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WHI 29 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE SANITARY CONDITION OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDED 1st JANUARY, 1881, BY JOHN LIDDLE, medical officer of health. LONDON: Penny & Hull, Steam Printers, 53, Leman Street, Whitechapel. F,. 1881. REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ended lst January, 1881. TO THE BOARD OF WORKS, WHITECHAPEL DISTRICT, Gentlemen, In the Quarter that ended on Saturday, the 1st January, 1881, the total births in the District were 621, viz., 316 males and 305 females; and the deaths 502, viz., 274 males and 228 females. The excess of births over deaths has therefore been, during the Quarter, 119. As the deaths of 115 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 387, and thus increasing the number of births above deaths to 234. 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 G55, and the total deaths 697. The weekly average of births was 50.3, and of deaths 53.6; and in the present Quarter the weekly average of births has been 47.7 and of deaths 38.6. In the Spitalfields sub-District the births were 164, and the deaths 80; in the Mile End New Town 178, and the deaths 119 (in this subDistrict the Workhouse is situated); in the Whitechapel North 103, and the deaths 41; in the Whitechapel Church 64, and the deaths 199 (in this sub-District the London Hospital is situated); in the Goodman's Fields 74, and the deaths 41; and in the Aldgate 38, and the deaths 22. The deaths have exceeded the births in the Whitechapel Church sub-District by 135, but the deaths of the 115 non-residents in the London Hospital must be deducted from the total deaths in that Institution ; the proportion of births to deaths is therefore 64 to 84. 4 The deaths in the London Hospital have been 169; of these 115 were of non-residents, 26 of residents, and 28 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 15.3 per cent. In the last Quarter ended 2nd October, the proportion of deaths of residents to non-residents was only 10.2 per cent. The deaths in the Workhouse have been 75. In the corresponding Quarter of last year they were 74. The deaths from epidemic diseases in the entire District have been 35; viz.: 1 from small-pox, to which must be added 4 deaths which occurred in the Small-pox Hospitals, thus making 5 deaths from small-pox ; 11 from measles, 6 from scarlet-fever, 5 from diphtheria, 1 from hooping-cough, 6 from diarrhcea and 8 from fever, including 3 which occurred in the Fever Hospitals. The number of patients suffering from small-pox and from fever, who were removed from this District to the Asylum Hospitals, will be seen on page 9. In the corresponding Quarter of the previous year, the deaths from epidemic diseases were 97 ; viz.: 0 from small-pox, 26 from measles, 31 from scarlet-fever, 6 from diphtheria, 14 from hoopingcough, 13 from diarrhcea, and 7 from fever. Mortality of Young Children. The mortality of children under 1 year of age was 79. This is 15.7 per cent, of the total mortality. In the corresponding Quarter of the previous year it was 17.9 per cent. In the Spitalfields subDistrict the rate is 26.2 per cent.; in the Mile End New Town 16.8 per cent. ; in the Whitechapel North 21.9 per cent.; in the Whitechapel Church 3.5 per cent.; in the Goodman's Fields 43.9 per cent.; and in the Aldgate 18.1 per cent. The difference in the rate of mortality of young children in the Mile End New Town and Whitechapel Church sub-Districts is thus explained :βin 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, 5 The total deaths under 5 years are 168, which shows a rate of mortality of 33.4 per cent, in relation to the total deaths, including those of non-residents, and 27.0 per cent. to the total births. The rate of mortality under 1 year, in relation to the total births, is 12.7 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended during the past Quarter 904 new cases of illness out of the Workhouse ; including 16 of small-pox, 16 of measles, 8 of scarlet-fever, 19 of diarrhΕa, 36 of febricula, 6 of fever, and 10 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 1056; including 2 of small-pox, 76 of measles, 18 of scarlatina, 9 of hooping-cough, 26 of diarrhΕa, 36 of febricula, 3 of fever, and 2 of erysipelas. The total number of cases of illness in the Workhouse has been 878 ; including 3 of measles, 1 of hooping-cough, 21 of diarrhoea, 2 of fever, 15 of erysipelas, and 8 of febricula. In addition to the above cases, there were 52 of syphilis and gonorrhΕa; thus making a total of 930. Uncertifred Deaths. Two uncertified deaths are recorded during this Quarter; 1 in Mile End New Town and 1 in the Whitechapel Church subDistrict. Meteorology of Greenwich. The Returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 12.54 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 2.24 inches. The average annual rain-fall at Greenwich in 63 years was 25.4inches. The mean temperature of the air was 43Β°.7. Inthecorresponding Quarter of last year it was 41Β°.0. The coldest days during the Quarter were Tuesday, the 2nd November, Sunday, the 21st of November, and Tuesday, the 9th November, when the thermometer indicated respectively 25Β°.0, 25Β°.8, and 26Β°.5. The coldest day during the corresponding Quarter of last year was on Saturday, the 6th December, when the thermometer indicated 13Β°.7, or 18Β°.3 below * In October, falls of rain exceeding one inch in 24 hours were of frequent occurrence. Rain fell on every day from the 8th to the 26th November. 6 the freezing point of water. The lowest mean temperature during any week in the Quarter was in that which ended November 4th, when it was 31Β°.2. Table of Weekly Mortality, &c., in London and in the Whiteciiapel District. The following Table, taken from the Returns of the Registrar-General, shows the comparative results of the Quarter:β Week ended. Deaths in London. Deaths in Wchl. District Rainfall. Inches. Mean Temperature of the air. Degrees DiarrhΕa. Fever. Small-pox. From all causes. From Smallpox. From all causes. Oct. 9 64 25 5 1398 0 42 3.07 50.5 β 16 66 27 6 1405 0 40 1.30 48.0 β 23 59 24 7 1518 0 33 1.35 42.9 β 30 28 21 2 1521 0 36 1.72 42.0 Nov. 6 35 22 7 1513 0 33 0.00 39.3 β 13 21 22 17 1636 0 29 0.24 46.3 β 20 22 17 10 1489 0 39 1.38 40.8 β 27 18 15 19 1521 0 42 0.46 42.1 Dec. 4 9 17 10 1446 0 39 0.04 44.1 β 11 16 9 12 1398 0 34 0.00 47.7 β 18 10 9 23 1377 0 36 0.76 43.3 β 25 15 14 15 1242 0 46 1.26 40.6 Jan. 1 15 14 17 1648 1 53 0.96 40.6 It will be seen from the above Table that the deaths from diarrhoea in London have been during the Quarter 378. In the Whitechapel District, as will be seen from the subjoined Tables, diarrhΕa has been much more prevalent during the year than in the preceding one. This is especially noticeable as regards children under one year of age. The great increase in the number of cases of diarrhΕa occurring in the third quarter of the year caused me some little feeling of anxiety, looking on it as a possible precursor of cholera, as diarrhoea was always very prevalent before the out-break and during the continuance of cholera, as may be seen on reference to my report on that disease ; but fortunately the diarrhoea subsided, and the cases have been, during this Quarter, not above the average number. i A Table showing the deaths from diarrhoea in the Whitechape District for the Four Quarters of the year ended Saturday, ist January, 1881, and the ages at death:β QUARTERS ENDED 0 and under 1 year. 1 year and under. 2. 2 years and under 3. 3 years and under 4. 4 years and under 5. 6 years and under 7. 7 years and under 8. 12 years and under 13. 13 years and under 14. 14 years and under 15. 30 years and under 40. 50 years and under 60. 60 years and under 70. 70 years and under 80. total. 1880. April 3rd (14 weeks). 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 July 3rd. 9 2 ... ... ... ... ... ... ... ... ... 1 ... ... 12 Oct. 2nd. 48 12 2 1 ... ... ... ... ... ... 1 1 4 1 70 1881. Jan. 1st. 5 ... ... ... 1 ... ... ... ... ... ... ... ... ... 6 Totals 63 15 2 1 1 ... ... ... ... ... 1 2 4 1 90 A Table showing the deaths from Diarrhoea in the Whitechape District for the Four Quarters of the Year ended 27th December 1879, and the Ages at Death:β QUARTERS ENDED 0 and under 1 year. 1 year and under 2. 2 years and under 3. 4 years and under 5. 6 years and under 7. 7 years and under 8. 12 years and under 13. 13 years and under 14. 14 years and under 15. 30 years and under 40. 50 years and under 60. 60 years and under 70. 70 years and under 80. TOTAL. 1879. March 29th. 3 ... ... ... ... ... ... ... ... ... ... ... ... 3 June 28th 0 1 ... ... ... 1 ... ... ... ... ... 1 ... 5 Sept. 27th 26 6 1 1 2 ... 1 1 1 ... 5 1 1 46 Dec. β 6 4 1 ... ... ... ... ... ... 1 1 ... ... 13 Totals 37 11 2 1 2 1 1 1 1 1 6 2 1 67 8 Vaccination. From the Vaccination Tables kindly prepared for me by Mr. Vallance, the Clerk to the Board of Guardians, it appears that re-vaccination is well attended to in this District. In my Report for the Quarter ended July, 1880, it appears, " from the Vaccination Returns which were laid before the Board of Guardians and by them submitted to the Local Government Board, that during the year 1879, 2735 births had been registered in the Union. Of that number 2409 had been successfully vaccinated ; one was unsusceptible of vaccination ; 227 died (or 8.3 per cent, of the number born); 22 had been postponed, and 26 had removed to other districts, or gone abroad. This Report, so far as the vigilance of the Vaccination Officer is concerned, in tracing the children whose births were registered in the District, and inducing the parents to obtain vaccination for their children, is highly satisfactory, and reflects great credit upon all those who are intrusted with the working of the Vaccination Act ; for it shows that only 61, or 2.2 per cent, were lost sight of; and as the authorities of those Districts where it was ascertained the children had been removed to were apprised, it is probable that some of the children were vaccinated in their new abodes." At the Meeting of the Board of Guardians held on Tuesday, 1st February, 1881, Mr. Vallance reported that in the half-year to June, 1880, there were 1,464 births, and 1,298 successful vaccinations; 113 died ; 9 were postponed by medical certificate; 9 had removed to districts, the Vaccination Officers of which had been apprized ; 33 removed to places unknown, and 2 were unaccounted for. Mr. Vallance ventured to say that no Union could show a better, if as good, a a return, and for a migratory district like Whitechapel, a loss of 2 and 2Β½ per cent, reflected the highest credit on the Vaccination Officer. This opinion is in accord with that of every person who has had experience in the difficulty of inducing parents in poor neighbourhoods to obtain the benefits of vaccination for their children. It was further stated by Mr. Vallance " that during the year 82 children had been born alive in the Infirmary, and that (with the exception of 2 who died before vaccination) they were all successfully vaccinated before discharge. Beyond this, children admitted are always inspected, and during the year 96 children under one year old had been vaccinated." Greater benefit may be expected to result from the vigilance of the Vaccination Officer during the intervals of small-pox epidemic, in promoting vaccination, than during the actual prevalence of the disease. It will be found that more cases of vaccination are performed under the panic caused by the existence of small-pox, than when the epidemic has passed away ; and thus it happens that many nnprotected persons are left as victims to the next epidemic. 9 VACCINATION. WHITECHAPEL UNION.βReturn 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 endingβ PUBLIC VACCINATOR Workhouse. Totals. Births Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. Registd. March, 1879 273 1 37 β 310 1 753 June 639 24 25 β 564 24 656 September 464 2 27 β 491 2 658 December 373 β 33 β 406 β 655 April 3rd, 1880 (14weeks) 380 2 31 β 411 2 846 June 533 β 25 β 558 β 676 September 387 6 15 β 402 6 590 December 335 1 35 β 370 1 621 Totals 3284 36 228 β 3512 36 5455 Quarterly Return of Small Pox and Fever Cases and Deaths in the Asylum Board Hospitals, September 30th to December 30th. FEVER.β19 Admitted. SMALL POX.β25 Admitted. Men. Women. Children. Total. Men. Women. Children. Total. North District 1 1 1 3 North District 4 3 5 12 South District 1 1 14 16 South District 6 5 2 13 19 25 Of these 19*β 10 were admitted from the London Hospital (8 being non-resident in Union). Of these 25β 7 were admitted from the London Hospital (4 being non-resident in Union). 3 Died. Craven, Thomas, aged 38, from 6, Angel-alley. 4 Died. Groves, Frederick, aged 50, from 13 Oxford-street, W.C. Tubb, Mary A., aged 29, from 101, Wentworth-st. Covney, Peter, aged 28, from 3, Norwich-court. Ratigan, Patrick, aged 4, from 10, Crown - court, Wentworth-street. Wood, James, aged 5, from London Hospital, (late of 111, Finnist., Bethnal Green.) Kenny, Mary A., aged 8, from 4, Paternoster-row. 10 Peabody Buildings, Royal Mint Street. The plans of the Peabody Buildings in the course of erection in Royal Mint Street under the scheme of the Metropolitan Board of Works having been considered by the Board, it was resolved that the Medical Officer of Health and the Surveyor should inspect the places and report their views thereon to the Committee of Works. The subjoined is the Report of the Medical Officer of Health and the Surveyor on the matter referred to them. JOINT REPORT OF THE MEDICAL OFFICER OF HEALTH AND SURVEYOR. To the Committee of Works. Gentlemen, In accordance with the resolution of the Board relative to the Peabody Buildings, near Royal Mint Street, under the Scheme of the Metropolitan Board of Works, we have inspected the Buildings now in course of erection on the West side of Glasshouse Street, and Blue Anchor Yard, and report that we find upon an area of 48,680 superficial feet, a space of 18,000 superficial feet is covered by the Buildings, leaving an area of 30,680 superficial feet as an open space. That in the construction of the Buildings attention has been paid to their sanitary arrangements ; but we would suggest as an improvement in future buildings of a similar character that the water closets should not be within the Buildings, but attached thereto, and provided with two windows opposite each other, and, where practicable, they should have windowed lobbies in addition, as suggested by Mr. Simon, late Medical Officer to the Privy Council, so that a thorough ventilation may be obtained. The rooms vary in size, being 13-ft. by 11-ft., 13-ft. by 9-ft. and 11-ft. by 10-ft.; and the rooms, excepting the top story, are 9-ft. 6-in. in height, and those are 8-ft. 6 inches in height. The average cubical contents of the upper rooms are therefore 1048-ft., and the average of those on the lower floor 1171-ft. A new public sewer has recently been constructed by tha Metropolitan Board of Works in Glasshouse Street, in place of a pipe drain (which formerly existed there). The arrangements for the drainage of the Buildings, we consider, are satisfactory. We are not in possession of the fact whether or not provision has been made for the ventilation of the soil pipes and drains ; but we consider it advisable that the soil pipes and drains should be ventilated above the roofs. With the exception of the water closets, we consider the general arrangements of the Buildings are satisfactory. Wo are, Gentlemen, Your obedient Servants, 17th November, 1880. (Signed) JOHN LIDDLE, S. W. IRON. 11 A copy of the above Report was sent to the Metropolitan Board of Works and the Peabody Donation Fund Society. This Society, after expressing thanks in a letter addressed to the Whitechapel Board of Works for a copy of the Joint Report, state, that if the officers of your Board will again visit the Buildings after they are occupied, they will find that all the soil pipes and drains are ventilated above the roof, and that no foul air or gas can enter the rooms. The trustees desire to express their wish that all future dwellings for the poor may have the closet accommodation as perfect as it will be found in the Whitechapel Buildings. There can be no doubt that a new Building Act is imperatively demanded, for the existing Act is extremely defective. The defects of the Building Act have been pointed out, in several of my Reports, and suggestions made for their amendment, and I would respectfully refer all who are interested in this important matter to those Reports, especially to pages 8, 9, 10, and 11, in the Report for the Quarter ended December, 1872; and I would also refer you to an excellent leading article in the " Times " of Thursday, February, 3rd, 1881, on the importance of building healthy houses, the conditions of which, among other things, require provisions against injury from frost, whereby the domestic comforts of a family may be secured. The principal points mentioned are the protection of the water supply pipe against the effects of severe frost, so that the water in these pipes may be so protected as to prevent the expansion of the water in them by freezing, and consequent bursting of them, whereby the family is not only put to the greatest possible inconvenience, but their health suffers most materially. The walls of the house should be of adequate thickness to keep out the cold and wet, and prevent the wasteful escape of heat which is generated within the buildingβthick walls, substantially constructed of good materials, are the first essentials. The roof should be so constructed as to prevent the drifting of rain or snow under the slates and tiles. As the public at large cannot be expected to insist on all these details in the building of a house, the officers of local boards of health should be required to examine all houses in the course of erection, to see that all things requisite for health are duly attended to, and the Board should insist on all the essentials for health in the building of a house being regarded. The apathy of the public in matters of health is truly lamentable, 12 It is greatly to be desired and hoped for, that as education extends, many of the evils which are now so productive of ill health will be removed, and the happiness, comfort, and longevity of mankind, will be promoted. It is well known that much danger to the public health arises from defectively built houses, more especially as regards the construction of the foundations, drains, water closets, and walls. These dangers might be prevented, if during the building of houses all the sanitary arrangements were to be frequently inspected by the surveyor and health officers of the several local boards, whose duty it should be to ascertain not only that the foundations of all the houses in the course of construction were properly made, but that the drains were so laid, and constructed of such materials, as should prevent leakage ; and that the water-closets should be formed of proper materials and so placed, and trapped, as the emanations from them should not escape into the rooms or passages of the house. It is also necessary that the workmanship should be approved by the official inspectors, and that no house should be allowed to be occupied as a dwelling unless the same be certified by the local board, in regard to all its sanitary arrangements, as being, in every respect, fit for habitation. Unless more stringent regulations are made and acted on in the construction of houses the health of the people must necessarily suffer. In the construction of houses the only thing that appears to be considered by many builders is that of cheapness. It will certainly be found to be less expensive to prevent the building of unhealthy houses, than to so alter them after they are built as to render them fit for habitation. Sanitary Works Performed during the Quarter ended 1st January, 1881. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ended 1st January, 1881. Number of inspections of houses as shown in the official returns 2191 Houses specially visited 335 Houses specially re-visited 1340 Preliminary notices served, such notices embracing 359 premises 164 Compulsory orders issued, embracing 145 premises 41 13 Summonses heard at Police Courts, under Sanitary Act 3 ,, under Act for the prevention of Adulteration of Food, &c. 0 Cellars used as dwellings discontinued for such use 1 Cases of overcrowding and indecent occupation abated 1 Houses in which rooms or passages have been whitewashed 185 Rooms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 144 Articles, consisting of beds, bedding, clothing, &c., removed from rooms to the Stone Yard and disinfected in the Apparatus 4459 Yards of houses paved, or the pavement repaired 36 Drains in houses improved 63 Dust-bins provided 2 Privies lime-washed, cleansed and repaired 91 Water supply provided or improved 18 Nuisances from dung and other offensive matter removed 29 Area gratings, cellar flaps, &c., repaired 36 Animals (swine, fowls and a horse) kept so as to be a nuisance, removed 24 ANNUAL REPORT. The number of births registered in this District during the year 1881 (consisting of 53 weeks), has been 2733, giving an average of about 51 per week; and the deaths have been 2302, which is a weekly average of about 43, including the deaths of non-residents in the London Hospital (439). In the preceding year, consisting of 52 weeks, the births were 2722, giving a weekly average of about 52, and the deaths were 2426, or a weekly average of about 46, including those of non-residents (434). The births are therefore less by 11 than they were in the preceding year, and the deaths are 124 less. The rate of mortality in this year (consisting of 53 weeks), as will be seen in Table V, has been 24.3 per 1000; while in the preceding year it was 26.0 per 1000, and in 1873, which also consisted of 53 weeks, deducting in both years the deaths of non-residents, was 26.5 per 1000. 14 Uncertified Deaths. The number of uncertified deaths has been, during this year, 7. This is 0.3 per cent, of the total deaths. During the last year the number of uncertified deaths was 19, or 0.78 per cent. of the total deaths. In London, the per centage of uncertified to certified deaths is about 1.6 per cent. The uncertified deaths in this District have been registered as follows:β CAUSE OF DEATH. Cases. Ages. Exhaustion 1 12 hours. These Cases were attended by Midwifes. Do. 1 24 β Convulsions after Birth 1 7 β Do. from Birth 1 3 β Convulsions and Exhaustion 1 12 β Bronchitis 1 2 years. Syncope, Disease of Heart 1 73 β The Medical Attendant not qualified. Total 7 Deaths from Epidemic Diseases. Of the total deaths recorded in this District during the year, there were 224 from epidemic diseases, viz.: 16 from small-pox, in which are included the 10 which occurred in the Hospital, thus making a total of 16 ; 26 from measles, 37 from scarlet-fever and diphtheria, 39 from hooping-cough, 90 from diarrhoea, and 16 from fever, including 4 which occurred in the Hospital. Small-Pox. In the first Quarter of this year (14 weeks) there were 4 deaths from small-pox; in the second Quarter 5; in the third Quarter 2, both of which occurred in the Hospital; and in the present Quarter there were 5, 4 of which occurred in the Hospital. 15 In the fifty-three weeks ended January 1st, the deaths in the District from small-pox were 16 ; of these 10 died in the Small-pox Hospital. In 1879, the deaths from small-pox were 7, including 6 which occurred in the Small-pox Hospitals. The deaths in London were 475, and in. the preceding year 454. DiarrhΕa. The deaths from diarrhcea in the District have been 90. In the preceding year they were 67, while in the whole of London the deaths from diarrhcea have been 3780, and in the preceding year they were 1900. For further particulars respecting the deaths from epidemic diseases see Table VI. in the Appendix. Fever. The deaths from fever, including 4 which occurred in the Fever Hospital, have been 16. In the preceding year, the deaths from fever were 33, including 4 which occurred in the Fever Hospital. In the whole of London the deaths from fever have been 887. The death-rate from epidemic diseases, including those in Hospitals for the year, in relation to the total mortality, is 9.7 per cent., and in relation to the population 2.9 per 1000. Last year the death-rate from epidemic diseases, in relation to the total deaths, was 13.1 per cent. Pauper Illness in the District. The number of out-door sick paupers who have been attended by the Medical Officers of the Union is 3660. During the previous year the number was 3833. The extraordinary annual diminution in the number 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 ratepayers of this District. Illness in the Workhouse. The Cases of illness in the Workhouse during the year have been 3268, including 184 cases of syphilis and 15 of lead poisoning. 16 Sanitary Works performed during the Year 1880. Number of inspections of houses, as shown in the official returns 9322 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each personβnuisance in each case abated 24 Houses specially visited 1335 ,, re-visited 13653 Rooms disinfected with sulphurous acid gas after the occurrence of fever and scarlet-fever therein 245 Articles disinfected, consisting of beds, bedding, clothing, &c. 7345 Preliminary notices served, such notices embracing 1321 premises 741 Compulsory orders issued, embracing 664 premises 213 Summonses heard at Police Courts, under Sanitary Act 7 ,, under Act for the prevention of Adulteration of Food, &c. 5 Houses in which rooms or passages have been whitewashed 679 Yards of houses paved or the pavement repaired 130 Cesspools abolished 1 Drains in houses improved 257 Dust-bins provided 22 Privies lime-washed, cleansed and repaired 404 Water-supply provided or improved 66 Area-gratings, cellar-flaps, &c., repaired 95 Cellars used as dwellings discontinued for such use 9 Nuisances from dung and other offensive matter removed 114 Animals kept so as to be a nuisance removed 121 All the Cow-houses and the Slaughter-houses have been visited four times during the year. 17 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.βCases 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 January, 1881. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. DiarrhΕa. Cholera and Choleraic D iarrhΕa. Continued Fever, Typhus & Typhoid. Febricula. PyΓ¦mia. 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 0 0 0 8 0 0 14 0 i 0 0 18 2 0 1 0 0 0 0 148 197 Mr. Champneys 3 5 0 0 5 0 0 0 0 5 0 0 67 0 0 0 0 0 0 1 255 341 Mr. Sequeira 2 11 1 0 1 0 3 18 0 2 0 1 17 3 1 1 0 0 0 0 78 139 Mr. H. Braye 5 0 7 0 4 0 3 3 0 1 0 0 32 2 1 0 0 0 0 0 116 174 Mr. Loane 1 0 0 0 1 0 0 1 0 1 0 0 16 0 0 1 0 0 0 0 32 53 Totals 16 16 8 0 19 0 6 36 0 10 0 1 150 7 2 3 0 0 0 1 629 904 Corresponding Qr. of previous Year. 2 76 18 9 26 0 3 36 0 2 0 1 177 13 0 36 0 0 0 3 654 1056 Workhouse Mr. J. J. Ilott. 0 3 0 1 21 0 2 8 0 15 0 0 128 32 3 83 2 2 7 3 568 878 In addition to the cases of illness in the Workhouse, which are above recorded, there were 52 cases of syphilis and gonorrhΕa. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ended 1st January, 1881. Sub-districts. Small-Pox. j Measles. Scarlet Fever Diphtheria. Hooping- Cough. DiarrhΕa. Fever. Cholera & Cholcraic DiarrhΕa. Total. Remarks. Spitalfields 0 1 2 0 0 1 1 0 5 Mile End New Town 1 3 2 1 0 0 1 0 8 Workhouse. Whitechapel North 0 3 1 0 0 4 0 0 8 Whitechapel Church 0 2 0 4 0 0 1 0 7 Hospital. Goodman's Fields 0 1 1 0 0 1 1 0 4 Aldgate 0 1 0 0 1 0 1 0 3 Totals 1 11 6 5 1 6 5 0 35 Deaths from Epidemics for the corresponding Quarter, 1879. 0 26 31 6 14 13 7 0 97 Four deaths from small-pox, of patients sent from this District, occurred in the Small-pox Hospital, thus making 5 deaths from small-pox of persons resident in the District. Three deaths from fever occurred in the Fever Hospital of patients sent from this District, thus making 8 deaths from fever. TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causesβ 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 January, 1881. Sub-districts. Enumerated Population in 1871. Birth s. 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 164 80 21 15 13 4 12 3 Mile End New Town 15550 178 119 20 16 33 4 16 75 Whitechapel North 11597 103 41 9 10 7 3 4 0 Whitechapel Church 7322 64 199 7 32 30 31 33 169 Goodman's Fields 10381 74 41 18 7 6 2 2 0 Aldgate 9224 38 22 4 9 4 0 0 0 Totals 76573 621 502 79 89 93 44 67 247 TABLE IV. Cases of illness attended annually by the Medical Officers of the Union, from the year 1856. Years ending Total cases attended during the year. Years ending Total cases attended during the year. Years ending Total cases attended during the year. 1856 12485 1865 15594 1874 3685 1857 10714 1866 16502 1875 2474 1858 11718 1867 17181 1876 2281 1859 11701 1868 17417 1877 2060 1860 11392 1869 14031 1878 3107 1861 13724 1870 14148 1879 3833 1862 14270 1871 10194 1880 3660 1863 14564 1872 4864 1864 14932 1873 4887 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 1880. 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 per cent, of Children under 1 yr. to the total deaths deducting the deaths of non-residents. Rate of mortality per 1000, deducting the deaths of nonresidents. Rate of mortality of Children under 1 yr. per 1000 of the population. 1866 78,970 2501 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 710 405 509 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 1878 ... 2658 2430 671 469 482 24.5 25.6 6.2 1879 ... 2722 2426 615 434 454 21.2 26.0 5.9 1880 ... 2733 2302 631 439 450 24.1 24.3 5.8 * These years contain 53 weeks. The number of Inquests which have been held this year in this District has been 297. In the preceding year the number was 328. 21 TABLE VI. Showing the Deaths from Epidemic Diseases in the Whitechapel District during the last 24 years. Name of Disease 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 Small Pox 3 4 60 21 28 33 69 5 22 44 40 11 1 56 159 19 1 1 2 8 23 11 7 16 Measles 60 78 31 81 27 153 26 137 28 139 33 69 71 36 42 23 44 33 40 16 96 32 49 26 Scarlet Fever & Diphtheria 43 87 96 59 70 91 200 50 80 76 26 48 208 59 25 96 24 199 51 18 28 24 89 37 Hooping Cough 89 117 50 49 89 62 52 74 97 94 72 55 113 50 43 9 79 16 61 57 44 84 73 39 DiarrhΕa 139 108 141 67 101 69 114 109 122 119 100 138 97 107 125 99 113 76 93 103 89 89 67 90 Fever 117 104 93 69 65 250 158 170 167 100 82 109 95 52 40 26 44 47 30 27 26 29 33 16 Cholera &Cho leraic-Diaha. 10 6 5 1 4 5 5 2 4 904 9 10 7 6 3 5 8 3 0 0 0 0 0 0 Totals 461 504 476 347 384 663 624 547 520 1476 362 440 592 366 437 277 313 375 277 229 306 269 318 224 Fever 2203 1902 1796 1302 1754 3635 2S02 3689 3232 2681 2174 2483 2211 2049 1755 1003 1548 1552 1282 1206 1240 1361 1084 887 Scarlta. & Diph. 1587 4118 4197 2457 3058 4194 5799 3806 2614 2316 1836 3418 6162 6306 2220 1063 932 3037 4038 2673 1776 2350 3212 3624 Small Pox 154 247 1156 877 215 345 2012 537 646 1388 1339 606 273 958 7834 1532 114 56 75 739 2544 1416 454 475 * In the above Table the years 1S63, 1869, 1873 and 1880, consist of 53 weeks. In the column of deaths for 1879 and 1880, the deaths from small-pox and from fever, which occurred in the Hospitals, are included. Scarlet-fever and diphtheria in the earlier records of the Registrar-General were not separated, but were classed under one heading, viz.: scarlet-fever. For some years past these diseases have been recorded under separate headings. The deaths from scarlet-fever during this year were 24 and from diphtheria 13. In London, the deaths from scarlet-fever were 3073, and from diphtheria 551. 22 TABLE VII. Showing the cases of Epidemic Diseases among the pauper population in the Whitechapel District during the last 24 years. Name of Disease 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 Small Pox 6 20 242 65 86 113 253 21 86 261 254 93 5 302 625 60 2 1 0 19 125 48 10 37 Measles 266 427 179 520 70 525 80 482 51 679 155 323 212 257 178 76 128 59 32 32 64 11 115 40 Scarlet Fever & Diphtheria 49 147 176 93 100 118 305 156 164 197 60 54 311 97 32 16 22 161 17 6 8 18 71 21 HoopingCough 150 230 146 83 388 153 169 217 280 217 219 144 30S 140 102 94 86 30 44 15 24 16 33 12 DiarrhΕa 1324 946 1209 773 1418 1085 1108 1127 1342 1664 1471 1631 1033 1097 590 283 212 150 101 120 61 76 91 119 Fever 1441 590 411 190 109 822 464 295 573 343 308 586 385 325 201 19 126 84 24 34 17 17 13 9 Cholera&Cho- leraic-Diaha. 16 0 1 1 0 1 1 4 4 58 5 8 1 4 2 3 2 0 0 0 1 2 0 0 Totals 3252 2360 2364 1725 2171 2817 2380 2302 2500 3419 2472 2839 2255 2222 1730 551 578 485 218 226 300 188 333 238 In the above Table the years 1863, 1869, and 1873, consist of 53 weeks. BOARD OF WORKS, WHITECHAPEL DISTRICT REPORT ON THE SANITARY CONDITION OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDED 2ND APRIL, 1881, BY JOHN LIDDLE, medical officer of health. LONDON: Penny & Hull., Steam Printers, 53, Leman Street, Whitechapel, E. 1881. REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ended 2nd April, 1881. TO THE BOARD OF WORKS, WHITECHAPEL DISTRICT. Gentlemen, In the Quarter that ended on Saturday, the 2nd April, 1881, the total births in the District were 694, viz., 361 males and 333 females; and the deaths 638, viz., 378 males and 260 females. The excess of births over deaths has therefore been, during the Quarter, 56. As the deaths of 126 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 512, and thus increasing the number of births above deaths to 182. 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 846, and the total deaths 772. The weekly average of births was 60.0, and of deaths 55.1; and in the present Quarter the weekly average of births has been 53.3 and of deaths 49.0. In the Spitalfields sub-District the births were 195, and the deaths 106 ; in the Mile End New Town 182, and the deaths 188 (in this subDistrict the Workhouse is situated); in the Whitechapel North 105, and the deaths 50 ; in the Whitechapel Church 58, and the deaths 223 (in this sub-District the London Hospital is situated); in the Goodman's Fields 107, and the deaths 44 ; and in the Aldgate 47, and the deaths 27. The deaths have exceeded the births in the Whitechapel Church sub-District by 165, but the deaths of the 126 non-residents in the London Hospital must be deducted from the total deaths in that Institution ; the proportion of births to deaths is therefore 58 to 97. 4 The deaths in the London Hospital have been 174 ; of these 126 were of non-residents, 16 of residents, and 32 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 18.3 per cent. In the last Quarter ended 1st January, the proportion of deaths of residents to non-residents was 15.3 per cent. The deaths in the Workhouse have been 102. In the corresponding Quarter of last year they were 152. The deaths from epidemic diseases in the entire district have been 58; viz.: *5 from small-pox, to which must be added 9 deaths which occurred in the Small-pox Hospitals, thus making 14 deaths from small-pox; 33 from measles, 5 from scarlet-fever, 2 from diphtheria, 4 from hooping-cough, 1 from diarrhcea and 8 from fever; no deaths from fever occurred in the Fever Hospital of patients removed from this District. The number of patients suffering from small-pox and from fever, who were removed from this District to the Asylum Hospitals, will be seen on page 7. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 50; viz.: 3 from small-pox, 10 from measles, 7 from scarlet-fever, 3 from diphtheria, 23 from hoopingcough, 2 from diarrhoea, and 2 from fever. Mortality of Young Children. The mortality of children under 1 year of age was 86. This is 13.4 per cent, of the total mortality. In the corresponding Quarter of the previous year it was 17.0 per cent. In the Spitalfields subDistrict the rate is 18.0 per cent.; in the Mile End New Town 12.7 percent.; in the Whitechapel North 26.0 per cent.; in the Whitechapel Church 6.7 percent.; in the Goodman's Fields 29.5 per cent.; and in the Aldgate 7.4 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:βin 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 residences of these 5 persons were as follows:β80, Pelham Street; 17, Swan Court, Whitechapel; 10, White's Row, Whitechapel; and 2 died in the London Hospital, both of whom were non-residents, one of whom resided in Lombard Street, City, and the other in John Street, Bethnal Green, 5 Rate of Mortality. The rate of mortality in the entire District, based on the population according to the present census, which is less by 5,297 than in 1871, is, deducting as usual the deaths of the non-residents, 23.9 per 1,000. The population in 1871 was 76,573, and is now only 71,276. The total deaths under 5 years are 185, which shows a rate of mortality of 28.9 per cent, in relation to the total deaths, including those of non-residents, and 26.6 per cent, to the total births. The rate ol mortality under 1 year, in relation to the total births, is 12.3 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended during the past Quarter 1246 new cases of illness out of the Workhouse; including 46 of small-pox, 85 of measles, 3 of scarlet-fever, 6 of diarrhoea, 17 of febricula, and 5 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 1175; including 6 of small-pox, 14 of measles, 4 of scarlatina, 5 of hoopingcough, 9 of diarrhoea, 28 of febricula, 1 of fever, and 4 of erysipelas. The total number of cases of illness in the Workhouse has been 1025 ; including 1 of small-pox, 15 of diarrhoea, 8 of erysipelas, 1 of puerperal fever, and 10 of febricula. In addition to the above cases, there were 42 of syphilis and gonorrhoea ; thus making a total of 1067. Uncertified Deaths. Five uncertified deaths are recorded during this Quarter; 1 in Mile End New Town sub-District, 2 in the Whitechapel North subDistrict, and 2 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 5.43 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 4.05 inches. The average annual rain-fall at Greenwich in 63 years was 25.4 inches. The mean temperature of the air was 37Β°4. In the corresponding Quarter of last year it was 40Β°0. The coldest days during the Quarter were Monday, the 17th January, Wednesday, the 26th January, Saturday, the 15th January, and Thursday, the 20th January, when the thermometer indicated respectively 12Q7, 13Β°2, ]4Β°2, and 14Q4. The coldest day during the corresponding Quarter 6 of last year was on Tuesday, the 27th December, when the thermometer indicated 17Β°.2 or 14.