WHI 30 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE SANITARY CONDITION OF THE WHITECHAPEL DISTRICT FOR THE QUARTER ENDED 1ST APRIL, 1882, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH. London: Printed by Penny & Hull, 53, Leman sr., Whitechapel, F. 1882. 1882. REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ended Ist April, 1882. TO THE BOARD OF WORKS, WHITECHAPEL DISTRICT. Gentlemen, In the Quarter that ended on Saturday, the 1st April, 1882, the total births in the District, were 644, viz., 321 males and 323 females; and the deaths 656, viz,, 347 males and 309 females. The excess of deaths over births has therefore been, during the Quarter, 12. 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 527, and thus increasing the number of births above deaths to 117. 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 694, and the total deaths 638. The weekly average of births was 53.3, and of deaths 49.0; and in the present Quarter the weekly average of births has been 49.5 and of deaths 50.4. In the Spitalfields sub-District, the births were 200, and the deaths 114; in the Mile End New Town 168 and the deaths 178 (in this sub-District the Workhouse is situated); in the Whitechapel North 83, and the deaths 61; in the Whitechapel Church 68, and the deaths 223 (in this sub-District the London Hospital is situated); in the Goodman's Fields 81, and the deaths 51; and in the Aldgate 44, and the deaths 29. The deaths have exceeded the births in the Whitechapel Church sub-District by 155, but the deaths of the 129 non-residents in the London Hospital must be deducted. The proportion of births to deaths is therefore 68 to 94. 4 The deaths in the London Hospital have been 190; of these, 129 were of non-residents in the District, 20 of residents, and 41 of persons who either died suddenly or from the result of accident. The deaths of persons who resided in this District, previous to their admission into the London Hospital, form but a very small proportion of the total deaths in that Institution. Excluding the deaths caused by accident (the previous residences of persons so dying not always being given in the weekly returns), the proportion of deaths of residents in this Quarter is 10.5 per cent. In the last Quarter, ended 31st December, the proportion of deaths of residents to nonresidents was 10.2 per cent. The deaths in the Workhouse Infirmary, Baker's Row, have been 114. In the corresponding Quarter ot last year they were 102. The deaths from epidemic diseases in the entire District have been 88; viz., 1 from small-pox, to which must be added the 2 deaths which occurred in the Small-pox Hospital of persons who had been resident in this District, thus making 3 from small-pox, 4 from measles, 7 from diphtheria, 59 from hooping-cough, 10 from diarrhcea, and 9 from fever, including 2 which occurred in the Fever Hospital of patients removed from this District. In the corresponding Quarter of the previous year, the deaths from epidemic diseases were 67, viz., 14 from small-pox (including 9 deaths which occurred in the Small-pox Hospital), 33 from measles, 5 from scarlet-fever, 2 from diphtheria, 4 from hooping-cough, 1 from diarrhcea, and 8 from fever. Mortality of Young Children. The mortality of children under 1 year of age is 105. This is 16.0 per cent, of the total mortality. In the corresponding Quarter of the previous year it was 13.4 per cent. In the Spitalfields subDistrict the rate is 22.8 per cent.; in the Mile End New Town 11.7 per cent.; in the Whitechapel North 24.5 per cent.; in the Whitechapel Church 6.1 per cent; in the Goodman's Fields 33.3 per cent.; and in the Aldgate 41.3 per cent. The difference of the rate of mortality of young children in the Mile End New Town and Whitechapel Church sub-Districts is thus explained:—In the former the Workhouse is situated, and in the latter the London Hospital; in both these Institutions the children under 1 year bear only a small proportion to the adults. The total deaths under 5 years, during the Quarter, are 208, which shows a rate of mortality of 31.7 per cent, in relation to the total deaths, including those of non-residents, and 32.2 per cent, to 5 the total births. The rate of mortality under one year, in relation to the total births, is 16.3 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter, 1075 new cases of illness out of the Workhouse; including 6 of small-pox, 3 of measles, 24 of hooping-cough, 8 of diarrhæa, 9 of fever, 24 of febricula, and 7 of erysipelas. In the corresponding Quarter of the previous year, the number of pauper cases of illness was 1246; including 46 of small-pox, 85 of measles, 3 of scarlatina, 6 of diarrhæa, 17 of febricula, and 5 erysipelas. The total number of cases of illness in the Workhouse has been 911; including 3 of small-pox, 3 of measles, 6 of hooping-cough, 3 of diarrhoea, 5 of erysipelas, and 9 of febricula. In addition to the above cases there were 41 of syphilis and gonorrhæa; thus making a total of 952. Uncertified Deaths. One uncertified death is recorded during the Quarter, and is returned in the Aldgate sub-District. Meteorology of Greenwich, The Returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter, has been 3.63 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 5.43 inches. The mean temperature of the air was 42.6 In the corresponding Quarter of last year it was 37.4. The weather during this Quarter has, like the previous one, been unusually mild. On only 16 days has the thermometer registered the temperature of the atmosphere as below 32°. The coldest days during the Quarter were Thursday, the 2nd February, Wednesday, the 25th January, and Saturday, the 3rd February, when the thermometer indicated respectively 24°8, 25°4, and 25°7. The coldest day during the corresponding Quarter of the previous year was on the 17th January, when the thermometer indicated 12°7. The lowest mean temperature during any week in the Quarter was that which ended Saturday, 28th January, when the thermometer indicated 34°2. In the corresponding Quarter of last year the lowest mean temperature in any week was in that which ended January 22nd, when it was 23°4. The results of the meteorological observation are to be understood as applying to the civil day, or from midnight to midnight. 6 Table of Weekly Mortality, &c., in London and in the Whitechapel District. Week ended Deaths in London. Deaths in Wchpl. District Rainfall. Inches. Mean Temperature of the air. Degrees  Diarrhæa and Dysentery. Fever. Small-pox. From all causes. From Smallpox. From all causes. Jan. 7 12 24 20 1858 0 41 0.60 43.9 „ 14 13 31 21 1737 0 63 0.58 43.9 „ 21 11 20 20 1700 1 60 0.00 36.2 „ 28 23 19 24 1971 0 48 0.00 34.2 Feb. 4 15 26 13 2023 0 55 0.17 36.7 ,, 11 8 18 17 2632 0 59 0.00 38.1 „ 18 11 18 17 2188 0 58 0.53 45.5 „ 25 14 28 8 1941 0 41 0.05 44.3 March 4 7 21 23 1790 0 47 0.79 44.3 „ 11 14 17 19 1793 0 50 0.14 48.1 „ 18 13 27 8 1691 0 51 0.01 47.6 25 19 37 13 1827 0 48 0.59 44.6 April 1 9 28 9 1655 0 45 0.17 46.6 VACCINATION. WHITECHAPEL UNION.—Return of the number of Cases Vaccinated by the Public Vaccinator and the Medical Officer of the Workhouse, together with the number of Births Registered during the same quarters. Quarter ended— PUBLIC VACCINATOR Workhouse. Totals. Births Registd. Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. June, 1880 533 — 25 — 558 — 676 September 387 6 15 — 402 6 590 December 335 1 35 — 370 1 621 March, 1881 428 84 41 2 469 86 694 J une 682 250 49 150 631 400 674 September 371 34 34 420 405 454 586 December 394 4 25 179 419 183 578 March, 1882 360 17 31 146 391 163 644 Totals 3390 396 255 897 3645 1293 5063 7 WHITECHAPEL UNION INFIRMARY. Table of Cases of Fever admitted into the Infirmary during the Quarter ending 1st April, 1882. Date of Admission, 1882. Where Admitted from. Date of sending to Fever Hospital. Length of time in the Infirmary. Whether Patients had Fever on admission.  