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AC 4366 ST MATTHEW BETHNAL GREEN BET 71 REPORT [1855] TO THE VESTRY OF St.Matthew Bethnal Green, ON THE SANITARY STATE OF THE PARISH, BY SAMUEL PEARCE, MEDICAL OFFICER OF HEALTH. PRINTED BY ORDER OF VESTRY, 1857. 38726 TO JOHN SIMON, Esq. F.R.S. MEDICAL OFFICER OF THE BOARD OF HEALTH; WHOSE NOBLE EXERTIONS IN SANITARY REFORM, HAVE SAVED THE CITY OF LONDON, TWO LIVES, PER THOUSAND, PER ANNUM: THE OFFICER OF HEALTH, OF BETHNAL GREEN, DEDICATES BY PERMISSION, AND IN TESTIMONY OF DEEP ADMIRATION AND RESPECT, HIS FIRST SANITARY REPORT. 135, Bethnal Green Road, April 21st., 1856.

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"As the Wolf has been extirpated from our forests, so may Pestilence be driven away from our towns." Gentlemen, In accordance with my duties as your first Officer of Health, I have the honour to present to you, a Report on the Parish of Bethnal Green. I have framed it throughout on the subjoined Instructions* of the General Board of Health, and in the order suggested therein. Natural Features. Bethnal Green has, naturally a gravelly soil, and a mean elevation of 38 feet above the high water mark of the Thames. It, therefore, stands high, on the Seventh of the Fourteen Terraces, into which the elevation of London has been divided by Dr. Farr. Some of its ground was, originally, swampy and covered with ponds.

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Such was "the former geography" * "The duties of the Officer of Health will be to the following effect:— "He will make himself familiar with the natural and acquired features of the place, with the social and previous sanitary state of its population, and with all its existing provisions for health—namely, with the levels, inclinations, soil, wells, and watersprings of the district; with its meteorological peculiarities; with the distribution of its buildings and open spaces, paved or unpaved; of its burial-grounds and lay-stalls: with a plan of its drains, sewers, and water supply; with the nature of its manufacturing and other industrial establishments; with the house accommodation of the poorer classes, and their opportunities for bathing and washing; with the arrangements for burial of the dead, and with the regulations in force for lodging houses and slaughtering places; for the cleansing of public ways and markets; and for the removal of domestic refuse.

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And if he be the first Officer of Health appointed in his district he will, without unnecessary delay, furnish to the Local Authority a connected account of these matters so far as they relate to the public health, making thereon such practical suggestions as he may think applicable." 4 of the old Hare Street Fields, and of the brickfield to the left of the Road:—the present site of Wolverly, Camden Streets, &c. When filled up with rubbish, houses were planted on that undrained ground. No wonder if some are damp to this day, and dispose, even now, to Zymotic disease ! At the eastern end of the Road, water is reached, in the winter, at 18 inches of depth; proving alike, the dense saturation, and the unhealthy condition below. This was the case where the talented and lamented Mr. Taylor resided, and this probably, with the harass of Cholera in 1849, predisposed to his untimely death.

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Bethnal Green forms a part of the eastern metropolitan boundary, and has a superficial area of 760 statute acres; whilst "the London" of the Registrar-General numbers 78,029. Its Registration divisions are Four: Hackney Road, Green, Church, and Town. Of these, the areas and elevations are given below:— Acquired Features, TABLE I. Sub-Districts. Area in Acres. Elevation. Hackney Road 141 44 Green 391 36 Church 132 36 Town 96 36 The next Table shows the New Parishes that have been formed, out of, and in addition to, Saint Matthew, Bethnal Green:— 5 TABLE II.* PARISHES. HOUSES 1851. POPULATION 1851. Inhabited. Uninhabited. Building Number Males Females St. Matthew 1167 19 1 7961 3928 4033 St.

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Andrew 1591 29 10272 4977 5295 St. Bartholomew 1472 49 10016 4957 5059 St. James the Great 750 15 1 4503 2168 2335 St. James the Less 368 21 14 2357 1147 1210 St. John 1090 47 61 7696 3591 4105 St. Jude 1686 68 15 10396 5025 5371 St. Matthias 1078 28 4 8696 4379 4317 St. Peter 900 31 11 5115 2432 2683 St. Philip 1336 32 11418 5681 5737 St. Simon Zelotes 662 24 10 4200 2099 2101 St.

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Thomas 1198 31 10 7563 3697 3866 Totals 13298 394 127 90193 44081 46112 Altogether there were, at the Census, 13,819 houses, or 18.1 to the acre, and the number of Inhabitants was 6 to each house. Population. In 1801 the population amounted to 22,310; in 1811, to to 33,619; in 1821, to 45,676; in 1831, to 62,018; and from that year to 1841, the annual per centage increase was 1.755.† The annexed Table exhibits the population in 1841 and 1851, the decennial advance, and the relative proportions of the Birth and Immigration Increase:— TABLE III. SUB-DISTRICTS. POPULATION. 1841 1851 Decennial per centage Increase.

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Excess of Births over Deaths. Census Returns. Immigration Increase. Hackney Road 20031 23910 19.36 3305 3848 543 Green 16766 23555 40.49 719 6763 6044 Church 17293 21787 25.98 3338 4468 1130 Town 19998 20941 4.71 3335 912 * This Table will hereafter be useful in comparing the salubrity of the several parts, † Ninth Annual Report of Registrar-General, p. 169. 6 While, therefore, the Births and Influx of Immigrants added 15,079 to the Hackney Road, Green, and Church Sub-Divisions, the same causes produced an increase only of 912 in the Town; being less by 2423 than the actual excess of the Births.

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For the entire Parish, the decennial increase was 2173* per 100 per annum; which ratio brings us up from 90,193,† to 100,000 in 1856. And as the people of the Metropolis number 2,565,579, it follows that one out of every 25'6 of the Great London Family lives at Bethnal Green. Social and Sanitary state of the Population. By the New Metropolis Management Act, the Parish is divided into Four Wards:—North, South, East and West. In these, its "medical topography" and social condition are very diverse. The North Ward contains many excellent houses, and several of the wealthier and more dlite of the residents in Bethnal Green. In the Hackney Road portion, Mr. Murray reports, that "deaths are comparatively very infrequent." Near the Canal, it is less healthy, and, moreover, is dirty and damp.

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So, too, are the sites of its original ponds. Fortunately—in so far as the fenny soil is concerned—the Imperial Gas Company have taken much of that ground, which they are extensively improving and draining. Along Ann's Place runs a black arched-over ditch;‡—to this day, I believe, a fertile source of disease. Generally, this division is not overcrowded; unless in and about Cambridge Circus where, Mr. Welch informs me, "Fever and Diarrhoea have been very prevalent from drains running immediately under the * In the 9th Annual Report, page 2, the Registrar-General, alluding to the Increase of Population, Immigration, and Emigration, says, "With so many unknown elements, the equation of increase becomes indeterminate, and as near an approximation to the true rate of increase is obtained by using the rate which prevailed in the years 1831-41, as by any other method that can be devised."

