WHI 20 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 30TH MARCH, 1872, BY JOHN LIDDlE, MEDICAL OFFICER OF HEALTH. Hontrmi: Peintbd by T. Penny & Co., 121, Lehan Steeet, "wnitecharel, E. 1872. /\/l ^ REPORT OF THE MEDICAL OFFICER OF HEALTH, fob the Quarter ending 30th March, 1872. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, March 30, 1872, the births registered in the Whitechapel District were 720; viz., 398 males and 322 females. During the same period the deaths have been 608:* of these, 351 have been of males and 257 of females. In the corresponding Quarter of the previous year, the births were 747 and the deaths 665. There has been, therefore, a decrease of 27 in the number of births, and a decrease of 57 in the number of deaths. The deaths in the London Hospital have been 143; viz., 101 males and 42 females. Of the total deaths in this institution there were 24 of persons resident within the District, 86 of non-residents, and 33 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 was one death from typhoid fever in the London Hospital during this Quarter. Two deaths occurred in this institution from pyaemia. The deaths in the Workhouse have been 75; viz., 46 males and 29 females. No death from epidemic disease occurred in this establishment. The deaths from epidemic diseases in the entire District have been 69; viz., 11 from small-pox, 8 from measles, 2 from scarlet-fever, 1 from diphtheria, 41 from hooping-cough, 1 from diarrhoea, and 5 from fever. To the deaths from small-pox as above recorded there must be added the 5 deaths which occurred in the Small Pox Hospitals, thus making a total of 16 deaths from small-pox. No death from fever occurred in the Fever Hospitals. There were G deaths from erysipelas, 2 from puerperal fever, 2 from pyaemia, 4 from rheumatism, and 4 from croup. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 130; viz., 83 from small-pox, from measles, 8 from scarlet-fever, 16 from hooping-cough, 8 from diarrhoea, and 11 from fever. *In the Registrar General's Returns, 609 deaths are recorded. This discrepancy is accounted for by there being a double return of an inquest in the Spitalfields SubDistrict, No. 387. 4 The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 131: of these, 70 were caused by bronchitis, 52 by pneumonia, 1 by laryngitis, 4 by pleuritis, and 4 by asthma. Consumption was fatal to 88 persons. The deaths from other tubercular diseases were 31; viz., 14 from mesenteric disease, 10 from tubercular meningitis, 7 from hydrocephalus or water on the brain; making a total of 119 deaths from tubercular diseases. Diseases of the organs of circulation were fatal to 41 persons; of these, 33 died from disease of the heart, 1 from aneurism, 2 from disease of the veins, 1 from anaemia, and 4 from pericarditis. The deaths from diseases of the urinary organs were 22; of these, 10 were caused by nephria or Bright's disease, 1 by diabetes, 4 by nephritis, 6 by other diseases of the kidneys, and 1 by stone in the bladder. There were 4 deaths from syphilis, 2 of which were of children under one year of age. Three persons died from stricture of the urethra. Convulsions caused the deaths of 27 children. There were 6 deaths from premature birth, 2 from teething, and 23 from atrophy and debility. Two persons died in childbirth. Three persons died from privation. The deaths of 17 persons are attributed to old age; of these, 9 were above 80 years of age. Five persons under 70 died from premature decay; two of whom had only reached their 53rd year. There were 22 deaths from mechanical violence; of these, 6 were caused by horses and vehicles in the streets. There were 5 deaths by manslaughter. Burns and scalds were fatal to 7 persons. One person was accidentally drowned. Two persons committed suicide. One child was suffocated in bed; and a man, aged 75, died from accidentally choking, while eating a beef-steak. The number of inquests has been 75. In the corresponding quarter of last year the number was 98. The number of deaths which have not been certified by a medical practitioner has been 12; of these, 11 were recorded in the Spitalfields sub-district. The mortality of children under five years of age was 206. This is 33.8 per cent, of the total mortality. In the corresponding quarter of the previous year the rate of mortality of children under 5 years was 37.8 per cent. of the total mortality. In the Artillery sub-district the rate is 40.0 per cent.; in the Spitalfields, 47.3 per cent.; in the Mile End New Town, 34.1 per cent.; in the Whitechapel North, 54.3 per cent.; in the "Whitechapel Church, 9.2 per cent.; in the Goodman's Fields, 54.1 per cent.; and in the Aldgate, 46.7 per cent. 5 Pauper Illness in the District. The Medical Officers of the Union have attended during the last quarter 1428 new cases of illness out of the "Workhouse ; including 28 of small-pox, 27 of measles, 6 of scarlet-fever, 42 of hooping-cough, 27 of diarrhoea, 6 of fever, 94 of febricula, and 13 of erysipelas. In the corresponding quarter of the previous year the number of pauper cases of illness was 3688; 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 order to obtain a more accurate return of the cases of sickness, it is desirable that the Medical Officers should revise their weekly returns of cases, for I can state, from my own experience as a Medical Officer of the "Union, that there is sometimes great difficulty in distinguishing cases, where only febrile symptoms are present when the patient is first seen by the medical officer. The alterations, if any, might be made in red ink. From personal inquiry of the Medical Officers, relative to the general accuracy of their weekly returns of sickness, Mr. Vallance informs me that they may be considered reliable. Meteorology of Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis during the quarter has been 5.66 inches. During the corresponding quarter of last year the rain-fall was 4.21 inches. The mean temperature of the air was 43.3°. In the corresponding quarter of last year the mean temperature was 40.0°. The coldest days during the quarter were Sunday, the 10th March, Monday, the 11th, and Thursday, the 21st March, when the thermometer indicated respectively 28.5°, 28.3°, and 26.2°. The coldest day during the corresponding quarter of last year was on Friday, January 13th, when the thermometer indicated 18.3°, or 13.7° below the freezing point. The following Table, taken from the returns of the Registrar-General, shows the comparative results during the quarter:— LONDON. Jan. 6 th Jan. 13th Jan. 20th Jan. 27th Feb. 3rd Feb. 10th Feb. 17 th Feb. 24th Mar 2nd Mar 9th Mar 16 th Mar 23rd Mar 30th Deaths from Small Pox 91 90 93 90 52 68 48 53 52 49 42 48 55 Deaths from Scarlet Fever 24 23 34 19 32 31 16 32 21 29 19 19 22 Mean Temperature of the air 41.5° 40.3° 39.1° 42.0° 44.4° 46.5° 43.8° 44.9° 45-6° 48.7° 44.6° 38.9° 43.5° Rain-fall in inches 1.19 0.71 0.54 1.18 0.04 0.20 0.11 0.34 0.17 0.07 0.02 1.00 0.79 Deaths in London 1617 1632 1628 1602 1433 1514 1320 1488 1423 1565 1475 1463 1641 Deaths in Whitechapel District 59 48 54 38 36 45 46 56 35 42 43 59 47 Deaths in ditto from Small-pox 1 2 1 2 1 0 0 0 1 0 0 0 3 Public Pumps in the District. All the public pumps in the District have now been taken away, and, by direction of the Board, the surface wells have been filled up. I believe 6 that there are a few private pumps in the District, a circumstance much to be regretted; for water drawn from these shallow wells is entirely unfit for beverage. Some of the cowkeepers have a pump on their premises, the water from which, if used for the purpose of mixing with the milk, may be attended with disastrous consequences to the consumers of the milk so adulterated. Small Pox. The deaths from small-pox registered in this District for the Quarter ending 30th March, 1872, have been 11. This is the same number that occurred in the previous Quarter. The total deaths from small-pox which have occurred in this District during the last eighteen months, including the deaths in the Small-pox Hospitals of those persons who were sent from this District, have been 28; viz., for the Quarter ending 31st December, 1870, the deaths in the District were 50, and 2 occurred in the hospitals; for the 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; for the Quarter ending 30th December, 1871, the deaths were 23, and 12 in the Hospitals ; and for the Quarter ending 30th March 1872, the deaths in the District were 11 and 5 occurred in the Hospitals. The deaths from small-pox in London during the same six quarters have been 9307. The total number of cases which have been attended by the Medical Officers of the Union during the same period has been 898. For the first named Quarter they were 245; for the second 352; for the third 174; for the fourth 41, for the fifth 58, and for the sixth 28. In 1869 there was only one death from small-pox registered in the District, while in 1871 there were 150. Vaccination. The cases of primary vaccination performed by Mr. Placeman, the Public Vaccinator, during this Quarter have only been 219, (while the births registered in the District have been 720); whereas, owing to the panic caused by the numerous cases of small-pox in this District in the first Quarter of 1871 there were 871 primary and 1179 secondary vaccinations performed by him during the six weeks ending 30th March. 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. The following return shows the number of successful primary vaccinations for each quarter during the year 1871, and for the quarter ending 30th March, 1872: 7 WHITECHAPEL UNION.—Return of the number of Cages Vaccinated by the I'ublic Vaccinator and the Medical Officer of the Workhouse, together with the number oi Births Registered during the same quarters. Quarter ending— PUBLIC VACCINATOR. Workhouse. Totals. Births Registd. Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. March, 1871 727 1169 10 0 737 1169 747 June 357 538 21 0 378 538 569 September 186 12 35 0 221 12 602 December 134 6 27 0 161 6 653 March, 1872 219 16 43 1 262 17 720 Totals 1623 1741 136 1 1759 1742 3291 New Sewers. Since the publication of the list of new sewers in my Report for the Quarter ending 28th December, 1867, two additional sewers have been constructed, viz., one in Mount Street, which is a 12-inch pipe, of 330 feet in length, and the other in Tenter Street North, and Alie Place, which is a 15-inch pipe, of 456 feet in length. The total length of new sewers, constructed in this District at the public cost, is now 21,345 feet, or upwards of four miles. Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending March 30th, 1872:— Number of inspections of houses as shown in the official returns 3345 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 11 Number of cases of indecent occupation discovered 15 Houses specially visited l90 Ditto specially re-visited 594 Preliminary notices served, many of such notices embracing several houses 299 Compulsory orders issued, embracing 79 premises 54 Houses in which the rooms or passages have been whitewashed 83 Rooms disinfected with sulphurous acid gas after the occurrence of) small-pox, fever or scarlet fever, therein 17 Yards of houses paved or the pavement repaired 20 Drains in houses improved 68 Dust-bins provided 7 Privies limewashed, cleansed, and repaired 113 Cesspool abolished 1 Water-butts and cisterns provided or repaired 18 Nuisances from dung and other offensive matter removed 30 Donkey, kept so as to be a nuisance, removed 1 When rooms are disinfected after any contagious disease, the landlord is required to strip off the paper, and thoroughly cleanse and disinfect the walls and ceilings. On stripping off the paper, it is sometimes found to be upwards of an inch in thickness, layer upon layer of paper having been 8 pasted on the walls. This supposed economical plan, of allowing the old and dirty paper to remain, is attended with considerable danger, as the paper so remaining is likely to retain the contagious matter of disease. Overcrowding and Indecent Occupation of Rooms. From the preceding return of sanitary works performed during the quarter, it appears that on the inspection of houses some of the rooms were found not only to be overcrowded, (that is to say, a less space than 300 cubic feet for each person) but, in some cases, they were indecently occupied. Prom the following report of Mr. "Wrack, one of the Inspectors, the Board will learn how the poorer class of people are occasionally lodged in some of the bye-places in this District. "On Saturday morning, the 2nd March, between 6 and 7 o'clock, I visited several houses in Goulston Street. At No. 5 I found one woman and three children sleeping in a dark cupboard on the ground floor, immediately adjoining an offensive privy ; the room in front of this cupboard was occupicd by a man and three young female children. At No. 13 1 found, in the back room of the ground floor, closely contiguous to three privies and a dusthole, one man, six women, and three children sleeping there. The room measured 12 feet X 9 X 7, giving only a cubic space of 756 feet for ten persons. The smell arising from each of these places, used as sleeping apartments, was most offensive." Trades' Nuisances. During the quarter a complaint has been made at this office respecting a nuisance from the premises in Goulston Street in which the manufacture of ''Saccharine for Brewers and Solid Glucose Sugar" is carried on. This complaint was followed by a memorial to the Board, signed by 56 inhabitants of the immediate vicinity, setting forth that the stench arising from these premises was injurious to the health of the neighbourhood. Steps were immediately taken by the Sanitary Officers of the Board to cause the owners to adopt such measures as would abate the nuisance complained of; but hitherto without any satisfactory result. Further proceedings will therefore be taken to compel the proprietors to abate the nuisance. The Board likewise received a memorial, signed by 56 inhabitants of the neighbourhood of Luke Street, Mile End New Town, complaining of a nuisance injurious to health, caused by the carrying on of the business of a Fellmonger in that street. The nuisance arising from this business has been repeatedly complained of, and legal proceedings have been from time to time instituted to obtain an abatement thereof. These proceedings have always had a temporary good effect in causing a diminution of the offensive effluvium; but of late the stench has been so great that the Board deemed it necessary to again institute legal proceedings. The proprietor therefore has ceased to carry on the business; and as no person, under the 55th clause of the Building Act, 1844, can newly carry on this business at a less distance than 40 feet from a public way, the neighbourhood will be entirely free from this disgusting nuisance. 9 Sanitary Condition of Houses and Places Improved. Since the publication of my last Report improvements have been effected under the provisions of the Nuisances' Removal Act, in the following localities, viz., 1.—Providence Court, Glass-House Street. 2.—Easington Buildings, Montague Street. 3.—Bell Court and Bell Place, Princes Street. 4.—Goulston Street. 5.—Jacob's Court. 6.—Upper Keate Street. 1. Providence Court.—In this court one of the houses was considered to be unfit for habitation, in consequence of its being close to two privies, which were common to the inhabitants of the eight houses constituting this court. Soon after the serving of the usual notices on the landlord to close this house, he pulled down the offensive privies, and has since erected, for the better convenience and health of the tenants, a separate privy for each house. 2. Easington Buildings.—This was a long, narrow court, consisting of 18 houses, nine on each side, and closed at the further end by a high wall. It was entered under an archway, formed by part of a house in Montague Street, so that it was impossible for the air properly to circulate therein. The landlord having received notice that the whole place was unfit for habitation, in consequence of its being insufficiently ventilated, (and which had been represented to me by the late Dr. Richardson as being the most unhealthy court in his medical district) had an interview with mo, respecting the condition of this court, when he proposed to give immediate notice to all the tenants to quit the premises, and said that he would pull down two of the houses, one on each side, at the end of the court, and erect on their sites the proper conveniences for the tenants; which conveniences were then so placed as to cause a nuisance to some of the inhabitants; that he would ventilate the court by taking down that portion of the house in Montague Street which extended over the entrance to it; that, as the houses had no back yards, he would ventilate them in the best practicable manner from the roof, so as to obtain a current of air through each house; and that he would provide a water-waste-preventer for the use of his tenants, so that they should have a constant supply of water direct from the main. All these improvements are now nearly completed. 3.—The fourteen houses in Bell Lane and Bell Place, Princes Street, have been taken down, in consequence of such defective ventilation as rendered them unfit for habitation. A better class of houses, fewer in number, is in the course of being erected in their stead. 4.—The ground-floors of Nos. 5, 7, 9, 11, 13 and 15, Goulston Street, being unfit for habitation, in consequence of defective ventilation, orders have been given to the owner either to improve the ventilation or to close the rooms. The landlord has so far complied with the orders as to close the room and cupboard at No. 5, as mentioned at page 8, and he has thrown the two rooms, at Nos. 7, 13, and 15, into one; and he is about to do the same with the rooms at Nos. 9 and 11. 5.