5 January Notting Hill 5 January Three hours Yes. 26 13, Grey Eaglestreet. 27 One day Slightly. 17 March 11, Flower and Dean-street. 20 March Three days No. 18 4, Dorset-st. 21 „ „ No. SMALL-POX. Cases of Small-pox admitted and sent to Small Pox Hospitals. Date of Admission, 1882. Where Admitted from. Date of sending to Small Pox Hospital. Length of time in the Infirmary. Whether Patients had Small-pox on admission. 5 January Flower & Deanst.,No. unkwn. 5 January One day Yes. 5 Casual Ward 5 A few hours „ 5 Paddington 5 „ „ „ One case of Fever and 2 of Small-pox were admitted from the Registered Lodging Houses. 8 Quarterly Return of Small-pox and Fever Cases sent to Small-pox and Fever Hospitals, to 31st March, 1882. SMALL POX. Men. Women. Children, Total North District 1 1 2 4 South 3 2 5 10* 14 *Of these 10 cases—3 were from the Loudon Hospital and non-residents. Deaths as under. Frederick Paddon G8, Bird-in-hand Terrace, Salmon's Lane, Limehouse. Eleanor Flynn 6, Little Pearl Street, Spitalfields. John Fellows Flower and Dean Street, Spitalfields. FEVER. Men. Women. Children. Total. North District 2 1 2 5 South „ 6 9 11 26* 31 * Of these 26 cases—10 were from the Loudon Hospital and non-residents. Deaths as under. Bridget Dillon 40, Boyal Mint Street. Thomas McLaughlin 5, Pell Street, St. George's East. Emma Slatters 23, Wellclose Square. Annie Simmonds 3, William Street, Bethnal Green. Peter McPhail The BarracltB, Brentwood. The following Table exhibits the weekly progress in London of the existing epidemic of small-pox, and is continued from page 7 of my Report for the Quarter ended 31st December, 1881. 1882. Week ending Deaths. Number of Patients in the Asylum Hospitals. January 7 20 504 14 21 504 „ 21 20 501 28 24 490 February 4 13 484 „ 11 17 473 18 17 447 25 8 436 March 4 23 407 „ 11 19 390 18 8 373 25 13 350 April 1 9 367 Total Deaths in London 212 9 ARTIZANS' AND LABOURERS' DWELLINGS IMPROVEMENT ACT, 1875. The Whitechapel District has already been greatly benefitted by' the operations of the above Act, and should all the official representations which have been made to the Metropolitan Board of Works, of the several areas referred to in former Reports, be carried out, will be still further benefitted. The five areas of which the Medical Officer of Health has made official representations, are— 1. The Royal Mint Street Scheme. 2. The Flower and Dean Street Scheme. 3. The Goulston Street Scheme. 4. The Great Pearl Street Scheme. 5. The Bell Lane Scheme. The whole of these several areas, together, comprise near twenty acres. At present, however, only three of these areas have been purchased by the Metropolitan Board of Works, viz., the Royal Mint Street, the Flower and Dean Street, and the Goulston Street areas. All the houses, with the exception of the "Crown" public house, in Butler's Buildings, and the Schools in Darby Street, within No. 1 area, have been taken down, and blocks of Peabody Buildings have been erected on part of the area. These buildings consist of eleven blocks, and are built to accommodate 286 families. The population in these buildings was, at the end of March last, 1207. Some idea of the wretched condition of the Royal Mint Street area may be formed, when I state that it consisted of about six acres, and contained 450 houses, which were occupied by 3,750 persons, thus allowing to each, on an average, a space of only 8.3 square yards; but in a court called Crown Court, which formed part of this area, and joined Blue Anchor Yard with Glass House Street, there was only an average space of 3.4 square yards for each person. All the particulars respecting the crowded condition and the un- 10 healthiness of the several above-named localities, I set forth in my official representations to the Metropolitan Board of Works, and are contained in my Reports for the Quarter ended July, 1875; April, 1876; June, 1876; September, 1877; and October, 1877. It may be here stated that from the Returns of the RegistrarGeneral, it appears that the area of London (the registration division so called) is 78,080 acres, or 122 square miles; a square mile being 640 acres. In the 78,080 acres are included 2,718 acres of the Thames. The density of the population is now about 51 persons to an acre, or 322,640 to a square mile. The area of the Whitechapel District is, according to the last Annual Summary of the Registrar-General, 405 statute acres, in which are included 27 acres of water. The whole area of the Whitechapel District gives 176 persons to an acre, or about 27.4 square yards for each person. The population at the period when the census was taken in 1881 was 71,301. Density of the Population of London for the Ten Years ended 1881, as Recorded by the Registrar-General in his Quarterly Returns. Years. Persons to an Acre. 1872 42.5 1873 43.0 1874 45.1 1875 45.7 1876 46.3 1877 46.9 1878 47.5 1879 48.0 1880 48.6 1881 50.8 From the preceding Table it appears that London is annually increasing in density, and hence the necessity of providing open spaces for the people; for, unless means are taken to provide parks and recreation grounds for the use of the inhabitants of the Metropolis, the increasing aggregation of human beings in confined spots, if continued for many years longer, will become a source of great danger to the public health. Open spaces, therefore, regardless of the cost, should be preserved for the people; and houses should be prohibited 11 from being built back to back; and the back yards or small gardens which are now attached to some houses, should not, unless under such special circumstances as the Local Authorities may approve, be built upon. Every house should be provided with an open space in the rear, not only for ventilation, but for the purpose of erecting thereon the necessary conveniences. Privies in the cellars of all new houses should be prohibited, for they frequently become such intolerable nuisances as to render the house unfit for habitation. London is already overpopulated. It is, therefore necessary, for the well-being of the people living in London, to afford every facility to new-comers to live beyond the present boundary of the Metropolis. Legislation must not only be directed towards the well-being of the inhabitants now living in the Metropolis, but its future condition, as regards the health of the people, must be considered. The annual rate of increase of the population of London per cent, was, in 1861—71, 1.50, and in 1871—81, 1.61. As some parts of London are becoming more and more densely crowded, it behoves each District Board to prevent overcrowding in every tenemented house, and a uniform system as regards overcrowding should be adopted; for if one District be strict in limiting the number of persons living in a room, and others are not so strict, it will follow that some Districts will become so overcrowded as to be dangerous to health; The health of the people ought to be the first consideration of Sanitary Boards, and no room ought to be tenanted which does not allow at least 300 cubic feet of space for each person; and in every case the Sanitary Officers should see that the ventilation of each room is properly provided for, and, if necessary, enforced. Sanitary Wobks Performed during the Quarter ended 1st April, 1882. