always attributed to vaccination, and the surgeon is erroneously blamed for using 'foul anil dirty matter.' Now every medical man knows that children at all ages are liable to eruptive diseases, and that syphilis does not always manifest itself on the child at birth, but many weeks frequently elapse before the peculiar eruption appears; and when it happens that a child, whose constitution from birth is tainted with syphilis, has been vaccinated, the parents, although they themselves are alone to blame for the diseased condition of their offspring, take the opportunity of casting the blame on vaccination. It may be satisfactory to know that no other disease than the cow-pox can be communicated from one child to another by the operation of vaccination if the lymph be taken from a true Jennerian vesicle: I may therefore boldly affirm, that the assertions of parents interested in concealing their own 15 shame, that their children have been inoculated with other diseases at the time of vaccination, are incorrect." This opinion is fully confirmed in the evidence adduced by Mr. Simon in his last Annual Report to the Lords of Her Majesty's Most Honorable Privy Council, from which evidence it appears that no other disease, except the vaccine disease, can be communicated by vaccination, not even in cases where the lymph is taken from a child suffering from syphilis, or other constitutional disease. Such evidence is, in my opinion, incontrovertible. "That the operation of the Vaccination Acts has not been attended with the beneficial result which the public had anticipated, is obvious from the following facts:— 1. That many children, above four months old, are unvaccinated, and die of small pox, as is shown by the returns of the local Registrars of the District. 2. That many children die of small pox after vaccination, as is shown in the returns of the Small Pox Hospital. The records of this valuable institution, the only hospital exclusively devoted to small pox in Europe, inform us that, out of 5,797 patients admitted from 1836 to 1851 inclusive, 3,094 or 53 per cent., were after vaccination; and since that period, as might have been anticipated, from the great increase in tho number vaccinated, the per centage is much larger, amounting now to about 72 per cent. 3. That, from a Table, kindly given to me by Mr. Pare, the Clerk to the Guardians of the Union, it appears that out of 2,783 registered births, only 1,824 or 65.5 per cent., were successfully vaccinated by tho Public Vaccinators; of which number 225 were above 12 months old. Although considerable allowance must be made for the children who die in early infancy, and for the cases which are vaccinated by private practitioners, and at the public vaccine institutions, still, there arc a great many in this District who are not vaccinated. Universal vaccination, if properly performed, would be, in the concurrent opinion of the most experienced medical men, a great and lasting benefit, both to the state and to every family; and hence the great necessity for the operation being performed in such a manner as will render the patient, if not entirely free from an attack of small pox, at all events, exempt from its fatal influence.* From the most extensive statistical returns of the Small Pox Hospital, carefully prepared by Mr. Makson, the Resident Medical Officer, it appears * Cows have been inoculated with small pox, and with the matter taken from the resulting vesicles of these animals, children have been vaccinated. Tho process, therefore, of preventing small pox by vaccination, is really only carrying people through small pox in a modified form. "The vaccinated are safe against small pox, because they in fact have had it." 16 that the mortality from small pox in the unvaccinatcd, of cases taken generally, is 35 per cent., but of children under 5 years of age, it is 50 per cent. The natural small pox may be said to destroy one-third of all whom it attacks. On the contrary, the mortality among the vaccinated attacked with small pox, is only 7 per cent., taken generally; but among what may be characterised as the badly vaccinated, it is 15 per cent. The danger, therefore, arising from an attack of small pox, may be said to be chiefly determined by the badness or insufficiency of vaccination. Such being the case, it is impossible to estimate too highly the importance of properly performing vaccination in infancy. A careless vaccination cannot be too strongly deprecated, for, 'by such a proceeding, the vaccination takes effect badly, and will never afterwards take effect properly, and yet the individual may take small pox severely.' The minutest particulars in the performance of the operation should bo regarded; for not only is the credit of the vaccinator concerned, but the lives of the people, and the pecuniary interests of the ratepayers are involved in the success of the operation. It