—The houses in Jacob's Court, Castle Alley, which were considered to 10 be unfit for habitation, have been greatly altered, and to some extent improved; but as there is no current of air through Nos. 18 and 19 it is questionable whether they can be made fit for habitation. 6.—The unused cellars belonging to eight houses in Upper Keate Street have been filled up, in consequence of the effluvium which was caused by the tenants throwing into them all sorts of refuse; and as many of the unused cellars in the houses occupied by the poor are made receptacles for filth, they ought all to be filled up. The example which has been set by the owner of Easington Buildings is well worthy of imitation; for the opening out to public view of all the enclosed courts, and so admitting a free current of air, will not only improve the physical health of the people, but will likewise improve their moral condition. The making of new thoroughfares has its advantages, but more good would be done to the public health by causing a freer circulation of air in those courts which are inhabited by the poor. Bate of Mortality in the District. It might reasonably have been expected from the unproved condition of the District, as regards the sewerage, paving, and cleansing, that the rate of mortality would have decreased; but, from the returns of deaths, from the year 1857 to 1871, it appears that the rate of mortality has varied very little from year to year, except in the year I860, when the deathrate was considerably increased, by the prevalence of cholera as an epidemic. In the year 1861, when the population was 78,970, the deaths were 2,331, including the 366 deaths in the London Hospital; while in 1871, in a population of 76,332, the deaths were 2,465, including the 551 in the London Hospital. If we exclude all the deaths in the London Hospital, in each of these years, it will appear that the rate of mortality in 1861 was 24.8 per 1000, while in 1871 it was 25.0 per 1000. If we exclude only the deaths in the London Hospital of those persons who, at the time of their admission, resided in other districts, and include in the calculation the deaths of those persons who died from accident, whether they had been resident in this district or elsewhere, it will be seen that the rate of mortality in the former year was 27.2 per 1000, and in the latter 27.8 per 1000. If, however, we compare the rate of mortality at the present time with that of 1838, it will be seen that a very considerable diminution of the death-rate has taken place, the rate being in 1838, excluding the deaths in the London Hospital, 38.6 per 1000, and for the whole of Loudon it was 28.0 per 1000. From the Registrar General's returns, it appears that the rate of mortality for the whole of London, in 1861, was 23.2 per 1000, and in 1871 it was 24.7 per 1000. The lowest rate of mortality in London, from the years 1840 to 1871, occurred in 1850, when it was 21.0 per 1000. The deaths from fever, which were formerly so great in London, and especially in this District, are now greatly reduced. The number of these deaths in London in 1861, among a population of 2,803,989, was 1754; 11 and in 1871, in a population of 3,254,260, it was 1746. The deaths from Fever in the Whitechapel District in 1861, were 63, while in 1871 they were 40. In 1862 these deaths were 250, and in London 3635. In 1838 the deaths from fever in London were 4078, and in the Whitechapel District 368. In my Report for the Quarter ending Sept. 30, 1871, I drew attention to the defective ventilation of the dwellings of the poor, and I pointed out that there was an intimate relation between such defective ventilation and the mortality from tubercular and other diseases of a similar class; and I further showed, by the returns of the Registrar General, that this class of disease, which is generally admitted to be caused by the breathing of impure air, has a greater mortality than the whole class of miasmatic diseases; the latter being 23.4 per cent. of the total mortality, while the former amounts to 27.8 per cent. During this quarter the deaths from miasmatic diseases have been 87, viz., 69 from epidemic diseases, six from erysipelas, two from puerperal fever, two from pyaemia, four from rheumatism, and four from croup ; while the deaths from those diseases which are principally caused by the breathing of impure air have been 176, or rather more than double the number of deaths produced by the miasmatic class. Nothing to my mind is more clear than that the attention of the Board and the Sanitaiy Officers must be directed to the defective state of the ventilation of the dwellings of the poor; for consumption, and the whole tubercular class, viz., scrofula, mesenteric disease, hydrocephalus, convulsions, premature birth, teething, atrophy and debility, and tubercular meningitis, are chiefly caused by the defective ventilation of dwelling-houses, and particularly of sleeping-rooms, in which at least one-third of one's existence is passed. Impurity op the Atmosphere in Crowded Localities. The question of the impurity of the atmosphere in crowded localities will probably, in due time, receive that consideration from public authorities which its importance demands, and then energetic measures in dealing with confined courts will be adopted. Chemists have proved, by experiment, that not only is "the atmosphere of some rooms deficient in the due proportion of oxygen, but it contains three times the usual amount of carbonic acid, besides a quantity of aqueous vapour, charged with alkaline matter, which stinks abominably."* In the Sixth Annual Report of Dr. ANGUS Smith, Inspector under the Alkali Act, 1863, numerous tables are given of the composition of the air in several localities in England and Scotland, particularly in reference to the amounts of oxygen, carbonic acid, ammonia, albuminated ammonia, or ammonia from organic matter, &c. As a result, from experiments made by that gentleman, it appears that the condition of the air in different localities may be settled by experiment. "We may therefore possess a certain reliable standard of the impurity of the atmosphere, below which, houses and courts could be authoritatively condemned—opinion giving way *See Dr. Letheby's Report for the Quarter ending March, 1857. 12 to positive certainty." Such however is the feeling of oppression on entering some of the courts and alleys in this District, that it does not require the aid of chemical experiments to prove that the atmosphere within them is uufit for the purpose of maintaining the health of the inhabitants. It has been gravely stated that, before sanitary improvements can be effectually carried out, the people must be so educated as to feel the necessity of them; but as all public sanitary improvemements cost money, which must be provided out of the local rates by the persons benefited, it will be a long time before the necessity of carrying out sanitary improvements will be acknowledged. The education of the people in sanitary science will only be effected by showing them its beneficial results. Indifference on the part of the Public to the Provisions of the artizans and labourers dwellings act. Although the Artizans and Labourers Dwellings Act has been in operation since 1868, very few houses have been taken down under its provisions. I cannot account for this supineness on the part of the public (who have the power in their own hands to commence action by writing to the Medical Officer of Health, and informing him that certain houses, in their opinion, are unfit for habitation) in not putting this Act in force. Suggestion of a New Clause in the proposed Public Health Bill. The Nuisances' Removal Act does not enable either the Local Boards or the Magistrates to compel the demolition of any house, or part of a house, which may so obstruct the ventilation of a court as to render the locality unhealthy. It is true, that the whole court, if not sufficiently ventilated, may be ordered to be closed; but the closing of the court may be a very great hardship on the owner, and especially so if he only hold a lease of the property; for it may so happen that, by the taking down of one house, the landlord can render all the adjoining houses fit for habitation; but if he should do that without the consent of the freeholder, he may not only vitiate his lease, but render himself liable to damages. Almost every person, in speaking of the unhealthiness of towns, states that such unhealthiness is chiefly caused by the defective sanitary condition of the dwellings of the poor. In this opinion I fully concur. The importance, therefore, of remedying this evil cannot be over-estimated. A new Building Act, which shall prevent the erection of unhealthy dwellings, has long been expected; but as there is no prospect of such an Act being passed during this Session, power should be given in the Public Health Bill, now before Parliament, to Local Boards, to make such byelaws as will provide for the sanitary condition of all new buildings, whereby the extension of unhealthy buildings may be prevented. 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 March, 1872. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhœa. Cholera and Choleraic-Diarrhœa. Continued Fever, Typhus & Typhoid. Febricula. 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 5 3 1 9 8 0 i 19 0 i 1 0 26 7 0 14 0 0 0 2 172 269 Mr. Champneys 5 6 0 12 10 0 0 27 0 2 0 0 80 3 0 0 0 0 1 1 208 355 Mr. Sequeira 4 3 0 3 3 0 2 16 0 4 0 0 11 3 1 3 0 1 0 0 174 228 Mr. H. Braye 5 2 1 14 5 0 0 23 0 4 0 0 53 1 0 3 4 0 1 3 203 325 Mr. Loane 9 13 4 4 1 0 3 6 0 2 0 0 53 0 0 9 3 0 0 2 142 251 Total 23 27 6 42 27 0 6 94 0 13 1 0 223 14 1 29 7 1 2 8 899 1428 Corresponding Quarter of previous Year. 352 15 4 50 97 0 82 0 0 24 0 1 523 81 2 28 11 1 1 10 2406 3688 TABLE II. Showing the Deaths from Epidemic Diseases, for the Three Months ending 30th March, 1872. Districts. Small-Pox. Measles. Scarlet F ever. Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera & Choleraic Diarrhea. Total. Remarks. Artillery 0 0 0 0 1 0 0 0 1 Spitalfields 2 1 1 0 9 0 1 0 14 Mile End New Town 1 2 0 0 14 0 2 0 19 Workhouse. Whitechapel, North 2 4 0 1 7 1 0 0 15 Whitechapel Church 0 0 0 0 3 0 1 0 4 Hospital. Goodman's Fields 1 1 1 0 3 0 1 0 7 Aldgate 5 0 0 0 4 0 0 0 9 Total 11 8 2 1 41 1 5 0 69 Deaths from Epidemics for the corresponding Quarter, 1871. 83 4 8 0 16 8 11 0 130 Two deaths from Pyæmia occurred in the Whitechapel Church sub-District, and 4 from Rheumatism. The two deaths in the Spitalfields sub-district from Small Pox were of children of the same family, aged respectively 5 and 7 years, neither of whom had been vaccinated. TABLE III. Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 30th March, 1872. 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 1871. Males, 46 Females, 29 Workhouse 6 0 4 18 18 27 2 75 93 London Hospital 0 2 23 53 49 16 0 Males, 101 143 Females, 42 143 TABLE IV. Ages at Death in each Registration District, for the Three Months tnding 30th March, 1872. Districts. 0 1 nd under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total. Remarks. Artillery 6 5 0 3 5 4. 2 25 Spitalfields 25 11 5 12 12 10 1 76 Mile E. N. Town 34 23 8 28 34 37 3 167 Workhouse. Whitechapel, N 11 20 2 7 10 7 0 57 Whitechapel Ch 9 7 25 56 52 24 0 173 Hospital. Goodman's Fields 13 13 2 5 9 5 1 48 Aldgate 16 13 4 6 13 8 2 62 Total 114 92 46 117 135 95 9 608 TABLE V. The Births and Deaths in each Registration District, for the Three Months ending on the 30th March, 1872. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M F. M F. Artillery 20 26 46 12 13 25 21 0 Spitalfields 77 63 140 41 35 76 64 0 Mile EndN. Town 103 71 174 93 74 167 7 0 Workhouse. Whitechapel, N. 75 60 135 25 32 57 78 0 WhitechplChurch 32 39 71 11S .55 173 0 102 London Hospital. Goodman's Fields 60 42 102 30 18 48 54 0 86 Non-residents died in the London Hospital. Aldgate 31 21 52 32 30 62 0 10 Totals 398 322 720 351 257 608 224 112 Excess of Births over Deaths, deducting the 86 non-residents, 198 Population in 1871, 76,332. Population in 1861, 78,970. BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT On the Sanitary Condition of the WHITECHAPEL DISTRICT for the QUARTER ENDING 29th JUNE, 1872, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH. LONDON: printed by r. j. donovan, 260a, whitechapel road, e. 1872. Aug 3 , * - . REPORT of the MEDICAL OFFICER OF HEALTH, for the Quarter ending 29th June, 1872. TO THE BOARD OF WORKS, WHITECHAPEL DISTRICT. Gentlemen,— In the Quarter that ended on Saturday, June 29, 1872, the births registered in the Whitechapel District were 684;—viz., 387 males and 307 females. During the same period the deaths have been 564, of these 320 have been of males and 344 of females. In the corresponding Quarter of the previous year, the births were 569 and the deaths 557. There has been, therefore, an increase of 115 in the number of births, and an increase of 7 in the number of deaths. The deaths in the London Hospital have been 150, viz., 98 males and 52 females. Of the total deaths in this institution there were 14 of persons resident within the District, 94 of non-residents, and 42 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 was one death of a nonresident from typhoid fever in the London Hospital during this Quarter: six deaths occurred in this institution from pyaemia. The deaths in the Workhouse have been 69, viz., 40 males and 29 females. No death from epidemic disease occurred in this establishment. The deaths from epidemic diseases in the entire District have been 53, viz., 7 from small-pox, 6 from measles, 1 from scarlet-fever, 22 from whooping-cough, 8 from diarrhoea, and 9 from fever. To the deaths from small-pox as above recorded there must be added the 2 deaths which occurred in the Small-pox Hospitals, thus making a total of 9 deaths from small-pox. Two deaths from fever occurred in the Fever Hospitals, thus making 11 deaths from this disease. There were 7 deaths from erysipelas, 1 from puerperal fever, 7 from pyaemia, 6 from rheumatism, and 9 from croup. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 85; viz., 42 from small-pox, 14 from measles, 1 from scarlet-fever, 11 from whooping-cough, 8 from diarrhœa, and 9 from fever. The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 85: of these 41 were caused by bronchitis, 35 by pneumonia, 1 by laryngismus, 3 by pleuritis, and 5 by asthma. The deaths from tubercular diseases were 105, viz., 15 from mesenteric disease, 7 from tubercular meningitis, 3 from hydrocephalus, or water on the brain, 2 from scrofula, and 78 from consumption. Diseases of the organs of circulation were fatal to 29 persons; of these 26 died from disease of the heart, and 3 from aneurism. 4 The deaths from diseases of the urinary organs were 13; of these 6 were caused by nephria or Bright's disease, 2 by diabetes, 4 by nephritis, and 1 by disease of the kidney. Convulsions caused the deaths of 17 children. There were 3 deaths from premature birth, 8 from teething, and 19 from atrophy and debility. Syphilis was fatal to 7 children, 6 of whom were under 1 year of age. Two persons died from privation, 1 from intemperance, and 2 children from want of breast milk. Three women died in childbirth. The deaths of 25 persons are attributed to old age: of these 12 were above 80 years of age, 2 of whom reached the advanced age of 97. Two persons died of premature decay under 63 years of age. There were 29 deaths from mechanical violence; of these 8 were caused by horses and vehicles in the streets. Burns and scalds were fatal to 9 persons. A boy 7 years of age died from mechanical obstruction caused by the swallowing of a glass bead. A labourer, aged 44, died from shock occasioned by accidentally falling into a tank of sulphuric acid. Six children were suffocated in bed. A child, 2 months old, died from purulent ophthalmia. Three persons committed suicide. There was 1 death by manslaughter. The number of inquests has been 87; in the corresponding Quarter of last year the number was 73. Uncertified Deaths. The number of deaths which have not been certified by a medical practitioner has been 20; of these 15 are recorded in the Spitalfields subDistrict. The mortality of children under 5 years of age was 202. This is 35.9 per cent. of the total mortality. In the corresponding Quarter of the previous year the rate of mortality of children under 5 was 36.0 per cent. of the total mortality. In the Artillery sub-District, the rate is 40.0 per cent.; in the Spitalfields, 57.1 per cent.; in the Mile End New Town, 30.0 per cent.; in the Whitechapel North, 56.9 per cent.; in the Whitechapel Church, 17.3 per cent.; in the Goodman's Fields, 57.1 per cent.; and in the Aldgate, 42.5 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended, during the last Quarter, 1151 new cases of illness out of the Workhouse;—including 26 of small-pox, 31 of measles, 3 of scarlet-fever, 29 of whooping-cough, 30 of diarrhoea, 4 of fever, 79 of febricula, 1 of pyaemia, and 10 of erysipelas. In the corresponding Quarter of the previous year, the number of pauper cases of illness was 2,657, including 174 of small-pox, 101 of measles, 8 of scarlet-fever, 28 of whooping-cough, 83 of diarrhoea, 29 of fever, and 14 of erysipelas. Thenumberof cases of illness among the paupers still continues to diminish. During this Quarter the number is less by 1506, when compared with that of the corresponding Quarter of the previous year; and, if compared with the corresponding period of 1866, the number then returned being 3426 the diminution of cases is most striking and satisfactory. During this Quarter Mr. Ilott, the resident Medical Officer of the Workhouse has furnished me with a return of sickness in that establishment. The return shows that there have been 486 cases of illness, including 3 of measles, 2 of whooping-cough, 68 of diarrhœa, 24 of febricula, 1 of fever, 1 of pyæmia, and 9 of erysipelas. 