WHI 19 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE Sanitarg condition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 1ST APRIL, 1871, BY JOHN LILDLE, MEDICAL OFFICER OF HEALTH. London: Printed By T. Penny & Co., 121, Leman Street, Whitechapel, E. 1871. REPORT of the MEDICAL OFFICER OF HEALTH, for the Quarter ending April, 1871. To the Board of Works, Whitechapel District, Gentlemen, In the Quarter that ended on Saturday, April 1st, 1871, the deaths registered in the Whitechapel District were 665, viz., 363 males and 302 females, During the same period, the births have been 747: of these, 382 have been of males and 365 of females. In the corresponding Quarter of the previous year, the births were 725 and the deaths 616. The deaths in the London Hospital have been 143, viz., 100 males and 43 females. Of the total deaths in this institution, there were 22 of persons resident within the District, 82 of non-residents, and 39 of persons who died from the result of accident and from sudden death. Five deaths from pyaemia, 1 from small-pox, and 1 from hooping-cough (a woman 31 years of age) occurred in this institution. The deaths in the Workhouse have been 93, viz., 42 males and 51 females. There were 13 deaths from epidemic diseases in this establishment, all of which were from small pox. Three deaths were caused by erysipelas. 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 130. Small-pox occasioned 83 deaths, measles 4, scarlet-fever 8, hooping-cough 16, diarrhcea 8, and fever 11. 4 In the corresponding quarter of the previous year, the deaths from epidemic diseases were 43, viz., 12 from measles, 8 from scarlet-fever, 2 from diphtheria, 8 from hooping-cough, 5 from diarrhoea, and 8 from fever. The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 116; of these, 69 were caused by bronchitis, 41 by pneumonia, 2 by laryngismus, 2 by spasm of the glottis, 1 by pleuritis, and 1 by asthma. Consumption was fatal to 75 persons, The deaths from other tubercular diseases were 35, viz., 15 from mesenteric disease, 4 from tubercular meningitis, 12 from hydrocephalus or water on the brain, and 4 from scrofula. Diseases of the organs of circulation were fatal to 43 persons; of these, 34 died from disease of the heart, 3 from aneurism, 1 from disease of the veins, 3 from anæmia, and 2 from pericarditis. The deaths from diseases of the urinary organs were 22; of these, 13 were caused by nephria or Bright's disease, 2 by diabetes, 3 by nephritis, 1 by disease of the bladder, and 3 by other diseases of the urinary organs. Convulsions caused the deaths of 23 children. There were 7 deaths from premature birth, 5 from teething, and 21 from atrophy and debility. The deaths from syphilis were 3; of these, one was that of a child under 1 year of age. Purpura was fatal to 2 persons, and 3 died from privation. The deaths of 22 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. There were 33 deaths from mechanical violence,; of these, 9 were caused by horses and vehicles in the streets. Burns and scalds were fatal to 10 persons. Two persons were accidentally drowned. One was poisoned by drinking raw spirits. One person died from hemorrhage from swallowing accidentally a fish-bone. Six children were suffocated in bed, and 3 died from shock produced by drinking hot water from a tea kettle. The number of inquests has been 98. In the corresponding quarter of last year the number was 80. The number of deaths which have not been certified by a medical practitioner has been 17; of these, 14 were recorded in the Spitalfield's sub-district. The mortality of children under five years of ago was 252. This is 37.8 per cent. of the total mortality. In the corresponding quarter of the previous year the rate of mortality of children under 5 was 31.3 per cent. of the total mortality. In the Artillery sub-district the rate is 35.3 per cent.; in the Spitalfields, 60.9 per cent.; in the Mile End New Town, 37.2 per cent.; in the Whitechapel North, 44 per cent.; in the Whitechapel Church, 21.3 per cent.; in the Goodman's Fields, 60.0 per cent.; and in the Aldgate 51.9 per cent. 5 Pauper Illness in the District. The Medical Officers of the Union have attended, during the last quarter, 3688 new cases of illness out of the "Workhouse, including 352 of small-pox, 15 of measles, 4 of scarlet-fever, 50 of hooping-cough, 97 of diarrhoea, 82 of fever, and 24 of erysipelas. In the corresponding quarter of the previous year, the number of pauper cases of illness was 3047, including 3 of smallpox, 34 of measles, 27 of scarlet-fever, 32 of hooping-cough, 109 of diarrhoea, 61 of fever, 2 of diphtheria, and 18 of erysipelas. Meteorology of Greenwich. The Returns of the Registrar-General show that the rain-fall in the Metropolis during the quarter has been 4.21 inches. During tho corresponding quarter of last year the rain-fall was 3.97 inches. The mean temperature of the air was 40.0°. In the corresponding quarter of last year the mean temperature was 36.8°. The coldest days during the quarter were Friday, the 13th January, Sunday, the 1st January, and Monday, the 2nd January, when the thermometer indicated respectively 18.3°, 19.2°, and 24.0°. In tho corresponding quarter of the previous year the greatest degree of cold was on Friday, the 18th February, when the thermometer indicated 19.4°. In the week ending January 21st, the rain-fall was 1.32 inches. The following Table, taken from the returns of the Registrar-General, shows the comparative results of the Quarter:— LONDON. Jan. 7th Jan. 14th Jan. 21st Jan. 28th Feb. 4th Feb. 11th Feb. 18th Feb. 25th Mar. 4th Mar. 11th Mar. 18 th Mar. 25th Apr. 1st Deaths from Small Pox 79 135 188 157 19G 211 218 227 213 194 185 205 192 Deaths from Scar- let Fever 112 77 68 66 49 46 48 47 53 54 33 36 33 Mean Tempera- ture of the air 31·1° 33·0° 37·1° 32·4° 34·9° 41·6° 42·7° 43·8° 45·7° 46·3° 41·7° 47·1° 43·8° Rain-fall in inches 0.07 0.08 1.32 0.54 0.19 0.72 0 02 0.06 0.11 0.47 0.58 0.02 0.03 Deaths in London- 1828 1896 184G 1632 1G33 1749 1625 1G33 1591 1601 1576 1665 1564 Deaths in Whitechapel District 55 64 56 60 40 71 55 63 61 55 54 62 51 Deaths in ditto from Small-pox 3 4 8 5 8 10 9 11 6 4 5 7 3 Water Supply. Since my last quarterly report was issued a Bill to amend the Metropolis Water Act of 1852, and to make further provision for the duo supply of water, has been introduced into the House of Commons. Although this Bill contains some very valuable provisions—especially those which require the Companies to provide under certain regulations a constant supply of water, which is to be of a certain standard as to purity, and to appoint an analyst who shall be required to test the quality of the water supplied by each Company by a daily analysis and see that it is 6 up to the required standard—yet the Bill appears to me in some respects objectionable, inasmuch as it does not propose entirely to repeal all the existing Acts relating to tho supply of water to the Metropolis, but purposes to repeal only certain clauses of the Metropolis Water Act (1852). This "patchwork" mode of legislation is attended with great inconvenience, for it not only entails upon the several parties who are appointed to carry out the provisions of the new Act the trouble of consulting all the Acts relating to tho subject, but it renders it almost impossible for tho general public to know the powers of the Companies on the one hand and their own rights and privileges on the other. In the framing of a new Act, all the important clauses of the existing Acts should be therein incorporated and the old Acts entirely repealed. The Metropolis "Water Bill now before the House appears to me to be objectionable so far as it does not propose to repeal the several clauses of " The Waterworks Clauses Act, 1847," relating to the cutting off of the supply of water from any inhabited house because the water-rate has not been paid. Any power short of that of cutting off the supply ought to be given to water companies to obtain payment for the water rate, but as a proper supply of water for domestic use is not only requisite for individual health' but is absolutely necessary for public health, the power of stopping the supply ought not to be given to a public company. In order to compel the supply of water to every house, and to protect the Companies from loss by persons obtaining water surreptitiously, it should be enacted that every house not adequately supplied with water should be deemed a nuisance. Tho sanitary officers of a district would then be enabled to take summary proceedings against the owner of any inhabited house which was not adequately supplied with water. It has been suggested that the local Board should have power in certain cases in poor neighbourhoods to contract with the Water Companies for a supply of water, and that the local Board should have the same power over the owners of such property so supplied with water for tho payment of the water-rate as the parish officers now have for the enforcement of the parochial rates. This arrangement would enable the local Board to insist upon any particular part of their district being supplied in a uniform manner upon the constant service system. Water-Waste-Preventers. During the quarter 25 additional water-waste-preventers have been erected. There arc now in this District 129 of these waste-preventers in use among the poor, who thereby obtain a constant supply of water direct from the main without the intervention of either butts or cisterns. Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending 1st April, 1871:— 7 Number of inspections of houses as shown in the official returns 4275 Houses systematically visited and the rooms measured to ascertain their cubic capacity 32 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each person, reckoning 2 children under 10 11 years of age for one adult; nuisance in each case abated Number of cases of indecent occupation discovered 10 Houses specially visited 454 Ditto specially re-visited 908 Ditto registered by order of the Board 18 Certificates and copies of same prepared for the registration of the above houses 36 Number of special notices served for the registration of houses 60 Preliminary notices served, many of such notices embracing several houses 477 Compulsory orders issued embracing 98 premises 37 Summonses heard at police courts 3 Workshops specially visited 15 Ditto specially re-visited 21 Copies of the Workshops' Regulation Act distributed 17 Houses in which the rooms or passages have been whitewashed 281 Rooms disinfected with sulphurous acid gas after the occurrence of 41 small-pox therein, Ventilation of houses improved 15 Yards of houses paved or the pavement repaired 71 Drains in houses improved 102 Dust bins provided 17 Privies limewashed, cleansed, and repaired 141 Water-butts and cisterns provided or repaired 34 Water-waste preventers erected 25 Area gratings, cellar flaps, &c., repaired 4 Nuisances from dung and other offensive matter removed 11 Cesspools abolished 1 The cow-houses in the District, 24, the slaughter-houses, 39, and the Bakehouses, 83, 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. Small-Pox. In my Report for the Quarter ending 31st December, 1870, I drew attention to the desirability of having a proper disinfecting apparatus erected in this District where clothing, bedding, and all articles likely to retain infection should be at once removed and submitted to a temperature of 250°; which amount of heat, according to a Memorandum on Disinfection prepared by Mr. Simon, the Medical Officer of the Privy Council, and published in 8 1866, is said to bo sufficient for the disinfection of woollens, bedding, or clothing, if such articles arc exposed for two or more hours in chambers constructed for the purpose to a temperature of F. 210°—250°. In Dr. Letheby's Report on the Sanitary Condition of the City of London, and published in 1860, it is stated that the plan recommended by the Medical Officers of Health for the Metropolis, after a careful consideration of the subject, for the disinfection of woollen fabrics is to submit such articles to a dry heat of 250 degrees Farenheit. Boiling water is supposed to be sufficient for destroying the contagium in linen articles. A disinfecting apparatus invented and patented by Messrs. Fraser Brothers, of Bromley, Middlesex, and recommended to the Board by Dr. Stevens, one of the Medical Officers of the Privy Council, has recently been erected, and is now in operation. Any inhabitant of the District can have, free of expense, infected clothing, &c., disinfected, upon giving information to the Sanitary Officers of the Board. In the same Report I also drew attention to the several arrangements made by the Guardians of the Whitechapel Union for arresting the progress of small-pox; one of which was, that the Medical Officers of the Union should be requested to fill up a printed form and transmit the same daily to the Clerk of the Board of Guardians. The following table shows the results of the information obtained by the Medical Officers during the months of January, February, and March: Districts and Medical Officers. No of Case of SmallPox reported. No. of such cases found to have been "Vaccinated. No. of such cases found not to have been Vaccinated. No. of members of Families(exclusive of Patient) reportd. No. of such Members found to have been Vaccinated. Not Vaccinated. Had Small-Pox. 1. Spitalfields, Dr. Swyer 27 12 15 106 102 1 3 2. Mile End, Mr. Champneys Not reported. 3. Goodmn's Fids, Mr. Sequeira 30 24 6 136 123 5 8 4. Whitechapel, Dr. Richardson 78 52 26 207 186 14 7 5 Aldgate, Mr. Loane 29 16 13 26 23 3 0 Total 164 104 60 475 434 23 18 Still further to bring the population under the influence of vaccination, the Guardians appointed the Medical Officers of the Union to institute in their respective districts a house-to-house visitation—in addition to the Officer (who was not a medical practitioner) whom they had appointed when the small-pox had assumed an epidemic form—for the purpose of making inquiry respecting the vaccination or otherwise of all persons living in the vicinity of those cases of small-pox which were under the care of the Medical Officers of the Union. 9 The result of the inquiries made by this Officer has been that 3671 persons had been vaccinated and 126 not vaccinated. Upon the latter, notices were served by the Clerk of the Board of Guardians, and their Officer subsequently reported that 56 of that number had been vaccinated. Of the remainder some are pending, others have not yet been ascertained, and several have removed. The Medical Officers, in the return of their house-to-house visitation, have reported 204 instances of non-vaccination. As the report was made direct to Mr. Blackman, the public vaccinator, it is presumed that all these cases were duly vaccinated by him. Mr. Blackman has successfully performed in the six weeks ending March last, 871 primary and 1179 secondary vaccinations, and has unsuccessfully performed 8 primary and 38 secondary vaccinations. Tho following table, showing the number of cases of small-pox admitted into the wards erected in the Stone Yard by the Guardians, has been kindly prepared for me by Mr. Ilott, the Resident Medical Officer of the Workhouse. Cases of Small-Pox admitted into the Temporary Wards under the care of Mr. Ilott, the Resident Medical Officer of the Workhouse. date. Number of Admissions. date. Number of Admissions. January 1 8 Feby. 11 17 „ 14 G ,, 13 10 „ 21 13 „ 25 16 „ 21 9 March 4 20 „ 28 6 „ 11 8 Februy. 