further appears, from the elaborate Tables of Mr. Maeson, that the mortality in those who are attacked with small pox, after vaccination, but having only one good cicatrix, is 4¼ per ccnt.; in those having an indifferent cicatrix, it is 12 per cent.; in those with two good cicatrices, is 2¼ per cent.; with indifferent cicatrices, 7¼ per cent.; in those with three good cicatrices, it is 1½ per cent.; with indifferent cicatrices, 2¼ per cent.; and in those patients who have four good cicatrices, the mortality is under 1 per cent.; and from more recent returns, out of 353 patients admitted into the Small Pox Hospital, having four or more vaccine cicatrices, one only has died of Small Pox." In Dr. Bkidges's Report, dated 17th January, 1871, the mortality from small pox among the patients who had been vaccinated, without specifying the number of cicatrices in each case, was 4 per cent., and among the unvaccinated, the mortality was 32 per cent. With regard to the value of vaccination, as a protection to the fatal results of small pox, these statistics, the Doctor says, need no comment. It is satisfactory for me to be able to state, from my own experience, and upon the authority of Dr. Dyte, the Medical Officer to the Board of Guardians to the Jewish poor, that vaccination is almost universally practised among the Jews, and, at the present time, the practice has been attended with the most happy results, for, out of 56 cases of small pox occurring to the Jewish poor, which have been attended by Dr. Dyte, only one ended fatally. The present epidemic of small pox commenced in this District about the latter end of August, when three cases were returned in the Spitalfields Medical District. For the fortnight ending October 1st, the cases returned in the entire District were 8, and the deaths from small pox in the Metropolis 17 were 28. In the previous fortnight the deaths in London from small pox were 23. During the first sis months of the year 1870, no deaths from small pox were registered in this District, and only 24 cases were attended by the Medical Officers of the Union, 12 of which were attended by care of Dr. Swyer. The disease had been epidemic in Paris for several months, where vaccination is very much neglected, before it appeared in this country, so that, having had due warning of its probable approach, we ought to have been better prepared to protect the inhabitants of London from its deadly effects. The great question, however, which concerns us is how to render the population more secure against the fatality of this disease, both in the present time and in the future. For this purpose, it will be necessary for the several local boards to adopt such measures without delay as will ensure the vaccination of the unvaccinated, and then to seek to obtain such alterations in the existing laws, relating not only to vaccination, but to the Act relating to the registration of births, so that hereafter we may be able to obtain the vaccination of every child who may survive its third month. As this is a question of such vast importance, and of such difficulty, I have sought the assistance of my friend Mr. Vallance, the Clerk to the Board of Guardians, who has had a very large experience in the practical working of the Vaccination Act, and in reply to my request, Mr. Vallance, in the subjoined Letter, has expressed his views upon the defects in the existing Acts of Parliament relating to vaccination, and has made extremely valuable suggestions for the amendment of those Acts. "Whilst, however, your Board is making arrangements to mitigate the sufferings occasioned by the present epidemic of small pox, and to arrest its progress, it may be desirable to ascertain, from the statistical returns of the Registrar General, the duration of the preceding epidemics of this disease. From these returns', it appears that the epidemic of small pox, which commenced in 1838, continued for about 14 months; that in 1844, about 14 months; that in 1848, about 16 months; that in 1852, about 19 months; that in 1855, about 29 months; that in 1859, about 26 months; and that in 1866, about 28 months. As the present epidemic has manifested greater severity, both in the number of cases and in the mortality, than in any of the preceding epidemics, during the last 40 years, it may be expected that it will continue its ravages for a longer period than any of the preceding visitations. My Deak Sir, The interesting discussion to which 1 had the privilege of listening by your kind invitation at the Scottish Hospital on Saturday evening, upon a paper read by Dr. Barnes, suggests to me the possibility that I may be able to offer to you in writing a few practical observations upon the working of the Vaccination Act of 1867 which may prove not entirely valueless, especially in view of the adjournment of the discussion. 