WHI 24 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE Sanitarg Condition of the WHITECHAPEL DISTRICT, for the QUARTER ENDING 1st JANUARY, 1876, BY JOHN LIDDLE, medical officer of health. London: Ptuntfd by T. Penny & Co., 121, Leman Street, Whitrchaped, E , 1876. REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ending 1st Jan., 1876. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, the 1st January, 1876, the total births in the District were 653, and the deaths 659. The excess of deaths over births has therefore been, during this Quarter, 6. As the deaths of the non-residents which occurred in the London Hospital are included in the mortality returns, a deduction of such deaths must be made in order to estimate the correct mortality of the District. These deaths are on an average 66 per cent., exclusive of sudden deaths and deaths from accidents, of the total mortality in this Institution; and, as the total deaths are 187, 124 must be deducted for the deaths of non-residents, thereby reducing the mortality of the District to 535, and increasing the number of births above deaths to 118. In the corresponding Quarter of the previous year the total births wore 675, and the total deaths 731. In the Spitalfields sub-District the births were 178, and the deaths 98 ; in the Mile End New Town 164, and the deaths 156 ; in the Whitechapel North 98, and the deaths 67 ; in the Whitechapel Church 57 and 223 (in this sub-District the London Hospital is situated); in the Goodman's Fields 99 and 52 ; and in the Aldgate 57 and 63. The deaths have exceeded the births in the Whitechapel Church District by 166; but, from this number, the deaths of 124 non-residents must be deducted. The deaths in the London Hospital have been 187. In the corresponding Quarter of the previous year the deaths in this Institution were 199. The deaths in the Workhouse have been 75. In the corresponding Quarter of last year they were 89. 4 The deaths from epidemic diseases in the entire District have been 86 ; viz.: 2 from small-pox, 22 from measles, 12 from scarlet-fever, 3 from diphtheria, 24 from hooping-cough, 14 from diarrhoea, and 9 from fever. Six deaths of patients from this District occurred in the District Fever Hospital; thus making a total of 15 deaths from fevor. In the return of the Registrar-General, for the week ending November 20th, he remarks, "It is worthy of note that no death has been referred to small-pox during the past four months in London, which has an estimated population of 3,445,160, although the corrected average number of fatal cases of this disease in the corresponding period of the last ten years is 337. This oomplete immunity from fatal small-pox in London, for so long a period, is without parallel since civil registration was established, and may be safely assumed to be entirely unprecedented. During the eighteen weeks ending last Saturday, 16 deaths in London resulted from varicella or chicken-pox." The two deaths from small-pox, which are recorded as having occurred in this District during this Quarter, may therefore be attributed to varicella or chicken-pox. It would, however, be more satisfactory, if the deaths from varicella were always recorded by the Registrar-General under that head. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 88; viz.: 5 from measles, 59 from scarlet-fever, 3 from diphtheria, 1 from hooping-cough, 3 from diarrhoea, and 17 from fever. In addition to the 17 deaths from fever, there were 5 deaths in the Fever Hospital; thus making a total of 22 deaths from fever for that Quarter. As I have not received the mortality returns from the local registrars since October, 1874, I am unable to report, as formerly, the specific diseases which have proved fatal to the inhabitants of this District. Neither am I able to specify the localities in which deaths have occurred, nor the sudden deaths, nor the deaths from accidents. I am also unable to report the proportionate number of deaths of males to females, nor to record the ages at death. Mortality of Young Children. The mortality of children under 1 year of age was 131. This is 19.8 per cent. of the total mortality. In the corresponding Quarter of the previous year the rate of mortality of children under 1, was 16.7 per cent. of the total mortality. In the Spitalfields sub-District the rate is 33.6 per cent.; in the Mile End New Town 20.5 per cent.; in the Whitechapel North 28.3 per cent.; in the Whitechapel Church 4.0 per cent.; in the Goodman's Fields 28.8 per cent.; and in the Aldgate 36.5 per cent. In the Goodman's Fields sub-District the deaths under 1 year were 15, and the total deaths 52 ; in the Whitechapel North sub-District the total deaths were 67, and those under 1 year were 19 ; while in the Whitechapel Church subDistrict the deaths under 1 year were only 9, and the total deaths 223. 5 This difference is explained by the deaths in the London Hospital, in which Institution the deaths of children under 1 year are very few. In the corresponding Quarter of the previous year the rate of mortality of children under 1 year in the Spitalfields sub-District was 30.6 per cent.; in the Mile End New Town it was 17.8 per cent.; in the Whitechapel North 27.4 per cent.; in the Whitechapel Church 4.5 per cent.; in the Goodman's Fields 25.8 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter, 588 new cases of illness out of the Workhouse; including 8 of measles, 1 of scarlet-fever, 2 of hooping-cough, 15 of diarrhoea, 11 of fever, 27 of febricula, and 4 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 895 ; including 8 of measles, 33 of scarlet-fever, 6 of hooping-cough, 12 of diarrhoea, 20 of fever, 32 of febricula, and 10 of erysipelas. The total number of cases of illness in the Workhouse has been 682; including 7 of measles, 1 of scarlet-fever, 2 of hooping-cough, 13 of diarrhoea, 11 of febricula, 15 of fever, 18 of erysipelas, and 37 of syphilis. Cases of Illness in the London Hospital of Persons belonging to this District. By the courtesy of the House Committee of the London Hospital I have been favoured with a return of all the patients belonging to this District who have been admitted into the London Hospital during this Quarter. The total number, including both medical and surgical cases, is 242 ; including 1 of typhus-fever, 2 of enteric-fever, 2 of diarrhoea, 9 of rheumatic fever, 2 of erysipelas, 5 of bronchitis, 3 of pneumonia and pleuritis, 10 of consumption, 3 of lead poisoning, 1 of poisoning by ammonia, 3 of syphilis, 1 of Addison's disease, and 21 of fractured bones. The case of typhus-fever was that of a nurse in the Hospital. She was sent to the Fever Hospital, and was discharged cured. Meteorology of Greenwich. Tho returns of the Registrar-General show that the rain-fall in the Metropolis, during the Quarter, has been 7.50 inches. Of the 7.50 inches of rain which fell during this Quarter, 2.16 inches fell in the week ending October 23rd, and 1.92 inches in the week ending November 13th. One inch deep of rain-fall on an acre weighs (allowing 10-lbs to a gallon, which is the weight of a gallon of distilled water) nearly 101 tons. During the corresponding Quarter of last year the rain-fall was 7.02 inches. The mean temperature of the air was 42.8°. In the corresponding Quarter of last year the mean temperature was 41.5°. The coldest days during the Quarter were Saturday, tho 4th December, Sunday, the 5th December, Monday, the 6 13th December, and Tuesday, the 14th December, when the thermometer indicated respectively 23.7°, 23.3°, 29.8°, and 24.2°. The coldest day during the corresponding Quarter of last year was on Friday, the 1st January, when tho thermometer indicated 18.2°, or 13.2° below the freezing point. The rain-fall during the year was 27.59 inches, and in the previous year the rain-fall was 18.31 inches. The following table, taken from the returns of the Registrar-General, shows the comparative results of the Quarter :— LONDON. Oct. 9 Oct. 16 Oct 23 Oct. 30 Nov. 6 Nov 13 Nov 20 Nov 27 Dec 4 Dec. 11 Dec. 18 Dec. 26 Jan 1 Deaths from Fever 29 29 26 24 23 20 27 25 29 26 24 20 20 Deaths from Scarlet Fever 110 122 127 128 129 116 96 120 104 103 107 85 75 Mean Temperature of the air 54.3° 45.8° 49.7° 43.0° 48.2° 43.0° 45.8° 360° 309 33.3° 37.5° 46.1° 43.1° Rain-fall in inches 0.49 0.48 2.16 0.25 0.62 1.92 0.32 0.01 0.41 0.31 0.01 0.35 0.17 Deaths in London 1397 1442 1563 1477 1583 1567 1603 1504 1628 1856 1834 1603 1782 Deaths in Whitechapel District. 39 46 60 49 56 41 50 59 52 58 58 43 68 Deaths in do. from Fever 1 1 1 3 0 0 0 0 1 0 0 0 0 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 Registd. Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. March, 1874 335 1 37 0 872 1 640 June 411 2 30 0 441 2 726 September 329 0 30 0 359 0 630 December 185 2 31 0 216 2 689 March, 1875 292 2 44 0 336 2 687 June 376 0 26 0 402 0 673 September 350 1 36 0 385 1 650 December 178 2 23 0 201 2 655 Totals 2456 10 256 0 2712 10 5350 7 Water Supply. I am happy to be able to state that the New River Company have recently supplied with water, on the constant service, 53 houses in the immediate vicinity of Middlesex Street, viz.: 33 houses in Love Court, 3 in New Goulston Street, 3 in Little Love Court, 5 in Hebrew Place, and 9 in Little Middlesex Street. About a quarter of the number of houses (900) in this District, which are supplied by the New River Company, are now on the constant service. Sanitary Improvements on the North Side of the District. Goodwin's Buildings, Wentworth Steeet. This court, which was one of the worst in the District, has been entirely demolished by the owner (Mr. Isaacs), in consequence of notices being so frequently served upon him by Mr. Wrack, the Inspector, to repair the dilapidated condition of the houses, to remove the recurring nuisance of the public privies, and to abate the overcrowded state of the houses. The court formerly contained six houses, without yards; the houses consisted of two rooms each. The entire six houses had an area for light and air of only 320 superficial feet, and in which space there was a dust-bin and two public privies, which were situated within a few feet of the street. The court now consists of only four houses, each of which has a yard and proper conveniences. The present arrangement of the court gives an area for light and air of 597 superficial feet. The court was formerly approached by a narrow covered way, but it is now open to Wentworth Street, and is well paved and drained. Two houses also in Wentworth Street, situated at the corner of Goodwin's Buildings, had neither yards nor closets (the tenants having to use the closets in Goodwin's Buildings), have also been demolished, and two houses have been erected in their stead, each having a yard and proper conveniences. Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending 1st January, 1876 :— Number of inspections of houses as shown in the official returns 1698 Houses specially visited 103 Ditto specially re-visited 404 Preliminary notices served, such notices embracing 221 premises 165 Compulsory orders issued, embracing 66 premises 30 Summonses heard at Police Courts under Sanitary Act 6 Cases of overcrowding and indecent occupation discovered and abated 0 Houses in which the rooms or passages have been whitewashed 73 8 Rooms disinfected with sulphurous-acid gas, after the occurrence of fever and scarlet-fever therein 8 Articles disinfected, consisting of beds, bedding, clothing, &c 42 Yards of houses paved or the pavement repaired 14 Drains in houses improved 37 Cesspools abolished 0 Dust-bins provided 9 Privies lime-washed, cleansed and repaired 86 "Water supply provided or improved 66 Nuisances from dung and other offensive matter removed 22 Area gratings, cellar flaps, &c., repaired 2 Cellars used as dwellings discontinued for such use 1 Animals kept so as to be a nuisance, removed 8 The cow-houses in the District, 26 in number, and the slaughter-houses, 11, have been visited during the Quarter. Pigs kept in a Kitchen at No. 37, Bbick Lane, Spitalfields. Mr. Wrack having received notice that pigs were kept in the kitchen of a house in Brick Lane, visited the premises, and found that several pigs were being kept there. The kitchen had a boarded floor, which was in a wet and filthy condition, and the smell arising from the place was most sickening. On notice being served, and intimation given to the owner of the pigs that a summons would be taken out, the pigs were speedily removed. I may here remark that legal proceedings, as regards the keeping of pigs in the District, are always taken under the 57th George III., chapter 29, better known as Michael Angelo Taylor's Act, and hitherto with success. Fever Cases in the Disteict. About the middle of December last I received intimation that several cases of fever had been admitted into the Fever Hospital at Homerton from this District. As only 8 cases of fever have been recorded in the books of the Medical Officers of the Union during the seven weeks ending on the 25th December, I applied for information respecting the prevalence of this disease to Mr. Ilott, the resident Medical Officer of the Workhouse, who stated that, within the period of 11 weeks, viz.: from the 14th October to the 29th December, 1875, no less than 9 cases of fever were sent from the Workhouse to the Homerton Fever Hospital, of persons who had been removed into that Institution from some of the registered common lodginghouses in Flower-and-Dean Street, situated on the north side of the District, and six from some of the other registered common lodging-houses also situated on the north side of the District. From the subjoined return, which has been prepared by Mr. Ilott, it appears that the patients were retained in the Workhouse, with one exception, for a period varying from one to eight days, from which we may 9 confidently state that they either had fever in the incubative stage when they entered the lodging-houses, or that they took the disease while they remained there, for I have no means of ascertaining the length of time each lodger remained in the lodging-house before his removal to the Workhouse;, but it is manifest that in all those cases that remained in tho Workhouse for a less period than eight days, fever did not originate therein, for the period of incubation of fever is about eight, nine, or ten days. TABLE Showing the localities from which the patients were received into the Workhouse, and other particulars relating to them. Cases and Description of Fever. Previous Residence. Date of Admissn. into Workhouse. Date of Admissn. into Fever Hsptl. Length of time in the Workhouse before appearance of Fever. Whether or not the Patients had Fever on Admsn. Enteric Fever 10, Flower-and-Dean Street 12 Oct. 14 Oct. 2 days No. Enteric Fever 32, Flower-and-Dean Street 16 Nov. 18 Nov. 2 days No. Enteric Fever 18, Thrawl Street 24 Nov. 25 Nov. 1day Very slightly. Typhus Fever 36, Flower-and-Dean Street 19 Nov. 27 Nov. 8 days No. Enteric Fever 7, Gun Street 25 Nov. 29 Nov. 4days No. Enteric Fever 52, Flower-and-Dean Street 29 Nov. 30 Nov. 1 day No. Typhus Fever 10, Lower Keate St. 30 Nov. 1 Dec. 1 day Very slightly. Enteric Fever 1, Osborn Place 30 Nov. 1Dec. 1 day No. Typhus Fever 34, Flower-and-Dean Street 1 Dec. 2 Dec. 1 day No. Typhus Fever 7, Flower-and-Dean Street 6 Dec. 9 Dec. 3 days No. Typhus Fever 52, Flower-and-Dean Street 6 Dec. 10 Dec. 4 days No. Enteric Fever 10, Lower Keate St. 15 Dec. 16 Dec. 1 days Very slightly. Enteric Fever 2, Flower-and-Dean Street 20 Nov. 27 Dec. This case Mr. Ilott thinks may have originated in the Wrkhse. No. Typhus Fever 1, Flower-and-Dean Street 27 Dec. 29 Dec. 2 days No. Enteric Fever 4, Angel Alley 29 Dec. 30 Dec. 1 day Very slightly. 10 The following arc the localities from which fever patients were removed to the Homerton Fever Hospital during the Quarter, viz.: 12 from Workhouse, 1 from the Black Horse, Tower Hill, 1 from 8 Sun Court, 4 from 52 Flower-and-Dean Street, 1 from 15½ Glasshouse Buildings, 1 from 10 Raven Street, 1 from 57 Lambeth Street, 1 from 68 Lambeth Street, 1 from 16 Bath Place, making a total of 23 cases. Of these, 6 died, viz.: 2 from 52, Flower-and-Dean Street (typhus), 1 from Workhouse (typhus), 1 from 10 Raven Street (enteric), and 2 from Workhouse (enteric). Registeeed Common Lodging Houses. On the receipt of the preceding return of Mr. Ilott, I instituted an inquiry into the sanitary condition of some of the registered common lodging-houses, when I found that several of the rooms were overcrowded; and the ventilation in many instances was very defective. From the result of the measurement of the 37 rooms contained in the five lodging-houses which I visited with the Inspectors, Messrs. Battram and Wrack, it appears that 32, or 86.4 per cent. of them were overcrowded; that is to say, that a space of less than 800 cubic feet was allotted to each bed, the space varying from 197 to 298 cubic feet. In addition to the evil of the overcrowding of the rooms, it was found that in one of them, which contained 14 beds, the foul air escaped by means of an open staircase into the room above containing 9 beds. Further, some of the rooms were very offensive, although my visit was made about 12 o'clock in the day, when the beds were empty. It is less disagreeable to imagine what must be the offensive condition of some of these overcrowded rooms at night, when each bed is occupied, than to realize it. Mr. Batteam has given me a return of the size of the rooms, and the number of beds in each (including those I visited with him), of the 22 registered common lodging-houses which have been visited. From this return it appears that out of the 158 rooms in these lodging-houses, in which there were 890 beds, 53 of these rooms, or 33.5 per cent. were overcrowded. In many of these overcrowded rooms the beds are so close together that it was impossible to pass between them ; and I may add, that some of the rooms, owing to defective ventilation and want of light, were altogether unfit for sleeping apartments. As I have directed the attention of the Chief Commissioner of Police to the overcrowding and to the defective sanitary condition of some of the common lodging-houses in this District, I have no doubt that the defects pointed out will be remedied. Mr. Battram's report is as follows:— Mr. Battram's Report on the Size of the Rooms and the Number of Beds in the Overcrowded Rooms. " On inspecting some of the registered lodging-houses I found that out of 158 rooms, 53 had less than 300 cubic feet allotted to each lodger. The 11 number of cubic feet for each lodger in these 53 rooms, was as follows:— 197, 210, 215, 219, 221, 221, 222, 223, 225, 228, 231, 232, 234, 234, 235, 235, 235, 236, 238, 240, 241, 242, 242, 242, 242, 242, 246, 246, 246, 247, 252, 252, 252, 252, 255, 257, 257, 259, 259, 267, 268, 269, 270, 270, 277, 280, 282, 288, 288, 292, 297, 298, and 298." As I have reason to believe that some of the other lodging-houses are overcrowded, Mr. Battram will shortly make a further report on the cubic space which is allotted to a bed in each room. In the month of October, 1870, I brought under the notice of the Board the question of the sanitary state, as regarded the overcrowding, of the registered common lodging-houses in the District; when the Board unanimously resolved that, in their opinion, a space of 300 cubic feet, at least, should be allowed to each lodger in the old, as well as in the new, registered lodging-houses. The space allotted in workhouses to each infirm person able to leave their dormitories during the day, is 500 cubic feet, and for healthy persons 300 cubic feet.* If 300 cubic feet of space is required for each healthy inmate in a dormitory of a workhouse, where scrupulous cleanliness and proper ventilation is observed, such a space is much more necessary for the class of persons who reside in the common lodging-houses, who, for the most part, have neither a clean skin nor clean clothes. ""Waking the Dead." At No. 1, Compasses Court, where a death had occurred from fever, Mr. Battram found, upon visiting the house, that a "wake" was being held over the body. He was informed by Mr. Loane, the Union Medical Officer, that upon his visit, after the death of the patient, there were no less than ten persons in the small room where the corpsc was lying. Upon his remonstrating with them for being there, they said they thought it was only showing an act of kindness to the friends of the deceased. The ceremony of watching the dead body, or "waking the dead," as it is called, is, during the prevalence of an epidemic, attended with great danger, as is shown to be the case in my Report on Cholera. Daily Cleansing of the Streets. The importance, in a sanitary point of view, of having the streets cleansed daily, and especially the back streets in which the poor principally reside, cannot be too highly estimated. There is little room for doubt that inflammatory affections of the lungs are frequently produced, and are always aggravated, by persons being exposed to a cold atmosphere, and especially when it is accompanied by moisture. The large evaporating surface of the streets in London, when covered with slush, frequently produces great suffering in those who are exposed to its influence, and especially in those whose constitutions are enfeebled by the want of * For these two classes of day-room accommodation there is required in addition to the amount of 500 and 300 cubic feet allotted to each respectively as sleeping apartments. 12 nourishing food and clothing. I find, from the last Quarterly Returns of the Medical Officers of the Union, that out of 588 cases of sickness among the out-door paupers, 105 or 17.8 per cent. are of inflammatory affections of the lungs ; and, if we take the returns for the five weeks ending on the 15th January, it will he seen that, out of the 239 cases of illness, 52 or 21.7 per cent. are from inflammatory diseases of the lungs. The luxury of having clean streets is known only to those who are compelled to walk along the thoroughfares in all kinds of weather; but, it may be asked, where are clean streets to be found in London, except in the City ? in which District, not only are the carriage-ways cleansed daily, but also the foot-ways. If the foot-ways were cleansed daily by the District Boards, and not left to be cleansed, as is the custom at present, by the inhabitants, the frontage of whose houses abuts on the foot-pavement, the work would be done much better than it is now, and in a more methodical manner; and the pavement in front of dead walls, churches, and chapels, would then receive the attention of the scavengers. Besides, from the perfunctory manner in which the foot-pavements are now swept by the several inhabitants when removing the loose Enow, the danger of pedestrians falling is greatly increased; for, by so cleansing the pavement, the surface, instead of being rough by the loose snow lying upon it, is rendered slippery, and consequently dangerous, by pieces of ice being suffered to remain thereon. Not only are clean streets a groat luxury, but as they contribute to the preservation of the health and comfort of the people, the ratepayers should cheerfully incur all reasonable expense in obtaining such a desirable result. And while writing on this subject, I may remark that it is of more consequence to the health of the District to have the narrow and back streets kept dry and clean, than to have the main thoroughfares so kept; because, in the former, the population is not only more dense, but poorer, than in the latter, and consequently more liable to suffer from such diseases as are caused by cold and damp. The importance of thoroughly cleansing the streets has been forcibly dwelt upon by the Registrar-General, in his Annual Report on the Mortality of London, for the year 1864. He states that "London has acquired almost as much fame for that highly agglutinative compound, its mud, as for its fogs ; and perhaps there is more connexion than is generally supposed between them. It would be a humble, but invaluable, sanitary work if the streets were subject to a perfect system of purification; if they were frequently and thoroughly cleansed and dried. The attention of Boards of Works may be well directed to this end. Old persons, whose avocations compel them to be much out of doors, in feebly urging their steps over filthy streets, waste much of that strength which should be husbanded for the employments by which they live. And how can poor people be expected to keep the inside of their houses free from damp and dirt, when all the adjacent exterior is a 13 ' mud-ocean ?' A good scavenger is a practical teacher of that cleanliness which is said to be next to godliness; and if the streets were well kept, the crowds who frequent them would read excellent plain sermons in the stones." In my Report for the Quarter ending December, 1865, in enumerating the several causes of ill health, I made the following remarks, which I hope will receive due attention from your Board. "The last causc of ill-health among the population of London, that I shall mention, is the dirty state of our public streets, and the accumulation of house refuse in the dust-bins. It is indeed a great luxury, as well as a matter most important to the public health, to have clean streets; but this cannot be enjoyed without considerable expense being incurred. It has been considered proper, in a sanitary point of view, that all the streets in London should be cleansed every day, and the public dust-bins emptied daily. The thorough cleansing of the streets throughout the Metropolis would have an excellent moral effect upon the inhabitants of the poor localities, who would then have a great inducement to keep the interior of their houses clean; for, at present, from the dirty state of the public ways, the poor, who live in houses let out in separate tenements, cannot be induced to remove the dirt from the passages and stairs which is continually being trodden in by each tenant. No accumulation of dust should be allowed to remain in the areas or back yards of any house for a period longer than a week. So far as the cleansing of the streets is concerned, London should be regarded as one district; not that it should be managed by one Board, but that each Board should adopt a uniform system of scavengering. Unless the daily cleansing of the streets is carried out by each District Board, the public generally will not derive much advantage by the activity and liberality displayed in this matter by one or two Districts only: for if the daily cleansing of the streets be not general throughout London, the dirt of the neglected Districts will be carried by the traffic into the adjoining clean ones, and thus give to all of them the appearance of not having been cleansed." On sanitary, on moral, and on economical grounds (for the poor-rate in unhealthy Districts is always greater than in healthy ones), I most strenuously urge upon the attention of the Board the desirability of having all the streets in the District cleansed daily. ANNUAL REPORT. The number of births registered in this District during the year has been 2660, and the deaths 2470, including those of non-residents in the London Hospital (465). In tho preceding year, the births were 2688, and the deaths 2613, including the deaths of 377 non-residents. 