21 „ 18 6 „ 25 19 From the above return it appears that the total number of cases of small-pox admitted in 13 weeks was 150; of these, 81 were sent to the Homerton Asylum Board Hospital, and 69 were treated in the wards in the Stone Yard. Of the 69 patients treated in these wards 13 died; of these, 10 were unvaccinated and 3 vaccinated. Of the 150 cases admitted into the Small-Pox Ward, the Medical Officer states that 114 had been vaccinated, and 36 unvaccinated. According to the report of Dr. Munk and Mr. Marson, the Medical Officers of the Small-Pox Hospital at Highgate, the present epidemic commenced in November, 1869, when in that month 51 cases were admitted into the Hospital as small-pox; in December the number admitted was 52; and in each succeeding month the cases admitted were respectively 79, 66, 73, 83, 112, 112 113, 89, 108, 144, 159, 178: total in the year 1870, 1,316. Of these, however, 31 were not cases of small-pox, thereby reducing the number of small-pox cases to 1,285, of these 962, or 74.8 per cent. had been vaccinated, and 322, or 25.0 per cent. unvaccinated. Of the 962 vaccinated cases 76 died, 10 giving a mortality of 7.9 per cent.; whilst of the unvaccinated cases, 124 died, being a mortality of 38.5 per cent. The general mortality, for the year 1870, in the Small-Pox Hospital, has been 15.4 per cent. The mortality amongst the unvaccinated children, under the age of 10 years, was as high as 42 per cent. The Medical Officers of the Small-Pox Hospital further state, that "not a single fact has occurred within our experience during the past year to shake our confidence in vaccination, when properly performed;" but, they add, that "vaccination is an operation of considerable delicacy, and requires much care, in order to secure the advantageous results it is capable of imparting. The failures of vaccination to prevent fatal small-pox, which have occurred, are almost all of them due to the careless and imperfect manner in which it has been practised." The Medical Officers conclude their very valuable annual report in the following words: "We believe that re-vaccination, extensively practised, and with the same precautions to ensure efficiency as ought to he observed in primary vaccinations, will prove to be the most ccrtain mode that could be adopted of checking the present epidemic of small-pox" The present epidemic, as stated in my last report, did not commence in this district until August last, a period of about nine months after the date of the commencement of the epidemic, as is shown in the number of admissions into the Small-Pox Hospital. As the disease does not at present show any signs of abatement, it is impossible to form an accurate judgment as to the length of time the epidemic may continue. It therefore follows that our efforts to check the spreading of the disease must not be relaxed. But in a large and closely-confined population, such as is found to exist in this district, the difficulties in adopting efficient measures to prevent the communication of the disease from one person to another are such as to be almost insurmountable. Thus we found, on a house-to-house inspection, a case of small-pox in a room occupied by several persons engaged in making coats and other woollen garments; in other rooms cases of small-pox have been found, where persons were engaged in sack-making; and in one case, the Inspector saw the sacks lying on the bed, in which a child was lying with small-pox in a confluent form. Again, the bodies of persons who have died of small-pox in a public institution, have been removed to rooms occupied as sleeping rooms by the relatives of the deceased. From this last mentioned cause small-pox appears to have extended to several of the adjacent houses. Further, we have no power to compel the removal of patients to a hospital, not even in the case where parents neglect their young children, by leaving them in a room accessible to all the other inmates of a house, under the charge of an elder child. A case of this kind occurred in the attic room of No. 33, Royal Mint Street, where the parents were said to get drunk daily, and who had left two of their children suffering from small-pox in the charge of a boy about 10 years of age. Then, again, the clothes and 11 ding which have been used by persons suffering from small-pox, are sometimes sent to be washed in the same court where the disease was prevailing, or to a neighbouring court, without such clothes having been previously disinfected; although, by the 38th section of the Sanitary Act, the sending away, without proper precaution, of infected clothes or bedding, renders persons so doing liable to a penalty; but nevertheless clothes, &c., are repeatedly so sent to be washed, the majority of the poor people being ignorant of the law. Many persons having small-pox are often seen walking in the streets. It is to be hoped that some useful lessons will be learnt from this severe epidemic of small-pox, so that more preparation may be made to combat the disease on the occasion of another epidemic, and that the admission of patients to the Asylum Board Hospitals will not be attended with the same unwise restriction which has prevailed at the Homerton Hospital; whereby some patients who were sent from the Whitechapel Union Workhouse were refused admission into that Hospital, because the Medical Officer of the Union Workhouse had not sent with the patients the particulars of the cases, according to a prescribed form kept only at the Hospital. These patients, on their return to the Workhouse, having been provided with a form by the hospital authorities were immediately sent back to the Hospital, with the form duly filled up, when they were admitted. This piece of red-tapism unnecessarily inflicted a double journey upon these unfortunate patients. It is most desirable that better regulations should be formed in these hospitals for the admission of patients than have hitherto prevailed, and that the anxiety of the friends of patients should be appeased to the utmost, by affording speedy information to them respecting the dangerous condition or death of the patients. If a new act for the prevention of the spreading of epidemic diseases be passed during this session, among other things it should enact, that whenever a case of small-pox, scarlet fever, fever, or cholera, should occur in any house, whether such house be occupied by a poor or a rich person, information of the same should be sent to the Medical Officer of Health of the District. On perusing the table of mortality from epidemic diseases, it will bo seen that the deaths from small-pox in this district, for the quarter, have been 83, to which there must be added the 12 deaths which have occurred in the Small-Pox Hospitals of persons who had been removed thereto from this district; thus making the deaths from this disease 95, or 14.2 per cent. of the total mortality, which is at the annual rate of 5.0 per 1000 of the entire population. Large as is the mortality in this district from small-pox, it is very small as compared with the mortality at Rotterdam and the Hague during the same period. The population of Rotterdam is 121,017, and the deaths from small-pox have been 985, which is a mortality at the annual rate of 31.7 per 1000 of the population ; and in the Hague, which has a population of 92,021, the deaths from Small-pox have been 952, or a mortality at the annual rate of 41.2 per 1000. In both these cities vaccination is much 12 neglected. In London, during the same period, the deaths from small-pox have been 2,410, which gives a mortality at the annual rate of 3.0 per 1000. The following return from Holland, which is published by the Registrar General, in his weekly return of deaths, shows still further the severity of small-pox in Holland during January last. "In Rotterdam, of 605 deaths, showing an annual death-rate of 59 per 1000, 205 were fatal cases of smallpox ; in Utrecht the 365 deaths included 162 from small-pox, and gave a deathrate of 72 per 1000; and in the Hague, of 646 deaths, 392 resulted from small-pox, and the annual death-rate in the month was equal to 83 per 1000 of the population." The subjoined remarks of the Registrar General, upon tho relative mortality of small-pox in different ages are important:—"Thus, the mortality under 5 years of age was, in the week ending 11th February, at the annual rate of 10.7 per 1000 ; in young persons of 5 and under 20, it was 3.2; in persons of the age of 20-40 it was 2.7; in men and women of 40-60 it was 0.8; and after 60 the rate was nominal. This has an important bearing on the question, docs the protective power of vaccination wear out with time ? The danger of dying from small-pox diminishes rapidly as age advances, which could not be the case if the effect of vaccination wore out with time. The facts of the ten years, 1851-60, over all England, bear out this deduction." Artizans' anb Labourers' Dwellings Act. On the 13th March last, I reported to the Board that the six houses comprised in a Court called Black Horse Court, situated in George Street, Spitalfields, were unfit for habitation, and that they could not be so altered as to render them fit for that purpose. This opinion was confirmed by the the report of the Surveyor, and a copy of cach of the reports was sent to the owner, who attended tho Board on the subject, when he frankly admitted that the houses in Black Horse Court belonged to him, and that they were unfit for human habitation. Tho owner requested the Board to allow him a a few weeks time, in order to enable him to get rid of the tenants, when he would take the houses down, and use the ground for the purpose of improving some of his adjacent property. This request was granted, and the case was allowed to stand over. The owner of four houses, comprising a Court called Avenue Place, situated in White's Row, Spitalfields, was summoned under the provisions of the Nuisances' Removal Act, to close the said houses, the same being unfit for human habitation. After the hearing of the case, the Magistrate made the order upon the owner to close the houses. I have the honour to be, Gentlemen, Your most obedient Servant, JOHN LIDDLE. 15, Great Alie Sheet. APPENDIX. TABLE I.-Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 1st April, 1871. 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 75 1 3 3 17 0 16 0 3 0 0 56 30 1 13 0 0 0 0 386 604 Mr. Champneys 117 4 1 15 21 0 21 0 7 0 1 174 3 0 2 2 0 0 2 650 1020 Dr. Richardson 82 5 0 22 3G 0 13 0 2 0 0 93 1 1 9 1 0 1 6 675 947 Mr. Sequeira 33 5 0 10 13 0 22 0 4 0 0 68 21 0 3 0 1 0 2 437 599 Mr. Loane 45 0 0 0 10 0 30 0 8 0 0 132 26 0 1 8 0 0 0 258 518 Total 352 15 4 50 97 0 82 0 24 0 1 523 81 2 28 11 1 1 10 2406 3688 Corresponding Quarter of previous Year. 3 34 27 32 109 0 61 2 18 0 0 177 41 0 37 6 8 1 1 3090 3647 Five cases of Small-pox in this District have have attended by Mr. Lepingwell, the Resident Medical Officer of the Eastern Dispensary, and 49 cases have been reported to me by 6 private Medical Practitioners. Six persons having Small-pox presented themselves for admission at the London Hospital, were sent, as far as could be ascertained, to their respective Parishes. Twenty-five cases of Small-pox occurred in the Registered Common Lodging Houses. TABLE II. Showing the Deaths from Epidemic Diseases, for the Three Months ending 1st April, 1871. Districts. Small-Pox. Measles. Scarlet-Fever. Diphtheria. HoopingCough. Diarrhœa. Fever. Total. ks. Artillery 6 0 2 0 1 0 0 9 Workhouse. Spitalfields 13 1 2 0 1 3 1 21 Mile End New Town 39 1 2 0 3 1 1 47 Whitechapel, North 9 1 0 0 4 0 4 18 Whitechapel Church 3 1 1 0 2 0 0 7 Hospital. Goodman's Fields 7 0 0 0 4 2 4 17 Aldgate 6 0 1 0 1 2 1 11 Totals 83 4 8 0 16 8 11 130 Deaths from Epidemics for the corresponding Quarter, 1870. 0 12 8 2 8 5 8 43 Five Cases of Pyaemia occurred in the Whitechapel Church sub-District. Of the 83 Deaths from Small-pox, 15 were recorded as having occurred in persons who had been vaccinated, 29 in persons who had not been vaccinated, and in 39 instances there is no record as regards vaccination. TABLE III. Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 1st April, 1871. 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 1870. Males, 42 Females, 51 8 4 10 17 19 32 3 93 115 London Hospital 3 7 14 61 41 17 0 Males, 100 128 Females, 43 143 TABLE IV. Ages at Death in each Registration District, for the Three Months ending 1st April, 1871. Districts. 0 and under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total. Remarks. Artillery 7 5 4 4 4 9 1 34 Workhouse. Spitalfields 28 25 4 12 5 12 1 87 Mile E. N. Town 36 30 18 26 28 34 5 177 Whitechapel, N 19 11 6 9 12 8 3 68 Whitechapel Ch 13 14 17 63 41 22 0 173 Hospital. Goodman's Fields 21 16 6 9 13 8 1 74 Aldgate 11 18 5 6 9 5 0 52 Totals 135 117 60 129 115 98 11 665 TABLE V. The Births and Deaths in each Registration District, for the Three Months ending on the 1st April, 1871. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks Artillery M. F. M. F. Workhouse. 26 29 55 1 17 34 21 0 Spitalfields 82 71 153 47 40 87 66 0 Mile End N. Town 92 78 170 88 89 177 0 7 Whitechapel, N. 55 65 120 32 36 68 52 0 WhitechplChurch 43 35 78 115 58 173 0 95 London Hospital. Goodman's Fields 47 60 107 41 33 74. 33 0 82 Non-residents died in the London Hospital. Aldgate 37 27 64 23 29 52 12 0 Totals 382 365 747 363 302 665 184 104 Excess of Births over Deaths, deducting the 82 non-residents, 164 Population in 1861, 78,970. Estimated Population in 1870, 76,000. BOARD OF WORKS WHITECHAPEL DISTRICT. REPORT ON THE Sanitarg Condition OF THE WHITECHAPEL DISTRICT, FOE THE QUARTER ENDING 1ST JULY, 1871, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH London: Printed by T. Penny & Co., 121, Leman Street, Whitechapel, E. 1871. REPORT of the MEDICAL OFFICER OF HEALTH, for the Quarter ending 1st July, 1871. To the Board Of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, July 1st, 1871, the births registered in the Whitechapel District were 569, viz., 280 males and 289 females. During the same period, the deaths have been 557: of these, 313 have been of males and 244 of females. In the corresponding Quarter of the previous year, the births were 664 and the deaths 585. There has been, therefore, a decrease of 95 in the number of births, and a decrease of 28 in the number of deaths. The deaths in the London Hospital have been 126, viz., 93 males and 33 females. Of the total deaths in this institution, there were 10 of persons resident within the District, 82 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 no deaths from epidemic diseases in the London Hospital during this Quarter. The deaths in the Workhouse have been 77, viz., 45 males and 32 females. There were 4 deaths from epidemic diseases in this establishment, all of which were from small pox. The deaths from epidemic diseases in the entire District have been 85; viz., 42 from small-pox, 14 from measles, 1 from scarlet-fever, 11 from hooping-cough, 8 from diarrhoea, and 9 from fever. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 66; viz., 12 from measles, 6 from scarlet-fever, 1 from diphtheria, 20 from hooping-cough (of these, 1 was that of a man 43 years of age), 12 from diarrhoea, and 15 from fever. The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 82: of these, 37 were caused by bronchitis, 34 by pneumonia, 1 by laryngismus, 1 by laryngitis, 2 by spasm of the glottis, 1 by pleuritis, and 6 by asthma. 4 The deaths from tubercular diseases were 110; viz., 21 from mesenteric disease, 2 from tubercular meningitis, 10 from hydrocephalus, or water on the brain, 2 from scrofula, and 75 from consumption. Diseases of the organs of circulution were fatal to 34 persons; of these, 32 died from disease of the heart, 1 from aneurism, and 1 from pericarditis. The deaths from diseases of the urinary organs were 14; of these, 6 were caused by nephria or Bright's disease, 1 by diabetes, 3 by nephritis, 1 by vesico vaginal fistula, and 3 by other diseases of the urinary organs. Convulsions caused the deaths of 21 children. There were 4 deaths from premature birth, 8 from teething, and 14 from atrophy and debility. The deaths from syphilis were 2: of these, one was that of a child under 1 year of age. Purpura was fatal to 2 persons, 1 died from privation, 1 from want of breast milk, 3 from intemperance, and 1 from lead-poisoning. The deaths of 24 persons are attributed to old age: of these 10 were above 80 years of age ; two of these reached the advanced age of 94. There were 24 deaths from mechanical violence: of these, 3 were caused by horses and vehicles in the streets. Burns and scalds were fatal to 6 persons. Two persons were accidentally drowned. One died from the effects of chloroform. Seven children were suffocated in bed. Four persons committed suicide. The number of inquests has been 73. In the corresponding Quarter of last year the number was 88. Uncertifien Deaths. The number of deaths which have not been certified by a medical practitioner has been 7. The mortality of children under 5 years of age was 211. This is 36.0 per cent. of the total mortality. In the corresponding Quarter of the previous year the rate of mortality of children under 5 was 34.7 per cent. of the total mortality. In the Artillery sub-District, the rate is 40.0 per cent.; in the Spitalfields, 51.8 per cent.; in the Mile End New Town, 49.6 per cent.; in the Whitechapel, North, 56T per cent.; in the Whitechapel Church, 12.5 per cent.; in the Goodman's Fields, 54.0 per cent.; and in the Aldgate, 46.8 per cent. Pauper Illness in the Disteict. The Medical Officers of the Union have attended, during the last Quarter, 2,657 new cases of illness out of the Workhouse, including 174 of small-pox, 101 of measles, 8 of scarlet-fever, 28 of hooping-cough, 83 of diarrhoea, 29 of fever, and 14 of erysipelas. In the corresponding 5 Quarter of the previous year, the number of pauper cases of illness was 3393, 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. The number of cases of pauper illness has greatly diminished during this Quarter. Whether this diminution is owing to the new arrangements, whereby all the pauper patients, who are capable of leaving their homes, are required to attend at the Workhouse, where they are seen and prescribed for by the Medical Officers, or whether it is owing to other causes I cannot say, but to be able to record so large a diminution as 736 sick paupers in a Quarter is highly satisfactory. Meteorology at Greenwich, The returns of the Registrar-G-eneral show that the rain-fall in the Metropolis during the Quarter has been 6.66 inches. During the corresponding Quarter of last year, the rain-fall was only 1.29 inches. The mean temperature of the air was 55.8°. In the corresponding Quarter of last year, the mean temperature was 54.7°. The hottest days during the Quarter, were Wednesday, May 24th, Thursday, May 25th, and Thursday, June 15th, when the thermometer, in the shade, indicated respectively 77.2°, 79.5°, and 77.2°. In the corresponding Quarter of the previous year, the highest reading of the thermometer, in the shade, was on Wednesday, 22nd of June, when it indicated 90.2°. The following Table, taken from the returns of the Registrar-General, shows the comparative results of the Quarter :— LONDON. Aprl 8th Aprl 15th Aprl 22nd Aprl 29th Slay 6th May 13 th May 20th May 27th June 3rd June 10th Tune 17th J une 24th July 1st Deaths from Smal lPox 214 265 276 261 288 232 267 257 229 245 240 332 235 Deaths from scarlet Fever 37 40 27 30 29 35 28 28 25 34 17 24 16 Mean Temperature of the air 43.1° 48.3° 50.0° 50.7° 49.7° 47.6° 50.1° 56.1° 53.9° 49.9° 59.5° 56.2° 56.6 Rain - fall in inches 0.01 0.36 1.75 0.80 0.20 0.15 0.16 0.22 0.10 0.31 1.05 1.50 0.05 Deaths in London 1493 1722 1578 1469 1522 1341 1426 1401 1393 1437 1349 1296 1328 Deaths in Whitechapel District 39 46 46 42 56 35 47 50 31 51 31 31 52 Deaths in ditto from Small-pox 5 5 7 1 4 1 5 6 1 2 0 1 4 Water Supply. The constant system of water supply, by the use of waste preventers in the poorer districts, is increasing, and continues to give great satisfaction, There are now 146 waste preventers (27 new ones having been erected during this Quarter;, by which upwards of 850 houses are supplied. So convinced am I of the great improvement of this mode of supply to the poor localities over the old intermittent system, that I 6 have no hesitation in saying that it should be made compulsory on landlords of small tenements to adopt it. The alleged usefulness of the intermittent