18 Beyond the clause in the Act which makes vaccination compulsory in the case of children born after the passing thereof, the paramount object of the various provisions is of course to secure its general and efficient application. The question thus naturally arises how far the Vaccination Act has been successful in this direction. The Act has been passed upwards of three years and yet small-pox prevails to an alarming extent. It is of little avail to point to certain model communities or districts and insist that the operation of the Act has there been to stamp out smallpox. Circumstances alter cases, and so do localities. The supervision and procedure which may have been entirely successful in one locality may have entirely failed in another. In one we may find a settled, thrifty, population, in another a sad admixture of the migratory "ne'er-do-we'el" classes, occupants of single rooms, here today and gone, no one knows whither, to-morrow, whilst perhaps an Anti-vaccination League is in active operation scattering broadcast its opinions and prejudices, and creating difficulties in the enforcement of the Act. It is equally unavailing to stigmatize Boards of Guardians as "obstructives" and to assume that the presence of small-pox in a district is unimpeachable evidence of the Vaccination Act not having been efficiently worked. Whilst the compulsory requirement of the vaccination of all children born after the passing of the Act will be generally admitted to have been a step in the right direction it should not be taken for granted that society, composed of all ages and conditions of people, will thereby, and at once, be exempted from the terrible scourge of small-pox. If this desirable end is to be attained by vaccination it can only be by an universal application of a compulsory Act to every individual, adult as well as child ; but this the Vaccination Act does not even attempt. In regard to infantine vaccination, I am of opinion that the Act of 1867 and its machinery are seriously defective. In the first place much too long a period is allowed to elapse before a case is brought under supervision. In many instances nine or ten months elapse before the case comes under the notice of the Guardians under sec. 10, and long before that time parents and child have probably migrated elsewhere, leaving no trace behind them. A large proportion of the returned " defaulters'' in this district will be found to come within this category. Next, no legal means arc provided for securing information of unvaccinated children. Sec. 31 does indeed provide that the registrar or other officer may give information to a justice where ho has reason to believe that a child under fourteen years of age is unvaccinated, but it is not stated how the informant is to become "informed," and excessive zeal in this direction would very likely lead to the unceremonious treatment not uncommon to the "public informer." I will only further advert, without detail or comment, to the difficulties which in some districts have already presented themselves upon its being sought to enforce the Vaccination Act before justices. It should moreover bo borne in mind that the half-yearly lists of "defaulters" under sec. 16 extends only to children whose births have been duly registered, and there is too much reason to conclude that a large proportion of the births in this country are not registered at all, and consequently never come directly under the notice of the vaccination authorities. This is unquestionably true to a very largo extent in many of the metropolitan districts. That the Vaccination Act of 1867 is not sufficiently comprehensive and its machinery simple and perfect will, I think, scarcely bo questioned, and it remains to be considered in what direction a remedy should be sought. First, I am strongly of opinion that the registration of births should be made compulsory, that medical practitioners, midwives, or nurses, in attendance at a birth should be required within three days to give notice to the Registrar of the District, 19 and, further, that in lieu of the present three-paged form of "Notice of Requirement of Vaccination" (so mystifying to parents and vexatious to medical men) a "Birth Certificate " in some such a form as the following should be adopted :— District of Goodman's Fields. Bk. No. (17.) Entry No. (475.) This is to Certify that the birth of Eleanor the daughter of Edward and Mary Barnes, at 100, Leman Street, Whitechapel, on the Fourth day of December, 1870, was this day registered by me. Dated this Tenth day of December, 1870. Richard Grace, Registrar. (Impressed Seal.) The above-named child has been successfully vaccinated by me. Dated this 12th day of January, 1871. Chas. T. Blackman, Registered Practitioner. This joint certificate should be on parchment and should be handed to the parent of every child upon registration of birth without fee or reward, and I have no hesitation in saying that such