14 The deaths in the Workhouse have been 351, against 354 for the previous year ; and the deaths in the London Hospital 710, against 675. The population of the District, at the taking of the census, was 76,573 ; which is 2397 less than when the census was taken in 1861. The deaths being (excluding 465 of non-residents) 2005, the rate of mortality has been, during the year, 26.1 per 1000, or 1 in 38.1 of all living. The rate of mortality during the preceding year was 29.2 per 1000. In making a comparison, however, of the rate of mortality of this District with that of others, the total deaths in the London Hospital must be eliminated, which this year, as above stated, amount to 710. This gives a rate of mortality 22.9 per 1000. The rate of mortality for this year is lower than it has been for the last ten years, as may be seen by referring to Table No. 5 in the Appendix. Deaths from Epidemic Diseases. Of the total deaths during the year there were 277 from epidemic diseases, viz.: 2 from small-pox, 40 from measles, 51 from scarlet-fever and diphtheria, 61 from hooping-cough, 93 from diarrhœa, and 30 from fever. During the last three years only 4 deaths from small-pox have occurred in this District, viz.: 1 in 1873, 1 in 1874, and 2 in 1875. No death from small-pox occurred in the " Metropolitan Asylum " of any patient resident in this District. (Sec Note to Table 6.) The death-rate from epidemic diseases for tho year, in relation to the total mortality, is 11.2 per cent. 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 2474. During the previous year the number was 3685. The extraordinary annual diminution of the out-door sick paupers, from upwards of 17,000, in the years 1867 and 1868, to 2474, is a matter of great satisfaction to the rate-payers of this District. Illness in the Workhouse. The cases of illness in the Workhouse, during the year, have been 2704; including 150 cases of syphilis, and 47 of lead poisoning. Prom the following Table it will be seen that a large amount of sanitary work has been accomplished during the year. To the amount of work as set forth in this Table there must be added that which the Inspectors have done under the Adulteration of Food Act. Sanitary Works Performed during the Year 1875. Number of inspections of houses, as shown in the official returns 9476 Number of rooms found to be over-crowded, 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 12 15 Number of cases of indecent occupation discovered 12 Houses specially visited 541 Houses specially re-visited 2253 Rooms disinfected with sulphurous acid gas after the occurrence of fever, and scarlet-fever, therein 23 Articles disinfected, consisting of beds, bedding, clothing, &c 77 Preliminary notices served, such notices embracing 1052 premises 708 Compulsory orders issued, embracing 342 premises 149 Summonses heard at Police Courts, under Sanitary Act 10 Ditto ditto Adulteration of Food Act. 1 Houses in which rooms or passages have been whitewashed 552 Ventilation of houses improved 0 Yards of houses paved or the pavement repaired 244 Cesspools abolished 2 Drains in houses improved 272 Dust-bins 49 Privies lime-washed, cleansed and repaired 464 Water-supply provided or improved 135 Area gratings, cellar flaps, &c., repaired 23 Cellars used as dwellings discontinued for such use 7 Nuisances from dung and other offensive matter removed 63 Animals kept so as to be a nuisance removed 8 The cow-houses in the District, 26 in number, and the slaughter-houses, have been visited four times during the year. The bake-houses, 71 in number, have been twice visited during the year. The total number of slaughter-houses in the District, since the last licensing day, is 14. The number of slaughter-houses before the last licensing day was 32. The efficient manner in which the Inspectors have performed their duty is shown by the fact that, although there is a public complaint-book in the Office, not a single complaint has been entered therein during the last three years. I am, Gentlemen, Your most obedient Servant, 15, Great Alie Street. JOHN LIDDLE. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 1st January, 187G. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhœa. Cholera and Choleraic-Diarrhzœa. 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 0 1 0 0 1 0 0 1 0 0 0 0 13 11 0 9 1 0 0 1 49 87 Mr. Champneys 0 1 0 2 2 0 4 5 0 1 0 0 21 1 0 9 0 0 0 0 103 140 Mr. Sequeira 0 2 0 0 7 0 5 9 0 2 0 0 15 2 0 4 0 0 0 0 56 102 Mr. H. Braye 0 3 1 0 4 0 0 9 0 0 0 0 24 2 0 3 0 0 1 0 98 145 Mr. Loane 0 1 0 0 1 0 2 3 0 1 0 0 16 0 0 5 0 0 1 0 78 108 Total 0 8 1 2 15 0 11 27 0 4 0 0 89 16 0 30 1 0 2 1 381 588 Corresponding Qr. of previous Year. 0 8 33 6 12 0 20 82 0 10 0 1 134 19 0 21 2 0 1 5 541 895 Workhouse Mr. J. J. Ilott. 0 7 1 2 13 0 15 11 0 18 1 0 151 19 4 63 3 6 5 14 349 682 In addition to the cases attended by Mr. Ilott in the Workhouse, there were 37 cases of syphilis. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ending 1st January, 1876. Districts. Small-Pox. Measles. Scarlet Fever. Diphtheria. HoopingCough. Diarrhoea. Fever. Cholera & Choleraic Diarrhœa. Total. Remarks. Spitalfields 2 3 2 0 6 3 3 0 19 Mile End New Town 0 10 3 1 5 2 1 0 22 Workhouse. Whitechapel, North 0 7 4 0 3 0 2 0 16 Hospital. Whitechapel Church 0 0 2 1 1 4 1 0 9 Goodman's Fields 0 1 1 1 3 3 2 0 11 Aldgate 0 1 0 0 6 2 0 0 9 Total 2 22 12 3 24 14 9 0 86 Deaths from Epidemics for the corresponding Quarter, 1875. 0 5 59 3 1 3 17 0 88 TABLE III. Showing Sub-districts. Enumerated Population, Total Births, and Deaths from all causes. Deaths under 1 year of age and above 60 years ; Deaths from Violence, Inquest cases, and Deaths in Workhouse and London Hospital, for the Quarter ending 1st January, 1876. Sub-districts. Enumerated Population in 1871. j Births. Deaths. Under 1 year of age. Persons aged 60 ye?rs and upwards. Violence. Inquest cases. Deaths in Public Institutions. 22499 178 98 33 14 4 13 0 Mile End New Town 15550 164 156 32 47 6 17 75 Whitechapel North ... 11597 98 67 19 7 2 7 0 Whitechapel Church 7322 57 223 9 30 40 48 187 Goodman's Fields ... 10381 99 62 15 9 1 2 0 9224 57 63 23 6 3 11 0 Totals 653 659 131 113 56 98 262 ???death from fever of a patient belonging to this District occurred in the Asylum District Fever Hospital at Homerton. TABLE IV. Total number of the undermentioned Diseases recorded in the Books of the Medical Officers of the Union, from 1865 to 1875, and the total cases of illness. Years. Erysipelas. Puerperal Fever Carbuncle. Bronchitis and Catarrh. Pneumonia and Pleuritis. Croup. Rheumatic Fever. Ague. Delirium Tremens. Lead Poisoning Total. 1865 97 2 1 745 123 0 14 12 4 0 15594 1866 62 0 7 546 244 7 66 12 13 0 16502 1867 65 1 6 642 228 5 183 10 10 0 17181 1868 80 2 5 450 208 3 157 18 10 20 17417 1869 75 1 6 632 258 1 100 35 11 12 14031 1870 82 0 1 825 195 0 134 44 5 12 14148 1871 56 3 7 1149 153 3 77 14 5 35 10194 1872 61 2 5 511 61 1 71 14 5 22 4864 1873 39 2 5 539 91 4 88 17 3 15 4887 1874 20 1 2 443 53 5 65 9 7 21 3785 1875 19 0 2 306 60 4 86 6 7 21 2474 TABLE V. Showing the total Births, Deaths, Deaths of Non-residents, Residents, and total Deaths in the London Hospital in each year, from 1865 to 1875. Year. Population. Total Births. J Total Deaths. Total Deaths in the London Hospital. Deaths of non-residents, exclusive of deaths from accidents. Deaths of Children under 1 year of age. Proportion of deaths per cent. of Children under 1 yr. to the total deaths deducting the deaths of non-residents. Rate of mortality per 1000, deducting the deaths of nonresidents. Rate of mortality of Children under 1 yr per 1000 of the population. 1865 78,970 2684 2532 416 208 549 23.6 29.4 6.8 1866 ... 2561 3495 733 432 465 15.1 38.7 5.8 1867 ... 2686 2331 445 241 525 25.1 26.4 6.6 1868 ... 2611 2519 536 324 513 23.3 27.7 6.4 1869* ... 2571 2675 504 283 526 21.9 29.6 6.6 1870 ... 2690 2465 599 374 515 24.6 26.4 6.5 1871 76,573 2571 2465 551 339 545 25.6 27.7 7.1 1872 ... 2705 2390 616 375 540 26.7 26.3 7.0 1873* ... 2727 2471 645 393 507 24.3 26.5 6.6 1874 ... 2688 2613 675 377 444 19.8 29.2 5.7 1875 ... 2650 2470 710 405† 509 25.3 26.1 6.6 These years contain 53 weeks. In making this calculation, one week's average of deaths is deducted, viz., 50 and 46 respectively. † Estimated number. The number of Inquests which have been held this year in this District has been 348. In the preceding year the number was 327. TABLE VI. Showing the Deaths from Epidemic Diseases in the Whitechapel District during the last 15 years. Name of Disease 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 Small Pox 28 33 69 5 22 44 40 11 1 56 159 19 1 1 2 Measles 27 153 26 137 28 139 33 69 71 36 42 23 44 33 40 Scarlet Fever & Diphtheria 70 91 200 50 80 76 26 48 208 59 25 9 24 199 51 Hooping Cough 98 62 52 74 97 94 72 55 113 50 43 96 79 16 61 Diarrhœa 101 69 114 109 122 119 100 138 97 107 125 99 113 76 93 Fever 65 250 158 170 167 100 82 1C9 95 52 40 26 44 47 30 Cholera &Choleraic-Diaha. 4 5 5 2 4 904 9 10 7 6 3 5 8 3 0 Totals 393 663 624 547 520 1476 362 440 592 366 437 277 313 375 277 London Fever 1754 3635 2802 3689 3232 2681 2174 2483 2211 2049 1765 1003 1548 1553 1282 Scarlta.& Diph. 3058 4194 5799 3806 2614 2316 1836 3418 6162 6306 2220 1063 932 3037 4038 Small Pox 216 345 2012 537 646 1388 1339 606 273 958 7834 1532 114 56 75 The deaths from Fever in the Fever Hospital belonging to the Asylum Board of patients removed from this District were 9, and 2 died of scarlet fever, thereby increasing the deaths from epidemic diseases by 11; but, on the other hand, the deaths from fever of non-residents which occurred in the London Hospital, must be deducted ; of these, however, I do not receive returns. The deaths, therefore, from epidemic diseases in this District were 384 for the year 1874. Note.—Four deaths from small-pox have been registered, but two of such deaths ought to have been registered as chicken-pox. TABLE VII. Showing the cases of Epidemic Diseases among the pauper population in the Whitechapel District during the last 15 years. Name of Disease 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 * 1873 1874 1875 Small Pox 86 113 253 21 86 261 254 93 5 302 625 60 2 1 0 Measles 70 525 80 482 51 679 155 323 212 257 178 76 128 59 32 Scarlet Fever & Diphtheria 109 118 305 156 164 197 60 54 311 97 32 16 22 161 17 Hooping Cough 388 153 169 217 280 217 219 144 308 140 102 94 86 30 44 Diarrhoea 1418 1085 1108 1127 1342 1664 1471 1631 1033 1097 590 283 212 150 101 Fever 109 822 464 295 573 343 308 586 385 325 201 19 126 84 24 Cholera&Choleraic-Diaha. 0 1 1 4 4 58 5 8 1 4 2 3 2 0 0 Total 2180 2817 2380 2302 2500 3419 2472 2839 2255 2222 1730 551 578 485 218 The cases of Febricula have been 109. In the preceding year the cases of Febricula were 285. * In the above Tables the years 1863, 1869, and 1873, consist of 53 weeks, BOARD OF WORKS, WHITECHAPEL DISTEICT. REPORT on the Sanitary Condition of the WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 1st APRIL, 1876, BY JOHN LIDDLE, medical officer of health. London: Printed by T. Penny & Co., 121, Leman Steeet, "wnitecirapei,, E. 1876. REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ending, lst April, 1876. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, the 1st April, 1876, the total births in the District were 721, and the deaths 653. The excess of births over deaths has therefore been, during this Quarter, 68. As the deaths of the non-residents which occurred in the London Hospital are included in the mortality returns, a deduction of such deaths must be made in order to estimate the correct mortality of the District. These deaths are on an average 66 per cent., exclusive of sudden deaths and deaths from accidents, of the total mortality in this Institution; and, as the total deaths are 185, 122 must be deducted for the deaths of non-residents, thereby reducing the mortality of the District to 531, and increasing the number of births above deaths to 190. In the corresponding Quarter of the previous year the total births were 703, and the total deaths 685. In the Spitalfields sub-District the births were 195, and the deaths 98 ; in the Mile End New Town 171, and the deaths 162 ; in the Whitechapel North 119, and the deaths 59 ; in the Whitechapel Church 80 and 229 (in this sub-District the London Hospital is situated); in the Goodman's Fields 98 and 56; and in the Aldgate 58 and 49. The deaths have exceeded the births in the Whitechapel Church District by 149; but, from this number, tho deaths of 122 non-residents must be deducted. The deaths in the London Hospital have been 185. In the corresponding Quarter of the previous year tho deaths in this Institution were 194. The deaths in the Workhouse have been 104. In the corresponding Quarter of last year they were 126. 4 The deaths from epidemic diseases in the entire District have been 59 ; viz.:—0 from small-pox, 6 from measles, 5 from scarlet-fever, 1 from diphtheria, 37 from hooping-cough, 3 from diarrhoea, and 7 from fever. Fourteen deaths of patients from this District occurred in the District Fever Hospital; thus making a total of 21 deaths from fever. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 28 ; viz. : 1 from small-pox, 1 from measles, 8 from scarlet-fever, 4 from diphtheria, 3 from hooping-cough, 6 from diarrhoea, and 5 from fever. In addition to the 5 deaths from fever, there were 2 deaths in the Fever Hospital; thus making a total of 7 deaths from fever for that Quarter. Mortality of Young Children. The mortality of children under 1 year of age was 102. This is 15.6 per cent. of the total mortality. In the corresponding Quarter of the previous year the rate of mortality of children under 1, was 15.0 per cent. of the total mortality. In the Spitalfields sub-District the rate is 27.5 per cent. ; in the Mile End New Town 17.2 per cent.; in the "Whitechapel North 27.1 per cent. ; in the Whitechapel Church 3.4 per cent.; in the Goodman's Fields 28.5 per cent. ; and in the Aldgate 14.2 per cent. In the Goodman's Fields sub-District the deaths under 1 year were 16, and the total deaths 56; in the Whitechapel North sub-District the total deaths were 59, and those under 1 year were 16 ; while in the Whitechapel Church subDistrict the deaths under 1 year were only 8, and the total deaths 229. This difference is explained by the deaths in the London Hospital, in which Institution the deaths of children under 1 year are very few. In the corresponding Quarter of the previous year the rate of mortality of children under 1 year in the Spitalfields sub-District was 23.4 per cent. ; in the Mile End New Town it was 13.0 per cent.; in the Whitechapel North 27.2 per cent.; in the Whitechapel Church 4.7 per cent.; in the Goodman's Fields 32.5 per cent.; and in the Aldgate 23.8 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter, 753 new cases of illness out of the Workhouse; including 14 of measles, 0 of scarlet-fever, 12 of hooping-cough, 3 of diarrhoea, 21 of fever, 25 of febricula, and 3 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 757 ; including 0 of measles, 7 of scarlet-fever, 6 of hooping-cough, 9 of diarrhœa, 3 of fever, 39 of febricula, and 3 of erysipelas. The total number of eases of illness in the Workhouse has been 1057 ; including 15 of measles, 2 of scarlet-fever, 7 of hooping-cough, 15 of diarrhœa, 48 of febricula, 41 of fever, 15 of erysipelas, and 33 of syphilis. 5 Meteorologt of Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis, during the Quarter, has been 5.76 inches. One inch deep of rain-fall on an acre weighs (allowing 10-lbs. to a gallon, which is the weight of a gallon of distilled water) nearly 101 tons. During the corresponding Quarter of last year the rain-fall was 3.83 inches. The mean temperature of the air was 39.6°. In the corresponding Quarter of last year the mean temperature was 40.1°. The coldest days during the Quarter were Saturday, the 8th January, Sunday, the 9th January, "Wednesday, the 12th January, and Monday, the 14th February, when the thermometer indicated respectively 17.4°, 22.5°, 19.6°, and 21.8°. The coldest day during the corresponding Quarter of last year was on Friday, the 5th March, when the thermometer indicated 23.3°, or 8.7° below the freezing point. The following table, taken from the returns of the Registrar-General, shows the comparative results of the Quarter:— LONDON. Jan. 8 Jan. 15 Jan. 22 Jan. 29 Feb. 5 Feb. 12 Feb, 19 Feb 26 Mar. 4 Mar. 11 Mar. 18 Mar. 25 Apr 1 Deaths from Fever 30 16 20 23 22 18 17 15 19 18 30 15 25 Deaths from Scarlet Fever 83 60 60 79 48 48 40 47 45 35 35 37 19 Mean Temperature of the air 348° 30.7° 39.5° 40.2° 4l.6° 31.5° 44.5° 44.6° 47.3 42.4° 39.0° 35.7° 45.3° Rain-fall in inches 0.25 0.16 0.54 0.00 0.20 1.03 0.61 0.54 0.58 0.46 0.83 0.18 0.38 Deaths in London 1526 1590 1782 1637 1771 1610 2005 1691 1544 1455 1546 1616 1696 Deaths in chapel District. 32 45 64 49 47 54 67 58 45 43 46 50 53 Deathsin do.from Fever 0 1 0 1 1 1 2 0 0 0 0 1 0 In the Registrar General's Annual Summary of Births, Deaths and Causes of Death in London and other large Cities, 1875, it is stated that " the mean temperature for the year at Greenwich was 49.2° ; the rain-fall was 28.2 inches; the temperature slightly above, the rain-fall 2.9 inches above the average of 60 years. The wind blew at the rate of 11.5 miles an hour, which is nearly one mile over the average of 26 years. And there was a cold period extending over February and the beginning of March; another extending over three weeks in the beginning of December, which produced a sensible effect on the mortality." 6 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 o 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. June, 1874 411 2 30 0 441 2 726 September 329 0 30 0 359 0 630 December 185 2 31 0 216 2 689 March, 1876 292 2 44 0 336 2 687 June 376 0 26 0 402 0 673 September 350 1 35 0 385 1 650 December 178 2 23 0 201 2 655 March, 1876 236 0 25 0 261 0 722 Totals 2357 9 244 0 2601 9 5432 Water Supply. It appears from the Report of Major Bolton, for the month of March, 1876, and dated 10th April, 1876, that the East London Company have already completed the extension of the constant system of supply in a large part of their district, which is densely populated; and during the past month over 3000 houses have been added to the number under constant supply. The Company propose to give further constant supply to Bethnal Green and Whitechapel, completing one section by 1st of April, and another section by 1st May. Upon the subject of water supply the Registrar-General makes the following remarks: "With an adequate supply of soft water, baths and shower-baths, the cleanliness of the mass of the population would be greatly promoted; and this is much required, as through the smoke of the Metropolis, the standard of cleanliness is low; the dried perspiration closes the pores of the skin, and hard-working men suffer excessively from fatal diseases of the lungs." I have reason to anticipate that a great improvement in the health of this District will take place when the Baths and Wash-houses in Goulston Street are again opened. All the public pumps have been abolished in this District; there may, however, be a few pumps on private property, and it is my duty to warn the owners of these pumps of the danger of drinking water from such polluted wells; for they are probably not aware of the danger they incur by doing so. Unfortunately, they will not be persuaded to discontinue its use, because the water is clear and sparkling, and agreeable to the taste. 7 Fever Cases in the District. In my last report I published a return of the fever cases, prepared by Mr. Ilott, the Medical Officer of the Workhouse, which had occurred in this District, and had been removed from the Workhouse to the Homerton Fever Hospital; and as the disease continues to prevail, Mr. Ilott has kindly given to me the following return of the cases which have occurred during the present quarter. TABLE Showing the localities from which the patients were received in the Workhouse, and other particulars relating to them. Cases and description of Fever. Previous Residence. Date of admission into Workhouse. Date of admission into Fever Hospital. Length of time in the Workhouse before appearance of fever. Whether or not Patients had Fever on admission. Typhus Fever 52, Flower & Dean Street Jan. 4 Jan. 6 2 days No Scarlet Fever Brought in by Police 2 8 6 „ „ Typhus Fever 5, Keate Court 5 8 3 „ „ Enteric Fever 56, Flower & Dean Street 3 8 5 „ „ Typhus Fever 2, George Street 10 12 2 „ Slightly Typhus Fever 17, Flower & Dean Street 12 13 1 „ „ Enteric Fever Casual Ward 13 14 1 „ „ Typhus Fever 30, Dorset Street 11 14 3 „ No Typhus Fever 55, Flower & Dean Street 17 19 2 „ „ Typhus Fever 17, Dorset Street 18 19 1 „ Slightly Typhus Fever 4, Paternoster Row 20 21 1 „ Typhus Fever 18, Thrawl Street 28 31 3 „ No Typhus Fever 17, Thrawl Street 29 31 2 „ „ Enteric Fever 1, Flower & Dean Street 31 Feb. 1 2 „ „ Typhus Fever Brought from CasualWard Feb. 1 1 A few hours Slightly Typhus Fever 38, Flower & Dean Street 2 3 1 day „ Typhus Fever 10, Lower Keate Street 2 3 1 „ „ Typhus Fever 60, Wentworth Street 2 3 1 „ „ Typhus Fever 5, Flower & Dean Street 3 3 A few hours „ Typhus Fever 2, George Street 3 5 2 days No Typhus Fever Workhouse 5 Ad old resident Slightly Typhus Fever Refuge, Crispin Street Feb. 6 7 1 day „ 8 TABLE—continued. Cases and description of Fever. Previous Residence. Date of admission into Workhouse. Date of admission into Fever Hospital. Length of time in the Workhouse before appearance of Fever. Whether or not Patients had Fever on admission. Typhus Fever 8, Nelson Court Feb. 9 Feb. 10 1 day Slightly Typhus Fever 57, Flower & Deau Street 8 10 2 „ No Typhus Fever 52, Flower & Dean Street 8 10 2 „ „ Typhus Fever 59, Wentworth Street 7 10 3 „ „ Scarlet Fever 6, Little Pearl Street Aug. 16 12 6 months „ Typhus Fever 1, Flower & Dean Street Feb. 11 15 4 days „ Typhus Fever 64, Wentworth Street 15 16 1 „ Slightly Typhus Fever 59, Wentworth Street 15 16 1 „ „ Typhus Fever Refuge, Crispin Street 14 16 2 „ No Typhus Fever — Flower & Dean Street 15 17 2 „ „ Typhus Fever 6, Crawford Court 21 22 1 „ Slightly Typhus Fever No home 21 22 1 ,, „ Typhus Fever 1, Garden Court 24 26 2 „ No Typhus Fever 7, Upper Keate Street 27 28 1 „ Slightly Typhus Fever Refuge, Crispin Street 17 29 12 „ No Typhus Fever Refuge, Banner Street* 28 29 1 „ Slightly Typhus Fever 4, Crown Court, Went. St 29 Mar. 2 4 „ No Typhus Fever Refuge, Crispin Street Mar. 4 6 2 „ „ Typhus Fever 18, Thrawl Street 8 8 A few hours Slightly Typhus Fever 18, Upper Keate Street 11 13 2 days No Typhus Fever 55, Flower & Dean Street 20 22 2 „ „ JAMES JOHN ILOTT, Resident Medical Officer. The above return shows that 38 cases of typhus fever, 3 of enteric fever, and 2 of scarlet-fever have been sent from the "Workhouse, during the last five months, to the Homerton Asylum Board Hospital, of persons residing in this District, who had been temporarily admitted into the Workhouse before fever had become developed. Of the above cases, 17 were removed into the Workhouse from the registered common lodging houses, 4 from the Refuge in Crispin-street and 1 from Banner-st.* In" my last Report a similar return is given of the number of patients who had been sent to the * Banner Street is not in this District. 9 Fever Hospital from the Workhouse, which, added to the present return, gives a total of 60; of these, 44 were of typhus, 12 of enteric, and 4 of scarlet - fever. Of this total number, the registered common lodging houses have furnished 35. Although it is difficult to say how far these lodging houses are answerable for this large amount of fever, yet, from the old and worn out condition of the internal walls of some of them, it is impossible thoroughly to scrape, purify, and limewash them, which unquestionably ought to be done, where so many persons are congregated together, as they are in the common lodging houses; and it is of the utmost importance to the public health that all such houses should be so ventilated as to render the air free from offensive smells, and at the same time to prevent currents of cold air passing through the rooms, whereby the temperature of those occupants who are exposed to its influence, becomes so lowered as to be almost unbearable. The best practicable means should be adopted to get rid of the heated and contaminated air which is engendered in every room in which many people are congregated together. In reply to a letter addressed to Mr. Vallance, the Clerk to the Board of Guardians, requesting information respecting the number of cases of fever which were sent from this District to the Homerton Fever Hospital, I have received the following reply:— WHITECHAPEL UNION. Clerk's Office, Workhouse, E., 3rd May, 1876. My Dear Sir, Of the 91 cases of Fever admitted into the Homerton Fever Hospital, during the six months ended Lady-day last, from this Union, 60 were from the "unhealthy area," complained of by the Guardians; that is to say— they were either admitted to the Fever Hospital direct from that area, or from the Workhouse, to which they had been first, and very recently admitted from that area. Of such 94 cases, moreover, 61 were from "Common Lodging Houses" within the Union, or from the Workhouse to which they had been very recently admitted from "Common Lodging Houses." In 55 of such 61 cases, the "Common Lodging Houses" were within the "unhealthy area" already mentioned. Of such 94 cases, 23 have died. Yours faithfully, W. VALLANCE. John Liddle, Esq. The above communication, which embraces the return given to me by Mr. Ilott, is of very great importance at the present time, as it bears materially on the question of the unhealthiness of the area complained of by the Board of Guardians, and already shows the desirability of taking down the unhealthy houses in the locality described by them. It will be seen in my report for this quarter that I have made an official representation of a portion of this area to the Metropolitan Board; 10 and I trust that the same will so commend itself to the favourable consideration of that Board, as to induce them to prepare a scheme to be laid before the Home Secretary, recommending the destruction of the several unhealthy localities which I have pointed out. It also appears from Mr. Vallance's Letter, that the mortality of fever has been unusually large; viz.: 23.4 per cent., or about 1 death out of every 4 cases, the average death-rate from fever being only 1 in 5. The 14 persons who died of fever at the District Fever Hospital were removed from the undermentioned places:— District No. 1.