system, by allowing the surplus water to run to waste and so clear the drains and pans of the closets, is not, in my opinion, of sufficient importance to justify its continuance. The poor are exposed to great danger by drinking water which is contaminated by its retention in dirty and decayed butts, and by its exposure to the air from the want of proper coverings to the receptacles. In many instances, the water is contaminated by the emanations from those privies which are in close proximity to the water receptacles; and which contamination is further increased when the privy and the water-butt are connected, as is frequently the case, by a waste-pipe. I may further add, that it is the exception, and not the rule, for the Companies to supply water on Sunday, so that the poor are frequently without water on that day, unless they fill their pails and tubs when the water is turned on, and preserve it for future use. But as the poor have neither proper covered vessels for holding water, and no other place for keeping their supply, except in their sleeping-rooms, and frequently under their beds, I need scarcely say that water so kept is unfit to drink. The objections against the supply of water on the intermittent system to the poor localities are so great, that I have no hesitation in giving it as my decided opinion— an opinion which has been formed after a long experience — that that system should be discontinued to all the poorer class of houses, and the constant system, by the use of waste preventers, a plan which has been in operation in this District for the last seven years, adopted in its stead. When, however, all those houses now occupied by the poor, which are unfit for habitation, are taken down and a new and better class erected, it may be desirable to have a supply of water on the constant system in the interior of every house; but under existing circumstances, where there is not a sink in any house, nor a vacant space in which one could be fixed, except perhaps in the room which is occupied by a family night and day: but then in such a case the emanations from the sink would render the room unfit for habitation. The proposal, therefore, to supply water on the constant service to the interior of every house is simply impracticable. But whatever may be the result of the New Water Bill in causing the Companies to give a constant supply, the butts now in use in the poor localities must be abolished. The plan which is generally adopted in this District for cleansing the pans of the privies, and for preventing the choking of the drains is, by flushing them with pails of water twice a day, or as often as may be required. For this purpose, the landlord finds it to be to his interest to pay one of his tenants a small sum weekly to perform this duty in a 7 proper manner, thereby relieving himself from the inconvenience and expense of being summoned for a nuisance. The poor people are now better acquainted with the construction of closets and soil-pans, so that the complaints of these conveniences being stopped, which were formerly very frequent, are now of comparatively rare occurrence. Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending 1st July, 1871:— Number of inspections of houses as shown in the official returns 3645 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each person, reckoning 2 children under 10 7 years of age for one adult; nuisance in each case abated Number of cases of indecent occupation discovered 10 Houses specially visited 265 Ditto specially re-visited 750 Ditto registered by order of the Board 8 Certificates and copies of same prepared for the registration of the above houses Number of special notices served for the registration of houses 9 Preliminary notices served, many of such notices embracing several houses 291 Compulsory orders issued, embracing- 69 premises 33 Summonses heard at police courts 4 Houses in which the rooms or passages have been whitewashed 198 Eooms disinfected with sulphurous acid gas after the occurrence of small-pox therein Yards of houses paved or the pavement repaired 38 Drains in houses improved 78 Dustbins provided 14 Privies limewashed, cleansed, and repaired 84 Water-butts and cisterns provided or repaired 19 Water-waste preventers erected 27 Area gratings, cellar flaps, &c., repaired 4 Nuisances from dung and other offensive matter removed 13 Cellars used as dwellings discontinued for such use 4 Cesspools abolished 2 The cow-houses in the District, 24, and the slaughter-houses, 39, in number, have been visited during the Quarter. 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 Small Pox. The deaths from small-pox registered in this District for the Quarter ending 1st July, 1871, have been 42. For the previous Quarter they were 83, and for that ending December 30th, 1870, they were 50. To these numbers there must be added the deaths of those patients belonging to this 8 District who died in the small-pox hospitals ; the total number of which, for the last three quarters, was 38; viz: 24, 12, and 2 for each quarter respectively. The total deaths therefore which have occurred in this District during the last 9 months have been 213, and for the whole of London 6241. The following return shows the progress of small-pox in this District from the commencement of the epidemic exclusive of the deaths in the small-pox hospitals. Dates. Cases among the Pauper population. Deaths among all classes in the District. Dates. Cases among the Pauper population. Deaths among all classes in the District. Dates, Cases among the Pauper population. Deaths among all classes in the District. 1 870. 1871. 1871. Sept. 24 3 2 Jan. 7 20 3 April 22 17 7 Oct. 1 5 0 „ 14 24 4 ,, 29 23 1 „ 8 10 2 „ 21 19 8 May 6 7 4 „ 15 16 0 „ 28 30 6 „ 13 4 1 „ 22 13 3 Feb. 4 33 8 „ 20 23 5 „ 29 7 3 „ 11 25 10 „ 27 13 6 Nov. 5 14 0 „ 18 31 9 June 3 5 1 „ 12 24 7 „ 25 31 11 „ 10 18 2 „ 19 23 7 Mar. 4 34 6 „ 17 9 0 „ 26 16 4 „ 11 32 4 „ 24 12 1 Dec. 3 18 4 „ 18 15 5 July 1 10 4 „ 10 25 5 ,, 20 33 7 „ 17 31 5 April 1 15 3 „ 24 25 6 „ 8 19 5 Totals 764 176 „ 31 18 3 „ 15 14 5 The cases and deaths for each week since 1st July have been as follows: for the week ending July 8th, 3 cases and 2 deaths, for that ending July 15th, 6 cases no deaths, for that ending July 22nd, 7 cases and 2 deaths, and for that ending July 29th, 2 cases and 1 death. Mr. Blackman has successfully performed during the quarter ending June 25th, 357 primary and 538 secondary vaccinations, and has unsuccessfully performed 2 primary and 10 secondary vaccinations. As regards the two unsuccessful primary vaccinations, Mr, Blackman remarks that one of the children had been vaccinated six times without success ; and in the other case the child was once unsuccessfully vaccinated : no opportunity was afforded to the vaccinator to vaccinate this child a second time, the parents having removed from the District. In my last report, it was stated, that out of the 871 primary vaccinations which had been performed by Mr. Blackman, 8 had been returned as unsuccessful. It would have been more correct to have said that there was no record of the cases having been successful, as none of these cases returned as unsuccessful had been seen again by Mr. Blackman after they had been vaccinated. The total primary cases of successful vaccination performed by Mr. Blackman during the last six months have been 1128. 9 The following table, showing the number of cases of small-pox admitted into the wards erected in the Stone Yard by the Guardians, has been kindly prepared for me by Mr. Ilott, the resident Medical Officer of the Workhouse, DATE. Number of Admissions. DATE. Number of Admissions. April 2 7 May 14 3 „ 9 32 „ 21 7 „ 16 9 ,, 28 3 „ 23 2 June 4 5 „ 11 1 „ 30 19 „ 18 0 May 7 8 „ 25 0 From the above return it appears that the total number of cases of small-pox admitted in 13 weeks was 76, which added to the 150 as returned in the last report, makes a total of 226 cases; 65 were sent to the Homerton Asylum Board Hospital, and 11 were treated in the wards in the Stone Yard. Of the 11 patients treated in these wards 3 died; all of whom were unvaccinated. Of the 76 cases admitted into the Small-Pox Ward, the Medical Officer slates that 58 had been vaccinated, and 18 unvaccinated. Since the publication of my last report, a select Committee of the House of Commons was appointed to inquire into the operation of the Vaccination Act (1867), and to report whether such Act should be amended. The Select Committee held eight meetings, and heard the evidence of persons who assert that vaccination is useless and injurious; and medical and other evidence given in reply. The Committee, after careful consideration, agreed with the general opinion "That the cow-pox affords, if not an absolute, yet a very great protection against an attack of small-pox; and an almost absolute protection against death from that disease. That if the operation be performed with due regard to the health of the person vaccinated, and with proper precautions in obtaining and using the vaccine lymph, there need be no apprehension that vaccination will injure health or communicate any disease." "That small-pox, unchecked by vaccination, is one of the most terrible and destructive of diseases as regards the danger of infection, the proportion of deaths among those attacked, and the permanent injury to the survivors; and therefore "That it is the duty of the State to endeavour to secure the careful vaccination of the whole population." The Committee also report" That if vaccination had been universal, the epidemic could not have approached its present extent." The only question to be solved as regards the prevention of death from Small-pox, is as to the best means to be adopted by legislative enactment to secure the proper vaccination of every child, and for this purpose I would suggest 1. That the Registration of Births should be made compulsory. 10 2. That there should be an officer appointed in each Registration district to enforce the provisions of the Vaccination Act, and that such officer should be the Registrar of Births. This would be a much better arrangement than that recommended by the Select Committee, which is, that the Vaccination Officer and the Registrar of Births should be distinct persons. 3. That the Medical Department of the Privy Council should have entrusted to them the entire duty of administering the laws as regards Vaccination, the appointment and the payment (which should be by salary) of the public vaccinators. In my last report I mentioned several instances of the carelessness or indifference of some of the working classes as regards the danger of contagion from small-pox; and I have now further to record another case of similar disregard to the danger of communicating the disease. In Walton's Court, a child died from small-pox; the body of this child was kept for four days on the ground floor room, in which there were three other children suffering from the same disease. When the Inspector visited the house there were two women in the room, who informed him that two persons lived up-stairs, and, from the faulty construction of the house, these lodgers had to pass through the ground-floor room in which the children lay suffering from small-pox, whenever they went out or returned home. Disinfecting Apparatus. From a report of the Inspectors it appears that from the 20th April to the 20th June, twenty-two applications have been made for the disinfection of beds, bedding, and wearing apparel; all of which have been submitted to the action of a heat of about 250° under their inspection and that of the Superintendent of the Stone Yard where the apparatus is erected. The Inspectors in every instance attended to the conveyance of the bedding, &c., to the Stone Yard, and to the re-conveyance of the same to the houses of the respective applicants. No charge has, in any instance, been made either for the disinfection of clothes, &c., or for the carriage of the articles to and from the disinfecting apparatus. Census Returns, 1871. Since the publication of my last quarterly Report, the census of the United Kingdom has been taken, and the Registrar-General has published tables of the population and houses, enumerated in England and Wales, and in the Islands of the British Seas, on the 2nd April, 1871. From this return, it appears that the population of the Whitechapel District is 76,332, or 2,638 less than in 1861, when the population was 78,970. The excess of registered births over registered deaths in the ten years 1861-71, is 446;* but if the deaths in the London Hospital of 2621 * According to the returns of the Registrar-General the excess of births over deaths in the 10 years is only 400. 11 residents be deducted from the registered deaths, the excess of births over deaths will be about 3,067. To this number there must be added the births that are not registered, which, in this District, from causes alluded to iu some of my former Reports, are probably very numerous. The registration of births in England is not, as in Scotland, compulsory, and a birth cannot be registered after the child has become six months old. In order to show in which of the Sub-districts the population has increased and decreased, I have been able, from the published returns of the Registrar-General, to construct the subjoined Table:— Districts. Population enumerated. Increase or Decrease in the No. of persons between 1861 & 1871. No. of Houses Inhabited during 1861 1871 Increase. Decrease. 1861 1871 Artillery 6557 6651 94 - 731 690 Spitalfields 15700 15844 144 - 1533 1512 Mile End New Town 15392 15550 158 - 1634 1745 Whitechapel North 12122 11434 - 688 1503 1429 Whitechapel Church 8062 7323 - 739 999 903 Goodman's Fields 11166 10381 - 785 1260 1140 Aldgate 9971 9149 - 822 999 894 Totals 78970 76332 396 3034 8664 8313 From this table it appears that an increase of the population has taken place in the Artillery, Spitalfields, and Mile End New Town Sub-districts, amounting in the aggregate to 396; while the Whitechapel North, Whitechapel Church, Goodman's Fields, and Aldgate Sub-districts have fallen off to the extent of 3,034. The number of houses has decreasd to the extent of 351. The average number of persons to each house, including the residents in public buildings, on board ship in the docks and on the river is 9.1, which is exactly the same as it was at the previous census. Iu 1851 the inhabited houses were 8,812 ; in 1861 they were 8,664, and in 1871 they were 8,313, showing a diminution in 20 years of 499 houses. "The enumerated population of London on the night of April 2nd, 1871, was 3,251,804. But this," says the Registrar-General "is now only a part of London. Within the radial lines of the Metropolitan Police District, drawn from 12 to 15 miles round Charing Cross, the population is 3,883,092." Within the limits of the School Board District, the population is 3,2C5,005. The Registrar-General has supplied the London School Board with details relating to nearly 700,000 children between the ages of 3 and 13, living within the limits of their jurisdiction. It appears from a Report of Mr. Hyams, the Registrar of the Subdistrict of Spitalfields, to the Registrar-General, a copy of which has been 12 kindly given to me by Mr. HyamS, that a large number of Polish and Dutch Jews inhabit numerous courts in his District. The same may be said of many of the courts in the Whitechapel North Sub-district. This class of persons occasionally crowd together to an extent dangerous to the public health; and it is not improbable, from the results of special night visits made by the Inspectors, that the number of nightly lodgers in some of the lowest class of houses, which are let out in tenements, has been understated by the owners of such houses in giving in their returns to the Collectors of the Census Papers, either from their ignorance of the fact, or from their fear of incurring legal proceedings for overcrowding; and hence the population of the District may be somewhat greater than is shown by the returns of the Registrar General. It is a matter for regret that, in taking the census, the persons occupying each room in a house had not been enumerated. Mr. Hyams says that in carrying out his duties as Registrar, he has four distinct classes of persons to deal with, viz :— 1. Ordinary inhabitants. 2. An Irish Colony. 3. A large number of Foreign Jews, and 4. An assemblage of Vagabond Characters. The obtaining of the necessary information from the last two mentioned classes, must have given a large amount of trouble to Ms. Hyams in arranging his plans, and in carrying them out. Great credit is therefore due to that officer for the manner in which his duties have been fulfilled. In concluding his Report, Mr. Hyams says, that during the 10 years since the taking of the previous census, "The Common Lodging Houses have much increased, and where a single family occupying a house suitable for the purpose has removed therefrom, it has, as a rule, been let in tenements. On the other hand, a large diminution of houses and inhabitants has taken place by the pulling down of Phoenix Street and the Courts therein, with portions of Brick Lane, Queen Street, Hope Street, Grey Eagle Street, and Wheeler Street, for the City Extension of the Great Eastern Railway." Similar remarks, as regards the conversion of family residences into lodging-houses let out in separate tenements, whereby the population is kept up in number, apply to nearly every part of this District. I have the honour to be, Gentlemen, Tour 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, of the Three Months ending on the 1st July, 1871. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Cholera and Choieraic-Diarrhcea. Continued Fever, Typhus & Typhoid. Diphtheria. Pytemia. 