WHI 25 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT on the Sanitary Condition of the WHITECHAPEL DISTRICT, for the QUARTER ENDING 31st MARCH, 1877, BT JOHN LIDDLE, medical officer of health. London: Printed by Penny & Hull, 121, Leman Street, Whitrchappel, E. 1877. REPORT oF the MEDICAL OFFICER OF HEALTH For the Quarter ending 31 st March, 1877. To the Board of Works, Whitchappel District. Gentlemen, In the Quarter that ended on Saturday, the 31st March, 1877, the total births in the District were 767, viz.: 383 males and 384 females; and the deaths 662, viz.: 383 males and 279 females. The excess of births over deaths has therefore been, during this Quarter, 105. As the deaths of 148 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, thereby reducing the total mortality to 514. An allowance, however, must be made for the deaths of residents in public institutions outside the District, but of those I have no return. In the corresponding Quarter of the previous year the total births were 721 and the total deaths 653. In the Spitalfields sub-District the births were 214 and the deaths 121; in the Mile End New Town 198, and the deaths 172; in the Whitechapel North 108, and the deaths 56; in the Whitechapel Church 73 and 217 (in this sub-District the London Hospital is situated); in the Goodman's Fields 106 and 45; and in the Aldgate 68 and 50. The deaths have exceeded the births in the Whitechapel Church District by 134, but from this number the 148 non-residents must be deducted. The proportion of births to deaths is therefore 73 to 69. The deaths in the London Hospital have been 180. In the corresponding Quarter of the previous year the deaths in this Institution were 185. The deaths in the Workhouse have been 98. In the corresponding Quarter of last year they were 104. The deaths from epidemic diseases in the entire District have been 62, viz.: 16 from small-pox, 11 from measles, 5 from scarlet-fever, 1 from diphtheria, 18 from hooping-cough, 5 from diarrhoea, and 6 from fever. Twelve deaths of patients from this District occurred in the District Small Pox Hospital, thus making a total of 28 deaths from small-pox. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 59, viz; 6 from measles, 5 from scarlet-fever, 1 from diphtheria, 37 from hooping-cough, 3 from diarrhœa, and 7 from 4 fever. In addition to the 7 deaths from fever there were 4 deaths 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 115. This is 17.3 per cent, of the total mortality. In the corresponding Quarter of the previous year the rate of mortality of children under 1 year was 15.6 per cent. of the total mortality. In the Spitalfields sub-District the rate is 28.9 per cent.; in the Mile End New Town 14.5 per cent.; in the Whitechapel North 39.2 per cent.; in the Whitechapel Church 3.6 per cent.; in the Goodman's Fields 31.1 per cent.; and in the Aldgate 22.0 per cent. The difference in the rate of mortality of young children in the Mile End New Town and Whitechapel Church District is thus explained:—in the former the Workhouse is situated, and in the latter the London Hospital. The total deaths under 5 years are 214; which shows a rate of mortality of 32.3 per cent. in relation to the total deaths, and 27.8 per cent, to the total births. The rate of mortality under 1 year, in relation to the total births, is 13.6 per cent. In the corresponding Quarter of the previous year the rate of mortality of children under 1 year in the Spitalfields sub-District was 27.5 per cent.; in the Mile End New Town it was 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. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter, 637 new cases of illness out of the Workhouse; including 69 of small-pox, 17 of measles, 9 of hooping-cough, 11 of diarrhoea, 22 of febricula, and 1 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 753; including 14 of measles, 12 of hooping cough, 3 of diarrhoea, 21 of fever 25 of febricula, and 3 of erysipelas. The total number of cases of illness in the Workhouse has been 830; including 49 of small-pox, 2 of measles, 3 of hooping-cough, 10 of diarrhœa, 14 of febricula, 5 of fever, 5 of erysipelas, and 37 of syphilis. I may here observe that the 69 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 10 cases which were attended by private medical practitioners; and it appears from the returns which have been kindly sent to me by Mr. Vallance that 96 patients were removed to the Metropolitan Small Pox Hospital during this Quarter from the District, of which number 12 died. Eight patients suffering from fever were sent to th 5 Metropolitan Fever Hospitals during the same period, all of whom recovered. All the rooms in which patients have suffered from small-pox, which were reported to the sanitary officers, have been disinfected. London Hospital. 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 Hospital during the last two quarters. The total number of Medical cases is 174. The cases of acute rheumatism were 17; of fever 4; of erysipelas 2; of small-pox 2; of ague 1; of Bright's disease 7; of lead poisoning 4; of bronchitis 12; of pneumonia and pleuritis 15; of gout 2; of laryngitis 2; and of consumption 6. The number of cases of erysipelas admitted into the Hospital among all the patients is 116; of these, 5 died. The number of cases of erysipelas acquired in the Hospital was 20; of these 2 died. Nine deaths occurred from pyaemia amongst all the patients. Meteorology of Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis, during the Quarter has been 8.35 inches. Of the 8.35 inches of rain which fell during this Quarter 3.30 inches fell in the two weeks ending January 13th, and in the last two weeks of March the rain-fall was 1.47 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 5.76 inches. The mean temperature of the air was 42.3, and in the corresponding Quarter of last year it was 39.6. The coldest days during the Quarter were Thursday, the 1st March, Wednesday, the 28th February, and Tuesday, the 11th March, when the thermometer indicated respectively 23.5°, 24.7°, and 24.8°. The coldest day during the corresponding Quarter of last year was on Wednesday, the 12th January, when the ther mometer indicated 17.4°, or 14.6° below the freezing point. The mean weight of a cubic foot of air for the year ended 31st December, 1876, was, according to the Meteorological Table for London, 540 grains. It varied in the several Quarters as follows:—In the first Quarter the mean weight was 552 grains; in the second 540; in the third 528; and in the fourth 541 grains. The Registrar-General, in his last Quarterly Report, remarks that the "death-rate in the first Quarter of the year is mainly dependent upon the temperature. During that Quarter the lowest recorded temperature of the air fell below the freezing point of water on twenty days; these twenty lowest readings showing an aggregate of 70.2° of frost, and an average of 3.5° During the three months of the severe winter of 1855 there were 56 frosty days, with an aggregate 6 of 405° of frost. The warmest winter quarter of recent years was that of 1872, when the thermometer fell below the freezing point of water on but twelve days, showing an aggregate of only 35° of frost. The deathrate in this warm quarter was, however, equal to 23.5 per 1000, and exceeded by 1.2 the rate which prevailed last quarter." In Mr. Glaisher's thermometrical observations, published in 1848, the greatest degree of cold during one day occurred on the 20th January, 1838, when the thermometer indicated 10.7°, or 21.3° below the freezing point. This was the coldest day in any year from 1814 to 1856. The following table, taken from the returns of the Registrar-General, shows the comparative results of the Quarter:— LONDON. Jan. Jan. Jan. Jan. Feb. Feb. Feb. Feb Mar. Mar. Mar. Mar. Mar. 6 13 20 27 3 10 17 24 3 10 17 24 31 Deaths from Diarrhœa 18 16 18 11 18 11 16 14 22 10 10 11 7 Deaths from Fever 22 22 18 21 20 20 18 17 16 25 21 25 14 Deaths from Small Fox 116 100 79 86 103 90 72 104 84 96 100 76 86 Mean Temperature of the air 46.8° 41.5° 45.5° 39.0° 43.0° 46.3° 46.4° 40.4° 39.1° 36.9° 41.7° 37.7° 46.4° Rain - fall in inches 1.34 1.96 0.39 0.40 0.42 0.06 0.78 0.68 0.31 0.47 0.07 0.56 0.91 Deaths in London 1507 1358 1491 1425 1528 1504, 1462 1495 1529 1782 1800 1802 2052 Deaths in Whitechapel District. 72 38 41 46 50 41 43 49 41 54 51 62 73 Deathsin do. from Small Pox 2 1 2 0 2 0 1 2 0 2 2 0 2 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 Registerd. Primary Cases. Re-Vaccination . Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. June, 1875 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 March, 1877 408 500 37 27 445 527 757 Totals 2618 704 263 27 2881 731 5499 7 Small Pox. From the 11th February to the 4th May, 60 cases of small-pox have been reported to the Inspectors of the District; of this number, 10 were attended by private practitioners and 4 occurred in the Registered Common Lodging Houses. At No. 17, Leman Street, 5 cases of small-pox occurred; of these, 2 died, neither of whom had been vaccinated, the parents saying that they objected to vaccination. At No. 11, King Street, Spitalfields, 5 children, all of one family, were attacked with small-pox, 4 of whom died; not one of the children having been vaccinated, the father objecting to vaccination. In the same house a child, aged 18 months, unvaccinated, belonging to another family, died of small-pox. The above cases strongly exemplify the fatal result of the disease when the patient is not protected by previous vaccination. At 45, Grey Eagle Street, 3 children in one family had smallpox, not one of them having been vaccinated; of these 3 children 1 died. At 33, Grey Eagle Street, an unvaccinated child, 4 years of age, had small-pox, and on visiting the house it was ascertained that another child of the same family, aged 3 months, had not been vaccinated; but the parents, at the instigation of the Inspector, took the child to be vaccinated, and it fortunately escaped an attack of the disease. In a house in Crown Court, Quaker Street, there was a family of six children, and the only one who had not been vaccinated, a child two years of age, was attacked with small-pox. This and the preceding cases clearly show the beneficial result of vaccination. In all cases where the Inspectors ascertained that children had not been vaccinated, information of the same was given to the Vaccination Officer; who, in a letter addressed to Mr. VALLANCE, the Clerk to the Guardians, states that "on inquiry the children referred to had neither been born nor registered within the District of the Whitechapel Union." He adds "that such cases are but a few amongst many of a like character now unfortunately continually occurring, in all of which instances information is readily afforded me by your relieving officers, and an early intimation as to vaccination and re-vaccination follows." On drawing the attention of Mr. COOMBES, the Vaccination Officer, to the above letter, that gentleman has favoured me with a few remarks to the following effect, viz.:—that during the half-year ended 31st March, he has been the means of securing, by visitation in the localities, the primary vaccination of 360 children, whose births had not been registered in the District. The inhabitants of this District are generally favourably disposed to vaccination, but the migratory habits, necessitous circumstances, and foreign nationality of many, involve a great amount of labour and time in explaining and effecting the desired end. It also appears that out of 1471 births registered during the 8 half-year Mr. Coombes succeeded in obtaining and recording certificates of the successful primary vaccination of 1409 children. The satisfactory manner in which vaccination is carried out in this District, and which I mentioned in my last report, may account for the comparative freedom from small-pox therein. In every house where small-pox existed, parents were cautioned not to send the other children to school during the prevalence of the disease ; and information of the existence of small-pox was, in every case, reported to the School Masters and Mistresses of the Schools where the children attended. All the rooms in which small-pox, fever, or scarlet-fever, occurred have been disinfected with sulphurous acid gas; and notices were served upon the respective owners to strip the old paper off the walls, and to thoroughly cleanse the walls and ceilings. The Inspectors report that in all cases these notices have been complied with. On the 19th February, a woman died in her confinement of malignant small-pox. The following table, exhibiting the weekly progress in London of the existing epidemic of small-pox, and that of 1870-71 in the corresponding weeks, is interesting, as showing a similar progression of the disease:— 1876-7. Deaths 1876-7. Deaths 1870-1. Deaths 1870-1. Deaths Week ending Week ending Weekending Week ending July 8 13 Jan. 6 116 July 9 13 Jan. 7 79 „ 15 2 „ 13 100 „ 16 11 „ 14 135 „ 22 8 „ 20 79 „ 23 15 „ 21 188 „ 29 7 „ 27 86 „ 30 11 „ 28 157 Aug. 5 1 Feb. 3 103 Aug. 6 15 Feb. 4 196 „ 12 9 „ 10 90 „ 13 11 „ 11 211 19 5 „ 17 72 „ 20 10 „ 18 218 „ 26 10 „ 24 104 „ 27 11 „ 25 227 Sept. 2 8 March 3 84 Sept. 3 9 March 4 213 „ 9 5 „ 10 96 „ 10 12 „ 11 194 „ 16 6 „ 17 100 ,, 17 11 „ 18 185 „ 23 11 „ 24 76 „ 24 15 „ 25 205 „ 30 15 „ 31 86 Oct. 1 13 April 1 192 Oct. 7 11 April 7 78 „ 8 27 „ 8 214 „ 14 16 „ 14 60 „ 15 13 „ 15 265 „ 21 22 „ 21 68 „ 22 17 „ 22 276 „ 28 15 „ 28 89 „ 29 21 „ 29 261 Nov. 4 21 May 5 54 Nov. 5 23 May 6 288 „ 11 48 „ 12 78 „ 12 40 „ 13 232 „ 18 52 „ 19 70 „ 19 45 „ 20 267 „ 25 43 „ 26 69 „ 26 41 „ 27 257 Dec. 2 67 June 2 61 Dec. 3 60 June 3 229 9 50 9 58 „ 10 61 „ 10 245 „ 16 75 16 55 „ 17 44 .. 17 240 „ 23 97 „ 24 82 „ 24 232 „ 30 75 „ 31 110 July 1 235 „ 8 164 9 From the preceding table it appears that the highest number of deaths from small-pox, during the present epidemic, occurred in the week ending on the 24th February, when 104 died, and in the corresponding week in the year 1871, the deaths were 227; but the epidemic in 1871 did not reach its culminating point until the week ending May 6th, when 288 deaths were recorded; and the deaths did not materially decline until the week ending July 8th, when the number fell from 235 (the number registered for the week ended July 1st,) to 164; after which the number of deaths gradually declined; but London could not be said to be comparatively free from small-pox until August, 1872; the epidemic having lasted upwards of three years. As the weekly return of deaths from small-pox does not steadily decline, and the cases in the Hospitals do not materially diminish in number, while some of them show great malignancy, we cannot, with any feeling of certainty, assert that we are even approaching the termination of the present epidemic. In my last quarterly report I stated that this Board had fitted up a temporary building in the Stone Yard for the reception of non-pauper patients who were able to pay ten shillings per week during the time of their residence therein. I am happy in being able to state that only one person availed himself of the accommodation. Owing to the difficulty which the majority of Local Boards in the Metropolis would find in obtaining suitable sites for the reception of nonpauper patients who are suffering from small-pox, fever, scarlet-fever, or from cholera, and the opposition which would be raised by the inhabitants to the erection of any such hospital in their neighbourhood, and the enormous expense which would be incurred by providing everything requisite for the treatment of the patients, it would be almost impossible to adopt such a plan. At the same time it must be admitted, " that adequate prevision for the isolation and treatment of epidemic infectious diseases in the Metropolis does not exist." It is, therefore, incumbent on the several local authorities to make suitable provision for the reception of persons suffering from such diseases who are able to pay for the accommodation ; and, having duly considered the matter, I am of opinion that the resolution adopted by the Vestry of St. James', Westminster, is practicable, and might advantageously be acted on. The resolution is as follows:— Vestry Hall, St. James', WestminsteE. 