5 Meteorology of Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 5.86 inches. During the corresponding Quarter of last year, the rain-fall was 6.66 inches. The mean temperature of the air was 52.6°. In the corresponding Quarter of last year, the mean temperature was 55.8°. The hottest days during the Quarter, were Sunday, June 16th, Monday, June 17th, and Tuesday, June 18th, when the thermometer, in the shade, indicated respectively 85.6°, 86.0°, and 84.2°. In the corresponding Quarter of the previous year, the highest reading of the thermometer, in the shade, was on Thursday, 25th of May, when it indicated 79.5°. The following Table, taken from the returns of the Registrar-General, shows the comparative results of the Quarter:— LONDON. Aprl 6th Aprl 13th Aprl 20th Aprl 27th May 4th May 11th May 18th May 25th June 1st June 8th June 15th June 22nd June 29th Deaths from Small Pox 65 49 48 41 62 39 54 54 37 27 37 26 43 Deaths from Scarlet Fever 23 26 11 17 11 10 16 20 18 18 12 9 11 Mean Temperature of the air 44.7° 514° 462° 501° 526° 472° 475° 498° 57 7° 5260 57 9° 665° 603° Rain-fall in inches °.47 0.05 0.08 0.38 0.14 0.85 1.95 0.05 0.15 0.77 0.33 0.19 0.45 Deaths in London 1559 1470 11410 1415 1387 1250 1268 1205 1336 1289 1207 1230 1070 chapel District 34 45 47 51 45 37 51 40 40 42 43 48 41 Deaths in ditto from Small-pox 2 1 1 1 0 1 0 0 1 0 0 0 0 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 154 waste preventers (8 new ones having been erected during this Quarter), by which upwards of 880 houses are supplied. This mode of supply to the poor localities appears to me, after a long experience, to be the best for houses which are let in separate tenements. In some of my previous reports I have made mention of the danger of drinking water which is drawn from the cistern that supplies the water closet; and this danger is increased when the water in the cistern is not sufficient to cover the valve through which the water flows into the pan of the closet when the valve is raised, for then the foul air of the closet passes directly into the cistern. When waste pipes are used in cisterns care must be taken to ascertain that they are properly trapped, for if the waste pipe passes into the drain of the house, the emanations from the drain will not only contaminate the water but will occasion a nuisance in the house. Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending June 29th, 1872:— Number of inspections of houses as shown in the official returns 3592 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 27 Number of cases of indecent occupation discovered 17 Houses specially visited 269 Ditto specially re-visited 824 6 Preliminary notices served, such notices embracing 632 premises 267 Compulsory orders issued, embracing 124 premises 64 Summonses heard at Police Courts 7 Cellars used as dwellings discontinued for such use 2 Houses in which the rooms or passages have been whitewashed 164 Rooms disinfected with sulphurous acid gas after the occurrence of small-pox, fever or scarlet fever, therein 19 Yards of houses paved or the pavement repaired 54 Drains in houses improved 77 Dust-bins provided 15 Privies limewashed, cleansed, and repaired 87 Cesspools abolished 2 Water-butts and cisterns provided or repaired 20 Water waste preventers erected 8 Nuisances from dung and other offensive matter, removed 9 Goat kept so as to be a nuisance, removed 1 Area gratings and cellar flaps repaired 139 Overcrowding and Indecent Occupation of Rooms. From the preceding return of sanitary work performed during the Quarter, it appears that on the inspection of houses some of the rooms were found not only to be overcrowded, (that is to say, a less space than 300 cubic feet for each person) but, in some cases, they were indecently occupied. From the following report of Mr. Wrack, one of the Inspectors, the Board will learn how the poorer class of people are occasionally lodged in some of the bye-places in this District. "On Saturday morning the 13th April, between 6 and 7 o'clock, I visited all the houses (6 in number) in Goodman's-buildings. I found all the rooms 12 in number both overcrowded and indecently occupied. There were in several of the rooms as many as nine or ten persons, principally adults of both sexes, sleeping together. The rooms measure 12ft. x 9ft. X 8ft. giving a cubic space to each room of 864 feet or about 96 cubic feet to each person. The smell arising from each of these rooms was most offensive. Notice was at once served upon the owner to abate the overcrowding, when he at once caused the tenants to remove, and then thoroughly cleansed the houses. As'these rooms were insufficiently ventilated notice has been served upon the landlord to provide more efficient ventilation by carrying an air shaft from each room through the roof of the house." On this subject Mr. Battram reports as follows: "In making an inspection of the houses in Wells-place, Whitechapel, I found some of the rooms at the rear, which were built for kitchens, used as living and sleeping rooms. The kitchen at No. 9 was occupied by a married couple and three children. This room measured 15ft. X 8ft. X 7ft., thus giving a cubic space of 840 feet. This allowed only 168 cubic feet for each person. In the kitchen of No. 15 a man and his wife, two adult daughters, and a boy six years of age, lived and slept. This room measured 9ft. x 6ft. X 6ft., giving only a space of 324 cubic feet for 5 persons, or 65 cubic feet for each." Hayes Court. "Upon the inspection of the houses in this court, I found that several of the rooms were overcrowded and indecently occupied; also some of the rooms in the buildings at the rear of Nos. 3, 5, 7 and 9, Glasshousestreet, which project into the said court, were found to be overcrowded. At No. 9 on the ground floor room four persons slept, namely, one boy 2ged 18, and three girls, aged respectively 13, 10 and 7 years. This room 7 measured 8ft. 10in. X 5ft. 4in. X 7ft., thus giving less than 330 cubic feet of space, or about 82 cubic feet for each person." In consequence of the defective state of ventilation of all the houses (8 in number) in this court, legal proceedings were taken against the several owners. The case was heard at the Thames Police Court on the 24th April, and was adjourned for fourteen days, the magistrate intimating his intention to view the property during the interval. On the 8th May the case was again heard, when the magistrate made an order upon each of the owners to provide means of ventilating the said houses, by constructing a ventilating shaft to each house to pass through the several rooms of each house, and to be carried up to a height above the roof of each house, and of the walls belonging thereto or abutting therefrom; and that the shaft be so constructed, as to provide for the ventilation of each room through which it passes; and also to construct an air shaft to each of the three privies that are situated at the end of the court, and which are in close contiguity to two of the houses, to a height above the height of the wall against which such privies are situate. Owing to the buildings projecting into this court, as mentioned above in Mr. Battram's report, and there being no thoroughfare in it, the air is nearly stagnant. The entire open space in this court is only 93 square yards, and the houses are occupied by 87 persons, thus affording about one square yard of open space to each. It is, however, expected that some further sanitary improvement will soon be effected in this court. Furnished Rooms. In my report for the Quarter ending September, 1871, it is stated that the Inspector, having found in some of the so-called furnished rooms (but in which there are only a few dilapidated pieces of furniture, and which are let at rents varying from two to four shillings per week) several filthy flock beds, straw mattresses, and pillows, gave directions to the owners of the houses in which such articles were in use to destroy them and provide new ones, as those condemned were a nuisance and injurious to health. These orders were attended to. The Inspector now further reports that he has found several other rooms let as furnished apartments, which arc provided with similarly offensive articles. Orders have in each case been given to have all these unwholesome beds, mattresses and pillows destroyed. Small Pox. The total deaths from small-pox which have occurred in this District during the last twenty-one months, including the deaths in the Smallpox Hospitals of those, persons who were sent from this District, have been 295: viz., for the Quarter ending 31st December, 1870, the deaths in the District were 50, and 2 occurred in the hospitals; for the 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; for the Quarter ending 30th December, 1871, the deaths were 23, and 12 in the Hospitals; for the Quarter ending 30th. March, 1872, the deaths were 11 and 5 in the Hospitals; and for the Quarter ending 29th June the deaths were 7, and 2 in the Hospitals. The deaths from small-pox in London during the same seven quarters have been 9,307. The total number of cases which have been attended by the Medical Officers of the Union during the same period has been 924. For the first-named Quarter they were 245; for the second, 352; for the third, 174; for the fourth, 41; for the" fifth 58; for the sixth, 28"; and for the seventh, 26. 8 Vaccination. The following return shows the number of successful primary vaccinations for each Quarter during the year 1871, and for the two Quarters ending 29th June, 1872; and also the number of births registered. 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 same Quarters. quarter Ending— PUBLIC VACCINATOR. Workhouse. Totals. Births regstd. Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination- Primary Cases. Re-Vaccination. March, 1871 727 1169 10 0 737 1169 747 June 357 538 21 0 378 538 569 September 186 12 35 0 221 12 602 December 134 6 27 0 161 6 653 March, 1872 219 16 43 1 262 17 720 June 29 289 9 32 0 321 9 684 Totals 1912 1750 168 1 2080 1751 3975 Owing to the exertions of the Vaccination Officer in calling upon the parents of all the children who have been born in this District and have obtained the age of three months, a very favourable result as regards the number of vaccinations is shown in the above table. This table, however, only shows the number of vaccinations which are paid for by the Guardians, but it appears from the returns furnished to me by Mr. Vallance that, from certificates obtained, 284 children resident in the District have been successfully vaccinated by private practitioners, making a total for this Quarter of 605. As it is estimated that about eleven per cent. of the children born in this District die before they have obtained the age of four months, it appears from the above returns that the total number of successful vaccinations has been very satisfactory. But as 284 of the vaccinations are divided amongst the several medical practitioners in the District, the average number of vaccinations performed by each gentleman is comparatively small, I venture most respectfully to express my opinion, that from the large number of vaccinations which are performed by the public vaccinator, it would be better for the protection of the public against the fatality of small-pox, that all the children should be vaccinated by that officer. It is of the utmost importance that the operation of vaccination should be performed in a uniform manner; for it is stated on the authority of those most competent to form an opinion that the mortality from small-pox is in the inverse ratio of the number of cicatrices, and that success cannot be relied on unless four good cicatrices are left on the arm of the child; thence it is necessary for every medical practitioner who vaccinates to adopt the recommendation of making at least four punctures with the lancet charged with recent lymph, and not to regard the wishes of the parent to make only one or two punctures. Dr. McCann, in his valuable report on small-pox which was recently made to the Committee of Management of the Stockwell Fever and Small-pox Hospitals, makes the following remarks, "When a considerable mortality occurring from variola is seen amongst those reported in statistical tables as having been vaccinated, great allowance must be made for the correctness of any conclusion formed from them; for I feel convinced that not more than 20 per cent. of all the cases admitted into 9 the Hospital bore cicatrices of vaccination undoubtedly genuine." It appears from Table No. 2 of Dr. McCann's report that the rate of mortality from small-pox in children under five years of age is among the vaccinated 10.5, and among the unvaccinated 59.0 per cent.; and in young persons from ten to fifteen years the rate of mortality in the vaccinated is 6.8 per cent., while in the unvaccinated it is 45.9 per cent. No stronger proof is needed to show the necessity of vaccination. The following Table, compiled from the annual returns of the Registrar-General, shows the deaths in London from small-pox, measles, scarlet fever, whooping-cough, diarrhoea, and fever* (typhus, typhoid, or enteric, simple continued fever), registered in the years 1838-71:— Years 1838 1839 1840 1841 1842 1843 1844 1845 1846 Days 365 365 365 364 364 364 364 364 364 Small Pox 3817 634 1235 1953 360 438 1804 909 257 Measles 585 2056 1132 973 1293 1442 1182 2318 747 Scarlet Fever 1524 2699 1954 663 1224 1867 3029 1085 928 Whooping Cough 2083 2561 1069 2275 1603 1908 1292 1816 2035 Diarrhœa 393 258 460 465 704 834 705 841 2152 Fever 4078 1819 1262 1150 1174 2083 1696 1301 1851 Totals 12,480 10,027 7,112 6,579 6,358 8,572 9,708 8,270 7,970 Years 1847 1848 1849 1850 1851 1852 1853 1854 1855 Days 371 364 364 364 364 364 371 364 364 Small Pox 955 1617 518 498 1066 1166 217 676 1024 Measles 1778 1143 1153 977 1322 600 1007 1399 864 Scarlet Fever 1433 4756 2145 1178 1269 2549 2069 3439 2602 Whooping Cough 1600 1628 2145 1572 2161 1565 2652 2471 2415 Diarrhœa 1979 1913 3463 1884 2271 2164 2310 3235 2061 Fever 3232 3614 2515 1967 2404 2209 2701 2715 2375 Totals 10,974 14,671 12,139 8,076 10,493 10,253 10,956 13,935 11,341 Years 1856 1857 1858 1859 1860 1861 1862 1863 1864 Days 364 371 364 364 364 364 364 371 364 Small Pox 522 154 247 1156 877 215 345 2012 537 Measles 1445 1400 2383 1305 2054 1070 2281 1698 2750 Scarlet Fever 1795 1587 4118 4197 2457 2358 3457 50/5 3212 Whooping Cough 2078 2551 2700 1741 2023 3497 2150 2229 2386 Diarrhœa 2251 3145 2093 3335 1383 2625 1735 2448 2861 Fever 2674 2203 1902 179b 1392 1754 3636 2892 3689 Totals 10,765 11,040 13,443 13,530 10,186 11,519 13,603 16,354 15,435 Years 18651 1866 1S6- 1868 1869 1870 1871 - — Days 364 364 364 371 364 364 364 — - Small Pox 646 1388 1332 606 273 273 7876 - - Measles 1302 2259 1125 1989 1425 1425 1431 - - Scarlet Fever 2181 1885 1438 2921 5803 3803 1896 — — Whooping Cough 2921 2953 2251 2369 3756 3755 2299 - - Diarrhœa 3557 3184 2942 4060 3400 3400 3894 - - Fever 3232 2681 2171 2483 2414 2414 1746 - - Totals 13,839 14,330 11,262 14,428 17,070 16,163 19,142 - — *It was not until the year 1869 that the Registrar-General recorded separately under their respective nomenclature, typhus enteric, or typhoid, and simple continued fever, but those diseases were classed under the head, typhus. 10 Several interesting facts may be learnt from the above table: thus we learn that the most fatal of these diseases is scarlet-fever, the deaths from this disease having been in the course of 34 years 86,791; the next in fatality is fever, the deaths having been during the same period 78,866; then follows whooping-cough, which shows a mortality of 74,969; then diarrhoea, 74,478; then measles, 49,331; and lastly, smallpox, which, notwithstanding the great epidemic of 1871, shows a mortality of only 37,388. We also learn that the metropolis is never entirely free from any of these diseases. If the deaths in one year are few from any one of these epidemics, it frequently happens that either one or more of the others is in excess. Thus, in 1846, when the deaths from small-pox were only 154, the deaths from fever were 2,203, and in 1871, when the deaths from small-pox were 7,876, the deaths from fever were reduced to 1,746. The two great epidemics of small-pox which have occurred within the last 34 years happened in 1838 and in 1871; the proportionate number of deaths in each of those years being, in relation to the population, nearly the same. Thus the deaths from small-pox in 1838 were 3,817, which in a population of about 1,700,000, is at the rate of 22.4 per 10,000, and the deaths from the same disease in 1871 were 7,876, which is at the rate of 24.2 per 10,000. Scarlet-fever during the years 1869-70-71 was very fatal, the deaths in the metropolis from this disease amounting to 13,697, while the deaths from small-pox during the same period were 9,107. It further appears from the perusal of the preceding table that while small-pox is only an occasional epidemic, scarlet-fever is almost always with us in a severe form. The smallest number of deaths in any one year from this disease in London was in 1841, when the deaths were only 663, the average number for each year is 2,552, and the annual average number of deaths from small-pox is 1,099. Science is not sufficiently advanced to enable us to account for the rapid spread of an epidemic disease, which at one time extends its ravages over large communities, while the same disease at another time attacks only a very few. If there be any peculiar condition of the atmosphere which causes the particular disease to spread at one time and not at another, chemists have not been able to tell us what it is ; and if, as is alleged, some people are more susceptible to disease at one time than at another, we may fairly ask in what does that susceptibility consist? Again, if any epidemic disease were propagated by contagion only we may further ask, why does it cease its ravages in large communities where intercourse is always going on, and which cannot be prevented? but the disease does cease, and for a time we hear little or nothing about it; but, after a period of a longer or shorter duration, it again makes its