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 31 4 2 1 17 0 4 2 0 1 1 0 29 23 0 4 0 0 0 2 355 476 Mr. Champneys 57 12 1 8 20 0 7 0 0 2 0 0 80 2 0 2 1 3 0 3 537 735 Dr. Richardson 44 12 1 6 24 0 5 0 0 3 0 0 78 0 1 11 0 0 0 3 512 710 Mr. Sequeira 23 27 3 11 13 0 2 0 0 3 0 0 22 4 0 4 0 0 0 0 267 377 Mr. Loane 19 46 1 2 9 0 11 0 0 5 0 0 06 2 0 3 1 0 0 2 192 359 Total 174 101 8 28 83 0 29 2 0 14 1 0 275 31 1 24 2 3 0 10 1863 2657 Corresponding Quarter of previous Year. 21 143 21 37 235 0 27 0 1 9 0 0 99 48 0 38 24 3 1 2 2704 3393 Mr. Lepingwell, the Resident Medical Officer of the Eastern Dispensary, has not had a single case of Small-Pox during this quarter. TABLE II. Showing the Deaths from Epidemic Diseases, for the Three Months ending 1st July, 1871. Districts. Small-Pox. Measles. Scarlet-Fever. Diphtheria. HoopingCough. Diarrhoea. Fever. Total. Remarks. Artillery 6 0 0 0 0 0 1 7 Workhouse. Spitalfields 4 0 0 0 1 2 1 8 Mile End New Town 15 2 1 0 2 2 3 25 Whitechapel, North 11 1 0 0 4 1 0 17 Hospital. Whitechapel Church 1 0 0 0 3 1 1 6 Goodman's Fields 2 7 0 0 1 2 2 14 Aldgate 3 4 0 0 0 0 1 8 Totals 42 14 1 0 11 8 9 85 Deaths from Epidemics for the corresponding Quarter, 1870. 0 12 6 l 20 12 15 66 There were six deaths from Pyemia in the London Hospital. TABLE III. Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 1st July, 1871. 0 and under 1. 1 and under 5. 5 and under 20. j 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total Males, 45 Females, 32 Corresponding Quarter of 1870. Workhouse 6 3 1 15 22 24 6 77 85 London Hospital 0 7 15 47 44 12 1 Males, 93 157 Females, 33 126 TABLE IV Ages at Death in each Registration District, for the Three Months ending 1st July, 1871 Districts 0 and under 1 1 and under 5 5 and under 20 20 and under 40 40 and under 6 0 60 and under 80 80 and upwards Total Remarks Artillery 5 5 6 2 4 2 1 25 Workhouse Spitalfields 18 15 4 10 6 11 0 64 Mile E N Town 29 28 4 22 32 33 7 155 Whitechapel, N 17 15 2 5 7 10 1 57 Hospital Whitechapel Ch 8 12 17 51 49 19 3 159 Goodman's Fields 9 18 2 6 10 4 1 50 Aldgate 13 9 3 4 13 5 0 47 Totals 99 102 38 100 121 84 13 557 TABLE V The Births and Deaths in each Registration District, for the Three Months ending on the 1st July, 1871 Districts Births Total Deaths Total Excess of Births over Deaths Excess of Deaths over Births Remarks M F M F Workhouse Artillery 21 22 43 14 11 25 18 0 Spitalfields 57 56 113 32 32 64 49 0 Mile EndN Town 73 76 149 84 71 155 0 6 Whitechapel, N 49 39 88 23 34 57 31 0 London Hospital WhitechplChurch 18 24 42 113 46 150 0 117 Goodman's Fields 39 51 90 27 23 50 40 0 82 Non-residents died in the London Hospital Aldgate 23 21 44 20 27 47 0 3 Totals 280 289 569 313 244 557 138 126 Excess of Births over Deaths, deducting the 82 non-residents, 94 Population in 1871, 76,332 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE Sanitary condition OF THE FOR THE QUARTER ENDING 30TH SEPT., 1871, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH London Printed by T. Penny & Co., 121, Leman Street, Whitechapel, E. 1871. REPORT of the MEDICAL OFFICER OF H E A L T II, for the Quarter ending 30th Sept., 1871. To the Board op Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, September 30, 1871, the births registered in the Whitechapel District were 602, viz., 304 males and 298 females. During the same period, the deaths have been 574 : of these, 312 have been of males and 262 of females. In the corresponding Quarter of the previous year, the births were 631 and the deaths 609. There has been, therefore, a decrease of 29 in the number of births, and a decrease of 35 in the number of deaths. The deaths in the London Hospital have been 127, viz., 81 males and 46 females. Of the total deaths in this institution, there were 18 of persons resident within the District, 80 of non-residents, and 29 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 2 deaths from epidemic diseases in the London Hospital during this Quarter, viz., 1 from diarrhoea, and 1 from diphtheria. The deaths in the Workhouse have been 55, viz., 35 males and 20 females. There were 2 deaths from epidemic diseases in this establishment, both of which were from diarrhoea. The deaths from epidemic diseases in the entire District have been 142; viz., 11 from small-pox, 12 from measles, 5 from scarlet-fever, 1 from diphtheria, 4 from hooping-cough, 99 from diarrhoea, 7 from fever, and 3 from choleraic-diarrhœa. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 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. The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 48: of these, 23 were caused by bronchitis, 21 by pneumonia, 1 by laryngitis, and 3 by asthma. 4 The deaths from tubercular diseases were 111, viz., 30 from mesenteric disease, 4 from tubercular meningitis, 9 from hydrocephalus, or water on the brain, 3 from scrofula, and 65 from consumption. Diseases of the organs of circulation were fatal to 24 persons; of these, 23 died from disease of the heart, and 1 from pericarditis. The deaths from diseases of the urinary organs were 13; of these, 6 were caused by nephria or Bright's disease, 1 by vesico-vaginal fistula and 6 by other diseases of the urinary organs. Convulsions caused the deaths of 20 children. There were 10 deaths from premature birth, 4 from teething, and 23 from atrophy and debility. There were 2 deaths from congenital syphilis. A child died from want of breast milk. The deaths of 16 persons are attributed to old age; of these, 14 were above 80 years of age ; three of whom had reached the advanced age of 93 years. The deaths from premature decay were 2, both of which were of persons under 70 years of age. There were 22 deaths from mechanical violence; of these, 9 were caused by horses and vehicles in the streets. Burns and scalds were fatal to 5 persons. A child, aged 11 months, died in the London Hospital from accidentally swallowing a fish bone. One death occurred from the effects of chloroform. Three children were suffocated in bed. Two persons committed suicide. The number of inquests has been 58. In the corresponding Quarter of last year the number was 64. Uncertified Deaths. The number of deaths which have not been certified by a medical practitioner has been 6, all of which are recorded in the Spitalfields sub-district. The mortality of children under 5 years of age was 275. This is 47.9 per cent, of the total mortality. In the corresponding Quarter of the previous year the rate of mortality of children under 5 was 41.0 per cent, of the total mortality. In the Artillery sub-district the rate is 69.6 per cent.; in the Spitalfields, 65.1 per cent.; in the Mile End New Town, 40.1 per cent.; in the Whitechapel North, C6.6 per cent.; in the Whitechapel Church, 21.6 per cent.; in the Goodman's Fields, 74.5 per cent.; and in the Aldgate, 79.1 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter, 2144 new cases of illness out of the Workhouse, including 41 of small-pox, 22 of measles, 8 of scarlet-fever, 58 of hooping-cough, 368 of 5 diarrliœa, 66 of fever, 2 of choleraic-diarrhoea, and 8 of erysipelas. In the corresponding Quarter of the previous year, the number of pauper cases of illness was 3585, including 33 of small-pox, 75 of measles, 27 of scarlet-fever, 39 of hooping-cough, 646 of diarrlicea, 4 of choleraicdiarrhoea, 66 of fever, and 19 of erysipelas. Meteorology at Greenwich, The returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 8.42 inches. In the week ending September 30th the rain-fall was 3.34 inches. Daring the corresponding Quarter of last year, the rain-fall was 4.50 inches. The mean temperature of the air was 61.3°. In the corresponding Quarter of last year, the mean temperature was 68.8°. The hottest days during the Quarter were Friday, August 11th, Saturday, August 12th, and Sunday, August 13th, when the thermometer, in the shade, indicated respectively 87.5°, 88.2°, and 89.2°. In the corresponding Quarter of the previous year, the highest reading of the thermometer, in the shade, was on Friday, August 8th, when it indicated 89.7°. The following Table, taken from the returns of the Registrar-General shows the comparative results of the Quarter :— LONDON. July 8 th July 15th July 22nd July 29th Aug 5th Aug 12th Aug. 19 th Aug 26th Sep. 2nd Sep. 9th Sep. 16 th Sep. 23rd Sep. 30th Deaths from Small Pox 164 133 135 122 87 96 80 82 78 81 57 89 51 Deaths from Scarlet Fever 24 40 24 19 24 30 21 24 24 26 32 27 30 Mean Temperature of the air 60.5° 61.7° 65.5° 60.1° 60.3° 68.3° 67.1° 63.0° 61.0° 60.5° 62.6° 53.6° 50.2° Rain - fall in inches 0.87 1.51 0.05 0.66 0.23 0.00 0.69 0.09 0.02 0.66 0.00 0.01 3.34 Deaths in London 1200 1259 12S1 1420 1382 1568 1715 1682 1435 1422 1422 1411 1390 Deaths in White chapel District 37 46 36 42 48 51 42 50 50 44 42 46 39 Deaths in ditto from Small-pox 2 0 2 1 0 4 0 1 1 0 0 0 0 Water Supply. Since the issuing of my last Quarterly Report, an Act, 34 and 35 Vict., c. 113, entitled "The Metropolis Water Act, 1871," has been passed. The Act is dated 21st August, 1871. This Act contains very important provisions in the interest of the public. 1. A supply of water is to be given on Sundays. 2. Every company subject to. the provisions of this Act, may, and from and after the expiration of eight months from the passing of this Act, shall, when required to do so, provide a constant supply of water for the domestic purposes of the inhabitants. The application for constant supply to any district must be made by the Metropolitan Board of Works to the company within the water limits in which such district is situated, and any company 6 may, without any such application, propose to the Metropolitan Authority to give a constant supply in any district. 3. The Board of Trade may appoint persons to inquire into and report as to the quality of the water. 4. By the 32nd section it is enacted, that if the provisions of the Act as regards proper fittings are not complied with, the company may cut-off the supply to that house in which the necessary fittings to prevent waste have not been provided; but in every case of so cutting-off or ceasing to supply, the company shall, within twenty-four hours thereafter, give to the Local Board notice thereof. The 33rd section enacts that the absence of proper water-fittings in any inhabited house shall be a nuisance, within section 11 and sections 12 to 19 (inclusive) of the Nuisances' Removal Act, 1855; and that nuisance, if in any case proved to exist, shall be presumed to be such as to render the premises unfit for human habitation within section 13 of the said Act, unless and until the contrary is shown to the satisfaction of the Justices acting under that section. Before, however, the company cut-off the supply of water to any inhabited house which is not provided with proper fittings I may express a hope that they will give notice of their intention to do so to the sanitary officers of the Local Board, so that the owner of such house may have timely warning given to him of the consequences which will follow from his non-compliance with the company's regulations. Under the provisions of the Metropolis Water Act 1852, before a constant supply could be obtained, it was necessary to procure the signatures of four-fifths of the owners or occupiers of the houses supplied by the district main to a requisition addressed to the company. Owing to the provisions of this clause it was seldom, if ever, acted on. Small Pox. The deaths from small-pox registered in this District for the Quarter ending 30th September, 1871, have been 11. For the previous Quarter they were 42; for the Quarter ending April 2nd, they were 83, and for that ending December 30th, 1870, they were 50. To these numbers there must be added the deaths of those patients belonging to this District who died in the small-pox hospitals; the total number of which, for the last four quarters, was 49, viz., 2 for the quarter ending December, 1870; 12 for the quarter ending April, 1871; 24 for the quarter ending July; and 11 for the quarter ending September. The total deaths from this disease, therefore, which have occurred in this District during the last twelve months have been 23G, andfor the whole of London 7496. 7 The following return shows the progress of small-pox in this District from the commencement of the epidemic, exclusive of the deaths in the small-pox hospitals. Dates. Cases among the Pauper population. Deaths amongall classes in the District. Dates. Cases among the Pauper population. Deaths amongall classes in the District. Dates. Cases among the Pauper population. Deaths among all classes ii the District. 1870 Sept. 24 3 2 1871 Feb. 11 25 10 1871 July 1 10 4 Oct. 1 5 0 „ 18 31 9 „ 8 3 2 „ 8 10 2 „ 25 31 11 „ 15 6 0 „ 15 16 0 Mar. 4 34 6 „ 22 7 2 , 22 13 3 „ 11 32 4 „ 29 2 1 „ 29 7 3 „ 18 15 5 Aug. 5 10 0 N v. 5 14 0 „ 25 33 7 „ 12 4 4 „ 12 24 7 April 1 15 3 „ 19 2 0 „ 19 23 7 „ 8 19 5 „ 26 1 1 „ 26 16 4 „ 15 14 5 Sept. 2 3 1 Dec 3 18 4 „ 22 17 7 „ 9 1 0 „ 10 25 5 „ 29 23 1 „ 16... 1 0 „ 17 31 5 May 6 7 4 „ 23... 1 0 „ 24 25 6 „ 13 4 1 „ 30... 0 0 „ 31 18 3 „ 20 23 5 1871 Jan. 7 20 3 „ 27 13 6 Totals 812 187 ,, 14 34 4 June 3 5 1 Deaths in Smallpox Hospitals 49 „ 21 19 8 „ 10 18 2 „ 28 30 5 „ 17 9 0 236 Feb. 4 33 8 „ 24 12 1 Mr. Ilott, the Resident Medical Officer of the Workhouse, informs me that during this Quarter no cases of small-pox have been treated in the small-pox wards. All the patients who were conveyed to the small-pox hospital were taken direct from their respective residences ; and that out of the cases so sent by the District Medical Officers eleven died. From the foregoing returns, it appears that the cases of small-pox are now so few as not to occasion any alarm in the minds of the people ; and when we observe that during the last four weeks of the Quarter not a single death from small-pox has been recorded in this District, we may reasonably expect that the force of the epidemic has nearly expended itself. SixiTARY Works Performed during the Quarter. The following return shows the amount of work done' by the Sanitary Inspectors during the Quarter ending September 30th, 1871:— Number of inspections of houses as shown in the official returns 3552 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each person, reckoning 2 children under 10 > 23 years of age for one adult; nuisance in each case abated 8 Number of cases of indecent occupation discovered 15 Houses specially visited 347 Ditto specially re-visited 1041 Ditto registered by order of the Board 3 Certificates and copies of same prepared for the registration of the 6 above houses Number of special notices served for the registration of houses 12 Preliminary notices served, many of such notices embracing several houses 209 Compulsory orders issued, embracing 157 premises 52 Summonses heard at police courts 1 Houses in which the rooms or passages have been whitewashed 283 Ventilation of houses improved 6 Rooms disinfected with sulphurous acid gas after the occurrence of ) small-pox therein) Yards of houses paved or the pavement repaired 47 Drains in houses improved 56 Dust bins provided 4 Privies limewashed, cleansed, and repaired 92 Water-butts and cisterns provided or repaired 06 Water-waste preventers erected 0 Area gratings, cellar flaps, &c., repaired 6 Nuisances from dung and other offensive matter removed 20 Cellars used as dwellings discontinued for such use 4 The cow-houses in the District, 24, the slaughter-houses, 39, and the Bake-houses, 83 in number, have been visited during the Quarter. 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 have promptly attended to. The Inspectors further report that on visiting the houses Nos. 3 & 4, Sugar Loaf Court, Spitalfields, and Nos. 5, 6, 7, & 8, Goulston Court, Whitechapel, all of which are let out in separate furnished apartments, the beds and mattresses, 15 in number, were found to be in such a filthy condition as to be a nuisance and injurious to health. Notices were served upon the landlords of these houses to destroy the filthy beds and mattresses therein, and provide new ones. The requirements in the notices were complied with. Report or the Medicai Oeeicer oe Health on the new Houses in course of Erection in Nelson Court. At a Meeting of the Committee of Works, held on Thursday, September fth, I drew attention to the fact that seven new houses were in course of erection in Nelson Court, Whitechapel Road, when I was requested to make an inspection of the locality and report to the Board thereon. The following is a copy of such report: " To the Board of Works, Whitechapel District. Gentlemen, 1 ith September, 1871. On Saturday last, in company with your Surveyor, I inspected the seven houses now in course of erection in Little North Street and Nelson Court. Nelson Court is entered from the Whitechapel Road by a narrow entrance of less than two feet in width, and the width of the Court opposite to the houses in the course of erection is only 6 feet 9 inches. 9 Independently of the want of a due proportion of light and air for the rooms facing the Court, the rooms themselves are very faultily constructed. In the first place, there are no passages to the houses, but the entrance doors open directly from the Court iuto the front rooms. 2ndly. From the construction of the staircases, the foul air of the lower rooms will pass directly into the rooms above, the staircases forming ventilating shafts to the lower rooms. 