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ended 1st April, 1882. Number of inspections of houses as shown in the official returns 2050 Houses specially visited 170 Houses specially re-visited 680 Preliminary notices served, such notices embracing 268 premises 170 Compulsory orders issued, embracing 106 premises 47 Summonses heard at Police Courts, under Sanitary Act 1 ,, under Act for the prevention of Adulteration of Food, &c. 1 Cellars used as dwellings discontinued for such use 1 12 Cases of overcrowding and indecent occupation abated 2 Houses in which rooms or passages have been whitewashed 90 Rooms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 49 Articles, consisting of beds, bedding, clothing, &c., removed from rooms to the Stone Yard and disinfected in the Apparatus 1745 Yards of houses paved, or the pavement repaired 41 Drains in houses improved 82 Dust-bins provided 1 Privies lime-washed, cleansed and repaired 79 Water supply provided or improved 17 Nuisances from dung and other offensive matter removed 32 Area gratings, cellar flaps, &c., repaired 6 Animals, fowls, dogs, and ducks kept so as to be a nuisance, removed 23 Nuisance from the retention of dead bodies in living rooms removed 2 The cow-houses in the District, 23 in number, and the slaughter-houses, 13, 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 Alif, 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 1st April, 1882. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhæa. Cholera and Choleraic-Diarrhæa. 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. Mr. Champneys 1 1 0 12 2 0 i i 0 4 0 0 143 0 0 0 0 0 0 o 487 654 Mr. Sequeira 2 2 0 12 6 0 4 22 0 2 0 0 40 1 0 0 0 0 0 3 212 306 Mr. Loane 3 0 0 0 0 0 4 1 0 1 0 0 36 2 0 0 0 0 0 0 59 106 Totals 6 3 0 24 8 0 9 24 0 7 0 0 219 3 0 0 0 0 0 5 758 1066 Corresponding Qr. of previous Year. 46 85 3 0 6 0 0 17 0 5 0 0 227 0 0 0 0 0 0 4 853 1246 Workhouse Mr. J. J. Ilott. 3 3 0 6 3 0 4 9 0 5 0 0 172 6 2 83 2 1 6 6 600 911 In addition to the cases of illness in the Workhouse, which are above recorded, there were 41 cases of syphilis and gonorrhæa. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ended 1st April, 1882. Sub-diotricts. Small-Pox. Measles. Scarlet Fever Diphtheria. HoopingCough. Diarrhæa. Fever. Cholera & Choleraic Diarrhæa. Total. Remarks. Spitalfields 1 1 0 0 25 2 0 0 29 Mile End New Town 0 1 0 1 10 4 1 0 17 Workhouse. Whitechapel North 0 1 0 0 10 1 0 0 12 Whitechapel Church 0 0 0 6 5 3 4 0 18 Hospital. 0 1 0 0 7 0 0 0 8 Aldgate 0 0 0 0 2 0 2 0 4 1 4 0 7 59 10 7 0 88 Deaths from Epidemics for the corresponding Quarter, 1881. 5 33 5 2 4 1 8 0 58 Two deaths from small-pox, of patients resident in this District, occurred in the Small-pox Hospital, thus making 3 deaths from small-pox of persons resident in the District. Two deaths from fever of residents in this District also occurred in the Fever Hospital, thus making a total of 9 deaths from fever. 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 1st April, 1882. Sub-districts. Enumerated Population in 1881. Births. Deaths. Under 1 year of age. 1, and under 5 years. Persons aged GO years and upwards. Violence. Inquest cases. Deaths in Public Institutions. Spitalfields Unrerised 22586 200 114 26 28 19 11 16 3 Mile End New Town 15474 168 178 21 19 68 3 11 114 Whitechapel North 10001 83 61 15 16 12 1 7 0 Whitechapel Church 7489 68 223 14 26 35 40 45 190 Goodman's Fields 9708 81 51 17 11 4 2 5 0 Aldgate 6092 44 29 12 3 2 4 5 0 Totals 71350* 644 656 105 103 140 61 89 307 *The last corrected return of the census is 71,301 or 49 less than in the uurevised return. BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE SANITARY CONDITION OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDED 1ST JULY, 1882, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH. London: Printed br PeNny & Hull, 53, Leman St., Whitechapel, E. 1882. REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ended 1st July, 1882. TO THE BOARD OP WORKS, WHITECHAPEL DISTRICT. Gentlemen, In the Quarter that ended on Saturday, the 1st July, 1882, the total births in the District were 696, viz., 357 males and 339 females; and the deaths 520, viz., 281 males and 239 females. The excess of births over deaths has therefore been, during the. Quarter, 176. As the deaths of 123 non-residents, which occurred in the London Hospital, are included in the mortality returns, a de. duction of such deaths must be made in order to estimate the correct mortality of the District, thereby reducing the total mortality to 397, and thus increasing the number of births above deaths to 299. 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 674 and the total deaths 534. The weekly average of births was 51.8 and of deaths 41.0; and in the present Quarter the weekly average of births has been 53.5 and of deaths 40.0. In the Spitalfields sub-District the births were 230, and the deaths 82; in the Mile End New Town 168 and the deaths 133 (in this sub-District the Workhouse is situated); in the Whitechapel North 68, and the deaths 39; in the Whitechapel Church 69, and the deaths 202 (in this sub-District the London Hospital is situated); in the Goodman's Fields 108, and the deaths 33; and in the Aldgate 53, 4 and the deaths 31. The deaths have exceeded the births in the Whitechapel Church sub-District by 133, but the deaths of the 123 non-residents in the London Hospital must be deducted. The proportion of births to deaths is therefore 69 to 79. The deaths in the London Hospital have been 179 ; of these, 123 were of non-residents in the District, 19 of residents, and 37 of persons who either died suddenly or from the result of accident. The deaths of persons who resided in this District, previous to their admission into the London Hospital, form but a very small proportion of the total deaths in that Institution. Excluding the deaths caused by accident (the previous residences of persons so dying not always being given in the weekly returns), the proportion of deaths of residents in this Quarter is 11.5 per cent. In the last Quarter, ended 1st April, the proportion of deaths of residents to non-residents was 10.5 per cent. The deaths in the Workhouse Infirmary, Baker's Row, have been 73. In the corresponding Quarter of last year they were 67. The deaths from epidemic diseases in the entire District have been 37; viz., 5 from measles, 3 from scarlet-fever, 1 from diphtheria, 15 from hooping-cough, 9 from diarrhoea, and -4 from fever. To this number must be added 2 who died in the Fever Hospital. Thus making a total of 6 deaths from fever. No death from small-pox is recorded during the Quarter, although 9 patients from this District were sent to the SmaJl-pox Hospital. Nineteen patients suffering from fever were sent from this District to the Fever Hospital, 8 of whom were sent from the London Hospital and were non-resident in the District. In the corresponding Quarter of the previous year, the deaths from epidemic diseases were 76; viz.,17 from small-pox (including 14 which occurred in the Small-pox Hospital), 28 from measles, 1 from scarlet-fever, 7 from hooping-cough, 20 from diarrhcea, and 3 from fever. Mortality of Young Children. The mortality of children under 1 year of age is 98. This is 18.8 per cent, of the total mortality. In the corresponding Quarter of the previous year it was 20.6 per cent. In the Spitalfields subDistrict the rate is 32.9 per cent.; in the Mile End New Town 17.2 5 per cent.; in the Whitechapel North 38.4 per cent.; in the Whitechapel Church 5.9 per cent.; in the Goodman's Fields 24.2 per cent.; and in the Aldgate 41.0 per cent. The difference of the rate of mortality of young children in the Mile End New Town and Whitechapel Church sub-Districts, is thus explained:—In the former the Workhouse is situated, and in the latter the London Hospital; in both these Institutions the children under 1 year bear only a small proportion to the adults. The total deaths under 5 years during the Quarter, are 177, which shews a rate of mortality of 34.0 per cent, in relation to the total deaths, including those of non-residents, and 25.4 per cent, to the total births. The rate of mortality under 1 year, in relation to the total births, is 14.0 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter, 912 new cases of illness out of the Workhouse; including 5 of small-pox, 11 of measles. 