appearance. When an epidemic attacks a large city, the number of deaths usually increases week by week until a culminating point is reached, when it is observed gradually week by week to decline, until it ceases to prevail as an epidemic. As it has been with our occasional visitor the cholera, so it was with the cattle plague; the number of deaths at first augmenting week by week, and then in a similar way gradually declining, and then entirely ceasing. The effect we see, but we cannot satisfactorily explain the cause. It would appear, that the disease after a time loses its power of reproduction. Typhoid, or enteric fever, is said upon high authority to be caused only by a specific poison which hals been thrown off from the body of some person sick of the same disease, and that this disease is not produced by the emanations arising from the decomposition of foecal matter which are given off from the sewers ; but as typhoid fever is 11 never entirely absent from London, there being seldom less than 2,000 deaths annually from this disease, and about 14,000 cases, it may reasonably be expected that the specific poison which is given off by the sick is always in a greater or less degree present in the sewers. It is therefore of the utmost importance to the well-being of the community that not only should the emanations from the sewers be prevented from entering our dwellings, but that the most scrupulous care should be taken to prevent the water which we drink from being contaminated by foul gases from water-closets, sinks, and drains. Slaughter Houses. I have in several of my Reports alluded to the desirability of abolishing all slaughter-houses from the confined districts of the Metropolis, and the time is now drawing nigh when, by the provisions of the Building Act of 1844, it will not be lawful, after the lapse of 30 years from that date, to slaughter cattle in any building or vault, or in the open air, at a less distance than 40ft. from a public way, or than 50ft. from a domestic dwelling; and if any person acts in contravention of this section he is liable, on summary conviction, to a penalty not exceeding £50 for every day during which the business is carried on. It is much to be regretted that this valuable provision, which was enacted nearly 30 years ago, is now sought to be repealed, by the introduction of a Bill to amend that Act, so far as it relates to the slaughtering of cattle and sheep, and to render permissible the slaughtering of cattle in butchers' private slaughter-houses. This Bill merely consists of one clause, which is as follows:—"From and after the passing of this Act the slaughtering of cattle or sheep by a butcher, in his private slaughter-house, duly licensed, shall not be held to be the carrying on of an offensive or noxious business within the meaning of the said Act." Now, if it was deemed desirable by the Legislature 30 years ago (when sanitary science was not so well understood as it is at the present time, or the injurious effects of breathing air charged with the offensive gases given off by decomposing animal matter) to prohibit the establishing or the carrying on anew the noxious business of slaughtering cattle, at a less distance than 50ft. from a dwelling-house is surely more necessary at the present time. But the legislature having a regard to the vested interests of the owners of slaughter-houses gave them the very long period of thirty years to make such necessary arrangements for the slaughtering of cattle in other places so as to meet the sanitary requirements of the Metropolis. Under such circumstances it is absurd on the part of the slaughterers of cattle to state that the continuance of the Act of 1844 would be a virtual confiscation of their property when situated in slaughter-houses within the prohibited distance from a dwelling-house. It has certainly been a mistake on the part of the licensing magistrates to license any new slaughter-house so situated as to be within 50ft. of a dwelling-house, but as the licences are only granted for one year, it is to be hoped that in the year 1874 this and the several noxious businesses specified in the 7th and 8th Vic., c. 84, will cease to exist in the Metropolis. For the following reasons I am of opinion that the provisions of the Act of 1844, relating to slaughter-houses, should be continued:— 1. Because slaughter-houses as now conducted are nuisances, and injurious to health, and although, theoretically, they may be kept "as clean as any paved wash-house," it would be found impracticable to do so ; and it would be impossible to enact a law which should compel the owner of a slaughter-house to prevent offensive smells from issuing from his premises. 12 2. Because private slaughter-houses afford facilities for the slaughtering of diseased animals, and enable the owners of such diseased animals readily to dispose of the unwholesome meat. The improper use which is made of private slaughter-houses was pointed out in my Quarterly Report for December, 1869. 3. Because thedriving of cattle through the crowded streets of London is not only a great annoyance to the inhabitants, but is a source of danger to life and limb. 4. Because theerection of asufficientnumberof well-ventilated public slaughter-houses in suitable places within reasonable distances from the centre of the Metropolis would be highly advantageous to the whole population, inasmuch as the animals intended for slaughter would be inspected by qualified officers, and if found to be diseased proper steps would be promptly taken to prevent the use Of such meat for human food. 5. Because the flesh of the animals slaughtered in airyand well-ventilated public slaughter-houses, and under proper inspection, will keep longer in a fresh state than when animals are slaughtered in some of the ill-ventilated slaughter-houses in London. If the City of Glasgow, with a population of 500,000, has thought it expedient, as a means of improving the public health, to prohibit the use of private slaughter-houses, and has erected three public slaughter-houses for the use of the butchers, it is surely quite possible, with the same object in view, for the local authorities in London to erect a sufficient number of public slaughter-houses for the slaughtering of all the cattle which are required for the use of the inhabitants of this vast city. In the reign of Henry VII. a petition was presented to Parliament by the Parishioners of the Parish of St. Faith and St. Gregory, in London, setting forth that they had been greatly annoyed and distempered by the corrupt airs engendered in the said Parishes by occasion of blood and other foul things by the reason of the slaughter of beasts. In consequence of this petition it was enacted, Anno Quarto Henrici VII., cap. iii., that no butcher or his servant should slay any beast within the walls of London. It was also enacted that half the penalty for committing the offence should go to the King, and the other half to every one of the King's lieges that would sue for the same by action of debt. I am, Gentleman, Your obedient Servant, JOHN LIDDLE. 15, Great Alic Street. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 29th June, 1872. Names of Medical Officers. Small Pox. Measles. Scarlatina. Whooping Cough. Diarrhoea. Febricula. Continued Fever, Typhus and 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 5 2 1 6 12 18 2 0 0 2 0 0 10 8 0 5 0 0 0 0 129 200 Mr. Champneys 1 8 0 7 5 15 0 0 1 6 0 0 31 2 0 0 0 1 0 2 176 255 Mr. Sequeira 12 11 I 5 I 14 0 0 0 1 0 0 7 6 0 5 0 0 0 3 142 208 Mr. H. Braye 6 5 1 10 4 17 0 0 0 1 0 0 34 2 1 1 0 0 1 1 85 269 Mr. Loane 2 5 0 1 8 15 2 0 0 0 0 0 19 1 0 3 3 0 0 0 160 219 Total 26 31 3 29 30 79 4 0 1 10 0 0 101 19 1 1'4 3 1 1 6 792 1151 Corresponding Quarter of Previous Year. 174 101 8 28 83 0 29 2 o 14 1 0 275 31 1 24 2 3 0 10 1863 2657 Workhouse Mr. Bott. 0 3 0 2 68 24 1 0 1 9 0 0 47 24 0 48 6 6 2 6 257 486 TABLE II. Showing the Deaths from Epidemic Diseases, for the Three Months ending 29th June, 1872. Districts. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping-Cough. Diarrhoea. Fever. Cholera & Choleraic Diarrhoea. Total. Remarks. Artillery 0 0 0 0 1 0 1 0 2 Spitalfields 1 3 1 0 7 1 2 0 15 Mile End New Town 0 3 0 0 2 2 2 0 9 Workhouse. Whitechapel, North 0 0 0 0 2 1 1 0 4 Whitechapel Church 1 0 0 0 4 1 1 0 7 Hospital. Goodman's Fields 5 0 0 0 5 2 2 0 14 Aldgate 0 0 0 0 1 1 0 0 2 Totals 7 6 1 0 22 8 9 0 53 Deaths from Epidemics for the corresponding Quarter, 1872. 42 14 1 0 11 8 9 0 85 Six deaths from Pyaemia occurred in the Whitechapel Church sub-district, and 2 from Rheumatism; I death from Pyaemia occurred in the Mile End New Town sub-district. TABLE III. Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 29th June, 1872. 0 and under 1. I and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total. Males, 40 Females, 29 Corresponding Quarter of 1871. Workhouse 8 1 2 17 l6 23 2 69 77 London Hospital 4 8 21 43 53 20 1 Males, 98 Females, 52 126 150 TABLE IV. Ages at Death in ??? Registration District, for the three Months ending 29th June, 1872. 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 5 3 3 2 4 3 0 20 Spitaliields 18 18 4 7 11 3 2 63 Mile E. N. Town 27 14 6 28 22 33 5 135 Workhouse. Whitechapel, N 9 10 0 10 7 5 0 51 Whitechapel Ch 12 20 22 47 57 24 3 185 Hospital. Goodman's Fields 18 18 4 6 9 8 0 63 Aldgate 10 10 1 10 9 5 2 47 Totals 109 93 40 110 119 81 12 564 Population in 1871, 76,332. Population in 1861, 78,970. TABLE V. The Births and Deaths in each Registration District, for the Three Months ending on the 29th June, 1872. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks. M. F. M. F. Workhouse. Artillery 33 18 5 13 7 20 31 0 Spitalfields 80 55 135 28 35 63 72 0 Mile E. N. Town 93 71 164 74 61 35 29 0 Whiteehapel, N 52 56 108 28. 23 51 57 0 London Hospital. Wbitechapel Ch 41 33 74 122 63 85 0 111 Goodman's Fields 61 35 96 31 32 63 33 0 94 Non-residents died in the London Hospital. 27 29 56 24 23 47 9 0 387 307 684 320 344 564 231 111 Excess of Births over Deaths, de ducting 94 Nonresidents, 214. BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 28th SEPT., 1872, BY JOEN LIDDLE, MEDICAL OFFICER OF HEALTH. London: Printed By T. Penny & Co., 121, Leman Street, Whitechapel, E. 1872. REPORT of the MEDICAL OFFICER OF HEALTH, for the Quarter ending 28th September, 1872. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, September 28, 1872, the births registered in the Whitechapel District were 640; viz., 325 males and 315 females. During the same period the deaths have been 670: of these, 397 have been of males and 273 of females. In the correspondingQuarter of the previous year the births were 602 and the deaths 574. There has been, therefore, an increase of 38 in the number of births, and an increase of 96 in the number of deaths. The deaths in the London Hospital have been 168; viz., 121 males and 47 females. Of the total deaths in this institution there were 29 of persons resident within the District, 100 of non-residents, and 39 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 record. There was one death of a non-resident from typhoid fever in the London Hospital during this Quarter. The mortality in the London Hospital, during the last three weeks, has been unusually large; no less than 54 deaths having taken place therein in that time; while the total deaths for the Whitechapel Church Sub-district, in which the Hospital is situated, was, for the same period, 66. This is 81.8 per cent. of the total mortality of the Sub-district. The mortality in the Hospital for the whole quarter was 77.8 per cent. of the total deaths in the Sub-distriet; and in the corresponding quarter of the previous year it was 78.4 per cent. The population of the Sub-district is 7323. On making inquiry of the House Governor and Secretary to the London Hospital, relating to the cause of this large mortality, I have been favored by that gentleman with the following remarks:—"The mortality is not due, as you are well aware, to the prevalence of any epidemic in the district 4 neither does it result from any predisposing causes within the Hospital itself. It is simply traceable to the fact that the applications for admission into this Hospital have for some time past been so numerous, and so many persons applying in the first instance as out-patients have been necessarily received into the wards, that the beds have been to a great extent filled with the most urgent cases, to the exclusion of others more capable of benefit from hospital treatment. "That this view of the question is correct, may be gathered from the individual dates of the 54 deaths in three weeks, to which your letter refers. " I find that of these deaths no less than 33 (or about 60 per cent, of the entire number) occurred within the first 14 days after admission of the patients, this number including 6 on the day of admission, and 13 between the first and seventh day of residence." It would appear, from the above remarks of the House Governor, that the Hospital, which within the last six years has been greatly enlarged, is still too small for the poor of the large population of this manufacturing district, in which are congregated more of the working people than in any other district in London ; and it is obvious, from the numerous applications for admission into its wards, that the Hospital must either be still further enlarged, or numerous urgent cases refused admittance. The deaths in the Workhouse have been 64; viz., 41 males and 23 females. No death from epidemic disease occurred in this establishment. The deaths from epidemic diseases in the entire District have been 114; viz., 6 from measles, 2 from scarlet-fever, 18 from hooping-cough, 78 from diarrhoea, 5 from fever, and 5 from choleraic diarrhoea. No death from small-pox occurred among the patients belonging to this District who were removed to the Hospital, consequently not a single death has occurred in this District from that disease during the quarter. Two deaths from fever occurred in the Fever Hospital, thus showing the mortality from fever to be 7 instead of 5, as above stated. Erysipelas was fatal to 6, pyemia to 6, rheumatism to 1, croup to 9, and carbuncle to 1. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 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 diarrhsea. To the 142 deaths from epidemic diseases, must be added 11 deaths from small-pox which occurred in the Small-Pox Hospital. The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 79 : of these, 29 were caused by bronchitis, 42 by pneumonia, 4 by pleuritis, 1 by laryngitis, 1 by asthma, 1 by growths upon the larynx, and 1 by spasm of the glottis. The deaths from diseases of the respiratory organs were, in the corresponding quarter of the previous year, only 48. 5 The deaths from tubercular diseases were 107; viz., 28 from mesenteric disease, 11 from tubercular meningitis, 2 from hydrocephalus, or water on the brain, and 66 from consumption. Convulsions proved fatal to 23 children. There were 21 deaths from cancer. Diseases of the organs of circulation were fatal to 38 persons; of these, 31 died from disease of the heart, 1 from pericarditis, and 6 from aneurism. The deaths from these causes in the corresponding quarter of the previous year were 24. The deaths from diseases of the urinary organs wore 22; of these, 9 were caused by nephria or Bright's disease, 1 by diabetes, 3 by retention of urine, and 9 by other diseases of the urinary organs. During the corresponding quarter of the previous year the deaths from these causes were 13. Two persons died in childbirth. There were 12 deaths from premature birth, 13 from teething, and 4 from malformations Three children died from want of breast milk. There were 7 deaths from syphilis; 3 of which were caused by congenital syphilis. Twenty-nine persons died of old age; of these, 20 were above 80 years of age. The deaths from premature decay were 3, all of which were of persons under 70 years of ago. The deaths from atrophy and debility were 34; while in the corresponding quarter of last year they were 23. There were 28 deaths from mechanical violence; of these, 10 were caused by horses and vehicles in the streets. Burns and scalds were fatal to 8 persons, one of whom, a man aged 35, was killed by the bursting of a boiler worked at overpressure. The deaths from mechanical violence and from burns were for the corresponding quarter of last year 22 and 5 respectively. Two children died from sunstroke, aged respectively 6 years and 2½ years. One death occurred from the effects of chloroform. A man aged 72 died in the Workhouse from inadvertently swallowing opium pills. A man aged 35 died in the London Hospital from necrosis (diseased bone) caused by the poisonous vapour of phosphorus given off in the process of lucifer-match making. The particulars of this case were sent by me to the Medical Officer of Health of the District, where the factory in which this man worked, is situated, who will no doubt make inquiry with a view of ascertaining whether additional precautions are necessary to prevent the injurious effects of phosphorus on the workmen employed there. 