3rdly. There is no other way for the inhabitants of the front and upper rooms to pass into the back yards, except through the back rooms of the houses—a most indecent practice. For the above reasons, I consider that if these houses are completed in accordance with the accompanying plan, they will be unfit for habitation. If these houses are being built in conformity to the provisions of the Building Act, then it is full time that a new Building Act was in force, so that the erection of similarly constructed houses may be prevented. No builder should be allowed to erect dwelling-houses unless the local authority approved of the plans in all their details. A power of appeal to a central authority might be allowed to the builder if his plans were not approved by the local board. I am, Gentlemen, Your obedient Servant, 15, Great Alie Street. JOHN. LIDDLE." Upon the reading of this report, it was resolved that a communication be addressed to the Metropolitan Board of Works explaining the farts and enclosing a copy of the Medical Officer's Report; and that a notice of the contents of the Medical Officer's Report be sent to the builder or owner of the houses referred to.' The Clerk accordingly wrote to the Architect of the Metropolitan Board, and in his letter he stated that the Whitechapel Board are of opinion that houses such as those proposed to be erected are highly objectionable in such a locality as that in which it is intended they shall be built. In reply, the following letter, addressed to the Clerk, dated 15th September, 1871, was received from Mr. Vulliamy, the Superintending Architect to the Metropolitan Board of Works:— " Dear Sir, I beg to acknowledge the receipt of your letter of tlie 13th instant relative to the erection of buildings in Little North Street and Nelson Court in which you request me to bring the matter before the Board for the purpose of preventing that which your Special Committee and Medical Officer of Health unanimously consider objectionable. I quite concur in the view taken that the erection of buildings in so limited a space should be restricted as much as possible, but I do not see how I can bring the subject before this Board with any likelihood of a satisfactory result. It appears to me that unless your District Board take action under the 74th section of the Metropolitan Local Management Amendment Act and compensate the proprietor for widening the existing public ways, there is nothing to prevent him from erecting a 10 row of buildings in Little North Street to the general line of frontage thereof, nor upon the old foundations in Nelson Court, subject of course to the provisions of the Building Act, 1855." This letter would have been more satisfactory if the writer had stated, in addition to his opinion, that the erection of houses in so limited a space should be restricted; that the Metropolitan Board intended to insert a clause in the new Building Bill which should prohibit the erection of new houses in any locality which has a less space for air, light, and ventilation than twenty feet in width; and that every newly erected house, whether in a new or old Court, should have that amount of space in front, and a space of at least ten feet square in the rear. So soon as the working classes are thoroughly alive to the importance of living in healthy habitations, and the ratepayers become convinced that it is much cheaper to prevent disease than to support the sick and provide for widows and orphans; then something more effectual will be done than has hitherto been accomplished, both in the prevention of the erection of unhealthy dwellings and the taking down of such as now exist. From the letter of the Architect of the Metropolitan Board it would appear that the vested rights of those persons who embark in building speculations are protected, while the vested rights of the poor, which are their health and comfort, are disregarded. Can anything, I would ask, be more absurd than to prohibit the erection of buildings in newly-formed places unless such places are of a prescribed width, while new houses are permitted to be erected upon old foundations without regard to the width of the Court or Alley ? It is either necessary for health, or it is not so, to build houses which shall have a width of twenty feet in front, but if such an open space be necessary, then it cannot signify whether houses are erected in new or old places. A Bill for the Amendment of the Building Act was brought into the House of Commons by Mr. Tite and Colonel Hogg in the Session of 1866-7, which was prepared by the Metropolitan Board of Works, and in each successive Session it has, with some alterations, been read a first time, but it has not, in any Session, reached a second reading. It is to be hoped that better success will attend its introduction in the approaching Session. As the sanitary clauses of this Bill are, however, very defective, it might be better to omit them altogether from the new Bill, and incorporate them in a new Sanitary Bill, which should be taken charge of by a member of the Government. The Metropolis Buildings and Management Bill should therefore be divided into two parts; the one relating to the profession of an Architect and the business of a builder, and the other to all the sanitary requirements of a dwelling house; the former part might be advantageously left in the hands of the Metiopolitan Board, and the latter should be undertaken by the Government. It would also be necessary to obtain provisions for giving facilities to local Boards to purchase, under compulsory powers, any property that is required for the purposes of the Acts which they are empowered to execute. The 47th section of the Sanitary Act, 1866, appears to give such power, but it is so worded as not to be easily understood, and therefore not likely to be enforced. In the framing of the clauses of a new Sanitary Act relating to dwelling houses it should be enacted that such structural alterations made in any property held on lease, as may be ordered by any local board for the purpose of rendering such property fit for habitation, shall not, if carried out to the satisfaction of such authority, vitiate the lease. As the law now stands I believe that any structural alterations made in property held on lease, unless such are approved by the freeholder, will vitiate a lease. Defective Ventilation of the Dwellings of the Poor. The intimate relation between defective ventilation and the mortality from tubercular diseases, convulsions in children, teething, atrophy, debility, infantile diarrhoea, and insanity, is not sufficiently understood; and until the public thoroughly understand that the above named diseases are caused by the want of fresh air, sufficient attention will not be given to the danger arising from the crowded localities in large towns, so that these nuisances may be effectively dealt with. Hitherto the attention of local boards has been principally directed to the number of deaths from epidemic diseases, many of which are supposed to be caused by filth and defective drainage; and hence the formation of sewers and drains has been extensively carried out in the Metropolis ; but the numerous deaths which are caused annually by consumption and its allied diseases have not been duly considered. As the local rates, however, are continually increasing for the relief of sickness and the support of widows and orphans—the building of asylums for the insane, and the providing of workhouse infirmaries for the debilitated and prematurely old—it is probable that local boards will direct more attention to the condition of the houses of the poor than they have hitherto done. The courts and.alleys in which are the residences of the poor have been so frequently described that the public are now well acquainted with them. These places have formed the stock topic of lectures, of declamatory speeches, and of sensational articles in the periodical press, but the meaningless generalities which are so freely indulged in do little or no good; for neither the speakers nor the writers venture to suggest a remedy. If talking would take down some of the defectively ventilated houses and convert the sites into open spaces, the work would have long since been accomplished, and we should not have to mourn the annual loss of so many lives, and the annual increase of the poor rate. 12 From the Returns of the Registrar General, it appears that in 1868 the deaths in the Metropolis from the miasmatic class of diseases (18 in number) including all the epidemic diseases, were 17,131, while the tubercular and the allied class of diseases were fatal to 19,541; the former being 23.4 percent. and the latter 27.8 percent. of the total mortality. If we were to include the deaths from infantile diarrhoea, premature births, and insanity, in the return of deaths from scrofulous diseases, for they are to a considerable extent likewise caused by defective ventilation, the proportion of such deaths to the total mortality would far exceed 27.8 per cent. The last annual return issued by the Poor Law Board shows that on the first of January, 1871, there were 48,444 insane persons receiving relief from the poor rate in England and Wales—22,000 males and 26,444 females. The return states that 4.5 percent. of the pauperism on the 1st January last is attributable to insanity. With these startling facts before us, the question for our earnest consideration is how can we so effectually deal with that mass of property in London which is so defectively ventilated as to cause not only a large annual mortality but which likewise so enfeebles the constitution of those who escape early death, as renders them unable to obtain a livelihood by honest labour, and thus tending to increase our criminal population. The very aspect of our pauper and criminal classes will readily convince the beholder that the greater number of such persons are both mentally and physically incapacitated from performing remunerative labour. When, however, it is proposed either to close houses unfit for habitation under the Nuisances' Removal Act, or to take proceedings against the owner of property which is in like condition, then difficulties arise, which either prevent or delay the carrying out of the law. The sympathy of the public is more frequently manifested towards the owners of the unhealthy property than to the victims, the poor, who, by inhabiting such houses, are deprived of their health, and consequently are compelled to become burdensome to the ratepayers. Surely the vested rights of the ratepayers ought to be fully as much considered as the vested rights of the owners of property which is unfit for habitation. We have certainly no right to tax the ratepayers for the support of those sick persons whose sickness is caused by the unhealthy state of their dwellings, in order that the owner of such property may receive the annual income derived from it. To give compensation, therefore, to the owners of unhealthy dwellings, when such are ordered either to be closed or demolished, is out of the question, and should not be for one moment considered. In fact when houses are unfit for habitation and cannot be made fit for that purpose, they cease to be property as dwelling houses. 13 Houses Closed under the Nuisances' Removal Act. The four houses in Avenue Place, Spitalfields, which, at the commencement of this year, were ordered by the Magistrate at the Worship Street Police Court to be closed in consequence of their being unfit for habitation, are still unoccupied; and as it is not possible, owing to the limited space on which they stand, to render them fit for that purpose, they must either remain closed or they must be demolished. Houses demolished under the Artizans and Labourers Dwellings Act. The six houses in Black Horse Court, Spitalfields, which were brought under the notice of the Board in March last, in accordance with the Artizans and Labourers Dwellings Act, as being unfit for habitation, have been demolished. Improvements effected in Property inhabited by the Poor. Improvements in the sanitary condition of several houses in unhealthy localities have been made by their owners without the direct interference of the Board, but simply on the recommendation of the Medical Officer of Health. Of these localities I may particularly mention two, viz., Miller's Court, Dorset Street, and Garden Court, Mile End New Town. The former, viz., Miller's Court, owing to its confined situation, can never be so altered as to meet my views as regards sanitary arrangements. It has, nevertheless, had such alterations made therein as greatly to improve the ventilation. This has been effected by the taking down of a part of one of the houses, and building on the vacant space three privies and a dust bin, which were formerly so placed as to he nuisances. Air bricks have likewise been inserted in the outer walls. The latter, viz., Garden Place, in which there were fourteen houses, but now only thirteen, one at the farther end of tho Court having been taken down to afford a space for the erection of three privies and a dust bin. These conveniences were formerly situated in front of the houses, and within a few feet of the front windows, and they were a perpetual nuisance to the inhabitants of those houses. All the rooms had their ventilation improved by the insertion of air bricks in the back walls ; the Court was repaved, and a new water-waste preventer erected. The result of these improvements has been that the Court is more healthy, and a better class of tenants occupy the houses. As there is a great deal of property in the Metropolis occupied by the poor which might reasonably be condemned as being unfit for habitation, it is a question well worthy the attention of the several Boards of Guardians whether out-door relief should be given to persons living in such unhealthy places, as the money received from the Guardians is applied for the payment of the rent. A small yard belonging to one of the houses in Old Montague Street, Whitechapel, in which were the dust-bin, privy, and water receptacle, was found, on a visit made by the Inspector, to be covered over by a roof, and 14 thus became converted into a workshop. Information of the same was given to the District Surveyor, and, on a subsequent visit, the Inspector ascertained that the building was taken down. This is not tho only case of converting a back yard into a workshop which has come under the notice of the Inspectors. Without the utmost possible vigilance on the part of the Inspectors similar occupations of the very small open spaces at the backs of houses would be carried on to a great extent. Duties of Medical Officers of Health as regards Unhealthy Dwellings. It is the duty of the Medical Officers of Health to bring under the notice of their Local Boards all such houses as are unfit for habitation, so that the Local Board may adopt such proceedings in each case as their legal adviser may recommend. The Artizans and Labourers Dwellings Act is not a permissive A.ct as regards the duty of the Medical Officer of Health in reporting to the Local Board all such houses as are unfit for habitation, but it makes it imperative upon such Officer to do so; the word shall being used in the Act; and if the Medical Officer of Health shall fail in his duty in not reporting to the Local Board such houses which are unfit for habitation, then any four householders living in or near to any street in which there are any houses which, in their opinion, are unfit for habitation, can direst the attention of the Mcdical Officer of Health thereto, who, upon receiving information in writing signed by them, must make a report to the Local Board upon the condition of the houses complained of. It is of no use in the public saying, as is frequently the case, that half the houses in London occupied by the poorer classes should be demolished, when no one is willing to specify, in the form required by the Act, the particular houses which are unfit for habitation. Compensation for Property. When property which is unfit for habitation is either ordered by a Magistrate to be closed until the same is rendered fit for that purpose, or a similar property is ordered to he demolished under tho provisions of the Artizans and Labourers Dwellings Act, no compensation can be given to the owner. But there may be property respecting which a difference of opinion may exist as regards its unfitness for habitation. Under such circumstances, it might be desirable, by statutory enactment, to empower local boards to give a moderate compensation to the owners of such property, in preference to the incurring of expense in adopting legal proceedings to compel the owner to demolish it. Open Spaces. The subject of open spaces is now engaging the attention of the public, and no one can reasonably doubt the propriety, not only of providing them for the purpose of health, but of setting them apart as recreation grounds for 15 the poor of the densely populated districts. In order that such recreation grounds may he of still further utility, it has been suggested—and with this suggestion I fully concur—that every local hoard should he compelled to provide an open space of about one acre which might he advantageously planted with trees and shrubs. This space would not only afford the means of healthy recreation, but it might be rendered available, under the pressure of a severe epidemic, for tho erection of a temporary hospital for the treatment of the sick poor of the district. Proposed New School Board Schools. It having been determined by the London School Board to erect schoolrooms in different parts of the Metropolis, in which the children of the poor will be congregated together in large numbers, many of whom will be found to have their vital powers considerably below the healthy standard, it is therefore of the utmost importance for the protection of their health, that the best attention should be given to the ventilation, warming, drainage, provision for personal cleanliness, and other sanitary arrangements in the buildings. For this purpose, as the Board have not appointed a medical officer, they should direct their Architect, during the progress of the buildings, to confer upon these matters with, the Medical Officer of Health of the District, whose duty, among other things, under the provisions of the 132 section of the Metropolis Local Management Act, is to point out the most efficient modes for the ventilation of schools, &c., so that the sanitary arrangements may be completed simultaneously with the completion of the buildings. The Benefits arising from Fresh Air, Exercise and Cleanliness. In September last I availed myself of the opportunity which was kindly afforded me to visit the training-ship, Goliath, which is moored off Grays, Essex, where I saw the most striking benefits resulting from fresh air, good food, regular exercise, personal cleanliness, and cheerful industry, in the boys who are taken from the Forest Gate Industrial School, and who are in the course of training for Her Majesty's Navy. These hoys are the children of pauper parents, and were received into the Industrial School, at Forest Gate, from some of the crowded and badly ventilated courts of the Whitechapel District. The increase in the height, weight, and breadth of chest in the boys is most remarkable. If this improvement in the physical condition of the boys were the only benefit obtained by their living on board ship, and being subjected to the discipline necessary for fitting them for useful service, it would indeed be most valuable; but on observing the countenances of the boys, I found that they had lost the usual peculiar expression of features so common to that class from which the boys are taken; and instead of the downcast and sullen look, there was observable an expression of intelligence and cheerfulness; and I was informed that habits of self respect are soon developed in each of them. 16 Owing to the sanitary and other arrangements, the sick-list is exceedingly small, averaging only one per cent., and out of 400 hoys in a ship of 2,596 tons, where a good deal of hard work in all kinds of weather must he performed, only two or three cases of catarrh occurred during the last winter, which, as mav he recollected, was a severe one. The following are the particulars respecting the physical condition of eighteen of the hoys when admitted, and their condition at the time of my visit. when admitted. present time. No. Date. Height. Weight, Chest. Height. Weight. Chest. 