Β°8 below the freezing point of water. The lowest mean temperature during any week in the Quarter was in that which ended January 22nd, when it was 18Β°.5. The Registrar-General, in his last Quarterly return of marriages, births, and deaths registered in England and Wales, remarks, "that so low a death rate for the first Quarter of the year has not been recorded since that of 1856, when a similar rate prevailed. This low death rate in the Quarter under notice is the more remarkable on account of the exceptionally severe frost that prevailed during a considerable portion of January. There were 40 frosty days during the Quarter, and the lowest reading on each of those days showed an aggregate of 278.3 degrees of frost. This amount of cold weather exceeds that recorded in the corresponding period of any year since 1855, when the aggregate degrees of frost were 404.7." The falls of snow throughout the Quarter were exceptional. Snow fell on 53 days, and the snow-storm of the 18th day of January was very remarkable. Nearly all the lines of railway out of London were blocked. Trains were embedded in the snow all night, and during the next day. 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;β Week ended. Deaths in London. Deaths in Wchpl. District Rainfall. Inches. Mean Temperature of the air. Degrees Diarrhoea. Fever. Small-pox. From all causes. From Smallpox. From all causes. Jan. 8 17 10 33 1510 1 33 0.00 38.4 β 15 25 16 27 1604 0 55 0.13 28.0 β 22 12 16 42 2016 0 45 0.46 23.4 β 29 8 19 52 2113 1 58 0.49 32.5 Feb. 5 16 9 54 1926 1 60 0.22 42.8 β 12 10 10 52 1633 0 52 0.77 38.8 β 19 11 20 55 1564 0 49 0.51 38.0 β 26 17 12 44 1525 0 55 1.00 34.4 Mar. 5 13 9 52 1663 0 63 1.20 38.1 β 12 8 17 58 1590 0 36 0.26 49.4 β 19 8 20 43 1459 1 44 0.00 44.8 β 26 9 15 49 1516 0 45 0.39 39.5 April 2 16 12 56 1547 1 43 1 0.00 39.1 7 VACCINATION. WHITECHAPEL UNION.βReturn of the number of Cases Vaccinated by the Public Vaccinator and the Medical Officer of the Workhouse, together with the number o Births Registered during the same quarters. Quarter endingβ PDBL1C VACCINATOR Workhouse. Totals. Births Registd. Primary Cases. Re-Vaccination. Primary Cases. Rc-Vaccination Primary Cases. Re-Vaccination. June, 1879 539 24 25 β 564 24 656 September 464 2 27 β 491 2 658 December 373 β 33 β 406 β 655 April 3rd, 1880 380 2 31 β 411 2 846 June 533 β 25 - 558 β 676 September 387 6 15 β 402 6 590 December 335 1 35 β 370 1 621 March, 1881 428 84 41 2 469 86 694 Totals 3439 119 232 2 3671 121 5396 Quarterly Return of Small Pox and Fever Cases and Deaths in the Asylum Board Hospitals, December 31st, 1880, to March 31st, 1881. FEVER.β5 Admitted. SMALL POX.β75 Admitted. Men. Women. Children. Total. Men. Women Children Total North District 0 0 2 2 North District 13 4 24 41 South District 0 0 3 3 South District 16 4 15 34 *5 *75 *Of these 5β 2 were admitted from the London Hospital (and both were nonresident in the Union). * Of these 75β 11 were admitted from the London Hospital (8 being non-resident in Union). No Deaths. 9 Died. age. Hoare, Charles, 30, 18J, Heneage-st. Fennell, Alice, 9, 26, Queen-st., C.C. Webster, Elizth. 6, 6, Hunt-court. Hussey, Charles 8, 24, Queen-st., C.C. Bull, Rebecca, 17, 15, Leman-street. Jenkins, Chas. 30, 12, Dock-street. Roberts,Harriet 28, 31, Gt. Garden-st Wolfe, Mary A, 7, 75, do. do. Barrett, Esther, 15 mo, 53, Charlottestreet, Whitechapel β’ 8 Compulsory Notification of Infectious Diseases. The question of the compulsory notification of infectious diseases has for some time past engaged the attention of the public interested in the prevention of the spreading of such diseases, and the importance of it was clearly manifested by the large deputation, consisting of members of the several Vestries and District Boards of the Metropolis, the members of the British Medical Association, members of the Association of the Medical Officers of Health, and members of the Social Science Association, to the President of the Local Government Board. That such information to the Sanitary authorities is absolutely required for the better protection of the public health is universally admitted by all who have paid attention to the subject. If facts were required to be adduced to show the necessity for such information being given, they could be abundantly furnished by Medical Officers of Health. In the Whitechapel District in the year 1877, smallpox broke out in a severe form in Spring Gardens, and it was not until a death occurred in that place that the Medical Officer of Health became informed of the existence of the disease. On inquiry it was ascertained that several days had elapsed since the disease had first manifested itself, and at the time of the visit of the Sanitary Officer, it was found that several persons had received the infection. I have no hesitation in saying that had I had information of the first case when it became known, and had it been promptly removed to a Small-pox Hospital, the extension of the disease would have been prevented. If this disease should occur in an establishment where a large number of persons live on the premises, and where an extensive business is carried on, I can readily understand the reluctance which would be felt by the proprietor to give information. At the same time, the information given to the sanitary authority would merely be a temporary inconvenience, since steps would be immediately taken to isolate the patient, and, thus, there would be little or no danger to the other persons living on the premises; but otherwise, the danger of such disease spreading would be very great, and the proprietor of the establishment would suffer much more inconvenience in his business by the extension of the disease in his establishment. If benefit has resulted in those towns where the law of compulsory intimation of infectious disease obtains, I see at present no good reason why the same law should not be extended to the 9 Metropolis, where there is more need of it, as small-pox has been far more severe in London than in other places in England. If legally safe for a person having a large establishment not to divulge the existence of an infectious disease among the inmates, it certainly cannot be morally right to do so, when it is so well known that such disease sometimes rapidly spreads, and death results therefrom. The existence of such a disease in a large establishment may be a great inconvenience to the proprietor, but the concealment of it may be the means of converting such private inconvenience into a public danger. The only means a Sanitary Officer has of learning the existence of infectious diseases among the middle and upper classes is by the occurrence of a death. If intimation were given of infectious disease in a private family to the local Medical Officer of Health, measures might promptly be taken to advise the family, with the concurrence of the medical practitioner in attendance, to adopt the best means for so isolating the patient as to prevent the disease extending to other members of the family. The isolation of patients in a hospital, when they cannot otherwise be kept apart, is what must be insisted on ; and the question of having a hospital in every district, or having a sufficient number of hospitals within, or a short distance from the metropolis, is one which is engaging the attention of the public. Some of the districts in London are so small in area and the population therein so dense, that the erection of a hospital in their midst would be impracticable. Hospitals, however, for the poorer classes must be provided, as it is impossible for them to isolate a case of infectious disease ; and we must bear in mind that small-pox is never entirely absent from London. Small Pox. Small pox has prevailed to a great extent in the Metropolis during the last four months, as is shown in the subjoined table; but on comparing the deaths from small-pox in London with those of the corresponding weeks of the year 1871, when the disease prevailed as an epidemic, it will be seen that the deaths have been considerably less in number, viz., 617 to 2400. 10 The following Table exhibits the Weekly Progress in London of the existing epidemic of Small-pox. 1881. Week ending Deaths. Number of ration's in the Asylum Hospitals. January 8 33 447 β 15 27 476 β 22 42 516 β 29 52 520 February 5 64 617 ,, 12 52 683 β 19 55 704 β 26 44 752 March 5 52 779 β 12 58 792 β 19 43 853 β 26 49 820 April 2 56 890 Total Deaths in London 617 The deaths in London from small-pox in the corresponding weeks of 1871 were 2401, and in the same months in the year 1877 they were 1192, while in the year 1881 they were only 617. The total deaths in London in the year 1871 from small-pox were 7834, and in the first three months of that year they were 2400, while in the corresponding weeks of this year they were only 617. In the year 1877 the total deaths from small-pox in London were 2544, and in the first three months of that year they were 1192. The following is the plan adopted by the Inspector, with a view to prevent the spreading of small-pox. Upon visiting houses in which cases of small-pox occur, inquiries are made as to whether all the children in the immediate neighbourhood have been vaccinated, and if unvaccinated children are discovered the parents are advised to get them vaccinated without delay, and information of all such cases is sent to the Vaccination Officer. The same plan is adopted in all the private cases of small-pox that are attended by medical practitioners that come under 11 the notice of the Inspectors. In all cases where the infected person is not properly lodged, his removal to hospital is advised. The danger of sending clothes out of infected rooms is pointed out, and persons who take in mangling are cautioned to discontinue that practice while infectious disease exists in their house. Parents are also advised not to send their children to school during the existence of small-pox in their houses, and information of the existence of small pox is given at the school where the children attend. All the rooms in which small pox occur are disinfected, and the bedding, clothes, &c., in such rooms are removed to the disinfecting apparatus, and there subjected to such heat as will destroy the contagious matter in them; but when the bedding and clothes are found to be very old and in a very filthy state, such articles are destroyed, and new bedding is supplied. It has been found that by speaking kindly to persons, and explaining to them the necessity of precautions being taken to prevent the extension of the disease, the advice is kindly received, and usually complied with. The Medical Officers of the Union and the Relieving Officers promptly send to the Sanitary Officers of the Board information of all cases of infectious disease which come under their notice. A very satisfactory result of the inspection of houses, and the care manifested by the several officers of the District, is shown by the large number of successful vaccinations which are performed by the Public Vaccinator of the District; there being in the half-year ended June 18th, 1298 successful vaccinations out of 1464 registered births. For further particulars on this important subject, the Board is respectfully referred to page 8 of my last Quarterly report. Notwithstanding all the care that is taken to induce parents to get their children vaccinated, there is a large number of them who remain unvaccinated, and these are children who were not born in the District. At page XXXI. of the report of the Registrar-General for the year 1873, the following remarks are made:β"It is interesting to compare the mortality from small pox in various cities during the first Quarter of 1870. The annual death-rate from this disease in the first three months of the year was equal to 3 per 1000 of the estimated population in London, 8 per 1000 in Liverpool, and 13 in South Shields ; in Brussels it was 9, in Bombay 1.4, and in New York 0.8 per 1000 respectively. Returns from the Dutch towns were only received for January and February; during those two months the annual death-rate from small-pox was equal to 48 per 1000 in The Hague, 36 12 in Utrecht, 25 in Rotterdam, and 3 in Amsterdam. It is well known that among the lower classes in Holland a very strong prejudice exists against vaccination. It may be useful to inquire what might be the result in London if prejudice against vaccination, which is so strongly held by a few in this countiy, should ever become so widely spread as in Holland. If the same death-rate from small-pox had prevailed in London during the Quarter as existed in The Hague during January and February, the deaths from this disease within the Metropolitan Division would have been 38,828 during the 3 months, instead of the 2400 which actually occurred." At pages 11 and 12 of my Quarterly report ended April 1st, 1871, it is stated on the authority of the Registrar-General, that during the first three months the mortality from small-pox in the Whitechapel District was 95, including 12 deaths which occurred in the Small-pox Hospitals of persons belonging to the District; in London during the same period the deaths from this disease were 2400, which gives a mortality at the annual rate of 3.0 per 1000 of the estimated population. Large as was the mortality in this district and in London, it was small when compared with the mortality at Rotterdam and The Hague during the same period. In Rotterdam the rate of mortality from small-pox was 31.7 per 1000 of the population, and in The Hague 41.2. In both these cities vaccination is much neglected. As regards the extent of vaccination in this country the RegistrarGeneral remarks that the information respecting vaccination, or otherwise, in fatal cases of small-pox is necessarily incomplete, failing the co-operation of the medical profession. In but a small proportion of the cases does the certificate of the cause of death state whether the deceased has been vaccinated or not; and although the Registrars have in some cases been instructed to enter this information in the death register on the authority of the informant, it is to be feared that this is not always reliable. Frequently the informant is not aware of the fact; and it is suspected that in many instances vaccination is falsely stated to have taken place to conceal the neglect on the part of the parents, who have some dread of legal proceedings. Census Return for the Whitechapel District. From a preliminary statement of the result of the Census for 1881, kindly furnished to me by Mr. Vallance, the Clerk to the Board of Guardians, it appears that the population of this District is less by 5,297 than it was in 1871, the time when the last census was taken. 13 The density of the population is therefore reduced from 190 persons to an acre, to 176. The following Table shows the Increase and Decrease in each of the Parishes in the District. PARISHES. Population, 1871. Population, 1881. Inckease and Decbease. 1. Whitechapel 34,874 30,704 -4170 2. Spitaliields 20,783 21,341 + 558 3. Mile End New Town 11,100 10,674 -426 4. St. Botolph, Aldgate 3812 2840 -972 5. Old Artillery Ground 2467 2516 + 49 6. Tower Without (including the ) Tower of London) 1329 1161 -168 7. Norton Folgate 1550 1528 -22 8. St. Katharine 241 63 -178 9. Holy Trinity, Minories 417 449 * + 32 Artizans' and Labourers' Dwellings Act (1875). Owing to the large number of houses which have recently been taken down under the Artizans' and Labourers' Dwellings Act (1875), the diminution of the population in this District may, during the last two years, be accounted for. It appears that in the Goulston Street scheme about 111 houses have been closed or demolished, which were inhabited by about 922 persons; some of whom, it has been ascertained, have removed to different parts of the metropolis, and some, (chiefly foreigners) have left the country. In the Royal Mint Street scheme, 192 houses have been taken down, and the inhabitants numbering about 1,996, have migrated to other parts of the Metropolis. The new buildings erected by the Peabody Trustees in this locality are built to accommodate 286 families, or about 1144 persons. The houses in Butler's Buildings, 17 in number, and those in Rose Court, 7 in number, mentioned at page 10 of my report for June, 1879, have not yet been taken down. It appears, from inquiries I have made, that although upwards of 3,200 persons have been displaced by the pulling down of houses, no extra overcrowding has been discovered in the district; and it is a matter of some satisfaction to find that the population of this overcrowded district is diminished. 14 Open Spaces. The importance of preserving for the public use open spaces in the Metropolis, has been frequently mentioned in my Quarterly reports. Open spaces for the recreation of children are essentially necessary for their health and well-being. Unless open air places for amusement and recreation are provided for the children living in the crowded courts of London, their growth will be stunted, and neither their physical nor mental powers will be developed. I may further add that unless more open space is provided for each house which in the future may be built in London, and a prohibition put to the building over the back yards of many of the houses which now exist, and the prevention of houses from being built back to back, it will be found that, should the population continue to increase in the same ratio as is shown by the recent census, many parts of London will become so unhealthy that the local authorities will be compelled for the public safety to open out the confined localities, and keep them as open spaces. Adulteration of Food and Drugs Act. Mr. Battram reports that he has submitted to Mr. Young, the Analyst for the District, seven samples of milk for analysis; out of which three were found to be adulterated with water in the following proportions, viz.: one of 25 per cent., one 26 per cent, and one 18 per cent. Summonses were taken out against the several parties, and a conviction in each case was obtained. One of the parties was fined Β£5 and 2s. costs, a previous conviction having been obtained against him. One was fined Β£1 10s. and 2s. cost, and the other Β£1 and 2s. costs. Mr. Wrack reports that during the Quarter ended 2nd April, he purchased 9 samples of milk, and submitted the same to the Public Analyst for analysis. One of such samples was found to be adulterated with 7 per cent, of added water, one 11 per cent., one 17 per cent., one 20 per cent., one 22 per cent., and one 35 per cent. In the four worst cases summonses were issued against the vendors thereof, one of whom was fined 10s. and 2s. costs, two were fined 20s. and 2s. costs, and the other 40s. and 2s. costs. With regard to the other two cases the vendors have been cautioned. 