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I have consequently calculated the rate prevailing in 1841-51, and the subsequent increase therefrom. † Males, 44,081; Females, 46,112—or 20,547 Families or Occupiers. ‡ This was open in 1849, and "near to its edge," in Shoreditch, "many deaths occurred from Cholera."—Notes on Cholera, p. 193. 7 floors." On the west side of Nelson Street, he also reports, "that several cases of Scarlet Fever, Typhus, and Small-pox have occurred." Those cases were probably referable to 30 feet of open sewer close by. The South Ward is remarkable for the cul-de-sac construction of several streets. It is traversed, almost at parallel lines, by Bethnal Green Road, and the Eastern Counties' Railway, which nearly sub-divide it into three equal parts. The superior contains many good modern houses in the district of St.

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Jude, and a large open space (late an old market-garden) capable of affording much more houseroom. In the central part, are the several free spaces of Camden and other Gardens, which,—though open to objection, in their present unpaved condition—might by judicious alteration, furnish the staple want of the parish—Model Lodgings, Baths, and Wash-houses. Westward of Camden Gardens stand the disease-inviting back-to-back houses of Alfred and Beckford Rows, where Fever reigned supreme in 1838, and Cholera in 1849. But, even here, "relief might be given" by converting every two back-to-back tenements "into one single row of houses with doors and windows before and behind," as admirably suggested, in certain City Courts, by Mr. Simon. In pleasing contrast to these upas spots, are the several improvements made in paving and draining through the praiseworthy exertions of our friend Mr. Goodwin.

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They illustrate how much each one may do, and forcibly urge us to "go and do likewise." To the south of the railroad is the third subdivision;—the far-famed Lamb Fields, or "St. Giles" of Bethnal Green: now teeming with life, and, perhaps retaining, in its oft-described soil—germs of future disease! Much hazard however, might be avoided by the ventilating chimney openings of Dr. Arnott, "which not only carry away the breath-poison, but also the aerial impurity" of undrained, or badly drained soil. Such chimney openings with the charcoal air filters of Dr. Stenhouse, which purify the air from without before it enters the lungs, would greatly ward off 8 their malarious ills. And, where so many pass their days in-doors, at the looms, and sleep, for the most part, on the ground floors, ventilation demands our foremost regard.

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The Bethnal Green portions of the Jews' Burial Grounds are in this sub-division. On the opposite side, the neighbourhood is very poor and bad, and is noted for Fever. Equally notorious is the Irish Colony of Elizabeth Place, or Devil's Alley near Mile End Gate. In that close parallelogram bounded before and behind by high walls, the imprisoned air stagnates, and is unfit to breathe. The East is, par excellence, our best drained and most healthy Ward. Open to the Park and the country beyond, it wafts the breezes of life to its less favoured districts. Nevertheless, these advantages have their alloy: for two manufactories of manure flourish still, in this, otherwise, "happy land." The West Ward comprises the more ancient portions of Bethnal Green. Many of its houses are large and lofty; but others, in the Courts and Gardens, are hovels only.

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The latter, usually do not exceed two rooms in height, which fortunately, lessens the intensity of the emanations, and diffuses them more readily into space. "All the neighbourhood," says Mr. Welch, "north of Church Street, Friar's Mount, and its pestilential blind alleys, all the streets bordering on Gibraltar Walk on the east, and Boundary Street on the west, suffered severely in the Fever Epidemic in 1836-37, and as severely from Cholera in 1849." Being densely peopled by the poorest class, and having but little breathing space, it registers low on the scale of health. Nor can this be a matter of surprise while hundreds swarm, like bees, in close, unsunned, low-lying courts. Here in 1849, "in a space of about 400 yards by 150, out of 342 deaths, 208 were from Cholera, and 27 from Diarrhcea."

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Here too, "on the 12th, 13th, & 14th of August, Surgeons were wanted in many places at once, and the hurried passing and repassing of messengers, and the wailing of relatives filled the streets with confusion and woe." And here, still, on a low 9 open space, are daily piled enormous mounds of London refuse; "to the sight, disgusting; to the olfactory sense, sickening;" to the health, poisoning! Hence this region is, in a sanitary and social sense, our darkest spot, and imperatively calls for—Regeneration. Mortality. Gentlemen, these differential circumstances influence materially the death returns. It is our lot to live in the least healthy* of the five great London Divisions—to have an early average age at deathf—and consequently to lose several of the best years of life.

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In the Eastern Division, there were, in 1855, 37 persons living; and in the Northern, 44 to every death; and "the rate of mortality varied from 23 in 1000, in the Western and Northern Divisions; to 25 in 1000 in the Eastern Division." Last year we lost 2143 persons, of whom, 284 died in the Workhouse, and 57 in Bethnal House Asylum. During the previous 9 years, the subjoined were the several variations:— TABLE IV. YEARS. 1846 1847 1848 1849 1850 1851 1852 1853 1854 DEATHS. 1730 2225 2245 2946 1672 1826 1941 2237 2437 The Table below shows the Epidemic Deaths in 1855. TABLE V. SUB-DISTRICTS. Small-pox. Measles.

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Scarlatina. Hooping Cough. Diarrhœa. Typhus. Total of Epidemics. Percentage of Epidemic to Total Deaths. Hackney Road 10 12 23 21 10 26 102 Green 5 37 16 40 20 40 158 22.16 Church 6 18 15 20 22 21 102 Town 10 12 42 20 18 11 113 Totals 31 79 96 101 70 98 475 2216 * Excepting the Southern Division in Cholera years. (Registrar-General). † Our mean age at death, in the decennium 1841-50 was about 26 years, and the corresponding average duration of life 34 years.

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10 Out of every 69 deaths, one person died of Small Pox, one in 27 of Measles, one in 22 of Scarlatina, one in 21 of Hooping Cough, one in 30 of Diarrhœa, and one in 21 of Typhus. In the Metropolis, generally, the per-centage, of the Epidemic to the total deaths was 18.36. The deaths in the SubDistrict Green, are swelled by the Workhouse and Lunatic Asylum returns. In the week ending March 24th, out of 20 deaths from Measles in all London, 6 died at our Workhouse. The per-centage of the Workhouse to the total deaths was 13 25. If we contrast our mortality with that of London, our ratio was 2.14 per cent, or one death to every 46 living, while that of London was 239, or one in 41.

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* The difference of these proportions is expressed by the numbers .895 and 1.000. Inclinations. Bethnal Green uprises, with slight undulations, from the South to the North, from the East to the West: the minimum elevation being 35.8 in the South; the maximum 59.8 in the North. In the East, the ascent is from 39'4 in Old Ford Lane, to 597 near Boundary Street, in the West. These altitudes are derived from sheets 14 and 21 of the Ordnance Maps, where they are given " n feet above the approximate mean water of Liverpool;" from which a deduction of 12 feet reduces them to their London Reading. Levels. As some of the streets were built in the hollows of the lowlying grounds, with little regard to any general level, and as, subsequently, levels were made—many houses are left below the roadways.

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Such instances occur behind the high road, in Hill Street, Crab Tree Row, Mount Street, &c. Soil. In our Geology, according to Myine's Topographical Map *See Table VII. 11 of London, the soil is formed of gravel and sand, excepting a small patch in the south eastern division of brick-earth loam. Where there are sewers with "dry bricks" at the sides to admit subsoil drainage, this loose porous mould carries off the fluid, and relieves the surcharged strata above. In the cellars of the house in which I reside, the water rose at times, more than a foot, but when a sewer was made, the ground became dry, and the water was drawn away from a well in the yard. Wells. With some few exceptions, our wells are not deep, nor is their water wholesome from the number of cesspools and easy infiltration of the soil.