—30, Dorset Street, 4, Paternoster Row, Refuge, Crispin Street, (2 cases). Total 4. District No. 2.—Child removed from Leman Street Police Station; 34, Flower and Dean Street; 8, Nelson Court; 10, Lower Keate Street; 4, Angel Alley; and 61, Lambeth Street. Total 6. District No. 3.—42, Leman Street, (2 cases). Total 2. District No. 4.—1, Garden Court and 4, Crown Court. Total 2. District No. 5.—No persons removed from this District. The following is a copy of the communication addressed to me by the Guardians respecting the unhealthy area referred to in Mr. Vallance's Letter, dated 3rd May, 1876. To John liddle, Esq., Medical Officer of Health, for the District of Whitechapel, in the County of Middlesex. We, the undersigned Guardians of the Poor of the Whitechapel Union, in the County of Middlesex, being persons liable to be rated to the rate out of the proceeds of which the expenses of the Local Authority, under "The Artizans' and Labourers' Dwellings Improvement Act, 1875," are made payable, do hereby mate complaint to you of the unhealthiness of the area which comprises the Streets, Courts, and Alleys hereinafter mentioned, together with all intervening Courts, Yards, and Alleys, and which said area is within your jurisdiction, namely:— Fashion Street, Spitalfields. George Street, Spitalfields. Flower & Dean Street, Spitalfields. New Court, Spitalfields. Keate Street, Spitalfields. George Yard, Whitechapel. Upper Keate Street, Spitalfields. Queen's Place, Whitechapel. Keate Court, Spitalfields. Wentworth Street, Whitechapel. Lower Keate Street, Spitalfields. Angel Alley, Whitechapel. Thrawl Street, Spitalfields. We submit that the condition of health amongst the population of the area referred to is generally low, as is evidenced by the large extent of sickness prevailing therein and arising therefrom, and that such prevalence may reasonably be attributed to the closeness, narrowness, and bad arrangement, and condition of the houses within such area, and to other sanitary defects. In support of this complaint we do further state That the population of the Whitechapel Union, according to the last census, is 76,573; and that, during the year 1875, the number of deaths registered 11 as having occurred therein (exclusive of deaths in the London Hospital of non-residents) was 2,016, being 2.6 per cent. of population. That the estimated population of the area in question is 4,354; and that during the year 1875 the number of deaths registered as having occurred therein was 112, in addition to 89 deaths of persons who had been admitted to the Workhouse of the Whitechapel Union from such area, making together 201, being 4.6 per cent. of population. That, during such year, 1,823 applications for relief were entered by the Relieving Officers of the Whitechapel Union as of persons resident within the said area ; of which number 1,415 were on account of sickness ; and, generally, That the said area is fruitful of sickness, misery, pauperism, and crime, within the Whitechapel Union. We therefore request that you will, under and by virtue of the provisions of the said act, inspect such area and make an offioial representation to the Local Authority thereon. Dated this 25th day of January, 1876. William Plumpton, 68, Whitechapel Road. R. Gladding, 76, Whitechapel Road. Samuel A. Babnett, St. Jude's, Commercial Street. M. Bamberger, 29, Leman Street. George Roberts, Sheppy Yard, E. George Wood, 55, Brushfield Street. William Kirk, 14, Hunt Street, Mile End New Town. T. R. Struthers, 29, Dunk Street, Mile End New Town. George Young, Pavilion Yard, Whitechapel Road. John Jacobs, Whitechapel. John Loans, Whitechapel. Thomas Carnall, Tower Hill. Morbis Abrahams, Road Side. Edward Lact, 156, Whitechapel Road. Thomas Catmur, 280, Whitechapel Road. John Outhwaite, 34, Upper East Smithfield. C. Gadsdon, Old Artillery Ground. The total area of the District complained of in the above communication, is about 52,477 square yards. On the receipt of the above communication I inspected the locality complained of, and made the following official representation to the Metropolitan Board of Works:— In the Matter of the "Artizans' and Labourers' Dwellings Improvement Act, 1875." To the Metropolitan Board of Works, the Local Authority as respects the Metropolis appointed by the said Act. Gentlemen, I, the undersigned, John Liddle, the Medical Officer of Health of the District of Whitechapel, within the Metropolis, have received a communication in writing, signed by 17 persons liable to be rated as in this Act mentioned, (a copy of which 12 communication I send herewith) complaining to me of the unhealthiness of an area comprising the Streets, Courts, and Alleys undermentioned, together with all the intervening Courts, Yards and Alleys, and which area is within the jurisdiction for which I am Medical Officer of Health, namely:—Fashion Street, Flower and Dean Street, Keate Street, Upper Keate Street, Keate Court, Lower Keate Street, Thrawl Street, George Street, George Court, New Court, Dales Place, Fashion Court, Kosemary Court, Wilson's Place, Nelson's Court, and Sugar Loaf Court. All the above named Streets, &c., are in Spitalfields Parish. George Yard, New Court, George Yard, Wentworth Street, Crown Court, Wentworth Street, Commercial Court, Tewkesbury Buildings, Inthorn Court, and Queen's Place. All the last named Streets, &c., arc in the Parish of Whitechapel. In accordance with the Provisions contained in the above-named Act, I have inspected the area referred to in such complaint, and I hereby make an official representation to your Board, that, by reason of the closeness, narrowness, and bad arrangement of the several Streets, Courts, and Alleys, which form a part of the area complained of, and from the old and worn-out condition of many of the houses contained therein, and from the want of proper conveniences to the same, such places and houses therein are unfit for habitation ; and that the same cannot be effectually remedied otherwise than by an Improvement Scheme, for the re-arrangement and re-construction of the several Streets, Courts, and Alleys which are bounded on the east and north by an imaginary line drawn from the south-east angle of Queen's Place, including Queen's Place, thence crossing Angel Alley and George Yard, from thence to Wentworth Street, crossing Wentworth Street on to Flower and Dean Street, including the houses on the south side of Flower and Dean Street, from that part to the premises abutting upon Commercial Street, and bounded on the west and south by the rear of the warehouses in Commercial Street, (except as to the portion described as Keate Court, the whole of which is included in this description), and by the rear of houses in High Street, Whitechapel, and which area is more particularly delineated on the plan hereto annexed and coloured red. This area is about 18,382 square yards, and contains about 190 houses, and has a population of about 2,277; which gives about 8 square yards on an average to each person. The Streets, Courts, and Alleys embraced in this area are as follows:—Tewkesbury Buildings, Inkhorn Court, George Yard (south end, west-side), Angel Alley (south-end), Queen's Place, New Court, George Yard, Wentworth Street, George Street, Flower and Dean Street (south-side, from George Street to Commercial Street), Wilson's Place, Lower Keate Street, Keate Court, Upper Keate Street, Sugar Loaf Court, Crown Court, and Commercial Court. Although the whole area described above gives 8 square yards to each person, yet we find that the density of some of the oourts is much greater. For instance, in Tewkesbury Buildings the space for each person is only 4 square yards; in Inkhorn Court it is 4 square yards for each person; in that portion of Angel Alley comprised in the area, it is also 4 square yards to each person; and in Queen's Place it is 5 square yards to each person. From inquiries I have instituted, I find that the mortality in this area is largely in excess of the average rate of the District of Whitechapel; and I believe that it is not overstated in the complaint made. So far as the residue of the area complained of is concerned, I am bound to represent that it is in many respects most objectionable, and that great benefit, in a sanitary point of 13 view, would result if the whole were included in a scheme of re-construction; yet, as a matter of comparison, I feel it to be my duty to represent that I have selected the portion, which with few exceptions, comes within the definition "unfit for habitation" I am, Gentlemen, Your obedient Servant, JOHN LIDDLE. Board of Works, Whitechapel District, 27th April, 1876. For the information of your Board, and for that of the Metropolitan Board of Works, I may state that while the rate of mortality in the Whitechapel District, for the year ending 4th October, 1874—the same being the latest return in my possession—was 28.0 per 1000, the rate of mortality in that portion comprised in my official representation was 36.4 per 1000, about 30 per cent. in excess of the total mortality of the entire District; in other words, while 7 died in the whole of the Whitechapel District, 9 died in this locality. I may add, as showing the unhealthiness of these several places, that out of the 83 deaths which occurred here in the year, there were no less than 22, or 26.5 per cent. of them from scrofulous and the allied diseases—such as consumption, tabes mesenterica, convulsions in children, infantile diarrhœa, atrophy, and debility; all of which diseases are of more frequent occurrence in crowded than in more open Districts. Further, in a letter which I have recently received from Dr. Dyte, the Medical Officer to the Board of Guardians for the Belief of the Jewish Poor, he says, in reply to a written communication respecting the health of those places mentioned in the above official representation, that, from the occasional visits he has made to them, he is strongly convinced that words can hardly be found to describe the horrible condition of some of them— notably Keate Court, Keate Street, and the eastern end of Wentworth Street; and that Inkhorn Court and Commercial Court, especially the former, have always been in a very unwholesome condition. New Building Act Required. In this District alone, owing to the defects in the existing Building Act, several houses within the last fifteen or sixteen years have been built, which are, in my opinion, unfit for habitation. These have been pointed out by me not only to your Board, but to the Metropolitan Board of Works; but owing to the defective sanitary provisions of the Building Act, there was no power to prevent their erection. It appears now to be highly probable, that in due course upwards of 450 houses will be taken down in this District on the south side of Royal Mint Street, and on the site a superior class of new houses for the accommodation of the working classes will, probably, be built; it is, therefore, of the utmost importance that a new Building Act should be speedily obtained, whereby the erection of 14 unhealthy houses may be prevented; the said Act to contain sanitary provisions as regards the foundation and the prevention of the rise of damp in the walls; to further enact that all the rooms, staircases and passages, shall be properly lighted and ventilated,—that all the rooms shall have sufficient superficial space, and bo not less than 8 feet in height; that all the necessary conveniences shall be provided separately for each house, and that each house shall have an open space at its rear It appears to be a waste of money to pull down unhealthy houses, and, at the same time, allow others alike unhealthy to be built, which shortly after their erection, may be condemned as unfit for human habitation. In building a new class of houses, for the better accommodation of the working classes, it is in my opinion essentially necessary, as tending not only to promote their health, but to improve their moral condition, that every room should be light—that there should be no dark corners for the accumulation of dirt—and that the houses should not exceed four storys in height; for, unless the streets are made proportionally wide, the higher the houses the greater will be the absence of sunlight, and thus interfere with the proper ventilation of the rooms. High houses on each side of narrow streets, in which little or no sunlight is admitted, are not healthy. It is true that the current of air is greater while passing between rows of high houses, but currents of air, without the accompanying heat of the sun's rays, cannot be considered as proper ventilation. A currcnt of air passing through a tunnel may, perhaps by some persons, be considered as efficient ventilation; but I apprehend that few persons with any regard to their health, would like to reside therein. I firmly believe that many persons who are compelled to occupy rooms in which the rays of the sun never enter soon lose their health, and find it necessary to change their residence; and this remark applies, although perhaps with less force, to those who are confined to counting - houses during the day, in which no sunlight is admitted. Sunlight is especially necessary for the healthy existence of children; and this is strongly pointed out in the evidence of the late Mr. N. B. Ward (the inventor of the "Wardean Cases," for rearing plants in towns, and conveying them to and from distant places, a gentleman of great eminence in the medical profession; and who had given much attention to the influence of the temperature of air and light on the health, and growth of animals and plants) says, in his evidence before the Commissioners appointed for inquiry into the state of large towns and populous districts, that, as the result of his experience, the influence of light is a matter of the highest importance to the proper physical development of the human species; and whatever stints the growth of a child, certainly operates upon his physical capacity for labour; that the amount of disease among persons 15 occupying light rooms is infinitely less as compared with, that in dark ones; and that the influence of light, especially solar light, in preventing the fatal termination of disease, is a fact well known to him. In further illustration of this subject, Mr. Ward quotes a fact stated " on the authority of Sir James Wylie,—" that the cases of disease on the dark side of an extensive barrack at St. Petersburg, have been uniformly, for many years, in the proportion of three to one, to those on the side exposed to strong light." Registered Common Lodging Houses. In my last Quarterly Report I drew your attention to the overcrowded condition of several of the Registered Common Lodging Houses in this District. Since the date of that Report the Inspectors have visited several others. The result of their inspection has been laid before Captain Harris, the Commissioner of Police under whose authority these houses are placed, and is recorded in a letter addressed to Captain Harris, of which the following is a copy:— Board of Works, Whitechapel District, 5th, April, 1876. Dear Sir, Since the 18th of January last, the date of my letter addressed to Colonel Henderson, on the subject of the defective ventilation and overcrowding of some of the Registered Common Lodging Houses in this District, the Sanitary Inspectors have measured the several rooms of the under-mentioned houses, which were not returned in my letter above mentioned. Nos. 4, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 19, 20, 48, 56, and 56, Flower and Dean Street. Nos. 19 and 20, George Street, and 1, Wilson's Place. Nos. 20, Green Dragon Yard, and 12, Princes Street. Nos. 9, 10, 11, 12, 16, 17, 19, 20, 28, 29, and 30, Dorset Street. Nos. 4, 5, and 6, Paternoster Row. No. 7, George Street, 5, Frostic Court, and 57, Brick Lane. In No 4, Flower and Dean Street, there are 2 rooms overcrowded ; at Nos. 6, 7, and 8, there are 5 overcrowded; at No. 11, 4 overcrowded; at No. 12, 2 overcrowded ; at No. 13, 3 overcrowded; at No. 14, 2 overcrowded; at Nos. 15 and 16, 6 overcrowded; at No. 19, 3 overcrowded; at No. 48, 5 overcrowded; at No. 55, 4 overcrowded; and at No. 56, 5 overcrowded. Total 41. At Nos. 19 and 20, George Street, there are 6 rooms overcrowded; at No. 1, Wilson's Place, 2 rooms overcrowded; at No. 20, Green Dragon Yard, 1 room overcrowded ; at No. 12, Princes Street, 4 rooms overcrowded; at Nos. 9 and 10, Dorset Street, 1 room overcrowded; at Nos. 11 and 12, Dorset Street, 7 rooms overcrowded; at Nos. 16 and 17, Dorset Street, 3 rooms overcrowded; at Nos. 19 and 20, Dorset Street, 5 rooms overcrowded; at No. 28, Dorset Street, 3 rooms overcrowded; at No. 29, Dorset Street, 2 rooms overcrowded; at No. 30, Dorset Street, 3 rooms overcrowded; at No. 4, Paternoster Row, 1 room overcrowded; at No. 5, Paternoster Row, 1 room overcrowded; at No. 6, Paternoster Row, 4 rooms overcrowded; at No. 7, Gun Street, 3 rooms overcrowded. Total 46. 16 The total number of rooms in the above mentioned Lodging Houses, found to be overcrowded, is 87: that is to say, that in those 87 rooms, there is a less space allotted to each lodger, than 300 cubic feet. The number of cubic feet which is allotted for each lodger in these rooms respectively, was ascertained on measurement to be as follows 145, 166, 175, 195, 210, 225, 226, 228, 229, 232, 233, 237, 237, 238, 240, 210, 240, 243, 244, 245, 245, 247, 247, 248, 248, 250, 250, 252, 252, 252, 255, 256, 257, 261, 262, 263, 263, 263, 263, 261, 265, 268, 268, 269, 270, 270, 272, 272, 272, 272, 273, 273, 273, 274, 275, 275, 275, 275, 2/5, 277, 278, 280, 281, 281, 282, 282, 283, 284, 285, 285, 288, 289, 289, 291, 291, 291, 292, 292, 293, 294, 291, 297, 297, 299, 299, 299, 299. The numbers of the several rooms in each Lodging House arc not given in the above return; for it was found on inspection that the tickets showing the number of beds each room is licensed to contain were in many cases removed, and in others the tickets did not correspond with the number of beds in the room. In order, therefore, to facilitate the inspection of these houses, and to particularize each room in any further communication that I may have with you on the subject, I would suggest that each room should be not only numbered, but its cubic capacity legibly painted on a plate of zinc or tin; the number of beds which it is registered to contain, and the same to be nailed to the wall in the most conspicuous part of the room. It might be also advantageous if not only a number but a name be given to each room. The under-mentioned sanitary defects require your attention, viz.:— At No. 6, Paternoster Row, the rooms numbered 3 and 6 are badly ventilated. No. 12, Princes Street, the several staircases leading from No. 4 room to No. 1 room are not enclosed, but they form a part of each of the said rooms; whereby the foul air which is generated in the lower rooms is carried by means of the ventilating shaft of the staircases from the lower to the upper rooms. Room No. 1 contains 27 beds, and rooms Nos. 2, 3, and 4 contain 70 beds each. The room No. 1, at 4 Flower and Dean Street is badly ventilated. The room No. 8, at 4 Flower and Dean Street is very dark and badly ventilated. The walls of No. 2 room, 11, Flower and Dean Street are wet from the overflow of the tank. The yard of No. 13, Flower and Dean Street is badly paved. No. 20, George Street, room No. 3 is badly lighted and ventilated. In measuring those rooms which are appropriated to married couples, a larger open space is required than 300 cubic feet for each person; for these numerous divisions very materially diminish the amount of air which is requisite for the healthy existence of those occupying these compartments. In the course of the next three months I expect to be able to complete my inspection of the Registered Common Lodging Houses in this District. I am, Dear Sir, Very truly yours, Captain Harris, Scotland Yard. JOHN LIDDLE, Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending April 1st, 1876. Number of inspections of houses as shown in the official returns 2375 Houses specially visited 269 Houses specially re-visited 1176 17 Preliminary notices served, such notices embracing 298 premises 209 Compulsory orders issued, embracing 74 premises 48 Summonses heard at Police Courts, under Sanitary Act 1 Ditto ditto Adulteration of Food Act. 1 Cellars used as dwellings discontinued for such use 1 Cases of overcrowding and indecent occupation abated 13 Houses in which rooms or passages have been whitewashed 74 Rooms disinfected with sulphurous acid gas after the occurrence of fever, and scarlet-fever, therein 19 Ventilation of houses improved 20 Articles disinfected, consisting of beds, bedding, clothing, &c. 35 Trades' Nuisances abated 0 Yards of houses paved or the pavement repaired 29 Drains in houses improved 66 Cesspools abolished 0 Dust-bins provided 6 Privies lime-washed, cleansed and repaired 118 Water-supply provided or improved 7 Nuisances from dung and other offensive matter removed 48 Area gratings, cellar flaps, &c., repaired 21 The cow-houses in the District, 26 in number, and the slaughter-houses, 14, and the bake-houses, 76 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. On the 1st of May, 1876, Mr. Battram reported to the Board that he had taken out two summonses which were heard on the preceding Friday, at Worship Street, Police Court; one of which was against the owner of Nos. 3 and 4, Sugar Loaf Court, and No. 51, Wentworth Street, abutting upon the yards of the said two houses, for the defective drainage, and for the dilapidated and filthy condition of the several houses, so as to render them unfit for habitation. The Magistrate, on hearing the case, ordered the houses to be closed forthwith. The other summons which was heard on the same day, was against the owner of a rag store in Sugar Loaf Court, for permitting to remain on his premises a very large accumulation of filthy and offensive rags, amounting to several tons; the same being a nuisance and injurious to health. In this case the Magistrate made an order for the removal of the accumulation of the filthy material within twenty-one days. I am, Gentlemen, Your most obedient Servant, 15, Great Alie Street. JOHN LIDDLE. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 1st April, 1876. 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. Acuta 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 0 0 0 0 1 0 0 0 0 11 16 0 2 0 0 1 0 75 108 Mr. Champneys 0 0 0 4 0 0 9 0 0 1 0 0 50 2 0 9 0 0 0 1 132 208 Mr. Sequeira 0 4 0 1 2 0 10 9 2 0 0 0 16 4 0 4 0 0 0 0 80 132 Mr. H. Braye 0 3 0 1 1 0 0 9 0 2 0 0 46 1 0 2 0 0 0 1 89 155 Mr. Loane 0 5 0 6 0 0 2 6 0 0 0 0 21 3 0 6 0 1 0 1 99 150 Total 0 14 0 12 3 0 21 25 2 3 0 0 144 26 0 23 0 1 1 3 475 753 Corresponding Qr. of previous Year. 0 0 7 6 9 0 3 39 0 3 0 4 131 21 1 26 4 0 2 5 496 757 Workhouse Mr. J. J. Ilott. 0 15 2 7 15 0 41 48 0 15 1 0 273 38 4 129 6 4 10 12 437 1057 In addition to the cases attended by Mr. Ilott in the Workhouse, there were 33 cases of syphilis. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ending 1st April, 1876. Districts. Small-Pox. Measles. Scarlet Fever. Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera & Choleraic Diarrhœa. Total. Remarks. Spitalfields 0 0 2 0 7 0 1 0 10 Mile End New Town 0 2 0 0 4 0 1 0 7 Workhonse. Whitechapel North 0 0 1 0 6 0 0 0 7 Whitechapel Church 0 4 1 0 5 1 2 0 13 Hospital. Goodman's Fields 0 0 1 1 5 1 2 0 10 Aldgate 0 0 0 0 10 1 1 0 12 Totals 0 6 5 1 37 3 7 0 59 Deaths from Epidemics for the corresponding Quarter, 1875. 1 1 8 4 3 6 5 0 28 Fourteen deaths from fever of patients belonging to this District occurred in the Asylum District Fever Hospital at Homerton. TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causes— Deaths under 1 year of age and above 60 years ; Deaths from Violence, Inquest cases, and Deaths in Workhouse and London Hospital, for the Quarter ending 1st April, 1876. Sub-districts. Enumerated Population in 1871. Births. Deaths. Under 1 year of age. Persons aged 60 years and upwards. Violence. Inquest cases. Deaths in Public Institutions. Spitalfields 22499 195 98 27 23 5 17 0 Mile End New Town 15550 171 162 28 64 4 20 104 Whitechapel North 11597 119 59 16 12 0 4 0 Whitechapel Church 7322 80 229 8 30 49 52 185 Goodman's Fields 10381 98 56 16 9 1 3 0 Aldgate 9224 58 49 7 4 1 5 0 Totals 721 653 102 142 60 101 289 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 1st JULY, 1876, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH. London: Printed by T. Penny & Co., 121, Leman Street, Whitechapel, E. 1876. REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ending, 1st July, 1876. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, the 1st July, 1876, the total births in the District were 680, and the deaths 527. The excess of births over deaths has therefore been, during this Quarter, 153. As the deaths of the non-residents which occurred in the London Hospital are included in the mortality returns, a deduction thereof must be made in order to estimate the correct mortality of the District. These deaths are on an average 66 per cent., exclusive of sudden deaths and those resulting from accidents, of the total mortality in this Institution; and, as the total deaths are 153, 102 must be deducted for the deaths of non-residents, thereby reducing the mortality of the District to 425, and increasing the number of births above deaths to 255. In the corresponding Quarter of the previous year the total births were 669, and the total deaths 558. As all the sudden deaths and those resulting from accident occurring in the London Hospital are included in the general mortality of the District, such deaths are estimated as about equal to the deaths of those persons who were resident within the district but which took place elsewhere. 4 In the Spitalfields sub-District the births were 217, and the deaths 92; in the Mile End New Town 160, and the deaths 133; in the Whitechapel North 110, and the deaths 37; in the Whitechapel Church 65 and 180 (in this sub-District the London Hospital is situated); in the Goodman's Fields 79 and 43; and in the Aldgate 49 and 42. The deaths have exceeded the births in the Whitechapel Church District by 125; but from this number the deaths of 102 non-residents must be deducted. The deaths in the London Hospital have been 153. In the corresponding Quarter of the previous year the deaths in this Institution were 166. The deaths in the Workhouse have been 91. In the corresponding Quarter of last year they were 88. The deaths from epidemic diseases in the entire District have been 38; viz.:—5 from measles, 2 from scarlet-fever, 1 from diphtheria, 14 from hooping-cough, 10 from diarrhœa, and 6 from fever. Four deaths of patients from this District occurred in the Homerton Fever Hospital; thus making a total of 10 deaths from fever. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 67, viz.:—1 from small-pox, 7 from measles, 9 from scarlet-fever, 5 from diphtheria, 19 from hooping-cough, 16 from diarrhœa, and 10 from fever. In addition to the 10 deaths from fever, there was 1 death in the Fever Hospital; thus making a total of 11 deaths from fever for that Quarter. Mortality of Young Children. The mortality of children under 1 year of age was 77. This is 14.2 per cent. of the total mortality. In the corresponding Quarter of the previous year, the rate of mortality of children under 1, was 20.9 per cent. of the total mortality. In the Spitalfields sub-District the rate is 34.7 per cent.; in the Mile End New Town 9.7 per cent.; in the Whitechapel North 18.9 per cent.; in the Whitechapel Church 3.3 per cent.; in the Goodman's Fields 16.2 per cent.; and in the Aldgate 28.5 per cent. In the Goodman's Fields sub-District the deaths under 1 year were 7, and the total deaths 43; in the Whitechapel North sub-District the total deaths were 37, and those under 1 year were 7; while in the Whitechapel Church sub-District the deaths under 1 year were only 6, and the total deaths 180. This difference is explained by the deaths in the London Hospital, in which Institution the deaths of children under 1 year are very few. In the corresponding Quarter of the previous year the rate of mortality of children under l year in the Spitalfields sub-District was 38.6 per cent.; in the Mile End New Town it was 21.4 per cent.; in the Whitechapel North 33.3 per cent.; in the Whitechapel Church 6.7 per cent.; in the Goodman's Fields 33.3 per cent.; and in the Aldgate 21.0 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter, 487 new cases of illness out of the Workhouse; including 5 of measles, 2 of scarlet-fever, 2 of hooping-cough, 22 of diarrhœa, 9 of fever, 19 of febricula, and 1 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 580; including 7 of measles, 4 of scarlet-fever, 21 of hooping-cough, 28 of diarrhœa, 4 of fever, 22 of febricula, and 6 of erysipelas. The total number of cases of illness in the Workhouse has been 758; including 4 of measles, 4 of hoopingcough, 11 of diarrhœa, 25 of febricula, 9 of fever, 11 of erysipelas, and 31 of syphilis. Cases of Illness in the London Hospital of Persons belonging to this District. By the courtesy of the House Committee of the London Hospital I have been favoured with a return of all the patients belonging to this District who have been admitted into the London Hospital during this quarter. The total number of medical cases is 141; including 12 of acute rheumatism, 10 of sub-acute rheumatism, 3 of rheumatic arthritis, 1 of diarrhœa, 1 of hooping-cough, 3 of croup, I of erysipelas, 12 of bronchitis, 7 of pneumonia, 3 of pleuritis, 15 of consumption, 4 of lead poisoning, 1 (a brass-worker) of metallic tremor, 1 of pyrexia, 1 of febricula, and 2 of Bright's disease. Meteorology of Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 3.48 inches. "This amount," says the Registrar-General, "is 2.3 inches less than the average amount in the corresponding period of the preceding 60 years." One inch deep of rain-fall on an acre weighs (allowing 10-lbs. to a gallon, which is the weight of a gallon of distilled water) nearly 101 tons. During the corresponding Quarter of last year the rain-fall was 6.23 inches. The mean temperature of the air was 51.8°. In the corresponding Quarter of last year the mean temperature was 50.7°. The hottest days during the Quarter were Wednesday, the 28th June, Tuesday, the 20th June, and Wednesday, the 21st June, when the thermometer in the shade indicated respectively 81.8°, 82.°6, and 83.9°. The hottest day during the corresponding Quarter of last year was on Friday, the 4th May, when the thermometer indicated 83.3°. 6 The following table, taken from the returns of the Registrar-General, shows the comparative results of the Quarter:— LONDON. Apr. 8 Apr. 15 Apr. 22 Apr. 29 May 6 May 13 May 20 May 27 Jun. 3 Jun 10 Jun. 17 Jun. 24 July 1 Deaths from Diarrhœa 19 16 17 7 15 6 15 14 13 14 16 30 49 Deaths from Fever 22 18 18 23 16 25 20 25 21 22 22 14 17 Mean Temperature of the air 51.1° 40.9° 47.5° 50.3° 448° 47.1° 49.2° 51.1 56.0 54.5° 56.5° 62.4° 62.9° Rain-fall in inches 0.00 0.69 0.20 0.21 0.17 0.00 0.00 1.13 0.12 0.09 0.54 0.33 0.00 Deaths in London 1581 1434 1631 1524 1416 1457 1341 1446 1343 1286 1280 1304 1175 Deaths in Whitechapel District. 48 29 54 37 42 36 46 49 38 26 42 37 43 Deathsin do. from Diarrhœa 2 1 0 0 0 0 0 0 0 0 1 1 5 The deaths from Diarrhœa in London during this Quarter have been 231, while the deaths for the corresponding Quarter of the previous year were 436. 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 Registd. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. September, 1874 329 0 30 0 359 0 630 December 185 2 31 0 216 2 689 March, 1875 292 2 44 0 336 2 687 June 376 0 26 0 402 0 673 September, 350 1 35 0 385 1 650 December 178 2 23 0 201 2 655 March, 1876 236 0 25 0 261 0 722 June 369 0 36 0 405 0 684 Totals 2315 7 250 0 2565 7 5390 Fever Cases in the District. In my last report I published a return prepared by Mr. Ilott, the Medical Officer of the Workhouse, of the fever cases which had occurred in this District, and had been removed from the Workhouse to the Homerton Fever Hospital. As the disease continues to prevail, although not to the same extent, Mr. Ilott has kindly given to me the subjoined return, prepared in the same form, of the cases which have occurred during the present quarter. 7 TABLE Showing the localities from which the patients were received in the Workhouse, and other particulars relating to them. Cases and description of Fever. Previous Residence. Date of admission into Workhouse. Date of admission into Fever Hospital. Length of time in the Workhouse before appearance of Fever. Whether or not Patients had Fever on admission. Typhus Fever 187a, Brick Lane Mar. 31 April 1 A few hours Slightly Typhus Fever 9, Dorset Street April 6 8 1 day No Typhus Fever 7, Flower & Dean Street 10 11 A few hours Slightly Typhus Fever 2, George Street May 2 May 5 2 days No Typhus Fever 55, Flower & Dean Street 14 17 2 „ „ Enteric Fever 1, Garden Court 17 22 4 „ „ Enteric Fever 93, Wentworth Street 22 23 A few hours Slightly Enteric Fever 34, Flower & Dean Street 29 30 A few hours „ Typhus Fever 12, Thrawl Street 20 31 10 days No The following are the localties from which fever patients were removed to the Homerton Fever Hospital during the quarter, viz:—9 from Workhouse, the previous residences of whom are given above; in addition to which number 8 patients were admitted into the Fever Hospital; viz.: 1 from No. 9, Gregg's-court, 1 from No. 56, Flower and Dean-street, 2 from No. 10, King-street, Mile End New Town, 1 from No. 5, Marlboroughcourt, 1 from No. 20, Goodman's-yard, 1 from No. 3, Butler-street, and 1 from No. 34, Flower and Dean-street; total number of admissions 17; of which 10 were from the Registered Common Lodging Houses. Of the total admissions 4 died. According to the return given to me by Mr. Vallance, and recorded in my last report, it appeared that 94 cases of fever were admitted into the Homerton Fever Hospital during the six months ended Lady-day last. Of these 94 cases, 61 were from the Common Lodging Houses; and if to these numbers we add the cases recorded during this quarter, we find that the total number of fever cases which have been received in the Hospital from this District, during the last nine months, is 108; of which no less than 71, or 65.7 per cent., were sent from the Common Lodging Houses. The rate of mortality has been 25 per cent. Registeeed Common Lodging Houses. In my last two Quarterly Reports I drew your attention to the overcrowded condition of several of the Registered Common Lodging Houses in 8 this District. Since the date of those Reports the Inspectors have visited all the others in the District, the particulars of which are set forth in the following letter addressed to Captain Harris, the Commissioner of Police, under whose authority these houses are placed. BOARD OF WORKS—WHITECHAPEL DISTRICT. July 14th, 1876. Dear Sir, The Sanitary Officers of this Board have completed the Inspection of the Registered Common Lodging Houses situated within this District. During the last three months 100 Registered Common Lodging Houses have been visited, and the Inspectors have measured all the rooms containing beds for nightly lodgers, with the view of ascertaining the cubic space which is allotted to each occupant of a bed. As the result of this Inspection it has been found that out of the 100 houses containing 355 rooms, 238 of such rooms were ascertained to be overcrowded; that is to say, that a less space than 300 cubic feet is allotted to each lodger. The houses inspected during the last three months are situated in the undermentioned localities:— Nos. 46, 47, 48, 49, 60, 62, 63, 64, 65, 75, 76, 77, 78, 79, 80, 96 and 98, Wentworthstreet, including the cottage at the rear of No. 49. Nos. 6, 7, 32, 33, 34 and 35, George-yard ; Nos. 1, 2, 5, 6, 7, 8, 9, 16, 17, 18 and 19, George-street; No. 1, George-court; No. 1, Garden-court, George-yard ; Nos. 11, 12, 12a, 13, 14, 15, 15a, 16 and 17, Thrawl-street; Nos. 1, 1a, 2, 3, 3a and 4, Osbornplace Nos. 3, 4, 5, 6, 7, 17 and 18, Upper Keate-street; Nos. 8, 9, 11, 12 and 13, Lower Keate-street; No. 37, Glasshouse-street; Nos. 1, 2, 3 and 4, Bull-court ; No. 13, Osborn-street; No. 29, Royal Mint-street; Nos. 1, 2, 3 and 4, New Montaguestreet ; No. 32, Crown-court, Aldgate ; Nos. 48, 49 and 50, Gun-street; Nos. 2 and 5, New Martin-street; No. 6, Little Pearl-street; Nos. 5 and 14, Plough-street; Nos. 6, 17, 18 and 19, Buckle-street; Nos. 65 and 69, Lambeth-street; Nos. 231 and 232, Whitechapel-road; No. 12, Wellclose-square, including the house at the rear ; Nos. 4, 5, 6 and 7, Gower's-row, including the cottages at the rear, Nos. 1 and 2. The rooms which have been found to be overcrowded are as follows:— No. Rooms. 46 Wentworth-street 5 47 ditto 4 49 ditto 4 Cottage at the rear 1 60 ditto 4 62 ditto 3 63 ditto 2 64 ditto 2 65 ditto 2 75 ditto 1 79 ditto 2 No. Rooms. 96 Wentworth-street 4 98 ditto 2 6 George-yard 4 7 ditto 4 35 ditto 1 1 George-street 2 2 ditto 4 5 ditto 3 7, 8 & 9, ditto 6 1, Garden-court, George-yard 2 9 No. Rooms. 11, Thrawl-street 12 ditto 12a ditto 13 ditto 14 ditto 15 ditto 15a ditto 16, George-street 17 ditto 18 ditto 19 ditto 3 16, Thrawl-street 3 17 ditto 3 1, Osborn-place 17 la ditto 4 2 ditto 7 3 ditto 6 3a Osborn-place 4 4 ditto 2 13, Osborn-street 3 3, Upper Keate-street 4 4 ditto 2 5 ditto 2 6 ditto 2 7 ditto 2 18 ditto 2 1, Bull-court 3 No. Rooms. 2, Bull-court 2 3 ditto 2 4 ditto 2 29, Royal Mint-street 4 1, 2, 3 & 4, New Montague-st. 13 32, Crown-court, Aldgate 2 48, Gun-street 2 49 ditto 1 50 ditto 2 2, New Martin-street 2 5 ditto 1 6, Little Pearl-street 4 6, Plough-street 3 14 ditto 2 6, Buckle-street 3 17 ditto 1 18 ditto 1 231, Whitechapel-road 3 232 ditto 3 12, Wellclose-square, including house at the rear 5 4,5, 6 & 7, Gower's-row, including cottages at the rear, 1 & 2 12 65, Lambeth-street 2 69 ditto 3 37, Glasshouse-street 2 11, Lower Keate-street 2 12 ditto 3 The number of cubic feet which is allotted for each lodger in these rooms respectively, was ascertained on measurement to be as follows:— Rooms Overcrowded. 151, 151, 152, 152, 163, 168, 170, 184, 189, 190, 192, 193, 195, 196, 197, 199, 199, 200, 203, 203, 204, 206, 208, 208, 209, 209, 210, 211, 211, 212, 214, 215, 215, 215, 216, 216, 218, 218, 218, 218, 220, 220, 222, 224, 224, 225, 225, 227, 228, 228, 228, 229, 230, 231, 231, 231, 231, 231, 231, 231, 232, 232, 233, 233, 233, 233, 233, 233, 233, 233, 234, 234, 234, 234, 234, 235, 235, 236, 236, 237, 237, 237, 238, 238, 238, 239, 239, 239, 239, 239, 210, 210, 240, 240, 240, 240, 240, 241, 242, 243, 213, 243, 243, 243, 243, 243, 244, 244, 244, 244, 245, 245, 245, 245, 246, 246, 246, 247, 247, 247, 247, 247, 248, 218, 249, 250, 250, 250, 251, 252, 252, 252, 252, 252, 253, 253, 253, 255, 255, 256, 256, 256, 256, 257, 259, 259, 259, 260, 260, 260, 261, 261, 261, 261, 262, 263, 264, 264, 264, 265, 266, 266, 267, 268, 268, 269, 270, 270, 271, 273, 273, 275, 275, 275, 275, 275, 275, 276, 276, 276, 276, 276, 278, 279, 279, 280, 280, 280, 280, 280, 280, 280, 281, 282, 282, 283, 284, 284, 286, 286, 286, 286, 286, 287, 288, 288, 288, 288, 288, 288, 288, 288, 288, 288, 288, 290, 290, 290, 290, 291, 291, 291 291, 292, 292, 292, 293, 293, 294, 294, 294, 294, 294, 294, 296, 297, 297, 297, 297, 299, 299, 299. Total 242. The houses Nos. 11, 12, 12a, 13, 14, 15 and 15a, Thrawl-street, and Nos. 16, 17, 18 and 19, George-street form one block; but in consequence of the Register Tickets not being placed in the rooms, and from the parties in charge not being able or willing 10 to describe the Nos. of the houses, or the number of the rooms, it is impossible to convey to you the situation of the looms in which the overcrowding existed. This will apply to the lodging houses generally. In addition to the overcrowding of the above-named houses, there are four rooms unfit for occupation, from their being dark and badly ventilated; one is No. 7 room in No. 11, Thrawl-street; the other three are facing the cooking stoves. At Nos. 48, 49 and 50, Gun-street, the sanitary arrangements are very defective. In consequence of the dilapidated condition of these houses they have been reported . to the Metropolitan Board of Works as dangerous structures. At No. 232, Whitechapel-road, in addition to the overcrowding, most of the compartments are dark and badly ventilated, and, in my opinion, should not be allowed to be occupied as sleeping apartments. No. 5 room in No. 7, George-street, is badly ventilated, and, at the time of the visit smelt very offensive. At No. 2, Osborn-place, room No. 7 is very dark and badly ventilated ; also No. 2 room down stairs is badly ventilated. The Sanitary Officers have inspected, during the last nine months, 167 Registered Common Lodging Houses, containing 733 rooms, and having a population of 4952. The number of rooms found to be overcrowded was 388, or more than the half of them. Sanitary defects, such as want of light, defective ventilation, defective drainage, want of traps to drains, offensive privies, defective pavement in yards, were found to exist in a great many instances. In addition to the suggestions contained in my two previous letters, I would further suggest, that in all cases where the numbers of the rooms are not kept up, such rooms should cease to be registered. I am, Dear Sir, yours truly, JOHN LIDDLE, Medical Officer of Health. Capt. Harris, Scotland Yard. I may here state that when the Act relating to Common Lodging Houses came into operation (1851), Medical Officers of Health had not been appointed in the Metropolis, and the sanitary arrangements for such houses were left entirely to the care of the Police; but since that time opinions have undergone considerable change, and what may have been considered as a sufficient space for a person occupying a bed in registered Common Lodging Houses in 1851 is not now considered to be so. As a fifteenth part of the population of this District sleep in the Registered Common Lodging Houses, it is very important to make such arrangements in these houses as are likely to protect the health of such a large population. All the particulars relating to my authority in inspecting the Registered Common Lodging Houses, are fully set forth in some of my previous Reports, and which were duly forwarded with my letter addressed to Colonel Henderson, on the 18th of January last. 11 Copy of an Official Representation made to the Metropolitan Board of Works of the unsanitary condition of certain localities in this District. In the Matter of the Artizans' and Labourers' Dwellings Improvement Act, 1875. To the Metropolitan Board of Works, the Local Authority as respects the Metropolis appointed by the said Act. Gentlemen, I, the undersigned John Liddle, the Medical Officer of Health of the District of Whitechapel, within the Metropolis, desire to make to your Board an official representation of the unhealthiness of a certain area within your jurisdiction, and which area is situated within the Parish of Whitechapel, and is comprised within the following boundaries, viz.:—Wentworth-street on the North, Old Castle-street and New Castle-street on the East, partly by High-street, Whitechapel, partly by the rear of houses abutting upon High-street, Whitechapel on the South ; and by the rear of the houses abutting upon Middlesex-street on the West; and is defined upon the plan which is annexed hereto and distinguished by the colour Red thereon. This area may be roughly estimated as containing 4 acres or thereabouts, and contains about 314 houses; has a population of about 2757, and it comprises some courts and alleys of the most wretched description, and includes the west side of New Castle-street, part of the west side of Old Castle-street, the whole of Castle-alley, the south-side of Wentworth-street, the whole of Goulston-street, Goulston-court, Three Tun-alley, Marlborough-court, the larger portion of New Goulston-street, the whole of Love-court, Little Love-court, Horse Shoe-place, Elizabeth-place, Swan-court, Little Middlesex-street, Hebrew-place, and Boar's Head-yard. I desire to represent to your Board that by reason of the closeness, narrowness, and bad arrangement, as well as by reason of the bad condition of the courts and houses within such area, diseases indicating a generally low condition of health amongst the population have been from time to time prevalent, and most of the houses within the area are unfit for human habitation. I further desire to represent, that the evils connected with such houses, courts, and alleys, and the sanitary defects of such area cannot be effectually remedied otherwise than by an Improvement Scheme for the re-arrangement and re-construction of the courts and houses within such area, or some of such streets and houses. The density of this entire area is such as to afford, upon an average, less than 8 square yards to each person. I am, Gentlemen, Your obedient Servant, JOHN LIDDLE. 31st May, 1876. 15, Great Alie Street. 12 Artizans' and Labourers' Dwellings Improvement Act, 1875. Since the above-named Act came into operation I have made four official representations to the local authority (Metropolitan Board of Works) respecting the unhealthiness of certain areas within this District; but virtually I have made only three such representations; for Scheme No. 2 related merely to the narrow part of Goulston-street, and which was brought under my notice by a communication in writing addressed to the District Board of Works, signed by twenty-five inhabitants of this District, drawing the Board's attention " to the shocking condition of the houses in that street." Upon the Board referring to me this communication I made a special inspection of all the houses in the narrow part of Goulston-street; and the result of such inspection is published in my Report for the Quarter ending 2nd October, 1S75. Scheme No. 1 embraces an area of about 29,000 square yards, is situated partly in the Parish of Whitechapel and partly in the Parish of Aldgate, contains about 450 houses, and has a population of about 3,750. This Scheme has been enlarged by the Medical Officer of Health to the Limehouse District, who made an official representation to the Metropolitan Board of Works of a certain area in his District, consisting of 1,804 square yards, on which there are 30 houses, inhabited by a population of 188. The total number of houses embraced in the combined Schemes of Whitechapel and Limehouse, is 480, containing a population of 3,938. Scheme No. 2 contains an area of about 18,382 square yards, on which there are about 190 houses, with a population of about 2,277. This Scheme embraces portions of the Parishes of Spitalfields and Whitechapel, and is published in my Report for the last Quarter. Scheme No. 3. The locality embraced in this Scheme is set forth in the above official representation made to the Metropolitan Board of Works. The total area consists of about 21,400 square yards, and is entirely confined to the Parish of Whitechapel. The number of houses included in this Scheme is 314, and are inhabited by a population of about 2,757. The total area embraced in these three Schemes, including the small portion of the Limehouse District, is rather more than 16 acres. The number of houses proposed to be taken down is 948, and the number of people to be displaced is 8,972. The rate of mortality for the year 1874, was, deducting the deaths of non-residents in the London Hospital, 28 per 1,000 ; while the rate of mortality in the same year in Scheme No. 1, was 42 per 1000; in Scheme No. 2, the rate of mortality was 36.4 per 1000; and in Scheme No. 3 it was 30.0 per 1000. In estimating the unhealthiness, or otherwise, of a particular locality not much reliance can be placed upon the mere death rate; for, in forming an opinion on the health of any place, the birth rate must be considered, the ages of the persons living, the occupations, 13 the wealth or poverty of the inhabitants, and the nature of the diseases which prevail among them. The death rate in the several streets and courts, comprised in the last two Schemes which I have submitted to the Metropolitan Board of Works, varies from 105.2 per 1000 (Sugar Loaf Court) to 8.3 per 1000 (Inkhorn Court); and from 59.2 per 1000 in Wentworth-street to 6.5 in Newcastlestreet ; and in two places, New Goulston-street and Hebrew-place, no deaths in 1874 are recorded. If, however, we inquire into the causes of death in the majority of the confined courts in the District, it will be seen that the mortality from scrofulous diseases and their congeners, is, in relation to the total mortality, as high as 33.8 per cent., which clearly indicates the unhealthiness of the locality; for such diseases are principally caused by defective ventilation. The unhealthiness of the several localities embraced in these Schemes is not only shown by the causes of death prevailing therein, but by the evidence of the medical practitioners who have the medical charge of these areas. Of all the places in this District which require demolition the most urgent is Castle-alley, for, from its confined situation, it is impossible to render it fit for habitation. If Scheme No. 3 should be approved by the Metropolitan Board of Works, and if, in their discretion, they should deem it advisable to extend it so as to include the houses on the east side of Petticoat-lane, a splendid opportunity will be afforded for effecting a most beneficial improvement in a sanitary point of view; especially so, if the City authorities should carry out a similar improvement on the west side of Petticoat-lane. As some misapprehension appears to exist as regards the duty of the Medical Officer of Health in making an official representation under the Artizans' Dwellings Act to the Metropolitan Board of Works, I have ventured to make the few following remarks on the subject: From the provisions of the several sections of the Artizans' Dwellings Act, 1875, it appears to me that the Medical Officer of Health is required to make an official representation to the local authority appointed by this Act, whenever he sees cause to make the same, that any houses, courts or alleys, within a certain area under the jurisdiction of the local authority, are unfit for human habitation; and that such unfitness for human habitation may reasonably be attributed to the closeness, narrowness, and bad arrangement, or the bad condition, of the streets and houses, or groups of houses, within such area, or to the want of light, air, ventilation, or proper conveniences; or to any other sanitary defects; and that the evils connected with such houses, courts, or alleys, cannot be effectually remedied otherwise than by 14 an improvement scheme for the re-arrangement and re-construction of the houses and streets within such area, or of some of such streets and houses; and that any number of such areas may be included in an improvement scheme. The Medical Officer of Health is, by the provisions of the 4th section, compelled to inspect any area within the jurisdiction of the Local Board to which he is the appointed Medical Officer of Health, which is complained of to him by two or more Justices of the Peace acting within such jurisdiction, or by twelve or more ratepayers within the District; and the Medical Officer of Health shall inspect such area and make an official representation, stating the facts of the case, and whether, in his opinion, the area is an unhealthy area or not an unhealthy area for the purposes of this Act. The section does not, however, say that he shall, if he think proper, enlarge the area complained of by the two Justices of the Peace, or by the twelve or more ratepayers. The Metropolitan Board of Works having received from the Medical Officer of Health an official representation setting forth the unhealthiness of a certain area may prepare a Scheme of their own, excluding any part of such area and including any neighbouring lands which they may deem to be necessary for making their Scheme efficient for sanitary purposes. The local authority may likewise provide for widening any existing approaches to the unhealthy area or otherwise for opening out the same for the purposes of ventilation or health; also it shall distinguish the lands proposed to be taken compulsorily, and shall provide for the accommodation of at the least as many persons of the working class as may be displaced in the area with respect to which the Scheme is proposed, in suitable dwellings, &c. (See section 5 of the Act.) In carrying out the provisions of the Act all that is required of the Medical Officer of Health, in the first instance, is to make an official representation, in the terms of the Act, to the local authority, of any group or groups of houses which are unfit for habitation. The Medical Officer of Health must give satisfactory reasons why the houses he condemns are unfit for habitation ; but he has nothing to do with the setting out of a given area in the vicinity of such houses so as to afford room for the reconstruction of suitable houses for the working classes. The title of this Act must be strictly borne in mind; and in the carrying out of its provisions there must be no attempt made to convert it into a Towns Improvement Act. Yet, in preparing a Scheme for the approval of the Home Secretary, such provision must be made therein as to allow a sufficient space; the streets must be sufficiently widened in proportion to the height of the adjacent buildings, and intervening buildings must be taken, if required, to convert the area into a convenient and appropriate site for working men's dwellings. Large sums of money have been spent in the ornamentation of London and in the 15 ment of the carriage traffic; and it is earnestly hoped, by all those who have the public health of this great city at heart, that no reasonable expense will be refused in improving the habitations of the poorer classes. " As the Whitechapel District is, for the most part, a very old portion of London, it will probably be found that, proportionally, there are more houses unfit for habitation within its area than in any other District in the Metropolis; and this circumstance will satisfactorily account for the several areas which I have thought it to be my duty to bring under the notice of the Metropolitan Board. The 31 and 32 Vic., cap. cxxx., better known as "Torrens' Act," may be looked upon as a failure; for, although the District Boards may compel landlords to take down houses which cannot be made fit for human habitation, yet they have no power to purchase the land which would then be rendered vacant; and even, if they were empowered to purchase it, it would be found, in some instances, not to be of sufficient width for making it into a thoroughfare, or for selling it to build houses thereon. In building a new class of houses for the poor some difficulty will be experienced in so arranging the necessary conveniences that nuisances shall not arise; and the pipes for the water supply must be so situated as to be out of the reach of children, who, from the love of mischief, might damage them. Great watchfulness must be exercised over the tenants to prevent nuisances in the rooms arising from the accumulation of filthy rags, skins of animals, and other offensive materials, which, from my own experience of the habits of some classes, will occasionally occur. Some open spaces must be provided within the curtilage of these buildings for a large class of persons who earn a living by wood chopping and sack making, who, unless careful supervision is used, will soon destroy the property. Whitechapel and Limehouse Improvement Scheme. In the Provisional Order, signed by the Home Secretary, as set forth in the Metropolis (Whitechapel and Limehouse) Improvement Scheme confirmation, it appears that the number of persons of the working classes who will be displaced by the Scheme, if carried out in accordance with this order, is estimated to be 3669. The dwellings to be erected on the lands constituting the Improvement Scheme shall be built in 24 Blocks; 19 of which Blocks shall be 5 storys in height, and 5 shall consist only of 4 storys; and each story shall not be less than 8 feet in height in the clear. The Blocks shall be so constructed as to provide, in the aggregate, accommodation for not less than 3870 persons of the working classes; or 201 more persons will be accommodated in the area than will be displaced therefrom. 