15 Sanitary Works Performed during the Quarter ended 2nd April, 1881. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ended 2nd April, 1881. Number of inspections of houses as shown in the official returns 2630 Houses specially visited 175 Houses specially re-visited 875 Preliminary notices served, such notices embracing 305 premises 203 Compulsory orders issued, embracing 70 premises 28 Summonses heard at Police Courts, under Sanitary Act 1 ,, under Act for the prevention of Adulteration of Food, &c. 7 Cellars used as dwellings discontinued for such use 4 Cases of overcrowding and indecent occupation abated 0 Houses in which rooms or passages have been whitewashed 176 Rooms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 115 Articles, consisting of beds, bedding, clothing, &c., removed from rooms to the Stone Yard and disinfected in the Apparatus 3381 Yards of houses paved, or the pavement repaired 43 Drains iD houses improved 47 Dust-bins provided 15 Privies lime-washed, cleansed and repaired 72 Water supply provided or improved 41 Nuisances from dung and other offensive matter removed 38 Area gratings, cellar flaps, &c., repaired 4 Animals (swine) kept so as to be a nuisance, removed 9 Cesspools abolished 0 I am, Gentlemen, Your obedient Servant, JOHN LIDDLE. Great Alie Street. APPENDIX. TABLE I.βCases 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 2nd April, 1881. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. | Diarrhoea. Cholera and Choleraic - D iarrh oea. Continued Fever, Typhus & Typhoid. Febricula. Pyeemia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. i Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Mr. Champneys 24 46 2 0 3 0 0 3 0 2 0 0 123 0 0 0 0 0 0 4 494 701 Mr. Sequeira 20 37 1 0 3 0 0 13 0 2 0 0 83 0 0 0 0 0 0 0 306 465 Mr. Loane 2 2 0 0 0 0 0 1 0 1 0 0 21 0 0 0 0 0 0 0 53 80 Totals 46 85 3 0 6 0 0 17 0 5 0 0 227 0 0 0 0 0 0 4 853 1246 Corresponding Qr. of previous Year. 6 14 4 5 9 0 1 28 0 4 0 0 306 31 0 42 0 0 0 3 722 1175 Workhouse Mr. J. J. Ilott. 1 0 0 0 15 0 0 10 0 8 1 0 182 43 4 125 5 0 7 5 619 1025 In addition to the cases of illness m the Workhouse, which are above recorded, there were 42 cases of syphilis and gonorrhoea. TABLE 11. Showing the Deaths from Epidemic Diseases for the Three Months ended 2nd April, 1881. Sub-districts. Small-Pox. Measles. Scarlet Fever Diphtheria. HoopingCough. Diarrhoea. Fever. Cholera 4 Choleraie Diarrhea. Total. Remarks. Spitalfields 0 14 1 0 1 0 2 0 18 Mile End New Town 1 10 2 0 1 0 0 0 14 Workhouse. Whitechapel North 2 6 1 0 0 1 1 0 11 Whitechapel Church 2 1 0 2 1 0 5 0 11 Hospital. Goodman's Fields 0 0 1 0 1 0 0 0 2 Aldgate 0 2 0 0 0 0 0 0 2 5 33 5 2 4 1 8 0 58 Deaths from Epidemics for the corresponding Quarter, 1880. 3 10 7 3 23 2 2 0 50 Nine deaths from small-pox, of patients sent from this District, occurred in the Small-pox Hospital, thus making 14 deaths from small-pox of persons resident in the District. Two out of the 5 deaths from small-pox occurred in the London Hospital, and were of non-residents. TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causesβ 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 2nd April, 1881. Sub-districts. Enumerated Population in 1871. 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 195 106 19 33 14 8 15 4 Mile End New Town 15550 182 188 24 24 66 7 36 102 Whitechapel North 11597 105 50 13 15 11 2 2 0 Whitechapel Church 7322 58 223 15 11 32 44 60 174 Goodman's Fields 10381 107 44 13 11 5 2 4 0 Aldgate 9224 47 27 2 5 7 2 3 0 Totals 76573 694 638 86 99 135 65 120 280 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT on the SANITARY CONDITION of the WHITECHAPEL DISTRICT, for the QUARTER ENDED 2nd JULY, 1881, BY JOHN LIDDLE, medical officer of health. LONDON: Penny & Hull, Steam Printers, 53, Leman Street, Whitechapel, E. 1881. REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ended 2nd July, 1881. TO THE BOARD OP WORKS, WHITECHAPEL DISTRICT. Gentlemen, In the Quarter that ended on Saturday, the 2nd July, 1881, the total births in the District were 674, viz., 315 males and 359 females; and the deaths 534, viz., 296 males and 238 females. The excess of births over deaths has therefore been, during the Quarter, 140. As the deaths of 101 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 433, and thus increasing the number of births above deaths to 241. 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 676, and the total deaths 472. The weekly average of births was 52.0, and of deaths 36.3; and in the present Quarter the weekly average of births has been 51.8 and of deaths 41.0 In the Spitalfields sub-District the births were 197 and the deaths 95; in the Mile End New Town 168 and the deaths 144 (in this subDistrict the Workhouse is situated); in the Whitechapel North 109, and the deaths 43; in the Whitechapel Church 72, and the deaths 168 4 (in this sub-District the London Hospital is situated) ; in the Goodman's Fields 81, and the deaths 44 ; and in the Aldgate 47, and the deaths 40. The deaths have exceeded the births in the Whitechapel Church sub-District by 96, but the deaths of the 101 non-residents in the London Hospital must be deducted. The proportion of births to deaths is therefore 72 to 67. The deaths in the London Hospital have been 140; of these, 101 were of non-residents, 12 of residents, and 27 of persons who either died suddenly pr 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 10.6 per cent. In the last Quarter ended 2nd April, the proportion of deaths of residents to non-residents was 17.3 per cent. The deaths in the Workhouse Infirmary, Baker's Row, have been 67. In the corresponding Quarter of last year they were likewise 67. The deaths from epidemic diseases in the entire District have been 62 ; viz.: 3 from small-pox, to which must be added 14 deaths which occurred in the Small-pox Hospitals, thus making 17 deaths from small-pox ; 28 from measles, 1 from scarlet-fever, 7 from hooping-cough, 20 from diarrhcea and 3 from fever. No deaths from fever occurred in the Fever Hospital of patients removed from this District. The number of patients suffering from small-pox and from fever, who were removed from this District to the Asylum Hospitals, will be seen on page 8. In the corresponding Quarter of the previous year the deaths from epidemic diseases were 27 ; viz.: 2 from small-pox, 1 from measles, 2 from scarlet-fever, 1 from diphtheria, 8 from hoopingcough, 12 from diarrhcea, and 1 from fever. Nine deaths from smallpox occurred in the Small-pox Hospital of persons belonging to this 5 District, thereby increasing the total deaths from this disease from 2 to 11. Mortality of Young Children. The mortality of children under 1 year of age is 110. This is 20.6 per cent, of the total mortality. In the corresponding Quarter of the previous year it was 21.4 per cent. In the Spitalfields subDistrict the rate is 85.7 per cent.; in the Mile End New Town 19.4 percent.; in the Whitechapel North 18.6 per cent.; in the Whitechapel Church 7.2 per cent.; in the Goodman's Fields 40.9 percent.; and in the Aldgate 25.0 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:βin 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. Rate of Mortality. The rate of mortality in the entire District, for the year ended 2nd July, 1881, based on the population according to the present census, and recorded in the weekly returns of the Registrar-General, is, deducting as usual the deaths of the non-residents, 24.7 per 1000. The population in 1871 was 76,573 and is now only 71,350. The total deaths under 5 years, during the Quarter, are 215, which shows a rate of mortality of 40.2 per cent, in relation to the total deaths, including those of non-residents, and 31.8 per cent, to the total births. The rate of mortality under 1 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 1064 new cases of illness out of the Workhouse; including 61 of small-pox, 46 of measles, 4 of scarlet-fever, 7 of 6 hooping-cough, 21 of diarrhoea, 30 of febricula, and 5 of erysipelas. In the corresponding Quarter of the previous year the number of pauper cases of illness was 7G0; including 13 of small-pox, 5 of measles, 1 of scarlatina, 5 of hooping-cough, 13 of diarrhcea, 26 of febricula, 1 of fever, and 4 of erysipelas. The total number of cases of illness in the Workhouse has been 997; including 2 of small-pox, 4 of measles, 3 of hooping-cough, 12 of diarrhoea, including 1 of cholera or choleraic-diarrhoea, 4 of erysipelas, and 7 of febricula. In addition to the above cases, there were 28 of syphilis and gonorrhoea; thus making a total of 1025. Uncertified Deaths. Two uncertified deaths are recorded during the Quarter; 1 in the Spitalfields sub-District, and 1 in the Whitechapel Church subDistrict. Meteorology of Greenwich. The Returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 4.10 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 5,53 inches. The average annual rain-fall at Greenwich in 63 years wa3 25.4 inches. The mean temperature of the air was 53Β°5. In the corresponding Quarter of last year it was 52Β°7. The hottest days during the Quarter were Wednesday, the 1st June, Saturday, the 4th June, and Friday, the 1st July, when the thermometer indicated respectively 81Β°1, 83Β°9, and 82Β°6. The hottest day during the corresponding Quarter of the previous year was on the 30th June, when the thermometer indicated 87Β°5. The deaths from diphtheria in London during the Quarter were 143, none of which are recorded as having occurred in the Whitechapel District. The following Table, taken from the Returns of the Registrar General, shows the comparative result of the Quarter* 7 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 Diarrhoea. Fe^er. Small-pox. From all causes. From Smallpox. From all causes. April 9 9 11 72 1532 0 43 0.00 40.5 β 16 14 19 77 1636 2 41 0.15 50.8 ,, 23 13 17 84 1600 0 62 0.11 43.5 β 30 10 12 70 1600 0 48 0.36 49.9 May 7 10 10 88 1472 1 36 0.41 51.0 β 14 13 9 69 1427 0 40 0.00 50.7 β 21 14 14 103 1488 0 41 0.53 53.1 β 28 13 15 92 1452 0 41 0.39 59.5 June 4 14 33 82 1507 0 45 0.29 62.9 β 11 22 7 59 1346 0 36 1.09 51.2 β 18 30 11 82 1403 0 38 0.57 60.4 β 25 44 10 88 1399 0 39 0.19 60.6 July 2 72 12 52 1440 0 34 0.01 61.9 VACCINATION. YH1TECHAPEL UNION.βReturn of the number of Cases Vaccinated by the Public Vaccinator and the Medical Officer of the Workhouse, together with the number o Births Registered during the same quarters. Quarter endingβ PUBLIC VACCINATOR workhodse. Totals. Births Registd. Primary Cases. Re-Vaccination. Frimary Cases. Re-Vaccination Primary Cases.* Re-Vaccination. September, 1879 464 2 27 β 491 2 658 December 373 β 33 β 406 β 655 March, 1880 380 2 31 β 411 2 846 June 533 β 25 β 558 β 676 September 387 6 15 - 402 6 590 December 335 1 35 β 370 1 621 March, 1881 428 84 41 2 469 86 694 June 582 250 49 150 631 400 674 Totals 3482 345 256 152 3738 497 5414 8 At a Meeting of the Board of Guardians, held on Tuesday, the 2nd July, the Vaccination Returns showed that during the last six months the births had been 1,200, and of that number 1,087 had been successfully vaccinated, 93 died, 2 postponed by medical advice, 2 had removed to other districts where the Vaccination Officer had been apprised, and 25 only were unaccounted for. Quarterly Return of Small Pox and Fever Cases and Deaths in the Asylum Board Hospitals, to June 30th, 1881. SMALL POX. Men. Women. Children. Total North District 15 9 34 58 South β 17 6 24 *47 105 *Of these 47β 20 were admitted from the LondonHospital (6 being resident, and 14 non-resident) in the Union. 15 Died. Smith, Alice, aged 2 years, of 10, Whites-row, c.o. Leahy, Patrick, aged 12 years, Do. Catherine, aged 13 years, of 15, Castle-alley. Butler, William, aged 38 years, of 10, Lower Keate-st. Smith, Fredk. W., aged 20 years, of 15, Green-st., New-rd. Padmore, Mary, aged 3 years, of 21, Grey Eagle-street. Dowsky, Jane, aged 10 months. Do. Lazarus, aged 11 years, of 23. Goulston-street. Whitehead, Elizabeth, aged 17 yrs., of 1, Hobson's-place. Westropp, Angelina, aged 6 years, of 85, Pelham-street. De Woolf, Betsy, aged 5 weeks, of 11, White's-row, c.c. Yangoe, Louisa, aged 1J years, of 168, Hanbury-street. Keppler, Henry, aged 3 years, of 20, White's-row, c.o. Castle, George, aged 21 years, of 9, Elder-street. Stephens, Joseph, aged 9 years, non-resident (Clapton). FEVER. Men. Women. Children. Total. North District 0 0 0 0 South β I 1 13 15 β’15 *Of these 15β 9 were admitted from the London Hospital, 1 resident, 8 non-resident. The remaining 6 cases were all from one house, No. 18, Oxford Street. 1 Died.βKnight, Elizabeth Ada, aged 9 years (non-resident), from West Ham. With reference to No. 18, Oxford Street, in which six cases of fever have occurred, as recorded in the above Table, I directed the attention of Mr. Battram, the Sanitary Inspector, thereto, and he informs me that the patients were all removed to the Hospital, where one subsequently died. The bedding was removed and disinfected, the rooms were fumigated with sulphur, the old paper stripped from the walls, and the walls and ceilings cleansed. 9 The walls of the rooms in which the fever occurred have not been re-papered. There is no want of cleanliness in any portion of the house, and the water supply is on the constant service. There is a dust-bin in the yard, and the closet is provided with a pan and properly trapped. Previous to the fever breaking out, the drains were out of order, and Mr. Battram's attention was called to the fact. Upon visiting the premises he found the men at work cleansing them, and they are now in good order. This house consists of four rooms, besides the underground kitchens ; the front kitchen was illegally occupied. A notice was served on the landlord to discontinue the use of the room for habitation ; this order was obeyed, and the tenants were displaced, but on a subsequent visit this room was again occupied as a living room. This involved the serving of a second notice. Mr. Battram adds that the first case of fever occurred in this underground kitchen. The following Table exhibits the Weekly progress in London of the existing epidemic of Small-pox, and is continued from Page 10 of my Report for the Quarter ended 2nd April, 1881. 1881. Week ehding Deaths. Number of Tatients in tho Asj'lum Hospitals. April 9 72 921 β 16 77 940 β 23 84 963 β 80 70 948 May 7 88 1093 β 14 69 1225 β 21 103 1390 β 28 92 1552 June 4 82 1644 β 11 59 1633 β 18 82 1612 β 25 88 1578 July 2 52 1408 Total Deaths in London 1018 10 Artizans' and Labourers' Dwellings Act, 1875. A Bill for the improvement of the Dwellings of the Working Classes was, in 1875, introduced by Mr. Cross, the then Home Secretary, and which resulted in the Artizans and Labourers' Dwellings Act. This Act, at present, has not been so productive of benefit as was anticipated, but the subject has lately received much additional attention, not only from the public but from the Local Boards and the Metropolitan Board of Works; and, moreover, has lately been brought under the notice of the House of Commons and referred to a Select Committee who have taken evidence thereon. It may, therefore, be reasonably expected, that considerable improvement in the working of the Act will be effected. The unhealthy dwellings which exist in this vast metropolis are, when we consider its wealth, a great opprobrium, and now earnestly calls for an effectual remedy which we may expect will soon be found. The Select Committee of the House of Commons appeared to be thoroughly in earnest in the matter, and they did not confine their attention to the mere taking of the evidence of those capable of affording practical knowledge of the subject, but they personally inspected several of the unhealthy areas which had been submitted to the Metropolitan Board of Works for their consideration and approval, previous to clearing away the unhealthy houses from those localities. On the 7th July, the Select Committee of the House of Commons visited the Rosemary Lane and the Flower and Dean Street areas in the Whitechapel District. There can be no doubt that the large buildings which have been erected on the sites previously crowded by most filthy and unhealthy houses are an improvement, and if the class of persons who have been displaced by the pulling down of the filthy slums should occupy them, their health and physical well-being will be greatly benefitted. The question, however, may be raisedβis the present plan, viz : the erection of large buildings, capable of lodging numerous families under the same roof, the best for providing habitations for the working classes, and is it desirable that so many persons of the same class should live together in close proximity? It may be further asked, is it desirable that facilities should be afforded for the crowding together in London of such a mass of people 11 of the poorer class who seem desirous of living in the metropolis ? The population of this city is already too large, and is increasing annually. In the census of 1871 the population of London was 3,254,260, and that of 1881 was 3,829,751, showing an increase in ten years of 575,491, and during the same period the density of the population has increased from 42 persons to an acre to 50.8. Unless more effectual means are adopted to prevent the building of houses so close together as is the custom at present, the health of the people will materially suffer. In my opinion, it would be in every respect much better if houses of a moderate size were built, capable of accommodating only three families in each, and so built that every house should have a certain open space exclusively belonging to it, where the water-closet, wash-house, and dust-bin should be placed. These conveniences should be detached from the house, but should be within the curtilage of the same, and should be used only by the tenants of each house. As privies in courts, which are built only for the use of the tenants in the court, are, for the most part, open to the public, they are at all times a nuisance, and the further erection of them should be prohibited. Unless stringent provisions are made in a New Building Act to prevent the erection of houses in localities where there is not sufficient space for the health of the tenants, the same class of unwholesome dwellings will be