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Most of the superficial ones are fraught with impurities derived in this way, and are, "practically, reservoirs into which all soluble surface nuisances drain." Some, however, do good by relieving the sodden subsoil; as, for instance, the well in the slaughter houses of Messrs. Stevens and Long, where, nearly a hundred cattle are slaughtered each week, and thousands of gallons are pumped up from below. To the deep well-waters, more particularly if softened by the elegant liming process of Dr. Clark, such objections do not apply. The Plumstead Company, by this plan, reduce the hardness 12 84 degrees, or from 309 grains to 18.06, (Thomson) and free it besides, according to Drs. Hofmann and Hassall from all traces of confervœ and infusorial life. Meteorology.

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On our meteorological history—beyond the influence of the low day and high night temperatures, and the less daily range which Mr. Glaisher tells us, distinguish the London from a country climate; coupled with the fact that the emanations, from the undrained places render our air less salubrious—I regret that I possess no information. But as 12 atmospheric phenomena, and temperature especially, are the most influential agents on life, I have tabulated the variations and deaths of each month in 1855, and the meteorology, and mortality of the year. TABLE VI, Illustrating the London Temperature, and Deaths of each month, and the relative Mortality in Bethnal Green. Months. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Mean Temperature.

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34.9 29.4 37.9 45.8 48.8 56.9 62.1 62.1 57.1 51.2 41.3 35.6 Deaths in London. 6049 6229 7349 4792 4698 5507 3818 4054 5170 3651 3953 6236 Deaths in Bethnal Green. 245 192 262 144 143 179 160 162 175 119 136 226 TABLE VII. Comprising the Summary of the Weather and Deaths in 1855. METEOROLOGY. DEATHS. Mean Temperature of Air. Dryness of Atmosphere. Mean daily movement of the Air in Miles. Fall of Rain in Inches Mean Reading of Barometer. In London. Percentage Ratio of London Deaths. In Bethnal Green. Percentage Ratio of Bethnal Green Deaths.

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46.9 5.3 90 21.1 29.780 61506 2.39 or one in 41 2143 2.14 or one in 46 Our proportion of deaths in each Quarter was 699, 466, 497, and 481. 13 Distribution of Buildings and Open Spaces. Although some parts of the Parish are too thickly peopled, the area of the open spaces is large, and the density is less than in many other districts. The following is the density of each sub-division:— TABLE VIII. SUB-DISTRICTS. Persons to an Acre Hackney Road 170 Green 60 Church 165 Town 218 As population has increased, new streets have been built, and more sewers made: hence were it possible to disperse certain numbers among the new dwellings, our health might improve, or not retrograde. But poverty, which compels herding together, is the poison that prevents such circulation.

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Our crowded streets and courts are therefore becoming more over thronged. So mortality mounts up, and physical degeneration results. Accordingly, we find that after 1841, when the mortality was one to every 41 living, or 24 in 1000, it rose in the decennium 1841-50 to 1 in 38, or 26 in 1000.* To me it appears that the antidote is—to raze to the ground certain unhealthy buildings, and to erect small Model Dwellings instead. On the differences between Whitechapel, Shoreditch, and Bethnal Green, Dr. Parr remarks, "they are inhabited by very much the same class of people, the sewerage and supply of water are nearly the same, but the density is different, and the mortality is highest in the densest districts." Those differences I append from the Registrar-General's 16th. Report.

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* Since 1861 several of the worst streets have been furnished with sewers, and their sickness and mortality have very much decreased. 14 TABLE IX. DISTRICTS. Persons to a Square Mile Deaths annually to 1000 living. Excess in Deaths above 17 in 1000. Whitechapel 118942 29 12 Shoreditch 95450 28 11 Bethnal Green 69171 26 9 In that Report "the deaths of 17 persons in 1000" are "considered natural deaths, and all the deaths above that number" are "referred to artificial causes." On every 1000 deaths, in the years 1841-50, we therefore lost 9 persons in excess of the standard proposed. Some of this excess is traceable, I think, to the unpaved, undrained state of many of our by-ways, gardens, and courts. Burial Grounds.

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The Burial Grounds, closed and unclosed, number 12: those in use are but 2—the Victoria Park Cemetery, and the Jews'. Whether it would be better to super-impose on any a layer of charcoal, as strongly recommended by Dr. Stenhouse, I, with all deference, leave to you to determine. But "as putrefactive changes, for some years longer, must proceed in these saturated soils," it behoves us to supply "sufficiency of vegetation, gradually to appropriate, as fast as they are evolved, the products of animal decay." Lay Stalls. In a public sense, Lay-stalls do not exist; in a minor one, each cow or cattle keeper may be said to have lay-stalls of his own. There are, however, certain courts and corners where accumulations of refuse are made. Certain open spaces also, are, in this respect open nuisances too—Nova Scotia Gardens, to wit.

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The ground likewise, under and about several arches of the Eastern Counties Railway, and of the 15 passages termed "holes in the walls," (as in Essex, Lisbon Mount Streets, &c.) harbours all sorts of filth. Drains and Sewers. Unhappily our sewers are few, and as a consequence, cesspools abound. "The cesspools now under our houses," says the Registrar-General, "will inflict more pains and destroy more living than 10,000 mad dogs let loose in our streets." Hence, until our highways and by-ways are properly drained, Fever (which begins where sewerage ends) will, ever and anon, decimate our ranks, and spread desolation among our friends and our homes! In the last year alone 194 deaths from Typhus and Scarlatina, were the life price that we paid. How diseases and pauperism are reflected on us in Rates, Dr.

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Farr thus illustrates:—"in Bethnal Green, a person assessed to £100 a year, pays £13 12s. to the relief of the poor; in St. George, Hanover Square, £2 8s. only." Water Supply. Our Water-supply, (derived from the Lea) has of late been improved; being drawn from a purer source, and filtered "through an extensive surface of sand." But every house has not yet, as each should have, an independent supply; nor are there in many places, taps to the pipes. Consequently the cellars or yards become sodden and wet, the refuse decomposes, and diffuses its gases among the dwellers around. The ill-health depending on this cause alone forms a serious item in the poor-rate account. Dr.

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R. D. Thomson's analysis of the water of the East London Company shows, in eaeh gallon, 1.940 grains of organic matter, 14.2 of hardness, and 18.461 of total impurity. 16 Manufacturing Establishments. The manufacturing establishments (unless each weaver's household be so considered) are neither numerous nor extensive. The Lead Works in Holly Bush Gardens, Palmer's Candle Factory in Twig Folly, and the Manure Factories in Digby Street, which are also Night Soil Yards, are the most prejudicial. In the Candle Factory, Mr. Welch states, that great care is taken to protect the workmen, chemically, from the arsenical matters employed. House accommodation of the Poorer Classes. The House accommodation of the poorer classes is often faulty and deficient. Frequently there is neither cellar nor yard, no storage room, and not enough water to keep the dwellings clean.

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To that want of water (that great essential to health) I earnestly invoke your special regard. Another evil is, that in certain cul-de-sac houses, as in Providence Place, the privies belonging to the houses behind abut on the walls, and infiltrate ordure under the floors. Thus "unhealthy and unhappy homes induce thousands to seek escape fron miserable depression in the temporary excitement of intoxicating liquors." If we will apply it, the remedy is —to institute Model Lodgings, Baths, and Washhouses. The pecuniary and moral gain will be great:—there will be less orphanage, less widowhood, more useful, more productive labour. Sensible of the paucity of healthy houseroom, I respectfully suggest to you whether it would not be of advantage to convert some of the larger houses into Renovated Model Dwellings, or to build some small groups after the plans of Prince Albert—out of our rates ?