a document would be appreciated by the poor and ignorant equally with the rich and educated. Indeed its universal adoption would be to render its possession indispensable. An instance of the value attached to such a document came under my notice only a day or two since. I was receiving a "Notice of Marriage" between two parties, natives of Holland, and to enable me correctly to spell their names, birth-papers, almost identical in form to the above, (minus certificate of vaccination), one 26 and the other 22 years old, were handed to me, and the careful preservation of the documents attested the importance with which they were regarded. Once compulsory registration of birth is established there will be little difficulty in attaching to the Certificate a simple form of Certificate of Vaccination and requiring the same to be registered by the Registrar as at present. The adoption of such a Certificate of Birth and Vaccination would unquestionably lead to the authorities of schools, public [institutions, clubs, insurance offices, and employers of labour requiring its production upon all reasonable occasions, and indeed, with the Elementary Education Act in force the production of such Certificate might with great public advantage be made compulsory in governmental schools. Provision would, of course, be necessary for the replacement of certificates lost or destroyed. It should further be provided that the production of such certificate (or vaccination certificate only whore there is no birth certificate) should alone be an answer to any information before justices under the Vaccination Act; whilst encouragement might be given to all persons born since the passing of the Registration Act (1836) to obtain such joint certificate of birth and vaccination. But, in any event, whether adult or child, and whether registered or not, every person should be required to be vaccinated and to hold and produce, when called upon, a certificate thereof, such certificate to be obtainable under proper regulations, upon inspection by the public vaccinator of the district whether the vaccination bo of recent date or not. As to the machinery, I am of opinion that it is inexpedient and unnecessary to require the intermediary action of Boards of Guardians or their Officers at all. I think it would be found far more effective if the Registrars of Births and Deaths were in all cases appointed the Officers to enforce the provisions of the Act, with an adequate fee upon the registration of every certificate of successful primary vaccination. In this way we should have the compulsory registration of birth and the compulsory vaccination of every child carried out upon one uniform system and by one officer, whilst the certificate of registration and vaccination would form one 20 document. It would of course be necessary to give the Registrar power to require the production of Certificate of Vaccination from all persons resident within his district; the legal responsibility in regard to obtaining such certificate to be cast upon every adult and the parent of every child. The proposals thus shadowed forth are merely prospective. It remains to be suggested, as of the utmost importance at the present time when small-pox prevails to an alarming extent, that during periods of epidemic the Poor Law Medical Officers of infected districts should be appointed supplementary Vaccinators and empowered to make a house-to-house visitation for the purpose of then and there vaccinating all unvaccinated children over three months old, or where this is considered undesirable the public vaccinator should, at all events, be authorised to make such visitation as far as practicable. This would be far more effective than a similar course of visitation by a prosecuting officer now being carried out in many districts. To briefly recapitulate the foregoing suggestions it is, in my opinion, essential that there should be 1. Compulsory registration op birth; 2. Gratuitous issue of birth and vaccination certificate (see Form above); 3. Provision for replacing lost certificates ; 4. A legal responsibility cast upon every adult and the parents of every child in regard to possession of certificate; 6. No valid answer to any information before justices but the production oe certificate; 6. Means provided for inspection of every person duly vaccinated, but holding no certificate, and for grant of certificate by public vaccinator; 7. Compulsory requirement of production of certificate upon admission of children into Schools under Elementary Education Act; 8. Authority to Registrars of Births to require production of Certificate; 9. But one Officer to enforce the provisions of the Vaccination Act in a registration district and that the Registrar himself; 10. Remuneration of Registrar by fee upon registration of each case of primary vaccination (whether birth registered by him or not); and 