22nd April, 1877. "That a communication be addressed to the Local Government Board stating that, in the opinion of this Yestry, it if) desirable that powers should be given to Vestries and District Boards to send small-pox patients to the 10 hospital, under the supervision of the Metropolitan Sick Asylum Boards; the Vestries and District Boards paying such sums for admission, &c., as shall be agreed upon between the several bodies, and reimbursing themselves by charging the same to the patients." Extracted from the Minutes. GEORGE BUZZARD, Vestry Clerk. The above recommendation does not involve the necessity of the formation of an additional Board for the government of the Metropolis. Fever Cases. Four cases of fever and 4 of small-pox have occurred in the Registered Common Lodging Houses. The Inspectors inform me that copies of all the handbills and posting bills, relating to infectious and contagious diseases, which have been largely distributed about the District, have been left at each of the Schools and Registered Common Lodging Houses. Return of fever cases received into the Infirmary for the six months ending Saturday, 30th March, 1877— TABLE showing the Localities from which the Patients were received into the Infirmary of the Workhouse, and other particulars relating to them. Class and description of Fever. Previous Residence. Date of admission into Infirmary. Date of admission into Fever Hospital. Length of time in the Infirmary before appearance of Fever. Whether or not Patients had Fever on admission. Scarlet Hall's Coffee House, Brushfield Street Oct. 3 Oct. 4 1 day No Enteric Found in the street by Oct. 30 Nov.6 5 days No Enteric Found by Police, no abode Jan. 6 Jan.11 5 days No Typhus 187, Brick Lane Feb. 12 Feb. 13 1 day Slightly Typhus 187, Brick Lane „ 14 „ 15 1 day Slightly Enteric 16, George St., Spitalfields „ 22 „ 24 2 days No Enteric Sailors' Home. Well St. „ 17 26 9 days No Enteric 1, Dorset Street ,, 28 Mar. 2 2 days No Typhus 32, Flower & Dean Street Mar.12 „ 13 1 day Slightly Typhus Casual Ward „ 22 „ 23 1 day Slightly The following Table, compiled from the annual returns of the Registrar* General, shows the deaths in London from small-pox, measles, scarlet-fever, 11 hooping-cough, diarrhœa, and fever* (typhus, typhoid, or enteric, simple continued fever), registered in the years 1838-71:— Years 1838 1839 1840 1841 1842 1843 1844 1845 1846 Days 365 365 365 364 364 364 364 364 364 Small Pox 3817 634 1235 1053 360 438 1804 909 257 Measles 585 2056 1132 973 1293 1442 1182 2318 747 ScarletFever 1524 2699 1954 663 1224 1867 3029 1085 928 Hooping Cough 2083 2561 1069 2275 1603 1908 1292 1816 2035 Diarrhœa 393 258 460 465 704 834 705 841 2152 Fever 4078 1819 1262 1150 1174 2083 1696 1301 1851 Totals 12480 10027 7112 6579 6358 8572 9708 8270 7970 Years 1847 1848 1849 1850 1851 1852 1853 1854 1855 Days 371 364 364 364 364 364 371 364 364 Small Pox 955 1617 518 498 1066 1166 217 676 1024 Measles 1778 1143 1153 977 1322 600 1007 1399 864 Scarlet Fever 1433 4756 2145 1178 1269 2549 2069 3439 2602 Hooping Cough 1600 1628 2345 1572 2161 1565 2652 2471 2415 Diarrhœa 1976 1913 3463 1884 2271 2164 2310 3235 2061 Fever 3328 3614 2595 1967 2404 2209 2701 2715 2375 Totals 11070 14671 12219 8076 10493 10253 10956 13935 11341 Years 1856 1857 1858 1859 1860 1861 1862 1863 1864 Days 364 371 364 364 364 364 364 371 364 Small Pox 522 154 247 1156 877 215 345 2012 537 Measles 1445 1400 2383 1305 2054 1070 2281 1698 2750 Scarlet Fever 1795 1587 4118 4197 2457 2358 3457 5075 3212 Hooping Cough 2078 2551 2700 1741 2023 3497 2150 2229 2386 Diarrhœa 2251 3145 2093 3335 1383 2625 1735 2448 2861 Fever 2674 2203 1902 1796 1392 1754 3635 2892 3689 Totals 10765 11040 13443 13530 10186 11519 13603 16354 15435 Years 1865 1866 1867 1868 1869 1870 1871 1872 1873 Days 364 364 364 371 364 364 364 365 371 Small Pox 646 1388 1332 606 273 958 7876 1781 115 Measles 1302 2259 1125 1989 1425 1443 1431 1680 2195 Scarlet Fever 2181 1885 1438 2921 5803 5998 1896 904 652 Hooping Cough 2921 2933 2251 2369 3755 1935 2299 3249 2689 Diarrhœa 3557 3184 2942 4060 3400 3776 3894 3490 3879 Fever 3232 2681 2174 2483 2414 2053 1746 1340 1549 Totals 13839 14330 11262 14428 17070 16163 19142 12444 11079 Years 1874 1875 1876 Days 364 364 364 Small-pox 56 75 735 Measles 1655 1427 1741 Scarlet Fever 2662 3651 2297 Hooping Cough 1861 3232 2730 Diarrhœa 3077 3198 3518 Fever 1754 1282 1176 Totals 11065 12865 12197 *It was not until the year 1859 that the Registrar-General recorded separately under their respective nomenclature, typhus, enteric or typhoid, and simple continued fever, but those diseases were classed under the head, typhus. 12 In 1848 the deaths from cholera in London were 652, and in 1849 they were 14,137; total during the epidemic 14,789. In 1853 the deaths from cholera were 883, and in 1854 they were 10,738; total 11,621. In 1865 the deaths from cholera were 196, and in 1866 they were 5596; total 5792. TABLE, showing the Death-rate of London, and of the "Whitechapel District from 1838 to 1876. Years. LONDON. Death-rate per 1000. WHITECHAPEL. Death-rate per 1000, after deducting deaths of , non-residents. REMARKS. Years. LONDON. Death-rate per 1000. WHITECHAPEL. Death-rate per 1000, after deducting deaths of non-residents. REMARKS. (1838.) 1838 32.9 44.2 In this year 368 persons died of fever in the Whitechapel District, and 219 of small-pox. 1858 23.9 27.9 Measles & scarlet-fever were very fatal in 1858. 1839 26.1 35.2 1859 22.7 26.8 Diarrhœa was very fatal in 1859. 1840 24.8 28.3 In the last six months of 1837 the deaths trom fever in the Whitechapel District were 249—Total deaths from fever in 18 months 617. 1860 22.5 27.2 1841 24.0 28.3 1861 23.2 27.3 In 18651 hooping-cough and diarrhœa prevailed. 1842 23.5 29.4 1862 23.6 29.2 In 1862-3 fever and scarlet-fever were very fatal. 408 deaths from fever and 291 from scarletfever occurred in the Whitechapel District in the two years. 1843 24.7 29.9 1863 24.5 32.0 1844 25.0 28.2 Scarlet-fever was in 1844 very fatal. 1861 26.6 32.7 1845 23.2 26.8 1865 24.6 29.4 In 1864-5 fever was very fatal in Whitechapel, 337 deaths having occurred therein during the two years. 1846 23.3 28.2 In 1846 diarrhœa and hooping-congh were very fatal. 1866 26.5 38.7 1847 27.0 37.8 In 1847-48-49, fever, diarrhœa and scarletfever extensively prevailed. In the last quarter of 1847 influenza was very severe in the Whitechapel District. 1867 23.0 26.4 1848 25.8 34.2 1868 23.6 27.7 1849 30.1 36.0 1869 24.6 29.6 In 1869 there were 208 deaths from scarletfever. 1850 21.0 26.0 1870 24.1 26.4 1851 23.4 27 4 1871 24.6 27.7 1852 22.6 26.3 1872 21.5 26.3 1853 24.4 28.4 In 1853-4-5, scarletfever, hooping-cough, diarrhœa and fever was very fatal. 1873 22.5 26.5 1854 29.4 33.7 1874 22.6 29.2 In 1874 the deaths from scarlet-fever in the Whitechapel District were 199. 1855 24.3 28.4 1875 23.7 26 1 1856 22.1 25.9 1876 *22.3 23.9 In the year 1876 the deaths by accident or negligence exceeded the corrected average by 69. 217 persons were killed ir. the streets of London, and 2974 persons were so severely wounded as to fall under the notice of the police. 1857 22.4 265 Diarrhœa was very fatal in 1857. The yeara in which cholera prevailed were 1832-3, 1848-9, 1853-4, and 1865-6. *This, says the Registrar-General, is 1.9, or nearly 2 per 1000 below the average of years since 1810; the average rate being 24.2 per 1000—One person to 41 living dies yearly. 13 As the rate of mortality in the Whitechapel District for the year 1847 is considerably above the rate of all the subsequent years, with the exception of that for 1866, when the cholera so extensively prevailed, it is desirable to offer some explanation of the cause of such mortality; and for this purpose, I may direct your attention to the unusual prevalence of influenza which occurred in the last three months of the year 1847, when the deaths in London from it in that period alone, were 1161; the total number for the year being 1253. The deaths from diarrhoea and fever were very numerous, especially among the Irish poor, who flocked over to England owing to the potato famine in Ireland. Small-pox, scarlatina, diarrhoea, typhus and erysipelas also prevailed. The Kegistrar-General records the fact, that "the mortality in London was raised by influenza from 1086 in the week ending November 20th, to 1677 in the week ending November 27th; 2454 in the first, 2416 in the second week of December; the epidemic then gradually declined. The deaths, directly or indirectly caused by influenza, were not less than 5000 in six weeks" There being a very large and poor population, consisting of numerous Irish in this district; the severity of the disease and its consequent mortality may be accounted for therein. It may be stated, as a general rule, that the more destitute the population, the larger is the rate of mortality, particularly among young children. I have not at hand the returns of death from influenza in the Whitechapel District for 1847, but I perfectly well recollect that the cases of influenza among the poor in the courts abutting on Rosemary Lane, Castle Alley, and Goulston Street were very numerous; and I had on one day about 60 new cases of illness among the pauper population to attend to. As so much has been recently said on the unsatisfactory result of the labours of the numerous persons engaged in the science of preventive medicine—in proof of which it has been alleged that the rate of mortality in London is as high as it was forty years ago—I have deemed it advisable to investigate the matter. In order to facilitate the inquiry I prepared the preceding table, which shows, at a glance, the annual deaths in the Metropolis from 1838 to 1876. From this it will be seen that the allegation I allude to is not quite correct. Thus, in the ten years, 1838-47, the average annual death-rate for London was 26.0 per 1000; while in the decenniad, 1867-76, it was only 23.2 per 1000; and if there had been a systematic and reliable annual publication of the death-rate before the year 1838 it would probably have been seen that it was at an earlier period much higher ; and the comparison of it with the present annual death-rate would have proved much more favourable. This table also shows that the death-rate in London, which in 1839 was 26.1 per 1000, was in 1876 22.3 per 1000. Some inaccuracies must necessarily occur in estimating the number of 14 the population in the interval between each census, but, for all practical purposes, the tables as published by the Registrar-General may be relied on. If, however, we merely take the death-rate for the whole of London for the last forty-six years, we canuot say that it has materially diminished; and, taken by itself without explanation, would not exhibit a very satisfactory result for the great cost incurred in carrying out the sanitary improvements in the Metropolis. I may observe that the death-rate in the years 1849, 1854, and 1866, was materially increased by the epidemics of cholera. Although, as before stated, no very great improvement has taken place in the death-rate of London taken as a whole, yet, it will be found that the death-rate of the densely crowded localities has decreased; while, as might reasonably be expected, the death-rate in those districts which, thirty or forty years ago were sparsely populated, is increased—it being a well ascertained fact that, cœteris paribus, the death-rate increases with the density of the population; and that epidemics, especially fevers, generated in crowded dwellings, spread among the whole population. By way of illustration of the increase of the death-rate in some of the Districts iu London, where the population has vastly increased, I may adduce the Districts of Islington and Hackney. The population of Islington in 1831 was only 37,316, and that of Hackney, 34,527; the death-rate in the former, according to the returns of the Registrar-General for 1838, was 21.0 per 1000, and in 1839, 17.8 per 1000; and in the latter for the same years, 17.8 and 16.7 per 1000; while in the Whitechapel District, the rate of mortality in 1838 was 44.2, and iu 1839, 35.2 per 1000. In the year 1876, the rate of mortality in Islington* was 23.lt per 1000, and in Hackney, 24.8 per 1000. As the population in both these districts has undoubtedly increased since the census of 1871, when the population in Islington was 213,778, but was, as estimated by Dr. Tidy in the middle of the year 1875, 244,680, and in Hackney in 1871 it was 124,951, the rate of mortality will be now somewhat less than that just stated. The rate of mortality will be still further reduced by abstracting from the total deaths those of non-residents in the hospitals, situated within the respective districts. In the Whitechapel District, according to the same returns, the death-rate in 1876 was 30.6 per 1000. In my annual report for 1876, in which I have deducted the deaths of non-residents in the London Hospital, the rate of mortality is 23.9 per 1000. Prom the above returns it appears that while the densely populated District of Whiteshapel has had a diminished rate of mortality since 1838 of 13.6 per 1000, Islington shows an increase of 2.1 per 1000, and Hackney of 7.0 per 1000. But as the year 1838 was an exceptional year, (the rate of mortality for the whole of London being greatly in excess, the same * See Annual Summary of Births and Deaths in London, 1876, p. XXIV and XXV. † Dr. Tidy states, in his report for 1875, that the death, rate for that year in Islington was 19.02 per 1000. 