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The experiment is neither uncertain nor new; it has been put to the test by Baths and Wash-houses, in St. Martin-in-the-Fields, and has realized 5 per cent. of returns. And, as regards the health question, when, in 1852, the mortality of all London was 22 17 in the 1000,—that of the Model Dwellings reached in each 1000—7 only. Gentlemen, I have ventured, en passant, to touch on these matters because it is one of my privileges, as well as my duties, in the situation that I have now the honor to hold, "to point out the most efficacious mode of checking and preventing the spread of contagious or epidemic disease," and because I believe there is no other plan so efficacious or cheap of increasing the comfort, the utility, the length of life of the poor. Arrangements for the Burial of the Dead.

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Since the closure of the Burial Grounds, the Victoria Park Cemetery has become the great graveyard of Bethnal Green, and of other places besides. It is easily reached, and has, in some parts plenty of room. But in the pauper divisions, the practice of piling coffin upon coffin, and of barely separating one pit from another deserves deep condemnation. In the more crowded portions, no vegetation enlivens the gloom nor helps to appropriate the gases evolved. It scarcely contains 12 acres of ground. "We alone—on the estimates of Mr. Simon and Dr. Waller Lewis—require a much larger space. To bury in perpetuity—the one says, there should be half an acre to each 1000 living; the other, 18 acres at least to every thousand who die in a year. Lodging Houses. The Registered Common Lodging Houses are 12, and accommodate 176 persons.

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The names of the Keepers, the situations of the Houses, and the numbers for which they are licensed, I have ascertained from the Police. Slaughtering Places. There are upwards of 50 butchers who kill, but as some kill sheep or pigs only, and those in their kitchens, the 18 regular Slaughter-Houses are not so many. Whether they are "whitewashed with quick lime, at least twice in each year, or have a sufficient number of vessels with tight close fitting covers," it will be hereafter my duty to learn. Cleansing of Public Ways and Removal of Domestic Ref use.

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With respect to the cleansing of Public Ways, I take leave to suggest, that it would be an advantage to have the refuse more frequently carted away, and that the contractors (so far as relates to the removal of house dust) require both remonstrance and supervision After the purer supply of water, "the next most effectual measure of sanatory improvement will be the purification of the London atmosphere, by the complete removal from the houses and streets daily of the residue of the organic matter which is brought into them daily." (Registrar-General.) Such is the brief sketch that I have to present. Gentlemen, while in the Country 202 out of every 1000 live to be "threescore years and ten,"—105 only arrive at that age in Bethnal Green. Hence, how noble the aim to lengthen the term, and to augment the value of that "great property—Life."

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But before we shall accomplish desiderata so grand, our highways and by-ways must be thoroughly drained, and mile upon mile of sewerage made. Until then, we are doomed to eke out existence on unhealthy ground—to inhale a slow poison at every breath—and perhaps, at last, to die prematurely— holocausts to preventible, yet unremedied ills!

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Gentlemen, when the "ordures that now pollute our river shall fertilize our fields, and ceasing at length to breed disease and death, shall spring up, strangely transmuted, in rich crops of the life-sustaining grain," or, when discharged at high water below Barking Creek, they pass down the stream, slowly but surely, one mile per day, to the great ocean beyond:— then, but not 19 until then, may we hope like the long-lived Cornaro, to "number the years of life decreed by nature, and be gathered like a shock of corn, ripe to the tombs of our fathers." I have the honor to be, Gentlemen, With great respect, Very faithfully your's, SAMUEL PEARCE. To the Gentlemen of the Vestry of Bethnal Green. London: J. S. FORSAITH, Printer, 118, Bethnal Green Road.

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2 BET 72 FIRST ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the SANITARY STATE AND TRANSACTIONS IN BETHNAL, GREEN, DURING 1858. London: PRINTED BY ORDER OF VESTRY. mdccclvii. TO THE GENTLEMEN of the VESTRY OF ST. MATTHEW, BETHNAL GREEN, whose untiring exertions for the physical improvement of their important parish, will save hundreds in money and lives: amongst whom the medical officer of health has the honor to number many old friends: HIS FIRST ANNUAL REPORT is dedicated with sentiments of deep and lasting respect. 135, Bethnal Green Road, February 15, 1857. "

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The great work of the day it to improve the health of the people" Gentlemen, The Instructions* to Medical Officers of Health direct them to inquire into, and to report, periodically, upon the physical conditions of the place and people, their vital statistics and sanitary state, the ventilation and drainage of houses, the drinking waters and water supply, the condition of the burial grounds, slaughtering places, and homes of the industrial classes, and to state, on referring to existing evils, what sanitary appliances are best for their mitigation. Accordingly, in my Report on 1856, I have comprised these several matters under the following heads:— 1. Births and Immigration—Increase. 2. Mortality and Sickness. 3. Health, Present, and Previous. 4. Sanitary Transactions. 5. Defects and Requirements. 6. Correlative Matters. 7. Summary and Conclusion. 1.—BIRTHS AND IMMIGRATION—INCREASE.

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The number of Births fell from 3717, in 1855, to 3640, in 1856. 3.6 children were born to each hundred persons, or 1.9 to every death. As 1905 persons died, the natural addition to our population by excess of Births over Deaths was 1735. But the births do not constitute all the increase; the influx of * From the General Board of Health, December 20th, 1855. 4 immigrants forms nearly a third. In the 10 years 1841—50, out of a total increase of 15,991, the excess of births over deaths was 10,697, the immigration—addition 5,294, or 529.4 per year. Where an area is not over crowded, immigration recruits the original stock.

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Where too, the migratory stream ebbs and flows, as in our Irish colonies of Elizabeth Place and John's Court, the sickness and deaths are probably less than a stationary population would have.* Since the census many new streets have been built, and the influx has, doubtless, further advanced. 2.—MORTALITY AND SICKNESS. Mortality. 1905 Deaths were registered in the Parish in 1856; of which, 518 occurred in the first, 422 in the second, 468 in the third, and 497 in the fourth quarters of the year. They were, consequently, less by 238 than in 1855, and 449 below the corrected average of the preceding 10 years. One person died of cholera at 16, Anchor Street, opposite a gully hole which receives the surface drainage of several streets and at times overflows.† The 6 Epidemics proved fatal to 385 persons, or to 1 in every 259 of the population.

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Their percentage to the total deaths was 20.2—nearly 1 in 5. Numerically—385 against 475, and 20.2 per cent against 22.16— they also contrast favourably with the previous year. One in every 90 deaths arose from Small Pox; 1 in 50 from Measles; 1 in 32 from Scarlatina; 1 in 22 from Hooping Cough; 1 in 25 from Diarrhœa; and 1 in 17 from Typhus. These returns, tested by those of last year, show, that the first 4 diseases were of less, and the last 2 (which depend more on endemic causes) were of greater amount. Their relative proportions, in the several Sub-districts during 1856, are * On shifting the Surgeons annually on the west coast of Africa, the mortality fell 53 per cent. Taper by Alex.