11. House-to-house medical visitation, for purposes of vaccination, in infected localities during periods of epidemic. I must apologise for the length to which this letter has extended, but the importance which you have been pleased to attach to some of the foregoing suggestions verbally made by me in the course of recent conferences upon the subject, must be my justification. I am, my dear Sir, Yours very faithfully, Whitechapel. W. VALLANCE. Jan. 21,1871. The suggestions contained in the above letter are of a very practical character, and I hope that they will meet with the attention they deserve from all persons who are interested in the promotion of the public health, and especially from those who may have the framing of an amended Vaccination Act. One of the most important of these suggestions is perhaps that which relates to the providing for the freest communication between the 21 registrar of births and deaths and the public vaccinator. It certainly would be sound economy on the part of the local authorities so to pay the registrar of births as to induce him to take such steps as will compel the parents to obtain vaccination for all the children which arc registered at his office. That the Act of 1867 requires amendment is obvious to all who have been engaged in the practical working of its several provisions. In the first place the 16th clause which requires a child to be vaccinated within three months of its birth is so worded as to lead to different interpretations of its meaning; secondly, the working of the 31st clause is attended with so much trouble and difficulty that it will under the present arrangements be seldom acted on; and thirdly, the 8th clause which relates to the payment for revaccination is very unsatisfactory, for there is the same amount of trouble in revaccinating as in vaccinating a child for the first time, yet the payment for such revaccination is only two-thirds of the amount paid for the first vaccination. Again, there is no provision made in the Act for the public vaccinator to examine the children in the public schools and vaccinate all such children who have not been, in his opinion, satisfactorily vaccinated. Moreover the numerous notices, forms, and certificates which are required to be filled up are so long, and to the uninformed so complicated, that they are not properly attended to. Again, the amount of writing which is demanded from the public vaccinator in filling up his vaccination books (one of these books consisting of sixteen columns, all of which must be filled up for every person vaccinated) is a needless encroachment on his time. Further, under existing circumstances, when all the children requiring vaccination must be brought to the public station, and the vaccinator is prohibited from vaccinating children at the residences of their parents, the payment per case for each successful vaccination is faulty in the extreme, inasmuch as it offers an inducement to the public vaccinator to vaccinate all children registered in the District whether they be fit subjects for the operation or not; and it may happen that children suffering from hereditary syphilis or from other skin diseases, or from febrile disorders may be vaccinated whereby unsatisfactory results are obtained. If it should be determined to pay the public vaccinator a fixed salary, he should be appointed by the Government, and he should be required to submit to the Privy Council his reports in such form and as often as the Medical Officer of the Privy Council may require. The importance of making the registration of births compulsory in England as it is in Scotland and in Ireland is now generally insisted on. Under the present law relative to the registration of births, very many births are not registered, and for this reason it will be a very difficult matter to enforce the Vaccination Act as regards infants. ANNUAL REPORT. The number of births registered in this District, during the year 1870, has been 2690, and the number of deaths 2465. The births in 1869 were 2571, and the deaths 2675. The births, therefore, are in excess of those in 1869 by 119, and the deaths are less by 210. The return of births and deaths for this year is therefore more satisfactory. The deaths in the "Workhouse have been 342 against 328 for the previous year, and the deaths in the London Hospital 599 against 504. If the population of this District be rightly estimated at about 70,000, which is nearly 3000 less than when the census was taken in 1861, the rate of mortality has been, during this year, 32.4 per 1000, or 1 in 30.6 of all living. In making a comparison, however, of the rate of mortality of this District, with that of others, the deaths in the London Hospital must bo eliminated, which this year amount to 599. Deducting, therefore, the deaths in this institution, from the total deaths, the rate of mortality is 24'6 per 1000, or 1 in 40.7 of