15 being 39.2 per 1000,) I prefer taking the returns for the following year, 1839, when the difference of the rate of mortality in Islington, between that year and 1876, is an increase of 5.5 per 1000; for Hackney of 8.1 per 1000 ; and for Whitechapel, a decrease of 4.6 per 1000. Since the year 1831, the population of Islington has increased about six-fold, and the density from 271 square yards to a person, to about 70. The density of Hackney has increased from 434 square yards to a person to about 151. The density of the population of Whitechapel has remained much the same from 1831 to the present time. The following table is taken from the supplement to the 35th Annual Report of the Kegistrar-General, which shows at one view the relative density of Islington, Hackney, and Whitechapel. Density of Population, and Annual Mortality in the Three Decenniads, 1841-50, 1851-60, and 1861-70, in the undermentioned Districts. Districts. Density of Population. Acres to a Person. Annual Mortality. Deaths to 1000 living. 1841-50. 1851-60. 1861-70. 1841-50. 1851-60. 1861-70. Mean of 30 years, 1841-70. Islington .041 .025 .017 19 21 22 21 Hackney .078 .055 .038 19 19 20 19 Whitechapel .005 .005 .005 29 28 30 29 The density to an acre, in each of the above Districts, was in 1871, for Islington, 69 to an acre; Hackney, 32 to an acre ; and Whitechapel, 190 to an acre. The density in the whole of London was, in the same year, 42 to an acre. That the rate of mortality in Islington and in Hackney should, under the circumstances of such a large increase of population, be so small, reflects great credit on the Local Boards and their Sanitary Officers; for had it not been for their exertions in promoting sanitary improvements, a much larger rate of mortality would have been the result. Not only has it been asserted that the annual rate of mortality in London has not been diminished during the last twenty years, and deducing therefrom that sanitary provisions as at present carried out are of no avail in reducing the annual rate of mortality, but, it has also been said " that if improvements and changes are to be effected in the sanitary arrangements of our large towns and cities, let them be carried out—not upon the necessity of such municipal innovations, to avert a pestilential havoc in human life—but on the true merits of the question—the comforts, conveniences, and elevation of moral purity, thence arising."* * See contributions to vital Statistics, by T. G. P. Neison, p. 110. 16 That the opinions as expressed above are inaccurate is proved not only by the facts adduced in this report, but also from the improved condition of health and diminished rate of mortality among the population of Easington Buildings and other places in this District, which have followed the re-arrangement and re-construction of unhealthy houses; the particulars of which are given in my Quarterly Report for March, 1872. Still further improvement in the rate of mortality may be looked for when all such public sewers as have not a proper fall shall be re-constructed, and the whole of the main drainage placed under one Board, and not, as it is at present, under the divided authority of the Vestries and District Boards and the Metropolitan Board of Works. The offensive emanations from the sewers are at present a source of great danger to the public health, charged, as they are, with the excreta of patients suffering from typhoid fever—a disease never absent from London—the deaths from which having annually varied in number from 4078 in 1838 to 1206 in 1876. Some misapprehension exists respecting the danger to health arising from the emanations of sewers. *Typhoid fever is said, upon high authority, to be caused only by a specific poison which has been thrown off from the body of some person sick of the same disease; and that this disease is not produced by the emanations arising from the decomposition of foul matter which is given off from the sewers or from cesspools. Without explanation, the statement of such opinion, given on high authority, is highly dangerous ; for it may induce persons to disregard the nuisance arising from many of the public sewers, which must always, to some extent, be charged with the excreta of patients suffering from typhoid fever and other epidemic diseases; all of which are, in the opinion of Sir Thos. Watson and others produced only from germs which are given off from patients suffering from any of the epidemic diseases. If this opinion be correct, it is obvious that the only way of stopping the progress of an epidemio disease is by the perfect isolation of the patient. But how to accomplish so desirable a proceeding in the numerous cases of children, when attacked by measles, hooping-cough and diarrhoea, I am at a loss to conjecture. *See a very valuable Article by Sir Thos. Watson, published in the "Nineteenth Century," May number, page 380, on the Abolition of Zymotic Disease. Sir Thos. Watson is so sanguine, as to imagine that, "by the rigid enforcement of judicious Sanitary Laws, these terrible diseases, with their terrible consequences, may finally be banished from this island. The object of the enforcement of the Sanitary Laws is to destroy the contagium ; more popularly the particles are called germs or seeds, and each disease in the group has its own proper and peculiar seed; and to prevent the seed of zymotic disease from taking root, the same mu3t be destroyed. To this end the requisites are—first, the unfailing and immediate notification to the proper authorities of the occurrence of every case—second, the instant isolation of the sick person—third, the thorough disinfection of his clothes, furniture, and place of isolation—fourth, vigilant and effectual measures to prevent the importation of this disease from abroad, and to strangle it should it by mischance return." 17 That the annual rate of mortality for London will still further diminish when educatiou becomes more extended and the laws of health better understood, and when the workmen who are employed in unhealthy businesses are relieved by judicious appliances from breathing the poisonous emanations which are given off from the materials used in the manufactory—the long hours of labour are diminished—the workrooms of tailors and milliners are better ventilated and less crowded, and the work-people have greater facilities of inhaling the fresh air and in taking exercise whereby the physical constitution may become developed—the old "sweating system," so graphically described by the late Canon Kingsley, in "Alton Locke," is entirely abolished—when every room in which more than two persons work for hire shall come under the factory regulations—mothers are able to provide better food and clothing for their young children and devote more time to the care of them—the drinking habits of the people are altered for the better—when the spreading of epidemics, especially those attacking young children, such as hoopingcough and measles, can be prevented—when greater care is taken to prevent accidents in the public streets—and when more general and efficient measures are taken to prevent syphilis, from which disease the average yearly mortality in London is 468.4—then we may reasonably hope to find the mortality greatly reduced. I may, however, here remark that notwithstanding all the care which may be given to the carrying out of the most approved sanitary arrangements a poor district will always have a much larger rate of mortality than a rich one ; and it will be found that the mean duration of life in a population is several years longer in a district where all the necessaries and comforts of life can be procured in required quantities, than in a district where the reverse of that is the case. Thus the mean duration of life of males and females in 1841 in St. George's, Hanover Square, in children under 1 year to 10 years was 38.5 years; from 10 to 20 it was 48.6, and from 20 to 30 it was 41 years; while in the Whitechapel district for the same years it was 32.6, 43.6, and 35.5 years respectively, showing that the expectation of life in the three decenniads was, in the Whitechapel district, as compared with that of St. George, Hanover Square, less in the first decenniad by 5.9 years, in the second by 5 years, and in the third by 5.5 years. Health of London.† "The mortality was at its usual rate of 24.2 per 1000 over the 24 years 1840-73; it was as high as 30.1 In 1849 ; 29.4 in 1854; and 26.5 in 1866, when cholera was epidemic—it was as low as 21.5 in 1872; and 22.5 * See remarks in table on p. 12. † See Registrar-General's 36tli Annual Report, p. LX. 18 in 1873; the mortality having never been so low for any two consecutive years since 1840, and, by fair inference, never so low in any two years since London existed. It is a general law that the mortality increases with the density of the population; and this, no doubt, would have been observed in London, had it not have been for the increased purity of the water supply ; the new system of drainage which is now, though incomplete, in operation; and some improvement in that most important condition of life—LODGING." Improved Lodging. As regards improved lodging, from which much benefit to the public health is expected to arise, such will probably soon be effected by the operations of the Artizans' and Labourers' Dwellings' Act, 1875. This Act has been the result of the spread of information among all classes; which has been diffused by the exertions of individuals and societies engaged in the promotion of Public Health since 1839, when the Poor Law Commissioners published an appendix to their Fourth Annual Eeport, in which the danger to the public health arising from the then existing condition of the houses of the labouring classes was forcibly pointed out; but nothing of any importance to improve the wretched condition of the houses of the poor was done by the legislature until the passing of Torrens' Act in 1868, and the more important Act of 1875. To the passing of this Act the public is greatly indebted to the Right Honourable Eichard Assheton Cross, Secretary of State for the Home Department. The memorials of the Corporation of the Royal College of Physicians, and of the Council of the Charity Organization Society, and other Societies engaged in the promotion of improved dwellings of the labouring classes—the former memorial presented to the Right Honourable Benjamin Disraeli, and the latter to the Home Secretary—had unquestionably considerable influence in obtaining the Act of 1875. " Torrens' Act," although it has only been very partially enforced, has nevertheless, in some districts, been highly beneficial in obtaining for the poor better house accommodation. The memorial of the Council of the Charity Organization Society states —"That the power intrusted to local authorities to condemn houses as unfit for human habitation is insufficient to bring about the requisite improvements, inasmuch as the power of closing and removal can only in practice be put in force against tenements which are of the most ruinous and obviously unhealthy character; while the space occupied by such houses, without the addition of adjacent areas, may be, and often is, too limited in extent to be of any value as a site for dwellings constructed on sound sanitary principles." 19 Sanitary Authority in 1837. Before the formation of you, Board the Board of Guardians was the sanitary authority of this District; and several nuisances of an unhealthy character were then either abated or removed—notably that of a patent manure manufacturer, conducted by a Frenchman of the name of Poittevin, situated only 100 feet from the walls of the old Spitalfields Workhouse—now the site of the Union Workhouse. Mr. Samuel Byles, Surgeon to the Spitalfields Workhouse, in his evidence before the Magistrate at Worship Street Police Court, stated that, whenever the wind blew from the defendant's premises, the smell was in the highest degree offensive, and calculated to produce the most pernicious consequences. On such occasions he found that whenever diseases happened to prevail in the Workhouse they exhibited a great tendency to putrescence, and assumed a most malignant and intractable character. Whenever the effluvium became powerful the adult portion of the inmates were attacked with severe diarrhoea, which invariably subsided as soon as the wind changed; and he felt satisfied that the nuisance in question was the proximate cause of their illness. The evidence of Mr. Byles was confirmed by Mr. Burch, the resident Apothecary in the London Hospital, and myself. Mr. Hammill, after hearing the evidence, said that this was clearly a monstrous evil, and, as he could not allow the health of the inhabitants of a densely peopled district to be sacrificed to the pecuniary interests of a private individual, he must refuse to sanction any suggestion which had not for its object the immediate and total suppression of the cause of the mischief. I record the proceedings taken in this case to show that attention was paid by the Guardians and Medical Officers of the Union to the existence of unhealthy nuisances ever since 1837; and I can state that attention was given to the sanitary condition of the District generally. The beneficial result of their labours may be seen in the table showing the annual rate of mortality from 1838 to the present time. The beneficial result of sanitary improvements is most satisfactorily shown in the Report of the Registrar-General for 1876. On page XIX of that Report there is a table exhibiting the average annual mortality in thirteen districts in different county registration districts, in which the average annual rate of mortality, owing to an improved health administration, has been steadily reduced in Hull from 31 per 1000, which was the rate of mortality in the decade 1841-50, to 26 per 1000 in the decade 1861-70. In North Witchford, Cambridgeshire, in the same decade, the annual rate of mortality has been reduced from 27 per 1000 to 20 per 1000; and in the four years 1871-4, the results are still more remarkable, the mortality being reduced to 17 per 1000. This district, 20 (North Witchford) the Registrar-General remarks, affords a striking instance of the important results that can be attained through health administration. The average annual rate of mortality fell from 27 per 1000 in 1841-50 to 21 in 1851-60, and to 20 in 1861-70. In the four years 1871-4 the results are still more remarkable, the mortality being reduced to 17 per 1000. If further testimony were requisite to show the beneficial results of sanitary works in promoting the public health, I may refer you to the Report of Dr. Buchanan, which is published in the Ninth Report of the Medical Officer of the Privy Council who, at Page 40, in words to the following effect, states—that he had visited in the course of 1865-66 twenty-five towns, containing an aggregate population of 606,186 persons, according to the census of 1861, in which the authorities had carried out works designed for the improvement of public health. The nature of the sanitary operations carried out in these twentyfive towns consisted of one, or all, of the following:—1, drainage works affecting surface, sub-soil, or houses; 2, improved water supply; 3, adoption of measures designed for the removal of decomposing organic matters; 4, the substitution of the water-closet