1870 ft. in. lbs. inches ft. in. lbs. inches. 1 October 19th 4 6 73 27 4 9½ 90 294 2 ,, 4 6½ 83 27 4 10 94 29 3 ,, 4 9 77 29½ 4 l1¼ 89 30 4 ,, 4 4 60 25 4 6 68 26 5 ,, 4 5½ 74 30¼ 4 81 89 31 6 December 7th 5 1 92 27½ 5 3 97 29½ 7 ,, 9th 4 9 78 28 4 10½ 86½ 29½ 8 ,, 20th 4 10¼ 974 29 5 0½ 104 30½ 9 ,, 4 9 87 29¾ 4 ll¾ 91 29¾ 1871 10 April 13th 4 6¾ 73 26 4 8 75 27¾ 11 ,, 4 9½ 87 27 4 11 89 28¼ 12* January 25th 4 8 59 27 4 11½ 107 31* 13 ,, 4 7½ 71 27 4 9½ 86 28 14 February 2 2nd 4 9½ 88 27½ 4 11 92 29 15 ,, 4 8½ 83 27½ 4 10¼ 88 27½ 16 March 1st 4 4¼ 75 26 4 6 78 27½ -17 „ 8th 4 7 77 28 4 8 84 29 18 April 17th 4 4½ 75 27 4 6 82 28½ * Cook's Mate. In referring to the rapid growth of the boys, the Captain mentions other instances than those above recorded. Thus, one boy grew two inches in seven months, and his chest increased in proportion, so much so that he was enabled to pass the standard required for boys entering the Navy. Another boy increased in height no less than 2½ inches in eight months, and his chest also increased in proportion. Similar remarks will apply to many other of the hoys. I have the honour to he, Gentlemen", Your obedient Servant, 15, Great Alie Street. JOHN LIDDLE. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, of the Three Months ending on the 30th Sept., 1871. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Cholera and Choleraic-Diarrhoea. Continued Fever, Typhus & Typhoid. Diphtheria. Pyaemia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Dr. Swyer 9 i 0 85 2 ii 0 0 1 1 0 8 15 1 5 0 0 2 0 260 411 Mr. Champneys 9 4 0 0 97 0 21 0 0 2 0 0 35 1 1 3 0 3 1 3 389 569 Dr. Richardson 9 2 2 1 114 0 11 0 0 1 0 0 29 0 0 1 0 1 0 0 396 567 Mr. Sequeira 0 3 3 4 46 0 17 0 0 1 0 1 13 0 0 1 0 1 0 2 219 311 Mr. Loane 14 3 2 0 26 0 6 0 0 3 0 0 14 i 1 0 0 0 0 4 212 286 Total 41 22 8 5 368 2 66 0 0 8 1 1 99 17 3 10 0 5 3 9 1476 2144 Corresponding Quarter of previous Year. 33 75 27 39 646 4 66 0 0 19 0 0 133 32 0 21 7 8 3 5 2467 3585 ABLE II. Ages at Death in each Registration District, for the Three Months on ding 30th Sept., 1871. Districts. 0 and under 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 19 4 0 4 0 6 0 33 Workhouse. Spitalfields 40 18 1 10 7 10 3 89 Mile E. N. Town 34 17 6 17 27 20 6 127 Whitechapel, N 27 13 2 3 9 4 2 60 Whitechapel Ch 20 15 19 40 47 20 1 162 Hospital. Goodman's Fields 28 13 4 1 6 1 2 55 16 11 3 9 6 3 0 48 184 91 35 84 102 64 14 574 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 47.9 per cent. It varies, however, in the several sub-districts. Thus, in the Artillery sub-district it is 69.6 percent.; in the Whitechapel North, it is 66.6 per cent.; in the Goodman's Fields it is 74.5 percent.; and in the Spitalfields it is 65.1 percent. TABLE III. The Births and Deaths in each Registration District, for the Three Months ending on the 30th Sept, 1871. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M. F. 27. ..19 46 15. ..18 33 13 0 Spitalfields 63 ..50 113 48. ..41 89 24 0 MileEndN.Town 73 ..71 144 72. ..55 127 17 0 Workhouse. Whitechapel, N. 54 ..40 94 23. ..37 60 34 0 WliitechplChurch 31. ..41 72 99. ..63 162 0 90 London Hospital. Goodman's Fields 38 ..56 94 34. ..21 55 30 0 Aldgate 18 ..21 39 21. ..27 48 0 9 died in the London Hospital. Totals 304 208 G02- 312 262 574 127 99 Excess of Births over Deaths, deducting the 80 non-residents, 108 Population in 1871, 76,332. Population in 1861, 78,970. TABLE IV. Showing the Deaths from Epidemic Diseases, for the Three Months ending 30th Sept., 1871. Districts. Small-Pox. | Measles. Scarlet-Fevre Diphtheria. HoopingCough. Diarrhoea. Fever. Cholera k Choleraic] Diarrhoea. Total. Remarks. Artillery 0 4 0 0 0 11 1 0 16 Spitalfields 1 3 1 02 14 1 0 22 Mile End New Town 3 0 0 0 0 17 4 2 26 Workhouse. Whitechapel, North 0 2 0 0 1 16 1 0 20 Whitechapel Church 1 2 0 1 0 11 0 0 15 Hospital. Goodman's Fields 0 1 4 0 0 19 0 0 24 Aldgate 6 0 0 0 1 11 0 1 19 Deaths from Epidemics for the corresponding Quarter, 1870. 11 12 5 1 4 99 7 3 142 Deaths from Epidemics for the corresponding Quarter, 1870. 6 7 13 1 12 78 10 6 133 Two deaths occurred from Puerperal Fever, 4 from Croup, 10 from Erysipelas, 5 from Rheumatism, and 1 from Pyamia. TABLE V. Showing the Ages at Death iu the Workhouse, and in the London Hospital for the Quarter ending 30th Sept., 1871. I—H & "d _ fl fl rd u <D fl fl pd © u D -d a fl 'd © *4 a> a fl T5 § © CO ti ip 'xi fl fl § o co D •n fl fl *d fl 'd 1 •S fl Ti § Total Males, 35 Females, 20 orresponding larter of 1870. o c3 i—1 c3 vo o o o CO o CO 7 0 0 12 15 16 5 55 6G London Hospital... 4 9 20 34 44 16 0 Males, 81 Females, 46 127 159 1 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE . Sanitarg Condition OF THE WHITECHAPEL DISTRICT FOR THE QUARTER ENDING 30TH DEC., 1871, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH London: Printed by T. Penny & Co., 121, Leman Street, "Whitechapel, E. 1872. 1 REPORT OF THE • MEDICAL OFFICE OF HEALTH, for the Quarter ending 30th Decr., 1871. To the Board of "Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, December 30, 1871, the births registered in the Whitechapel District were 653; viz., 331 males and 322 females. During the same period the deaths have been 669: of these, 360 have been of males and 309 of females. In the corresponding Quarter of the previous year, the births were 670 and the deaths 655. There has been, therefore, a decrease of 17 in the number of births, and an increase of 14 in the number of deaths. The deaths in the London Hospital have been 154; viz., 95 males and 59 females. Of the total deaths in this institution there were 14 of persons resident within the District, 95 of non-residents, and 45 of persons who died either suddenly or from the result of accident. 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 complete record. There were 2 deaths from epidemic diseases in the London Hospital during this Quarter, viz., 1 from measles and 1 from typhus fever. One death occurred in this institution from puerperal fever. The deaths in the Workhouse have been 79; viz., 47 males and 32 females. No death from epidemic disease occurred in this establishment. The deaths from epidemic diseases in the entire District have been 80; viz., 23 from small-pox, 12 from measles, 10 from scarlet-fever, 12 from hooping-cough, 10 from diarrhoea, and 13 from fever. To the deaths from small-pox as above recorded there must be added the 12 deaths which occurred in the Small Pox Hospitals, and to the deaths from fever the 4 which occurred in the Fever Hospital; thus making a total of 35 deaths from small-pox and 17 from fever. There were also 3 deaths from erysipelas, 1 from puerperal fever, 1 from pyaemia, 4 from rheumatism, 1 from mumps, and 4 from croup. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 124; viz., 50 from small-pox, 5 from measles, 28 from scarlet-fever, 10 from hooping-cough, 12 from diarrhoea, and 19 from fever. 4 The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 152 : of these, 85 were caused by bronchitis, 55 by pneumonia, 2 by laryngitis, 2 by pleuritis, and 8 by asthma. Consumption was fatal to 81 persons. The deaths from other tubercular diseases were 25 ; viz., 17 from mesenteric disease, 5 from tubercular meningitis, 2 from hydrocephalus or water on the brain, and 1 from scrofula; making a total of 131 deaths from tubercular diseases. Diseases of the organs of circulation were fatal to 39 persons; of these, 34 died from disease of the heart, 2 from aneurism, 1 from phlegmasia dolens, 1 from hoemorrhage from the nose, and 1 from pericarditis. The deaths from diseases of the urinary organs were 11; of these, 7 were caused by nephria or Bright's disease, 1 by diabetes, 1 by nephritis, 1 by stone in the bladder, and 1 by retention of urine. There was 1 death from syphilis and 1 from stricture of the urethra. Convulsions caused the deaths of 20 children. There were 6 deaths from premature birth, 4 from teething, and 25 from atrophy and debility. One person died in childbirth. Want of breast-milk was fatal to 3 persons, and 1 died from privation. The deaths of 25 persons are attributed to old age; of these, 17 were above 80 years of age; two of these reached the advanced age of 92. Two persons under 70 died from premature decay. There were 32 deaths from mechanical violence ; of these, 9 were caused by horses and vehicles in the streets. There were 3 deaths by manslaughter. Burns and scalds were fatal to 10 persons. One person was accidentally drowned. Two persons committed suicide. Six children were suffocated in bed. One death was occasioned by chloroform, and 1 person died from accidentally swallowing an overdose of laudanum. The number of inquests has been 95. In the corresponding quarter of last year the number was 79. The number of deaths which have not been certified by a medical practitioner has been 12; of these, 10 were recorded in the Spitalfield's sub-district. The mortality of children under five years of age was 225. This is 32.1 per ccnt. of the total mortality. In the corresponding quarter of the previous year the rate of mortality of children under 5 was 35.2 percent. of the total mortality. In the Artillery sub-district the rate is 37.9 percent.. in the Spitalfields, 40.9 percent. in the Mile End New Town, 30.1 percent. in the Whitechapel North, 54 per cent.; in the Whitechapel Church, 15.3 percent.; in the Goodman's Fields, 52.1 percent.; and in the Aldgate, 62.7 percent. 5 Pauper Illness in the Disteict. The Medical Officers of the Union have attended during the last quarter 1705 new cases of illness out of the "Workhouse; including 58 of small-pox, 40 of measles, 12 of scarlet-fever, 19 of hooping-cough, 42 of diarrhcea, 24 of fever, and 10 of erysipelas. In the corresponding quarter of the previous year the number of pauper cases of illness was 3523; including 245 of smallpox, 7 of measles, 19 of scarlet-fever, 32 of hooping-cough, 107 of diarrhoea, 171 of fever, and 36 of erysipelas. The diminution in the number of fever cases is very remarkable. Meteorology of Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis during the quarter has been 3.12 inches. During the corresponding quarter of last year the rain-fall was 7.66 inches. The mean temperature of the air was 41.9°. In the corresponding quarter of last year the mean temperature was 41.8°. The coldest days during the quarter were Saturday, the 18th November, Sunday, the 19th, and Friday, the 8th December, when the thermometer indicated respectively 25.0°, 20.3°, and 18.6°. The coldest day during the corresponding quarter of last year was on Christmas-day, when the thermometer indicated 9.8°, or 22.2° below the freezing point. The total rain-fall during the year was 22.41 inches. In the previous year the rain-fall was 18.6 inches. The following Table, taken from tho returns of the Registrar-General, shows the comparative results during the quarter:— LONDON. Oct. 7 th Oct. 14th Oct. 21st Oct. 28th Nov 4th Nov 11th Nov 18th Nov 25th Dec. 2nd Dec. 9 th Dec. 16 th Dec. 23rd Dec. 30th Deaths from Small ) Pox 72 61 53 1 61 54 76 67 78 104 106 90 97 Deaths from Scarlet Fever 38 29 40 31 38 32 40 34 39 34 37 28 34 Mean Temperature of the air 51.9° 45.5° 53.5° 46.9° 47.3° 39.2° 35.3° 34.3° 36.4° 29.80 39.9 41.6 43.0° Rain - fall in inches 0.77 oo.o 0.55 0.01 0.04 0.03 0.29 0.10 0.12 0.04 0.10 0.51 0.56 Deaths in London 1283 1275 1291 13G6 1400 13615 1626 1863 19'l8 1856 2121 1493 1686 Deaths in Whitechapel District 42 47 33 48 41 49 47 73 58 54 78 55 44 Deaths in ditto from Small-pox 1 0 2 2 1 2 2 4 2 2 1 2 2 Water Supply. The constant system of water supply, by the use of waste-preventers in the poorer districts, is increasing, and continues to give great satisfaction. There are now 156 waste-preventers, (10 new ones having been erected during the quarter), which supply water to about 1200 houses. So convinced am I of the great improvement of this mode of supply to the poor over the old intermittent system, that I have no hesitation in saying that it should be made compulsory on landlords of small tenements to adopt it; and I am happy in being able to state that the Metropolitan Board of Works 6 by virtue of the 8th section of three Metropolis Water Act, 1871, can, whenever they are of opinion that there should be in any district a constant supply, require the Company within the water limits in which such district is situate, to give a constant supply in such district. The powers however, given in this Act, do not appear to me to be sufficient to compel the owner of any house to provide the same with an adequate supply of water. In my opinion the only effectual way of obtaining such supply will be by the insertion in a new Sanitary Act for the Metropolis of that portion of the 258th clause in the Public Health and Local Government Bill relating to nuisances, which is, as follows: "Any inhabited house without an ade''quate supply of wholesome water or access to an adequate supply within " a reasonable distance " shall be deemed a nuisance. Public Pumps in the District. I have the satisfaction of reporting that all the public pumps in the District have now been removed, and, in some instances, the surface wells have been filled up. The last pump which remained was that near to Spitalfields Church, and this has, within the last two weeks, by order of the Board, been discontinued for use. An analysis of the water in the surface well which supplied this pump was made by Dr. Letheby on the 27th December, 1871. The result of Dr. Letheby's Analysis was that the water contains the altered products of drainage matters, and that it is entirely unfit for domestic use. The constituents of the water per gallon were ammonia in combination 0.410 grains. Ammonia obtainable from organic matter 0.015. Carbonate of lime 28.82 grains. Sulphate of lime 14.69 ,, Sulphate of magnesia 0.42 ,, Common salt 9.08 ,, Nitrate of magnesia 3.19 ,, Silica, alumina, and oxyde of iron 0.59 ,, Organic matter 0.68 ,, A similar result would be obtained from an analysis of nearly all the surface wells in London. I may here refer to the fact that in the year 1858 Dr. Lankester wrote to every Medical Officer of Health in the Metropolitan Districts requesting his opinion on the expediency of closing the street pumps in London, and that thirty-three of the Medical Officers of Health replied in writing to the effect that the use of London pump water was detrimental to health. Mr. Simon, in his reply to Dr. Lankester, states that "pumps supplying such "waters can never in London be otherwise than dangerous sources of supply. "The porous soil from which they suck is that into which our cesspools and "leaky drains discharge a great part of their fluids—sometimes even a part "of their solid contents—and in which, till very recently, all our interments "have taken place. It is a soil which consequently abounds with putrid "and putrifiable matter. The waters derived from it invariably contain "products of organic decomposition, more or less oxydised; and it is a mere "chance, beyond the powers of water drinkers to measure or control, whether 7 "that oxydation shall at all times be so incomplete, as to have left the "water still capable of a very dangerous kind of fermentation." After the expressed concurrent opinion of so many medical men and eminent chemists as to the unfitness for domestic use of the water obtained from tho pumps in London, it is my duty to advise the Board not only to keep closed the pump in Spitalfields, but to remove it and all the other disused pumps in the District, and to fill up the wells under the direction of the Surveyor; for these excavations in the earth are merely receptacles for retaining offensive gases, the gradual diffusion of which may be dangerous to the public health. The following are the localities where wells, over which pumps existed, have not been filled up; viz., one in Norton Folgate, near to the City Theatre; one in "Whitechapel Road, corner of Thomas Street; one in High Street, Whitechapel, near to Spectacle Alley, and one in Commercial Street, near to Spitalfields Church. Small-Pox. The deaths from small-pox registered in this District for the Quarter ending 30th December, 1871, have been 23. This is an increase of 12 upon tho return of the previous Quarter. The total deaths from small-pox which have occurred in this District during the last fifteen months, including the deaths in the Small-pox Hospitals of those who were sent from this District, have been 270; viz., for the Quarter ending 31st December, 1870, the deaths in tho District were 50, and 2 occurred in the Hospitals; for tho Quarter ending April, 1871, the deaths were 83, and 12 in the Hospitals; for the Quarter ending July the deaths were 42, and 24 in the Hospitals; for the Quarter ending September the deaths were 11, and 11 in the Hospitals ; and for the Quarter ending 30th December, 1871, the deaths in the District were 23, and 12 occurred in the Hospitals. The deaths from small-pox in London during the same five quarters have been 8476. The total number of cases which have been attended by the Medical Officers of the Union during the same period have been 870. Por the first named Quarter they were 245; for the sccond 352; for the third 174; for the fourth 41, and for the fifth 58. Vaccination. The eases of primary vaccination performed by Mr. Placeman, the Public Vaccinator, during this Quarter have only been 134, (while the births registered in the District have been 653); whereas, owing to the panic caused by the numerous cases of small-pox in this District in the first Quarter of this year, there were 871 primary and 1179 secondary vaccinations performed by him during the six weeks ending 30th March last. Now that the panic is subsiding, the desire of procuring vaccination has subsided with it; and unless the law relating to compulsory vaccination be stringently enforced, the number of cases of vaccination will rapidly decline, and thousands of children will thus be exposed to the fatal effects of small-pox. 8 The following return shows the number of successful primary vaccinations for each quarter during the year 1871 : WHITECHAPEL UNION.