6 Three persons died from intemperance. Six children were suffocated in bed. One person committed suicide. A hoy aged 13 died from shock caused by immersion in potash water used in the process of candle making. The number of inquests has been 84. In the corresponding quarter of last year the number was 58. While it is satisfactory to note that the deaths from zymotic diseases are twenty-eight less than in the corresponding quarter of the previous year, yet, as there is an increase in the number of deaths from diseases of the organs of circulation—from the urinary organs—from the respiratory organs—from atrophy and debility—and from violence, the total mortality, as compared with the corresponding quarter of the previous year, is greater by 96. Uncertified Deaths. The number of deaths which have not been certified by a medical practitioner has been 21 ; 15 of which are recorded in the Spitalfields sub-district. Hoetality of Young Childeen. The mortality of children under five years of age is 304. This is 45.3 per cent, of the total mortality. In the corresponding quarter of the previous year the rate of mortality of children under 5 years was 47.9 per cent, of the total mortality. In the Artillery sub-district the rate is 55.5 per cent.; in the Spitalfields, 70.3 per cent.; in the Mile End New Town, 51.6 per cent.; in the "Whitechapel North, 58.8 per cent.; in the "Whitechapel Church, 17.0 per cent.; in the Goodman's Fields, 73.3 per cent.; and in the Aldgate, 52.0 per cent. Padpee Illness in the Disteict. The Medical Officers of the Union have attended, during the past Quarter, 1227 new cases of illness out of the "Workhouse, including 5 of small-pox, 13 of measles, 5 of scarlet-fever, 9 of hooping-cough, 189 of diarrhoea, 5 of fever, 3 of choleraic-diarrhoea, 87 of febricula, and 16 of erysipelas. In the corresponding Quarter of the previous year, the number of pauper cases of illness was 2144, including 41 of small-pox, 22 of measles, 8 of scarlet-fever, 58 of hooping-cough, 368 of diarrhoea, 2 of choleraicdiarrhoea, 66 of' fever, and 8 of erysipelas. The return of cases of epidemic diseases in the "Workhouse as furnished by Mr. Ilott, are as follows, viz., 18 of diarrhoea, 1 of fever, 26 of febricula, 8 of erysipelas, and 1 of carbuncle. The total cases of sickness in the Workhouse were 375. The return of sickness among the pauper population still continues to he very satisfactory, when compared with previous returns. 7 Meteorology at Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 6.39 inches. During the corresponding Quarter of last year, the rain-fall was 8.42 inches. The mean temperature of the air was 61.2°. In the corresponding Quarter of last year, the mean temperature was 61.3°. The hottest days during the Quarter were Sunday, July 21st, Monday, July 22nd, and Thursday, July 25th, when the thermometer, in the shade, indicated respectively 87.0°, 87.1°, and 90.9° In the corresponding Quarter of the previous year, the highest reading of the thermometer, in the shade, was on Sunday, August 13th, when it indicated 89.2°. The following table, taken from the returns of the Registrar-General, shows the comparative results of the Quarter:— LONDON. July 6th July 13th July 20th July 27th Aug. 3rd Aug 10th Aug 17th Aug 24th Aug 31st Sep. 7th Sep. 14th Sep. 21st Sep. 28th Deaths from Small Pox 35 26 29 33 28 15 16 15 8 6 12 5 9 Deaths from Scarlet Fever 17 12 3 7 6 12 15 12 13 10 22 12 17 Mean Temperature of the air 64.5O 631° 614° 711° 61.7° 59.2° 60.6° 64.3° 60.1° 64.5° 62.7° 543° 49.0° Rain-fall in inches 0.31 0.71 0.16 1.00 0.01 138 0.01 0.00 0.47 0.33 0.07 0.10 0.84 Deaths in London 1193 1285 1467 1643 1695 1598 1445 1274 1236 1236 1203 1106 1279 Deaths in Whitechapel District 46 41 68 51 51 60 41 54 46 40 55 46 71 Deaths in ditto from Small-pox 0 0 0 0 0 0 0 0 0 0 0 0 0 Small-Pox. During this quarter it will be observed, from the returns of sickness and mortality, that only five cases of small-pox have occurred, and that not a single case of the disease has proved fatal. We may therefore consider that the epidemic of small-pox has now passed away. This however is the time to most strongly urge upon all the officers who have been appointed to carry out the provisions of the Vaccination Act, not to relax in their exertions to bring all the children bom in the District under the influence of vaccination; for parents are too apt to neglect the duty when the epidemic has ceased. Vaccination. The following return, prepared by the Vaccination Officer to the Board of Guardians, is very satisfactory, inasmuch as it shows that considerable diligence, in the performance of his duty, has been shown; for out of 949 births 692 children have been successfully vaccinated. 8 Return by Mr. E. Coombes, Vaccination Officer of the Whitechapel Union, respecting the vaccination of children whose births were registered in his District from 2 1st August to 31st December, 1871, inclusive. Registration Sub - districts comprised in the Vaccination Officer's District. Number of Births returned in the " Birth List Sheets" as registered up to 31st Dec., 1871. Number of these Births duly entered by 31st August, 1872, in columns 10,11,anil 13 of the Vaccination Register (Birth List Sheets,) viz: Number of these Births which, on the 31stAug., 1872, remained unentered on the Vaccination Register on accnt. (as shown by Report Book) of All cases not accounted for in preceding columns. Col. 10. Col. 11. Col. 13. Total duly entered in Register. Postponement by Medical Certificate. Removal to Districts the Vaccination Officer of which has been duly apprized. Removal to places unknown or which cannot be reached ; and cases not having been found. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Dead—unvaccinated. 1 2 3 4 5 6 7 8 9 10 11 1 Artillery 90 63 - — 6 69 — — 11 10 2 Spitalfields 181 135 - — 19 154 3 — 14 10 3 MENT 220 103 — — 30 193 — 4 16 7 4 Wh. North 149 115 — — 15 130 1 5 5 8 5 Wh.Chrch. 98 64 — - 13 82 2 3 9 2 6 Good-fids. 135 92 — - 24 118 2 2 9 6 7 Aldgate 70 CO — - 6 66 - — 8 2 Total 949 692 — - 118 810 8 14 72 45 WHITECHAPEL UNION.—Return of tlis number of Cases Vaccinated by the Public Vaccinator and the Medical Officer of the Workhouse, together with the number of Births Registered during the same quarters. Quarter Ending— PUBLIC VACCINATOR Workhouse. Totals. Births Registd. Primary Cases. Re-Vaccination. Primary Cases." Re-Vaccination Primary Cases. Re-Vaccination. March, 1871 727 1169 10 0 737 1169 747 June 357 538 21 0 378 538 569 September 186 12 35 0 221 12 602 December 134 6 27 0 161 6 653 March, 1872 219 16 43 1 262 17 720 June 29 289 9 32 0 321 9 684 Sep. 28 30G 1 20 4 332 5 640 Totals 2218 1751 194 5 2412 1756 4615 9 The preceding return shows the number of successful primary vaccinations for each Quarter during the year 18,71, and for the three Quarters ending 28th September, 1872 ; and also the number of births registered. Prom the returns of the cases of vaccination performed by Mr. Blackman, it appears that that gentleman has vaccinated 321 children, 15 of whom were above one year of age ; and of the total number of children vaccinated, 14 did not return for inspection, and one was re-vaecinated. All of the 26 cases returned by Mr. Ilott were successful. Water Supply. During this quarter six new water-waste-preventers have been erected in the District. In my last report the number of waste-preventers was 154, but two of them have been taken away, in consequence of two small courts in Baker's Row (in each of which was one of these machines), having been demolished for the widening of that thoroughfare. There are therefore at the present time 158 waste-preventers in the District. The Regulations made under the Metropolis Water Act. 1871, respecting the necessary fittings for preventing undue consumption or contamination of water, have been printed. These regulations are 33 in number; and as Regulation No. 12 affects the landlords of numerous small houses in this District, I have thought it advisable to quote it. It is as follows:—"No wooden receptacle, without a proper metallic lining, shall be hereafter brought into use for the storage of any water supplied by the Company." It would be very desirable to publish some of the more important regulations, and distribute them largely over the District. Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending- September 28th, 1872:— Number of inspections of houses as shown iu the official returns 3077 Houses specially visited 317 Ditto specially re-visited 951 Preliminary notices served, such notices embracing 277 premises 207 Compulsory orders issued, embracing 73 premises 29 Summonses heard at Police Courts 8 Cellars used as dwellings discontinued for such use 2 Houses in which the rooms or passages have been whitewashed 333 Rooms disinfected with sulphurous acid gas after the occurrence of small-pox, fever or scarlet fever, therein 5 Yards of houses paved or the pavement repaired 132 Drains in houses improved 70 Dust-bins provided 40 Prives limewashed, cleansed, and repaired 143 Cesspools abolished 4 Water-butts and cisterns provided or repaired 39 Water-waste preventers erected 6 Nuisances from dung and other offensive matter removed 20 Area gratings and cellar flaps repaired 11 Ventilation of houses improved 7 10 The cow-houses in the District, 24, the slaughter-houses, 39, and the hake-houses, 74, 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. Sanitary Improvements carried out in Houses and Localities. King Edward Street. The houses numbered 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20, KingEdward Street, Mile End New Town, have been taken down, notices having been served upon the owners to close them, in consequence of their being in such a state as to be unfit for human habitation. These 10 houses, which contained six rooms each, were very old wooden structures, and had become not only much dilapidated, but the drainage, water receptacles, back yards and privies, had been so neglected, that they had become nuisances injurious to health. Upon notices being served on the owner to remedy the defects, and so render them fit for habitation, it was represented that the lease of tho premises had nearly expired, and the leaseholder intimated that she would prefer to give up the property to the freeholder, rather than incur the expense of putting it in habitable condition. So soon as the lease fell into the hands of the freeholder, all the houses were pulled down, and the ground is now hoarded in. Hayes Court. The improvements effected in this court were mentioned in my last report; since then, further improvements have been effected therein, by tho owner having taken down the upper rooms of three of the houses which projected into the court, but leaving the lower rooms to be used as wash-houses. This court, although not in a satisfactory state as regards its sanitary condition, is nevertheless much improved. Great Tongue Yard, "Whitechapel Road. The houses in this court, in consequence of the Inspector calling the attention of the landlord to their unhealthy condition, have undergone a thorough repair. The two public privies, which stood at the west end of the court, in close proximity to the windows of the inhabited houses on each side, have been taken down, and a new privy has been erected in a more suitable situation for the use of the inhabitants of the four small houses on the south side. As each of the houses on the north side of the court has a back yard, a separate privy has been erected therein for the use of the tenants in each house. A new drain has been made from the court to the sewer in the Whitechapel Koad, the back yards have been re-paved and drained, and the 11 front court, common to all the houses, has been paved with asphalte ; a new dust-bin has been provided, and three water-waste-preventers have been erected. Court Yards held in common by several Owners, Improved. There is frequently great difficulty in removing a nuisance arising from defective drainage and paving of those courts which are used in common by several persons; nevertheless the Inspectors have succeeded in removing a nuisance, caused by the defective state of the paving of a yard known as No. 15, Osborn Street, by inducing the owners, at their joint expense, to properly pave and drain the same. The same remarks apply to a yard in Church Lane, which is similarly occupied. Both these improvements were effected without taking out summonses. Complaints having been made of the unhealthy condition of Barber's Yard, Spitalfields, in consequence of the same being badly paved and drained, notices were served upon the three owners to carry out the necessary work; but as the several owners were unable to agree upon the terms for carrying out the work, a summons was served upon one of them, under the 34th section of the Niysances Removal Act. The case was heard at the "Worship Street Police Court on the 4th of July last, when the Magistrate made an order upon the person summoned to pave the place in question. The work has been satisfactorily carried out. Furnished Rooms. The condition of the furniture in some of these rooms has been mentioned in my reports for the last two quarters. Notices have been served on several owners of these so-called furnished rooms, to remove such beds and bedding as were found to be in such a filthy state as to be a nuisance, and injurious to health. All the notices so served have been complied with. Bacon unfit for Food. Information having been given to the Officers of this Board that a large quantity of bacon, unfit for human food, was on the premises of a Provision Merchant, I visited the premises with one of the Inspectors, and found there about twenty-three hundred weight of bacon, in a decomposed state. The whole of this meat was taken away and conveyed to a fat-melter's premises, and there destroyed under the inspection of Mr. "Wrack. Underground Rooms illegally Occupied. An inquest was recently held on the body of a woman who was found dead in an underground room, at No. 5, Chicksand Street, when the medical practitioner who was called in to give evidence, stated that the room was unfit for habitation. In this opinion I fully concur; and I may add, that the room was occupied in contravention of the Statute. The attention of the Sanitary Officers has, during the last fourteen 12 years, been directed to this matter, and, as is recorded in my quarterly reports, numerous cellars and under-ground rooms, used as dwellings, have been discontinued for such use. There is, however, considerable difficulty indealing with these cases; for it frequently happens that no sooner has one family been compelled to remove, than, in the course of a short time another, or perhaps the same family, again occupies the room. The Inspectors, on visiting several new houses which have recently been erected in this District, found that the under-ground rooms therein were not fit for habitation, yet many of them were occupied by families as sleeping-rooms, contrary to the provisions of the Building Act. It surely would be much better to get enacted a clause, in the proposed new Building Act, to prohibit the letting of any new house, unless all the rooms therein were fit for habitation, than to allow houses to be built with rooms unfit for habitation, and then, when such rooms are found to be occupied, to empower the Local Board to proceed against the persons using them as sleeping apartments. So far back as March, 1863, I directed public attention, in my quarterly report, to the provisions of section CO of the Amended Local Management Act, which requires the District Surveyor to make a report twice in every year, or oftener if required, of all underground rooms or cellars occupied as dwellings, within the meaning of the 103rd section of the 18 and 19 Vict., c. 120. This clause has not been acted on. The Baths and Wash-houses in Goulston Squabe. These Baths and Wash-houses, which were erected about 30 years ago, were the first of the kind in London, and being the first, the building was unavoidably very costly; and I am grieved to find that this model establishment, which has done so much good to the poor of this district, has for several years past been closed. There is, however, a prospect at the present time of re-opening them, as several influential ladies and gentlemen, who feeling a lively interest in the welfare of the poorer classes, to whom this institution was such a boon, have resolved to make an earnest endeavour to put the building in thorough repair, and re-open the baths and wash-houses for the use of the public, and particularly for the poor of this populous district. My cwn testimony, and that of the Dean of Lichfield, who was for many years the esteemed Rector of Whitechapel, have been strongly given in letters recently published in " The Times'''' newspaper, in favor of the moral and physical advantages which the poor derived from the Baths and Wash-houses in Goulston Square. The full advantages of this establishment will not however be realized unless a convenient access be made to it. At present, the building is hid from view, and the approaches to it are through such narrow courts and places, that the public are deterred from availing themselves of the advantages which are there offered to them. 13 But as the London School Board has purchased a large site for erecting a District School, abutting upon the back part of the Baths and Wash-houses and as there is now in the same line of thoroughfare a School in which about 2600 Jewish children assemble daily for instruction, it will be absolutely necessary, on the ground of public health, and safety to the numerous children who will assemble in this locality, to widen the thoroughfare which extends from Whitechapel High Street to Brushfield Street. The traffic at the north end of this thoroughfare, where this large Jewish School is situated, has now become so great as to render it dangerous for tho children going to and from school. The danger of this narrow place has unfortunately been recently exemplified by one of the children having been run over and killed. As this proposed thoroughfare could be made at comparatively little cost, tho property which would be required to be taken down for the purpose being for the most part very old and dilapidated, it is most earnestly to be desired that this great sanitary improvement, which will afford an open space for the better ventilation of these large schools, will be carried into effect. This improvement would also be a great public benefit. Bake-houses. Although the bake-houses in this district have been duly inspected once in every six months since the passing of the Bake-houses Regulation Act, 1863, with a view of ascertaining whether the provisions of that Act, relating to the limitation of the hours of labour of persons under 18 years of age; the carrying out of the regulations as to