system for cesspools and middens; 5, improved paving, scavengery, and public cleanliness; 6, amendment of the lodgment of the inhabitants, the regulation of the Common Lodging Houses and the repression of overcrowding. In the great majority of the twenty-five towns there has been distinct reduction of the total death-rate. In nine of them, having an aggregate population of 204,641, the reduction has amounted to about a fifth part of the previous rate of death. In eleven other towns, the fall in the death-rate has been less considerable. In three or four towns (including one that has scarcely finished its works,) the rate has been stationary; and one shows an increase in the rate of mortality since the period when the works designed for its improvement were executed. The chief reduction in mortality is in those towns where the previous deathrate was most excessive; and, secondly, in those towns where, along with sanitary improvements, suitable changes in the social and industrial condition of the population has taken place; and, thirdly, in those towns that cannot yet have got the full fruit of the sanitary works. In judging therefore, of the relative value of sanitary measures, these considerations must be kept in view. The most recent information on the subject of the beneficial results afforded by the carrying into effect of sanitary works is exemplified in the health of Tottenham. "During the years 1871-2-3, Tottenham was suffering from the effects of long continued sanitary neglect. During the last three years (1874-5-6) Tottenham was reaping the benefits of 21 important and wide-spreading sanitary improvements." The average yearly death-rate in Tottenham in 1871 was 20.6 per 1000; and in 1876 it was 16.8 per 1000. From 1871 to 1873 the average annual death-rate was 19.3 per 1000; and from 1874 to 1876 it was 17.4 per 1000. It is manifest from the table showing the death-rate for London and for the Whitechapel District since 1838 that the mortality per 1000 in London, has been reduced from 32.9, the rate of mortality for that year, to 22.3, the rate of mortality for the year 1876; and in the Whitechapel District from 42.8 per 1000 to 23.9 per 1000; but, if we examine the records of fever in this District from 1838 to the present time, it will be seen that the deaths from this cause are reduced from 368 in one year (1838) to 48 (1876); including 21 deaths in the Fever Hospital belonging to the Asylum Board. The reduction of mortality [from fever may, in a great measure, fairly be attributed to the carrying out of sanitary improvements. The following table, which was prepared by the late Mr. John Smith, shows the prevalence of fever in this District in the year ended March 25th, 1838. WHITECHAPEL UNION—May 19th, 1838. Number of cases attended by the three Medical Officers during the year ended 25th March, 1838. In-door. Out-door. Total. First quarter ending Midsummer, 1837 632 485 1117 Second quarter 424 608 1032 Third quarter 489 787 1276 Fourth quarter 878 1009 1887 During the Year 2423 2889 5312 Of these were— Cured. Died. Under Treatment. Sent to Hospital. Total. Fever 2134 214 107 82 2537 Surgical 216 13 43 22 294 Midwifery 80 0 0 0 80 General 2026 138 237 0 2401 4456 365 387 104 5312 The extra expense for fever during tbe quarter ending Lady-Day, 1838, I consider to have been £400. JOHN SMITH, Clerk to the Board of Guardians. 22 In the twelve months ended on the 25th June, 1838, the deaths from fever in this District were 489. In the quarter ended September, 1837, they were 94; in that ended December, 155; in that ended Lady-Day, 1838, 141; and in the quarter ended June 25th, the mortality from fever was 99. It was in consequence of the extensive prevalence of fever in the Metropolis in 1837 and 1838 that the Poor Law Commissioners, in their report to the Right Honourable Lord John Russell, dated 14th May, 1838, stated that they had directed local examinations to be made in those parts of the Metropolis where fever was stated to be most prevalent, by Dr. Aknott and Dr. Southwood Smith; and to this inquiry we may ascribe the origin of the several sanitary laws which aro now in force in this country. Before that date little or no attention was paid to the construction and condition of house drains, to accumulations of refuse, to the lodgment of filth in cesspools and privies, &c. The public sewers in this district were under the control of the Tower Hamlet's Commission, who, on application being made to them by the Goodman's Fields Paving Commission, constructed a sewer in each of the undermentioned streets, viz.:—Leman Street, Great Prescot Street, Mansell Street, Great Alie Street, and Lambeth Street, and on a petition signed and presented by myself the Commission constructed a sewer in Blue Anchor Yard. The tables which are published in my Annual Reports will show that there is a diminution in the mortality of all the epidemic diseases since the year 1856, when your Board was constituted. Sanitaky Works Performed during the Quarter ended 31st March, 1877. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter euded 31st March, 1877.:— Number of inspections of houses as shown in the official returns 3360 Houses specially visited 225 Houses specially re-visited 716 Preliminary notices served, such notices embracing 423 premises 274 Compulsory orders issued, embracing 286 premises 96 Summonses heard at Police Courts, under Sanitary Act 0 ,, „ ,, Adulteration Act 0 Cellars used as dwellings discontinued for such use 2 Cases of overcrowding and indecent occupation abated 4 Houses in which rooms or passages have been whitewashed 198 Rooms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 59 23 Articles disinfected in rooms, consisting of beds, bedding, clothing, &c. 590 Yards of houses paved, or the pavement repaired 48 Drains in houses improved 48 Dust-bins provided 26 Privies lime-washed, cleansed and repaired 123 Water supply provided or improved 11 Nuisances from dung, and other offensive matter removed 19 Area gratings, cellar flaps, &c., repaired 8 Animals kept so as to be a nuisance removed 25 The cow-houses in the District, 30 in number, the slaughter-houses, 14, and the bake-houses, 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, 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 31st March, 1877. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhœa. Cholera and Choleraic - Diarrhœa. Continued Fever, Typhus & Typhoid. Febricula. Pysemia. 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 17 3 0 3 1 0 0 2 0 0 0 0 8 6 0 2 0 0 0 0 59 101 Mr. Champneys 7 5 0 1 1 0 0 0 0 1 0 0 40 0 0 3 0 0 0 1 103 162 Mr. Sequeira 10 0 0 0 2 0 0 10 0 0 0 0 12 0 0 2 0 0 0 0 73 109 Mr. H. Braye 34 9 0 5 0 0 0 2 0 0 0 0 28 3 0 2 0 0 0 2 81 166 Mr. Loane 1 0 0 0 7 0 0 8 0 0 0 0 15 0 0 5 2 0 0 0 61 99 Total 69 17 0 9 11 0 0 22 0 1 0 0 103 9 0 14 2 0 0 3 377 637 Corresponding Qr. of previous Year. 0 14 0 12 3 0 21 25 2 3 0 0 144 26 0 23 0 1 1 3 475 753 Workhouse Mr. J. J. Ilott. 49 2 0 10 10 0 5 14 0 5 0 0 186 23 3 90 3 4 11 6 416 830 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 31st March, 1877. Districts. Small-Pox. Measles. Scarlet F ever. Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera & Choleraic Diarrhœa. Total. Remarks. Spitalfieldas 7 4 5 0 7 0 0 0 23 Mile End New Town 5 3 0 0 3 1 0 0 12 Workhouse. Whitechapel North 1 4 0 0 3 1 3 0 12 Whitechapel Church 3 0 0 0 3 2 2 0 10 Hospital. Goodman's Fields 0 0 0 0 1 0 0 0 1 Aldgate 0 0 0 1 1 1 1 0 4 Totals 16 11 5 1 18 5 6 0 62 Deaths from Epidemics for the corresponding Quarter, 1876. 0 6 5 1 37 3 7 0 59 Twelve deaths from small-pox of patients belonging to this District occurred in the Small Pox Hospital at Homerton. TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causes— Deaths under 1 year of age, 1 and under 5 years, and above 60 years; Deaths from Violence, Inquest cases, and Deaths in Workhouse and London Hospital, for the Quarter ending 31st March, 1877. Sub-districts. Enumerated Population in 1871. Births. Deaths. Under 1 year of age. 1 and under 5 years. Persons aged 60 ye?rs and upwards. Violence. Inquest cases. Deaths in Public Institutions. Spitalfields 22499 214 121 35 34 17 6 12 3 Mile End New Town 15550 198 172 25 25 49 6 19 98 Whitechapel North 11597 108 56 22 15 4 1 2 0 Whitechapel Church 7322 73 217 8 8 21 42 47 180 Goodman's Fields 10381 106 45 14 9 5 1 5 0 Aldgate 9224 68 50 11 8 5 4 9 0 Totals 76573 767 662 115 99 101 60 94 281 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT on the Sanitary Condition of the WHITECHAPEL DISTRICT, for the QUARTER ENDING JUNE 30th, 1877, BY JOHN LIDBLE, medical officer op health. London: peinted by Penny & Hull, 121, Lemah Street, whitechapel, E. 1877. A 9422 7C REPORT of the MEDICAL OFFICER OF HEALTH For the Quarter ending 30Ih June, 1877. To the Board of "Works, Wihtechapel Distbict. Gentlemen, In the Quarter that ended on Saturday, the 30th June, 1877, the total births in the District were 691, viz.: 328 males and 363 females; and the deaths 652, viz.: 374 males and 278 females. The excess of births over deaths has therefore been, during this Quarter, 39. As the deaths of 129 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, thereby reducing the total mortality to 523. An allowance, however, must be made for the deaths of residents in public institutions outside the District, but of those I have no return. In the corresponding Quarter of the previous year the total births were 680 and the total deaths 527. In the Spitalfields sub-District the births were 214 and the deaths 126 ; in the Mile End New Town 177 and the deaths 181; in the "Whitechapel North 95, and the deaths 56; in the Whitechapel Church 55 and 196 (in this sub-District the London Hospital is situated); in the Goodman's Fields 93 and 47; and in the Aldgate 57 and 46. The deaths have exceeded the births in the Whitechapel Church District by 141, but from this number the 129 non-residents must be deducted. The proportion of births to deaths is therefore 55 to 67. The deaths in the London Hospital have been 176. In the corresponding Quarter of the previous year the deaths in this Institution were 153. The deaths in the Workhouse have been 78. In the corresponding Quarter of last year they were 91. The deaths from epidemic diseases in the entire District have been 86, viz.: 4 from small-pox, 44 from measles, 3 from scarlet-fever, 1 from diphtheria, 15 from hooping-cough, 17 from diarrhœa, and 2 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 10 deaths from small-pox, and 3 from fever. "While small-pox has been less fatal in this District than in most of the other Districts in London, measles has been unusually fatal, particularly in 4 the Spitalfield9 sub-District; for out of the total mortality from this disease, 24, or more than the half of the deaths occurred in that sub-District, In the corresponding Quarter of the previous year the deaths from epidemic diseases were 3S, viz.: 5 from measles, 2 from scarlet-fever, 1 from diphtheria, 14 from hooping-cough, 10 from diarrhoea, and 6 from fever. In addition to the 6 deaths from fever there were 4 in the Fever Hospital; thus making a total of 10 deaths from fever for that Quarter. Mortality of Young Children. The mortality of children under 1 year of age was 136. This is 20.8 per cent. of the total mortality. In the corresponding Quarter of the previous year the rate of mortality of children under 1 year was 14.2 per cent. of the total mortality. In the Spitalfields'sub-District the rate is 30.9 per cent.; in the Mile End New Town 19.8 per cent.; in the Whitechapel North 41.0 per cent.; in the Whitechapel Church 5.1 per cent.; in the Goodman's Fields 34.0 per cent.; and in the Aldgate 26.0 per cent. The difference in the rate of mortality of young children in the Mile End New Town and Whitechapel Church District is thus explained:—in the former the Workhouse is situated, and in the latter the London Hospital. The total deaths under 5 years are 249; which shows a rate of mortality of 38.2 per cent. in relation to the total deaths, and 36.0 per cent. to the total births. The rate of mortality under 1 year, in relation to the total births, is 19.6 per cent., and under 5, 36.0 per cent. In the corresponding Quarter of the previous year the rate of mortality of children under 1 year in the Spitalfields sub-District was 34.7 per cent.; in the Mile End New Town it was 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. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter, 569 new cases of illness out of the Workhouse; including 27 of small-pox, 19 of measles, 12 of hooping-cough, 6 of diarrhoea, 26 of febricula, and 2 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 487; including 5 of measles, 2 of hooping-cough, 22 of diarrhoea, 9 of fever, 19 of febricula, and 1 of erysipelas. The total number of cases of illness in the Workhouse has been 797; including 6 of small-pox, 2 of measles, 1 of hooping-cough, 16 of diarrhœa, 19 of febricula, 2 of fever, and 7 of erysipelas. In addition to the above cases, there were 19 cases of syphilis, thus making a total of 816. I may here observe that the 27 cases of small-pox which are recorded in the books of the Medical Officers of the Union, give only a portion of the 5 cases which have occurred in the District; for tbe Sanitary Officers have received information of 10 cases which were attended by private medical practitioners; and it appears from the returns which have been kindly sent to me by Mr. vallance, that 39 patients were removed to the Metropolitan Small Pox Hospital during this Quarter from the District, of which number 6 died. Two patients, suffering from fever, were sent to the Metropolitan Fever Hospital during the same period, of whom 1 died. All the rooms in which patients have suffered, either from fever, scarlet-fever, and small-pox, which were reported to the Sanitary Officers, have been disinfected. Water Supply. Lieut.-Col. Bolton, in his Report of the examination made of the water supplied by the Metropolitan Water Companies, during the month of June, 1877, states that— "The East London Company have already completed the extension of the constant system of supply in a large part of their district, the whole of which is being brought, section by section, under constant supply. "On and after the 1st day of December, 1877, it is proposed to give a constant supply in and throughout that area which is contained within imaginary lines drawn on the north-western side thereof, along the centre of the Whitechapel High Street and of Whitechapel Road; on the southern side thereof, along the centre of Commercial Road East; and on the eastern side thereof, along the centre of Turner Street, for the whole length of this area, situate within the Parish of St. Mary, Whitechapel, the Hamlet of Mile End Old Town, and in the Parish of St. George in the East; and "On and after the 1st day of January, 1878, in and throughout the area, along the centre of Turner Street, on the northern side thereof, along the centre of Whitechapel and Mile End Roads." Meteorology of Greenwich. The returns of the Registrar-General show that the rain-fall in the Metropolis, during the Quarter, has been 5.26 inches. Of the 5.26 inches of rain which fell during this Quarter, 2.58 inches fell in the two weeks ending August 14. 