—Return of the number of Cases Vaccinated by the Public Vaccinator and the Medical Officer of the Workhouse, together with the number of Births Registered during the year ended December 30th, 1871. Quarter ending— PUBLIC VACCINATOR' Workhouse. Totals. Births Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. Registd. March 727 1169 10 0 737 1169 747 June 357 038 21 0 378 538 569 September 186 12 35 0 221 12 602 December 134 6 27 0 161 6 653 Totals 1404 1725 93 0 1497 1725 2571 Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending December 30th, 1871:— Number of inspections of houses as shown in the official returns 3766 Number of rooms found to be overcrowded, the space being less than ") 300 cubic feet for each person, reckoning 2 children under 10 l 20 years of age for one adult; nuisance in each case abated ) Number of cases of indecent occupation discovered 19 Houses specially visited 222 Ditto specially re-visited 663 Houses specially visited at night 36 Number of special notices served for the registration of houses 13 Preliminary notices served, many of such notices embracing several houses 322 Compulsory orders issued, embracing 81 premises 47 Summonses heard at police-courts 4 Houses in which the rooms or passages have been whitewashed 148 Rooms disinfected with sulphurous acid gas after the occurrence of [ small-pox and fever therein .' j Yards of houses paved or the pavement repaired 75 Drains in houses improved 93 Dust-bins provided 11 Privies limewashed, cleansed, and repaired 179 Water-butts and cisterns provided or repaired 30 Water-waste-preventers erected 10 Area gratings, cellar flaps, &c., repaired G Nuisances from dung and other offensive matter removed 25 Cellars used as dwellings discontinued for such use 3 Pigs kept so as to be a nuisance removed 29 The cow-houses in the District, 24, and the slaughter-h&uses, 39 in number, have been visited during the Quarter. 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 have promptly attended to. 9 ANNUAL REPORT. The number of births registered in this District, during the year 1871, has been 2571, and the number of deaths 2465. The births in 1870 were 2690, and the deaths 2465. The births therefore are less than those in 1870 by 119, and the number of deaths is precisely the same. The deaths in the Workhouse have been 304, against 342 for the previous year; and the deaths in the London Hospital 557 against 599. The population of this District at the taking of the last census was 76,332, which is 2638 less than when the census was taken in 1861. The rate of mortality has been, during the year, 32.2 per 1000, or 1 in 31.0 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 551. Deducting, therefore, the deaths in this institution from the total deaths the rate of mortality is 25.5 per 1000, or 1 in 39.1 of all living. By adding, however, the deaths of residents in this District which took place in other parts of London, the rate of mortality is probably about 29 per 1000 annually. The rate of mortality in this District exceeds that of the whole of London by about 4'6 per 1000. The deaths of the residents in this District which occurred in the London Hospital, exclusive of those from accident, have been 64, which is 11.6 per cent. of the total mortality in this institution. 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 10,194. During the previous year the number was 14,148, On referring to Table VI. in the Appendix it will be seen that in the year 1856 the pauper cases of illness amounted to 9,897, and that they annually increased up to 1868, when they reached the large number of 17,417, notwithstanding the decrease in the population. In the following year the sick cases were 14,031 ; in 1870 there was a slight increase, the number being 14,148 ; while in 1871, when a new system of medical attendance was adopted and an increase of the number of Medical Officers and of Relieving Officers was made, this gratifying result has been attained. On making inquiry of Mr. Vallance, the Clerk to the Board of Guardians, for an explanation of the great diminution of the pauper cases, he kindly furnished me with the following Memorandum : "Memorandum.—The diminution in the number of cases of sickness "recorded in the books of the Medical Officers as compared with former "years is not entirely real, by reason of the practice which formerly existed "in this Union of the Medical Officers requiring, in continuous cases, at 10 "intervals of a month or thereabouts, 'renewal' orders from the Relieving "Officers and of the entries of such ' renewal' orders in the Medical Officers' "books precisely as in the case of original orders. This fact, however, by no "means accounts for more than a proportion of the apparent diminution in "the number of separate cases, and other causes must be sought for the "extraordinary comparative figures which your tabular returns contain. "But here a difficulty presents itself, from the impossibility of assigning the "diminution with any positiveness to a given cause. Having conferred "upon the subject with Medical Officers and Relieving Officers I am led to "the conclusion that various causes have contributed to the very satisfactory "results indicated by your Returns. In the first place there is reason to "believe that there has been an actual diminution of sickness to a moderate "extent. Next the continuous improvements, under your own direction, "which have been effected in the sanitary condition of the District must "necessarily have been conducive to a greater degree of health among "the poorer classes. This opinion appears to be confirmed on persual "of the column headed 'Fever' in Table VI., the number of such cases "having been greatly reduced during the last three years; the number in "1868 being 586, while in 1871 they were only 201. And lastly, to the "improvements which have been effected in the administration of Poor Law "medical relief within the Union must be attributed to a large extent the "favourable returns now comparatively presented. "Whilst reasonable, and "indeed, increased facilities are afforded to the necessitous poor to obtain "medical and other relief, there is now, as regards the official staff, a greater "sub-division of labour than formerly, and this without division of responsibility. There is also a stricter discrimination exercised in the grant of "medical relief and a closer investigation of the circumstances of persons "who may apply for medical relief than was possible under the old regime. "You have recollection of the time when each of the two Relieving Officers "of the Union was compelled to ventilate their crowds of morning applicants "by disposing first of the large number who came for ' doctor's orders,' and "having ' given such orders—many upon trifling pretexts - that it was "absolutely impossible for the Relieving Officers promptly to visit and closely "to investigate such cases. Now, however, a salutary change has been "effected. In lieu of two Relieving Officers and two Assistants there are "five Relieving Officers (without Assistants), the Relief Districts being con"terminous with the five Medical Districts. There is now but one Dispensary "for the entire Union, and at this Dispensary (which adjoins the Relief "Office and communicates with it by means of a speaking tube) the Medical "Officers attend each morning to see patients and prescribe medicines. The "Relieving Officers being in attendance during corresponding hours in the "adjoining office, the immense advantage of the Relieving Officer and "Medical Officer of a District being enabled to confer upon cases which "present themselves is apparent. Prom these two departments an applicant "may, when the circumstances justify, obtain medical order, medical advice 11 ''and medicine, and ordinary or special extra relief. Every reasonable facility is "afforded for their obtaining promptly what they may stand in actual need "of; and yet, as an illustration of how trilling an inconvenience will often "deter persons applying for relief, instances are found in which, rather than "walk from the more remote parts of the Union (in no case more than "a mile) to the Workhouse Dispensary and there mingle with pauper appli"cants, the parties will attend the Medical Officer at his private surgery and "there actually pay for their medicines and attendance. The persons to "whom I refer were previously paupers, but, under the former regime, were "not required to attend other than at the Medical Officer's private surgery "and from thence at a Dispensary (now abolished) within a very short "distance." This Memorandum appears not only to confirm the opinion that the more efficient is the system of medical poor relief, the less will be the number of paupers; but it also shows the intimate connexion between diminished pauperism and improved sanitary arrangements. Sanitary Improvements. The Metropolis Local Management Act having now been sixteen years in operation, I have deemed it advisable to lay before you, in as brief a manner as I am able to do, an account of some of the most important of the sanitary improvements which have been carried out in this District; and as, perhaps, the extension of the sewerage may claim the first consideration, I may state, on the authority of the late Surveyor, Mr. Pricker, as is set forth and published in my Annual Report for December, 1867, in a Table furnished to me by that gentleman, that 20,559 feet, or nearly four miles, of new sewers have been laid down since 1857. Although sewers existed in most of the principal streets in Whitechapel Parish at the commencement of the operations of the Board, it was found, upon a house-to-house inspection, that the larger number of the houses were not drained into the sewers, but into cesspools in the basements. In those parts of the District in which there were no sewers the drainage into cesspools was unavoidable : and such was the indifference of owners of property to the importance of drainage that, on making an inspection of the houses in Great Prescot Street, it was found that 22 of them, or about 21 per cent., were drained into cesspools. Whenever it was found on inspection that a cesspool existed for receiving the filth of an inhabited house, and that there was a public sewer within 100 feet, an order was given by the Inspector to the owner requiring him to provide a trap and pan to the closet, to abolish the cesspool, and to make a drain from the premises direct into the sewer. On referring to my Report for the Quarter ending March, 1862, I find it recorded that 3450 cesspools had been filled up since the formation of your Board. Several cesspools have been discovered and filled up since 1862, but some of those which were recorded as having been abolished, have been found, upon subsequent inspection, not to have been so; the owners, from a 12 short sighted policy, instead of filling up the cesspools, merely supplied the privy with a trap and pan, thereby temporarily removing the nuisance and so deceiving the Inspectors. Sanitary Condition of Houses and Places improved. The improvements effected under the provisions of the Sanitary Acts in the condition of houses and places in this District have been duly recorded in my Quarterly Reports. I may, however, here recapitulate a few of the most important of these sanitary improvements, and the first that I shall mention are the houses in Leman Row. These houses were, in consequence of legal proceedings being taken against the owner, ordered by the Police Magistrate to be closed, the same having been proved to his satisfaction as being unfit for human habitation. This Court is entirely abolished and now forms part of the premises of a sugar refinery. 2. The nine houses in Swan Court, Glasshouse Street, which were unfit for habitation have been pulled down, the Court abolished, and a better class of houses erected on the site, having a frontage to the street. 3. The four houses in Avenue Place, Spitalfields, which were ordered by the Magistrate to be closed in consequence of their being unfit for habitation, still remain unoccupied. 4. Four houses in Rose Court, Upper East Smithfield, have been shut up for several years, the Landlord preferring to keep them empty rather than comply with the orders of the Board to register them and put them in a state fit for human habitation. 5. Miller's Court, Dorset Street, has been improved, in consequence of legal proceedings having been taken against the owner. This Court was so confined that it was considered to be unfit for habitation. The owner, in order to give more space for ventilation, took down part of a house, and, on the vacant space, erected the necessary domestic conveniences for the use of the inhabitants. G. The sanitary condition of Garden Place, Mile End New Town, has been greatly improved by the landlord carrying out a similar arrangement. 7. The same may be said of Swan Court, Middlesex Street. 8. Six houses which formed Black Horse Court, Spitalfields, have been demolished under the provisions of the Artizans and Labourers Dwellings Act. 9. Two houses in Bridgman's Alley having been considered by tho Medical Officer of Health to be unfit for habitation, legal proceedings were adopted to obtain an order from the Magistrate to close them. The order was obtained, and the houses were kept closed until the sanitary requirements were satisfactorily carried out. 10. A room in No. 107, New-road, was ordered by the Magistrate to be discontinued for use as a habitable room, the same being unfit for such purpose in consequence of deficiency of light and ventilation. 11. Lastly, I may mention George Court, Mile End New Town, in which there arc six houses of two rooms each, which I reported to the Board as 13 being unfit for habitation under the provisions of the Artizans and Labourers Dwellings Act; but the owner having made some improvements in the property, the Board did not think it advisable to order the houses to be demolished. These houses are nevertheless, in my opinion, still unfit for habitation, for the following reasons, viz., the small size of the rooms, which is only 12 x 12 x 6½ feet. The Court is entered by a narrow archway and is blocked up at each end by a wall, so that there is no current of air through it. The houses are without passage entrances, and the stairs leading to the upper rooms open from the lower rooms, thus forming a ventilating shaft to carry the foul air of the lower rooms into the rooms above. In addition to this sanitary defect there is no back ventilation to the houses; the floor of the lower rooms is six inches below the level of the Court, and the privies are within a few feet of the front doors of the houses. I have no hesitation in saying that all houses in such narrow Courts, and so constructed, are unfit for habitation, and ought to be demolished. Slaughter-Houses, Cow-Houses, and Bake-houses. The slaughter-houses and cow-houses are annually licensed for their respective purposes, and rules and regulations have been prepared by the Board, which are, as far as practicable, enforced by the Inspectors, who frequently make an inspection of all these premises. Convictions have been obtained against persons using unlicensed slaughterhouses. Legal proceedings have been taken and convictions obtained against several persons for exposing for sale food unfit for the use of man. The bake-houses are likewise regularly inspected with the view of ascertaining if the provisions of the Act relating to them are duly observed. The Closing of Vaults undek Churches. The vaults under Whitechapel Church, Spitalfields Church, Trinity Minories Church, the German Church in Hooper-square, and the Danish Church in Well close-square, have been filled up in accordancc with the order of, and in the manner prescribed by, the Privy Council. The whole of these works were carried out under my supervision. Trades Nuisances Abolished. The most important of these Nuisances, and which more seriously affected the health of the inhabitants living in their vicinity, were the Bone Boiling Factories in Thomas Street and in Buck's Row. These are now abolished, and as no person, under the provisions of the 55th section of the Building Act, 1844, can lawfully establish or newly carry on this business, the District will in future be relieved from this disgusting and health-destroying nuisance. A Bone Boiling Business in Speck's Buildings was abolished, iu consequence of proceedings having been taken against the owner. Also, 14 A Grease Making Business in George Yard, Whiteehapel. Also, A Fat Melting Business in Green Street, Whiteehapel. The undermentioned businesses have either been entirely discontinued, or the nuisance arising from them considerably abated. 