16 The total number of holdings shall be 888, and are thus set forth, viz.: 121 holdings of 1 room each, 650 of 2 rooms each, and 117 of 3 rooms each ; making the total number of rooms 1772. The 121 holdings of a single room are intended to accommodate 302 persons, or on an average, 2.5 persons to each room. The 650 holdings of 2 rooms each are intended for the accommodation of 2925 persons, or on an average, 4.5 persons to each holding. The 117 holdings are intended for the accommodation of 643 persons, or on an average, 5.5 persons to each holding. These returns will be perhaps better understood by transferring to this report the table as given in the Provisional Order. No. of Holdings. No. of Rooms in each Holding. Total No. of Rooms. Average No. of Persons of the Working Class which each Holding shall be capable of accommodating. Total No. of Persons of the "Working Class which the Holdings shall be capable of accommodating. 121 1 121 2.5 302 650 2 1300 4.5 2925 117 3 351 5.5 643 888 — 1772 — 3870 Each Block shall, according to the number and size of holdings therein, be furnished with water-closets, sinks and water supply, and dust-shoots. The buildings on the lands constituting the improvement area, when the same shall have been acquired, shall be taken down and removed in sections of buildings, and new buildings upon the said lands shall be erected according to regulations to be from time to time made in that behalf by the Metropolitan Board of Works, with the approval of one of Her Majesty's Secretaries of State. Cartwright-street shall be widened to 30 feet, and extended southward into Upper East Smithfield. Glasshouse-street shall be widened to 30 feet from Royal Mint-street to Sir Henry Peek's premises. A roadway 20 feet wide shall be formed in continuation of Blue Anchor-yard, so as to maintain the present access to the arches under the Great Eastern Railway Viaduct. In the Provisional Scheme, as sanctioned by the Home Secretary, the superficial area of the rooms is not mentioned, but in the Scheme as prepared by the Board of Works the superficial area for single rooms is proposed to be 140 feet; for the tenements of 2 rooms, each tenement shall contain an aggregate clear area of not less than 250 feet; and for the tenements of 3 rooms, each tenement shall contain an aggregate clear area of not less than 350 feet. 17 In neither of the Schemes as prepared by the Home Secretary, or by the Board of Works, has any provision been made for the ventilation of the rooms, nor for the size of the windows in the rooms, nor for the light and ventilation of the staircases and passages; and there is no prohibition against the building of cellars. Cellars under these buildings may not only become nuisances, but they may be rendered dangerous from the storeage of inflammable materials. Suggestions for the Amendment of the Nuisances' Removal Act. In any Bill for the Amendment of the Nuisances' Removal Act, which may be laid before the Houses of Parliament, it would be desirable to insert clauses to the following effect: 1.—That the clauses of the New Act should be set forth in full length, and should not contain references to former Acts. 2.—That a minimum penalty, say the eighth of the maximum penalty, should be fixed by the Act. 3.—That when a nuisance in one District affects injuriously the inhabitants of another District, the local authority for the District so affected should be empowered to take proceedings against the parties by whose act, default, permission or sufferance, the nuisance arises. 4.—That when Articles of Food, unfit for the use of man, have been brought into a District, the Medical Officer of Health, or the Inspector for that District, may seize the same ; although they may have been removed into another District. 5.—That a definition of overcrowding should be given in the Act. 6.—That the Works ordered by a Magistrate shall be done to the satisfaction of the Medical Officer of Health. 7.—That to obtain uniformity of action, the word nuisance, in addition to the nuisances enumerated in section 8 of the Nuisances' Removal Act, 1855, and in section 19 of the Sanitary Act, 1866, shall include— 1.—Any dead body retained in a room, used as a living or sleeping room longer than four days, or any body in a state of decomposition, or the body of any person who shall have died from an infectious disease.* * The prolonged retention of a dead body in a living room is of frequent occurrence in this District, and is a very serious evil; but it might be mitigated if it were made compulsory upon every local authority to provide a mortuary. 18 2.—Carts, trucks, or barges used at any hour for the carrying of offensive matter, unless so covered as to prevent effluvium. 3.—Foul or dirty urinals. 4.—Pigs kept within 40 yards of a highway or dwelling-house. 5.—Any public building not sufficiently ventilated. 6.—Any dwelling-house not sufficiently supplied with water.* 7.—Any house so dilapidated in the roof, staircase, or floors, as to be dangerous or injurious to health. 8.—Any house not having a proper dust-bin.† 9.—Any house not having sufficient eaves-gutters, and stack pipes, so as to keep the house dry. 10.—Any premises whereon the smelting of the precious metals is carried on, so as to be injurious to the health of the inhabitants. As such premises are exempted by the 45th section of the Nuisances' Removal Act from interference by the Local authority, this clause should be repealed. 11.—Any underground rooms used as living or sleeping rooms, unless the same be in accordance with the provisions of the Building Act. 12.—Any factory or workshop not having suitable privy accommodation. 13.—Any house not being sufficiently ventilated, or being without proper drainage, or without a suitable water-closet or privy accommodation ; or any other matter or circumstance rendering any inhabited house, building, or premises, or part thereof, injurious to the health of the inmates. 14.—Any work, manufacture, trade or business, so conducted, as to be offensive or injurious to health. 15.—That in all cases of emergency, such as the stoppage or overflowing of a drain, the Medical Officer should have power to institute legal proceedings without delay, and not to wait for the meeting of the Board to obtain its sanction. • Since the date of the report of the Royal Sanitary Commissioners, Sir Charles Adderley introduced a Public Health Bill, containing the following clause,—" That the word Nuisance shall include 'any inhabitated house or building without an adequate supply of wholesome water.' " † Although a house may be provided with a proper dust-bin, yet if the same be not regularly emptied, it not only becomes a nuisance to the tenants, but the nuisance may injuriously affect the whole neighbourhood. It should therefore be enacted, that whenever a Local Board makes arrangement for the dust-men to call periodically—say once a week at every house in the District—and the occupier refuses to have the dust-bin emptied, the Local Board should have power to inflict a penalty on the occupier for such refusal. 19 16.—For the Recovery of Penalties, the 22nd section of the 11th and 12th Vic., c. 43, (Public Health Act, 1848) should be inserted. The above recommendations for the Amendment of the Nuisances' Removal Act having been approved by the Association of the Medical Officers of Health in the Metropolis, were handed in by me at the close of my evidence, given before the Royal Sanitary Commissioners in 1870, and are published as a portion of my evidence in the third volume of the second report of the Royal Sanitary Commission. TABLE, Showing the area in acres, density of population, acres to a person, deaths to 1000 living in the three decenniads in the ten most populated Districts in London, according to the calculation made by the Registrar-General, and published in his Annual Summary of Births, Deaths, &c., in London, for 1875, and in the Supplement to the 35th Annual Report of Births, Deaths, and Marriages in England. Localities. Area in Acres. Density of Persons to an Acre. Acres to a Person. Annual Deaths to 1000 living. Mean of 30 years. 1841-50. 1850-61. 1861-70. 1841-50. 1851-60. 1861-70. 1841-70. Westminster* 216 237 .004 .005 * 22 23 * 23 Saint Giles 245 219 .005 .005 .005 26 28 29 28 Holborn† 816 200 .004 .004 † 26 26 † 26 Saint George, East 244 197 .005 .005 .005 29 29 30 29 Shoreditch 648 196 .007 .005 .005 27 24 26 26 Whitechapel† 405 190 .005 .005 .005 29 28 30 29 Bethnal Green 755 159 .009 .008 .007 25 23 27 25 St. Saviour,S'thw'k § 1170 150 .006 .005 § 30 27 25 27 Mile End Old Town 679 137 .012 .011 .008 25 24 25 25 City of London|| 731 104 .007 .007 .007 26 26 26 26 * In 1868, the sub-District of St. Anne, Soho, was taken from the Strand District and added to St. James, Westminster. Before the merging of these two Districts the Strand District was the most densely populated in London, its density being .004 of an acre to a person. † In 1869, the Districts of Clerkenwell and Saint Luke's were merged in the Holborn District. ‡ These areas have recently been supplied to the Registrar - General by the Ordinance Survey Department, and include 2,178 acres of tidal water or River Thames. The area of Whitechapel, by the new measurement, is 405 acres instead of 406 acres. § In 1870, the District of St. George, Southwark, and Newington, were merged in the District of St. Saviour, Southwark. || On 1st January, 1870, the Districts of East London and West London were merged in the London City District. 20 A Mortuary required for this District. The question of erecting a Mortuary has been on more than one occasion discussed by your Board, and I have no doubt that one would long ago have been erected had the Board possessed the power of obtaining land compulsorily for that purpose. If the Board determine to erect a Mortuary, I would recommend that it should be built not only with architectural taste, but that it should possess conveniences for making post-mortem examinations, and for the holding of inquests, which are now, for the most part, held at public houses. Sanitary "Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending July 1st, 1876. Number of inspections of houses as shown in the official returns 2513 Houses specially visited 206 Houses specially re-visited 618 Preliminary notices served, such notices embracing 301 premises 192 Compulsory orders issued, embracing 60 premises 36 Summonses heard at Police Courts, under Sanitary Act 4 Cellars used as dwellings discontinued for such use 1 Cases of overcrowding and indecent occupation abated 240 Houses in which rooms or passages have been whitewashed 120 Rooms disinfected with sulphurous-acid gas, after the occurrence of fever and scarlet-fever therein 7 Articles disinfected in rooms, consisting of beds, bedding, clothing, &c. 50 Yards of houses paved or the pavement repaired 30 Drains in houses improved 90 Dust-bins provided 9 Privies lime-washed, cleansed and repaired 137 Water supply provided or improved 11 Nuisances from dung and other offensive matter removed 15 Area gratings, cellar flaps, &c., repaired 9 21 The cow-houses in the District, 26 in number, and the slaughter-houses, 14 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. I am, Gentlemen, Tour obedient Servant, JOHN LIDDLE. 15, Great Alie Street. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union for the Three Months ending on the 1st July, 1876. 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 0 0 0 1 3 0 1 2 0 0 0 0 2 5 0 1 0 0 0 0 63 78 Mr. Champneys 0 1 1 0 6 0 3 0 0 0 0 0 18 1 0 2 0 1 0 0 76 109 Mr. Sequeira 0 1 0 0 5 0 4 5 0 0 0 0 9 2 0 4 0 0 0 0 65 95 Mr. H. Braye 0 0 1 1 4 0 1 3 0 1 0 0 10 4 0 1 0 0 0 0 75 101 Mr. Loane 0 3 0 0 4 0 0 9 0 0 0 0 13 0 0 1 0 0 2 2 70 104 Total 0 5 2 2 22 0 9 19 0 1 0 0 52 12 0 9 0 1 2 2 349 487 Corresponding Qr. of previous Year. 0 7 4 21 28 0 4 22 0 6 0 0 60 15 0 13 1 0 0 7 392 580 Workhouse Mr. J. J. Ilott. 0 4 0 4 11 0 9 25 0 11 1 0 123 16 1 100 5 5 5 6 432 758 In addition to the cases attended by Mr. Ilott in the Workhouse, there were 31 cases of syphilis. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ending 1st July, 1876. Districts. Small-Pox. Measles. Scarlet Fever. Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera & Choleraic Diarrhoea. Total. Remarks. Spitalfields 0 2 1 1 4 4 0 0 12 Workhouse. Mile End New Town 0 0 1 0 2 1 1 0 5 Whitechapel North 0 0 0 0 5 1 2 0 8 Whitechapel Church 0 0 0 0 1 0 1 0 2 Hospital. Goodman's Fields 0 1 0 0 1 2 1 0 5 Aldgate 0 2 0 0 1 2 1 0 6 Totals 0 5 2 1 14 10 6 0 38 Deaths from Epidemics for the corresponding Quarter, 1875. 1 7 9 5 19 16 10 0 67 Four deaths from fever of patients belonging to this District occurred in the Asylum District Fever Hospital at Homerton. TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causes— Deaths under 1 year of age and above 60 years ; Deaths from Violence, Inquest cases, anc Deaths in Workhouse and London Hospital, for the Quarter ending 1st July, 1876. Sub-districts. Enumerated Population in 1871. Births. Deaths. Under 1 year | of age. Persons aged 60 ye?rs and upwards. Violence. Inquest cases. Deaths in Public Institutions. Spitalfields 22499 217 92 32 8 7 15 3 Mile End New Town 15550 160 133 13 36 5 10 91 Whitechapel North 11597 110 37 7 7 1 4 0 Whitechapel Church 7322 65 180 6 20 21 32 153 Goodman's Fields 10381 79 43 7 11 1 2 0 Aldgate 9224 49 42 12 2 2 7 0 Totals 680 527 77 84 37 70 247 BOARD OF WORKS WHITECHAPEL DISTRICT. REPORT ON THE Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 30TH SEPTEMBER, 1876, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH. London: Printed by T. Penny & Co., 121, Leman Street, Whitechapel, E. 1876. REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ending 30th September, 1876. To the Board of Works, Whtechapel District. Gentlemen, In the Quarter that ended on Saturday, the 30th Sept., 1876, the total births in the District were 640, and the deaths 562. The excess of births over deaths has therefore been, during this Quarter, 78. But a number of deaths of non-residents occur in the London Hospital and are included in the mortality returns. In order therefore to estimate the correct mortality of the District, a deduction must be made in respect of these deaths. These deaths are, on an average, 88 per cent, of the total mortality in this Institution; and, as the total deaths are 167, 147 must be deducted for the deaths of non-residents, thereby reducing the mortality of residents in the District to 415, and increasing the number of births above deaths to 225. In the corresponding Quarter of the previous year the total births were 635, and the total deaths 568. Some allowance must, however, be made for the deaths of residents in public institutions outside the District. 4 In the Spitalfields sub-District the births were 179, and the deaths 87 ; in the Mile End New Town 180, and the deaths 119; in the Whitechapel North 97, and the deaths 50; in the Whitechapel Church 71, and 212 (in this sub-District the London Hospital is situated); in the Goodman's Fields 79, and 41; and in the Aldgate 34, and 53. The deaths have exceeded the births in the Whitechapel Church District by 141; but from the total numbor of deaths about 147 deaths of non-residents must be deducted. The deaths in the London Hospital have been 167. In the corresponding Quarter of the previous year the deaths in this Institution were 163. The deaths in the Workhouse have been 59. In the corresponding Quarter of last year they were 62. The deaths from epidemic diseases in the entire District have been 94 ; viz.:—2 from measles, 3 from scarlet-fever, 1 from diphtheria, 4 from hooping-cough, 80 from diarrhoea, and 4 from fever. Two deaths of patients from this District occurred in the Homerton Fever Hospital; thus making a total of 6 deaths from fever. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 98, viz.:—0 from small-pox, 10 from measles, 7 from scarlet-fever, 3 from diphtheria, 15 from hooping-cough, 57 from diarrhoea, and 6 from fever. In addition to the 6 deaths from fever there was 1 death in the Fever Hospital; thus making a total of 7 deaths from fever for that Quarter. Mortality of Young Children. The mortality of children under 1 year of age was 149. This is 24.7 per cent, of the total mortality. In the corresponding Quarter of the previous year the rate of mortality of children under 1 was 26.2 per cent, of the total mortality. In the Spitalfields sub-District the rate is 40.2 per cent.; in the Mile End New Town 32.3 per cent.; in the Whitechapel North 42.0 per cent.; in the Whitechapel Church 10.3 per cent.; in the Goodman's Fields 51.2 per cent.; and in the Aldgate 20.7 per cent. In the Goodman's Fields sub-District the deaths under 1 year were 21, and the total deaths 41 ; in the Whitechapel North sub-District the total deaths were 50, and those under 1 year were 21; while in the Whitechapel Church sub-District tho deaths under 1 year were only 22, and the total deaths 212. This difference is explained by the deaths in the London Hospital, in which Institution the deaths of children under 1 year are very few. In the corresponding Quarter of the previous year the rate of mortality of children under 1 year in the Spitalfields sub-District was 40.2 per cent. ; in the Mile End New Town it was 28.0 per cent.; in tho Whitechapel North 52.0 per cent.; in the Whitechapel Church 6.7 per cent.; in the Goodman's Fields 51.0 per cent.; and in the Aldgate 24.5 per cent. 5 Tauter Illness in the District. The Medical Officers of the Union have attended, during the last Quarter, 529 new cases of illness out of the Workhouse; including 10 of measles, 2 of scarlet-fever, 1 of hooping-cough, 72 of diarrhoea, 1 of fever, 13 of febricula, 1 of pyaemia, and 3 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 549; including 17 of measles, 3 of scarlet-fever, 15 of hooping-cough, 49 of diarrhoea, 6 of fever, 21 of febricula, and 6 of erysipelas. The total number of cases of illness in the Workhouse has been 725 ; including 1 of scarlet-fever, 38 of diarrhoea, 7 of febricula, 3 of fever, 16 of erysipelas, and 38 of syphilis. Meteorology of Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 5.25 inches. One inch deep of rainfall on an acre weighs (allowing 10-lbs. to a gallon, which is the weight of a gallon of distilled water) nearly 101 tons. During the corresponding Quarter of last year the rain-fall was 10.03 inches. The mean temperature of the air was 61.8°. In the corresponding Quarter of last year the mean temperature was 58.3°. The hottest days during the Quarter were Sunday, the 13th Aug., Monday, the 14th Aug., and Tuesday, the 15th Aug., when the thermometer in the shade indicated respectively 92.6°, 93.8°, and 93.1°. The hottest day during the corresponding Quarter of last year was on Tuesday, the 17th Aug., when the thermometer indicated 83.6°. The following table, taken from the returns of the Registrar-General, shows the comparative results of the Quarter :— LONDON. July 8 July 15 July 22 July 29 Aug. 5 Aug. 12 Aug. 19 Aug 26 Sept 2 Sept 9 Sept 16 Sept 23 Sept 30 Deaths from Diarr- hœa 116 249 457 522 401 294 232 198 134 99 53 45 42 Deaths from Fever 20 12 20 19 16 19 24 15 19 15 21 37 27 Deaths from Small Pox. 13 2 8 7 1 9 5 10 8 5 16 11 15 Mean Temperature of the air 65.5° 65.5° 70.5° 63.5° 61.2° 66.7° 72.0° 59.0° 56.7° 57.5° 51.5° 57.5° 56.8° Bain-fall in inches 0.18 0.00 0.00 0.35 0.67 0.00 0.25 0.64 0.74 0.99 0.18 0.29 0.96 Deaths in London 1322 1475 1878 1973 1679 1572 1509 1370 1288 1231 1119 1280 1230 Deaths in Whitechapel District, 48 43 44 40 38 52 47 43 48 24 31 47 57 Deaths in do. from Diarrhœa 6 7 9 11 8 4 9 5 7 2 4 3 5 6 The deaths from small-pox in London for the Quarter have been 110; and the weekly returns, since the 30th September, have been respectively 11, 16, 22,15, 21, 48, and 52. The deaths in the corresponding Quarter of 1870, when the great epidemic of small-pox (1871-2) commenced, were 146. The weekly return, as given by the Registrar-General, was as follows: 13, 11, 15, 11, 15, 10, 11, 9, 12, 11, 15, 13. The deaths continued to increase weekly, thus, 27, 13, 17, 21, 23, 40, 45, 41, 60, 61, 44, 82, and for the week ending December 31st, they were 110, and continued to increase until the week ending July 1st, 1871, when they reached the culminating point; the number of deaths being 235; after which they gradually declined, and on the week ending 7th September, 1872, they were only 6. The total deaths from small-pox in London for the year 1870, were 958, and in the two following years they were respectively 7834 and 1532. The gradual rise, culmination, and gradual decline of epidemic diseases is not satisfactorily explained. 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— PUBL1C VACCINATOR Workhouse. Totals. Births Registd. Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases.* Re-Vaccination. December, 1874 185 2 31 0 216 2 689 March, 1875 292 2 44 0 336 2 687 June 376 0 26 0 402 0 673 September, 350 1 35 0 385 1 650 December 178 2 23 0 201 2 655 March, 1876 236 0 25 0 261 0 722 June 369 0 36 0 405 0 684 September 354 0 40 0 394 0 644 Totals 2340 7 260 0 2600 7 5404 Shall Pox. The Registrar-General, in his weekly returns, having drawn public attention to the prevalence of small-pox in the Metropolis, and having stated that a large proportion of the deaths from this disease have occurred among those who have not been vaccinated, I deemed it to be my duty to direct the attention of your Board to the fact that, not only is small-pox unusually prevalent in the Metropolis, but so also is scarlet-fever; the deaths from the former disease having been during the Quarter 110, and from the 7 latter 543, although in this District not a single death from small-pox has been recorded; neither has a death occurred in the Small Pox Hospital of any patient belonging to this District; and out of 543 deaths from scarletfever in the Metropolis only 3 occurred in this District. In a Report to your Board dated October 16th, 1876, I stated that, "although the 110 deaths from small-pox in London during the last Quarter gave an average of only about 8 per week, yet the number of deaths from this disease during the last five weeks has been respectively 11, 16, 22, 15, 21, 48, and 52, which shows that this disease is on the increase, and may soon assume the appearance of a great epidemic." It is therefore of the utmost importance that every means likely to bo useful in checking its progress should be adopted. For this purpose I would respectfully suggest that your Board should communicate with the Board of Guardians on the subject, and urge upon them the importance of adopting similar means to those which were carried out in 1871-2, when small-pox was so fatal in the Metropolis, and which means were attended with, great success. It would also be most desirable to draw the attention of the Managers of Schools in the District to the prevalence of small-pox, and suggest that a medical officer should be requested to inspect all the children attending the several schools with a view of ascertaining whether or not, in his opinion, each child has been satisfactorily vaccinated; and if not, then, by consent of the parents, to re-vaccinate such child which, in his opinion, is not sufficiently protected from an attack." An anonymous communication complaining of the overcrowding of seven schools in this District having been sent to the School Board of London, the same was forwarded to me. Upon the receipt of which I directed Mr. Battram:, one of your Sanitary Inspectors, to ascertain the dimensions of each school, and the number of children in daily attendance. Every one of these schools was, without any unnecessary delay, carefully measured, and the following is the result of Mr. Battram's visit of each school, viz., that only two out of the seven were overcrowded. Notices were issued to abate the overcrowding in these schools. As a preliminary, however, to this inspection, I applied for information respecting the space which is allowed for each child in a School Board School, and I obtained the following memorandum:— It is provided as a preliminary condition, "before any grant is made to a school (Article 4) the Education Department must be satisfied that the school premises are healthy, well lighted, warmed, drained, and ventilated, properly furnished, supplied with suitable offices, and contain in the principal school-room at least 80 cubic feet of internal space, and in the school-room and class-rooms at least 8 square feet of area for each child in average attendance." 