1 of scarlatina, 6 of hooping-cough, 12 of diarrhæa, 4 of fever, 27 of febricula, and 4 of erysipelas. In the corresponding Quarter of the previous year, the number of pauper cases of illness was 1064; including 61 of small-pox, 46 of measles, 4 of scarlatina, 7 of hooping-cough, 21 of diarrhæa, 30 of febricula, and 5 of erysipelas. The total number of cases of illness in the Workhouse has been 931; including 1 of measles, 2 of hooping-cough, 5 of diarrhæa, 10 of erysipelas, and 12 of febricula. In addition to the above cases, there were 36 of syphilis and gonorrhæa; thus making a total of 967. Uncertified Deaths. Four uncertified deaths are recorded during the Quarter. One is returned in the Spitalfields sub-District, 2 in the Goodman's Fields sub-district, and 1 in the Aldgate sub-District. Meteorology of Greenwich. The Returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 6.15 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 4.10 inches. The mean temperature of the air was 53.1 In the 6 ponding Quarter of last year it was 53.5 The hottest days during the Quarter were Monday, the 22nd May, Monday, the 29th May, and Tuesday, the 27th June, when the thermometer indicated respectively 76.°1, 76.°5, and 74.°1. The hottest day during the corresponding Quarter of the previous year was on Wednesday, the 26th May, when the thermometer indicated 87.°5. The hottest mean temperature during any week in the Quarter was that which ended Saturday, July 1st, when the thermometer indicated 59.°9. In the corresponding Quaiter of last year the highest mean temperature in any week was in that which ended July 2nd, when it was 83.°9. The results of the meteorological observation are to be understood as applying to the civil day, or from midnight to midnight. Table of Weekly Mortality, &c.( in London and in the Whitechapel District. Week ended Deaths in London. Deaths in Wchpl. District Rainfail. Inches. Mean Temperature of the air. Degrees Diarrhæa and Dysentery. Fever. Small-pox. From all causes. From Smallpox. Form all causes. April 8 9 22 14 1596 0 46 0.00 47.6 „ 15 9 24 8 1727 0 43 0.37 47.6 „ 22 13 9 8 1573 0 43 0.28 49.9 „ 29 14 15 16 1520 0 26 1.75 46.5 May 6 18 14 13 1495 0 28 0.95 52.0 „ 13 14 8 10 1438 0 52 0.00 53.7 „ 20 12 18 9 1419 0 31 0.01 50.7 „ 27 15 20 10 1435 0 37 0.44 57.6 June 3 13 15 6 1s04 0 35 0.09 58.5 „ 10 28 15 10 1369 0 48 1.08 56.2 „ 17 42 11 15 1335 0 50 0.42 53.1 „ 24 32 10 9 1387 0 39 0.56 57.3 July 1 41 12 0 1303 0 42 0.20 59.9 7 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 ended— PUBLIC VACCINATOR workhoose. Totals. Births Registd. Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. September, 1880 387 6 15 — 402 6 590 December 335 1 35 — 370 1 621 March, 1881 428 84 41 2 469 86 694 June 582 250 49 150 631 400 674 September 371 34 34 420 405 454 586 December 394 4 25 179 419 183 578 March, 1882 360 17 31 146 391 163 644 June 543 6 36 125 579 131 520 Totals 3400 402 266 1022 3666 1424 4907 The following Table exhibits the weekly progress in London of the existing epidemic of small-pox, and is continued from page 8 of my Report lor the Quarter ended 1st July, 1882. 1882. Week ending Deaths. Number of Patients in the Asylum Hospitals. April 8 14 352 15 8 337 22 8 350 29 16 321 May 6 13 300 13 10 296 „ 20 9 285 27 10 256 June 3 6 272 „ 10 10 257 „ 17 15 251 „ 24 9 242 July 1 0 233 Total Deaths in London 128 The week ended July 1st, was the first since November, 1879, in which no fatal case of small-pox was registered within registration London. The average weekly number of deaths from this disease in the corresponding week of the last ten years was 22. 8 Return of Cases sent to Small-pox and Fever Hospitals during the Quarter ended 24th June, 1882. SMALL POX. Men. Women. Children. Total North District 1 0 0 1 South „ 3 2 3 8* 9 * Of these 8 cases—1 was from the London Hospital and non-resident. Only Death. William Fordham, 11 Carter Street, Bethnal Green. FEVER. Men. Women. Children. Total. North District 4 2 2 8 South „ 0 4 7 11* 19 * Of these 11 cases—8 were from the London Hospital and non-residents. Two Deaths. Henry Williams 55, Flower-and-Dean Street. Louisa Reynolds 56, ditto WHITECHAPEL UNION INFIRMARY. Only one case of Fever was admitted into the Infirmary during the Quarter ended 1st July, 1882. Date of Admission, 1882. Where Admitted from. Date of sending to Fever Hospital. Length of time in the Infirmary. Whether Patients had Fever on admission. 1 May Pelham House, Spital Sq. 13 May Two days Slightly. Bakehouses. Public attention having been forcibly directed to the defective sanitary condition of several of the bakehouses in London, I gave directions to the Sanitary Inspectors to visit all the bakehouses in the District, and reports to the following effect were prepared by those officers. It was found that some of the premises used as bake- 9 houses were in a very unsanitary condition. In Mr. Battram's District it appeared that there are 38 bakehouses, and 23 of them were found to be dirty and ceilings broken; 8 were badly paved, and in one the drainage was defective, the soil oozing up into the bakehouse. In another it was ascertained that a man suffering from fever had been sleeping for some nights on flour sacks belonging to the bakehouse, whilst in another the structure was in a dangerous condition. Mr. Wrack reports that there are 37 bakehouses in his District, and that several of them were in a dirty state. The Inspectors have been further directed to visit, from time to time, all the bakehouses in the District, and report on the existence of any nuisance injurious to health which may exist on the premises, and to take the necessary proceedings to obtain the removal of such nuisances. The opinion which I expressed several years ago as to the best mode of regulating bakehouses, was, that they should be annually licensed, like cowhouses and slaughter-houses; for since the power of the local Boards has been transferred to the Factory Inspectors, the Sanitary Officers of this District have no reason to congratulate your Board on the improvement effected in the bakehouses. Notification of Infectious Diseases. The following case shows the importance of the early notification to the Sanitary Authorities of cases of infectious disease:— The Inspector, Mr. Wrack, reports that, on visiting the premises No. 2, Finch Street, Whitechapel, he learnt that a girl, 11 years of age, was suffering from small-pox in a severe form. The patient had been attended by a private medical practitioner for several days. The premises are used as a laundry, and several persons are engaged therein in washing, ironing, and mangling clothes belonging to several families in the neighbourhood; and in the room occupied by the patient it was found at the time of the Inspector's visit, that there was a large number of articles of clothing which were ready to be taken away by their respective owners. The child was promptly conveyed to the Small-pox Hospital, and no person was allowed to remove any of the articles of clothing from the house until they had been disinfected by Mr. Wrack at the disinfecting apparatus. This case affords exemplification of the desirability of early information being given to the Sanitary Officers of the existence of contagious disease in the District. Other cases illustrating the importance of 10 early information of the existence of contagious and infectious disease being forwarded to the Sanitary Officer, will be seen on reference to several of my previous Reports. The Flushing of the Courts. In the month of June the regular flushing of the courts was resumed by the Surveyor, and will be continued during the warm weather. The cool and refreshing effect of the flushing of confined courts is very beneficial to the comfort and health of the inhabitants, and, as some of my Reports testify, has been attended with good results as regards the diminution of cases of fever. Lead Poisoning. The attention of your Board was recently directed by a circular, signed by the Clerk to the Board of Guardians for the Parish of Shoreditch, calling attention to the prevalence of cases of lead poisoning