built as those which have been recently demolished at great expense, under the provisions of the Act now under consideration ; and the money which has been expended in clearing certain ill-ventilated sites will have been wasted; for after a time a similar process of demolition, as regards the newly constructed houses, will have to be repeated. At present, every piece of vacant ground large enough to erect a small house is speedily purchased and built upon without any efficient control; the Local Authorities having very little power to insist on proper provision being made for sanitary arrangementsβin fact, houses can still be built back to back, there being no law in existence to prevent the creation of such a nuisance. A Bill for the amendment of the existing faulty Building Act should be introduced by the Government, and the Government only could successfully carry such a Bill, which shall contain efficient sanitary clauses, through the Houses of Parliament Owing to the formation of new streets, the clearance of several crowded sites, the increase of the population and the number of 12 immigrants continually pouring into London, the suburbs are being built upon to a very great extent. It is therefore most desirable for the maintenance of the public health, that any new Building Act should apply, not only to the Metropolis, but to the entire country. I may here remark that the rents of the wretched houses which are now standing in some parts of the District of Whitechapel are very high; so much as 5/0 per week is demanded for three small rooms, and these rooms are usually sub-let at 2/6 each. A single room is sometimes obtained for 2/0 per week. Other houses, of a similar description, are let at 6/0 per week, and the cost for two rooms varies from 4/0 to 7/6, while the rents of the rooms in the Peabody Buildings, in which the comfort and convenience of the tenants have been studied are infinitely better, and are not nearly so high. It has generally been supposed that the greater number of the people living in the densely crowded courts are engaged at work in the vicinity of their dwellings, but on inquiry I find that it is not the case. Many work at the river side as wharf and dock labourers, and on the river as stevedores and coal whippers. I was further informed that this class of persons, if they had to move further eastward would not be inconvenienced, as a number of them are employed in the East and West India Docks, and even as far as the Victoria Docks. The coal whippers have to go to various places down the river, sometimes as far as Gravesend. In my evidence recently given before the Select Committee of the House of Commons, on the subject of the working of the Artizans' Dwellings Act (1875), I stated that it would be much cheaper to many of the working classes, and infinitely better for their health, if they were to live in the suburbs, and ride either by rail or tram-car into London and back every working day. Not only by so doing would their health be improved, but their comfort would be greatly increased, and the additional expense which they would incur by riding into town would be recouped by the lower rent that would be incurred by lodging in the country. It appears from the Table of Fares published by the Great Eastern Railway, that Third Class Return Tickets for Workmen are issued daily on Week-days to Liverpool Street at 2d. each from all the intervening stations on the Great Eastern Line as far as Enfield. 13 Third Class Tickets, at the same price, are also issued to Workmen from Stratford Market, Stratford, and Coborn Road; and this accommodation is, I am informed, greatly appreciated, daily tickets becoming more and more used as new houses for the working classes increase. The Peabody Trustees have printed certain rules which are to be observed by the tenants of their buildings, all of which rules, if strictly observed, will prove not only beneficial to them individually, but will add to the comfort of all the other residents. Although great advantages are offered by the Peabody Buildings, I do not find many of the poor people, who have been displaced by the demolition of their houses, occupying these new Buildings. It is most earnestly to be desired that the work of demolishing the filthy slums in London, which has been fairly commenced in this District, will be persevered in by the Metropolitan Board of Works, until the whole of these unhealthy localities are entirely swept away. It is truly a good work, and I am encouraged to expect from the following remarks, contained at Page 38 of the last Annual Report of the Metropolitan Board, that the work will not cease until the entire demolition of the rookeries is accomplished. The report says, "It is understood a full inquiry will shortly be made into the whole subject, and that the Board will avail itself of the opportunity to suggest in general terms the new legislation, which (so far as the Metropolis is concerned), appears to be necessary to ensure the satisfactory operation of the Artizans' Dwellings Acts, and the attainment of the objects aimed at by the promoters." The above remarks will give general satisfaction to all persons who have taken an active part in endeavouring to improve the moral and physical condition of the lower class of labourers. Let the slums be demolished without unnecessary delay; for unless the crowded and unhealthy localities be entirely demolished, any better class of dwellings which may be erected in proximity to them will not be attractive, and consequently will not be tenanted. The nuisances must first be cleared away, and then the work of building new and healthy houses may be advantageously carried on. The Act passed in 1879, and known as "Torrens' Amendment Act" provided, among other things, for the opening out by the Local Authorities of closed, or partially closed, alleys or courts 14 inhabited by the labouring classes, and the widening of the same by pulling down any building or otherwise, leaving such open spaces as may be necessary to make such alleys or courts healthful. The provisions of this Act, if carried out by the Metropolitan Board of Works, would prove very beneficial to the health of the crowded districts in the Metropolis; but as the working of this Act is intrusted to the several Local Authorities, it is not likely that the Act will be applied to any great extent. If "Torrens' Act" were to be incorporated with the Artizans' Dwellings Act (1875) and worked by the Metropolitan Board, such alterations in both these Acts being made as will lessen the expense to the ratepayers, London, in the course of a few years, would present a totally different aspect to what it does at present, and the rate of mortality would be greatly reduced. It cannot be expected that the Local Boards will carry out the provisions of "Torrens' Act," when the cost of doing so will fall entirely on the ratepayers of the district, perhaps a small and poor one, instead of the same being spread over the whole Metropolis, as is the case under the provisions of the Artizans' Dwellings Act; and so long as "Torrens' Act" is kept on the Statute Book unaltered, it will, to a great extent, be a "dead letter." It must strike every member of a Local Board how unjust such a proceeding would be, to charge its ratepayers with the necessary heavy expense for such improvements as would be for the benefit of the entire Metropolis. It is well known that diseases which are generated in the crowded localities do not stop there, but travel to all parts of the Metropolis, and persons living at a distance from the places which generate infectious diseases do not escape with impunity from the deadly effects of them. Moreover, it so happens that the poorest districts are those in which the greatest sanitary improvements are required, and it is just those which are the least able to defray the cost. As all London, therefore, is benefitted by uprooting unhealthy localities, so all London should contribute in rateable proportion to the cost. All the powers of "Torrens' Act" should be transferred to the Metropolitan Board of Works; and, in so doing, care must be taken not to allow compensation to be awarded for the condemned houses on the rent which is received from the tenants. It is well known that the poor pay a much higher rent for their dwellings in proportion to their incomes, than is obtained from the upper and middle classes. 15 Houses which were built for single families, and when so occupied were well suited for the healthy enjoyment of all the members of the family, are now let out in tenements, and are occupied by several families, for whom they are, in a sanitary point of view, totally unfitted for habitation, and it is just this class of houses which is the most difficult for Sanitary Officers to deal with in a satisfactory manner; for not only is each room overcrowded, and without sufficient ventilation, but the stairs are generally dark and in a filthy state; it being the duty of no one in particular to clean them. Such houses, I believe, are very profitable to the owners, for exorbitant rents are exacted from the tenants. It is true that such houses maybe registered under the provisions of the Sanitary Act (1866), and Bye-laws may be made by each Local Board for their regulation, but experience has proved that such Bye-laws are not entirely satisfactory. The Sanitary Act, as regards the Registration of Houses, has been put in force in this District, and very good results, as regards the procuring of a better water supply, have thereby been obtained. Adulteration of Food and Drugs Act. Mr. Battram reports that he has submitted to Mr. Young, the Analyst for the District, four samples of milk, three of bread, and two of butter, for analysis; one sample of milk was found to be adulterated with 15 per cent. of water. A summons was taken out against the vendor, a conviction obtained, and a fine of Β£1 10s. and 2s. costs was imposed. Mr. Wrack reports that during the Quarter ended 2nd July, he purchased five samples of milk, and four of bread, and submitted the same to the Public Analyst for analysis, all of which were reported to be genuine. Sanitary Works Performed during the Quarter ended 2nd July, 1881. The following return shows the amount of work done by the Sanitary Inspectors during the Quarter ended 2nd July, 1881. Number of inspections of houses as shown in the official returns 3048 Houses specially visited 292 16 Houses specially re-visited 1022 Preliminary notices served, such notices embracing 367 premises 231 Compulsory orders issued, embracing 167 premises 57 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 Cases of overcrowding and indecent occupation abated 16 Houses in which rooms or passages have been whitewashed 197 Rooms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 119 Articles, consisting of beds, bedding, clothing, &c., removed from rooms to the Stone Yard and disinfected in the Apparatus 4258 Yards of houses paved, or the pavement repaired 20 Drains in houses improved 52 Dust-bins provided 7 Privies lime-washed, cleansed and repaired 91 "Water supply provided or improved 18 Nuisances from dung and other offensive matter removed 42 Area gratings, cellar flaps, &c., repaired 0 Animals kept so as to be a nuisance, removed 0 Cesspools abolished 0 Nuisance from the retention of dead bodies in living rooms removed 2 The Cow-houses in the District, 25 in number, and the Slaughterhouses, 14, 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 2nd July, 1881. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Cholera and Choleraic-Diarrhoea. Continued Fever, Typhus & Typhoid. Febricula. Pyaemia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleuritis and Pneumonia. Mr. Champneys 41 14 0 1 11 0 0 0 0 1 0 0 85 0 0 1 0 0 0 1 441 596 Mr. Sequeira 19 32 4 6 10 0 0 29 0 4 0 0 30 1 0 1 0 0 0 2 266 404 Mr. Loane 1 0 0 0 0 0 0 1 0 0 0 0 5 0 0 0 0 0 0 0 57 64 Totals 61 46 4 7 21 0 0 30 0 5 0 0 120 1 0 2 0 0 0 3 764 1064 Corresponding Qr. of previous Year. 13 5 1 5 13 0 1 26 0 4 1 0 62 6 0 26 0 0 2 6 589 760 Workhouse Mr. J. J. Ilott. 2 4 0 3 11 1 0 7 0 4 0 0 95 20 0 79 0 0 10 2 759 997 In addition to the cases of illness in the Workhouse, which are above recorded, there were 28 cases of syphilis and gonorrhoea. TABLE 11. Showing the Deaths from Epidemic Diseases for the Three Months ended 2nd July, 1881. Sub-districts. Small-Pox. Measles. Scarlet Fever Diphtheria. HoopingCough. Diarrhoea. Fever. Cholera 4 Choleraic DiarrlΕa. Total. Remarks. Spitalfields 1 9 0 0 2 6 0 0 18 Workhouse. Mile End New Town 0 2 0 0 1 6 0 0 8 Whitechapel North 1 6 1 0 0 0 1 0 9 Whitechapel Church 1 6 0 0 1 3 1 0 12 Hospital. Goodman's Fields 0 2 0 0 3 2 0 0 7 Aldgate 0 3 0 0 0 4 1 0 8 Totals 3 28 1 0 7 20 3 0 62 Deaths from Epidemics for the corresponding Quarter, 1880. 2 1 2 1 8 12 1 0 27 Fourteen deaths from small-pox, of patients sent from this District, occurred in the Small-pox Hospital, thus making 17 deaths from small-pox of persons resident in the District. TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causesβ 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 2nd July, 1881. 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. Spitalfields 22586 197 95 34 26 10 5 13 2 Mile End New Town 15474 168 144 28 20 38 5 19 67 Whitechapel North 10001 109 43 8 10 7 0 5 0 Whitechapel Church 7489 72 163 12 28 21 25 25 140 Goodman's Fields 9708 81 44 18 10 4 2 3 0 Aldgate 6092 47 40 10 11 3 3 6 0 Totals 71350 674 534 110 105 83 40 71 209 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE SANITARY CONDITION OF THE WHITECHAPEL DISTRICT, FOR THE QUARTER ENDED 1ST OCTOBER, 1881, BY JOHN LIDDLE, MEDICAL OFFICER OF HEALTH. London: Printed by Penny & Hull, 63, Leman St., Whitechapel, E. 1881. REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ended 1st October, 1881. TO THE BOARD OP WORKS, WHITECHAPEL DISTRICT. Gentlemen, In the Quarter that ended on Saturday, the 1st October, 1881, the total births in the District were 586, viz., 272 males and 314 females; and the deaths 601, viz., 344 males and 257 females. The excess of deaths over births has therefore been, during the Quarter, 15. As the deaths of 102 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 499, and thus increasing the number of births above deaths to 87. 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 590, and the total deaths 556. The weekly average of births was 45.3, and of deaths 2.7; and in the present Quarter the weekly average of births has been 45.0, and of deaths 46.2. 4 In the Spitalfields sub-District the births were 194, and the deaths 114; in the Mile End New Town 144, and the deaths 140 (in this sub-District the Workhouse is situated); in the Whitechapel North 78, and the deaths 40; in the Whitechapel Church 51, and the deaths 211 (in this sub-District the London Hospital is situated); in the Goodman's Fields 79, and the deaths 57; and in the Aldgate 40, and the deaths 39. The deaths have exceeded the births in the Whitechapel Church sub-District by 160, but the deaths of the 102 nonresidents in the London Hospital must be deducted. The proportion of births to deaths is therefore 51 to 109. The deaths in the London Hospital have been 174; of these, 102 were of non-residents, 25 of residents, and 47 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 14.3 per cent. In the last Quarter, ended 2nd July, the proportion of deaths of residents to non-residents was 10.6 per cent. The deaths in the Workhouse Infirmary, Baker's Row, have been 80. In the corresponding Quarter of last year they were 68. The deaths from epidemic diseases in the entire District have been 12C; viz.: 3 from small-pox, to which must be added the 7 deaths which occurred in the Small-pox Hospitals, thus making 10 deaths from small-pox; 20 from measles, 12 from scarlet-fever, 2 from diphtheria, 14 from hooping-cough, 66 from diarrhoea, and 9 from fever. No deaths from fever occurred in the Fever Hospital of patients removed from this District. The number of patients suffering from small-pox and from fever, who were removed from this District to the Asylum Hospitals, will be seen on pages 8 and 9. In the corresponding Quarter of the previous year, the deaths from epidemic diseases were 98, viz.: 4 from measles, 9 from scarletfever, 4 from diphtheria, 7 from hooping-cough, 70 from diarrhoea, and 4 from fever. Seven deaths from small-pox occurred in the Smallpox Hospital of persons belonging to this District, Mortality of Young Children. The mortality of children under 1 year of age is 150. This is 24.9 per cent. of the total mortality. In the corresponding Quarter of the previous year it was 24.8 per cent. In the Spitalfields subDistrict the rate is 35.9 per cent.; in the Mile End New Town 22.8 percent.; in the Whitechapel North 32.5 per cent.; in the Whitechapel Church 12.3 per cent.; in the Goodman's Fields 45.6 per cent.; and in the Aldgate 30.0 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:βIn 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. Rate of Mortality. The rate of mortality in the entire District, for the year ended 1st October, 1881, based on the population according to the present census, and recorded in the Weekly Returns of the Registrar-General, is, deducting as usual the deaths of the non-residents, 27.0 per 1000. The population in 1871 was 76,573, and is now only 71,350. The total deaths under 5 years, during the Quarter, are 257, which shows a rate of mortality of 42.5 per cent. in relation to the total deaths, including those of non-residents, and 43.8 per cent. to the total births. The rate of mortality under 1 year, in relation to the total births, is 25.4 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter 910 new cases of illness out of the Workhouse; including 21 of small-pox, 25 of measles, 7 of hooping-cough, 55 of diarrhoea, 32 of febricula, and 11 of erysipelas. In the corresponding Quarter of the previous year, the number of pauper cases of illness was 821; including 2 of small-pox, 5 of measles, 8 of scarlatina, 2 of hoopingcough, 78 of diarrhoea, 31 of febricula, 1 of fever, and 9 of erysipelas. The total number of cases of illness in the Workhouse has been 7C8; including 1 of small-pox, 7 of measles, 1 of hooping-cough, 23 of diarrhoea, 2 of fever, 9 of erysipelas, and 10 of febricula. In addition to the above cases, there were 33 of syphilis and gonorrhΕa; thus making a total of 801. 