8 In the Board Schools, however, 9 square feet of area are provided for each child. This is not a very large space; but if children are not kept in the school for a longer period at one time than three hours, and care taken to open the windows and doors so soon as the children are dispersed, and to keep them open until the children re-assemble, this space may be deemed to be sufficient. I may here observe that the subject of overcrowded school-rooms has frequently engaged my attention; and on referring to several of my early Reports I find that the space allotted to each child in some of the schools I inspected varied from 24 cubic feet to 72 cubic feet. One school, however, was found to allow 85 cubic feet for each child. On referring to my Report for the Quarter ending 28th September, 1861, the following remarks on this subject will be seen : *The ventilation of the overcrowded school-rooms was very defective. In an atmosphere rendered impure by the exhalations from the lungs and skin of many persons congregated in a confined space, the nervous system becomes so depressed, that, from the inability of fixing the attention, scholars cannot learn, and teachers cannot teach; and if the breathing of such an atmosphere be long continued the health of both scholars and teachers will be impaired. In the Minutes of the Council of Education (1851-2) relating to the organization of schools, it is recommended that, in planning a school-room, if it be not more than 18 feet in width, then about 8 or 9 square feet will be sufficient for each child in actual attendance; if the width be greater, there must be a proportionate increase of area allotted to each child. If the school-room be lighted from above, which, the Committee say, is the best possible mode, care should be taken, to prevent the skylights from leaking! "It is very important," say this Committee, "that the dimensions of a school-room should be graduated to suit the sizes of the elder and younger children." The recommendation of regulating the area of a school to the size of a child is at variance with the laws of physiology, which demand the same space for a child as for an adult, in consequence of the greater rapidity of respiration in the former than in the latter; and, moreover, a child is more susceptible to the bad effects of impure air than is an adult; and more air is required for the proper nourishment of its body during its growth than is required for it in after life. On the subject of small-pox, now so prevalent in London, the RegistrarGeneral, in his last Quarterly Return of Marriages, Births, and Deaths, makes the following remarks, which are of such interest as to induce me to quote them for the information of the members of your Board : "In London, the deaths referred to small-pox, which had been but 6 and 7 in the last three months of 1875 and the first three of 1876, rose to 26 in the Quarter ending June, and further increased to 110 during July, 9 August, and September last. This is the highest Quarterly number of deaths from small-pox registered in the Metropolis since the epidemic of 1871-2. Of the 110 deaths from small-pox in London, 62 occurred in hospitals, and 48 in private dwellings; 42 were of children under 10years of age, 17 of persons aged between 10 and 20 years, and 51 were of adults aged upwards of 20 years. Excluding the deaths of a mechanical engineer, of a solicitor's clerk, a grocer's wife, and three children of licensed victuallers, the whole of the fatal cases of small-pox in London occurred among the labouring classes. The 110 deaths included 36 which were certified as vaccinated, and 49 as unvaccinated; in 25, or 23 per cent, of the cases the medical certificates gave no information as to vaccination. Among the vaccinated cases only three were of children under 10 years of age ; whereas, of the 49 cases certified as unvaccinated, 30, or 61 per cent., were of children aged under 10 years. No less than 92 per cent, of the vaccinated persons who died from small-pox in London last quarter were of persons aged over 10 years." Fever Cases in the District. In each of my three previous Reports I published a return of the fever cases which had been admitted into the Workhouse under the care of Mr. Ilott, the whole of which were transferred to the Homerton Hospital. For the Quarter ending January 1st, the total number was 15; of these, 9 were of enteric fever and 6 of typhus. In the following Quarter the total cases were 43; of those, 3 were of enteric, 2 of scarlet-fever, and 38 of typhus. In the succeeding Quarter the total number was 9; of these, 3 were of enteric and 6 of typhus. In this Quarter the total number is 4, viz.: 1 of typhus, 1 of scarlet-fever, and 2 of enteric fever. The number of cases of typhus fever removed from the Workhouse to the Homerton Hospital, for the 12 months ending on the 30th September, was 51; of enteric fever 17, and of scarletfever 3. Total cases 71. In addition to this number there were sent from other parts of the District 41; thus making a total of 112 cases of fever admitted into the Homerton Hospital from this District. It will be seen, on reference to the Tables in the Appendix to this Report, that the epidemic of fever is now on the decline; the number of deaths from this disease having been for the Quarter ending January last, 15, including those which occurred in the Homerton Hospital; for the Quarterending April 1st, the deaths were 21 ; for the Quarter ending 1st July, they were 10, while for this Quarter they have been only 0, including 2 deaths in the Homerton Hospital. Since writing the above remarks on fever, Mr. Yallance has addressed to me the subjoined Letter:— 10 WHITECHAPEL UNION. Clerk's Office, Workhouse, E., 23rd October, 1876. My Deae Sir, In the recently published Report of the Commissioner of Police of the Metropolis, for the year 1875, reference is made generally to the "comparatively few " cases of infectious and contagious diseases which have occurred in the Metropolitan Common Lodging Houses ; and it is specifically stated that but IS such cases had arisen therein, of which G were scarlet-fever, 3 continued fever, and 3 typhus 1'cver, in addition to 15 "said to have occurred " therein, but not declared to be fever until " the lapse of some time " after removal to the Workhouse Infirmary. Doubtless these statements and figuries are strictly accurate within the scope of information in the possession of the police authorities ; but I would suggest, for your consideration, whether—upon reference to the following figures, which relate to the Whitechapel District only (and this but a small section of the Metropolitan area)—the Returns supplied to the Chief Commissioner are not incomplete, and, being so, whether a more favourable impression of the state of the common lodging houses is not created in the public mind than is deserved. During the year 1875, 50 pauper patients were removed from this Union to the Homerton Fever Hospital. Of these, 7 were sent direct from common lodging houses and 19 from the workhouse to which they had been admitted from common lodging houses, as follows : — One day previously 9 Two days ,, 5 Three days „ 2 Four days „ 1 Five days „ 1 Eight days ,, 1 19 As you were good enough to draw my attention to the Police Commissioner's Report, I think it well to furnish you with the foregoing figures. W. VALLANCE. John Liddle, Esq., Medical Officer of Health, Whitechapel. 11 TABLE, Showing the Localities from which the Patients were received in the Workhouse and other particulars relating to them. Class and description of Fever. Previous Residence. Date of admission into Workhouse. Date of admission into Fever Hospital. Length of time in the Workhouse before appearance of Fever. Whether or not Patients had Fever on admission. Typhus Fever 58, Wentworth Street July 22 July 24 2 days No Scarlet Fever 62, Usher Road, Old Ford Aug 13 Aug 13 2 hours Yes Enteric Fever 5, Charlotte Court Sep. 13 Sep. 14 1 day Slightly Enteric Fever 50, Wentworth Street Sep.15 Sep. 19 4 days No The following cases of fever were removed to the Homerton Hospital direct from the patients' residences. Typhoid...2, Seven Star Court. Scarlet-fever...7, Black Lion Yard. Typhus...1, Buttress Gardens, Wile End New Town. Out of above seven cases two died. Artizans and Labourers Dwellings Act, 1875. The two official representations respecting the unsanitary condition of certain localities in the District which I made to the Metropolitan Board of Works, the particulars of which are set forth in my last two quarterly reports have, with some alterations, been adopted by that Board, and orders have been given to their officers to prepare schemes under the Artizans and Labourers Dwellings Act, and that the necessary steps should be taken with a view to their being confirmed by the Secretary of State. In addition to the statistics relating to the death-rate in the two schemes, which were only prepared for one year and published in connection with my official representations, I have prepared the following statistics respecting the death-rate of the areas complained of for the 5 years ending October, 1874, which may not be uninteresting to your Board. Scheme 2. The area comprised in Scheme No. 2, and known as the Flower and Dean Street Scheme, contains a population of 2277. The deaths for the 5 years ending October 3rd, 1874, were 370; the average annual death-rate per 1000 for the 5 years was 32.4; while for the entire district it was 27.9 per 1000. The ages at death were as follows: 0 and under 6 months 55 6 months and under 1 year 27 1 year and under 5 years 68 5 years and under 10 years 12 10 „ and under 20 „ 11 20 „ and under 40 „ 60 40 „ and under 60 ,, 79 60 „ and under 80 „ 55 80 „ and upwards 3 Total deaths 370 12 The deaths of children under 5 years of age were 150; which is at the rate of 43.2 per cent., while the deaths of children under 5 in the entire district were 43.8. It may be here observed that the area contains a large number of registered lodging-houses which arc occupied principally by adults. The deaths from epidemic diseases in this area were 24, which is 64.8 per 1000 of the total deaths; and the deaths from scrofulous diseases were 137, which gives a death rate from those diseases of 370.2 per 1000 of the total deaths; and in the entire district the proportion of deaths from epidemic diseases is as 120.6 per 1000 of the total deaths; and the proportion of deaths from scrofulous and the allied diseases, including consumption, was 252.1 per 1000 for the year ending 2nd January, 1874. The deaths under 5 years are in proportion to the total deaths 43.8 per cent. Inkhorn Court. This court which in the year 1874 gave a rate of mortality of only 8.3 per 1000, gives, in the 5 years, an average annual death-rate of 21.6 per 1000. As this Court is one of the most confined and badly ventilated courts in the district, with very defective drainage, and the inhabitants subjected to the constant emanations of two public privies, might reasonably be expected to have a large rate of mortality. It is described by Dr. Dyte, whose remarks on this Court and on others in the. area embraced in Scheme No. 2, arc published in my last report, as always being in a very unwholesome condition; nevertheless the annual death rate is below that of the entire district. The death-rate in this Court for 1870 was at the rate of 41.6 per 1000; in 1871 it was 16.6; in 1872 16.6; in 1873 25.0; and in 1874 it was, as stated above, only 8.3 per 1000. As the people occupying this Court are very poor and consist almost entirely of foreign Jews, it is probable that when they are ill tliev are removed to some institution outside the District, and their deaths arc there registered. This low death-rate may, perhaps, to some extent, be accounted for by the population being migratory, the same parties not remaining long in the locality. The ages at death were as follows:— 0 and under 6 months old 7 6 months and under 1 year 1 1 year and under 5 years 1 5 years and under 10 years 1 10 years and under 40 1 40 years and under 60 1 60 years and under 80 1 13 The rate of mortality of children under 5 years was 69.3 per cent. 13 Sugar Loaf Court Contains a population of 38. The total deaths in the 5 years ending 3rd October, 1874, were 9, which gives an average annual death-rate of 47.3 per 1000. The ages at death were as follows: 2 weeks old 2 3 „ 1 5 „ 1 6 „ 1 4 months old 1 36 years 1 58 „ 1 68 „ 1 9 Out of the 9 deaths 6 were of children under 1 year. This is at the rate of 66.6 per cent. of the total deaths. Scheme 3. The area comprised in Scheme 3, and known as the Goulston Street Scheme, contains a population of about 2757. The deaths for the 5 years ending 3rd October, 1874, were 338. The annual average death-rate per 1000 was 24.5. The deaths from epidemic diseases were 45; the same being 133.1 per 1000 of the total deaths; and the deaths from scrofulous diseases were 113, which is at the rate of 334.3 per 1000 of the total deaths, and is 22.5 per cent. above the rate of mortality of the entire District from these causes. The ages at death were as follows:— 0 and under 6 months 56 6 months and under 1 year 41 1 year and under 5 years 84 5 years „ 10 „ 11 10 „ „ 20 „ 9 20 „ „ 40 „ 35 40 „ „ 60 „ 43 60 „ „ 80 „ 45 80 „ and upwards 14 Total deaths 338 The deaths of children in this area under 5 arc at the rate of 53.5 per cent. of the total deaths. 14 Wentworth Street. That portion of Wentworth Street which is comprised in this area contains a population of 135. The total deaths for the same period were 31, which gives an annual average death-rate of 45.9 per 1000. The ages at death were as follows:— 0 and under 6 months 3 6 months and under 1 year 3 1 year and under 5 years 2 5 years „ 10 „ 3 10 „ „ 40 „ 1 40 „ „ 60 „ 2 00 „ „ 80 „ 8 80 „ and upwards 9 31 The rate of mortality of children under 5 years is 25.8 per cent. in this portion of Wentworth Street. In order to be able to draw a comparison between these unhealthy areas and the areas occupied by the several model lodging-houses in this District, I made application for the last Annual Reports of the Metropolitan Improved Dwellings, situated in Mile End New Town; the Peabody Buildings, situated in Commercial Street, and the Improved Industrial Dwellings Company. From the Report of the first-mentioned Company, it appears that the rate of mortality for the year ending March, 1876, was 15.7 per 1000; that of the Trustees of the Peabody Buildings, for the year 1875, 20.8 per 1000; and that of the Improved Industrial Dwellings Company, for the year 1875, 15.2 per 1000. For the information of every Member of the Board I have thought it advisable to transcribe the two Schemes of the Metropolitan Board of Works, which have been prepared upon my official representations of certain unhealthy areas in this District. These Schemes are set forth in the following words:— Goulston Street Scheme (Whitechapel.) "This Scheme comprises an extensive area lying between High Street, Whitechapel, and Wentworth Street, bounded on the west by Middlesex Street, and on the east generally by the houses in Goulston Street. Many of the houses are very old and in bad repair, but they are not all equally bad. The worst properties are in Castle Alley, and your Committee recommend that it be included in the Scheme. With the exception of some large business premises it is proposed to clear away all the houses in Goulston 15 Street, on the east side of Middlesex Street, and on the south side of Wentworth Street, together with the courts and alleys abutting on them. This will enable the Board not only to re-house the persons displaced with more liberal accommodation, but to widen Middlesex Street, Wentworth Street, and the southern end of Goulston Street to 40 feet, and New Goulston Street to 30 feet, and to reserve a considerable area fronting Middlesex Street for recoupment. Your Committee propose to widen Wentworth Street for a length of 500 feet in connection with this Scheme, and a length of 300 feet in connection with Flower-and-Dcan Street Scheme (No. 11). A further widening might conveniently be effected after these Schemes have been carried out, but your Committee do not propose that it shall be taken in hand at the present time. The net cost of this Scheme is estimated at £124,700." Flowee-and-Dean Street Scheme (Whitechapel.) "This area is situated to the East of Commercial Street, and extends from High Street, Whitechapel, on the south, to Flower-and-Dean Street on the north. It contains an unusually large proportion of dwellings of the worst description, and includes a considerable number of registered lodging houses. Your Committee recommend the removal of the whole of the northern portion of the block between Flower-and-Dean Street and Wentworth Street, except the north side of Wentworth Street, which is occupied by some large business premises, and the east side of George Street, which is occupied by a large registered lodging house, and could not readily be made available for re-arrangement. To the south of Wentworth Street your Committee have omitted a large proportion of the area referred to by the Medical Officer, as its condition does not appear to warrant its demolition. It is not proposed to interfere with any of the courts leading out of High Street, Whitechapel, except Inkhorn Court, nor with the stables in George Yard in rear of the houses in High Street. Some lodging-houses of an improved character have recently been erected in George Yard, in which the Vicar of St. Jude's and other parties arc interested, and for the extension of which they have taken some adjacent property. They would probably be glad to avail themselves of the Board's assistance to enable them to extend their Scheme. Your Committee recommend the erection of 5-story buildings in this block, and they suggest the widening of Wentworth Street to 40 feet, and of Flower-and-Dean Street, Keate Street, and George Street, each to 30 feet. The net cost of this Scheme is estimated at £23,073." The facts which I have laid before you in this Report respecting the sanitary condition of the two areas satisfactorily prove that both of them arc, in every respect, very unhealthy, whether we consider the ages at death, 16 the numerous cases of illness among the people inhabiting the several courts, the large amount of scrofulous diseases and their congeners, which are principally caused by defective ventilation and overcrowding, and the large proportionate number of zymotic diseases. Under these circumstances we may congratulate ourselves that there is now a probability of these unhealthy areas, or part of them, being demolished, and new and more healthy dwellings erected on the sites. We may, therefore, reasonably hope that by the clearing away of these plague spots the health of this District will improve and the rate of mortality diminish. I cannot, however, conclude this Report without expressing my regret that the Metropolitan Board of Works do not, as stated in that portion of their Report relating to this District, propose to interfere with the courts leading out of High Street, Whitechapel, with the single exception of Inkhorn Court. The other three courts leading out of the High Street, Whitechapel, which formed a portion of my official representation, viz., Tewkesbury Buildings, Angel Alley, and Queen's Place, are all, from their defective ventilation and the bad arrangement of the houses, unfit for human habitation. Tewkesbury Buildings. The houses in this court, which consist of three stories each, have been recently built and present a tolerably decent appearance; but as they have neither back yards, thorough ventilation, nor privies conveniently situated, they are not adapted for the use of more than one family in each. But as all the rooms in those houses are occupied by separate families, who have the use of only the one privy in the basement, which privy is always, more or less, in a filthy condition, and emits an offensive smell which permeates every room,, the houses are unfit for habitation. Angel Alley is not only badly ventilated, but the houses are without back yards, and the tenants are provided with public privies, which are frequently productive of offensive smells, thereby increasing the evil arising from defective ventilation. Queen's Place: This court is unfit for habitation owing to its confined space and defective ventilation, and the smell arising from the public privies therein. This place has formed the subject of frequent complaint to your Board. It may be recollccted by some Members of the Board that about the year 1861 I pointed out that on the west side of Queen's Place there formerly stood a warehouse, but the owner of the ground thought it would be more profitable to him to take down the warehouse and erect dwelling-houses on the site. Having cleared the land the owner commenced building two dwelling-houses of six rooms in each, and having left a space in the rear of these two houses of only 100 square feet, I informed the builder that he would not be allowed to complete them in 17 the manner contemplated, and that instead of his building two rooms on cach floor only one would be allowed. Notwithstanding my remonstrance the houses were completed, each having two rooms on a floor; but the builder complied, and apparently with effect, with the provisions of tho Building Act by making a door-way between the houses, and then the two houses were said to be only one house, and that the space in the rear was 100 square feet which was all that the Act required. This arrangement was considered by the District Surveyor to be legally satisfactory; but when the houses were tenanted the door-way was built up, thus again converting the one house into two houses. The back rooms of these houses are lighted and ventilated by a space only of 50 square feet. The above-named courts cannot be, in my opinion, satisfactorily dealt with under Torrens' Act, 1868, for the houses are not unfit for habitation from any defective condition in point of repair, but the confined space on which they stand, and the stagnant atmosphere which surrounds them, render them unfit for habitation. Torrens' Act appears to refer to the defective structural condition of the houses and not to the external surroundings of the premises, which, from want of light and ventilation, is often the greater evil; and if the Act does not provide a remedy in this respect it is a very serious defect. Sanitary Works Performed during the Quarter. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending 30th September, 1876. Number of inspections of houses as shown in the official returns 2544 Houses specially visited 199 Houses specially re-visited 555 Preliminary notices served, such notices embracing 277 premises 131 Compulsory orders issued, embracing 109 premises 54 Summonses heard at Police Courts, under Sanitary Act 0 Cellars used as dwellings discontinued for such use 1 Cases of overcrowding and indecent occupation abated 2 Houses in which rooms or passages have been whitewashed 150 Rooms disinfected with sulphurous-acid gas, after the occurrence of fever and scarlet-fever therein 7 Articles disinfected in rooms, consisting of beds, bedding, clothing, &c. 55 Yards of houses paved or the pavement repaired 56 Drains in houses improved 95 Dust-bins provided 21 Privies lime-washed, cleansed and repaired 127 "Water supply provided or improved 21 Nuisances from dung and other offensive matter removed 23 Area gratiDgs, cellar flaps, &c., repaired 5 I am, Gentlemen, Your obedient Servant, JOHN L1DDLE. 15, Great Alie Street. appendix. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 30th September, 1876. 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 0 i 0 0 17 0 0 2 1 2 0 0 0 6 0 2 0 0 1 0 51 83 Mr. Champneys 0 0 1 0 16 0 0 0 0 0 0 0 19 2 0 1 0 0 0 1 84 124 Mr. Sequeira 0 0 0 0 6 0 0 6 0 0 0 0 3 2 0 6 1 0 1 0 67 92 Mr. H. Braye 0 8 1 1 20 0 1 2 0 1 0 0 1 0 0 4 0 0 0 0 96 135 Mr. Loane 0 1 0 0 13 0 0 3 0 0 0 0 6 0 0 - 0 0 0 0 0 67 95 Total 0 10 2 1 72 0 1 13 1 3 0 0 29 10 0 18 1 0 2 1 365 529 Corresponding Qr. of previous Year. 0 17 3 15 49 0 6 21 0 6 0 0 26 8 1 17 0 1 3 8 368 549 Workhouse Mr. J. J. Ilott. 0 0 1 0 38 0 3 7 0 16 0 0 97 14 2 78 3 6 11 6 443 725 In addition to the cases attended by Mr. Ilott in the Workhouse, there were 38 cases of syphilis. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ending 30th September 1876. Districts. Small-Pox. Measles. Scarlet Fever. Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera & Choleraic Diarrhea; Total. Remarks. Spitalfields 0 0 0 0 2 16 1 0 19 Mile End New Town 0 0 0 0 0 21 0 0 21 Workhouse. Whitechapel North 0 1 1 0 0 13 0 0 15 Whitechapel Church 0 1 2 1 0 10 1 0 15 Hospital. Goodman's Fields 0 0 0 0 2 9 0 0 11 Aldgate 0 0 0 0 0 11 2 0 13 Totals 0 2 3 1 4 80 4 0 94 Deaths from Epidemics for the corresponding Quarter, 1875. 