admitted into their infirmary. In this circular the Guardians state that they are deeply impressed with the necessity of stringent regulations for the protection of persons working in lead factories, and they respectfully desire to bring the subject under notice. Since I received a copy of the above circular, a Report by Mr. Redgrave, Her Majesty's Chief Inspector of Factories, has been presented to Parliament, "upon the precautions which can be enforced under the Factory Act, and as to the need of further powers for the protection of persons employed in white-lead works." This matter has, on more than one occasion, been brought under the notice of your Board in my Quarterly Reports, for although there is no whitelead factory in the Whitechapel District, several cases of lead poisoning have been attended by the Medical Officers of the Union ; and patients suffering from the poisonous effects of lead are being frequently admitted into the London Hospital. Important recommendations for the safety of persons employed in whitelead factories, have been, from time to time, made by experienced medical men, yet, as there is no law which will compel the observance of any regulations, however valuable such may be, it would be desirable that a code of regulations should be prepared by a committee of experienced medical practitioners, by the observance of which, the lives and health of the workpeople would be protected; but, unless it were made obligatory by Act of Parliament on the 11 owners of lead factories to have everything provided on the premises for the comfort and well-being of the persons employed, and the work-people compelled under penalties to use them, very little advance towards the improvement of health will be made. Mr. Redgrave in his Report on this subject, has made some very valuable observations to which I would direct public attention. Mr. Redgrave concludes his Report in the following words:— " I feel most strongly that, in an occupation such as that of the whitelead manufacturer, the factories should be periodically visited, and the work-people examined by a medical man; and that on the appearance of symptoms of illness, a visit to a medical man should be the first step." Open Spaces. In my Report for the Quarter ended July 3rd, 1880, I had the pleasure of recording that a piece of ground known as the Friends' Burial Ground, situated in Baker's Row, Whitechapel, consisting of about an acre and one-eighth of an acre, had been dedicated to the use of the public as a recreation-ground. This vacant space, now converted into a garden, is well kept, and is highly appreciated by the inhabitants of Whitechapel and the vicinity, as is shown by the numerous frequenters of the locality. Since the date of the above Report, I have the satisfaction of recording that another piece of ground situated at the back of the London Hospital, and which is partly in the Parish of Whitechapel, and partly in the Hamlet of Mile End Old Town, has been set apart for the use and recreation of the public. The extent of this piece of ground is about half an acre, which, although small, is nevertheless valuable, for it will not only afford relaxation and enjoyment to many, but will prevent more houses from being built in this already overcrowded locality. On my visiting this recreation ground, now laid out with much taste, and ornamented with trees and flowers, and provided with seats for the comfort and convenience of the people, I was much pleased. A fountain of fresh filtered water is provided for the use of the visitors. As more open spaces in London are needed for preserving the health of the inhabitants of overcrowded London, it is to be hoped that the example which has been set by the Committee of this small recreation-ground will be followed in every District. 12 Sanitary- Works Performed during the Quarter ended 1st July, 1882. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ended 1st July, 1882. Number of inspections of houses as shown in the official returns 3120 Houses specially visited 320 Houses specially re-visited 1280 Preliminary notices served, sach notices embracing 281 premises 182 Compulsory orders issued, embracing 131 premises 58 Summonses heard at Police Courts, under Sanitary Act 0 ,, under Act for the prevention of Adulteration of Food, &c. 3 Cellars used as dwellings discontinued for such use 6 Cases of overcrowding and indecent occupation abated 4 Houses in which rooms or passages have been whitewashed 140 Rooms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 59 Articles, consisting of beds, bedding, clothing, &c., removed from rooms to the Stone Yard and disinfected in the Apparatus 1941 Yards of houses paved, or the pavement repaired 33 Drains in houses improved 80 Dust-bins provided 16 Privies lime-washed, cleansed and repaired 61 Water supply provided or improved 11 Nuisances from dung and other offensive matter removed 46 Area gratings, cellar flaps, &c., repaired 18 Fowls kept so as to be a nuisance, removed 12 A large quantity of rotten potatoes removed 0 The cow-houses in the District, 23 in number, and the slaughterhouses, 13, 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 Alle 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 1st July, 1882. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhœa. Cholera and Choleraic-Diarrhoea. Continued Fever, Typhus & Typhoid. Febricula. Pyaemia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation Carbuncle. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Mr. Champneys 1 6 0 1 7 0 3 14 0 2 0 0 82 1 0 0 0 0 0 1 461 579 Mr. Sequeira 4 3 1 1 4 0 0 11 0 2 0 0 32 3 0 1 0 0 0 0 189 251 Mr. Loane 0 2 0 4 1 0 1 2 0 0 0 0 14 6 0 0 0 0 0 0 52 82 Totals 5 11 1 6 12 0 4 27 0 4 0 0 128 10 0 1 0 0 0 1 702 912 Corresponding Qr. of previous Year. 61 46 4 7 21 0 0 30 0 5 0 0 120 1 0 2 0 0 0 3 764 1064 Workhouse Mr. J. J. Hott. 0 1 0 2 5 0 0 12 0 10 0 0 107 17 0 100 5 0 10 4 658 931 In addition to the cases of illness in the Workhouse, which are above recorded, there were 36 cases of syphilis and gonorrhœa. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ended 1st July, 1882. Sub-districts. Small-Pox. Measles. Scarlet Fever Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera & Choleraic Diarrhœa. Total. Remarks. Spitalfields 0 1 0 0 9 3 2 0 15 Mile End New Town 0 0 0 0 1 3 0 0 4 Workhouse. Whitechapel North 0 2 0 0 2 0 0 0 4 Whitechapel Church 0 0 0 1 1 2 1 0 5 Hospital. Goodman's Fields 0 0 2 0 0 1 0 0 3 Aldgate 0 2 1 0 2 0 1 0 6 Totals 0 5 3 1 15 9 4 0 37 Deaths from Epidemics for the corresponding Quarter, 1881. 3 28 1 0 7 20 3 0 62 One death from small-pox, of a patient sent from this District, occurred in the Small-pox Hospital, and that was of a non-resident who was sent from the London Hospital. No deaths from small-pox of residents occurred in this District. Two deaths from fever occurred in the Fever Hospital of persons belonging to this District, thus making a total of 6 deaths from fever. 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 1st July, 1882. Sub-districts. Enumerated Population in 1881. 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. Spitalfieldas 22585 230 82 27 15 13 5 7 6 Mile End New Town 15473 168 133 23 8 40 8 22 73 Whitechapel North 10001 68 39 15 8 6 1 4 0 Whitechapel Church 7489 69 202 12 32 19 35 40 179 Goodman's Fields 9713 108 33 8 6 7 2 6 0 Aldgate 6102 53 31 13 10 5 1 3 0 Totals 71363 696 520 98 79 90 52 82 258 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE SANITARY CONDITION OF THE WHITECHAPEL DISTRIT FOR THE QUARTER ENDED 30TH SEPTEMBER, 1882. BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH. London: Printed by penny & Huli, 63, Leman St., Whitechapel, F. 1882. REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ended 30th September, 1882. TO THE BOARD OF WORKS, WHITECHAPEL DISTRICT. Gentlemen, In the Quarter that ended on Saturday, the 30th September, 1882, the total births in the District were 588, viz.: 313 males and 275 females; and the deaths 550, viz.: 321 males and 229 females. The excess of births over deaths has therefore been, during the Quarter, 38. As the deaths of 149 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 401, and thus increasing the number of births above deaths to 187. 