all living. For the previous year, the rate of mortality in this District, was 35.0 per 1000, or 1 in 28.5 of all living, and, on deducting the deaths in the London Hospital, the rate of mortality was 28.3 per 1000, or 1 in 35 of the population. Pauper Illness in the District. The number of out-door sick paupers who have been attended by the Medical Officers of the Union, has been 14,148. Although it appears from Table VI., that the sick paupers are still very numerous, yet, I have the satisfaction to remark, that during the last year the number has diminished to the extent of more than 3000. This large number, however, of sick paupers, the same being 18.6 per cent. of the total population, need not surprise us when the condition of the houses in most of the poor localities and the extreme poverty of the people arc considered. In my last Report, I pointed out the unfitness for habitation of many of the dwellings of the poor in this District, and I pointed out what I conceived to be the best mode of remedying the evil, premising that a stop must be put, by legislative enactment, in the form of a new Building Act, to the further erection of houses unfit for habitation. Nevertheless, much might bo done by local Boards, with the powers intrusted to them by the existing Sanitary Acts. The most important of these Acts, in enabling local Boards to get houses unfit for habitation demolished, is the Artizans' and Labourers' Dwellings' Act, which was passed in 1867, and although its provisions are of a mandatory character, they have not been put in force by your Board; 23 and, notwithstanding the power that is given to any four householders, living in or near to any street, to put in action your Board, by stating in writing to the Officer of Health, that in or near that street, any premises are in a condition unfit for habitation, yet no letter has been addressed to me upon that subject by any of the inhabitants of this District. The fault of allowing the several important provisions of the Sanitary Act, 1866, to be disregarded, does not altogether lie with the local Boards, and especially with those who have jurisdiction in such crowded Districts as that of Whitechapel, where very few square yards of space are to be found. The framers of the Act have required certain provisions to be made for the protection of the public health, but they have not caused to be inserted in the Act such clauses as will enable the local authorities to obtain the possession of land by compulsory purchase, whereon to erect the required buildings, for the purposes specified by the Act. Unless such powers be given for the purchase of land, for the purposes required, it will bo almost impossible for local Boards to obtain suitable sites for the carrying into effect the requirements of the Sanitary Act. Let these powers be granted, and local Boards will have no difficulty in carrying out the most important of the provisions of the Sanitary Act. These buildings, which I consider absolutely necessary for the protection of the public health, are—1st, A mortuary for the reception of the dead when the bodies cannot be retained in rooms, which are occupied day and night with the relatives or friends of the deceased. 2nd, A proper disinfecting apparatus for the disinfection of clothes, bedding, &c., belonging to and used by persons who have suffered from any contagious disease. 3rd, A carriage for the conveyance of persons, not aupers, afflicted with contagious disease to the public hospitals set apart for such patients. 4th, A. post mortem room, furnished with everything necessary, to enable the Surgeon to make such an examination of a body as will enable him to speak with confidence as to the cause of death. The nuisance and inconvenience occasioned to poor families, where a post mortem examination is conducted in their only room, are so great, that a proper place for such examinations should be provided. Besides, it is almost impossible to make a post mortem examination properly, unless the room is light and well ventilated. A building of sufficient height might be erected in this district, and the same might be so arranged as to contain all the rooms required for the abovementioned purposes, under the same roof. It is further necessary, for the health of the District, that a hospital be provided for the reception and treatment of such persons, not paupers, residing in the District, who are suffering from contagious disease, so that, by the removal of such patients to a hospital, the number of the centres of contagion may be diminished. Lastly, it is important that a house of refuge bo provided to receive the healthy inmates of a house in which persons arc suffering from a contagious disease, and where they can remain until the infected house has been subjected to a process of thorough disinfection. 