1. The preparation and drying of the Bladders and Entrails of Animals, which was carried on in Grey Eagle Street. 2. The Roasting of Malt. 3. The making of Soap. 4. The keeping of Pigs. 5. The keeping of Offensive Matter on Premises. G. The storing of large quantities of Methylated Spirits. 7. The making of Lucifer Matches. 8. The Dressing of Skins. 9. The prolonged keeping of Manure. 10. A Malleable Iron Foundry. 11. A Cotton-Waste Factory. 12. The Burning of Creosote for Fuel. 13. The Burning of Coke in open baskets, for the purpose of DryingPaper. 14. The Melting of Old Lead. 15. The Overcrowding of Dame Schools, In one of these Schools it was ascertained that 30 cubic feet was allowed for each child, and in another case only 20 cubic feet. 16. The Overcrowding of Workshops. 17. Numerous instances where Animals were so kept as to be a nuisauce. 18. The making of Fiddle Strings. 19. The making of Gelatine. 20. The re-burning of Animal Charcoal. 21. The business of a Fellmonger, &c. Other Sanitary Improvements. 1. The better paving of the private courts. 2. Ditto of back and front yards of inhabited houses. 3. The Registration of Lodging-houses under the provisions of the 35th section of the Sanitary Act (1866), and the adoption by the Board of rules and regulations for their better management. 4. The discontinuance of numerous cellars for habitation. 5. The erection of a disinfecting apparatus. 6. The providing of means for disinfecting rooms. 7. The improved water supply, by the use of water-waste-preventers, whereby about 1200 houses are supplied with water direct from the main. 8. The causing to be erected numerous public dust-bins, which, by arrangement with the contractor, are emptied daily. 15 9. The flushing of courts and alleys. For further particulars respecting the sanitary work performed by the Officers of the Board, I must refer you to my sixty-two Quarterly Reports, which have been printed aud circulated during the sixteen years that your Board has been in existence. Provisions of Acts which have NOT been complied with. While on the one hand I have set forth the amount of work which your Board have accomplished for improving the sanitary condition of the District, I feel bound to mention some of the provisions of the Sanitary Act which have not been carried out. As these clauses are of great importance to the public health, I hope that the Board will soon be convinced of the necessity of putting them in force. The clauses I refer to are five in number, viz., the 47th, 24th, 27th, 28th, and 37th. By the 'provisions contained in the 47th section, powers appear to be given to a Local Board to purchase and take lands otherwise than by agreement. By this section of the Sanitary Act, the Board would be enabled to purchase a house, or portion of a house stretching over any court or alley to the prevention of that free circulation of air which is so essential to the health of the inhabitants. Besides, a majority of these covered entrances are used by the public as urinals, and are thus not only rendered nuisances to the public generally, but are detrimental to the health of the immediate residents. It is true that such improvements as those I have indicated would not, to the general public be so apparent, as the opening out of a new thoroughfare ; nevertheless, the influence which such improvements, steadily persevered in, would have upon the public health of the District would be incalculable, while a corresponding saving in poor-rate expenditure, for the maintenance of sick paupers, would be effected. By the provisions of this section land may be obtained, and may either be kept as open spaces, or might be used for the erection of a temporary hospital for epidemic diseases, or for the erection of a mortuary, or for any other purpose contemplated in the Act. The 24th section authorizes the Local Board to provide and maintain a carriage or carriages for the conveyance of persons suffering under any contagious or infectious disease, to a hospital or place for the reception of the sick, or to their own homes. The 27th section authorizes the Local Board to provide a proper place for the reception of dead bodies ; and when such place has been provided, the relieving officer, upon his obtaining an order from the Magistrate, is in duty bound to bury the body within the time prescribed by the Magistrate, provided that the friends of the deceased refuse to bury it; and the expense 16 so incurred by the relieving officer may be recovered by him, in a summary manner, from any person legally liable to pay the expenses of such burial. The 28th section authorizes the Local Board to provide a place for the reception of dead bodies, (otherwise than at a workhouse or at a mortuary) during the time required for the making of post mortem examinations, when the same are ordered to be made by the coroner of the district, or any other constituted authority; and, Lastly, the 37th section empowers each local authority, either separately or in combination with two or more authorities, to provide for the use of the inhabitants within its district, district hospitals, or temporary places for the reception of the sick. Under the existing arrangements for the removal of the sick to hospitals, it appears to be injurious to the self-respect of a large and highly useful class of persons to compel them to go to a pauper establishment while suffering from illness; for there is no provision made in the existing pauper hospitals for the reception of respectable domestic servants, tradesmen's assistants, and others, whose employers would be willing to pay for their maintenance and treatment in a hospital. It would be very desirable if an arrangement could be made with the poor-law authorities, whereby a portion of each hospital for infectious diseases could be set apart for self-dependant cases, i. e., those patients for whom a maintenance or weekly allowance would be offered and paid. There are two or three other Acts of Parliament which have not been acted on by your Board, viz. The Labouring Classes Dwellings Act of 1851, and the Public Works Loan Commissioners Act of 1860, and the Act to amend the above-named Acts, 1867. These are permissive Acts, and were passed for the encouragement of local authorities to establish improved lodging houses for the labouring classes. Additional Paving Works required eor Sanitary Purposes. The places in the poorer districts which more immediately require the attention of the Board for a re-lay of the carriage-ways, for the health of the inhabitants, are the following, viz. Flower and Dean Street, Fashion Street, Thrawl Street, and Keate Street. As a matter of convenience to all the officers of the Board, it is most desirable that all the above-mentioned Streets should be re-numbered. 17 The following Table shows the localities which are either entirely without Sewers, or in which the Sewerage is imperfect; and Mr. S. W. Iron has kindly, at my request, made his observations on the state of the Sewerage in the several localities:- LOCALITIES. REMARKS. Whitechapel. Angel Alley 12-inch pipe sewer, very defective. Newnham Street 9-inch pipe sewer only. Scarborough Street Ditto ditto Tenter Street (East) Ditto ditto Tenter Street (West) No sewer. Tenter Street (North) 9-inch pipe sewer only. Tenter Street (South) Ditto ditto Alie Place 6-inch pipe sewer only. Gower's Row No sewer. Half-Moon Passage Small piece of brick sewer only. Colchester Street 18-inch brick sewer, defective. Rupert Street Partly drained by an 18-inch brick sewer, defective. Little Middlesex Street 9-inch pipe sewer only. New Castle Street Brick sewer, very defective. Old Castle Street Ditto ditto New Castle Place No sewer. Boar's Head Yard 9-inch pipe sewer, very defective. New Goulston Street 9-inch pipe sewer, defective. Wellclose Square Brick sewer, defective. Grace's Alley Old pipe and brick sewers, defective. Spitalfields. Grey Eagle Street 18-inch brick sewer, very defective. Fashion Street Old brick sewer, defective. Union Court 18-inch brick sewer, defective. Fashion Court Pipe sewer, defective. Princes Street Brick sewer, defective. Wood Street Ditto ditto Wilkes Street Ditto ditto Artillery Passage Pipe sewer, very defective Lower Keate Street 12-inch pipe sewer, defective. Paternoster Row Ditto ditto Mile End New Town. North Place 6-inch pipe sewer, defective. Dunk Street 9-inch pipe only. Buttress Street Ditto ditto Norton Folgate. Fleur-de-lis Street Old and defective pipe sewer. Church Passage No sewer. Chapel Street Old and defective pipe sewer. Aldgate. Burr Street Old brick sewer, very defective. Lower East Smithfield Ditto ditto 18 Sanitary Works Performed during the year 1871. The following return shows the amount of work done by the Sanitary Inspectors during the year 1871. Number of inspections of houses as shown in the official return 15,238 Houses systematically visited, and the rooms measured to ascertain their cubic capacity 32 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 61 Number of cases of indecent occupation discovered 54 Houses specially visited 1388 Houses specially re-visited 3382 Houses specially visited at night 36 Ditto registered by the order of the Board 29 Certificates and copies prepared for the registration of the above houses 58 Number of special notices served for the registration of houses 94 Preliminary notices served, many of such notices embracing several houses 1299 Compulsory orders issued, embracing 405 premises 169 Summonses heard at police courts 12 Houses in which rooms or passages have been whitewashed 910 Ventilation of houses improved 21 Yards of houses paved or the pavement repaired 231 Cesspool abolished 1 Drains in houses improved 329 Dust bins provided 46 Privies limewashed, cleansed and repaired 496 Water-butts and cisterns provided or repaired 149 Water-waste preventers erected 62 Area gratings, cellar flaps, &c. repaired 21 Cellars used as dwellings discontinued for such use 12 Animals, so kept as to be a nuisance, removed 29 Nuisances from Dung and other offensive matter removed 69 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 iu number) have been twice specially visited during the same period. A return was furnished by the Inspectors, in accordance with the in- , structions of the Committee of Works, on the 11th January, 1872, with reference to the number of rooms which have been disinfected, and the number of articles conveyed to the Stone Yard, and there disinfected, in the apparatus erected for that purpose. The number of rooms disinfected during the past year is 145. The number of articles disinfected is 1281, viz. 64 beds, 73 mattresses, 125 pillows, 71 bolsters, 240 blankets, 125 sheets, 68 counterpanes, and 515 sundry other articles. I am, Gentlemen, Your obedient Servant, 15, Great Alie Street. JOHN LIDDLE. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, of the Three Months ending on the 30th Dec., 1871. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Cholera and Choleraic-Diarrhœa. Continued Fever, Typhus & Typhoid. Diphtheria. 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 3 9 7 0 14 0 14 0 0 2 1 0 32 18 0 8 0 0 0 0 197 305 Mr. Champneys 10 11 0 2 6 0 6 0 0 5 0 0 101 3 0 1 0 1 0 4 295 445 Dr. Richardson 1 15 0 1 12 0 2 0 0 1 0 1 54 0 0 3 0 0 0 0 332 422 Mr. Sequeira 26 5 5 7 7 0 1 0 0 1 0 0 19 3 0 1 0 0 0 0 213 288 Mr. Loane 18 0 0 9 3 0 1 0 0 1 0 0 46 0 2 1 0 1 2 160 245 Total 58 40 12 19 42 0 24 0 0 10 1 1 252 25 0 15 1 1 1 6 1197 1705 Corresponding Quarter of previous Year. 245 7 19 32 107 0 171 1 0 36 0 0 416 74 1 38 6 2 0 4 2364 3523 The Medical Officers of the Union have, during the last five weeks, in addition to the above-recorded cases of Fever, attended 32 cases of Febricula. TABLE II. Showing the Deaths from Epidemic Diseases, for the Three Months ending 30th Dec., 1871. Districts. Small-Pox. Measles. Scarlet-Fever. Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera & Choleraic Diarrhœa. Total. Remarks. Artillery 0 2 1 0 0 0 1 0 4 Spitalfields 2 4 0 0 0 3 1 0 10 Mile End New Town 6 0 1 0 2 2 4 0 15 Workhouse. Whitechapel, North 1 4 0 0 0 3 1 0 9 Whitechapel Church 0 1 4 0 3 0 3 0 11 Hospital. Goodman's Fields 3 1 4 0 5 1 1 0 15 Aldgate 11 0 0 0 2 1 2 0 16 Totals 23 12 10 0 12 10 13 0 80 Deaths from Epidemics for the corresponding Quarter, 1870. 50 5 23 0 10 12 19 0 124 One death from Pyaemia and 3 from Erysipelas occurred in the Whitechapel Church sub-District. During this quarter there were 4 deaths from Fever in the Fever Hospital, and 12 deaths smallpox in the Small Pox Hospitals. TABLE III. Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 30th Dec., 1871. 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, 47 Females, 32 Corresponding Quarter of 1870. Workhouse 4 1 3 17 18 32 4 79 76 London Hospital 1 7 16 64 47 18 1 Males, 95 155 Females, 59 154 TABLE IV. Ages at Death in each Registration District, for the Three Months ending 30th Dec,, 1871. Districts. 0 and under 1. and under5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total. Remarks. Artillery 6 4 2 4 3 8 2 29 Spitalfields 21 13 9 13 9 17 1 83 Mile E. N. Town 28 20 11 23 28 40 6 159 Workhouse. Whiteehapel, N 19 21 1 2 10 18 3 74 Whitechapel Ch 17 13 18 68 52 23 5 196 Hospital. Goodman's Fields 24 12 7 4 10 8 4 69 Aldgate 12 15 5 10 8 8 1 59 Total 127 98 53 127 120 122 22 669 TABLE V. The Births and Deaths in each Registration District, for the Three Months ending on the 30th Dec., 1871. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M. F. Artillery 31 29 60 12 17 29 31 0 Spitalfields 64 64 128 38 45 83 45 0 Mile End N.Town 79 77 156 84 75 159 0 3 Workhouse. Whitechapel, N. 49 50 99 36 38 74 25 0 Whitechpl Church 37 32 69 125 71 196 0 127 London Hospital. Goodman's Fields 40 41 81 41 28 69 12 0 95 Non-residents died in the London Hospital. Aldgate 31 29 60 24 35 59 1 0 Totals 331 322 653 360 309 669 114 130 Excess of Births over Deaths, deducting the 95 non-residents, 79 Population in 1871, 76,332. Population in 1861, 78,970. TABLE VI. Total number cf the undermentioned Diseases, recorded in the Books of the Medical Officers of the Union, from 1860 to 1871, and the total cases of illness. Year. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea and Dysentery. Fever. Cholera & Choleraic-Diarrhœa. Erysipelas. Puerperal Fever. Carbuncle. Bronchitis and Catarrh. Pneumonia and Pleuritis. Croup. Rheumatic Fev. Ague. Delirium Trem. 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 l 74 1 6 533 134 12 20 11 8 14564 1864 21 482 156 217 1127 295 l 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 6 632 258 1 100 35 11 14031 1870 302 257 97 140 1118 325 4 82 0 1 825 195 0 134 44 5 14148 1871 625 178 32 102 600 201 2 56 3 7 1149 153 3 77 14 5 10194 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 had been 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." A remarkable decrease in the number of sick paupers has occurred this year. The diminution, as compared with the returns of last year, is nearly 4000 ; and if we compare the returns of the last two quarters with the corresponding quarters of the previous year, the diminution in the numbers on the sick list is still more remarkable, the numbers being for the last two quarters of this year 3849, and for the corresponding quarters of the previous year 7108. 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 1871. Year. Total Births. Total Deaths. Deaths of Non- residents exclusive of Deaths from Accident. Total Deaths in the London Hospital. Total Deaths in the Workhouse. 1857 (53 weeks) 2868 2350 147 338 272 1858 2742 2444 140 325 269 1859 2826 2321 189 354 239 1860 2746 2302 163 326 282 1861 2686 2331 179 366 287 1862 2813 2551 187 330 369 1863 (53 weeks) 2796 2764 181 418 324 1864 2803 2792 212 453 414 1865 2684 2532 208 416 362 1866 2561 3495 432 733 413 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 1871 2571 2465 339 551 304 The number of inquests which have been held this year in this District has been 324. In the year 1870 the number was 311. TABLE VIII. Showing the Deaths from Epidemic Diseases in the Whitechapel District during the last 15 years. Name of Disease 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 Small Pox 3 4 60 21 28 33 69 5 22 44 40 11 1 56 159 Measles 60 78 31 81 27 153 26 137 28 130 33 69 71 36 42 Scarlet Fever & Diphtheria 43 87 96 59 70 91 200 50 80 76 26 48 208 59 25 Hooping Cough 89 117 50 49 98 62 52 74 97 94 72 55 113 50 43 Diarrhoea 139 108 141 67 101 69 114 109 122 119 100 138 97 107 125 117 104 93 69 65 250 158 170 167 100 82 109 95 52 40 Cholera & leraic-Diaha. 10 6 5 1 4 5 5 2 4 904 9 10 7 6 3 Total 461 504 476 347 393 663 714 547 520 1476 362 440 592 366 437 London Fever 2203 1902 179G 1302 1754 3635 2802 3689 3232 2681 2174 2483 2211 2049 1755 Scarlta. & Diph. 1587 4118 4197 2457 3058 4194 5799 3806 2614 2316 1836 3418 6162 6306 2220 Small Pox 154 247 1156 877 215 345 2012 537 646 1388 1339 606 273 958 7834 TABLE IX. Showing the cases of Epidemic Diseases among the pauper population in the Whiteehapel District during the last 15 years. Name of Disease 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 Small Pox 6 20 242 65 86 113 253 21 86 261 254 93 5 302 625 Measles 266 427 179 520 70 525 80 482 51 679 155 323 212 257 178 Scarlet Fever & Diphtheria 49 146 175 93 109 118 305 156 164 197 60 54 311 97 32 Hooping Cough 150 230 146 83 388 153 169 217 280 217 219 144 308 140 102 Diarrhœa 1324 946 209 773 1418 1085 1108 1127 1342 1664 1471 1631 1033 1097 590 Fever 1441 590 411 190 109 822 464 295 573 343 308j 586 385 325 201 Cholera & Choleraic-Diaha. 16 0 1 1 0 1 1 4 4 58 5 8 1 4 2 Total 3252 2359 1363 1725 2180 2817 2380 2302 2500 3419 2469 2839 2255 2222 1730