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 586, and the total deaths 601. The weekly average of births was 45.0 and of deaths 46.2; and in the present Quarter the weekly average of births has been 45.2 and of deaths 42.3. In the Spitalfields sub-District the births were 177 and the deaths 88; in the Mile End New Town 173 and the deaths 140 (in this subDistrict the Workhouse is situated); in the Whitechapel North 60 and the deaths 29; in the Whitechapel Church 57 and the deaths 228 (in this sub-District the London Hospital is situated); in the Goodman's Fields 80 and the deaths 44; and in the Aldgate 41 and the deaths 21. The deaths have exceeded the births in the Whitechapel Church sub-District by 171, but the deaths of the 149 nonresidents in the London Hospital must be deducted. The proportion of births to deaths is therefore 57 to 79. 4 The deaths in the London Hospital have been 192; of these 149 were of non-residents in the District, 24 of residents, and 19 of persons who either died suddenly or from the result of accident. The deaths of persons who resided in this District, previous to their admission into the London Hospital, form but a very small proportion of the total deaths in that Institution. Excluding the deaths caused by accident (the previous residences of persons so dying not always being given in the weekly returns), the proportion of deaths of residents to non-residents in this Quarter is 16.1 per cent. The deaths in the Workhouse Infirmary, Baker's Row, have been 76. In the corresponding Quarter of last year they were 80. The deaths from epidemic diseases in the entire District have been 79, viz.: 16 from measles, 5 from scarlet-fever, 5 from diphtheria, 14 from hooping-cough, 37 from diarrhœa, and 2 from fever. To this number must be added 3 who died of small-pox in the Small-pox Hospital, and 4 who died of fever in the Fever Hospital; thus making a total of 3 deaths from small-pox, and 6 deaths from fever. The deaths from epidemic diseases during this Quarter instead of being 79 as recorded above are therefore 86. Nineteen patients suffering from fever were sent from this District to the Fever Hospital, 8 of whom were sent from the London Hospital and were non-resident in the District. In the corresponding Quarter of the previous year, the deaths from epidemic diseases were 126; viz.: 10 from small-pox (including 7 which occurred in the Small-pox Hospital), 20 from measles, 12 from scarlet-fever, 2 from diphtheria, 14 from hooping-cough, 66 from diarrhœa, and 9 from fever. Mortality of Young Children. The mortality of children under 1 year of age is 118. This is 21.4 per cent. of the total mortality. In the corresponding Quarter of the previous year it was 24 9 per cent. In the Spitalfields subDistrict the rate is 39.7 per cent.; in the Mile End New Town 20.0 percent.; in the Whitechapel North 34.4 per cent.; in the Whitechapel Church 10.0 per cent.; in the Goodman's Fields 36.3 percent.; and in the Aldgate 28.5 per cent. The difference of the rate of mortality of young children in the Mile End New Town and Whitechapel Church sub-Districts, is thus explained: in the former the Workhouse is situated, and in the latter the London Hospital; in both these Institutions the children under 1 year bear only a small proportion to the adults. The total deaths under 5 years during the Quarter are 217, which shows a rate of mortality of 39.4 per cent. in relation to the 5 total deaths, including those of non-residents, and 36.7 per cent. to the total births. The rate of mortality under 1 year, in relation to the total births, is 20.0 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter, 780 new cases of illness out of the Workhouse; including 5 of small-pox, 19 of measles, 7 of scarlatina, 15 of hooping-cough, 30 of diarrhœa, 2 of fever, 33 of febricula, and 9 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 910; including 21 of small-pox, 25 of measles, 7 of hooping-cough, 55 of diarrhœa, 1 of choleraic-diarrhœa, 32 of febricula, and 11 of erysipelas. The total number of cases of illness in the Workhouse has been 809; including 2 of small-pox, 1 of measles, 2 of scarlatina, 1 of hooping-cough, 27 of diarrhœa, 8 of fever, 3 of erysipelas, and 17 of febricula. In addition to the above cases, there were 24 of syphilis and gonorrhoea; thus making a total of 833. Uncertified Deaths. Three uncertified deaths are recorded during the Quarter. One is returned in the Whitechapel North sub-District, 1 in the Goodman's Fields sub-District, and 1 in the Aldgate sub-District. Meteorology of Greenwich. The Returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 6.00 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 8.9 inches. The mean temperature of the air was 59.2°. In the corresponding Quarter of last year it was 59.7°. The hottest days during the Quarter were Wednesday, the 2nd August, Saturday, the 12th August, and Sunday, the 6th August, when the thermometer indicated respectively 80.0°, 80.6°, and 81.0°. The hottest days during the corresponding Quarter of the previous year were Monday, the 18th July, Friday, the 15th July, and Tuesday, the 5th July, when the thermometer indicated respectively 96.2°, 97.1°, and 92.8°. The hottest mean temperature during any week in the Quarter was that which ended Saturday, August 5th, when the thermometer indicated 62.5°. In the corresponding Quarter of last year the highest mean temperature in any week was in that which ended July 16th, when it was 70.1°. The results of the meterological observation are to be understood as applying to the civil day, or from midnight to midnight. 6 Table of Weekly Mortality, &c., in London and in the Whitechapel District. Week ended Deaths in London. Deaths in WchpL. District fall. Mean perature of the air. From Diarrhoea and Dysentery. From Fever. From Small-pox. From all causes. 1' rom Smallpox. From all causes. Inches Degree. July 8 73 15 6 1293 0 40 0.88 59.9 „ 15 102 18 4 1347 0 43 0.85 59.8 „ 22 118 11 4 1321 0 41 0.34 61.0 „ 29 108 19 2 1399 0 35 0.37 60.2 Aug. 5 118 14 1 1369 0 43 0.03 62.5 „ 12 147 13 4 1432 0 38 0.01 61.0 „ 19 164 12 5 1528 0 57 0.33 60.6 „ 26 158 16 1 1401 0 42 0.44 57.0 Sept. 2 153 9 7 1473 0 51 0.42 58.1 „ 9 95 15 9 1322 0 48 0.31 57.3 „ 16 78 18 3 1269 0 32 0.46 51.3 „ 23 78 15 0 1450 0 38 0.60 53.0 „ 30 34 22 7 1449 0 42 0.91 53.8 Return of Cases sent to Small-pox and Fever Hospitals during the Quarter ended Michaelmas, 1882. SMALL POX. Men. Women. Children. Total North District 2 4 5 11 South „ 4 0 1 5* 16 * Of these 5 cases—3 were from the London Hospital and non-resident. Three Deaths. James Webb, 3G, Brick Lane. Michael Walters, 46, Wentworth Street. Lewis Lyons, 10, Shepherd's Buildings, Spitalfields. FEVER. Men. Women. Children. Total. North District 5 6 1 12 South „ 2 1 8 11* 23 * Of these 11 cases—3 were from the London Hospital and non-residents. Four Deaths. Mary Alcock, 9, Lower Keate Street. Elizabeth Wills, 10, Brunswick Place, Back Church Lane. Catherine Drew, 4, Hayden Square, Minories. Elizabeth Drew, ditto ditto 7 FEVER Cases admitted into Infirmary during the Quarter ended Michaelmas, 1882. Date of Admission, 1882. Where Admitted from. Date of sending to Fever Hospital. Length of time in the Infirmary. Whether Patient had Fever on admission. Nurse in Infirmary In the Infirmary July 3 3 days No. Was in Infirmary ditto „ 14 ditto ditto July 18 17,Dorset-st „ 19 1 day Slightly. Was in Infirmary In the Infirmary „ 19 2 days No. July 18 58, Flower and Dean-street „ 19 1 day Slightly. Aug. 20 18, Thrawl-st Aug. 21 ditto ditto. „ 22 South Grove Workhouse „ 23 ditto ditto. „ 28 60, Wentworth- street „ 30 2 days No. Sept. 4 23, George-yd Sept. 5 1 days Slightly. „ 7 52, Flower and Dean-street.. „ 11 4 days No. SMALL-POX Cases admitted and sent to Small-Pox Hospitals. Date of Admission, Where Admitted from. Date of sending to Smal Pox Hospital. Length of time in the Infirmary. Whether Patient had Small-pox on admission. July 24 13, Brick-lane . July 25 1 day No. Sep. 10 Casual Ward Sep. 16 2 hours Yes. 