24 As regards the building of a hospital for contagious diseases, the expense would be most materially diminished, if two or three Districts were to combine and agree upon the suitable place for such purpose. To enable the public to derive the utmost possible benefit from the carrying into effect of the sanitary provisions of the several Acts relating to health, London must be treated as one District, so that a uniform mode of proceeding may bo adopted in every District, as regards the lighting, paving, and cleansing of the streets, the inspection of the houses, and other sanitary work, and the keeping of a uniform system of accounts. Sanitary Works Performer during the year 1870. The following return shows the amount of work done by the Sanitary Inspectors during the year 1870. Number of inspections of houses as shown in the official returns 17,475 Houses systematically visited and the rooms measured to ascertain their cubic capacity 106 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each person, reckoning 2 children under 10 years of age for one adult, nuisance in each case abated 98 Number of cases of indecent occupation discovered 94 Houses specially re-visited 3334 Ditto registered by the order of the Board 33 Certificates and copies prepared for the registration of the above houses 109 Number of special notices served for the registration of houses 192 Preliminary notices served many of such notices embracing several houses 1682 Compulsory orders issued embracing 447 premises 202 Summonses heard at police courts 12 "Workshops specially visited 74 Ditto overcrowded, orders for abatement given 8 Ditto specially re-visited 64 Copies of the Workshops' Regulation Act distributed 71 Houses in which the rooms or passages have been whitewashed 1105 Ventilation of houses improved 6 Yards of houses paved or the pavement re-paved 659 Cesspools abolished 22 Drains in houses improved 645 Dust bins provided 328 Privies limewashed, cleansed and repaired 657 Water-butts and cisterns provided or repaired 554 Water-waste preventers erected 22 Area gratings, cellar flaps, &c., repaired 39 Cellars used as dwellings discontinued for such use 39 Instances where corpses were kept in inhabited rooms for prolonged periods so as to be a nuisances 4 25 Animals, so kept as to be a nuisance, removed 27 Nuisances from Dung and other offensive matter removed 57 Trades nuisances abate 4 The cow-houses in the District, 24, and the slaughter-houses, 38, in number, have been visited four times during the year. The bake-houses (83 in number) have been twice specially visited during the same period. I have the honour to be, Gentlemen, Your most obedient Servant, JOHN LIDDLE 15, Great Alre Street. 4th Feb., 1871. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Tooks of the Medical Officers of the Union, for the Three Months ending on the 31st December, 1870. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhœa. Cholera and Choleraic-Diarrhœa. Continued Fever, Typhus & Typhoid. Diphtheria. 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 123 1 1 9 14 0 17 0 11 0 0 50 30 0 11 1 0 0 0 387 655 Mr. Champneys 38 2 6 7 23 0 38 0 13 0 0 135 2 0 3 2 0 0 0 722 991 Dr. Richardson 17 2 8 10 41 0 37 0 3 0 0 87 3 0 12 2 2 0 1 600 825 Mr. Sequiera 13 2 3 1 19 0 16 1 6 0 0 46 5 1 10 0 0 0 3 320 446 Mr. Loane 54 0 1 5 10 0 63 0 3 0 0 98 34 0 2 1 0 0 0 335 606 Total 245 7 19 32 107 0 171 1 36 0 0 416 74 1 38 6 2 0 4 2364 3523 Corresponding Quarter of previous Year. 0 56 112 54 212 0 142 0 27 0 . 0 227 82 2 46 7 4 3 3 2876 3853 TABLE II. Showing the Deaths from Epidemic Diseases, for the Three Months ending 31st December, 1870. Districts. Small-Pox. Measles. Scarlet-Fever Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera. Total. Remarks. Artillery 4 0 3 0 1 0 0 0 8 Spitalfields 18 0 5 0 2 4 2 0 31 Mile End New Town 10 2 11 0 4 4 9 0 40 Workhouse. Whitechapel, North 1 0 1 0 1 1 3 0 7 Whitechapel Church 3 0 4 0 1 1 3 0 12 Hospital. Goodman's Fields 2 1 2 0 0 1 1 0 7 Aldgate 12 2 2 0 1 1 1 0 19 Totals 50 5 23 0 10 12 19 0 124 Deaths from Epidemics for the corresponding Quarter, 1869. 0 24 62 2 24 15 11 1 139 Six patients suffering from small pox have been sent to the hospital under the management of the Metropolitan Asylum Board, of which two died, thus making the deaths from small pox 52. TABLE III. The Births and Deaths in each Registration District, for the Three Months ending on the 31st December, 1870. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M. F. Artillery 31 23 54 21 15 36 18 0 Spitalfields 60 67 127 45 46 91 36 0 Mile End N.Town 76 78 154 95 76 171 0 17 Workhouse. Whitechapel, N. 52 51 103 31 21 52 51 0 WhitechplChurch 37 43 80 115 81 196 0 116 London Hospital. Goodman's Fields 46 42 88 29 22 51 37 0 96 Non-residents Aldgate 29 35 64 32 20 58 6 0 died in the London Hospital. Totals 331 339 670 368 287 655 148 133 Excess of Births over Deaths, deducting the 96 non-residents, 111 Population in 1861, 78,970. Estimated Popultion in 1870, 76,000 TABLE IV. Ages at Death in each Registration District, for the Three Months ending 31st December, 1870. Districts. 