0 10 7 3 15 57 6 0 98 Two deaths from fever of patients belonging to this District occurred in the Asylum District Fever Hospital at Homerton, thus increasing the total deaths from 5 to 6. TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causes— Deaths under 1 year of age and above 60 years; Deaths from Violence, Inquest cases, and Deaths in Workhouse and London Hospital, for the Quarter ending 30th September, 1876. Sub-districts. Enumerated Population in 1871. Births. Deaths. Under 1 year of age. Persons aged 60 ye?rs and upwards. Violence. Inquest cases. Deaths in Public Institutions. Spitalfields 22499 179 87 35 9 7 13 4 Mile End New Town 15550 180 119 39 22 2 13 59 Whitechapel North 11597 97 50 21 6 3 4 0 Whitechapel Church 7322 71 212 22 24 49 58 167 Goodman's Fields 10381 79 41 21 3 2 3 0 Aldgate 9224 34 53 11 3 4 6 0 Totals 640 562 149 67 67 97 230 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDING 30TH DECEMBER, 1876, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH. London: Printed by T. Penny & Co., 121, Leman Steeet, Whitechapel, E. 1877. REPORT OF THE MEDICAL OFFICER OF HEALTH, For the Quarter ending 30th December, 1876. To the Board of Works, Whitechapel District. Gentlemen, In the Quarter that ended on Saturday, the 30th Dec., 1876, the total births in the District were 713, and the deaths 606. The excess of births over deaths has therefore been, during this Quarter, 107. As the deaths of the non-residents which occurred in the London Hospital are included in the mortality returns, a deduction of such deaths must be made in order to estimate the correct mortality of the District. These deaths are, on an average, 66* per cent., exclusive of sudden deaths and those resulting from accidents, of the total mortality in this Institution; and, as the total deaths arc 211, 140 must be deducted for the deaths of non-residents, thereby reducing the mortality of the District to 466, and increasing the number of births above deaths to 247. In the corresponding Quarter of the previous year the total births were 633, and the total deaths 659. In the Spitalfields sub-District the births were 218, and the deaths 108 ; in the Mile End New Town 179, and the deaths 142; in the Whitechapel North 101, and the deaths 39; in the Whitechapel Church 59 and 235 (in this sub-District the London Hospital is situated): in the Goodman's Fields 96 and 36; and in the Aldgate 60 and 46. The deaths have exceeded the births in the Whitechapel Church District by 176; but from this number the deaths of 140 non-residents must be deducted. The deaths in the London Hospital have been 211. In the corresponding Quarter of the previous year the deaths in this Institution were 187. The deaths in the Workhouse have been 81. In the corresponding Quarter of last year they were 75. The deaths from epidemic diseases in the entire District have been 38; viz.: 8 from small-pox, 3 from measles, 4 from scarlet-fever, 1 from diphtheria, 2 from hooping-cough, 10 from diarrhoea, and 10 from fever. Six deaths of patients from this District occurred in the District Small Pox Hospital, and 1 in the Fever Hospital; thus making a total of 14 deaths from small-pox and 11 from fever. * By estimating the deaths of non-residents at 66 per cent. instead of at 88 per cent., which was the estimated rate for the previous Quarter, allowance is made for the deaths of residents in public institutions outside the District, 4 In the corresponding Quarter of the previous year the deaths from epidemic diseases were 86; viz.: 2 from small-pox, 22 from measles, 12 from scarlet-fever, 3 from diphtheria, 24 from hooping-cough, 14 from diarrhoea, and 9 from fever. In addition to the 9 deaths from fever, there were 6 deaths in the Fever Hospital; thus making a total of 15 deaths from fever for that Quarter. As I now receive the mortality returns regularly from the Local Registrars, I hope to be able to resume my Quarterly Reports in the form I adopted before 1874. Mortality of Young Children. The mortality of children under 1 year of age was 123. This is 20.2 per cent. of the total mortality. In the corresponding Quarter of the previous year the rate of mortality of children under 1, was 19.8 per cent. of the total mortality. In the Spitalfields sub-District the rate is 37.0 per cent.; in the Mile End New Town 20.4 per cent.; in the Whitechapel North 25.6 per cent.; in the "Whitechapel Church 7.2 per cent.; in the Goodman's Fields 44.4 per cent.; and in the Aldgate 23.9 per cent. In the Goodman's Fields sub-District the deaths under 1 year were 16, and the total deaths 36 ; in the Whitechapel North sub-District the total deaths were 39, and those under 1 year were 10; while in the Whitechapel Church sub-District the deaths under 1 year were only 17, and the total deaths 235. This difference is explained by the deaths in the London Hospital, in which Institution the deaths of children under 1 year are very few. In the corresponding Quarter of the previous year the rate of mortality of children under 1 year in the Spitalfields sub-District was 33.6 per cent.; in the Mile End New Town it was 20.5 per cent.; in the Whitechapel North 28.3 per cent.: in the Whitechapel Church 4.0 per cent.; in the Goodman's Fields 28.8 per cent. Pauper Illness in the Disteict. The Medical Officers of the Union have attended, during the past Quarter, 512 new cases of illness out of the Workhouse; including 19 of small-pox, 3 of measles, 2 of scarlet-fever, 23 of diarrhœa, 3 of fever, 29 of febricula, and 2 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 588; including 8 of measles, 1 of scarlet-fever, 2 of hooping-cough, 15 of diarrhœa, 11 of fever, 27 of febricula, and 4 of erysipelas. The total number of cases of illness in the Workhouse has been 676; including 49 of small-pox, 1 of scarlet-fever, 10 of diarrhoea, 13 of febricula, 1 of fever, 4 of erysipelas, and 49 of syphilis. I may here observe that the 19 cases of small-pox which are recorded in the books of the Medical Officers of the Union give only a portion of the cases which have occurred in the District; for the sanitary officers have received information of 17 cases which were attended by private medical practitioners. All the rooms in which patients have suffered from small-pox 5 which are reported to the sanitary officers, have been disinfected. Eight cases of fever 'which have not been recorded in the books of the Medical Officers were sent to the Hospital. Meteorology or Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis, during the Quarter, has been 10.28 inches. Of the 10.28 inches of rain which fell during this Quarter, 2.19 inches fell in the week ending December 23rd, and 1.69 inches in the week ending December 2nd. The total rain-fall in December, from the week ending Saturday 2nd to Saturday 30th inclusive, a period of five weeks, was 6.75 inches. One inch deep of rainfall on an acre weighs (allowing 10-lbs. to a gallon, which is the weight of a gallon of distilled water) nearly 101 tons. The rain-fall during the year 1876 amounted to 24.2 inches, and was 1.1 inch below the average in 61 years. The remarkable deficiency of rain-fall in the six months ending September was not counterbalanced by the unprecedented fall during December. During the corresponding Quarter of last year the rain-fall was 7.50 inches. The mean temperature of the air was 47.2°, being 3.2° above the average. In the corresponding Quarter of last year the mean temperature was 42.8°. The coldest days during the Quarter were Friday, the 10th November, Saturday, the 11th December, and Thursday, the 8th November, when the thermometer indicated respectively 25.5°, 27.6°, and 29.8°. The coldest day during the corresponding Quarter of last year was on Saturday, the 4th December, when the thermometer indicated 23.3°, or 8.7° below the freezing point. The following table, taken from the returns of the Registrar-General, shows the comparative results of the Quarter:— LONDON. Oct. 7 Oct. 14 Oct. 21 Oct. 28 Nov. 4 Nov. 11 Nov. 18 Nov. 25 Dec. 2 Dec. 9 Dec. 16 Dec. 23 Dec. 30 Deaths from Diarrhœa 0 0 0 0 0 0 0 0 0 0 0 0 0 Deaths from Fever 34 38 28 30 22 24 33 32 30 30 28 25 27 Deaths from Scarlet Fever 57 57 60 60 35 32 55 42 41 42 54 37 29 Mean Temperature of the air 58.0° 57.3° 53.7° 45.9° 44.1° 38.6° 50.0° 13.6° 46.0° 47.5° 42.5° 39.9° 43.3° Rain-fall in inches 0.45 0.97 0.00 0.16 0.20 0.05 1.40 0.30 1.69 1.40 0.24 2.19 1.23 Deaths in London 1200 1257 1224 1277 1483 1635 1886 1504 1558 1446 1443 1456 1510 Deaths in Whitechapel District. 45 71 70 38 57 59 41 55 48 58 62 60 49 Deaths in do. from Scarlet-fever 0 0 0 0 0 0 0 2 0 0 1 0 0 6 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 Registd. Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. March, 1875 292 2 41 0 336 2 687 June 376 0 26 0 402 0 673 September, 350 1 35 0 385 1 650 December 178 2 23 0 201 2 655 March, 1876 236 0 25 0 261 0 722 June 369 0 36 0 405 0 684 September 354 0 40 0 394 0 644 December 347 201 41 0 388 201 714 Totals 2502 206 270 0 2772 206 5429 It will be seen by referring to the above Table that the number of persons who have been vaccinated, and re-vaccinated, during this Quarter, has been considerably greater than in the corresponding Quarter of last year. This may be attributed to the fear occasioned by the prevalence of small-pox; but it will probably happen that when the epidemic has subsided the same indifference to the protective result of vaccination and re-vaccination will be again shown. In the December Quarter for 1875, only 178 persons were vaccinated and 2 re-vaccinated; while in the present Quarter 388 have been vaccinated and 201 re-vaccinated. In the Quarter ending March, 1871, the primary vaccination cases were 737, and the number of persons re-vaccinated was 1,169. As vaccination is a part of preventive medicine, it appears to many sanitarians that it would be desirable to place all the Officers who are engaged to carry out the important regulations in relation to vaccination under the Local Boards, instead of, as is the case at present, under the Guardians; for, it must be borne in mind, that vaccination has nothing whatever to do with pauperism : the same may be said as regards the registration of births, deaths and marriages. Vaccination is, however, exceedingly well performed in this District. Mr. Charles Blackman is the appointed Public Vaccinator. This gentleman, by the great care and attention which he gives to this important subject, has achieved much success; and it appears from his official Returns that during the last 12 months he has performed 1306 primary cases of vaccination, all of which have proved successful. Mr. Blackman's success is greater than appears to have fallen to the lot of most public vaccinators, as 95 per cent. is said to be the average of succcssful cases. Mr. Blackman makes five punctures, and in nearly every instance there arc five cicatrices. 7 Small Pox. In ray last Quarterly Report I directed the attention of your Board to the fact that small-pox had been, during the months of July, August, and September, unusually prevalent in the Metropolis, although no case of that disease had been recorded in this District by the Medical Officers of the Union; neither had a death been registered by the Local Registrars, nor had a case been sent by the Guardians to the Asylum Hospital. The first case that was recorded by the Poor Law Medical Officers was for the week ending 28th October; and no death was recorded until the week ending November the 4th. Since these dates, however, the disease gradually increased; and for the 13 weeks ending the 13th December, the total number of cases was 19, and tho deaths registered in the District were 8. In addition to this number there must be added the 6 deaths which occurred in tho Asylum Hospital, making a total mortality from this disease of 14. Since tho termination of the Quarter, and up to the 10th February, 1877, the cases have been more numerous, 43 having been recorded in the books of the Medical Officers, and the deaths in the District have amounted to 8. It may be interesting to show the weekly mortality of the present epidemic of small-pox from its commencement in July last, and compare it with the progress of that in 1870-71-72. In the week ending 8th July, 1876, the deaths in London from small-pox were 13, and they arc recorded week by week in tho following order:—2, 8, 7, 1, 9, 5, 10, 8, 5, 16, 11, 15, 11, 16, 22, 15, 21, 48, 52, 43, 67, 50, 75, 97, 75, 116, 100, 79, 86, 103, and for the week ending February 10th, 90. In 32 weeks the mortality from small-pox has been 1,260. In the corresponding 32 weeks for 1870-71, the total deaths from smallpox were 1,689. The deaths for the week ending January 7th, 1871, were 79, and for the weeks following they were 135, 188, 163, 106, and for the week ending February 11th, 211. It thus appears that the number of cases of small-pox has been less by 429 in 32 weeks than in the epidemic of 1870-71; yet it appears that the rate of mortality is greater. From the Registrar-General's Returns, it appears that in the 31 years, 1840-70, small-pox destroyed in London 25,061 lives. The annual deaths averaged 808; the lowest number in any one year was 154 in 1857, and the highest number was 2,012 in the year 1863. A new small-pox epidemic of unexampled severity began at the end of the year 1870, which continued for about two years, and in that time destroyed 10,110 lives in London alone; of which number 7,876 died in the year 1871; which was at the rate of 2.4 per 1,000 of the population. In the last Quarter of 1870 the deaths from small-pox were 584. In the first Quarter of the following year the deaths rose to 2,400; in the second three months to 3,241; while in the last two Quarters of the year they declined to 1,255 and 980 respectively. In the first three Quarters of 1872 the deaths in the first Quarter were 831, and in the second and third Quarters respectively 582 and 237; making a total of 1,650. 8 From the foregoing returns it would appear that temperature does not materially affect the mortality of small-pox. Small-pox, like other epidemic diseases, is of periodical recurrence, hut the interval between the return of each epidemic is not of uniform duration. An interval of six years has intervened since the last epidemic in 1871; and the epidemic preceding that of 1871 occurred in 1863, when the mortality was 2,012, in a population of 2,803,989; whereas, the population in 1871 was 3,251,804, and the deaths amounted to 7,876; the former giving a rate of mortality of 0.71 per 1,000, and the latter, as before stated, of 2.4 per 1,000. On referring to Table VI. in the Appendix to this Report it will be seen that small-pox is never entirely absent from the population of London. Every year shows that a certain number of deaths occur; the lowest number in any one year was in the year 1874, when only 56 deaths occurred. In the year following the deaths were 75, and the cases probably amounted to about 450. In the unvaccinated cases nearly the half die; in the imperfectly vaccinated about 25 per cent. die, and in the well vaccinated cases the mortality is only 0.4 per cent. The practice of variolous inoculation has long ceased to be practised in this country. It was discontinued in the Small-pox and Vaccination Hospital in June, 1822. From the records of that hospital we learn that the rate of mortality from small-pox in London in those who had been inoculated was about 1 per cent., while its fatality in those who had not been inoculated was about 18 per cent. DEATHS from SMALL-POX in LONDON, during the fifty-two weeks ending 30th December, 1876, at Six Groups of Ages. At all ages. 0-1 1-5 5-20 20-40 40-60 60 and upwards Certified as Vaccinated 219 6 6 49 123 33 2 Certified as Un-vaccinated 325 47 81 88 93 12 4 Not stated as to Vaccination in Medical Certificate 191 35 38 38 53 24 3 Total 735 88 125 175 269 69 9 The Registrar-General states that of the 735 deaths 338 occurred in hospitals and 397 out of hospitals. The mortality, says the Registrar-General, during the present epidemic, in the Hospitals has been higher than it was in the preceding epidemic. "During the London small-pox epidemic in 1870—1—2, 14,808 cases were treated in the Metropolitan Asylum Hospitals, showing a mortality equal to 18.7 per cent. During 1876, the number of completed cases treated in the same Hospitals, was 1,377, and the 338 deaths (46 per cent. of all the small-pox deaths in London), were equal to a mortality of 24.5 per cent." The increase in the rate of mortality in 1876 above that in the last epidemic was 5.8 per cent. 9 The years when small-pox was epidemic in London were 18.38, 1844, 1848, 1852, 1855, 1859, 1863, 1867, and 1871. The present epidemic commenced in London about the same period of the year as that in 1870, viz., in September. The question why zymotic diseases are at times epidemic is not easily answered. The period of their return is uncertain, and, consequently, very little attention in the way of prevention is given by the public to the subject after the epidemic has passed away. As the people, however, become more enlightened in the science of preventive medicine, more attention will be paid to the causes and to the prevention of disease. Formerly the Government was greatly in advance of the public in the knowledge and in the practice of public hygiene; but now the public are probably in advance of the Government, for the latter are becoming more slow to act, while the former are becoming more pressing for improved sanitary laws. Although the period of the return of epidemic diseases is uncertain, they nevertheless demand special attention; and it behoves all sanitary authorities to make suitable provision for the reception of the sick in any case of emergency. For this purpose every local authority should obtain permanent possession of a suitable site on which an iron building, when required, might be speedily erected. "When this building was not required for patients it might be taken down, and the ground kept as an open space and used for recreation or for other purposes. In any amended sanitary act provision should be made enabling Local Boards to obtain land compulsorily for any purpose connected with the health of the District. Zymotic diseases, as is remarked by the Registrar-General in his Annual Summary of the causes of death in London, in 1871, "give rise to all the epidemics, and they may be popularly explained on the assumption that their phenomena are the effect of changes in man and in the higher animals, wrought by the invasion of self-multiplying molecules of the lowest, simplest forms of life, having thus in common with the highest forms, that they succeed each other in generations, with the marvellous variations of numbers so commonly observed in vegetable blights, fungi, flies, locusts, and parasites. The precautions commonly adopted have had in view the isolation of the sick, which, in cases of leprosy, hydrophobia, and syphilis, where the zymotic matter is fixed in a solid or fluid, proves effectual at least in restraining the disease within narrower limits than it would otherwise attain." In connexion with the above paragraph from the Registrar-General's Report, the following remarks by Prefessor J. Bischof, which appeared in the Times of January 30th, 1877, may be read with advantage: "According to the most recent researches, certain microscopic organized or living bodies constitute, in all probability, the specific poison or contagion which causes the spreading of epidemics. Whenever there is a fresh outbreak of an epidemic in a locality, the first cause is sure to be in connexion with a like 10 case in some other locality. This fact, the result of extensive experience, goes far to demonstrate that contagia can only he produced hy self-multiplication, and not by any chance of coincidence. If this be so, they are endowed with one of the properties of living beings, and they may be conveyed either by the air, or by river water polluted by sewage which is drunk by the inhabitants of those towns which are supplied from such source." These speculations are feasible and deserve attentive consideration and further investigation. Ee-vaccination and isolation are the best means which science has pointed out to prevent the spreading of small-pox, and these provisions should, by all practicable means, be insisted on by the authorities. It is true that great difficulties in the way of obtaining the necessary isolation of patients in all cases occasionally present themselves. Such cases are, however, rare, and when they do occur, the Medical Officer of Health must act to the best of his judgment. Ee-vaccination after the age of puberty might with advantage be made compulsory, inasmuch as the operation is attended with little inconvenience to the patient, and, if successful, will render him almost impregnable to an attack of small-pox. This would prove highly beneficial to the community at large. It is, however, in my opinion, unnecessary to repeat the operation of re-vaccination more than once. It is a well ascertained fact that small-pox rarely attacks a person a second time; cases, however, do occasionally occur, but the disease is then very seldom fatal. In a Table prepared by Mr. J. F. Marson, it appears that out of 14 patients suffering from a second attack of small-pox who were admitted into the Small-pox and Vaccination Hospital in London, not one died, although 3 of the cases were of the confluent kind. It is, however, a well known fact, that small-pox attacking a person a second time has occasionally proved fatal. A law respecting epidemics prevails that when a person has once had an epidemic disease be is not attacked by it a second time. If, therefore, the public could be generally impressed with the idea that cow-pox is the smallpox of the cow (variolœ vaccina J, and was so called by Edward Jenner, the discoverer of cow-pox; and that small-pox and cow-pox are mere modifications of the same disease, the one attended with no danger and the other proving fatal in a large degree, the prejudices which now prevail among the unthinking part of the people would soon be dissipated, and all parents would gladly seek to have their children vaccinated. The probability is, that if all children were properly vaccinated in infancy, and the operation repeated at the ago of puberty, we should not have a recurrence of an epidemic of small-pox. Some medical men of great experience do not consider it necessary to perform re-vaccination; and if what I have said above as regards the law of epidemic diseases be correct, it is perhaps unnecessary. 11 It is proved that cow-pox and small-pox are identical diseases, and consequently if a person has had cow-pox he may be said to have had small-pox. Mr. Ceely, of Aylesbury, and Mr. Badcock, of Brighton, infected cows with small-pox, and with the lymph taken from the animals so infected, vaccinated several thousand persons and furnished supplies of lymph to several hundred medical practitioners. Animal vaccination, or the vaccination of the human subject from calves or heifers which had been inoculated from the virus derived from pocks upon the cows spontaneously affected with the natural disease, was several years ago extensively practised on the Continent, but owing to the numerous failures which attended the use of the lymph taken from the calves which had been infected, the practice is now nearly, if not entirely, discontinued. In 1869 De Sbyton thoroughly investigated the subject, and came to the conclusion that the success attendant upon animal vaccination is very far short of that which attends the ordinary practice of vaccination from arm to arm; but as it is probable more care has since that time been taken on the Continent in performing the operation with lymph taken from the calf—for it is said that the failures are now reduced to 2 per cent.—further inquiries respecting the alleged benefits might with advantage be instituted by the Government. Proceedings of the Board. At a Meeting of the Board of Works held on the 8th January, 1877, a Letter from the Local Government Board, dated 3rd January, 1877, addressed to the Clerk of the Board, upon the subject of the prevalence of small-pox in the Metropolis, was read ; by which the attention of the Board was directed to the fact that there were only 13 vacant beds in the Asylum Hospitals for the reception of patients suffering from small-pox; and that the Local Government Board was desirous of being informed what provision the District Board had made for the Hospital accommodation of non-pauper cases, under Section 37 of the Sanitary Act, 1866, and pointed out that the Hospitals provided for the reception of cases of small-pox by the Metropolitan Asylum Board are essentially intended to meet the requirements of the destitute class. The Local Government Board also desire to impress upon the Board of Works the importance of exercising the beneficial powers conferred on them by making, as early as practicable, reasonable provision for that large class of persons not needing relief, but whose isolation in Hospitals is necessary for preventing the spread of the disease. A circular Letter was also read from Mr. Jebb, the Clerk to the Metropolitan Asylum Board, which stated that the attention of the Managers had been drawn to the 42nd Section of the Poor Law Amendment Act, 1876; and as some misapprehension appears to have arisen in reference to the meaning of that Section of the said Act, the Metropolitan Asylum Board would remind the District Boards that the Hospitals of the 12 Managers are intended for the reception only of paupers chargeable to Parishes and Unions in the Metropolis, except in cases in which a refusal to admit a person not a pauper might be attended to such person with dangerous results. The Clerk reported to the Board that he had seen Mr. Vallance, the Clerk to the Guardians of Whitechapel, who kindly informed him that every assistance should be given in the necessary administration to the non-pauper patients, who should be admitted to the ward in the stone-yard, which had been appropriated by the Guardians for the use of the Board. The Surveyor reported to the Board that, in accordance with the directions of the Medical Officer, the ward in the stone-yard was being fitted up and adapted for the reception of non-pauper patients, and that it would be finished and ready for occupation within forty-eight hours. The Board approved of the suggested arrangements. At a Meeting of the Committee of Works, held on the 8th January, the Surveyor reported that the premises in the stone-yard were ready for the reception of patients. The Clerk directed the attention of the Committee to the consideration of the interpretation of the term "non-pauper patients," and proposed as a test of the term the ability to pay on the part of the proposed patients. It was resolved that the patients to be admitted to the accommodation provided be such as are able to pay, and that the sum to be demanded be ten shillings per week ; and that persons unable to pay such amount be referred to the Believing Officer, to be provided for in the usual manner. Mr. Battram's Report.—Small Pox. From the 19th October, 1876, to the 10th February, 1877, 34 eases of smallpox have been recorded in the South District. Of this number, 4 cases took place in the Begistered Common Lodging Houses. The whole of the rooms in which small-pox occurred have been disinfected with sulphurous acid gas, and Notices served upon the respective owners to strip the old paper off the walls and to thoroughly cleanse the walls and ceilings. In all cases these Notices have been complied with. Copies of all the hand-bills and posters, which have been largely distributed about the District, cautioning people not to expose their bedding, &c., before such articles had been properly disinfected, have been left at all the Schools and the Registered Common Lodging Houses. Fever. Between the 21st November, 1876, and the 10th February, 1877, 8 cases of fever have been recorded in the South District, 1 of which was in a Registered Common Lodging House. The deaths in this portion of the District have been 5, and the rooms have been dealt with in the same manner as where small-pox had occurred. 