6 Uncertified Deaths. Two uncertified deaths are recorded during the Quarter; 1 in the Whitechapel North sub-District, and 1 in Goodman's Fields subDistrict. Meteorology of Greenwich. The Returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter has been 8.9 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 7.99 inches. The average annual rain-fall at Greenwich in 63 years, was 25.4 inches. The mean temperature of the air was 59Β°7. In the corresponding Quarter of last year it was 61Β°3. The hottest days during the Quarter were Monday, the 18th July, Friday, the 15th July, and Tuesday, the 5th July, when the thermometer indicated respectively 90Β°2, 97Β°1, and 92Β°8. The hottest day during the corresponding Quarter of the previous year was on the 30th June, when the thermometer indicated 87Β°2. The highest mean temperature during any week in the Quarter was in that which ended Saturday, 16th July. In the corresponding Quarter of last year, the highest mean temperature in any week was in that which ended September 4th, when it was 67Β°3. The deaths from diphtheria in London during the Quarter were 137, 2 of which are recorded as having occurred in the Whitechapel District. The following Table, taken from the Returns of the RegistrarGeneral, shows the comparative result of the Quarter :β 7 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 Diarrhoea. Fever. Small-pox. From all causes. From Smallpox. From all causes. July 9 135 14 73 1585 0 53 1.00 65.1 β 16 292 12 49 1816 1 53 0.04 70.1 β 23 449 17 43 1943 1 52 0.11 66.4 β 30 495 12 39 2000 0 49 0.54 60.5 August 6 297 14 38 1717 0 42 0.52 63.8 β 13 210 21 29 1578 1 48 1.76 59.0 ,, 20 141 19 38 1474 0 46 0.25 58.1 β 27 117 15 80 1342 0 40 1.43 53.0 Sept. 3 57 14 22 1190 0 37 0.36 54.5 β 10 39 14 27 1229 0 5G 0.49 55.4 β 17 40 24 26 1151 0 36 0.14 55.0 β 24 33 45 26 1279 0 37 1.19 58.2 Oct. 1 34 53 15 1217 0 52 0.36 53.2 VACCINATION. WHITECHAPEL UNION.βReturn 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 endedβ PUBLIC VACCINATOR workhodse. Totals. Births Primary Cases. Re-Vaccination. Primary Cases. Re-Vaccination Primary Cases. Re-Vaccination. REQISTn. December, 1879 373 β 33 β 406 β 655 March, 1880 380 2 31 β 411 2 846 June 533 β 25 β 558 β 676 September 387 6 15 - 102 6 590 December 335 1 35 β 370 1 621 March, 1881 428 84 41 2 469 86 694 June 582 250 49 150 631 400 674 September 371 34 34 420 405 454 536 Totals 3389 377 263 572 3652 949 5342 8 The following Table exhibits the weekly progress in London of the existing epidemic of small-pox, and is continued from page 9 of my Report for the Quarter ended 2nd July, 1881. 1881. Week ending Deaths. Number of Patients in the Asylum Hospitals. July 9 73 1192 16 49 1112 23 4.3 941 30 39 852 August 6 38 773 13 29 692 20 38 647 27 36 587 September 3 22 557 10 27 582 17 26 528 β 24 26 476 October 1 15 454 Total Deaths in London 461 Quarterly Return of Fever and Small-pox Cases sent to Small-pox and Fever Hospitals, June 30th, to September 29th, 1881. SMALL POX. Men. Women. Children. Total North District 3 2 15 20 South β 6 4 9 19* 39 *Of these 19β 7 were admitted from the London Hospital, 2 being residents and 5 non-residents of the Union. 1 was admitted from the Casual Ward (non-resident). 7 Died. Pepper, Alexander, aged 6 years, of 60, Quaker Street, C.C. Do. William, β 5 β β β Lacey, Alfred β 8 β 14, Hope Street, C.C. Lefevre, Joseph, β 5 β 6, Dunk Street, M.E.N.T. Do. Henry β 7 β ,, ,, Parker, Mary A. β 1 β 8,, β β Marks, Emily β 21 β 28, Eaven Street. 9 FEVER. Men. Women. Children. Total. North District 0 0 0 0 South β 2 0 7 9* 9 *Of these 9β 7 were admitted from the London Hospital, 1 being a resident and 6 nonresidents of the Union. (The other 2 cases were admitted from the Infirmary, having been sent there from Well Yard, Whitechapel.) One case was omitted in the Return for the last Quarter, instead of 15 cases as returned at page 8, the number should be 16. 1 Died.βA non-resident (Bethnal Green.) Small-Pox. The deaths from small-pox in the Quarter ended on July 2nd, were, in this District, including those which occurred in the Small-Pox Hospital, 17, and for the Quarter now under consideration 10. In the previous Quarter, the number of patients admitted into the Small-pox Hospitals in London, was 10,947, while, in this Quarter, the number is only 9,393, showing a decrease of 7,554. The deaths in London during the same periods were 1,018 and 461. There is reason, therefore, for believing that the epidemic is on the decline. TABLE showing the Population, total number of Deaths from all causes, and the number of Deaths from Small Pox in London, and in nineteen of the largest Towns of England, during the Quarter of the Year ended 1st October, 1881. LOCALITIES. POPULATION. Deaths from all causes during the Quarter ended 1st Oct., 1881. Deaths from Small Pox during the same period. Rate of Mortality per 1000 from Small Pox in relation to the total deaths. London 3,829,751 19,521 461 23.6 Nineteen of the largest Towns in England .. 3,779,024 19,427 26* 1.3 From the above Table, it appears that in the 19 great towns, whose aggregate population nearly equals that of the Metropolis, the deaths from small-pox during the last three months has been 26, or 1.3 per cent. of the total deaths; while the deaths in London from this disease have been 431, or 23.6 per cent. of the total deaths. The facts here recorded unquestionably deserve attentive consideration. *It is stated that in most of these cases the disease was imported from the Metropolis. 10 The population and number of persons to an acre in those towns in which deaths from small-pox occurred during the present Quarter, are set forth in the subjoined Table. The 12 towns in which no death from small-pox occurred, are Portsmouth, Norwich, Plymouth, Bristol, Wolverhampton, Birmingham, Leicester, Nottingham, Manchester, Salford, Sheffield, and Sunderland ; the population in each of these towns varies from 402,296 (Birmingham), to 75,934 Wolverhampton). TOWNS. Deaths from Small Pox. Persona to an Acre. Population. Liverpool 12 106.3 553,988 Brighton 4 45.9 107,934 Oldham 3 24.0 112,176 Hull 2 42.7 155,161 Leeds 2 14.4 310,490 Newcastle-on-Tyne 2 27.1 145,675 Bradford 1 25.5 184,037 Total 26 Memorandum of Dr. Buchanan. Dr. Buchanan, Medical Officer of the Local Government Board, in a Memorandum, dated 3rd June, 1881, on the present prevalence of small-pox in London among vaccinated and unvaccinated persons respectively, inserts the following Table :β TABLE of comparative Small Pox Death-rate among Londoners, Yaeeinated anc Unvaccinated respectively, for the 52 weeks ended 29th May. Death-rate of People of subjoined Ages. Per million of each age of the Vaccinated class. Per million of each age of the Unvaccinated class. All Ages 90 3,350 Under 20 years 61 4,520 Under 5 years 40} 5,950 11 Dr. Buchanan considers that the following lessons may be learnt from the above Table :β 1. "The vaccinated are much less liable to die of small-pox than the unvaccinated. 2. "Vaccination is not an absolute protection against small-pox. In recording the present illustration of a quite admitted fact, it will be convenient to refer to the possibility of difference in the degree of protection afforded by vaccination now-a-days as compared with former times." The data with which we are furnished do not enable us to form an entirely correct opinion as to the greater protection afforded by vaccination at an early period after its introduction, yet there is reason for believing that the protective influence of vaccination was greater in the beginning of this century than it is at the present time. In an Address on Micro-Organisms and Diseases, which Dr. Cameron, M.P., the President of the Health Department of the Social Science Congress, delivered at the Meeting which was held in Dublin, in October, 1881, remarked that, "whilst comparing the results of vaccination as performed in Dr. Jenner's time and in the present time, although the operation was not then so carefully performed as it now is, yet the protection conferred, as measured by the death-rate in cases of small-pox occurring in vaccinated persons, was ten times more efficient than that secured by the most complete form of vaccination practised at the present day, and twenty-five times greater than that afforded by our vaccination, good, and indifferent, as at present practised." Dr. Cameron accounts for the falling off in results by "a deterioration of the vaccine virus." In Dr. Jenner's time, one vaccination was deemed a sufficient protection during life, but now-a-days it is considered necessary to repeat the operation two or more times for the protection of the individual. Vaccination, however, still affords a great protection against small-pox, as is shown from the figures above tabulated by Dr. Buchanan, from which it appears that the degrees of protection, both actual and relative, afforded by vaccination, is greatest to people under 5 years of age; less when ages from birth to 20 years are examined; and still less when people of all ages are taken into account. 12 Londoners can, says Dr. Buchanan, "by availing themselves of one average vaccination, diminish the chances of their children dying of small-pox in the proportion of 146 to 1, for the first five years of their life; and the same vaccination serves to lessen, in the proportion of 74 to 1, the chance of their being killed by the disease before they reach the age of 20. After that age, the vaccination in infancy is further reduced in its protective influence, for the difference in small-pox mortality between the unvaccinated and the vaccinated class, through the whole period of life, is as 1 to 37, a protection incomplete indeed, but obviously important for everybody to possess." For further information on this subject, I may refer you to my Quarterly Reports ended April 2nd, 1859, pages 4 to 8; December 1870, pages 10 to 21; December 1876, pages 7 to 13. In page XXI. of the Forty-second Annual Report of the Registrar-General, for the year 1879, and published in the year 1881, is the following Table, showing the deaths from small-pox, 1877β78β79, among the vaccinated, unvaccinated, and those in whom no statement as to vaccination has been made. Deaths from Small Pox, 1877β78β79. localities. Vaccinated. Unvaccinated. No Statement as to Vaccination. London 1,097 2,073 1,248 Best of England and Wales 396 634 1,222 All England and Wales 1,493 2,707 2.470 The Registrar-General remarks that, "there can be no doubt that the main cause of the outbreaks of small-pox is neglect of vaccination; and from information supplied by various registrars, there is reason to believe that it is no uncommon thing for a parent, in order to avoid the vaccination acts, not to register the birth of a child at all, or to give the registrar a false address. What numbers of the children, or persons generally, who die of small-pox, owe their deaths to such violation of the law, it is impossible to say with 13 ness; for, in the three years, 1877β9, in a very large proportion of fatal cases, 28.2 per cent. in London, and 54.3 per cent. in the rest of all England and Wales, the medical attendant was unable, or neglected to state, in the certificate, whether the deceased was vaccinated or not. But, confining ourselves to those cases in which the necessary information is given, it appears that 64.5 per cent. of the persons who died of small-pox in England and Wales, in these three years, were unvaccinated, and only 35.5 per cent. were vaccinated. In London, 65.4 per cent. of the fatal cases, concerning which the necessary information was forthcoming, were unvaccinated, while, in the rest of England and Wales, the per centage was 61.6. "This, however, does not necessarily imply that a larger proportion of persons were unvaccinated in London than elsewhere; the difference might possibly be due to better and more efficacious vaccination in London, owing to which a smaller proportion out of the vaccinated was liable to infection." In the Annual Summary of Births, Deaths, and Causes of Death, for the year 1880, it appears that London, at the time when the census of 1871 was taken, contained a population of 3,254,260, and there died of small-pox 475; of which 104, or 21.9 per cent. had been vaccinated; 229, or 48.2 per cent. had not been vaccinated, and in the remainder 142, or 29.8 per cent., there was no statement as to vaccination. In order to improve this state of things it might be desirable to have a Public Register kept of every certified case of successful vaccination, to which should be added the number of cicatrices in each case. The Register should also contain the name and address of the vaccinator, and the] name of the patient vaccinated, so that when a case of small-pox occurred in every public hospital, reference might be made to this Register for information relating to the name and address of the vaccinator. I recommended at page 8 of my Quarterly Report for June, 1877, that vaccination should be performed only by the Public Vaccinator, and I gave my reasons for such recommendation. 14 Importance of the Early Notification of Epidemic Diseases to the Sanitary Authority. The neglect in not giving early intimation of a case of small-pox is strikingly exemplified by the following disastrous consequences which occurred in a street in Mile End New Town. On the 10th of August last, a child aged six years, died of smallpox, at No. 6, Dunk Street, when notice of the death was sent to the Sanitary Officer by the Local Registrar of the District. Inquiry into the particulars of this death was immediately instituted by the Sanitary Inspector, who learnt that the patient had been attended by a medical practitioner, but who did not send a notification of the case either to the Inspector or the Medical Officer of Health. Shortly after the visit of the Sanitary Inspector the body was removed by the Relieving Officer to the dead house in the stone yard, where it remained until it was buried. On revisiting the same house on the 18th of August, the Inspector ascertained that another child of the same family was suffering from small-pox. This case was also attended as a private patient by a medical practitioner, who did not intimate the existence of the disease to the Sanitary Officer. On the same day the Inspector ascertained that two other children, living in the same house, were suffering from smallpox, and, on revisiting the house on the following day, two more children were found by the Inspector to have been attacked with the same disease. The Inspector having reason to believe that there were other cases of small-pox in the same street, visited the whole of the houses therein, 42 in number, and ascertained that 7 other cases of small-pox existed in that street, thus making a total of 12 cases, all of which were removed to the hospital. Some difficulty was experienced in inducing the parents to have their children removed to the hospital. So soon as all the children were removed from the several houses in which cases of small-pox had existed, the rooms, clothes, and bedding, which had been used by the patients, were disinfected. I have no hesitation in saying that had intimation been given to the Sanitary Officer of the existence of the first case of small-pox, this sad calamity would have been prevented. 15 Trade Nuisances. Complaints having been made of a nuisance caused by the drying of fish skins upon the first floor of No. 12, Duke Street, Old Artillery Ground, the Sanitary Inspector, Mr. Wrack, visited the premises, and informed the occupier that the locality was not suitable for the carrying on of such an offensive business, and requested him, without delay, to discontinue the use of the premises for any offensive business purposes. Mr. Wrack subsequently reported that the nuisance had been removed from the District. An application was made to the Metropolitan Board of Works by a Mr. Stanton, for sanction to establish anew the business of a tripe boiler, at the rear of No. 29, Thomas Street, Whitechapel. The matter was referred to your Board by the Metropolitan Board of Works, and the same being objected to, Mr. Stanton withdrew his application. Adulteration of Food and Drugs Act. Mr. Battram reports that he has submitted to Mr. Young, the Analyst for the District, five samples of milk, three of coffee, and one of arrow-root, for analysis; one sample of milk was found to be adulterated with 25 per cent. of water. A summons was taken out against the vendor, a conviction obtained, and a fine of Β£1 and 2s* costs imposed. Mr. Wrack reports that, during the Quarter ended 1st October, he purchased 11 samples of milk, and two of bread, and submitted the same to the Public Analyst for analysis; four of the milks were reported to be adulterated with water in the following proportions, viz., 11, 13, 14 and 22 percent. The vendors were cautioned; several samples of milk had been previously purchased of the same persons, which were reported to be pure. The breads were reported to be free from adulteration. 16 Sanitary Works Performed during the Quarter ended 1st October, 1881. The following return shows the amount of work done by the SanitaryInspectors during the Quarter ended 1st October, 1881. Number of inspections of houses as shown in the official returns 2925 Houses specially visited 262 Houses specially re-visited 1048 Preliminary notices served, such notices embracing 299 premises 220 Compulsory orders issued, embracing 80 premises 33 Summonses heard at Police Courts, under Sanitary Act 1 β 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 6 Houses in which rooms or passages have been whitewashed 162 Rooms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 86 Articles, consisting of beds, bedding, clothing, &c., removed from rooms to the Stone Yard and disinfected in the Apparatus 2079 Yards of houses paved, or the pavement repaired 30 Drains in houses improved 53 Dust-bins provided 4 Privies lime-washed, cleansed and repaired 88 Water supply provided or improved 20 Nuisances from dung and other offensive matter removed 30 Area gratings, cellar flaps, &c., repaired 0 Animals (pigeons and a horse) kept so as to be a nuisance, removed. 21 Cesspools abolished 0 Nuisance from smoking and curing of fish removed 1 Nuisance from the retention of dead bodies in living rooms removed 2 The cow-houses in the District, 24 in number, and the slaughter-houses, 14, 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 1st October, 1881. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Cholera and Choleraic - Diarrh Εa. Continued Fever, Typhus & Typhoid. Febricula. PyΓ¦mia. 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 14 17 0 0 30 0 0 3 0 2 0 0 64 0 0 3 0 0 0 1 411 545 Mr. Sequeira 5 7 0 6 21 0 0 23 0 7 0 0 20 0 0 1 0 0 0 0 182 272 Mr. Loane 2 1 0 1 4 1 0 6 0 2 0 0 16 0 0 2 0 0 0 0 58 93 Totals 21 26 0 7 55 1 0 32 0 11 0 0 100 0 0 6 0 0 0 1 651 910 Corresponding Qr. of previous Year. 2 5 8 2 78 0 1 31 0 9 0 0 90 3 1 18 0 0 1 4 568 821 Workhouse Mr. J. J. Ilott. 1 7 0 1 23 0 2 10 0 9 0 0 64 10 3 64 0 4 7 2 561 768 In addition to the oases of illness in the Workhouse, which are above recorded, there were 33 cases of syphilis and gonorrhΕa. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ended 1st October, 1881. Sub-districts. Small-Pox. Measles. Scarlet Fever Diphtheria. HoopingCough. Diarrhcea. Fever. L holers & Choleraic Diarrhoea. Total. Remarks. Spitalfields 1 1 6 0 6 14 0 0 28 Workhouse. Mile End New Town 1 2 1 2 5 15 1 0 27 Whitechapel North 0 4 1 0 1 10 1 0 17 Whitechapel Church 1 1 1 0 1 11 6 0 21 Hospital. Goodman's Fields 0 9 2 0 0 10 0 0 21 Aldgate 0 3 1 0 1 6 1 0 12 Totals 3 20 12 2 14 66 9 0 126 Deaths from Epidemics for the corresponding Quarter, 1880. 0 4 9 4 7 70 4 0 98 Seven deaths from small-pox, of patients sent from this District, occurred in the Small-pox Hospital, thus making 10 deaths from small-pox of persons resident in the District. No deaths from fever occurred in the Fever Hospitals of any patient belonging to this District. TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causesDeaths 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 October, 1881. 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. Spitalfields 22586 194 114 41 23 14 9 16 10 Mile End New Town 15474 144 140 32 18 38 3 14 80 Whitechapel North 10001 78 40 13 14 4 3 5 0 Whitechapel Church 7489 51 211 26 26 20 36 42 174 Goodman's Fields 9708 79 57 26 17 3 0 1 0 Aldgate 6092 40 39 12 9 3 0 2 0 Totals 71350 686 601 150 107 82 51 80 264 BOARD OF WORKS, WHITECHAPEL DISTRICT. REPORT ON THE SANITARY CONDITION OF THE WHITECHAPEL DISTRICT, for the QUARTER ENDED 31st DECEMBER, 1881. BY JOHN LIDDLE, medical officer of health. London: Printed by- Penny & Hull, 63, Leman St., Whitechapel, E. 1882 REPORT of the MEDICAL OFFICER OF HEALTH, For the Quarter ended 31st December, 1881. TO THE BOARD OF WORKS, WHITECHAPEL DISTRICT. Gentlemen, In the Quarter that ended on Saturday, the 31st December, 1881, the total births in the District, were 612, viz, 310 males and 302 females; and the deaths 578, viz., 329 males and 249 females. The excess of births over deaths has therefore been, during the Quarter, 34. As the deaths of 117 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 461, and thus increasing the number of births above deaths to 151. 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 621, and the total deaths 502. The weekly average of births was 47.7, and of deaths 38.6; and in the present Quarter the weekly average of births has been 47.0, and of deaths 44.4. In the Spitalfields sub-District the births were 171, and the deaths 105; in the Mile End New Town 172, and the deaths 166 (in this sub-District the Workhouse is situated); in the Whitechapel North 79, and the deaths 48; in the Whitechapel Church 59, and the deaths 194 (in this sub-District the London Hospital is situated); in the Goodman's Fields 92, and the deaths 37; and in the Aldgate 39, and the deaths 28. The deaths have exceeded the births in the Whitechapel Church sub-District by 135, but the deaths of the 117 non-residents in the London Hospital must be deducted. The proportion of births to deaths is therefore 59 to 77. The deaths in the London Hospital have been 166; of these, 117 were of non-residents in the District, 16 of residents, and 33 of persons who either died suddenly or from the result of accident. The deaths of persons who resided in this District, previous to their 4 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 10.2 per cent. In the last Quarter, ended 1st October, the proportion of deaths of residents to non-residents was 14.3 per cent. The deaths in the Workhouse Infirmary, Baker's Row, have been 80. In the corresponding Quarter of last year they were 75. The deaths from epidemic diseases in the entire District have been 61; viz., 3 from small-pox, to which must be added the 3 deaths which occurred in the Small-pox Hospitals, thus making 6 deaths from small-pox, 7 from measles, 8 from scarlet-fever, 5 from diphtheria, 23 from hooping-cough, 4 from diarrhoea, and 11 from fever. Five deaths from fever occurred in the Fever Hospital of patients removed from this District, thus making 16 deaths from fever and increasing the deaths from epidemic diseases to 69. In the corresponding Quarter of the previous year, the deaths from epidemic diseases were 3.5, viz, 5 from small-pox (including 4 deaths which occurred in the Small-pox Hospital), 11 from measles, 6 from scarlet-fever, 5 from diphtheria, 1 from hooping-cough, 6 from diarrhoea, and 8 from fever, including 3 deaths which occurred in the Fever Hospital. Mortality of Young Children. The mortality of children under 1 year of age is 126. This is 21.8 per cent. of the total mortality. In the corresponding Quarter of the previous year it was 15.7 per cent. In the Spitalfields sub-District the rate is 34.2 per cent.; in the Mile End New Town 22,8 per cent.; in the Whitechapel North 29.1 per cent.; in the Whitechapel Church 7.7 per cent.; in the Goodman's Fields 27.0 per cent.; and in the Aldgate 46.4 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;βIn 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 35.8 per cent. in relation to the total deaths, including those of non-residents, and 35.4 per cent. to 5 the total births. The rate of mortality under one year, in relation to the total births, is 20.5 per cent. Pauper Illness in the District. The Medical Officers of the Union have attended, during the past Quarter 1009 new cases of illness out of the Workhouse; including 7 of small-pox, 8 of measles, 8 of scarlatina, 16 of hooping-cough, 15 of diarrhoea, 12 of fever, 28 of febricula, and 8 of erysipelas. In the corresponding Quarter of the previous year, the number of pauper cases of illness was 904; including 16 of small-pox, 16 of measles, 8 of scarlatina, 19 of diarrhoea, 36 of febricula, 6 of fever, and 10 of erysipelas. The total number of cases of illness in the Workhouse has been 954; including 2 of small-pox, 1 of measles, 1 of hoopingcough, 14 of diarrhΕa, 29 of fever, 9 of erysipelas, and 15 of febricula. In addition to the above cases, there were 25 of syphilis and gonorrhoea; thus making a total of 979. Uncertified Deaths. Six uncertified deaths are recorded during the Quarter; 3 in the Spitalfields sub-District, 1 in the Whitechapel North sub-District, 1 in the Goodman's Fields sub-District, and 1 in the Aldgate subDistrict. Meteorology of Greenwich. The Returns of the Registrar-General show that the rain-fall in the Metropolis during the Quarter, has been 7.52 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 12.54 inches. The average annual rain-fall at Greenwich in 63 years, was 25.4 inches. The mean temperature of the air was 44Β°.5. In the corresponding Quarter of last year it was 43Β°7. The weather during this Quarter has been unusually mild. On only twelve days has the thermometer registered the temperature of the atmosphere as below 32Β°. The coldest days during the Quarter were Saturday, the 24th December, Friday, the 23rd December, and Monday, the 17th October, when the thermometer indicated respectively 21Β°6, 26Β°0, and 26Β°0. The coldest day during the corresponding Quarter of the previous year was on the 2nd November, when the thermometer indicated 25Β°0. The lowest mean temperature during any week in the Quarter was that which ended Saturday, 24th December, when the thermometer indicated 31Β°7. In the corresponding Quarter of last year the lowest mean temperature in any week was in that which ended November 4th, when it was 31Β°2. 6 The results of all the meteorological observations are to be understood as applying to the civil day, or from midnight to midnight. The deaths from diphtheria in London during the Quarter were 243; only 5 of which are recorded as having occurred in the "Whitechapel District. 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 Diarrhoea. Fever. Small-pox. From all causes. From Smallpox. From all causes. Oct. 8 38 50 13 1362 0 61 0.69 47.1 β 15 26 36 22 1460 0 42 0.51 49.0 β 22 18 67 14 1586 1 45 0.52 43.7 β 29 19 54 24 1588 0 46 0.98 43.5 Nov. 5 13 62 12 1 645 0 37 0.19 43.1 β 12 13 39 27 1636 0 46 0.25 51.6 β 19 16 44 13 1434 0 38 0.18 49.0 β 26 10 50 20 1600 0 36 1.07 49.5 Deo. 3 16 35 28 1460 0 42 0.80 44.6 β 10 13 33 22 1521 0 43 0.91 40.4 β 17 9 42 25 1636 1 45 0.71 38.8 β 24 11 36 23 1655 0 43 0.69 36.8 31 10 28 32 2079 1 54 0.02 41.4 VACCINATION. WHITECHAPEL UNION.βReturn of the number of Caaes Vaccinated by the Public Vaccinator and the Medical Officer of the Workhouse, together with the number ol Births Registered during the same quarters. Quarter endedβ PUBLIC VACCINATOR Workhouse. Totals. Births Registd. Primary Cases. Re-Vaccination . Primary Cases. Re-Vaccination Primary Cases.* Re-Vaccination. March, 1880 380 2 31 β 411 2 846 June 633 β 25 β 658 β 676 September 387 6 15 β 402 6 590 December 335 1 35 β 370 1 621 March, 1881 428 84 41 2 469 86 694 June 682 250 49 150 631 400 674 September 371 34 34 420 405 454 586 December 394 4 25 179 419 183 578 Totals 3410 381 255 751 3665 1132 5265 7 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 for the Quarter ended 2nd October, 1881. 1881. Week ending Deaths. Number of Patients in the Asylum Hospitals. October 8 13 422 ,, 15 22 443 ,, 22 14 455 ,, 29 24 453 November 5 12 453 β 12 27 440 ,, 19 13 452 ,, 26 20 499 December 3 28 477 ,, 10 22 460 ,, 17 25 471 ,, 24 23 474 β 31 32 485 Total Deaths in London 275 Quarterly Return of Small-pox and Fever Cases sent to Small-pox and Fever Hospitals, to 31st December, 1881. SMALL POX. Men. Women. Children. Total North District 2 0 2 4 South β 5 4 6 15* 19 *(Jf these loβb were non-resident in the Union. 5 of them were admitted from the London Hospital. 1 β was β ,, Infirmary, where he had walked from Hungerford Street, Commercial Eoad, E. 3 Died. Chester, Thomas, aged 46 years, of 5, Osborn Place, W.C. Chapman, Henry β 10 β 63, Great Garden Street, M.E.N.T. Elderbright, Mary A. 21 ,, London Hospital (St. George St., East). FEVER. Men. Women. Children. Total. North District 7 4 4 15 South β 4 7 17 28* 43 *0f these 28β 13 were admitted from the London Hospital, 10 being non-residents and 3 being residents of the Union. 5 Died. Thomas, Sarah, aged 30 years, of 18, Brady Street, W.C. Wills, John ,, 35 β 3, Charlotte Court, W.C. Hobbs, Ellen β 24 ,, 19, George Street, C.C. Bagley, Winifred β 8 ,, 2, Little Tun Yard, W.C. Dillon, Bridget β 15 β 40, Koyal Mint Street. 8 Analysis of Cases of Fever admitted into the Whitechapel Infirmary during the Quarter, prepared by Mr. Ilott the Medical Officer of the Union Workhouse. Description of Fever. Where from. Date of Admission. Date of Leaving the Fever Hospital. Whether had Fever or not on Admission. Time in the House before sending to Fever Hospital. Typhus. 5, Keate court Oct. 10 Oct. 12 Slightly 2 days. Do. 30, Dorset street β 19 β 20 Ditto 1 day. Do. 16, Peter's court β 24 β 25 Ditto 1 day. Do. Ditto β 24 β 25 Ditto 1 day. Do. 30, Dorset street β 24 β 25 Ditto 1 day. Do. Old inmate Some time. β 27 No Some months. Do. Ditto Sept. 30 β 27 No 4 weeks. Do. 30, Dorset street Oct. 26 β 27 Slightly 1 day. Do. 16, New court β 22 β 27 No 5 days. Do. 32, Flower & Dean street β 26 β 27 Slightly 1 day. Do. 12, Flower & Dean street β 28 β 28 Ditto A few hours. Do. 30, Dorset street β 28 β 28 Ditto Ditto. Do. Old inmate Some time. ,, 29 Out 2 days on leave Some time before. Do. South Grove Workhouse Oct. 29 β 30 Slightly 1 day. Do. 15, Peter's court 29 ,, 30 Ditto 1 day. Enteric Workhouse β 29 β 30 Ditto 1 day. Typhus 48, Flower & Dean street β 28 β 31 No 3 days. Do. 33, George street β 31 β 81 Slightly Few hours. Do. 12, Thrawl street β 31 β 31 Ditto Ditto. Enteric Workhouse β 31 Nov. 1 Ditto 1 day. Do. 3, Queens street Nov. 3 β 3 Ditto 3 hours. Typhus Workhouse ,, 1 ,, 12 Ditto 2 days. Do. 33, George street β 18 β 18 Ditto 3 hours. Do. 13, Court street β 26 β 26 Ditto 3 hours. Do. 19, George street Dec. 2 Dec. 4 Ditto 2 days. Do. 28, King street β 6 β 7 Ditto 1 day. Do. 187, Brick lane β 6 β 8 Ditto 2 days. Do. 19, George street β 9 β 9 Ditto 3 hours. Do. 11, Glass House buildings β 20 β 21 Ditto 1 day. 9 Improvements recently effected in matters connected with the Disinfection of Infected Bedding, Clothing, &c. On the 30th November last, I submitted a Report to the Committee of Works on the desirability of making certain additions to the means now in use for disinfecting bedding, &c. In the first place it was suggested in my Report that there should be erected, in addition to the disinfecting chamber, but forming no part of the same, a building which should be provided with proper means for the destruction by fire, without causing a nuisance, of such articles of bedding, clothing, &c., as had become infected, but which were so old and worn out as to render them perfectly useless. I am pleased to add that this new building and appliances were suggested and carried out by Mr. Struthers, a member of your Board, a gentleman who has devoted much time and given great attention in the perfecting of the furnaces used in the disinfecting of the several articles which are submitted to the heat required, for the purpose of effectually destroying the contagious matter contained in them, without injuring their texture. Secondly, it was recommended that there should be provided for the use of the men engaged in the work of disinfecting, means for washing their faces and hands. Thirdly, that stout bags, made of tick, should be purchased for enclosing the infected articles while they were being removed from the house where infectious disease had recently existed, so that such articles might be more safely conveyed to the disinfecting chamber. Fourthly. that gloves should be provided for the use of the men while engaged in the work of disinfecting; these gloves should be disinfected after each time they are used. Fifthly, that light overcoats or capes should be provided for the use of the Inspectors while superintending the process of disinfection, and some kind of dress should also be provided for the use of the men while engaged in the same work. All the above suggestions have been adopted and with satisfactory results. Overcrowding of a School Room- Mr. Inspector Wrack, in the course of his visitation of houses in Pelham Street, Spitalfields, found a serious case of overcrowding at 10 No. 11 in that street. The room was used by a foreigner lor a school, in which young children were taught the Hebrew language. In this room which was nine feet long, eight feet wide, and eight feet high, there were twenty-five children, whose ages varied from four to seven years, and also the master and his wife; in all twenty-seven persons; thus giving only an average of 21.3 cubic feet of space for each occupant of the room. Mr. Wrack learnt that occasionally there was a much larger number of children present at one time in this room. The Inspector further adds, that independently of the small size of the room, it was totally unfit for a school, in consequence of its confined situation. The atmosphere of the room was described as being most oppressive, and the children looked pale and sickly. The overcrowding of school rooms for young children, I am sorry to say, is of very frequent occurrence, and would not be discovered unless by a house to house visitation. Whenever cases of school rooms are found to be overcrowded, legal proceedings are always taken for the abatement of the nuisance. Retention of Dead Bodies in Rooms occupied by Families as Living and Sleeping Rooms. Mr. Inspector Battram reports that he discovered in two different rooms, which were occupied by families, two dead bodies; one was that of a young woman, at 58, Gower's Walk, which, at the time of the Inspector's visit, had been kept uncoffined for four days in the room where the father and two young children lived and slept. Information of this nuisance was given at the Sanitary Office, when Mr. Battram, immediately on seeing the case, directed the attention of the Relieving Officer to the same, and the body was removed. The other case was that of a man who died suddenly at No. 12, Everard's Place. In this case an inquest had to be held, and it was some time before the wife and relatives allowed the body to be removed for the purpose of holding the inquest. After the inquest the body was brought back to the same room in the house in which the man died, and was kept there for seven days. In this room three persons lived and slept. Surely it is full time that a proper mortuary was built for the use of this District, in which a dead body might be kept under the control of officials until the day of the funeral. 11 BOARD OF WORKS, WHITECHAPEL DISTRICT, A list of Streets and Places in which are recorded the number of Small-pox Cases that occurred therein during the years 1871, 1872, 1877, 1878, 1879, 1880, and 1881, which came under the notice of the Sanitary Officers. LOCALITIES. TEAKS. 1871 1872 1877 1878 1879 1880 1881 Number of Small-pox cases in each year. Albert street 2 13 2 3 3 Adelaide place 1 2 Artillery street 1 Angel alley 3 6 2 Alie street (Great) 1 β (Little) 2 1 Bath place 1 9 1 Buxton street 2 3 2 Bakers row 2 1 1 3 Brick lane 2 1 2 7 Bull court 1 Bucks row 1 2 Brushfield street 1 Boars Head yard 1 1 1 Blossom street 1 ' 1 Brady street 2 Boundary court 2 Booth street 1 Braceys buildings 2 Brunswick place 1 1 Back Church lane 2 3 1 2 Black Horse court 1 Butlers buildings 1 2 Brownsons court Buckle street 2 Cobbs yard 1 Caroline place 2 Chicksand street 3 2 1 Castle alley 3 1 2 Crown court (Quaker st.) 1 Church street, (C.C.) 1 1 Crown ct. (Little Pearl st.). 1 1 Court street 1 1 Castle court 1 Crispin street 1 1 Chapel street 1 Charlotte place 1 Coxs square 1 Corbetts court 1 4 Commercial street 1 1 2 Church passage 1 Cartwright street 1 1 2 β square 2 1 Commercial road 1 1 Carried forward 35 10 48 17 2 10 39 12 LOCALITIES. YEARS. 1871 1872 1877 1878 1879 1980 1881 Number of Small-pox cases in each year. Brought forward 35 10 48 17 2 10 39 Crawfords oourt 1 Christopher court 2 Chamber street 1 2 2 β court 3 Charlotte street 2 2 1 2 court 1 7 Crown ct. (Blue Anchor yd.) 2 Cable street 1 Crown ct. (Glasshouse st.) 2 1 Church lane 1 Cotton street 1 Commercial court 1 1 Crown ct. (Wentworth st.) 1 1 2 Conants place 1 Dorset street 1 1 1 1 Diamond court 1 1 Dunk street 2 13 Duke street 7 2 Deal street 1 Devonshire place 1 Darby street 1 Dock street 1 1 Dales place 3 Ely place 1 1 Eagle place 1 Eastmans court 1 Easington buildings 1 1 Emerys place 1 Elder street 1 Everards place 1 East Mount street 1 Enocks court 2 Frying Pan alley 2 1 1 Finch street 1 4 Farthing alley 1 Freeman street 1 Fleur-de-lis street 1 Fashion street 3 4 Fieldgate street 1 1 1 Fives court 1 Flower-and-dean street 1 s 4 4 Great Pearl street 4 1 Gun street 1 2 1 Grey Eagle street 1 4 1 Goulston street 3 3 1 1 2 George street, M. E. N. T 1 4 Green Dragon yard 1 Great Garden street 6 1 10 Goulston court 1 George court, M. E. N. T 1 β street (Tower hill) 1 Glasshouse street 3 1 1 Garden court 2 1 Carried forward 81 19 94 36 2 26 89 13 LOCALITIES. YEARS. 