the cleanliness and ventilation, and as to their being used as sleeping places, I have thought it desirable at the present time to make a more minute inspection of these places, and the results of the inspections have been tabulated for reference as follows: —1, the name of the proprietor; 2, bake-houses situated under-ground or otherwise; 3, bake-houses clean or otherwise; 4, light and ventilation; 5, paving and drainage; 6, situation and condition of privy; 7, water receptacles, what kind, where situated, and in what condition; 8, number of persons employed in bake-house; 9, size of bake-house, and number of ovens therein; 10, whether any portion of the bake-house is used as a sleeping apartment; 11, whether any person under the age of 18 years is employed between the hours of nine of the clock at night and five of the clock in the morning; 12, whether Sunday bakings are carried on. The following is a summary of these inspections. The Bake-houses in this district are 74 in number. Of these, 41 are situated under-ground. The condition of 27 was found to be very unsatisfactory as regards cleanliness, and 23 as regards light and ventilation. In 12 instances the privies are in the bake-houses, 5 of which were found to be in a filthy condition : only a few of them are properly supplied with water. In 19 instances the water receptacles, for the use of the bake-houses, were 14 defective as regards their general conditions, some of the butts in use being old and dilapidated, some without either covers or taps, while others were in the bake-houses adjoining the privies. In 19 instances the brick or stone floor of the bake-houses was defective. The total number of persons employed in the bake-houses was 158, and the number of ovens was 81. Tho number of bake-houses in which Sunday bakings are carried on is 42. There was no evidence of overcrowding in any of the bake-houses. In no instance was it ascertained that persons were found making a sleeping room of the bake-house; neither were persons under the age of 18 ascertained to be at work longer than the hours prescribed by the Act. In no case, however, was a proper lavatory provided for the men to wash before commencing or leaving work. The men are required to be in the bake-house about 14 hours daily, but they are said not actually to work more than eight hours. From the above return there will scarcely be a difference of opinion regarding the desirability of effecting a sanitary reform in the bake-houses. In those bake-houses which are situated under-ground, where there is a want of daylight, where gas is burned to a great extent, where ample provision is not made for carrying off the products of combustion and the heated air which is combined with the sulphurous acid gas which is given off from the oven-fires; and especially where adequate means are not provided for the admission of fresh air, it may reasonably be expected that men remaining in such places for 14 hours daily will suffer in their health . In addition to these evils the men are exposed to the inhalation of the fine particles of flour, which act as a mechanical irritant to the lungs. We need not therefore be surprised to find that consumption is a common complaint among the journeymen bakers. Nearly all the men whom I saw at work were pale and unhealthy looking. On entering the bake-houses I found in one or two instances such a difficulty of breathing, that I could not remain in them longer than a few minutes ; and I learned that, whenever a window was opened to let in light and air, the men, who are generally in a state of perspiration, cannot bear the cold draught which then poured in upon them; and they find it more comfortable to work in a heated and ill-ventilated place than to expose themselves to the painful effects of draughts of cold air. Habit appears to so reconcile the journeymen bakers to the injurious effects of working in ill-ventilated places, as to render them indifferent to them. I was exceedingly grieved to find, during the recent strike among these men, that, owing as I suppose to their ignorance of the laws of health, no public complaint was made of the unhealthy condition of the bake-houses in which they worked for so many hours daily. This indifference to the causes of ill health is, I am sorry to say, not confined to journeymen bakers. As regards Sunday bakings, it would in my opinion be alike advantageous to masters, journeymen, and the public, to discontinue such work; for if the 15 poorer classes could not obtain that supposed advantage of getting their meat, &c., baked, they would have recourse to a less extravagant mode of cooking. In Glasgow, (where there are 350 bake-houses without steam power) and I believe in all the other cities in Scotland, there are no Sunday bakings carried on ; indeed the bakers' shops are not open for any purpose on Sundays. It appears that in Scotland power is given to the Medical Officer of Health, through the Inspector of Bake-houses, to prohibit the use of any bake-house not adapted for the purpose, either through bad ventilation or otherwise. Pboposed Annual Licensing oe Bake-houses. As a result of my inspection of the bake-houses, I am of opinion that it is most desirable they should be annually licensed by the Magistrates, in a similar manner to cow-houses and slaughter-houses ; and if any bake-house is found to be so badly constructed, as to be neither fit, nor capable of being made fit, for healthy occupation, the license should not be granted, and the further use of such place prohibited. Registration oe Death and Sickness. The importance of the registration of Death, and the causes thereof, has been fully acknowledged, and great benefit has accrued to the community by the regular publication of the returns of the Registrar General. These returns enable the local authorities to direct special attention to those districts which show an increased amount of mortality, especially when such mortality is caused by epidemic diseases. But the value of these returns would be greatly enhanced if the diseases which most generally prevail, were forwarded to a public office simultaneously with the death registers, so that the public might be informed, not only of the mortality of any district, but of the amount of illness which prevailed among the inhabitants. In a letter which I addressed to the Editor of the Journal of Public Health, which was published in that periodical in July, 1848, I drew special attention to the importance of obtaining a statistical return of cases of sickness; and I stated, "that the mortality returns, as published by the Registrar General, afforded only an imperfect knowledge of the state of the public health; for it may happen that if the prevailing diseases in a particular District are of a severe character, although comparatively few persons are attacked, the deaths will be large ; while, on the other hand, cases of illness may be very numerous, and the deaths comparatively few." The only objection to obtaining and publishing the records of illness is that of expense; but, as at the present time so much is being said and written about obtaining a national record of sickness, and of the advantages to be derived by the public in their being early in possession of such returns, the money required for such purposes will, I am convinced, be readily granted by the Government. In the year 1857, Dr. conway Evans, one of the Medical Officers of Health for the Metropolis, undertook to prepare a weekly return of the rise and progress of disease in London. This was compiled from the District 16 Returns of cases of sickness which were obtained by the Medical Officers of Health, and forwarded by them every week without expense to the public. These returns were continued by that gentleman, with the assistance of one or more members of the Association of Health Officers, for two years, and were printed and circulated at the expense of the Government; but owing to some economical objections which were raised, the returns were discontinued. If all the Medical Officers of Health were to obtain weekly (and which could be easily done, without incurring expense), a return of the sickness prevailing among the pauper population of each district, and lay the same before each meeting of the Vestry or District Board, a tolerably good knowledge of the health of the Metropolis might be obtained; and as the returns of sickness are published in the local newspapers, the public would be informed of the state of health among the poor of each locality. I may here observe that, for any practical purposes, a general return of sickness in the United Kingdom must be made weekly, and this should be published simultaneously with the returns of the Registrar General. I have no doubt, from the desire which has been shewn by the Metropolitan Health Officers to promote the public health, that a return of the pauper cases of sickness could be readily obtained by the Local Government Board every week, if the Medical Officer of that Board were to request each Medical Officer of Health to send such a return to him in a prescribed form. I may here state that I have, ever since the formation of the Board, regularly, week by week, obtained from the books of the Medical Officers of the Union an account of all the new cases of illness occurring among the pauper population. This weekly return enables me to take prompt action in every instance where epidemic diseases occur. The Sanitary Commission, at page 177 of their report, make the following important recommendations:— 'That, in addition to the duties prescribed by the existing registration Acts, it should be made the duty of the Registrar General, and of the District Registrars, to register disease and sickness, or specified cases of disease and sickness." "That, in every case of death, the medical attendant, or, where none, the District Medical Officer of Health, should certify to the District Registrar the cause of death; and should also, in cases of suspicion, but not otherwise, givo notice to the coroner." The Acts of Parliament relating to Sanitary matters which have been passed during the last Session are—An Act to amend the Public Health; an Act for the better protection of Infant Life; an Act to amend the Law for the prevention of Adulteration of Food and Drink and of Drugs; an Act to regulate the use of Steam Whistles in certain Manufactories, and an Act for regulating the Sale of Intoxicating Liquors. This last Act contains several stringent sections relating to the adulteration of intoxicating liquors. 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 28th Sept., 1872. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhcea. Cholera and Choleraic-Diarrhoea. Continued Fever, Typhus & Typhoid. Febricula. 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 0 2 0 2 54 1 0 20 0 2 0 0 11 7 0 4 0 0 0 0 139 242 Mr. Champneys 2 3 0 4 30 1 1 18 1 8 0 0 30 1 1 0 0 9 1 2 183 288 Mr. Sequeira 0 1 0 1 38 0 1 18 0 2 0 l 7 3 0 0 0 0 1 0 132 205 Mr. H. Braye 2 6 4 2 52 1 1 19 0 3 0 0 25 1 1 1 0 l 0 2 216 337 Mr. Loane 1 1 1 0 15 0 2 12 0 1 0 0 0 1 0 1 3 0 0 3 114 155 Total 5 13 5 9 189 3 5 87 1 16 0 1 73 13 2 6 3 3 2 7 734 1227 Corresponding Quarter of previous Year. 41 22 8 5 368 2 66 0 0 8 1 1 99 17 3 10 0 5 3 9 1476 2144 Workhouse Mr. C. Ilott. 0 0 0 0 18 0 1 26 0 8 0 0 20 9 1 30 4 1 0 7 250 375 TABLE II. Ages at Death in each Registration District, for the Three Months ending 28th Sept, 1872. 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. 17 3 1 4 6 4, 1 36 Spitalfields 35 22 2 4 8 10 0 81 Mile E. N. Town 49 29 2 18 21 25 11 155 Workhouse. Whitechapel, N 32 11 4 10 7 7 2 73 Whitechapel Ch 18 19 23 62 63 27 5 217 Hospital. Goodman's Fields 31 13 2 5 5 3 1 60 A1 dgate 15 10 7 4 8 4 0 48 Total 197 107 41 107 118 80 20 670 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 45.3 per cent. It varies, however, in the several sub-districts. Thus, in the Artillery sub-district it is 55.5 per cent. ; in the Whitechapel North, it is 58.8 per cent. ; in the Goodman's Fields it is 78.3 per cent. ; and in the Spitalfields it is 70.3 per cent. Population in 1871, 76,332. Population in 1861, 78,970. TABLE III. The Births and Deaths in each Registration District, for the Three Months ending on the 28th Sept., 1872. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M F. Workhouse. 27 29 56 24 12 36 20 0 Spitalfields 52 49 101 41 40 81 20 0 MileEndN.Towr 80 84 164 89 66 155 9 0 Whitechapel, N. 58 54 112 34 39 73 39 0 London Hospital. WhitechplChurcl 35 35 70 149 68 217 0 147 Goodman's Field 42 44 86 35 25 60 26 0 100 Non-residents died in the London Hospital. Aldgate 31 20 51 25 23 48 3 0 Totals 325 315 640 397 273 670 117 147 Excess of Births over Deaths deducting the 100 Deaths of non-residents, 70 TABLE IV. Showing the Deaths from Epidemic Diseases, for the Three Months ending 28th Sept., 1872. Districts. Small-Pox. Measles. Scarlet Fever. Diphtheria. HoopingCough. Diarrhoea. Fever. Cholera & Choleraic Diarrœa. Total. Remarks. Artillery 0 0 0 0 0 6 0 0 6 0 2 0 0 3 10 1 1 17 Mile End New Town 0 4 0 0 5 20 2 3 34 Workhouse. Whitechapel, North 0 0 2 0 2 11 0 1 16 Whitechapel Church 0 0 0 0 4 8 0 0 12 Hospital. Goodman's Fields 0 0 0 0 2 14 0 0 16 Aldgate 0 0 0 0 2 9 2 0 13 Totals 0 6 2 0 18 78 5 5 114 Deaths from Epidemics for the corresponding Quarter, 1871. 11 12 5 1 4 99 7 3 142 The deaths from Pyæmia were 6, from Erysipelas 6, from Croup 9, from Rheumatism 1, from Carbuncle 1, and from Remittent Fever 1. Two deaths from Fever occurred in the Fever Hospitals, thus making the mortality from Fever in this district 7. TABLE V. Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 2Sth Sept., 1872. 0 and under 1. 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and upwards. Total Males, 41 Females, 23 Corresponding Quarter of 1871. Workhouse 7 3 1 13 15 19 6 64 55 London Hospital 3 13 20 59 54 17 2 Males, 121 Females, 47 127 168 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 28TH DEC., 1872, BY JOHN LIDLLE, MEDICAL OFFICER OF HEALTH. London: Printed by T. Penny & Co., 121, Leman Street, Whitechapel, E. 1873. REPORT of the MEDICAL OFFICER OF HEALTH, for the Quarter ending 28th December, 1872. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, December 28, 1872, the births registered in the Whitechapel District were 661; viz., 347 males and 314 females. During the same period the deaths have been 548: of these, 307 have been of males and 241 of females. In the corresponding Quarter of the previous year the births were G53 and the deaths 669. There has been, therefore, an increase of 8 in the number of births, and a decrease of 121 in the number of deaths. The deaths in the London Hospital have been 155; viz., 118 males and 37 females. Of the total deaths in this institution there were 22 of persons resident within the District, 86 of non-residents, and 47 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 3 deaths from typhoid fever in the London Hospital during this Quarter, 2 of which were of non-residents. The deaths in the Workhouse have been 55; viz., 23 males and 32 females. No death from epidemic disease occurred in this establishment. The deaths from epidemic diseases in the entire District have been 41; viz., 1 from small-pox, 3 from measles, 2 from scarlet-fever, 1 from diphtheria, 15 from hooping-cough, 12 from diarrhoea, and 7 from fever. There was no death during this quarter either in the Small-pox or Fever Hospital of patieuts from this District. There were 9 deaths from erysipelas, 3 from puerperal fever, 4 from pya3mia, and 8 from croup. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 80; viz., 23 from small-pox, 12 from measles, 10 from scarlet-fever, 12 from hooping-cough, 10 from diarrhoea, and 13 from fever. In the corresponding Quarter of last year the deaths from erysipelas were 3, from puerperal fever 1, from pyæmia I, from rheumatism 4, from croup 4, and from mumps 1. The deaths caused by diseases of the respiratory organs, exclusive of consumption, have been 94; of these, 39 were caused by bronchitis, 49 by 4 pneumonia, 1 by laryngismus, 1 by pleuritis, 3 by asthma, and 1 from inflammation of the tracbœa. Consumption was fatal to 57 persons. The deaths from other tubercular diseases were 25; viz., 15 from mesenteric diseases, 4 from tubercular meningitis, 5 from hydrocephalus, or water on the brain, and 1 from scrofula. The deaths from diseases of the respiratory organs in the corresponding Quarter of last year were 152, and from consumption 81. The deaths from diseases of the nervous system were 65; viz., 14 from disease of the brain, 14 from apoplexy, 15 from paralysis, 1 from tetanus, 2 from cerebro-spinal-meningitis, and 19 from convulsions. The deaths from diseases of the digestive organs were 18; viz., 1 from gastritis, 1 from ascites, 1 from ileus, 1 from ulceration of the intestines, 1 from peritonitis, 3 from hernia, 1 from disease of the stomach, 8 from disease of the liver, and 1 from stricture of the oesophagus. Diseases of the organs of circulation were fatal to 39 persons; of these, 33 died from disease of the heart, 4 from aneurism, and 2 from pericarditis. The deaths from diseases of the urinary organs were 18; of these, 13 were caused by nephria or Blight's disease, 1 by diabetes, 2 by disease of the bladder, and 2 by disease of the kidneys. There was 1 death from syphilis and 1 from stricture of the urethra. Congenital syphilis was fatal to 4 children. There were 5 deaths from premature birth, 8 from teething, and 27 from atrophy and debility. Three persons died in childbirth. Two persons died from intemperance. A child died from thrush. The deaths of 23 persons are attributed to old ago; of these 9 were above 80 years of age; one of whom reached the advanced age of 102. One person under 54 died from premature decay. There were 38 deaths from mechanical violence; of these, 6 were caused by horses and vehicles in the streets. There were 2 deaths by manslaughter. Burns and scalds were fatal to 9 persons. Three persons committed suicide. One child was suffocated in bed. A child aged 1 year and 11 months was suffocated by accidentally swallowing nitric acid. A man aged 42 was accidentally suffocated whilst eating. The number of inquests has been 76. In the corresponding quarter of last year the number was 95. The number of deaths which have not been certified by a medical practitioner has been 14; of these, 8 were recorded in the Spitalfield's sub-district. The mortality of children under five years of age was 193. This is 35.2 per cent. of the total mortality. In the corresponding quarter of the previous year the rate of mortality of children under 5 was 32.1 per cent. of the total mortality. In the Artillery sub-district the rate is 54.9 per cent.; in the 5 Spitalfields, 57.5 per cent.; in the Mile End New Town, 32.5 per cent.; in the Whitechapel North, 61.1 per cent.; in the Whitechapel Church, 14.5 per cent.; in the Goodman's Fields, 42.5 per cent.; and in the Aldgate, 46.9 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended during the last quarter 1078 new eases of illness out of the Workhouse; including 1 of small-pox, 5 of measles, 2 of scarlet-fever, 14 of hooping-cough, 37 of diarrhoea, 4 of fever, and 12 of erysipelas. In the corresponding quarter of the previous year the number of pauper cases of illness was 1705; including 58 of small-pox, 40 of measles, 12 of scarlet-fever, 19 of hooping-cough, 42 of diarrhoea, 24 of fever, and 10 of erysipelas. The diminution in the number of cases of epidemic diseases is very remarkable. The total number of cases of illness in the Workhouse has been 488; including 1 of measles, and 21 of diarrhoea. Meteorology of Greenwich The returns of the Registrar-General show that the rain-fall in the Metropolis during the quarter has been 11.22 inches. "The rain measured during October and November was 7.3 inches, or 2 inches above the average fall in 56 years. Rain fell on 46 out of the 61 days of those two months." During the corresponding quarter of last year the rain-fall was 3.12 inches. The mean temperature of the air was 45.5°. In the corresponding quarter of last year the mean temperature was 41.9°. The coldest days during the quarter were Monday, the 18th November, Thursday, the 19th, and Thursday, the 12th December, when the thermometer indicated respectively 32.3°, 33.3°, and 27.1°. The coldest day during the corresponding quarter of last year was on the 8th December, when the thermometer indicated 18.6°, or 13.4° below the freezing point. The total rain-fall during the year was 29.13 inches. In the previous year the rain-fall was 22.41 inches. The following table, taken from the returns of the Registrar-General, shows the comparative results of the Quarter:— LONDON. Oct. 5th Oct. 12th Oct. 19th Oct. 26th Nov. 2nd Nov. 9th Nov. 16th Nov. 23rd Nov. 30th Dec. 7th Dec. 14th Dec. 21st Dee. 28th Deaths from Small Pox 14 7 17 6 14 15 13 13 8 8 5 5 10 Deaths from Scarlet Fever 20 21 17 22 21 14 14 23 13 12 17 11 18 Mean Temperature of the air 52.4° 47.3° 44.1° 47 .4° 49.7° 50.3° 37.9° 43.9° 48.0o 41.9o 38.6o 41.5° 48.7o Rain-fall in inches 0.49 0.64 0.50 2.04 0.94 0.33 0.90 0.70 0.77 1.13 0.74 1.61 0.43 Deaths in London 1276 1218 1369 1381 1306 1181 1183 1277 1221 1205 1199 1288 1232 Deaths in 44 39 49 50 36 33 36 41 50 43 47 50 33 chapel District Deaths in ditto 0 0 0 0 1 0 0 0 0 0 0 0 0 from Small-pox 6 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 165 waste-preventers, (7 new ones having been erected during the quarter) which supply water to about 1230 houses. The regulations made under the Metropolis Water Act, 1871, respecting the necessary fittings for preventing undue consumption or contamination of water, having been confirmed by the Board of Trade, are now in force. These regulations are 33 in number; and as Regulations Nos. 16,17 and 18, affect the landlords of numerous small houses in this District, I have thought it advisable to quote them. They are as follow:—No. 16. No cistern, buried or excavated in the ground, shall be used for the storage or reception of water supplied by the Company unless the use of such cistern shall be allowed in writing by such Company. No. 17. No wooden receptacle, without a proper metallic lining, shall bo hereafter brought into use for the storage of any water supplied by the Company. No. 18. No draw tap shall in future be used unless the same be sound and suitable and of the screw-down kind. Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending December 28th, 1872:— Number of inspections of houses as shown in the official returns 3896 Houses specially visited 141 Ditto specially re-visited 560 Preliminary notices served, such notices embracing 247 premises 203 Compulsory orders issued, embracing 50 premises 34 Summonses heard at Police Courts 7 Cellars used as dwellings discontinued for such use 9 Houses in which the rooms or passages have been whitewashed 134 Rooms disinfected with sulphurous acid gas after the occurrence of small-pox, fever or scarlet fever, therein 8 Yards of houses paved or the pavement repaired 40 Drains in houses improved 60 Dust-bins provided 19 Privies lime-washed, cleansed, and repaired 119 Water-butts and cisterns provided or repaired 20 Water-waste preventers erected 7 Nuisances from dung and other offensive matter removed 18 Area gratings and cellar flaps repaired 4 The cow-houses in the District, 24, 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 have promptly attended to. 7 Fever on Board Ship in St. Katharine Dock. A death from fever having occurred on hoard the Ship "Navigator" on her passage home from the coast of Africa, information of the same was given to the Sanitary Officers of this Board so soon as the vessel arrived in St. Katharine Dock. It was deemed advisable to destroy the clothes belonging to the seaman, which was done by the Inspector; and notice was given to the Captain to cleanse and disinfect the forecastle of the ship where the man died. The order was duly attended to. Difficulty of keeping the Houses occupied by the Poor in a peoper, Sanitaey Condition. However much the landlords may feel disposed to keep their houses which are let to the poor in a proper sanitary condition, the tenants, owing to their filthy habits, render it almost impossible for them to do so. This remark refers more particularly to those houses in which every room is let to a separate family, and where the yard, privy, and staircase, are used in common by all the occupants of the house. Thus one tenant will not remove the filth from any part of the house or yard, so the filth remains, thereby causing a nuisance to the house. The landlord is required to cleanse and repair the walls and ceilings when necessary; but as a rule, the tenants seldom think of cleansing the floors of their rooms or the stairs. Some landlords keep a man or a woman to look after the privies and the yards for the purpose of keeping them clean. This work is usually performed early in the morning, and it often happens that the first person who uses the privy after the same has been cleansed will deposit filth on the seat, and the next person will do the same thing, or perhaps will throw the filth in the yard or into the dust-bin: as a rule, the tenants will not even take the trouble to put the dust into the bins, but will drop it down by the back door and sometimes in the passage of the house. The stairs are sometimes found to be so encrusted with dirt as to require a pickaxe or shovel to remove it. The teaching of cleanly habits to the poor would form a grand field for missionary enterprize, Small-Pox. During this quarter it will be observed, from the returns of sickness as shown in the books of the Medical Officers of the Union, and from the returns of mortality as given by the Registrar General, that only one case of smallpox has been entered, and that only one death has occurred. We may therefore consider that the epidemic of small-pox has now passed away. This however is the proper time to most strongly urge upon all the officers who have been appointed to carry oat the provisions of the Vaccination Act, not to relax in their exertions to bring all the children born in the District under the influence of vaccination; for parents are too apt to neglect the duty when the epidemic has ceased. 8 Vaccination. 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 same quarters. Quarter ending— PUBLIC VACCINATOR Workhouse. Totals. Births Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. Registd. March, 1871 727 1169 10 0 737 1169 747 June 357 538 21 0 378 538 569 September 186 12 35 0 221 12 602 December 134 6 27 0 161 6 653 March, 1872 219 16 43 1 262 17 720 June 29 289 9 32 0 321 9 684 Sep. 28 306 1 26 4 332 5 640 December 263 0 23 1 286 1 685 Totals 2481 1751 217 6 2698 1757 5300 Sanitary Improvements carried out in Emery's Place, and in Avenue Place. The Sanitary condition of the four houses in Emery's Place has been much improved. The water receptacles and dust bin, which were inconveniently placed in the small back yard of each house in close proximity to the privy and to the windows of the lower room, have been taken away, and in lieu thereof a water-waste preventer has been erected in each yard, and a public dust-bin has been built in the court for the use of the occupiers of the four houses. This dust-bin has been added to the list of public dust-bins and is emptied daily. Avenue Place. The houses in this court, (four in number), which have been closed by order of the Magistrate since March, 1871, in consequence of their being unfit for habitation, are now abolished. Nos. 244, 245 and 245a, Whitechapel Road. The attention of the Inspector was directed to the defective sanitary condition of No. 245, Whitechapel Road, in consequence of a complaint having been made against the occupier for throwing filth into the public way. On inspecting the house, which is known as the "Eel Pie House," the occupier stated that he had no place to deposit any house refuse, as there was no yard in which he could place a dust-bin. The sanitary provisions of this house are probably unique. In order to get to the water closet, the tenants of the lower room and shop have to ascend two flights of stairs, and then to descend other two flights before they can get to this convenience, which is situate at the bottom of the lower flight of stairs, and form part of the house. The 9 pies were manufactured in the cellar which was neither paved nor drained, and was in a most filthy condition. The houses numbered 244 and 245a are likewise without back yards, they having been taken for the erection of a warehouse. In No. 245a, the privy and water supply are in the cellar, and in No. 244, the privy is built on a lead flat over the shop. If these were the only houses in the District which have been rendered unhealthy by the owners building over the back yards, it would be sufficient to show how necessary it is so to amend the Building Act as shall prevent similar alterations from being made in other houses; but when there are also several other houses so unhealthily constructed as to be the means of conveying the poison of some diseases from one family to another, I may be excused for again directing attention to the necessity of the Government bringing in such a Bill as shall prevent the further erection of unhealthy dwellings. There can be no doubt that the healthy housing of the population is the foundation of all sanitary improvements, for unless stringent laws are passed to prevent the erection of unhealthy dwellings, the numerous statutes relating to the public health will be of comparatively little benefit. In order therefore that a more healthy class of houses may in the future be built, the sanitary provisions of any new Building Act should provide— 1.—That no house in any new street shall be occupied as a dwelling-house unless a sewer has been constructed along such street, and a properly constructed drain made from the house to the sewer. 2.—That, before any house is permitted to be occupied, the road and footway shall be paved, and the surface drainage properly provided for. 3.—That, before the building of any new house is commenced, plans of the drainage, and of all the sanitary arrangements of the house, shall be submitted for approval to the Local Board. This Board shall be invested with power to compel the builder of any new house within the district so to alter his plans, if necessary, as to render such house fit for healthy occupation. 4.—It shall likewise be made compulsory upon every builder to provide a separate water closet or privy and ashpit for each house, within the curtilage of the house. This provision would prevent the erection of public privies in courts occupied by the poorer classes, which are now for the most part nuisances, and injurious to the public health. 5.—That during the progress of the building of any house, the Surveyor to the Local Board shall be required to inspect the foundation thereof; and if such Surveyor be of opinion that the materials which are being used for such foundation are not proper for the purpose, he shall make known his objections to the builder, and shall report the same to the Board. This report having been made, the Board shall have power to prevent the use of all such improper materials. 6.—That the walls and foundation of every house shall be so constructed as to prevent the rise of damp. 7.—That every new house shall at all times have at the rear an open space of sufficient extent for the thorough ventilation of the staircases and 10 sages. The extent of the open space to be determined by the Act, (say 100 square feet) but the plan of this open space shall be approved by the Local Board before the builder is allowed to complete the building. 8.—That the floors of every house shall be properly ventilated, and that the floors of the basement shall not be laid upon the bare ground. 9.—That the back yards of houses shall not be built upon without the sanction of the Local Board; but in no instance shall the open space in the rear be less than 100 square feet, and so arranged, with regard to the house, as to be sufficient, in the opinion of the Local Board, for the purposes of ventilation. 10.—That all old buildings, such as warehouses, stables, &c., shall not be converted into dwelling-houses unless the plans, as regards all the sanitary arrangements, shall have been submitted to and approved of by the Local Board, 11.—That the same law as regards the width of new courts and alleys shall be applied to old courts, when any of the houses therein have been pulled down; for, if it be deemed necessary that new courts shall be, for purposes of health, of a certain width, it is as necessary for the public health that old courts should be equally as wide. 12.—In order that every new street shall have an adequate supply of sunlight, which is so essential to health, the buildings on either side of the street shall not be permitted to exceed in height the width of the street. This regulation will be of the utmost importance in courts which are not thoroughfares; but such is the desire of the owners of property to make the most rent of it, (and unfortunately such a proceeding is sanctioned by the Legislature) that they are perfectly regardless of the rights of the public to breathe the pure air of heaven and enjoy the light of the sun. 13.—That, in consequence of danger to the public while walking along the streets by the falling of snow or slates from the roof of any house unprovided with a parapet wall, no new house shall bo considered as completed unless the same is provided with a parapet wall. 14.—No house shall be allowed to be occupied unless there shall be a passage leading from the front door to the back yard; and unless the staircase leading to every room shall open into a landing, so that each room in every house shall be distinct and separate from the other rooms. Under present arrangements it is not uncommon to find that builders, on the score of economy, build houses with the front door opening direct from the sitting-room on the ground floor into the street, and the stairs leading to the upper rooms opening directly into and forming a part of the lower room, so that the foul air of the lower room is ventilated by means of the staircase into the room above. Such a faulty arrangement also destroys the privacy and comfort of families by converting rooms so arranged into thoroughfares. There are some houses in the Whitechapel District in which the tenants of one room are obliged to carry all their filth through their neighbour's room before it can be thrown into the privy or drain in the back yard. This proceeding is not only most indecent' 11 but, in case of a person suffering from epidemic disease, is dangerous to health the germs of such disease being frequently contained in, and given off from, the excrement of the sick. 15.—That no house shall be permitted to be occupied unless the person letting such house shall have a certificate, signed by the Surveyor and Medical Officer of Health to the Local Board, that all the rooms therein are fit for healthy occupation, which certificate shall be shown to every incoming tenant. 16.—That, in consequence of numerous unhealthy houses which are continually being built in the suburbs of London, and also in other large cities and towns, and the suburbs thereof, the area of the new Building Act shall be extended to all large towns and populous cities in England; and that the carrying out of all the sanitary arrangements of habitable buildings shall be intrusted to the Local Boards, who, by their several officers, would be able to superintend the erection of all houses. 17.—That the Building Act shall contain a section to give power to the Local Board to purchase, at a moderate compensation, such property as has been condemned by the Medical Officer of Health and Surveyor of the Local Board, under the provisions of the Artizans' and Labourers' Dwellings Act. 18.