13 Mr. Wrack's Report.—Small Pox. Since the 6th November, 1876, to the 10th February (inclusive), 52 cases of small-pox (in 46 houses) have occurred in the North District. Of this number, 35 were reported by the Relieving Officers of the Union, 4 were from private information, and 13 were discovered by the Inspector. In 11 of the houses in which small-pox had occurred, it was ascertained that 28 children were being sent to various Schools in the District, while the disease existed in their homes. In each case the parents were cautioned not to send their children to School during the prevalence of the epidemic in their houses; and information was at once given to the School Masters and Mistresses of the several Schools at which the children attended. In each case the premises have been disinfected with sulphurous acid gas, and Notices served upon the owners of the houses to thoroughly cleanse the walls and ceilings, which have been carried out. Fever. From the 30th November, 1876, to the 10th February, 1877 (inclusive), 3 cases of fever have been recorded. The rooms in which these cases occurred have been disinfected in the same manner as where small-pox had occurred. Disinfectants. The question has been often asked what is the best disinfectant to be used for preventing the spreading of infectious diseases, or in other words, which shall have the effect of destroying the specific poison of such diseases. The question has been well considered by Dr. Baxter, in his Report on an Experimental Study of certain Disinfectants, which is published at p. 216 in No. 61 of the New Series of the Reports by the Medical Officer of the Privy Council and Local Government Board. In this Report the results of numerous experiments on the efficacy of the several disinfectants commonly in use, viz.: carbolic acid, sulphur dioxyde, potassic permanganate, or chlorine, are given. From these, Dr. Baxter arrives at certain conclusions, among which are the following: ]. "Aerial disinfection, as commonly practised in the sick room, is either useless or positively objectionable, owing to the false sense of security it is calculated to produce. To make the air of a room smell strongly of carbolic acid by scattering carbolic powder about the floor, or of chlorine, by placing a tray of chloride of lime in a corner, is, so far as the destruction of specific contagion is concerned, an utterly futile proceeding." 2. "The use of carbolic vapour should be abandoned, owing to the relative feebleness and uncertainty of its action. Whether chlorine or sulphur dioxyde be chosen, it is desirable that the space to be disinfected should be kept saturated with the gas for a certain time; not less than an hour." 3. "Dry heat, when it can be applied, is probably the most efficient of all disinfectants. Care must be taken so as to submit every 14 particle of matter to the necessary heat." 4. "It is necessary to guard against giving a false security by the inadequate employment of artificial means. It is probable that all contagion disappears sooner or later under the influence of air and moisture, and that the absence of these influences may act as a preservative. "When, therefore, we cannot advantageously, or effectually, supersede the natural process of decay, we must be sure not to transfer it by the injudicious use of antiseptics." A. heavy storm of rain is a great purifier of the atmosphere, and may be the means of arresting the progress of an epidemic. As carbolic acid is said to arrest putrefaction, it is one of the worst means which can be adopted in disinfecting a cow-shed after the existence of cattle plague; for when cows are, after a longer or shorter time, put into a shed which has been submitted to the action of carbolic acid, the disease may re-appear. It is said that, although " carbolic acid will arrest the development of ferment cells, it does not destroy their vitality; for, if after such treatment, they are freely diluted with water, they again start into activity." Its antiseptic power is admitted to be great, which is exemplified in using it to preserve dead bodies. Dr. Letheby says,* that a very small quantity of carbolic acid in the sewers prevents decomposition, and that a solution of 1 per cent. of it upon meat arrests putrefaction.! I shall conclude this part of the subject by quoting the words of Mr. Simon, in his Memorandum on Disinfection, which was published in his Ninth Report, dated 1867, p. 236. "It is to cleanliness, ventilation, and drainage, and the use of perfectly pure drinking water, that populations ought mainly to look for safety against nuisance and infection. Artificial disinfectants cannot properly supply the place of these essentials, for, except in a small and peculiar class of cases, they are cf temporary and imperfect usefulness. That no house refuse, not only no excremental matter, but also no other kind of dust or refuse should remain in or about inhabited premises, is a first rule against infection." Although the facts which I have brought under your notice in this Report respecting small-pox and vaccination, and the hypotheses which have been advanced by scientific men regarding contagion, have been for many years well known to the medical profession, yet, as my Reports are addressed to gentlemen who have not made the science of preventive medicine a study, I thought that the information on these important subjects which I have collected, might be useful and interesting to you, not only individually, but as a Board, who have for many years past shown much zeal in the cause of sanitary science, and who have so kindly and ably assisted me in my endeavours to improve the sanitary condition of this District. * Dr. Letheby on the Right Use of Disinfectants. 15 Sanitary Works Performed during the Quarter ending 30th December, 1876. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ending 30th December, 1876. Number of inspections of houses as shown in the official returns 3067 Houses specially visited 210 Houses specially re-visited 645 Preliminary notices served, such notices embracing 400 premises 219 Compulsory orders issued, embracing 252 premises 71 Summonses heard at Police Courts, under Sanitary Act 1 ,, ,, ,, Adulteration Act 3 Cellars used as dwellings discontinued for such use 2 Cases of overcrowding and indecent occupation abated 1 Houses in which rooms or passages have been whitewashed 176 Booms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 32 Articles disinfected in rooms, consisting of beds, bedding, clothing, &c. 256 Yards of houses paved or the pavement repaired 76 Drains in houses improved 75 Dust-bins provided 26 Privies lime-washed, cleansed and repaired 140 Water supply provided or improved 11 Nuisances from dung and other offensive matter removed 14 Area gratings, cellar flaps, &c., repaired 7 Animals kept so as to be a nuisance removed 2 I have deemed it advisable for the guidance of your Board, to insert in this Report, a few extracts from a paper issued by the Local Government Board, entitled— "Memorandum on Hospital Accommodation to be given by Local Authorities. "A LARGE part of the mortality of England is caused by diseases which spread readily by infection from person to person; such as scarlatina, typhus and small-pox. In order to prevent the extension of such diseases in neighbourhoods where they have begun, it is of the utmost importance that, in addition to whatever other sanitary measures may be requisite, every practicable endeavour should be made to separate the sick from the healthy. Such separation is comparatively easy, if means to attain it are taken early, while cases of the disease are very few: but any interval of delay allows the cases of sickness to multiply, and perhaps at last to become so numerous that endeavours to isolate them cannot succeed. These considerations are especially important with regard to the poorer classes of the population, whose usually crowded and ill-ventilated dwellings give extreme facilities for infection ; and among these classes, the sick, generally speaking, cannot be separated from the healthy, except in proportion as they can be removed from home into proper hospital accommodation provided for their reception. Under section 131 of the Public Health Act, 1875, every Sanitary Authority (whether Urban or Rural) has power to provide 'for use of the inhabitants within its district, hospitals or temporary places for the reception of the sick.' When this provision has been made, any Justice may order the removal to such place of any person suffering from any dangerous infectious disease, if he is without proper lodging or accommodation, or lodged in a room occupied by more than one family, or is on board any ship or vessel, 16 A condition of the highest importance for the usefulness of any such accommodation is that the accommodation SHALL BE READY BEFOREHAND. It ia not proposed to discuss in detail, in this memorandum, the principles on which permanent hospitals for infectious diseases should be built; but it may be noted that, in order to the practical success of any such hospital, the following conditions have particularly to be studied:— Accessibility of situation, so that the sick may not be exhausted by long journeys; wholesomeness of situation; and, as far as consists with these conditions, an open, uncrowded neighbourhood. Adequate ward space for each patient, approaching as nearly as circumstances allow to 2,000 cubic feet, with a floor space of not less than 144 square feet. Thoroughly good provision for ward ventilation (i.e., for sufficient unceasing entrance of pure air and of exit of ward air), with arrangements also for immediate change of air in the whole ward, when necessary: Perfect security against the possibility of any foul air (as from privies or' sinks) entering any ward : Means of warming each ward in winter to a temperature of 60° Fahrenheit, and of keeping it cool in summer: Safe means (safe both for the hospital and for the neighbourhood) for disposing of exeremental matters and of slops, and for cleansing and disinfecting infected linen and bedding: Facilities for obtaining, in the use of the hospital, the very strictest cleanliness of every part. ON AMBULANCES. For the conveyance of patients who are sick with infectious disease special carriages, which are known by the name of 'Ambulances,' are necessary. Such carriages may be provided by the Sanitary Authorities under section 123 of the Public Health Act. The following points have to be attended to in the provision and use of such carriages:— 1.—If the ambulance be intended only for journeys of not more than a mile, it may be made so as to be carried between two people; or it may be on wheels to be drawn by the hand. If the distance be above a mile, the ambulance should be drawn by a horse. Every ambulance on wheels should have easy carriage springs. 2.—In the construction of an ambulance special regard should be had to the fact that after each use it has to be cleansed and disinfected. The entire interior, and the bed frame and bed, should be of material that can be washed. 3.—The ambulance should be such that the patient can lie full length in it, and the bed-frame and the bed should be moveable, so that the patient can be arranged upon the bed before being taken out of the house. 4.—With an ambulance there should always be a person in charge of the patient; and a horse ambulance should have a seat for such person inside the carriage. 5.—After every use of an ambulance for infectious disease it should be cleansed and disinfected to the satisfaction of a Medical Officer. 6.—Both-in populous districts, and in districts which are of very wide area, it may often happen that more than one ambulance will be wanted at one time ; and, in any district, if more than one infectious disease is prevailing, there will be an evident sanitary advantage in having more than one ambulance for use." ANNUAL REPORT. The number of births registered in this District during the year has been 2754, and the deaths 2348, including those of non-residents in the London Hospital (511). In the preceding year the births were 2660, and the deaths 2470, including the deaths of 465 non-residents. The deaths in the Workhouse have been 335, against 351 for the previous year; and the deaths in the London Hospital 716, against 710. The population of the District, at the taking of the last census, was 76,573; which is 2397 less than when the census was taken in 1861. 17 The deaths being (excluding 511 of non-residents) 1837, the rate of mortality has been, during the year, 23.9 per 1000, or 1 in 40.1 of all living. The rate of mortality during the preceding year was 26.1 per 1000. In making a comparison, however, of the rate of mortality of this District with that of others, the total deaths in the London Hospital must be eliminated, which this year, as before stated, amount to 716. This gives a rate of mortality of 21.3 per 1000. The rate of mortality for this year is lower than it has been for the last eleven years, as may be seen by referring to Table No. 5 in the Appendix. Deaths from Epidemic Diseases. Of the total deaths during the year, there were 229 from epidemic diseases, viz.: 8 from small-pox, 16 from measles, 18 from scarlet-fever and diphtheria, 57 from hooping-cough, 103 from diarrhoea, and 27 from fever. During the last three years 11 deaths from small-pox have occurred in this District, viz.: 1 in 1874, 2 in 1875, and 8 in 1876. During the three years 1871-2-3, only 4 deaths from small-pox occurred in this District, whereas 14 deaths, including the 6 which took place in the Small Pox Hospital, have occurred during the Quarter ending 30th December, 1876. The death-rate from epidemic diseases for the year, in relation to the total mortality, is 11.3 per cent. 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 2281. During the previous year the number was 2474. The extraordinary annual diminution of the outdoor sick paupers, from upwards of 17,000, in the years 1867 and 1868, to 2281, is a matter of great satisfaction to the rate-payers of this District. Illness in the 'Workhouse. The cases of illness in the Workhouse during the year have been 3216, including 151 cases of syphilis and 33 of lead poisoning. From the Table at page 19 it will be seen that a large amount of sanitary work has been accomplished during the year. To the amount of work as set forth in this Table there must be added that which the Inspectors have done under the Adulteration of Food Act. The healthiness, or unhealthiness, of a District ought not to be estimated by the rate of mortality only. A great many circumstances must be taken into account before we can arrive at the true sanitary condition of any locality, and are able to say authoritatively that a town having a mortality of 21 per 1000 is more healthy than another with a deathrate of 22 or 23 per 1000. There can, however, be no doubt that the death-rates of the various Districts, as given by the Registrar-General, have their value; and, wherever a death-rate is ascertained to be greatly in excess, it will certainly be found that several causes operating prejudicially 18 to the public health exist, to which the attention of the local authorities should be given. The causes which influence the rates of mortality are very numerous ; and among them are the following : 1. Birth-rate.—The greater the birthrate the greater is the death-rate. 2. Sex —As the mortality of males exceeds that of females, it will be found that in those localities where males are greatly in excess the death-rate will be higher. 3. Age.—Wherever there is a large proportion of persons in the period of life from 10 to 30 years of age the death-rate will be comparatively small; whereas, if there be an excess of children under 5, or a disproportionate number of persons above 65; then the death-rate will be increased. Mr. THOS. Wilton, at p. 25, in his pamphlet on the effect of migrations in disturbing local rates of mortality, remarks, "that if we wish to form an idea as to the comparative salubrity or otherwise of two country Districts, I think we must rely on the death-rates at the ages of 0—10, and 45—75, and abandon the thought of deducing any instructive result from their mortality statistics at the intervening ages." 4. Occupation.—In some towns there are numerous unhealthy manufactories in constant occupation, and in some of them a large population is employed; in such towns the rate of mortality will, of course, be greater than in those towns where such manufactories do not exist: and again, where there are healthy manufactories which give a constant remunerative employment to large numbers of skilled artizans who are not overworked, and not overcrowded while at work, and are provided with good ventilation, and where mechanical and other contrivances to carry out of the workshop mechanical or chemical impurities are provided. 5. Where the mothers can give due attention to their children the rate of mortality in such towns is comparatively small.* 6. The social condition of the people materially influences the rate of mortality. 7. The excessive use of intoxicants. 8. Other causes, of a moral character, may operate in producing a higher death-rate in one locality than in another. Therefore, before we can arrive at a just conclusion as regards the relative sanitary condition of a District, all these disturbing influences must be considered. Mortuary. In some of my former Reports I have brought under your notice the importance of having a Mortuary in this District, and I have pointed out the great inconvenience and danger to health which those families who occupy only one room are subject to when a death occurs among them ; and the danger is greatly increased during the prevalence of an epidemic. Under the provisions of the 27th Section of the Sanitary Act power is given to the local authority to provide a proper place for the reception of dead bodies, and unless such a place is provided, otherwise than at a Workhouse, a Magistrate has not the power of ordering the removal of a dead body, the retention of which, in the opinion of the Medical Officer of Health, is injurious to the health of the occupants of the house. It is, therefore, obvious that a proper Mortuary should be provided. * See 26th Report of the Registrar-General, p. 13. 19 SANITARY Works RERFORMED DURING THE YEAR 1876. Number of inspections of houses, as shown in the official returns 10,499 Number of rooms found to be over-crowded, the space being less than 300 cubic feet for each person—nuisance in each case abated 256 Houses specially visited 881 ,, re-visited 2437 Rooms disinfected with sulphurous acid gas after the occurrence of fever and scarlet-fever therein 65 Articles disinfected, consisting of beds, bedding, clothing, &c. 396 Preliminary notices served, such notices embracing 1276 premises 751 Compulsory orders issued, embracing 495 premises 209 Summonses heard at Police Courts, under Sanitary Act 6 ,, ,, ,, Adulteration of Food Act 4 Houses in which rooms or passages have been whitewashed 520 Yentilation of houses improved 20 Yards of houses paved or the pavement repaired 191 Cesspools abolished 0 Drains in houses improved 326 Dust-bins 62 Privies lime-washed, cleansed, and repaired 522 Water-supply provided or improved 50 Area gratings, cellar flaps, &c., repaired 42 Cellars used as dwellings discontinued for such use 5 Nuisances from dung and other offensive matter removed 100 Animals kept so as to be a nuisance removed 2 The total number of slaughter-houses in the District is 14. The cow-houses in the District, 26 in number, and the slaughter-houses, have been visited four times during the year. The bake-houses, 71 in number, have been visited twice during the year. The efficient manner in which the Inspectors have performed their duty is shown by the fact that, although there is a public complaint-book in the Office, only two complaints have been entered therein during the last three years. I am, Gentlemen, Your obedient Servant, JOHN LIDDLE. 15, Great Alie Street. APPENDIX. TABLE I.—Cases of Sickness of the Zymotic and Acute Classes, which are recorded in the Books of the Medical Officers of the Union, for the Three Months ending on the 30th December, 1876. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Cholera and Choleraic-Diarrhoea. Continued Fever, Typhus & Typhoid. Febricula. Pyaemia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. 1 Rheumatic Fever. Ague. Dysenteiy. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Dr. Swyer 1 0 0 0 2 0 1 1 0 0 0 0 14 6 0 4 0 0 0 0 71 100 Mr. Champneys 10 0 1 0 7 0 2 1 0 0 0 0 32 0 0 1 0 0 0 0 77 131 Mr. Sequeira 0 2 1 0 6 0 0 8 0 0 0 0 13 0 0 2 0 0 0 0 40 78 Mr. H. Braye 7 1 0 0 2 0 0 10 0 2 0 0 12 4 0 2 0 0 0 0 63 103 Mr. Loane l 0 0 0 6 0 0 9 0 0 0 0 10 0 0 3 2 0 1 2 66 100 Total 19 3 2 0 23 0 3 29 0 2 0 0 81 10 0 12 2 0 1 2 323 512 Corresponding Qr. of previous Year. 0 8 1 2 15 0 11 27 0 4 0 0 89 16 0 30 1 0 2 1 381 588 Workhouse Mr. J. J. Hott. 49 0 1 0 10 0 1 13 0 4 0 0 156 8 4 95 4 4 9 9 309 676 In addition to the cases attended by Mr. Hott in the Workhouse, there were 49 cases of syphilis. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ending 30th December, 1876. Districts. Small-Pox. Measles. Scarlet F ever. Diphtheria. HoopingCough. Diarrhoea. Fever. Cholera & Choleraic ' Diarrhoea. Total. Remarks. Spitalfields 2 1 2 0 2 2 1 0 10 Workhouse. Mile End New Town 6 0 1 0 0 1 0 0 8 Whitechapel North 0 1 0 1 0 0 1 0 3 Hospital. Whitechapel Church 0 1 0 0 0 1 4 0 6 Goodman's Fields 0 0 0 0 0 1 3 0 4 Aldgate 0 0 1 0 0 5 1 0 7 Totals 8 3 4 1 2 10 10 0 38 Deaths from Epidemics for the corresponding Quarter, 1875. 2 22 12 3 24 14 9 0 86 Six deaths from small-pox of patients belonging to this District occurred in the Small Pox Hospital at Homerton, and 1 in the Fever Hospital, TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causes— Deaths under 1 year of age and above 60 years ; Deaths from Violence, Inquest cases, and Deaths in Workhouse and London Hospital, for the Quarter ending 30th December, 1876. Sub-districts. Enumerated Population in 1871. j Births. Deaths. Under 1 year of age. Persons aged 60 ye?rs and upwards. Violence. Inquest cases. Deaths in Public Institutions. Spitalfields 22499 218 108 40 17 8 16 3 Mile End New Town 15550 179 142 29 45 8 18 81 Whitechapel North 11597 101 39 10 4 2 4 0 Whitechapel Church 7322 59 235 17 20 44 4,6 211 Goodman's Fields 10381 96 36 16 5 1 6 0 Aldgate 9224 60 46 11 10 4 7 0 Totals 713 600 123 101 67 97 295 TABLE IV. Total number of the undermentioned Diseases recorded in the Boois of the Medical Officers of the Union, from 1865 to 1876, and the total cases of illness. Years. Erysipelas. Puerperal Fever Carbuncle. Bronchitis and Catarrh. Pneumonia and Pleuritis. Croup. Rheumatic Fever. Ague. Delirium Tremens. Lead Poisoning Total. 1865 97 2 1 745 123 0 14 12 4 0 15594 1866 62 0 7 546 244 7 66 12 13 0 16502 1867 65 1 5 642 228 5 183 10 10 0 17181 1868 80 2 5 450 208 3 157 18 10 20 17417 1869 75 1 6 632 258 1 100 35 11 12 14031 1870 82 0 1 825 195 0 134 44 5 12 14148 1871 56 3 7 1119 153 3 77 14 5 35 10194 1872 51 2 6 511 61 1 71 14 5 22 4864 1873 39 2 5 539 91 4 88 17 3 15 4887 1874 20 1 2 443 53 5 65 9 7 21 3785 1875 19 0 2 306 60 4 86 6 7 21 2474 1876 9 0 0 306 58 0 62 3 6 8 2281 TABLE V. Showing the total Births, Deaths, Deaths of Non-residents, Residents, and total Deaths in the London Hospital in each year, from 1865 to 1876. Year. Population. Total Births. Total Deaths. Total Deaths in the London Hospital. Deaths of non-residents, exclusive ol deaths from accidents. Deaths of Children under 1 year of age. Proportion of deaths pei cent, of Children undei 1 yr. to the total death? deducting the deaths oi non-residents. Rate of mortality per 1000, deducting the deaths of nonresidents. Kate of mortality of Children under 1 yr per 1000 of the population. 1865 78,970 2684 2532 416 208 549 23.6 29.4 6.8 1866 ... 2561 8495 733 432 465 15.1 38 7 5.8 1867 •• ... 2686 2331 445 241 525 25.1 26.4 6.6 1868 ... 2611 2519 536 324 513 23.3 27.7 6.4 1869* ... 2571 2675 504 283 526 21.9 29.6 6.6 1870 ... 2600 2465 599 374 515 24.6 26.4 6.5 1871 76,573 2571 2465 551 339 545 25.6 27-7 7.1 1872 ... 2705 2390 616 375 540 26.7 26 3 7.0 1873* ... 2727 2471 645 393 507 24.3 26 5 6.6 1874 ... 2688 2613 675 377 444 19.8 29 2 5.7 1875 ... 2650 2470 710 465+ 509 25.3 26.1 6.6 1876 ... 2754 2348 716 511 451 24.0 23 9 5.8 • These years contain 53 weeks. In making this calculation, one week's average of deaths is deducted, viz., 50 and 46 respectively. + Estimated number. The number of Inquests which have been held this year in this District has been 365. In the preceding year the number was 348, TABLE VI. Showing the Deaths from Epidemic Diseases in the Whitechapel District during the last 15 years. Name of Disease 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 Small Pox 33 69 5 22 44 40 11 1 56 159 19 1 1 2 8 Measles 153 26 137 28 139 33 69 71 36 42 23 44 33 40 16 Scarlet Fever & Diphtheria 91 200 50 80 76 26 48 208 59 25 96 24 199 51 18 Hooping Cough 62 52 74 97 94 72 55 113 50 43 9 79 16 61 57 Diarrhoea 69 114 109 122 119 100 138 97 107 125 99 113 76 93 103 Fever 250 158 170 167 100 82 169 95 52 40 26 44 47 30 27 Cholera &Cho leraic-Diaha. 5 5 2 4 904 9 10 7 6 3 5 8 3 0 0 Totals 663 624 547 520 1476 362 440 592 366 437 277 313 375 277 229 aopno] Fever 3635 2802 3689 3232 2681 2174 2483 2211 2049 1755 1003 1548 1552 1282 1206 Scarlta. & Dipt 4194 5799 3806 2014 2316 1836 3418 6162 6306 2220 1063 932 3037 4038 2673 Small Pox. 345 2012 537 646 1388 1339 606 273 958 7834 1532 114 56 75 739 The deaths from Fever, ill the Fever Hospital belonging to the Asylum Board, of patients removed from this District were 21. The deaths, therefore, from epidemic diseases in this District were 250 for the year 1876. TABLE VII. Showing the cases of Epidemic Diseases among the pauper population in the Whitechapel District during the last 15 years. Name of Disease 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 Small Pox 113 253 21 86 261 254 93 5 302 625 60 2 1 0 19 Measles 525 80 482 51 679 155 323 212 257 178 76 128 59 32 32 Scarlet Fever & Diphtheria 118 305 156 164 197 60 54 311 97 32 16 22 161 17 6 Hooping Cough 153 169 217 280 217 219 144 308 140 102 94 86 30 44 15 Diarrhoea 1085 1108 1127 1342 1664 1471 1631 1033 1097 590 283 212 150 101 120 Fever 822 464 295 573 343 308 586 385 325 201 19 126 84 24 34 Cholera&Cho- leraic-Diaha. 1 1 4 4 58 5 8 1 4 2 3 2 0 0 0 Totals 2817 2380 2302 2500 3419 2472 2839 2255 2222 1730 551 578 485 218 226 The cases of Febricula have been 85. In the preceding year the cases of Febricula were 109. * In the above Tables the years 1863, 1869, and 1873, consist of 53 weeks.