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 3.48 inches. The mean temperature of the air was 51.8, and in the corresponding Quarter of last year it was 51.8. The hottest days during the Quarter were Tuesday, the 19th June, Monday, the 11th June, and Friday, the 29th June, when the thermometer indicated respectively 84.4°, 83.7°, and 85.1°. The hottest day during the corresponding Quarter of last year was on Wednesday, the 21st June, when the thermometer indicated 83.9. 6 The following Table, taken from the Returns of the Registrar-General, shows the comparative results of the Quarter:— Week ending Deaths in London. Deaths in Wchpl. District Rainfall. Mean Temperture of the air. Diarrhœa. Fever. Smll.-pox. From all causes. From Smallpox. From all causes. Inches. Degrees. April 7 9 27 78 1922 1 58 0.85 47.8 „ 14 13 12 60 1714 0 55 1.73 46.9 „ 21 11 26 68 1532 0 49 0.35 42.5 „ 28 12 18 89 1557 0 39 0.08 44.7 May 5 9 21 54 1490 1 66 0.20 41.3 „ 12 20 16 78 1618 1 47 0.24 49.2 „ 19 22 12 70 1564 0 48 0.80 51.1 „ 26 13 24 69 1392 0 37 0.23 49.1 June 2 13 16 61 1443 0 51 0.28 53.7 „ 9 16 16 58 1429 0 52 0.07 60.4 „ 16 27 16 55 1315 1 58 0.41 62.2 „ 23 46 13 44 1271 0 51 0.01 63.3 „ 30 50 26 44 1300 0 41 0.01 61.6 VACCINATION. WHITECHAPEL UNION.—Return of the number of Cages 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-Vaecination. September, 1875 850 1 35 0 335 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 0 338 201 714 March, 1877 408 500 37 27 445 527 757 June 382 5 24 1 406 6 699 Totals 2624 709 261 28 2885 737 5525 From the above Table, it appears that 52.2 per cent, of the number of children registered in this District have undergone primary vaccination at the hands of the Pubfio Vaccinator, and the Resident Medical Officer of the Workhouse. 7 The following Table is continued from my last Quarterly Report, and exhibits the weekly progress in London of the existing epidemic of smallpox, and that of 1870-71 in the corresponding weeks. 1876-7. Deaths 1876-7. Deaths 1870-1. Deaths 1870-1. Deaths Week ending Week ending Weekending Weekending July 8 13 Jan. 6 116 July 9 13 Jan. 7 79 „ 15 2 „ 13 100 „ 16 11 „ 14 135 „ 22 8 „ 20 79 „ 23 15 .. 21 188 „ 29 7 „ 27 86 „ 30 11 „ 28 157 Aug. 6 1 Feb. 3 103 Aug. 6 15 Feb. 4 196 12 9 „ 10 90 „ 13 11 „ 11 211 „ 19 5 „ 17 72 ,, 20 10 „ 18 218 „ 26 10 „ 24 104 „ 27 11 „ 25 227 Sept. 2 8 March 3 84 Sept. 3 9 March 4 213 9 5 „ 10 96 „ 10 12 „ 11 194 „ 16 6 ,, 17 100 „ 17 11 „ 18 185 „ 23 11 ,, 24 76 „ 24 15 „ 25 205 ,, 30 15 31 86 Oct. 1 13 April 1 192 Oct. 7 11 April 7 78 8 27 8 214 „ 14 16 14 60 „ 15 13 „ 15 265 „ 21 22 „ 21 68 „ 22 17 „ 22 276 „ 28 15 „ 28 89 „ 29 21 „ 29 261 Nov. 4 21 May 5 54 Nov. 5 23 May 6 288 ,, 11 48 „ 12 78 „ 12 40 „ 13 232 „ 18 52 „ 19 70 „ 19 45 „ 20 267 „ 25 43 „ 26 69 „ 26 41 „ 27 257 Dee. 2 67 June 2 61 Dec. 3 60 June 3 229 „ 9 50 9 58 „ 10 61 „ 10 245 „ 16 75 „ 16 55 „ 17 44 „ 17 240 „ 23 97 „ 23 44 „ 24 82 „ 24 232 „ 30 75 „ 30 44 „ 31 110 July 1 235 July 7 23 „ 8 164 „ 14 32 „ 15 133 „ 21 35 „ 22 135 „ 28 27 „ 29 132 August 4 22 Aug. 5 87 „ 12 96 „ 19 80 Small Pox and Vaccination. The deaths in London from small-pox during this Quarter have been 828; of these, as stated by the Registrar-General, 367 or 44.3 per cent. were certified as unvaccinated, 301 were not stated as to vaccination, and 160 as vaccinated, or 19.3 per cent. of the total mortality. These returns not only show that vaccination is not so generally performed as it ought to be, but they also prove that in the cases returned as vaccinated, the operation has not, in every instance, been properly performed. According to the published returns of the Small Pox Hospital at Highgate, as prepared by Mr. Marson, the Resident Medical Officer of that Institution, who is the highest authority in this country on small-pox, it appears that the rate of mortality in those cases in which there have been four well-defined cicatrices, or scara, is so small as to be under 1 per cent.; while amongst those who have been badly vaccinated the rate of mortality is 15 per cent. This being so, and the rate of mortality in London in the vaccinated cases, 8 being, during this Quarter, 4 per cent. above the normal rate of the badlyvaccinated cases, it is manifest that vaccination is very badly performed. It therefore behoves those in authority to consider what further measures are necessary not only for enforcing the universal practice of vaccination, but for securing a greater degree of success in vaccination than at present prevails ; and here I venture to suggest to the medical profession whether the lack of success is not largely due to the inability of private practitioners to secure " arm to arm vaccination," and whether iu the public interest many practitioners might not be disposed to give up the practice of vaccination, and refer their patients to the public vaccinator of the District. It may be a sacrifice to some medical practitioners, especially to those who have a large practice, and who have always a good supply of lymph, to yield to my suggestion; but wheD such facts as I have brought under public notice relating to the imperfect manner in which vaccination is performed are known, I am persuaded that, for the public good, many will make that sacrifice. The two points for consideration which are suggested by the returns of the Registrar-General, are 1st, as to the best means to be adopted for inducing parents to get their children vaccinated, and, 2nd, as to the securing of the best means for the better performance of vaccination. As regards the first, I feel disposed to suggest that a small voluntary association should be formed in every District, for the purpose of visiting the inhabitants of the poorer localities during the prevalence of small-pox. Any one member of this association who would address a few words of kindness to the mother of a family, and explain to her the law relating to vaccination and the importance of it as being the only known means of averting the disease, would confer a greater amount of benefit on the community than now results from the visits of the public Vaccination Officer. Not, however, that the visits of the one should supercede the visits of the other; but it is not improbable that if the visits of the proposed voluntary association were made in the manner suggested, the visits of the paid officer would be the less necessary. As regards the second, if private medical practitioners should not feel disposed to make so great a sacrifice as my suggestions imply, there can, in my opinion, be very little objection in requiring every medical practitioner who vaccinates a child, not only to state that the operation has been "successfully" performed, but to insert in the certificate the number of places in which the operation has been successful, and such certificates should be sent to a public office and there kept for inspection and reference. In my two last Quarterly Reports I made favorable comments on the manner in which the Public Vaccinator, Mr. Charles Blackman, and the Vaccination Officer, Mr. COOMBES, respectively perform their duties; and the beneficial result of their labours is shown in the relatively small mortality 9 from small-pox in this District, during the last six months of the present epidemic, when compared with that in the whole of London. The deaths in London from small-pox during the last six months, have been 2020, or 1 in 1727 of the population, and in the Whitechapel District, during the same period, the deaths have been 38, or 1 in 2015, including 18 which occurred in the Homerton Hospital of patients who had been removed thereto from this District. This fact is certainly remarkable, and especially so, when we consider the extreme density of the population; on which account small-pox is more likely to spread among those who have not been protected by vaccination than in less crowded localities. THE BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT on the outbreak of Small-pox in the Girls' Refuge and King Edward Certified Industrial Schools, Home No. 1, Albert Street, Mile End New Town. Gentlemen, On Monday, the 16th instant, in consequence of information received of the existence of small-pox in the above-named Schools, I visited the same, and from inquiries, the Matron informed me that there had been 9 cases of small-pox in the Institution since the 11th, all of which had been sent to the Small-pox Hospital at Homerton. The first case occurred on Wednesday, the 11th July, in a child named Emily Linstead, aged 13 years, who had been in the School upwards of three months. She had had no opportunity of associating with other children, for she had only been out for walking exercise with the other girls, at which times they are always accompanied with the Governess, and no visitor had been to see her. The second case was that of a child named Julia Price, aged 11 years, which occurred on the morning of the next day. In the evening of the same day another case occurred. On the following day, Friday, 3 other children were attacked, and on Saturday 3 more; and on the Tuesday, the day after my visit, another child was attacked with the disease, thus making a total of 10 cases in six days. I endeavoured to trace the cause of this outbreak of small-pox; but I have been unable to do so satisfactorily. It appears that no child during the fortnight previous to the first appearance of the disease who was admitted into the School had been in communication with any person suffering from small-pox; but as the inmates of this establishment are taken from a neglected and destitute class, it is highly probable that some of them may have associated with children who had recently recovered from the disease and may have brought the seeds, or germs, of it in their clothes. There is reason to believe that the oontagious matter of small-pox may remain in clothes for a considerable and perhaps indefinite period; and hence, in all future admissions it will be necessary not only to continue the practice of giving each child on admission a warm bath, and of washing the clothes, but it will be incumbent on the authorities of the School to submit the clothes to a dry heat of 250 degrees, so that any germs of a contagious disease which may be in them may be destroyed. 10 I visited the day rooms and dormitories and I found them well adapted for the purposes for which they are used. Everything in and about the rooms wero very clean. The rooms are well ventilated. There is a large play-ground, asphalted, in which there is a swing and other appliances for exercise. The institution is supported to a considerable extent by voluntary contributions, by a grant from Government, and by the School Board for London. The rooms in which small-pox existed have been disinfected by sulphurous acid gas; and I am able to say that no new case has occurred in this Establishment since the 17th inst. I am, Gentlemen, Your obedient Servant, JOHN LLDDLE. 15, Great Alie Street. Dated 23ril July, 1877. Return of fever cases received into the Infirmary of the Workhouse for the three months ending Saturday, 30th June, 1877. TABLE showing the Localities from which the Patients were received into the Infirmary of the Workhouse, and other particulars relating to them. Class and description of Fever. Previous Residence. Date of admission into Infirmary. Date of admission into Fever Hospital. Length of time in the Infirmary before appearance of Fever. Whether or not Patients had Fever on admission. Enteric 4, Little Paternoster Row, Brusbfield Street May 22 May 23 1 day No Enteric 6, Charlotte Place, W.C.. Jun.18 Jun.19 1 day Slightly The following is a copy of a communication signed by 34 inhabitants of the Spitalfields sub-District, which was sent to me, directing my attention to certain unhealthy courts and streets therein :— Artizans' and Labourers' Dwellings' Act, 1875. Spitalfields, March 5th, 1877. To JOHN LIDDLE, Esq., Medical Officer of Health of the District of Whitechapel in the County of Middlesex. We the undersigned ratepayers of the District of Whitechapel, within the jurisdiction of the Local Board to which you are appointed Medical Officer of Health, do hereby make complaint to you of the unhealthy condition of the areas hereinafter mentioned, arising from the closeness, narrowness, and bad arrangement of the streets and courts, and the defective Btate of the dwellings in respect of light, air and ventilation; and request that you will inspect the same under the provisions of tho Artizans' and Labourers' Dwellings' Improvement Act, 1S75:— 11 AREA No. I. Great Pearl-street, Spitalfields. Crown-court, Spitalfields. Little Pearl-street, „ New-court, do. Grey Eagle Street—part of east-side Wilk-court, do. adjacent to Great Pearl-street Half Wilk-court do. Vine-court, Spitalfields. Diamond-court, do. AREA No. II. King-street, Nos. 5, 6, 7, 8, 9, 10 and 11, Spitalfields. Matthew's-buildings in rear of above. Signed by Truman, Hanbury, Buxton & Co., and 33 other persons or firms. The following is a copy of the official representation made to the Metropolitan Board of Works on the above communication. In the Matter of the Aktizans' and Labobbebs' Dwellings' Impbovement Act, 1875— To the Metropolitan Board of Works, the Local Authority as regards 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 thirty-four persons liable to be rated as in the said Act mentioned (a copy of which communication I send herewith) complaining to me of the unhealthy condition of certain areas, comprising—Area No. I.: Great Pearlstreet, Little Pearl-street, Grey Eagle-street, part of east side adjacent to Great Pearl-street, Vine-court, Crown-court, New-court, Wilk-court, Half Wilk-court and Diamond-court, and—Area No. II., King-street, Nos. 5, 6, 7, 8, 9, 10 and 11, and Matthew's-buildings in rear thereof; all of which are in the Parish of Spitalfields, in the County of Middlesex, within your jurisdiction. In accordance with the provisions contained in the before-mentioned Act I have inspected the Areas 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, as well as by reason of the bad condition of the several streets, courts, and houses within an area which forms part of the Area No. I complained of are unfit for habitation, and that diseases indicating a generally low condition of health amongst the population have been from time to time prevalent there, and the death-rate of such population has been excessive. I further desire to represent that the evils connected with such houses, courts and alleys, and the sanitary defects in such area, cannot be effectually remedied otherwise than by an improvement scheme for the re-arrangement and re-construction of the streets and houses within the area extending on (he south from the rear of the building known as the Royal Cambridge Music Hall in Commercial-street, eastward along a portion of Vine-court and a portion of Little Pearl-street, to the rear of a building used as a bacon store in Grey Eagle-street; bounded on the east partly by the rear of 12 the Said store and the rear of six houses in Grey Eagle-street, numbered 23, 25, 27, 29, 31 and 33; on the north by the rear of the houses on the south side of Quakerstreet and extending from Grey Eagle-street to Wheeler-street; and on the west by the rear of a public-house in Wheeler-street, called "The Ship," and by Wheelerstreet to include the houses numbered 22, 23, and 23½ in that street; from thence eastward along Great Pearl-street by the side of the Cocoa Manufactory there; and from thence south along the rear of the said Royal Cambridge Music Hall in Commercial-street to the starting point; and which area is more particularly delineated on the plan hereto annexed and coloured red. This area is about 8650 square yards, and contains a population of about 1050; which gives about 8 square yards to each person. The annual rate of mortality in this area is exceedingly high, being on an average of the last three years 33.8 per 1000; while that for the whole District of Whitechapel during the same period has been 26.4 per 1000. In my opinion, as at present informed, the Area No. II. mentioned in the said communication, or complaint, is not an unhealthy area for the purposes of the said Act. I am, Gentlemen, Tour obedient Servant, JOHN LIDDLE. 