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Keith Johnston, F.R.S.E. † Because it only leads into a street reservoir. 5 given in Table 1, in the Appendix to this Report. In the same period, 23 persons died in the Consumption Hospital; 42 in Bethnal House Asylum; and 251 in our Workhouse. Hence, out of every 6 deaths, 1 occurred in our Public Institutions, while in all London, the proportion was about 1 in 5. According to population, our proportion of deaths in such Institutions would be 396, leaving a surplus of 80 to be distributed elsewhere. Conjointly, in the 6 Poor Law Divisions, there was 1 death to every 14 cases of sickness. Our total mortality was below that of London, being 19 per 1,000, or 1 death to every 52 living, while the London mortality was 22 per 1000, or 1 death to each 46.

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Our epidemic rate however was 1.3 per cent in excess, the London per centage forming 18.9 only. That excess apportions us more than our share of the diseases which rank in the preventible class. But if they be estimated, as Dr. Barnes estimates them, on our fractional proportions of the epidemics and population of London, the former would be represented by 385/10736, or 1/28; —the latter by 100,000/2,616,248, or 1/26, and would turn the scale in our favour. Inother words, instead of 385, our epidemics would number 410. Viewed either way, and contrasted with the healthier standards of Northumberland, Surrey and Sussex, our loss on those diseases is fearfully large. And as they are criteria of sanitary wants and defects, so, upon their amount will our labours and remedies especially tell.

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Should I have the honour to hold office next year, I shall be enabled—through the kindness and liberality of the Registrar-General, to furnish the Sub-district mortality, the death-rate of each Sub-division, and the Sex, Age, &c. of every death. To show the influence that weather has upon life, I have arranged, in Table 2, the atmospheric phenomena and deaths of each month after the plan of my monthly Reports. Sickness. The weather of 1856 was dry, the temperature, with 6 one short exception, was mild,* no great epidemic prevailed, and the health of Bethnal Green, as of all London, was "unusually good." In no year since 1850, the year after Cholera, has our mortality fallen so low. Among your Six Poor Law Divisions, the health-improvement was marked, for, notwithstanding the large population-increase, the cases of sickness were little more in amount than in 1846.

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Then however, the Dispensary and Consumption Hospital did not exist, now, doubtless they draw off a part. During the last six months of the year, 2825 cases were attended by your six Medical Officers. Of these 608 occurred in the Workhouse; —316 in District No. 1;—428 in No. 2;—514 in No. 3;— 568 in No 4;—and 391 in No 5. If calculated on the estimate of 8.25 attendances to every case,† the attendances would number about 23,300 in the latter half of the year. Two cases of Cholerac Diarrhoea in Wharf Road, on the borders of the Canal, and one in Claremont Cottages, all threatening collapse, were successfully treated by Mr. Welch. Of the epidemics, Typhus was most rife, and Hooping Cough next in amount.

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Their proportions one to another, and to each Sub-division, are given in No. 3 of the Tables adjoined. That Table shows that the epidemics formed nearly a third of the total attacks, and that 1 out of every 35 persons, was under the care of your efficient Medical Staff. 3.—HEALTH, PRESENT AND PREVIOUS. To estimate correctly our standard of health, we must compare the present and past, and contrast the Parish with other localities. The statistics of the Registrar-General prove that, of late years, our deaths have decreased. When Registration commenced, the mortality in Bethnal Green was at the * The "10 cold days (November 26th to December .5th,)" during which "the excess of deaths was 339, or nearly 34 daily." †This estimate is deduced from the returns of the Medical Officers in 1847, and closely agrees with the estimate of Mr. Welch.

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7 annual rate of 3.095* per cent ,or 1 death to every 32 persons; but in the decennium 1841—50, it fell to 2.6 per cent., or 1 death to each 38. I shall presently show that, since 1850, life has further improved. To contrast Bethnal Green with other localities, to test the life differences of high and low levels, wealth and destitution, density and space, sewerage and sewerage wants, I have selected certain London Districts from the Registrar-General's 16th Report. These Districts are shown in Table 4 of Appendix, in which column 5 gives the death-rate per 1000; column 6—the excess over 17 per 1000, or the number of preventible deaths. Lewisham alone among the London Divisions, reached that zenith of health, and had no greater loss.

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Applied to ourselves, Table 4 tells that we, with more space to our population, suffered three times the excess of the City of London, and almost doubled that of the densely crowded Strand. It tells too, that in 10 years, we lost 7393 persons more than would have died, had we not exceeded the Lewisham rate. With favouring conditions of soil elevation, a beautiful Park, and an open eastern contour—on what, it may be asked, did our excess depend? Probably, in great part, on our sewerage-wants, and the unpaved saturated state of many of our Gardens, By-ways, and Courts. Such was our standard up to 1851. If we now add together the deaths in 1851—56, and calculate their ratio by the formula given below† the per centage resulting is 2.307, or 1 death to each 43.

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In those years, many sewers were made, and life rose proportionally, in Bethnal Green. Again, if we compare the Sub-district mortality in 1841 and 1843, with that in 1851 and 1853, we arrive at this striking fact, that while the deaths of the Hackney Road, Green, and Church Sub-divisions advanced, those of the Town became less:— the death proportions being, in Hackney Road +111; in * Registrar-General's First Annual Report. Population 1851. 90193 Deaths in 6 years 12489/6 Persons. 100 x: =1248900/541168 Death-Rate obtained 2.307. This formula is deduced from page 159 of the Registrar-General's 9th Annual Report. 8 the Green +406; in the Church +184; in the Town—69. The Epidemic deaths too, in 1856, were least in the Town.

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These differences, most probably, result from the differences in the decennial per centage increase of their population which I showed in my First Report to have been respectively 19.36, 40.49, 25.98, and 4.71. They accord with the law of Dr. Farr, that "an increase of density implies an increase of mortality." 4.—SANITARY TRANSACTIONS. During the last 20 years, vast improvements have been effected in Bethnal Green. The Highway, and many of the By-way foot paths have been paved; levels, inclinations, and drainage channels made; and the roads and streets put in repair. To the protection afforded by those means, to the houses and ground, much, probably of our health-improvement is due. Since the Metropolis Management Act came into force, you, Gentlemen, have nobly advanced "the great work of the day."

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You have abolished the black ditch in Lamb Fields, and made a pipe sewer instead—have arched over 30 feet of open sewer behind Hackney Road—the cause I believe of much local disease;—have constructed sewers in several streets, in which Fever was, before, constantly rife; —have connected hundreds of houses with neighbouring sewers, and ordered their cesspools to be disused, and filled up. You have, also, at a cost of nearly £5000, organized, and commenced four grand Sewerage Blocks—life-saving works which will testify hereafter, to your wisdom and zeal. By these grand reforms you will enhance the salubrity of the climate and air, and diminish, alike, the sick and death rolls!

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Having, from time to time, reported many of the worst and most ill-conditioned places, (copies of which are kept in my Journal, and at your Town Hall) I have now grouped together the several improvements, in the Retrospective Synopsis appended to this Report. 9 5.—DEFECTS AND REQUIREMENTS. The first comprise the causes that war against life; the second the remedies for their suppression. The principal of each are given below:— SANITARY DEFECTS. 1. Poisonous state of the soil from insufficient draining, paving, and cleansing. 2. Atmospheric Vitiation, by privies and cesspools, untrapped gullies, open gutters, or drains. 3. Defective Ventilation of Houses, Schools, Factories, Churches, &c. 4. Insufficient Water Supply, and its contamination from storage in dirty vessels and rooms. 5. Foul dirty Dwellings. 6.