—That in all cases of dispute between the Local Board and the builder, as regards plans of drainage and other sanitary provisions, power of appeal to a competent authority shall be given; but in all cases it should be made imperative upon the builder to provide a separate drain for each house in direct communication with the main sewer. 19.—That whenever it has been ascertained by any public officer that the provisions of the Building Act, as regards an infringement of the open space in the rear of any house has taken place, no length of time that such infringement has existed shall legalize it. If the entire supervision of the sanitary arrangements of all new houses, and the additions to old ones, were entrusted to the Medical Officers of Health and to the Surveyors to Local Boards, some of the evils which are now occasionally taking place in the construction of dwelling-houses would be prevented, such as the filling up with improper materials the excavations which are made by the removal of gravel, and the use of an inferior kind of mortar for the building of houses. The importance of having healthy houses for the increasing population of this vast Metropolis cannot bo too strongly urged upon the Government; for it has been incontrovertibly shown that the death-rate is increased in consequence of unhealthy dwellings. ANNUAL REPORT. The number of births registered in this District, during the year 1872, has been 2705, viz., 1461 males, and 1244 females, and the number of deaths 2390, viz., 1375 males, and 1015 females. The births in 1871 were 2571, and the deaths 2465. The number of births therefore is greater than that in 1871 by 134, and the number of deaths is less by 75. The deaths in the workhouse 12 have been 263 against 304 for the previous year; and the deaths in the London Hospital 616 against 557. 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, 25.8 per 1000, or 1 in 36.7 of all living. The rate of mortality during the last year, was 32.2 per 1000. 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 616. Deducting, therefore, the deaths in this institution from the total deaths, the rate of mortality is 19.1 per 1000, or 1 in 52.3 of all living. The same deduction being made from the total number of deaths for 1871, the rate of mortality was for that year 25.5 per 1000. The rate of mortality in this District for the year 1872, is however, lower than it has ever been since the formation of the Board. Whether the excessive rain-fall which has occurred during the year, together with the increase of temperature, has contributed to the result, is a matter of conjecture. Although the excessive rain-fall during the last three months has occasioned great discomfort, and greatly interfered with farming operations, it may have so purified the air as to cause a groat diminution in the rate of mortality, and especially in lessening the number of deaths from epidemic diseases. The deaths from epidemic diseases have this year been, not only 277 against 437 for the previous year, but they have been considerably less than in any year since 1857; a similar remark applies to the cases of epidemic diseases which have been attended by the Medical Officers of the Union. Thus, in 1872, the total cases of epidemic diseases which were recorded in the books of the Medical Officers of the Union, were 551 against 1730 in 1871. The tables Nos. 8 and 9 in the Appendix show the return of death and sickness from epidemic diseases since 1858. 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 4,864. During the previous year the number was 10,194. On referring to the notes in Table VI. in the Appendix it will be seen that in the year 1856 the pauper cases of illness amounted to 9,897; 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, the cases of illness among the paupers were reduced to 10,194, and in this year to 4864. Small Pox. The total number of deaths from small-pox in the Whitechapel District, for the year 1872, has been 19, to which however there must be added the 7 deaths which have occurred in the Small-pox Hospital, making a total of 26. The total deaths from epidemic diseases during the year were 277, the 13 culars of which are recorded in table No. VIII. I have shown in this table the number of deaths which have occurred annually in this district from epidemic diseases since the year 1858; and in the following table No. IX. I have recorded the number of cases of the same diseases which have been attended by the Medical Officers of the Union. From both these tables it appears that the deaths from, and cases of, these diseases are less in number than in any of the preceding years. Sanitary Works Performed during the year 1872. Number of inspections of houses as shown in the official returns 13,910 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 39 Number of cases of indecent occupation discovered 33 Houses specially visited 917 Houses specially re-visited 2929 Ditto registered by order of the Board 1 Certificates and copies prepared for the registration of the above houses 2 Number of special notices served for the registration of houses 3 Preliminary notices served, such notices embracing 1488 premises 976 Compulsory orders issued, embracing 326 premises 181 Summonses heard at police courts 22 Houses in which rooms or passages have been whitewashed 714 Ventilation of houses improved 7 Yards of houses paved or the pavement repaired 246 Cesspools abolished 7 Drains in houses improved 275 Dust bins provided 81 Privies limewashed, cleansed and repaired 462 Water-butts and cisterns provided or repaired 97 Water-waste preventers erected 21 Area gratings, cellar flaps, &c., repaired 154 Cellars used as dwellings discontinued for such use 13 Animals, so kept as to be a nuisance, removed 3 Nuisances from dung and other offensive matter removed 77 The cow-houses in the District, 24, and the slaughter-houses, 39 in number, have been visited four times during the year. The bake-houses (74 in number) have been twice specially visited during the same period. Relapsing Fever. Information having been recently circulated, through the medium of the public press, that several cases of relapsing, or famine fever, have occurred in the Southern Districts of London, and in Manchester, it is probable that this disease will not be confined to those localities where it now prevails; but owing to its contagious nature may extend to other parts of the metropolis, and to other districts in the Country. It is therefore of the utmost importance that, where practicable, isolated temporary buildings should be erected for the reception of cases of this disease in every District, and also that the Metropolitan Asylum Hospitals should be made 14 fit to receive all such patients as cannot be attended at home without endangering the health of others living either in the same house or in the immediate locality. The following memorandum on relapsing fever, which has been issued by the Medical Officer of the Local Government Board, is of such importance at the present time as to justify me in adding it to this report. "MEMORANDUM ON RELAPSING FEVER. 1873. "RELAPSING fever, which in 1868-71, after many years absence, seriously affected the metropolis and other places in England, is now again threatening the country: cases of the disease having recently been seen in certain districts of South London and of Manchester. For the purposes of Local Authorities, responsible for taking precautions against this disease and its consequences, the chief practical points to be borne in view are the following. 1. Relapsing fever is in a very high degree communicable from sick to healthy. The greatest personal predisposition to the disease is given by states of poverty and privation; so much so that the disease is often known by the name of famine-fever. The more confined the atmosphere in which sick and healthy are together, the more certain is the disease to be communicated. 2. Relapsing fever is eminently a disease which cannot safely be treated in the houses of the poor; for in them, crowded and ill-ventilated as they generally are, and with inmates often insufficiently nourished, there must be every likelihood that the infection will spread. It is essential that, under such circumstances, the sick should at once be removed from amid the healthy. Ample hospital-accommodation is therefore an indispensable condition for limiting the extension of the disease. 3. Where relapsing fever has attacked, and when all its acute symptoms are past, the sufferers remain for a while extremely weak, requiring that food and restoratives should be liberally supplied them; in default of which, the feebleness left by the disease may often be of indefinite duration. This is the more important, because, where relapsing fever becomes epidemic, typhus often accompanies or follows it; and persons whom the relapsing fever has weakened not infrequently fall victims to typhus. 4. At present, (as in all times when epidemic disease is prevalent or threatening) it is particularly important that powers conferred by the Nuisances Removal and other Sanitary Acts should be well exercised by those in whom they are vested. Very detailed district-inspection is most necessary. Everything practicable should be done, especially in all poorer parts of each district, to promote cleanliness of and about dwellings. The washing and lime-whiting of uncleanly premises, especially of such as are densely occupied, should be pressed with all practicable dispatch. It is essential that overcrowding should, as far as possible, be prevented, and proper ventilation be enforced; and in these respects common lodging-houses, and houses which are sublet in several small holdings, will require particular attention. Great vigilance must be used with a view to the discovery of first cases of relapsing fever in such houses; and frequent inquiry should be made as to the sorts of illness prevailing among the poor. The attention of Authorities is invited to the powers conferred on them by various sections of the Sanitary Act of 1866, with reference to infectious disease; especially to the powers conferred for purposes of disinfection, and for the conveyance of sick persons, and for the separation of the sick from the healthy. 5. Relapsing fever, as described in medical text-books, has the following characters. The patient becomes suddenly ill with shiverings, headache, heat of skin, prostration, and generally vomiting. To these symptoms are usually added more or less yellowness of skin, and severe general pains resembling those of rheumatism. After from five to seven days, the symptoms abruptly cease. For a week the patient feels well, and has his ordinary appetite, his natural temperature. and a pulse often even slower than in health. On or about the fourteenth day from the commencement of the original attack, relapse takes place, with a sudden paroxysm of fever similar to the first. The duration of the stage of relapse is commonly three days. Second, or even several, relapses sometimes occur; and as above stated, convalescence is usually protracted." From the inquiries which I have made, I am glad to learn that ample provision will be made in this District for the reception and treatment of patients who may be attacked with relapsing fever. I have the honor to be, Gentlemen, Your most obedient Servant, JOHN LIDDLE. 15, Great Alie Street. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 28th Dec., 1872. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhœa. Cholera and Choleraic Diarrhœa. Continued Fever, Typhus & Typhoid. Febricula. Pyæmia. Erysipelas. Puerperal Fever. Croup. Acute pulmonary Inflammation. Carbuncle. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleunitis and Pneumonia. Dr. Swyer 1 1 0 0 12 0 0 9 0 3 0 0 21 12 0 5 0 0 0 0 64 216 Mr. Champneys 0 4 0 5 9 0 1 11 1 6 0 0 38 0 0 5 0 1 0 1 82 256 Mr. Scqueira 0 0 0 0 6 0 2 22 0 0 0 0 2 0 0 2 0 0 0 2 36 177 Mr. H. Braye 0 0 2 8 2 0 1 9 0 3 1 0 45 2 1 4 0 1 0 2 81 260 Mr. Loane 0 0 0 1 8 0 0 4 0 0 0 0 8 2 0 6 1 0 0 1 31 169 Total 1 5 2 14 37 0 4 55 1 12 1 0 114 16 1 22 1 2 0 6 294 1078 Corresponding Quarter of previous Year. 58 40 12 19 42 0 24 0 0 10 1 1 252 25 0 15 1 1 1 6 1197 1705 Workhouse Mr. C. Ilott. 0 1 0 0 21 0 0 28 0 5 0 0 83 9 0 63 2 0 0 4 272 488 TABLE II. Showing the Deaths from Epidemic Diseases, for the Three Months ending 28th Dee., 1872. Districts. Small-Pox. Measles. Scarlet Fever. Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera & Choleraic Diarrhœa. Total. Remarks. Artillery 1 1 0 0 1 0 0 0 3 Spitalfields 0 0 0 0 1 1 1 0 3 Mile End New Town 0 1 0 0 7 2 1 0 11 Workhouse. Whitechapel, North 0 1 0 0 2 2 0 0 5 Whitechapel Church 0 0 0 0 2 2 4 0 8 Hospital. Goodman's Fields 0 0 1 1 0 2 0 0 4 Aldgate 0 0 1 0 2 3 1 0 7 Totals 1 3 2 1 15 12 7 0 41 Deaths from Epidemics for the corresponding Quarter, 1871. 23 12 10 0 12 10 13 0 80 Four deaths from Pyæmia, 9 from Erysipelas and 3 from Puerperal Fever occurred in the District. Three deaths from Typhoid Fever, occurred in the London Hospital, two of which were of non residents. TABLE III. Showing the Ages at Death in the Workhouse, and in the London Hospital for the Quarter ending 28th Dec., 1872. 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 1871. Males, 23 Females, 32 Workhouse 1 1 0 16 9 24 4 55 79 London Hospital 1 9 15 54 56 19 1 Males, 118 Females, 37 154 155 TABLE IV.—Ages at Death in each Registration District, for the Three Months ending 28th Dec., 1872. Districts. 0 and under 3. l 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 13 4 0 3 6 5 0 31 Spitalfields 23 14 2 4 10 9 2 64 Mile E. N. Town 24 19 4 29 19 32 5 132 Workhouse. Whitechapel, N. 21 3 2 4 7 5 0 47 Whitechapel Ch. 11 16 15 .52 65 25 1 185 Hospital. Goodman's Fields 12 5 8 4 8 3 0 40 Aldgate 16 7 2 7 12 4 1 49 Totals 120 73 33 103 127 83 9 548 From the above Table, it will be seen that the rate of mortality of children under 5 years of age, in relation to the total deaths, is 35.2 per cent. In some of the subDistricts, however, the rate of mortality is much higher; thus, in the Artillery subDistrict, it is 54.9 per cent.; in the Goodman's Fields, 42.5 per cent.; in the Spitalfields, 57.5 per cent.; in the Aldgate, 46.9 per cent.; and in the Whitechapel North, it is 61.1 per cent.; while in the Whitechapel Church sub-District, in which the London Hospital it is situated, it is 14.5 per cent. TABLE V.—The Births and Deaths in each Registration District, for the Three Months ending 28th Dec., 1872. Districts. Births. Total. Deaths. Total. Excess of Births over Deaths. Excess of Deaths over Births. Remarks M. F. M. F. Artillery 30 29 59 14 17 31 28 0 Spitalfields 61 59 120 38 26 64 56 0 Mile End N. Town 97 68 165 57 75 132 33 0 Workhouse. Whitechapel, N. 55 55 110 20 27 47 63 0 WhitechplG'hurch 39 33 72 134 51 185 0 113 London Hospital. Goodman's Fields 42 39 81 20 20 40 41 0 86 Non-residents 27 27 54 24 25 49 5 0 died in the London Hospital. Totals 351 310 661 307 211 548 226 113 Excess of Births over Deaths deducting the 86 Deaths of non-residents, 199 Population in 1871, 76,332. Population in 1861, 78,970. TABLE VI. Total number of the undermentioned Diseases, recorded in the Books of the Medical Officers of the Union, from 1860 to 1872, and the total cases of illness. Year. Small-P ox. Measles. Scarlatina. Hooping Cough. Diarrhoea and Dysentery. Fever. Chol. & Choleraic-Diar. Erysipelas. Puerperal Fev. Carbuncle. Bronchitis and Catarrh. Pneumonia & Pleuritis. Croup. Rheumatic Fever. Ague. Delirium Tremens. Total. Cases. 1860 65 520 93 83 801 100 1 52 1 9 845 141 3 7 41 6 11392 1861 86 70 100 388 1452 109 ... 75 1 9 803 104 9 5 18 2 13724 1862 113 525 118 153 1106 822 1 56 ... 4 557 135 9 16 24 4 14270 1863 253 80 305 169 1139 464 1 74 1 6 533 134 12 20 11 8 14564 1864 21 482 156 217 1127 295 1 92 1 6 786 95 6 14 13 1 14932 1865 86 51 164 280 1342 573 4 97 2 1 745 123 ... 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 1872 62 76 16 94 290 19 3 51 2 5 511 61 1 71 14 5 4864 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 there 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 5310, or more than one half. 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 1872. 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 1872 2705 2390 375 616 263 The number of inquests which have been held this year in this District has been 322. In the year 1871 the number was 324. TABLE VIII. Showing the Deaths from Epidemic Diseases in the Whitechapel District during the last 15 years. Name of Disease 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 Small Pox 4 60 21 28 33 69 5 22 44 40 11 1 56 159 19 Measles 78 31 81 27 153 26 137 28 139 33 69 71 36 42 23 Scarlet Fever 87 96 59 70 91 200 50 80 76 26 48 208 59 25 9 & Diphtheria Hooping Cough 117 50 49 98 62 52 74 97 94 72 55 113 50 43 96 Diarrhœa 108 141 67 101 69 114 109 122 119 100 138 97 107 125 99 Fever 104 93 69 65 250 158 170 167 100 82 1C9 95 52 40 26 Cholera &Cho 6 5 1 4 5 5 2 4 904 9 10 7 6 3 5 leraic-Diaha Totals 504 476 347 393 663 624 547 520 1476 362 440 592 366 437 277 London Fever 1902 1796 1302 1754 3635 2802 3689 3232 2681 2174 2483 2211 2049 1755 1003 Scarlta. & Diph. 4118 4197 2457 3058 4194 5719 3806 2614 2316 1836 3418 6162 6306 2220 1063 Small Pox. 247 1156 577 215 345 2012 537 646 1388 1339 606 273 958 7834 1532 TABLE IX. Showing the cases of Epidemic Diseases among the pauper population in the Whitechapel District during the last 15 years. Name of Disease 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 Small Pox 20 212 65 86 113 253 21 86 261 254 93 5 302 625 60 Measles 427 179 520 70 525 80 482 51 679 155 323 212 257 178 76 Scarlet Fever 146 175 93 109 118 305 156 164 197 60 54 311 97 32 16 & Diphtheria Hooping Cough 230 146 83 388 153 169 217 280 217 219 144 308 140 102 94 Diarrhœa 946 209 773 1418 1085 1108 1127 1342 1664 1471 1631 1033 1097 590 283 Fever 590 411 190 109 822 464 295 573 313 308 586 385 325 201 19 Cholera&Cho- 0 1 1 0 1 1 4 4 58 5 8 1 4 2 3 leraic-Diaha. Totals 2359 1363 1725 2180 2817 2380 2302 2500 3419 2472 2839 2255 2222 1730 551