1871 1872 1877 1878 1879 1880 1881 Num ber of Small-pox cases in each year. Brought forward 81 19 '94 36 2 26 89 Gowers place 1 6 Goodmans yard 1 George yard 3 1 2 3 β street, (C.C.) 2 Green street 2 2 Gowers walk 1 1 1 ,, row Griggs court 2 Hanbury street 10 2 6 2 9 Hunt street 1 1 1 β court 1 1 1 3 Heneage street 1 5 Hobsons place 1 2 9 ,, court 2 Hope street 1 1 Halifax street 1 Harrisons buildings (Little North street) 1 1 Hope place, (W.C.) 1 1 Hay don street 1 β square 1 Hayes court 1 Half Moon passage 1 Holloway court 1 Inkhorn court 1 John street (Chicksand st.). 2 1 1 Johns pi. (Old Montague street). 1 John street (Hanbury st.) 4 Johns place (Hunt street) 1 1 Jacobs court 2 Jones buildings 1 Johns court (George street) 1 King street, (C.C.) 5 ,, street, M. E. N. T. 2 1 ,, street (Aldgate) 3 1 ,, Edward street 2 1 1 1 Keate street (Upper) 1 2 β street (Lower) 2 ,, court 1 1 Kent and Essex yard 2 Little North street 1 1 Luke street 2 1 1 Little Halifax street i Love Court 1 1 Luntley place 2 1 Little Pearl street 4 Lamb street 1 Little Middlesex street 1 Lambeth street 5 1 Leman street 1 6 1 1 4 Lower East Smithfield Middlesex street 1 1 1 Carried forward 138 26 130 52 2 41 139 14 LOCALITIES. YEARS. 1871 1872 1877 1878 1879 1880 1881 Number of Small-pox cases in each year Brought forward 138 26 130 52 2 41 139 Mosses buildings 2 1 Montague court 1 Minories 2 Maypole court 3 Mount street 2 4 Mansell street 1 Mundys place 1 Mill yard 1 Norton Folgate 1 New GouUton street 1 New ct. (Great Pearl street) 2 1 North place 2 2 New court (Wentworth st.) 1 Newcastle street 1 Nelson court, (W.C.) 1 New road 1 1 1 1 Norwich court 1 Newnham street 2 Osborn street 1 β place 1 1 β court (Osborn pl.) 6 Old Montague street 6 2 7 2 Orange row 1 1 Oxford street 1 1 3 1 Popes H ead court 2 2 Pelbam street 4 1 4 1 4 Parliament court 1 Princes place 1 Pools place 1 Paternoster row 1 3 Princes street 1 Pratts alley 1 PeterB court 4 Plough street 2 2 Providence row 1 Prescot Btreet (Great) 1 1 1 β street (Little) 2 Providence ct. (Glasshouse street) 3 Quaker street 3 1 3 Queen street (C.C.) 1 5 ,, street (Aldgate) 1 2 1 ,, Ann street 1 3 8 Raven row (C.C.) 1 Pied Lion court 1 1 Eussell court 1 Eose ct. (Blue Anchor yd.) 2 β court (Aldgate) 1 Boyal Mint street 5 Rosemary court 1 Rupert street 1 Eaven street 3 4 Carried forward 192 32 161 61 13 59 181 15 LOCALITIES. YEARS. 1871 1872 1877 1878 1879 1880 1881 Number of Small -pox cases in each year. Brought forward 192 32 161 61 13 59 181 Spring gardens 1 18 1 Steward street 1 Samuel street 2 1 β court 2 Spital street 2 Sandys row 1 1 Swan court (Middlesex st.) 1 4 Spicer street 2 Swan court (Mansell street) 2 Shorters rents, (W.C.) 1 1 Sugar Loaf court, (W.C.) 4 Spectacle alley 1 South street, (W.C.) 1 Tenter street (C.C.) 1 Thomas street 2 1 1 4 Tilley street 1 Tenter street (North) 1 Tongue yard (Little) 2 1 Thrawl street 4 2 3 Tenter street (South) 2 Underwood street 2 2 2 1 Upper East Smithfield 1 1 1 Vine court, (W.C.) 2 β court (C.C.) 1 3 ,, yard 3 1 Wellington street 1 4 Whites row (C.C ) 2 1 1 11 β row, (W.C.) 2 4 White Lion street 1 Wilk street I Wentworth street 3 1 8 Wheeler street 2 Wood street 1 White Bear court 2 Waltons court 3 Wells place (W.C.) 2 2 Wageners buildings 1 2 Whitechapel road 1 3 1 5 β High street 1 Wilsons place 1 4 Well street 1 2 1 W ellclose square 2 1 Wells row 1 Total No.of cases in each yr. 226 39 191 104 13 G8 233 It appears from the preceding Table, which has been prepared by Mr. Inspector Wrack, that the greatest number of small-pox cases which occurred in any locality in the District, was in Albert Street, Mile End New Town, and Spring Gardens, a place where there are thirty houses, having a population of about 210. Special Reports of the outbreaks were prepared by the Medical Officer of Health, and printed in the Reports for the Quarters ending June, 1877, and March, 1878. 16 Sanitaby Wobks Pebformed during the Quabteb ended 31st December, 1881. The following return shows the amount of work done by tho Sanitary Inspectors during the Quarter ended 31st December, 1881. Number of inspections of houses as shown in the official returns 2225 Houses specially visited 275 Houses specially re-visited 1104 Preliminary notices served, such notices embracing 272 premises 166 Compulsory orders issued, embracing 110 premises 49 Summonses heard at Police Courts, under Sanitary Act 1 ,, under Act for the prevention of Adulteration of Food, &c. 0 Cellars used as dwellings discontinued for such use 3 Cases of overcrowding and indecent occupation abated 3 Houses in which rooms or passages have been whitewashed 105 Rooms disinfected with sulphurous-acid gas, after the occurrence of small-pox, fever, and scarlet-fever therein 95 Articles, consisting of beds, bedding, clothing, &c., removed from rooms to the Stone Yard and disinfected in the Apparatus 2620 Yards of houses paved, or the pavement repaired 61 Drains iD houses improved 53 Dust-bins provided 3 Privies lime-washed, cleansed and repaired 76 Water supply provided or improved 16 Nuisances from dung and other offensive matter removed 30 Area gratings, cellar flaps, &c., repaired 0 Animals, fowls, pigeons, and several thousand tortoises kept so as to be a nuisance, removed Cesspools abolished 0 Nuisance from smoking and curing of fish removed 0 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. ANNUAL REPORT. The number of births registered in this District during the year has been 256G, and the deaths 2351, including those of non-residents in the London Hospital (446). In the preceding year the births were 2733 and the deaths 2302, including the deaths of 439 non-residents. The deaths in the Workhouse have been 329, against 350 for the previous year; and the deaths in the London Hospital 654 against 631. The population of the District, at the taking of the last census, according to the unrevised enumerated table, and published weekly in the Returns of the Registrar-General, was 71,350; but in a recently corrected return, the population is 71,301. 17 The inhabited houses are 7,594. In 1871 the population was 76,520, and the inhabited houses 8,264. The deaths (excluding 446 of non-residents) being 1905, the rate of mortality has been, during the year, 26.6 per 1000. The rate of mortality during the preceding year was 24.3 per 1000. In making a comparison, however, of the rate of mortality of this District with that of others in which there is no hospital, the total deaths in the London Hospital must be eliminated, which, this year, as before stated, amount to 654. This gives a mortality of 23.7 per 1000. The annual rate of mortality since the year 1866, which was the year when cholera was epidemic, may be seen on referring to Table No. 5 in the Appendix. Deaths from Epidemic Diseases. Of the total deaths recorded in this District during the year, there were 307 from epidemic diseases, viz., 14 from small-pox, to which must be added the 33 which occurred in the Small-pox Hospital, thus making a total of 47; 88 from measles, 26 from scarlet-fever, 9 from diphtheria, 48 from hooping-cough, 91 from diarrhoea, and 31 from fever, to which must be added the 5 deaths which occurred in the Fever Hospital, thus making a total of 36. The deaths from fever, including those which occurred in the Fever Hospital, have been 36. In the whole of London, the deaths from fever have been 1195. The death-rate from epidemic diseases, including those in hospitals, for the year, in relation to the total mortality, is 14.5 per cent. Small-pox in London. In the fifty-two weeks ended December 31st, the deaths in London from small-pox were 2371, which is equal to 621 per million of the population. Pauper Illness in the District. The number of out-door sick paupers who have been attended by the Medical Officers of the Union is 4229. Duiing the previous year the number was 3660. The extraordinary annual diminution in the number 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 ratepayers of this District. 18 Sanitary Works performed during the Year 1881. Number of inspection of houses, as shown in the official returns 10828 Number of rooms found to be overcrowded, the space being less than 300 cubic feet for each personβnuisance in each case abated 25 Houses specially visited 1004 ,, ,, re-visited 4049 Rooms disinfected with sulphurous acid gas after the occurrence of fever and scarlet-fever therein 415 Articles disinfected, consisting of beds, bedding, clothing, &c 1233S Preliminary notices served, such notices embracing 1253 premises 820 Compulsory orders issued, embracing 427 premises 167 Summonses heard at police courts under Sanitary Act 4 Summonses under Act for the Prevention of Adulteration of Food, &c. 9 Houses in which rooms or passages have been whitewashed. G40 Yards of houses paved or the pavement repaired 154 Drains in houses improved 205 Dust-bins provided 29 Privies lime-washed, cleansed, and repaired 327 Water-supply provided or improved 95 Area-gratings, cellar-flaps, &c., repaired 11 Cellars used as dwellings discontinued for such use 17 Nuisances from dung and other offensive matter removed 140 Animals, fowls, pigeons, and several thousand tortoises kept so as to be a nuisance, removed. All the cow-houses and the slaughter-houses have been visited four times during the year. 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. It gives me much pleasure in bearing testimony to the zeal and energy displayed by the Sanitary Inspectors, Messrs. Battram and Wrack, in the faithful performance of their duties. The work that the Inspectors perform is certainly onerous, and is not altogether unattended with danger. They feel, however, an interest in their work, and they are enabled to see not only a favorable result from their labours, in the fact of a diminished rate of mortality in the District, but that their services are acknowledged by the Board, and appreciated by the Medical Officer of Health. I am, Gentlemen, Your obedient Servant, JOIIN LIDDLE. 15, Great Alie Street. APPENDIX. TABLE I.βCases 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 31st Decmber, 1881. Names of Medical Officers. Small-Pox. Measles. Scarlatina. Hooping-Cough. Diarrhoea. Cholera and Choleraic - D iarrh oe a. Continued Fever, Typhus & Typhoid. Febricula. Pyjemia. Erysipelas. Puerperal Fever. Croup. Acute Pulmonary Inflammation. Carbuncle. Rheumatic Fever. Ague. Dysentery. Delirium Tremens. Lead Poisoning. All other Diseases. Total. Bronchitis and Catarrh. Pleuiitis and Pneumonia. Mr. Champneys 1 3 0 6 10 0 2 10 0 4 0 0 99 0 0 0 0 0 0 0 473 608 Mr. Sequeira 2 3 6 6 5 0 1 14 0 4 0 0 26 1 0 0 0 0 0 0 207 275 Mr. Loane 4 2 2 4 0 0 9 4 0 0 0 0 26 3 0 0 0 0 0 0 72 126 Totals 7 8 8 16 15 0 12 28 0 8 0 0 151 4 0 0 0 0 0 0 752 1009 Corresponding Qr. of previous Year. 16 16 8 0 19 0 6 36 0 10 0 1 150 7 2 3 0 0 0 1 629 904 Workhouse Mr. J. J. Ilott. 2 1 0 1 14 0 29 15 0 9 0 0 138 16 0 93 2 1 8 0 625 954 In addition to the cases of illness in the Workhouse, which are above recorded, there were 25 cases of syphilis and gonorrhΕa. TABLE II. Showing the Deaths from Epidemic Diseases for the Three Months ended 31st December, 1881. Sub-diutricts. Small-Pox. Measles. Scarlet F ever Diphtheria. HoopingCough. DiarrhΕa. Fever. Cholera & Choleraic DiarrhΕa. Total. Remarks. Spital fields 0 0 0 0 8 1 2 0 11 Workhouse. Mile End New Town 0 4 2 1 6 2 1 0 16 Whitechapel North 0 0 3 1 3 0 2 0 9 White chapel Church 2 2 3 2 4 1 4 0 18 Hospital. Goodman's Fields 1 0 0 1 1 0 1 0 4 Aldgate 0 1 0 0 1 0 1 0 3 Totals 3 7 8 5 23 4 11 0 61 Deaths from Epidemics for the corresponding Quarter, 1880. 1 11 6 5 1 6 5 0 35 Three deaths from small-pox, of patients sent from this District, occurred in the Small-pox Hospital, thus making 6 deaths from small-pox of persons resident in the District. Five deaths from fever occurred in the Fever Hospitals of patients belonging to this District, thus making a total of 16 deaths from fever. TABLE III. Showing Sub-districts, Enumerated Population, Total Births, and Deaths from all causesDeaths under 1 year of age, 1 and under o years, and above 60 years; Deaths from Violence, Inquest cases, and Deaths in Workhouse and London Hospital, for the Quarter ended 31st December, 1881. Sub-districts. Enumerated Population in 1881. Births. Deaths. Under 1 year of age. 1, and under 5 years. Persona aged 60 years and upwards. Violence. Inquest cases. Deaths in Public Institutions. * Spitalfields Uarevised 22586 171 105 36 21 11 6 18 6 Mile End New Town 15474 172 166 38 23 46 3 16 80 Whitechapel North 10001 79 48 14 12 7 1 3 0 Whitechapel Church 7489 59 194 15 23 24 35 35 166 Goodman's Fields 9708 92 37 10 7 7 1 4 0 Aldgate 6092 39 28 13 5 1 1 2 0 Totals 71350* 612 578 126 91 96 47 78 252 * The last corrected return of the census is 71,301 or 49 less than in the utivevised return. TABLE IV. Cases of illness attended annually by the Medical Officers of the Union, from the year 1856. Years ending Total caseB attended during the year. Years ending Total cases attended during the year. Years ending Total cases attended during the year. 1856 12485 1865 15594 1874 3685 1857 10714 1866 16502 1875 2474 1858 11718 1867 17181 1876 2281 1859 11701 1868 17417 1877 2060 1860 11392 1869 14031 1878 3107 1861 13724 1870 14148 1879 3833 1862 14270 1871 10194 1880 3660 1863 14564 1872 4864 1881 4229 1864 14932 1873 4887 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 1881. 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 per cent, of Children under 1 yr. to the total deaths deducting the deaths of non-residents. Rate of mortality per 1000, deducting the deaths of nonresidents. Kate of mortality of Children under 1 yr. per 1000 of the population. 1866 78,970 2561 8495 733 432 465 15.1 38 7 5 8 1867 ... 2686 2331 445 241 525 25.1 26.4 6.6 1868 ... 2611 2519 536 324 513 23.3 27.7 6.4 1869* ... 2571 2675 504 283 526 21.9 29.6 6.6 1870 ... 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 1878 ... 2658 2430 671 469 482 24.5 25.6 6.2 1879 ... 2722 2426 615 434 454 21.2 26.0 6.9 1880 ... 2733 2302 631 439 450 24.1 24.3 5.8 1881 71,350 2566 2351 654 446 472 24.7 26.6 6.6 * These years contain 53 weeks. The number of Inquests which have been held this year in this District has been 349. In the preceding year the number waB 297. TABLE VI. Showing the Deaths from Epidemic Diseases in the Whitechapel District daring the last 25 years. Name of Disease 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 Β« 1873 1874 1875 1876 1877 1878 1879 1880 1881 Small Pox 3 4 60 21 28 33 69 5 22 44 40 11 1 56 159 19 1 1 2 8 23 11 7 16 47 Measles 60 78 31 81 27 153 26 137 28 139 33 69 71 36 42 23 44 33 40 16 96 32 49 26 88 β Scarlet Fever & Diphtheria 43 87 96 59 70 91 200 50 80 76 26 48 208 59 25 96 24 199 51 18 28 24 89 37 35β‘ Hooping Cough 89 117 50 49 89 62 52 74 97 94 72 55 113 50 43 9 79 16 61 57 44 84 73 39 48 DiarrhΕa 139 108 141 67 101 69 114 109 122 119 100 138 97 107 125 99 113 76 93 103 89 89 67 90 91 Fever 117 104 93 69 65 250 158 170 167 100 82 109 95 52 40 26 44 47 30 27 26 29 33 16 36 Cholera&Choleraic-Diaha. 10 6 5 1 4 5 5 2 4 904 9 10 7 6 3 5 8 3 0 0 0 0 0 0 0 Totals 461 504 476 347 384 663 624 547 520 1476 362 440 592 366 437 277 313 375 277 229 306 269 318 224 345 London Fever 2203 1902 1796 1302 1754 3635 2802 3689 3232 2681 2174 2483 2211 2049 1755 1003 1548 1552 1282 1206 1240 1361 1084 887 1195 Scarlta. & Diph. 1587 4118 4197 2457 3058 4194 5799 3806 2614 2316 1836 3418 6102 6306 2220 1063 932 3037 4038 2673 1776 2350 3212 3624 2772 Small Pox 154 247 1156 877 215 345 2012 537 646 1388 1339 606 273 958 7834 1532 114 56 75 739 2544 1416 454 475 2371 * In the above Table the years 1863, 1869, 1873 and 1880, consist of 53 weeks. In the column of deaths for 1879,1880 and 1881, the deaths from small-pox and from fever, which occurred in the Hospitals, are included, β Scarlet-fever and diphtheria in the earlier records of the Registrar-General were not separated, but were classed under one heading, viz.: scarlet-fever. For some years past these diseases have been recorded under separate headings. β‘The deaths from scarlet-fever during this year were 26 and from diphtheria 9. In London, the deaths from scarlet-fever were 2118, and from diphtheria 654. TABLE VII. Showing the cases of Epidemic Diseases among the pauper population in the Whitechapel District during the last 24 years. Name of Disease 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 1881 Small Pox 6 20 242 65 86 113 253 21 86 261 254 93 5 302 625 60 2 1 0 19 125 48 10 37 135 Measles 266 427 179 520 70 525 80 482 51 679 155 323 212 257 178 76 128 59 32 32 64 11 115 40 164 Scarlet Fever & Diphtheria 49 147 176 93 100 118 305 156 164 197 60 54 311 97 32 16 22 161 17 6 8 18 71 21 15 Hooping Cough 150 230 146 83 388 153 169 217 280 217 219 144 308 140 102 94 86 30 44 15 24 16 33 12 30 DiarrhΕa 1324 946 1209 773 1418 1085 1108 1127 1342 1664 1471 1631 1033 1097 590 283 212 150 101 120 61 76 91 119 97 Fever 1441 590 411 190 109 822 464 295 573 343 308 586 385 325 201 19 126 84 24 34 17 17 13 9 12 Cholera&Choleraic-Diaha. 16 0 1 1 0 1 1 4 4 58 5 8 1 4 2 3 2 0 0 0 1 2 0 0 1 Totals 3252 2360 2364 1725 2171 2817 2380 2302 2500 3419 2472 2839 2255 2222 1730 551 578 485 218 226 300 188 333 238 454 * In the above Table the years 1863, 1869, and 1873, consist of 53 weeks. β . | Whitechapel.1881.b19883560.txt | Whitechapel | 1,881 | b19883560 |
"3650 leytonstone. AC 4411 (1) LEYTON LEY 60 H Borough of Leyton. HEALTH REPORT FOR THE YEAR 1937. A(...TRUNCATED) | Leyton.1937.b19823885.txt | Leyton | 1,937 | b19823885 |
"AC439(3)TOTTEN HAA Chater Mam B Tottenham Urban district Council. ANNUAL REPORT MEDICAL OFFICER OF (...TRUNCATED) | Tottenham.1924.b19881666.txt | Tottenham | 1,924 | b19881666 |
"Journal Rebind Co. Ltd. Unit 4, Pier Wharf Grays Essex COUNTY BOROUGH OF EAST HAM. Annual Report OF(...TRUNCATED) | EastHam.1935.b19874625.txt | EastHam | 1,935 | b19874625 |
"LIBRARY FIN 18 THE Metropolitan Borough of Finsbury ANNUAL REPORT ON THE Public Health of Finsbury (...TRUNCATED) | FinsburyMetropolitanBorough.1937.b1823723x.txt | FinsburyMetropolitanBorough | 1,937 | b1823723x |
"AC 4349 PAD 46 Metropolitan Borough of Paddington REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE Y(...TRUNCATED) | PaddingtonMetropolitanBorough.1946.b18245547.txt | PaddingtonMetropolitanBorough | 1,946 | b18245547 |
"Sou 77 London Borough of Southwark ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCH(...TRUNCATED) | Southwark.1967.b18246862.txt | Southwark | 1,967 | b18246862 |
"ER 141 AC 4412(1) BOROUGH OF ERITH ANNUAL REPORT of the Medical Officer of Health For the year 1961(...TRUNCATED) | Erith.1961.b19790028.txt | Erith | 1,961 | b19790028 |
"REPORT OF THE MEDICAL OFFICER OF HEALTH FOR the CITY OF LONDON for the year 1959 Printed by the, Au(...TRUNCATED) | CityofLondon.1959.b18253763.txt | CityofLondon | 1,959 | b18253763 |
"FUL 50 Metropolitan Borough of Fulham REPORT of the MEDICAL OFFICER OF HEALTH Including the Report (...TRUNCATED) | FulhamMetropolitanBorough.1959.b18235578.txt | FulhamMetropolitanBorough | 1,959 | b18235578 |
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