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Cellar abodes. 7. Overcrowding of Inmates. 8. Unwholesome Provisions. SANATORY REQUIREMENTS. 1. a. House, surface, and subsoil drainage. b. Stone or asphalte pavement. c. Daily Scavenging. 2. a. Water-closet Apparatus, and suppression of cesspools. b. Trapping and flushing of all gullies and drains. e. Impermeable pipe gutters. 3. a. Arnott chimney openings, and perforated zinc window panes. b. The Charcoal Air filters of Dr. Stenhouse. c. Vent tubes, roof outlets, &c. 4. Continuous high pressure supply. 5. Periodic cleansing and liming. 6. Their abolition. 7. Regulation of numbers by ging Houses' Acts. 8. Systematic Inspection.

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Other causes, besides, prejudice health: such are the culde-sac streets of Hope Town, and courts of a similar form, which impede the transit of currents of air, and concentrate, and intensify, the emanations evolved. Back-to-back houses too, those without back windows or doors, and others below the levels of the streets, gardens, and courts—all militate against a healthy physical state. In such cases the erasement of an occasional building, or wall "counter openings, additional windows, and open spaces," are the remedies sugested by Mr. Simon. Much mischief, also, is often entailed by using 10 rubbish and road mud to form building sites, the evolutions from which poison the air, and increase the malignancy of zymotic disease.

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Other sources of illness are the gases arising from night-soil depots, and manufactories of manure, from dust and refuse yards, cow sheds, and dung heaps, cat-gut spinners, paunch dressers, slaughter-houses, &c. But in these,—beyond the employment of "the best practicable means" for their abatement—the privileges of trade interfere and render sanitary improvement uncertain and slow. Some defects you can remedy: others you cannot control. You have full power to cleanse, light, pave, and water the Parish, to ventilate sewers, trap all gully holes, fill up open ditches and substitute drains, to order covered dustbins, and prevent overcrowding, and, if you think fit, to erect public pumps.

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You can compel owners of property to pave any court, passage, or place which is not a thoroughfare, to provide drains, sinks, water-closet apparatus, and water supply, whenever there is a sewer, lower in level, within 100 feet; can abolish the cesspools, regulate cellar dwellings as to area, drainage and light, and exercise stringent powers over houses about to be built, or rebuilt. The landlords of their own accord may do much, namely: ventilate and limewhite the rooms, furnish drains, dustbins, and water supply, and, so long as the service remains intermittent—covered cisterns or butts. They should also put taps to the pipes to prevent the waste water soaking into the soil, and where there are closet pans, not allow the supply pipe to pass from the house butt, or cistern, into the pan.

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* It would further conduce to our improvement in health, if the canals were more frequently cleansed, and the interments in the Victoria Park Cemetery were limited to the numbers directed, per acre, in the Burials' Acts. Finally, the establishment of New or Renovated Model Dwellings, Ragged Dormitories, Baths and Wash-houses, would, alike, improve the physique, and morale, of Bethnal Green. * "Butts placed in contact or communication with privics, must rapidly become infectcd by their foulness."—Mr. Simon's Reports, p. 112. 11 6. CORRELATIVE MATTERS. Water Supply. It being indisputably established, by the chemical and microscopical researches of Drs.

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Thomson and Hassall, that the shallow well waters, in towns, abound in impurities derived from above, and from cesspools and sewers around—one opinion only can be entertained—that these "infusions of filth" are unfit for drinking and culinary purposes, and should only be used for extinguishing fires, watering roads, and flushing sewers and drains. The East London Company, who supply Bethnal Green, furnish a bright colourless water which cxercises no solvent power upon lead.* The analyses of 1851, and those instituted by Professor Hofmann and Mr. Blyth, in the early part of 1856, give the following results:— YEARS. HAEDNESS. SOLID CONSTITUENTS in grains per gallon.

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Total Permanent Temporary Total Organic Matter Inorganic Matter 1851 15.00 .... .... 23.51 4.12 19.39 1856 13.98 7.53 6.45 22.05 1.09 20.96 In this Table, the terms Permanent and Temporary, as applied to hardness, signify the reduction caused by 5 minutes boiling. By improving the source, and filtering through a bed of sand, the water of the East London Company has undergone a diminution of 3.03 grains, per gallon, of organic matter, and of 1.02 of hardness. When examined microscopically by Dr. Hassall in 1854, it contained "organic matter dead and living, pieces of vegetable tissue, and fragments of granular organic debris." But of the Nine Water Companies, the East London had, with two exceptions,— West Middlesex and New River,—the least organic contamination; * Report of Mr. Taylor to Mr.

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Simon. 12 and it is on this, that the influence of water in promoting epidemics mainly depends. Hence in the Cholera of 1854, when the Company drew their supply three miles higher up the Lea, a great decrease of mortality (in comparison with that of 1849) occurred in those districts which they supplied, e.g., in our own. Were the Company to employ the softening process of Professor Clark "expelling chalk by chalk," many degrees of hardness, and most of the organic matter would be removed. In the absence of that advantage, boiling, and filtering through animal charcoal, are the most approved means. As to individual allowance, the present intermittent standpipe supply, common to many houses and courts, is decidedly below the requirements of health. In such cases, each standpipe should have a tap, and be on the main. This would, in great measure, supersede its storage in dirty vessels and butts. Provisions.

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Hitherto, neither complaints nor seizures of provisions have been made. As with drinking waters, so, I believe, with the perishable articles of fish, fruit, and vegetables, much harm is done, in the poorer districts, by costermongers and small dealers, storing their wares under the beds, and in close dirty rooms. In respect of adulteration, it has been suggested by the Select Committee of the House of Commons, that "one or more scientific analysers be delegated by the Board of Health, to whom local authorities might refer any article seized under suspicion of adulteration," and that "these analysers should also undertake to examine any articles sent to them by private individuals." Places of Interment. The Jews' Burial Grounds, which have still a good deal of unoccupied ground, will be finally closed this year. Of the Victoria Park Cemetery, the state of which was noticed 18 in my former Report, many complaints have been made.

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Government Inspectors have condemned the piling and close packing system as out of all proportion to the space in use. It is said that, on every Sunday, 130 bodies are interred:— that, in fact, 16000 pounds* of mortal matter are added, on that day alone, to the already decomposing mass. So continuous is the dead march down Bethnal Green Road, that it has got the cognomen of the Road to the Grave. According to the Instructions issued by the Secretary of State to guide Burial Boards, the interment rate is 120 bodies, per acre, per annum. By that estimate, the annual interments in the Victoria Park Cemetery ought not to exceed 1440. Slaughtering Places.

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Having, Gentlemen, informed you, last October, in a special Report, of the condition of each slaughtering place, I have only, on this occasion, to express my admiration of the alacrity displayed, by the several butchers, in carrying out your orders, and my conviction that the improvements effected Trill, equally, conduce to the health of the occupants, and the preservation of the meat. Although we may hope that the day is not distant when abattoirs will be established round London, surrounded by trees,† yet, without doubt, it is possible (where slaughter-houses are isolated, as in Bethnal Green, and when all due requirements are made) to carry on the business, with little injury or offence. Pauper Statistics. At the close of the year 1855, 1265 persons were inmates of the "Workhouse in Bethnal Green.