15 Great Alie Street, 20th July, 1877. In confirmation of the unhealthiness of the above-mentioned area I append the following letter from Dr. Swyer, one of the Medical Officers of the Whitechapel Union: 32, Brick Lane, Spitalfields, 16th July, 1877. Dear Sir, I think I can assert most positively, that diseases of a low type, and especially scrofula and mesenteric disease, amongst children prevail, and always have prevailed, to a larger extent than in any other part of my Medical District in the locality you have mentioned, viz.:—Great and Little Pearl-street, New-court, Wilk-court and Diamond-court, Great Pearl-street »nd Crown-court, Vine-yard, and Vine-court, Little Pearl-street. I am, Dear Sir, Yours very truly, SEP. SWTEE. J. Liddle, Esq. Inspector's Department. Mr. Battrah reported to the Board that he had seized about six hundred rotten eggs which were exposed for sale. The owner of the eggs was summoned before the Magistrate, who ordered them to be destroyed, and inflicted a fine of £10 and 2s. costs, or one month's imprisonment. 13 Sanitary Works Performed during the Quarter euded 30th June, 1877. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ended 30th June, 1877:— Number of inspections of houses as shown in the official returns 2449 Houses specially visited 386 Houses specially re-visited 965 Preliminary notices served, such notices embracing 367 premises 214 Compulsory orders issued, embracing 130 premises 60 Summonses heard at Police Courts, under Sanitary Act 3 ,, ,, ,, Adulteration Act 0 Cellars used as dwellings discontinued for such use 1 Cases of overcrowding and indecent occupation abated 0 Houses in which rooms or passages have been whitewashed 129 Rooms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 41 Articles disinfected in rooms, consisting of beds, bedding, clothing, &c. 410 Yards of houses paved, or the pavement repaired 31 Drains in houses improved 69 Dust-bins provided 15 Privies lime-washed, cleansed and repaired 127 "Water supply provided or improved 10 Nuisances from dung, and other offensive matter removed 24 Area gratings, cellar flaps, &e., repaired 1 Animals kept so as to be a nuisance removed 6 Cesspools abolished 1 The cow-houses in the District, 30 in number, and the slaughter-houses14, 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, 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 June, 1877. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhœa. Cholera and Choleraic - D iarrhœa. Continued Fever, Typhus & Typhoid. Febricula. Pyæmia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Dr. Swyer 5 9 0 0 1 0 1 7 0 0 0 0 8 8 0 1 0 0 0 0 70 110 Mr. Champneys 9 1 0 2 1 0 0 1 0 1 0 0 43 2 0 2 1 0 0 0 136 199 Mr. Sequeira 3 0 0 1 4 0 1 10 0 0 0 0 10 0 0 4 0 0 0 1 38 72 Mr. H. Braye 9 8 0 8 0 0 0 2 0 0 0 1 15 0 0 1 0 0 0 4 56 104 Mr. Loane 1 1 0 1 0 0 0 6 0 1 0 0 14 0 0 2 0 0 0 0 58 84 Total 27 19 0 12 6 0 2 26 0 2 0 1 90 10 0 10 1 0 0 5 358 569 Corresponding Qr. of previous Year. 0 5 2 2 22 0 9 19 0 1 0 0 52 12 0 9 0 1 2 2 349 487 Workhouse Mr. J. J. Ilott. 6 2 0 1 16 0 2 19 0 7 0 0 140 27 5 62 5 2 9 6 488 797 In addition to the cases attended by Mr. Ilott in the Workhouse, there were 19 cases of syphilis. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ending 30th June, 1877. Districts. Small-Pox. Measles. Scarlet Fever. Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera & Cholcraic Diarrhoea. Total. Remarks. Spitalfields 1 24 0 0 5 4 0 0 34 Mile End New Town 1 11 3 0 3 4 1 0 23 Workhouse. Whiteohapel North 1 5 0 1 3 3 1 0 14 Whitechapel Church 0 2 0 0 2 1 0 0 5 Hospital. Goodman's Fields 0 2 0 0 2 2 0 0 6 Aldgate 1 0 0 0 0 3 0 0 4 Totals 4 44 3 1 15 17 2 0 86 Deaths from Epidemics for the corresponding Quarter, 1876. 0 5 2 1 14 10 6 0 38 Six deaths from small-pox of patients belonging to this District occurred in the Small Pox Hospital at Homerton. TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causes— Deaths under 1 year of age, 1 and under 5 years, and above 60 years; Deaths from Violence, Inquest cases, and Deaths in Workhouse and London Hospital, for the Quarter ending 30th June, 1877. Sub-districts. Enumerated Population in 1871. Births. Deaths. Under 1 year of age. 1 and under 5 years. Persons aged 60 ye?rs and upwards. Violence. Inquest cases. Deaths in Public Institutions. Spitalfields 22499 214 126 39 26 16 3 11 5 Mile End New Town 15550 177 181 36 29 48 4 17 78 Whitechapel North 11597 95 56 23 18 1 1 4 0 Whitechapel Church 7322 55 199 11 16 31 47 53 176 Goodman's Fields 10381 93 47 16 11 8 3 3 0 Aldgate 9224 57 46 12 13 3 2 5 0 Totals 76573 691 655 137 113 107 60 93 259 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT on the Sanitary Condition OF THE WHITECHAPEL DISTRICT, FOE THE QUARTER ENDED DECEMBER 29TH5 1877, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH. London: Printed by Penny & Hull, 121, Lewan Street, Whitechapel, E. 1878, REPORT of the MEDICAL OFFICER OF HEALTH For the Quarter ended 29th December, 1877. To the Board of Works, Whitechapel Disteict. Gentlemen, In the Quarter that ended on Saturday, the 29th December, 1877, the total births in the District were 684, viz.: 363 males and 321 females; and the deaths 613, viz.: 348 males and 265 females. The excess of births over deaths has therefore been, during this Quarter, 71. As the deaths of 162 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, thereby reducing the total mortality to 451, and increasing the number of births above deaths to 233. An allowance, however, must be made for the deaths of residents in public institutions outside the District; but of those I have no return. In the corresponding Quarter of the previous year the total births were 713, and the total deaths 606. In the Spitalfields sub-District the births were 205, and the deaths 94; in the Mile End New Town 146, and the deaths 132; in the "Whitechapel North 114, and the deaths 52; in the Whitechapel Church 62 and 236 (in this sub-District the London Hospital is situated); in the Goodman's Fields 97 and 45; and in the Aldgate 60 and 54. The deaths have exceeded the births in the Whitechapel Church District by 174, but from this number the deaths of the 162 non-residents must be deducted. The proportion of births to deaths is therefore 62 to 74. The deaths in the London Hospital have been 204. In the corresponding Quarter of the previous year the deaths in this Institution were 211. 4 The deaths in the Workhouse have been 61. In the corresponding Quarter of last year they were 81. The deaths from epidemic diseases in the entire District have been 48 ; viz.: 3 from small-pox, 10 from measles, 8 from scarlet-fever, 4 from hooping-cough, 12 from diarrhoea, and 11 from fever. Three deaths of patients from this District occurred in the District Small Pox Hospital; thus making a total of 6 deaths from small-pox. No deaths occurred in the Fever Hospital in this quarter, or in the quarter ending 30th June. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 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. In addition to the 10 deaths from fever there was 1 in the Fever Hospital; and to the 8 deaths from small-pox there must be added 6 which occurred in the Small-pox Hospital, thus making a total of 11 deaths from fever and 14 from small-pox for that Quarter. Mortality of Young Children. The mortality of children under 1 year of age was 121. This is 19.7 per cent. of the total mortality. In the corresponding Quarter of the previous year it was 20.2 per cent. In the Spitalfields sub-District the rate is 37.2 per cent.; in the Mile End New Town 22.7 per cent.; in the Whitechapel North 20.9 per cent.; in the Whitechapel Church 7.2 per cent.; in the Goodman's Fields 24.4 per cent.; and in the Aldgate 25.9 per cent. The difference in the rate of mortality of young children in the Mile End New Town and Whitechapel Church Sub-District is thus explained:—in the former the Workhouse is situated, and in the latter the London Hospital. The total deaths under 5 years are 211; which shows a rate of mortality of 34.4 per cent. in relation to the total deaths, including those of non-residents, and 30.9 per cent. to the total births. The rate of mortality under 1 year, in relation to the total births, is 17.6 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter, 444 new cases of illness out of the Workhouse; including 18 of small-pox, 13 of measles, 2 of hooping-cough, 4 of diarrhœa, 12 of febricula, 12 of fever, and 4 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 512; including J 9 of small-pox, 3 of measles, 2 of scarlet-fever, 23 of diarrhœa, 3 of fever, 29 of febricula, and 2 of erysipelas. The total number of cases of illness in the Workhouse has been 765; including 3 of measles, 10 of diarrhoea, 31 of febricula, and 9 of fever. In addition to the above cases there were 34 of syphilis; thus making a total of 799. 5 I may here observe that the 18 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 20 cases which were attended by private medical practitioners; and it appears from the returns which have been kindly sent to me by Mr. Vallance, that 25 patients were removed to the Metropolitan Small Pox Hospital during this Quarter from the District, of which number 3 died. Fourteen patients, suffering from fever, were sent to the Metropolitan Fever Hospital during the same period, none of whom died. All the rooms in which patients have suffered, either from fever, scarlet-fever, or small-pox, which were reported to the Sanitary Officers, have been disinfected. The Committee of the London Hospital have kindly forwarded to me the following return of Medical Cases, from this District, admitted into the Hospital for the Quarter ended 30th September, 1877:— WHITECHAPEL (including Spitalfields, Mile End New Town, the Tower, Mint, &c.), DISTRICT. OCCUPATIONS. MALES. Total No. of Cases. Fatal Oases. General Diseases, Class I. General Diseases, Class II. Arthritic Diseases. Diseases of Nervous System. Diseases of Vaseular System. Diseases of Respiratory 6ystem. Diseases of Digestive System. Diseases of Urinary System. Zymotic Diseases. labourer, in-door—Heavy Work 6 1 1 3 1 „ „ light Work 16 2 3 1 4 4 2 „ out-door—Heavy Work 20 1 4 4 5 3 3 „ ,, Light Work 8 1 3 2 2 Seamen 2 1 1 Poisonous or injurious Professional Clerks Children and persons of no occupation 13 1 3 2 4 2 1 Total No. of cases 65 3 3 11 11 19 12 6 Fatal cases 7 1 2 3 1 6 WHITECHAPEL DISTRICT—Continued. OCCUPATIONS. FEMALES. Total No. of Cases. Fatal Cases. General Diseases, Class I. General Diseases, Class 11. Arthritic Diseases. Diseases of Nervous System. Diseases of Vascular System. Diseases of Inspiratory System. Diseases of Digestive System. Diseases of Urinary System. Diseases of Generative Organs. Zymotic Diseases. Domestic 30 2 1 4 5 3 9 3 1 2 1 In-door Trades 6 1 2 1 1 1 Out-door Trades 3 1 1 1 Poisonous or injurious 1 1 Professional Children and persons of no occupation 10 2 1 1 3 2 1 Total No. of cases 50 4 2 7 7 8 9 8 3 2 1 Fatal cases 4 2 1 1 "General Diseases, Class I.," embraces measles, scarlet fever, typhus fever, enteric fever, cerebro-spinal mehingitis, pyaemia, ague, erysipelas, puerperal fever, acute tuberculosis, pyrexia (from undetermined causes). "General Diseases, Class II.," embraces purpura, scurvy, scrofula, rickets, anosmia, cancer, syphilis, diabetes, general dropsy, &c. FRANCIS WARNER, M.D., Medical Registrar. Return of fever cases received into the Infirmary of the Workhouse for the three months ended Saturday. 29th December. 1877. TABLE showing the Localities from which the Patients were received into the Infirmary of the Workhouse, and other particulars relating to them. Class and description of Fever. Previous Residence. Date of sion into Infirmary Date of mission into Fever Hospital Length of time in the Infirmary before appearance of Fever. Whether or not Patients had Fever on admission. Enteric 7, Gun-street Oct. 4 Oct. 6 1 day No „ 9, Flower and Dean-street „ 4 „ 15 8 „ „ 186, Old Montague-street „ 13 „ 15 1 „ „ Typhus 9, Flower and Dean street „ 14 „ 15 1 „ Slightly Enteric 19, George-st. Spitalfields Nov. 20 Nov.24 1 „ No „ 48, Wentworth-street „ 24 „ 27 2 „ „ „ 1, Angel-alley „ 27 Dec. 4 3 „ „ Typhus 2, George-street Dec. 4 „ 5 1 „ Slightly Enteric 1, Crown-ct., Wentwth-st. „ 13 „ 15 2 „ No The residences mentioned in the above list, with one exception, are registered Common Lodging Houses. The above return, which has been kindly prepared by Mr. Ilott, shows that all the patients who were sent to the Fever Hospital from the 7 house, had been such a short time in that institution as to preclude the idea that fever originated therein; and as the period of incubation of fever is about eight, nine, or ten days, the patients had the disease before admission. Meteorology of Greenwich. The Returns of the Registrar-General show that the rain-fall in the Metropolis, during the Quarter, has been 6.73 inches. Of the 6.73 inches of rain which fell during this Quarter, 1.24 inches fell in the week ended October 27th, 1.12 inches in that ended November 24th, and 1.07 in the following week. Thus, more than the half of the rain which fell in the entire quarter fell in three weeks. 