0 and under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and. under 80. 80 and upwards. Total. Remarks. Artillery 8 7 5 2 9 4 1 36 Spitalfields 14 32 14 6 14 10 1 91 Mile E. N. Town 36 28 10 20 33 32 3 171 Workhouse. Whitechapel, N 16 10 1 8 10 6 1 52 Whitechapel Ch 11 11 26 69 55 22 2 196 Hospital. Goodman's Fields 19 7 4 1 9 11 0 51 Aldgate 14 18 8 5 8 5 0 58 Totals 118 113 68 120 138 90 8 655 TABLE V. Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 31st December, 1870. 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 Corresponding Quarter of 1869 Males, 39 Females, 37 Workhouse 9 0 2 13 21 28 76 75 London Hospital 1 7 22 60 45 20 0 Males, 97 120 Females, 58 155 TABLE VI. Total number of the undermentioned Diseases, recorded in the Books of the Medical Officers of the Union, from 1860 to 1870, and the total cases of illness. Year. Small-Pox. Measles. Scarlatina. H ooping-Cough. Diarrhoea and Dysentery. Fever. Cholera and Choleraic-Diarrhoea. Erysipelas. Puerperal Fever. Carbuncle. Bronchitis and Catarrh. Pneumonia and Pleuritis. 1 Croup. Rheumatic Fever. Ague. Delirium Tremens. Total Cases. 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 21 182 156 217 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 02 ... 7 546 244 7 66 12 13 16502 1867 254 155 60 219 1471 308 5 65 1 5 642 228 5 183 10 10 17181 1868 93 523 54 144 1626 586 8 80 2 5 450 208 3 157 18 10 17417 1869 5 212 311 308 1033 385 1 75 1 6 632 258 1 100 35 11 14031 1870 302 257 97 140 1118 325 4 82 0 1 825 195 0 134 44 5 14148 In the Annual Report for the last year, the following note was appended:— "On perusing the above Table, it will be seen, that the cases of illness among the pauper population had been annually increasing from 1860 to 1868, and, on referring to my Reports for the years 1857 and 1858, I find that the cases of illness, which were attended by the Medical Officers of the Union, were 10,708 and 11,718 respectively, while in 1856 they were only 9897. The great annual increase, as is shown in the above returns, cannot be ex plained jon the supposition that there has been an increase of the population, for the census returns show that the population of this District, so far from having increased, is less by two or three thousand than it was in 1857." The number of cases of illness among the pauper population has, for this year, again slightly increased. Table VII. Showing the Births, Deaths, Deaths of Non-residents, Deaths in the London Hospital and in the Workhouse, in each Year, from 1857 to 1870. 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(53week) 2796 2764 181 418 324 1864 2803 2792 212 453 414 1865 2684 2532 208 416 362 1866 2561 3495 432 733 413 1867 2686 2331 241 445 331 1868 2611 2519 324 536 376 1869 (53 weeks) 2571 2675 283 504 328 1870 2690 2465 374 599 342 The The number of inquests which have been held this year in this District has been 311. In the year I860 the number was 256. TABLE VIII. Showing the Deaths from Epidemic Diseases in the Whitechapel District during the last 15 years. Name of Disease 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 Small 31 3 4 60 21 28 33 69 5 22 44 40 11 1 50 Measles 12 60 78 31 81 27 153 26 137 28 139 33 69 71 36 Scarlet Fever & Diphtheria 45 43 87 96 59 70 91 200 50 80 76 26 48 208 59 Hooping Cough 64 89 117 50 49 98 62 52 74 97 94 72 55 113 50 Diarrhœa 81 139 108 141 67 101 69 114 109 122 119 100 138 97 107 Fever 188 117 104 93 69 65 250 158 170 167 100 82 1C9 95 52 Cholera & Choleraic-Diaha. 0 10 6 5 1 4 5 5 2 4 904 9 10 7 6 Totals 421 461 504 476 347 393 663 714 547 520 1476 362 440 592 366 London [Fever 2674 2203 1902 1796 1302 1754 3635 2802 3689 3232 2681 2174 2483 2211 2049 Searlta. & Diph. 1795 1587 4118 4197 2457 3058 4194 5799 3806 2614 2316 1830 3418 6162 6306 Small Pox 522 154 247 1156 877 215 345 2012 537 646 1388 1339 600 273 958 *The year 1868, in the returns for London, comprises 371 days. In the Whitechapel District, the year 1869 comprises 371 days. TABLE IX. Showing the cases of Epidemic Diseases among the pauper population in the Whitechapel District during the last 15 years. Name of Disease 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 Small Pox 115 20 212 65 86 113 253 21 86 261 254 93 5 302 Measles 71 266 427 179 520 70 525 80 482 51 679 155 323 212 257 Scarlet Fever & Diphtheria 105 49 146 175 93 109 118 305 156 164 197 60 54 311 97 Hooping Cough 98 150 230 146 83 388 153 169 217 280 217 219 144 308 140 Diarrhœa 898 1324 946 209 773 1418 1085 1108 1127 1342 1664 1471 1631 1033 1097 Fever 1929 1441 590 411 190 109 822 464 295 573 343 308 586 385 325 Cholera & Choleraic-Diaha. 0 16 0 1 1 0 1 1 4 4 58 5 8 1 4 Totals 2216 3252 2359 1363 1725 2180 2817 2380 2302 2500 3419 2469 2839 2255 2222