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During 1856, there were 2187 Paupers admitted, and 2129 discharged; 48 Children were born—18 legitimate, 30 illegitimate; 251 died; and 615 Vagrants and 46093 Out-door Poor had relief. On December 31st, the inmates numbered 1072; namely, 360 * Leading Article, Lancet, Nov. 8, 1856. †As the Abatttoir of Roule is in Paris. 14 Adult Males, 361 Females, 199 Boys and 152 Girls, and of these, 19 were Idiots, or Imbeciles. At the same date, there were 24 Lunatics at Hanwell; 72 at Colney Hatch; 4 at Peckham; 1 at Camberwell; and 13 at Bethnal House. Habitations of the Poorer Classes.

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The last subject of my Report—one of deep interest in its bearing on Pauper Statistics, on which, in fact, the amount of our Poor Rates chiefly depends—is the "Internal Life," or the homes of the poorer and industrial classes. If we would strike at the roots of disease—at the prime causes of our death excess, and untimely decease, we must obviate the dangers that many of these miserable dwellings entail. It is not enough, great as are the advantages resulting therefrom, that they have scavenging, drainage, and water: if there be not ventilation within and without; if the courts be culs-desacs, and the houses be also of the cul-de-sac form; if their structural arrangements shut out the light; and especially, if with these, overcrowding occur:—such physical conditions will still war against life. Their atmosphere will be fetid with breath and skin poisons, will generate fever, destroy their adults, and leave the poor orphans to burden our Rates.

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But,—without a thorough reform of all such pestiferous places as Nova Scotia Gardens with its mountains of house refuse, road mud, offal, and filth;—as the manure baking depots of Digby Street, Globe Lane;—as Elizabeth Place, or Devil's Alley where lately were harboured in 30 small rooms of 10 feet by 6, and 2 sheds, 90 human beings, 2 horses, a dogfancier's dogs, and a goat;—as John's Court where the houses comprise one room in depth, and two rooms in height, and are minus back yards, windows, and doors, where 2 privies, confined in a corner, are almost enough to knock a man down;—as No.

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1, Collingwood Street, where an open privy poisons the air, and the ground floor front room derives all its light from 2 small panes of glass; which, for want of a 15 window, the shutters contain;—as No. 10, Mead Street, with its rooms 3 feet lower down than the street, with its covered-in yard and overflowing privy and drain, where there has not been for months any water supply;—as Turville Buildings, Hepworth, Miring, and Nelson Places, Princes', Baker's, Shepherd's Courts, &c., &c.; and the conversion of their sites into better or Model Dwellings,—I know not how they can be adapted to cleanliness, comfort, or health. From the cradle to the grave their inmates "are a dircct money charge upon our funds." 7. SUMMARY AND CONCLUSION.

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The data furnished in this and in my former Report show, that comparing area and population, Bethnal Green is, by no means, overcrowded, and that, notwithstanding the rapid increase of its people, health and life have progressed. They show, also, that wherever sewers and drainage have been made, there mortality has most decreased. As we have yet much open ground, and as our new streets will be effectively drained, so, within certain limits, as our numbers grow, the value of life will increase. Hence if we supply our darker spots —"where the fuel is piled, and the spark is there"— with the sanatory remedies that they require, we may hereafter, as Sanitation has effected in the City, reduce our death roll, annually, 2 per 1000. Those remedies I have endeavoured to portray: they are briefly the greatest attainable purification of the soil and air, "the utmost possible improvement of each individual home."

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By their adoption we shall exalt the standard of life, and in the emphatic words of the Registrar-General, "obtain victories over death and the grave." So, too, shall we wipe out the reproach of 1849, that Cholera was allowed to fall on Bethnal Green as though the name of the pestilence had never been heard.* * Official Circular of Board of Health, Sept. 29, 1849, p. 107. 16 Gentlemen, our future is bright; our death rate last year was but 19 per 1000,—2 only beyond the normal or Lewisham rate, and we have still many foes to combat. Is it not then possible, and may we not hope to descend 2 more—to 17 per 1000, "the zero" of the death scale of Dr. Farr?

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May we not, too, expect that as in Wellington Street, Old Ford Lane, where, Fever in 1852, caused 11 preventible deaths, and sanatory measures arrested its march, so, that in all Bethnal Green, when likewise improved, the scythe of death will be stayed? This year, your four grand Sewerage Works will, in those favoured districts, prevent Fever, even as Vaccination protects from Small Pox. In another year we shall have constant, exhaustless water supply, and ere many more years elapse, the Great Middle Sewer will tunnel under our road, and purify much of the surrounding subsoil. So, works still progressing—Pestilence will not long "stalk in darkness'' among us, nor, like the fabled Atropos, cut short life's threads !

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Be it our pleasing task to labour on in the field, to further the health, and to lengthen the lives of some of the 100,000 people of Bethnal Green. And assuredly, no pursuit can be purer, nothing more Godlike than to give health to man* ! I have the honour to be Gentlemen, With great respect, Very faithfully your's, SAMUEL PEARCE. To the Gentlemen of the Vestry of Bethnal Green. • "Homines enim ad Dcos nulla re proprius accedunt quam salutem hominibus dando." 17 APPENDIX TO REPORT, Comprising Tables to Illustrate the Mortality, Relative Health, and Sanitary Transactions, in Bethnal Green, during 1856. Table 1. Sub-District Epidemic Mortality. 2. London Weather and Deaths, and relative mortality in Bethnal Green. 3.

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Synopsis of Cases, attended by the Poor Law Medical Officers, during the last six months of the year. 4. Comparison of Bethnal Green, with certain other Districts, in reference to Elevation, Density, and Mortality. 5. Retrospective Synopsis of Sanitary Works. 18 TABLE 1. Showing the Sub-District Epidemic Mortality in 1856. Sub-Districts of Bethnal Green. Small Pox. Measles. Scarlatina. Hooping Cough. Diarrhoea. Typhus. Total of Epidemics Per centage to Total Deaths. Hackney Road. 2 10 19 36 17 18 102 Green. 5 8 15 19 27 44 118 20.2 Church. 6 5 16 15 15 26 83 Town. 8 15 8 15 17 19 82 Totals.

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21 38 58 85 76 107 385 20.2 TABLE 2. Showing the London Weather and Deaths, and the relative Mortality in Bethnal Green. METEOROLOGY. DEATHS. 1856. Months. Mean Beading of Barometer. Mean Temperature of Air. Mean Dew point Temperature. Relative proportion of Wind. Daily Horizontal Movement of Air. Amount of Rain in Inches. In Bethnal Green contrasted with the Deaths in London. Total. Annual percentage of Deaths in Bethnal Green. Epidemic. Percentage of Epidemic to Total Deaths. Total. Annual percentage of London Deaths. Epidemic. Percentage of Epidemic to Total Deaths. N. E. S. W. º º º miles. January.

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29.468 39.4 36.4 7 8 8 8 103 2.6 159 42 4497 755 February. 29.899 42.0 37.8 6 6 7 10 123 1.1 161 25 4198 742 March. 30.011 38.7 33.1 9 16 2 4 99 1.1 198 32 5838 881 April. 29.615 46.8 38.7 6 10 7 7 132 2.3 136 19 4490 731 May.