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 10.28 inches. The mean temperature of the air was 45.0°. In the corresponding Quarter of last year it was 47.2°. The coldest days during the Quarter were Thursday, the 18th October, Friday, the 28th December, and Tuesday, the 25th December, when the thermometer indicated respectively 28.2°, 28.7°, and 28.9°. The coldest day during the corresponding Quarter of last year was on Friday, the 10th November, when the thermometer indicated 25.5". Table of "Weekly Mortality, &c., in London and in the "Whitechapel District. The following Table, taken from the Returns of the Registrar-General, shows the comparative results of the Quarter:— Week ending Deaths in London. Deaths in Wchpl. District Rainfall. Mean Temperature of the air. Diarrhœa. Fever. Small-pox From all causes. From Smallpox. From all causes. Inches- Degrees Oct. 6 36 19 14 1308 0 43 0.00 48.5 „ 13 48 29 14 1321 0 39 0.33 48.1 „ 20 25 47 8 1403 0 41 0.13 46.7 „ 27 23 39 14 1499 0 60 0.24 49.7 Nov. 3 19 39 9 1447 0 42 0.04 49.1 „ 10 12 42 25 1448 0 47 0.72 51.0 „17 23 28 14 1435 0 61 0.83 45.6 „ 24 13 38 27 1571 0 49 1.12 42.8 Dec. 1 16 36 31 1579 0 46 1.07 41.9 „ 8 19 27 25 1547 1 50 0.49 43.4 „ 15 10 26 31 1613 0 50 0.18 39.0 „ 22 14 41 31 1761 1 44 0.03 41.8 „ 29 12 36 29 1757 1 41 0.55 37.8 8 VACCINATION. WHITECIIAPEL 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 VACCINAT0R Workhouse Totals. Births Registd. Primary Cases "Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. 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 March, 1877 408 500 37 27 445 527 757 Juue 382 5 24 1 406 6 699 September 336 — 26 - 362 — 607 December 241 3 32 — 273 3 704 Totals 2673 709 261 28 2934 737 5531 From the above Table, it appears that 38.7 per cent, of the number of children whose births were registered in this District have undergone primary vaccination at the hands of the Public Vaccinator, and the Resident Medical Officer of the Workhouse, while in the preceding quarter there were 62.2 per cent. Small Pox. It appears from the returns of the Registrar-General, for the week ended on Saturday, the 19th January, that "the deaths from small-pox which had been 26 and 25 in the two preceding weeks, further rose to 51 last week; a higher number than in any week since the middle of June last; 30 occurred in the Metropolitan Asylum Hospitals, and 21 in private dwelling houses. Of the 51 fatal small-pox cases in the Metropolis, 25 were certified as unvaccinated, and 14 as vaccinated; while in the remaining 12 cases the medical certificates gave no information as to vaccination." The Registrar-General further remarks "that the number of small-pox patients in the Metropolitan Asylum Hospitals which had declined at the beginning of October last to 137, has since steadily increased to 309, 374, 415, and 468 at the end of the last four weeks. During the same weeks the numbers in the Highgate Small Pox Hospital had been 26, 36, 43 and 47. 9 Notwithstanding all the care which is taken by the several Local Authorities to induce parents to get their children vaccinated, we find that out of 735 deaths from small-pox which occurred in the year 1876, 325, or more than the half, took place among the unvaccinated ; to which a large number of the 191 cases may be added in which no medical certificate was given as to vaccination. I am sorry to observe that in this District the number of vaccinations has fallen off. The following Table is continued from my last Quarterly Report, and exhibits the Weekly progress in London cf the existing epidemic of Small-pox, and that of 1870-71 in the corresponding weeks:— 1876. Week ending Deaths 1877. Week ending Deaths 1870-1. Week ending Deaths 1870-1. Week ending Deaths July 8 13 May 5 54 July 9 13 June 3 229 „ 15 2 „ 12 78 „ 16 11 „ 10 245 „ 22 8 „ 19 70 „ 23 15 „ 17 240 29 7 „ 26 69 „ 30 11 „ 24 232 Aug. 5 1 June 2 61 Aug. 6 15 July 1 235 12 9 9 58 „ 13 11 8 164 „ 19 5 „ 16 55 „ 20 10 „ 15 133 „ 26 10 „ 23 44 „ 27 11 „ 22 135 Sept. 2 8 „ 30 44 Sept. 3 9 29 132 9 5 July 7 23 „ 10 12 Aug. 5 87 ,, 16 6 „ 14 32 „ 17 11 „ 12 96 „ 23 11 „ 21 35 „ 24 15 „ 19 80 „ 30 15 „ 28 27 Oct. 1 13 „ 26 82 Oct. 7 11 August 4 22 8 27 Sep. 2 78 „ 14 16 „ 11 20 „ 15 13 9 81 „ 21 22 „ 18 21 „ 22 17 „ 16 57 „ 28 15 „ 25 11 „ 29 21 „ 23 89 Nov. 4 21 Sep. 1 20 Nov. 5 23 „ 30 51 „ 11 48 „ 8 8 „ 12 40 Oct. 7 72 „ 18 52 „ 15 10 „ 19 45 „ 14 61 „ 25 43 „ 22 10 „ 26 41 „ 21 53 Dec. 2 67 „ 29 13 Dec. 3 60 „ 28 61 „ 9 50 Oct. 6 14 „ 10 61 Nov. 4 61 „ 16 75 „ 13 14 „ 17 44 „ 11 54 „ 23 97 „ 20 8 „ 24 82 „ 18 76 „ 30 75 „ 27 14 „ 31 110 „ 25 67 Jan. 6 116 Nov. 3 9 Jan. 7 79 Dec. 2 78 „ 13 100 „ 10 25 „ 14 135 „ 9 104 „ 20 79 „ 17 14 „ 21 188 „ 16 106 „ 27 86 „ 24 27 „ 28 157 „ 23 90 Feb. 3 103 Dec. 1 31 Feb. 4 196 „ 30 97 „ 10 90 „ 8 25 „ 11 211 1872 „ 17 72 „ 15 81 „ 18 218 Jan. 6 91 „ 24 104 „ 22 31 „ 25 227 „ 13 90 March 3 84 „ 29 29 March 4 213 „ 20 93 „ 10 96 1878 „ 11 194 „ 27 90 „ 17 100 Jan. 5 26 „ 18 185 Feb. 3 52 „ 24 76 „ 12 35 „ 25 205 „ 10 68 „ 31 86 „ 19 51 April 1 192 „ 17 48 April 7 78 „ 26 34 „ 8 214 „ 24 53 „ 14 60 Feb. 2 38 „ 15 265 Mar. 2 52 „ 21 68 „ 22 276 9 49 „ 28 89 „ 29 261 „ 16 42 May 6 288 „ 23 48 „ 13 232 „ 30 55 „ 20 267 „ 27 257 10 Having received information that small-pox was very prevalent in the western part of Mile End Old Town, I directed Mr. Battram to make a special visit to those houses situated at the eastern extremity of this District. The inspector visited about 26 houses abutting on Mile End Old Town, in which he found that sanitary defects existed in most of them, for which he served the usual notices on the respective owners to remedy the same; but he did not hear of the existence of any case of small-pox. The importance of inspecting the houses occupied by the poor is exemplified in the following instance:— On visiting a house, No. 23 Goulston-street, where a child was ill with small-pox in the first-floor room, Mr. Wrack, the Sanitary Inspector, ascertained that three children of the same family were attending respectively the Board School iu Castle-alley, the Jews' Free School in Bell-lane, and the Jews' Infaut School in Commercial-street. The Sanitary Inspector immediately went to each of these Schools, and on seeing the Master and Mistresses informed them that small-pox existed at the home of these children, and consequently they should not for the present be allowed to continue their attendance at these Schools. The children were immediately sent home, and the Master and Mistresses expressed their thanks to the Inspector for the information he had given them. In about a fortnight afterwards two of these children were attacked with small-pox, and were removed to the Small-Pox Hospital. The mother, who is a foreigner, said that the children had been vaccinated. Overcrowding. In my last Report I directed the attention of the Board to the subject of overcrowding which, from the reports of the Inspectors, prevails to a very great extent in this District; and not only in this, but probably in many other districts in London. As the danger to the public health from this cause cannot, perhaps, be over-estimated, I have instructed the Inspectors to make diligent inquiries respecting the extent of this evil, and ascertain as far as practicable, the general condition of the rooms in those houses which are let out in tenements; but I need scarcely say, that as there are about 4500 out of the 8313 houses in this District which are let out in separate tenements, it is impossible that all of them, within any reasonable time for taking action to prevent overcrowding, can be visited. Nevertheless, much has been done by the Inspectors who, I am pleased to be able to say, feel an interest in the promotion of sanitary measures, and have 11 expended much labour, of a most irksome and unpleasant kind, in investigating and bringing to light many instances of overcrowding and indecent occupation. It appears from the notes furnished to me by the Inspectors, that one cause of the overcrowding in this District is from the large immigration of foreigners, principally from Poland, who arrive here in a state bordering on destitution, and are received by their fellow-countrymen, who are not in a much better pecuniary condition; but who, nevertheless, allow them to occupy a portion of their only room, in which their own family resides, until the new comers can obtain work. The rents of the houses in many of the poor neighbourhoods, particularly those bordering on the city, are much increased, owing to such houses being in great demaud. Many of them are in the possession of foreigners who, in order to pay the advanced rent which is demanded, are compelled to crowd into each room as many as it will hold. A curious fact has been brought to light by the visits of the Inspectors, viz.: that the English and Irish, who formerly occupied these houses, have either been compelled to remove, or have left of their own accord in consequence of the advance of rent, although the accommodation is not improved. The result is, that they go a short distance from London and avail themselves of the early and cheap workmen's trains, or the tram cars. It further appears that the people of different nations do not harmoniously amalgamate; for we find that the English Jews, who are very numerous in this District, live together in certaiu localities, while the foreigners live together iu other parts ; the Irish are located by themselves, and so are the English. It might be inferred from what has been just stated that the high rent which is demanded for lodgings in poor neighbourhoods is the cause of overcrowding; it may be so to some extent; but in my opinion the price for which rooms are now let has not so much to do in causing overcrowding as many people may imagine; for, if rooms could be obtained for one shilling, or even for a less sum per week, the practice of sub-letting rooms would not be diminished; the desire of living not only rent free, but the obtaining of a further profit by sub-letting a portion of the room, would still prevail. The question may be properly asked—how is this state of things to be remedied? Every person, whatever his condition of life, and wherever his residence, is deeply interested in this inquiry; and it is in vain to assert that the question of overcrowding among the poor in narrow and confined 12 places does not concern the wealthy inhabitants of- cities and towns who live in well-ventilated houses, and which are surrounded by open spaces; but it, nevertheless, does concern the whole community, as is strikingly shown by the spread of many diseases which are, perhaps, in the first instance endemic, and confined to these overcrowded places, but which soon become epidemic and extend over large areas, attacking indiscriminately all classes. As laws have been enacted for the abatement of overcrowding, it is easy to say let those in authority put them in force; but I much fear, unless the question is taken up with a spirit of love towards the poorer and more ignorant classes by the upper and middle classes, and measures adopted to give instruction to the poor in matters concerning their physical well-being, the existing state of things will long continue. As a means to be adopted towards the amelioration of the condition of the poorer classes, it has been suggested that voluntary societies should be formed in every district for visiting the houses of the poor, similar to those which were commenced immediately after the publication of a Pastoral Letter by the Bishop of London in 1848, iu which his Lordship pointed out, in clear and forcible terms, the duty of the Clergy and laity in taking cognizance of those external circumstances which affect the moral and physical well-being of the poor; and setting forth, as the result of experience, the intimate connection between disease and pauperism—between filth and immorality. The formation of several District Sanitary Societies soon began after the circulation of this well-timed letter, and among others, one was instituted in the Parish of Whitechapel, of which the late Rev. W. W. Champneys, Rector, was President. The Association consisted of a President, Treasurer, a Committee of thirty-two, au Honorary Secretary and a Collector, and was entitled "The Whitechapel Association for promoting habits tending to the cleanliness, health, and comfort of the Industrious Classes in the Parish." It appears from the report which was issued in October, 1850, that the Committee engaged the services of an Inspector or Agent, at a weekly salary of 25 shillings, who visited every street, lane, and court; every house, tenement, and room inhabited by the class whose improvement was aimed at; and the accuracy of the Agent's statements was in many cases verified by the personal re-visitation of Members of the Committee. In almost every instance the Agent was received with kindness and civility by the poor people, and on many occasions gratitude was expressed 13 for the interest taken by the Committee in their welfare. The report, consisting of twelve pages, contains some valuable remarks on the subject of public health, and lays bare the condition of the houses and surroundings of the people visited, and concludes with the following summary of results:— Number of visits to families, including 51 special visits 7600 „ of persons induced to keep their rooms clean 460 „ „ „ their windows clean 591 „ „ „ to attend the public baths 461 Instances in which nuisances have been removed 26 Number of privies emptied 7 „ of rooms, &c., whitewashed, &c., by tenants at their own expense 14 The Committee, in closing their report, tendered their best thanks to the Trustees of the Parish for the very prompt manner in which they attended to the representations of their agent respecting nuisances, and for the anxiety they had shown in their endeavours to suppress the numerous fertile sources of disease which abound in this populous Parish, not only by the personal exertions of their own Committees, and giving strict injunctions to the Inspector of Nuisances to take legal proceedings against all persons who refused to abate the nuisance complained of (and it appears that within little more than twelve months 384 persons had been proceeded against for nuisances of various kinds but also for representing to the Home Secretary and the General Board of Health, such cases of overcrowding, vice and depravity, as were reported to them, but over which they had no control. I have given above a few details of the working of this useful Association, in the hope that the example will be followed by every district in London. Voluntary Associations for the promotion of Public Health might be advantageously organised, and inspections of the houses and localities, and kindly visits to the poor occupants, might be made from time to time by intelligent persons of both sexes, who would be able and willing to give instruction on matters relating to health. In my report for June, 1877, I suggested the formation of a small voluntary association in every district for the purpose of visiting the poorer localities during the prevalence of small-pox, and kindly explaining to the mother of a family her duty of having her children vaccinated. Such a proceeding would, I believe, do more in promoting the general adoption of vaccination than now results from the visits of paid officers. In 1866, during the prevalence of cholera, voluntary visiting associations were 14 formed in