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 ended— PD1SL1C VACCINATOR WORKHOUSE. Totals. Births Registd. Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. December, 1880 335 1 35 — 370 1 621 March, 1881 428 84 41 2 469 86 694 June 582 250 49 150 631 400 674 September 371 34 34 420 405 454 586 December 394 4 25 179 419 183 578 March, 1882 360 17 31 146 391 163 644 June 543 .6 36 125 579 131 520 September 441 25 45 105 486 130 588 Totals 3454 421 296 1127 3750 1548 4905 8 The following Table exhibits the weekly progress in London of the existing epidemic of small-pox, and is continued from page 7 of my Report for the Quarter ended 1st July, 1882. 1882. Week ending Deaths. Number of Patients in the Asylum Hospitals. July 8 6 214 15 4 204 „ 22 4 193 „ 29 2 159 Aug. 5 1 138 „ 12 4 123 „ 19 5 111 26 1 114 June 2 7 101 „ 9 9 91 „ 16 3 84 „ 23 0 79 „ 30 7 80 Total Deaths in London.. 53 Mortuary. In the following Memorandum on Mortuaries issued by the Local Government Board, dated 25th July, 1882, entitled Bye Laws for the use of Sanitary Authorities, it is suggested: lst. That in the choice of a site and structure, care should be taken to ensure that the buildings to be erected thereon shall, as far as practicable, be isolated and unobtrusive. It may, indeed, be desirable to place the buildings on the site in such a position and manner as to admit of their being concealed from public view until the entrance gate to the premises has been passed. The Buildings should be substantial structures of brick or stone. In their external appearance attention should be paid to such architectural features as may serve to convey the impression of due respect for the dead. 9 Every chamber intended for the reception of corpses should be on the ground or basement floor. In addition to such chambers, the premises should, if possible, comprise:— (a) A waiting room for visitors to the mortuary, and for the use of mourners assembling there for funeral purposes. (b) A caretaker's dwelling-house ; and (c) A shed or out-house, for the keeping of shells or other necessary appliances. *For these and other structural arrangements provision may be made for two mortuary chambers, one for infectious cases, and the other for non-infectious cases. Water and hose to each mortuary chamber. A place for coals, wood, ashes, &c., and a water closet. A waiting room. A sitting room. Place for stores. Kitchen. Bedroom. A hearse house, and A water closet for persons waiting. In the construction of each chamber intended for the reception of the dead, care should be taken to ensure convenience, decency, cleanliness, and coolness. The chamber should be lofty, and the area of its floor sufficient to allow freedom of movement between the slabs, or tables, on which the dead are to be placed. There should be a ceiling to the chamber, or, if it be open to the roof, there should be a double roof with a space of 8 inches at least between the outer and inner covering, or with the addition of an intervening layer of felt. Louvres, or air gratings, under the eaves will be the best means of ventilation. The chamber should, if practicable, be lighted by windows on the north side. If it is necessary to place windows on the south, east, or west sides, external louvre blinds should be provided for the windows. The floor should be paved evenly and closely. The material used may be stone or slate, but a uniform cement floor is preferable. Water should be laid on so as to draw from a tap within the chamber. Shelves should be conveniently placed around the interior of the chamber ; and tables, which may occupy any part of its area, should preferably be made of slate slabs If stone is used it should be smoothed on the upper surface and free edges. * See plan of Mortuary appended to the copy of Model Bye Laws issued by the Local Government Board. 10 The shelves and tables should be placed so that their upper surfaces may be at a height of 2½-ft., or of not more than 3 feet above the floor. The ceiling and internal surface of the walls should be whitewashed ; the outside of the roof should also be whitened. The entrance to the chamber should be direct, without the intervention of any passage. The number of chambers should be at least two, so that one may be appropriated exclusively for the bodies of persons who have died of infectious disease, and the other for the bodies of persons whose death has been due to other causes. It may be expedient to place these chambers as far apart as may be practicable, so that persons visiting the chamber used for the reception of the bodies of those who have died of non-infectious disease, may have no reason to fear infection. The Memorandum not only contains the above suggestions as to site and structure, but as to administrative arrangements; but these latter I have not thought it necessary to trouble you with at present. The last time that I brought before you the question of providing a proper Mortuary for the District, was in my Report for the Quarter ended March, 1878, in which I stated that "the Public Health Bill for the Metropolis, which was brought forward by Mr. Sclater Booth, contained some valuable regulations for promoting the Public Health ; among which was the rendering it compulsory on Local Boards to provide, if required by the Local Government Board, a place for the reception of dead bodies before interment (called a Mortuary.) As the law stands at present it is merely permissive for Local Boards to provide a Mortuary." There should also be provided a suitable place for a post mortem room, so constructed as to enable a medical man to properly examine a body when it is necessary to ascertain the cause of death. This room should be light and well ventilated, it being impossible to make a post mortem examination properly in the confined rooms of some of the houses occupied by the poor. It is also most desirable to provide a suitable room for the holding of Coroners' inquests; for public houses, in which inquests are frequently held, are highly improper places for holding such important inquiries. 11 Nuisance Complained of by Several Inhabitants in the Vicinity of a Small Factory in which Foreign Cheese and Foreign Butter are Manufactured. Mr. Battram reports that these articles are manufactured from sour milk; and when the refuse is emptied from the churns the smell is very offensive, and the drains become choked. The factory is small and in a very confined neighbourhood, and is unfitted for the purpose for which it is used. The nuisance is abated. Notification of Infectious Disease. The following case shows the importance of notifying to the Sanitary Officers, at an early date, the existence of infectious disease: — On the 27th July last, information of the death of a child, aged two years, from scarlet-fever, at 23, Buck's Row, Whitechapel, was received at the Office from the Local Registrar. Upon visiting the house the same day, Mr. Wrack, the Sanitary Inspector, was informed that there had been four other children ill of the same disease, but who were then convalescent; and there were two other children of the family ill with the same disease. Mr. Wrack ' advised the mother to let these children be removed to the hospital, to which she consented. The Relieving Officer was at once communicated with, and the children were removed the same day. The bedding and rooms occupied by the sick children were disinfected immediately after their removal to the hospital. The mother informed the Inspector that the medical gentleman who had been attending the children had neither advised, nor suggested, their removal to a hospital. In many cases it is only when a death occurs that the Sanitary Officers obtain information of the existence of an epidemic disease ; so that before the Sanitary Officers have intimation of such, much mischief has been occasioned by the disease having spread to several families in the vicinity; whereas, if information had been given to the Health Officers many cases of infectious disease would probably have been prevented, and much misery saved. It is now full time that it should be made compulsory on some person having the charge of a patient suffering from an infectious disease, to send notice of the same to the Local Board, and that the Sanitary Officers should be required to immediately attend to the same. In Edinburgh, Nottingham, and other towns, the authorities have procured the passing of Local Acts rendering the notification of infectious disease compulsory upon the medical attendant, or upon the householder, or upon both, and excellent 12 results have been already obtained. A. Bill for the compulsory notification of infectious disease has been prepared by Mr. Hastings, which, I hope, will soon be added to the Statute Book. To the Committee of Works, Whitechapel District. REPORT ON THE SEWERS IN FREEMAN STREET, SPITALFIELDS. Gentlemen, A complaint, signed by seventeen inhabitants of Freeman Street, Spitaltields, saying that the smell arising from the sewers in that street is "abominable and unbearable, and might cause a serious epidemic amongst their families, of whom some are already suffering from ill health," has been referred by your Committee to me. It appears on investigation that those sewers are nearly on a level, and they contained a large deposit of offensive matter. The number of gullies attached to the several sewers in the streets of the Tenter Ground, Spitalfields, is 17, and the ventilating shafts 7. Although the gullies and ventilating shafts are numerous in this locality, it will be unsafe to close any of them, for the doing so would render it impossible, without danger being incurred by men going into the sewers to cleanse them. In order to diminish the nuisauce the Surveyor proposes that an air shaft should be carried from the sewer above the roof of the highest house. There cannot be any objection to the carrying out of the suggestion of the Surveyor, and it will to a certain extent be useful As however a similar complaint as to the nuisance from the sewers is continually being made in many parts of London, a more extended plan of operations than that proposed must be adopted, so as to relieve the entire population of London from the serious nuisance and danger to health arising from the sewers ; and in order to carry out such a large scheme, the matter must be referred to the Metropolitan Board, so as effectually to deal with all the sewers, whether main sewers, which are under the jurisdiction of the Metropolitan Board, but also those which are under the management of the several District Boards. In some of my early Quarterly Reports I have brought under the notice of your Board the faulty condition of many of the sewers in your District, and stated that in all cases where the sewers were not built with a proper incline, such sewers should be re-constructed. Many of the sswers are little better than cesspools, and they give rise to typhoid fever and other contagious diseases; and so long as they are permitted to continue in their present state, so long will the inhabitants of London be liable to such diseases. In my Report for the Quarter ended June, 1872, it was staled that typhoid fever is never entirely absent from London, there being seldom less than 2000 deaths annually from this disease and 14,000 cases of sickness. I have the honour to be, Gentlemen, Your obedient Servant, 15, Great Alie Street, JOHN LIDDLE. 5th October, 1882. In one of my early Quarterly Reports, I stated that in 1862 we had removed the filth from 3471 cesspools. Although such a large amount of filth has been removed from our houses, and principally 13 from the back of them, not so much advantage to the public health has been gained as ought to have been, for the filth in some cases has merely been transferred from the back of the houses to the front of them ; many of the sewers being little better than cesspools. Sanitaby Works Performed during the Quarter ended 30th September, 1882. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ended 30th September, 1882. Number of inspections of houses as shown in the official returns 2262 Houses specially visited 219 Houses specially re-visited 876 Preliminary notices served, such notices embracing 205 premises 143 Compulsory orders issued, embracing 48 premises 23 Summonses heard at Police Courts, under Sanitary Act 0 „ under Act for the prevention of Adulteration of Food, &c. 1 Cellars used as dwellings discontinued for such use 9 Cases of overcrowding and indecent occupation abated 18 Houses in which rooms or passages have been whitewashed 112 Rooms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 56 Articles, consisting of beds, bedding, clothing, &c., removed from rooms to the Stone Yard and disinfected in the Apparatus 2210 Yards of houses paved, or the pavement repaired 46 Drains in houses improved 63 Dust-bins provided 10 Privies lime-washed, cleansed and repaired 71 Water supply provided or improved 16 Nuisances from dung and other offensive matter removed 35 Area gratings, cellar flaps, &c., repaired 3 Several thousand tortoises kept so as to be a nuisance, removed Cesspools abolished 2 One-hundred-and-four baskets of plums unfit for food destroyed by consent from St. Katharine's Wharf The cow-houses in the District, 23 in number, and the slaughterhouses, 13, 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 ended on the 30th September, 1882. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Congh. Diarrhœa. Cholera and Choleraic -Diarrhœa. Continued Fever, Typhus & Typhoid. Febricula. Pyaemia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Mr. Champneys 4 14 2 1 14 0 0 11 0 4 0 0 50 1 0 0 0 0 0 0 372 473 Mr. Sequeira 1 0 5 1 11 0 2 19 0 3 0 0 17 0 0 0 0 0 0 0 153 212 Mr. Loane 0 5 0 13 5 0 0 3 0 2 0 0 11 3 0 0 0 0 0 1 52 95 Totals 5 19 7 15 30 0 2 33 0 9 0 0 78 4 0 0 0 0 0 1 577 780 Corresponding Qr. of previous Year. 21 25 0 7 55 1 0 32 0 11 0 0 100 0 0 6 0 0 0 1 651 910 Workhouse Mr. J. J. Hott. 2 1 2 1 27 0 8 17 0 3 0 0 69 14 2 68 1 0 9 3 582 809 In addition to the cases of illness in the Workhouse, which are above recorded, there were 24 cases of syphilis and gonorrhoea. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ended 30th September, 1882. Sub-districts. Small-Pox. Measles. Scarlet Fever Diphtheria. HoopingCough. Diarrhœa. Fever. Cholera & Choleraic Diarrhœa. Total. Remarks. Spitalfields 0 11 0 0 3 9 0 0 23 Mile End New Town 0 1 1 0 5 12 0 0 19 Workhouse. Whitechapel North 0 1 2 0 0 3 0 0 6 Whitechapel Church 0 1 0 4 2 6 2 0 15 Hospital. Goodman's Fields 0 2 2 1 1 3 0 0 9 Aldgate 0 0 0 0 3 4 0 0 7 Totals 0 16 5 5 14 37 2 0 79 Deaths from Epidemics for the corresponding Quarter, 1881. 3 20 12 2 14 66 9 0 126 Three deaths from small-pox, of patients sent from this District, occurred in the Small-pox Hospital. Four deaths from fever occurred in the Fever Hospital of persons belonging to this District, thus making a total of 6 deaths from fever. 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 30th September, 1882. Sub-districts. Euumerated Population in 1881. 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 22585 177 88 35 21 9 3 10 2 Mile End New Town 15473 173 140 28 19 34 2 11 76 Whitechapel North 10001 60 29 10 5 4 2 5 0 Whitechapel Church 7489 57 228 23 33 23 36 39 192 Goodman's Fields 9713 80 44 16 15 5 0 2 0 Aldgate 6102 41 21 6 6 4 2 5 0 Totals 71363 588 550 118 99 79 45 72 270