Mile End New Town, in the Church District of Whitechapel, in Spitalfields, in St. Mark's District, Goodman's Fields, and in St. Jude's District, Commercial-street; and the importance of these associations in relieving and encouraging the sick and destitute is shown in the several letters which are printed in my report on the cholera in 1866. It cannot however be expected that such societies will, under the existing state of things, be carried on with much zeal, for since the enactment of the several sanitary laws a staff of officers has been appointed to carry into effect the provisions of the acts relating to the Public Health. There are, however, now in existence in several districts in London, and elsewhere, visiting and home missionary societies, whose usefulness would be vastly increased if attention were paid to the existence of the health destroying agents which so frequently surround the dwellings of the poor, and if the visitors would confidentially inform the sanitary officers of any nuisance which presents itself to their notice. Since the date of my last report I received a letter from Mr. Ilott, the resident Medical Officer of Health of the Whitechapel Union, respecting the sudden death of a child, aged two months, in a cellar at No. 24, Steward-street, Old Artillery Ground, informing me that at an inquest which was held on the body of that child, the coroner and jury requested him to report to the sanitary authority of the District that the cellar in which three or four persons resided was in a foul, unwholesome and uninhabitable state, and that the child's death was, in their opinion, accelerated by its condition. On visiting this cellar it was found to be occupied by a foreigner, his wife and child, aud a man lodger; and was used by these parties as a living and sleeping room, for which three shillings per week was paid for rent. This cellar, which was originally used as a wash-house and coal cellar, is dark and ill-ventilated, and is totally unfit to be used for a liviug and sleeping room. Proceedings were taken against the occupier for overcrowding, and the nuisance is abated. From inquiries it was ascertained that the house, which was formerly occupied by a respectable family, and for which a rent of £30 per annum was paid, is now tenanted by several families, all of whom are foreigners, and the house is now let at £60 per annum. The Sanitary Inspectors have recently made another night visit to three houses in Goulston-street, which they had reason to believe were overcrowded. These houses contained 19 rooms, all of which were inspected 15 and most of them found to be overcrowded. The cubic space which, in the overcrowded rooms, was allotted to each occupant varied from 288 feet, to 72 feet. In this last mentioned case there were seven persons sleeping, viz.: a man and his wife and five children. Out of the 19 rooms which were visited, 8 were overcrowded, and 7 indecently occupied. In a passage adjoining one of these rooms, it was ascertained that three men and three women were sleeping on the floor. These parties had recently arrived from Poland. The Inspectors were informed that the rents for these rooms varied from 2/3 to 4/6 per week. A similar disregard to ordinary cleanliness as was observed in the former visit of the Inspectors was found on this occasion. So long as such overcrowding continues, it will be found not only that the health of the individuals occupying such apartments will suffer, but the health of the public will also become lowered, and the rate of mortality increased. Furnished Rooms. On visiting the so called furnished rooms it was found that some of the bedding, which is made of the commonest sort of materials, was in a most filthy condition. In all those instances notices were given to the respective owners to provide new and clean bedding, &c., who complied with the notices. Sanitary Works Performed during the Quarter ended 29th December, 1877. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ended 29th December, 1877:— Number of inspections of houses as shown in the official returns 2984 Houses specially visited 335 Houses specially re-visited 1035 Preliminary notices served, such notices embracing 329 premises 177 Compulsory orders issued, embracing 165 premises 63 Summonses heard at Police Courts, under Sanitary Act 4 ,, under Act for the prevention of Adulteration of Food, &c. 2 Cellars used as dwellings discontinued for such use 3 Cases of overcrowding and indecent occupation abated 10 Houses in which rooms or passages have been whitewashed 116 Rooms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 43 Articles disinfected in rooms, consisting of beds, bedding, clothing, &c. 344 16 Yards of houses paved, or the pavement repaired 35 Drains in houses improved 44 Dust-bins provided 11 Privies lime-washed, cleansed and repaired 100 Water supply provided or improved 16 Nuisances from dung, and other offensive matter removed 28 Area gratings, cellar flaps, &c., repaired 2 Animals kept so as to be a nuisance removed 20 Cesspools abolished 0 ANNUAL REPORT. The number of Births registered in this District during the year has been 2751, and the Deaths 2506, including those of non-residents in the London Hospital (567). In the preceding year the births were 2754 and the deaths 2348, including the deaths of 511 non-residents. The deaths in the "Workhouse have been 315, against 335 for the previous year; and the deaths in the London Hospital 728 against 716. 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. The deaths being (excluding 567 of non-residents) 1939, the rate of mortality has been, during the year, 25.2 per 1000, or 1 in 39.6 of all living. The rate of mortality during the preceding year was 23.9 per 1000. In making a comparison, however, of the rate of mortality of this District with that of those in which there is no hospital, the total deaths in the London Hospital must be eliminated, which this year, as before stated amount to 728. This gives a rate of mortality of 23.2 per 1000. Deaths from Epidemic Diseases. Of the total deaths recorded in this District during the year, there were 306 from epidemic diseases, viz.: 23 from small-pox, to which must be added 25 which occurred in the Hospital, thus making a total of 48; 96 17 from measle3, 28 from scarlet-fever and diphtheria, 44 from hooping-cough, 89 from diarrhoea, and 30 from fever, including 4 which occurred in Hospital. 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, occurred during the Quarter ending 30th December, 1876. In the first quarter of this year the deaths from small-pox were 28, including 12 which occurred in Hospital; in the second quarter there were 10, including 6 in Hospital; in the third quarter 4, all of which occurred in Hospital; and in the present quarter there were 6, including 3 in Hospital. The total deaths from small-pox, including the 25 which took place in Hospital during the year in this District, containing a population of 76,573, was 48, or 1 in 1596 of the population; while the deaths in the whole of London from this disease, in a population of 3,533,484 were 2544, or 1 in 1388. Of the total deaths in London from small-pox during this year, it appears that 569 occurred among those persons who had been vaccinated; 1080 deaths were of those who had not been vaccinated ; and of the remainder, 895, no information was obtained as to vaccination. The deaths from fever, including those which occurred in the Fever Hospital, have been 30. This is in the proportion of 1 in 2552 of the population In the whole of London, the deaths from fever have been 1240, or 1 in 2841 of the population. From these figures it appears that small-pox has been less fatal in this District than in the whole of London, and fever has been rather more so. The death-rate from epidemic diseases, including those in Hospitals for the year, in relation to the total mortality, is 12.5 per cent. Paupe Illness in the District. The number of out-door sick paupers, who have been attended by the Medical Officers of the Union, has been 2060. During the previous year the number was 2281. The extraordinary annual diminution of the out-door sick paupers, from upwards of 17,000, in the years 1867 and 1868, to 2060 in 1877, 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 3047, including 124 cases of syphilis and 27 of lead poisoning. 18 From the following Table it will be seen that a large amount of sanitary work has been accomplished during the year. Sanitary Works performed during the Year 1877. Number of inspections of houses, as shown in the official returns 11,546 Number of rooms found to be overcrowded, the space being less than 300 cubic ft. for each person—nuisance in each case abated 16 Houses specially visited 1318 „ re-visited 3832 Rooms disinfected with sulphurous acid gas after the occurrence of fever and scarlet-fever therein 157 Articles disinfected, consisting of beds, bedding, clothing, &c. 1670 Preliminary notices served, such notices embracing 1360 premises 823 Compulsory orders issued, embracing 636 premises 25S Summonses heard at Police Courts, under Sanitary Act 8 „ under Act for the prevention of Adulteration of Food, &c. 2 Houses in which rooms or passages have been whitewashed 566 Yards of houses paved, or the pavement repaired 155 Cesspools abolished 1 Drains in houses improved 200 Dust-bins 67 Privies lime-washed, cleansed, and repaired 444 Water-supply provided or improved 53 Area gratings, cellar flaps, &c., repaired 32 Cellars used as dwellings discontinued for such use 7 Nuisances from dung and other offensive matter removed 93 Animals kept so as to be a nuisance removed 52 All the cow-houses 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. 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 ended on the 29th Dec., 1877. 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 8 1 0 0 0 0 3 3 0 0 0 0 5 3 0 3 0 0 0 0 43 69 Mr. Champneys 3 0 0 0 1 0 2 1 0 1 0 0 27 0 0 3 0 0 0 0 82 120 Mr. Sequeira 3 1 0 0 1 0 3 2 0 2 0 0 3 1 0 3 0 0 2 1 63 85 Mr. H. Braye 1 11 0 2 1 0 2 4 0 0 0 0 18 0 0 3 0 0 0 0 72 114 Mr. Loane 3 0 0 0 1 0 2 2 0 1 0 0 6 2 0 7 0 0 0 0 32 56 Totals 18 13 0 2 4 0 12 12 0 4 0 0 59 6 0 19 0 0 2 1 292 444 Corresponding Qr. of previous Year. 19 3 2 0 23 0 3 29 0 2 0 0 81 10 0 12 2 0 1 2 323 512 Workhouse Mr. J. J. Hott. 0 3 0 0 10 0 9 31 0 0 0 0 128 26 4 109 3 2 5 6 429 765 In addition to the cases attended by Mr. Ilott in the Workhouse, there were 34 cases of syphilis. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ended 29th Dec., 1877. Sub-districts. Small-Pox. Measles. Scarlet Fever. Diphtheria. HoopingCough. j Diarrhœa. Fever. Cholera & Choleraic Diarrhœa. Total. Remarks. Spitalfields 2 1 4 0 2 7 0 0 16 Mile End New Town 0 0 2 0 0 4 0 0 6 Workhouse. Whitechapel North 0 1 0 0 0 0 2 0 3 Whitechapel Church 1 2 1 0 1 1 7 0 13 Hospital. Goodman's Fields 0 3 1 0 1 0 1 0 6 Aldgate 0 3 0 0 0 0 1 0 4 Totals 3 10 8 0 4 12 11 0 48 Deaths from Epidemics for the corresponding Quarter, 1877. 8 3 4 1 2 10 10 0 38 Three deaths from small-pox of patients belonging to this District occurred in the SmallPox Hospital at Homerton. No death from fever occurred in the Fever Hospital, although 10 cases were sent from this District. TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causes- Deaths under 1 year of age, 1 and under 5 years, and above 60 years; Deaths from Violence, Inquest cases, and Deaths in Workhouse and London Hospital, for the Quarter ended 29th Dec., 1877. Sub-districts. Enumerated Population in 1871. j Births. Deaths. Under 1 year of age. 1, and under 5 years. Persons aged 60 years and upwards. Violence. Inquest cases. Deaths in Public Institutions. Spitalfields 22499 205 94 35 14 9 2 8 1 Mile End New Town 15550 146 132 30 17 36 5 16 61 Whitechapel North 11597 114 52 14 8 6 1 2 0 Whitechapel Church 7322 62 236 17 24 36 45 53 204 Goodman's Fields 10381 97 45 11 13 9 1 4 0 Aldgate 9224 60 54 14 14 7 5 12 0 Totals 76573 684 613 121 90 103 59 95 266 TABLE IV. Total number of the undermentioned Diseases recorded in the Books of the Medical Officers of the Union, from 1866 to 1877, 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. 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 51 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 1876 9 0 0 306 58 0 62 3 6 8 2281 1877 12 0 0 277 31 1 53 3 4 12 2060 TABLE V. Showing the total Births, Deaths, Deaths of Non-residents, Residents, and total Deaths in the London Hospital in each year, from 1866 to 1877. Year. Population. Total Births. 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 percent, 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. 1866 78,970 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 ... 2571 2465 551 339 545 25.6 27.7 7.1 1872 76,573 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 1877 ... 2751 2506 728 567 516 26.6 25.2 6.7 *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 366. In the preceding year the number was 365. TABLE VI. Showing the Deaths from Epidemic Diseases in the Whitechapel District daring the last 15 years. Name of Disease * 1863 1864 1865 1866 1867 1868 * 1869 1870 1871 1872 * 1873 1874 1875 1876 1877 Small Pox 69 5 22 44. 40 11 1 56 159 19 1 1 2 8 23 Measles 26 137 28 139 33 69 71 36 42 23 44 33 40 16 96 Scarlet Fever & Diphtheria 200 50 80 76 26 48 208 59 25 96 24 199 51 18 28 Hooping Cough 52 74 97 94 72 55 113 50 43 9 79 16 61 57 44 Diarrhœa 114 109 122 119 100 138 97 107 125 99 113 76 93 103 89 Fever 158 170 167 100 82 109 95 52 40 26 44 47 30 27 26 Cholera &Cho leraic-Diaha. 5 2 4 904 9 10 7 6 3 5 8 3 0 0 0 Totals 624 547 520 1476 362 440 592 366 437 277 313 375 277 229 306 London Fever 2802 3689 3232 2681 2174 2483 2211 2049 1755 1003 1548 1553 1282 1206 1240 Searlla. & Diph. 5799 3806 2614 2316 1836 3418 6162 6306 2220 1063 932 3037 4038 2673 1776 Small Pox. 2012 537 646 1388 1339 606 273 958 7834 1532 114 56 75 739 2544 The deaths from Fever, in the Fever Hospital belonging to the Asylum Board, of patients removed from this District were 4, and those from Small-pox were 25 The deaths, therefore, from epidemic diseases in this District were 335 for the year 1877. TABLE VII. Showing the cases of Epidemic Diseases among the pauper population in the Whitechapel District during the last 15 years. Name of Disease * 1863 1864 1865 1866 1867 1868 * 1869 1870 1871 1872 * 1873 1874 1875 1876 1877 Small Pox 253 21 86 261 254 93 5 302 625 60 2 1 0 19 125 Measles 80 482 51 679 155 323 212 257 178 76 128 59 32 32 64 Scarlet Fever & Diphtheria 305 156 164 197 60 54 311 97 32 16 22 161 17 6 8 Hooping Cough 169 217 280 217 219 144 308 140 102 94 86 30 44 15 24 Diarrhœa 1108 1127 1342 1664 1471 1631 1033 1097 590 283 212 150 101 120 61 Fever 464 295 573 343 308 586 385 325 201 19 126 84 24 34 17 Cholera & Choleraic-Diaha. 1 4 4 58 5 8 1 4 2 3 2 0 0 0 1 Totals 2380 2302 2500 3419 2472 2839 2255 2222 1730 551 578 485 218 226 300 The cases of Febricula have been 83. In the preceding year the cases of Febricula were 86. * In the above Tables the years 1863, 1869, and 1873, consist of 53 weeks.