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29.647 49.5 42.9 10 6 6 9 148 3.5 147 1.905 or 1 Death in 52 27 20.20 5403 2.178 or 1 Death in 46 949 18.90 June. 29.877 58.5 51.8 4 1 7 18 76 1.6 139 29 4176 784 July. 29.831 61.1 54.5 5 2 8 15 90 0.9 113 23 3999 873 August. 29.746 63.6 56.2 5 9 10 7 44 2.4 205 58 5710 1671 September.

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29.652 55.2 47.4 7 5 6 12 97 2.8 150 33 4357 955 October. 29.991 51.7 47.6 4 8 6 10 49 1.6 128 33 3944 763 November. 29.902 40.7 37.3 12 4 3 13 91 1.0 214 36 5484 910 December. 29.646 40.2 37.3 7 2 6 16 141 1.3 155 28 4690 722 Totals of year. 29.774 49.1 43.4 82 77 76 129 100 21.9 1905 385 56786 10736 20 TABLE 3.

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Cases of Sickness attended by the Poor Law Medical Officers of Bethnal Green, during the last Six months of 1856. Parish of Bethnal Green Small Pox. Measles. Scarlatina. Hooping Cough. Diarrhoea. Typhus. Total Epidemics. Other Diseases. Total Sickness. Percentage of Epidemic to Total Sickness. Proportion of Total Sickness to the Population of Bethnal Green. Births. Deaths. District No.

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1 3 1 4 52 53 113 203 316 19 1 2 8 12 5 7 54 94 180 248 428 13 24 3 15 2 8 91 64 180 334 514 32.49 1/35 4 28 4 3 18 22 10 76 53 182 386 568 4 28 5 11 20 19 45 56 151 240 391 10 21 Workhouse. 25 87 112 496 608 26 100 Totals. 14 57 53 44 343 407 918 1907 2825 32.49 1/35 76 202 21 TABLE 4. Contrasting Bethnal Green with certain other Districts. Certain London Districts. Elevation. Persons to an Acre.

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Persons to a Square Mile. Deaths to 1000 living Excess of Deaths over 17 in 1000. Lives lost in the 10 years, 1841-50 beyond 17 per 1000. Lewisham 28 1.7 1075 17 0 0 Hampstead 350 4.9 3137 18 1 110 St. Geo' Hanover Sq.

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49 60.0 38376 18 1 696 Hackney 55 12.8 8201 20 3 1510 City of London 38 128.9 82472 20 3 1678 Strand 50 252.4 161556 22 5 2196 Bethnal Green 38 108.1 69171 26 9 7393 Shoreditch 48 149.1 95450 28 11 10598 Whitechapel 28 185.8 118942 29 12 9054 "West London 28 213 136311 31 14 3982 St. Saviour 2 137.4 87944 33 16 5496 Retrospective Synopsis of Sanitary Works From January 1st, 1856, to March 25th, 1857. Open Ditches and Cesspools filled up. Open Sewers Arched-over.

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Blocks of Sewers Constructed. Nos. 360 Nos. 1 Nos. 5 Houses connected with Sewers. Street Cesspools Filled up. Gullies Trapped. Nos. 360 Nos. 60 Nos. 86 Privies altered to Water-closets. Privies Constructed. Sewer Ventilators Constructed. Nos. 420 Nos. 21 Nos. 2 Cellar Dwellings Abolished. Paving Works Completed. Dust Removals. Nos. 1 Nos. 4 or 2857½ yds. Nos. 6500 Dust-Bins Ordered. Houses lime-whited and Cleansed. Total of Works. Nos. 420 Nos. 12 Nos. 8252 About to be commenced. One Large Sewerage Block. 22 MEDICAL OFFICER'S FIRST QUARTERLY REPORT. 30th day of April, 1857.

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Gentlemen, To bring down our transactions to the termination of the first year of our sanitary cycle, I have appended a short summary of the first quarter of 1857. I have done so, because the RegistrarGeneral has recommended the Officers of Health to adopt his tabulation, and to publish in each quarter, uniform returns. To his Table I have added an Appendix to show, in each sub-division, the deathproportions of the most fatal classes of disease, and the ages at which the deaths occurred. During January, February, and March, the births of 513 boys, and of 487 girls, and the deaths of 593 persons were registered in Bethnal Green. The latter numbers exhibit a mortality fewer by 106 than the corresponding months of 1855, but higher by 75 than those of 1856.

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But although the sum total was more, the epidemic proportion was less, namely 87 against 99, or a percentage of 14.6 The same result obtained throughout Loudon, evidencing that Sanitation has already done good. 153 individuals fell victims to diseases of the respiratory class, 64 to consumption, 40 to hooping cough, and 2 to croup, forming conjointly 43.6 per cent of the total deaths. Grouped together those diseases and the epidemics destroyed 346 persons, or 50 beyond the half of all who died. Affections of the brain and nervous system cut off 54; those of the heart, 9; those of the digestive organs, 37; violence, privation, and other casualties were fatal to 25; and 42 persons died of age. One female, the widow of a dock servant died in the sub-district Church aged 90 years.

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The deaths of children under the age of 1 constituted 26 per cent of the total deaths; those under 5 about 48, while "in the more distant and rural part of Surrey, the latter do not quite reach 29," If, as Dr, Lyon Playfair says, to die between the ages 20—60 be to perish prematurely, then, in addition to our large infantile loss, out of 593, 148 were untimely deaths. The mean temperature of the quarter was "about the average, nearly 39°, on 9 weeks was above the average" but on "two days in the 5th and 6th weeks, the thermometer fell to 20°" The humidity also "was slightly above the average, remarkable storms of snow and hail occurred in March, and the ranges of the barometer exceeded one inch in each month." I have the honour to be, Gentlemen, with great respect, very faithfully yours, SAMUEL PEARCE, Medical Officer of Health.

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To the Gentlemen of the Vestry of Bethnal Green, TABLE 1. Deaths Registered in the Parish of St. Matthew, Bethnal Green, in the 13 Weeks ending March 28th, 1857. Causes of Death. Ages. Total. Causes of Death. Ages. Total Under 5 Under 20 20 and under 40 40 and under 60 60 and under 80 80 and above Under 5 Under 20 20 and under 40 40 and under 60 60 and under 80 80 and above Totals brought forward.. 225 27 46 81 60 7 446 I. Zymotic Class : VII.

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Digestive Organs : Small-pox I .. .. .. .. .. 1 Teething 18 .. .. .. .. .. 18 Measles 5 .. .. .. .. .. 5 Quinsy 1 .. .. .. .. .. 2 Scarlatina 13 1 .. .. .. .. 14 Gastritis Hooping Cough. 40 . . . . . 40 Enteritis 1 . . . 1 . 2 Croup 2 . . . . . 2 Peritonitis 1 . . . . . 1 Thrush 1 . . . . . 1 Ascites . . . 2 2 . 4 Diarrhœ (Bowel Complaint) 3 . 1 2 1 . 7 Ulceration of Intestines . 1 . . . . 1 Dysentery Hernia (Rupture) Cholera Ileus Influenza Intussusception Purpura;

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Scurvy Stricture of Intestinal Canal Ague Disease of Stomach, &c 1 . . . . . 1 Remittent Fever 1 . . . . . 1 Disease of Pancreas Infantile Fever Hepatitis Tyhus 7 4 4 3 2 . 20 Jaundice 2 . . . 1 . 3 Metria Disease of Liver . . . 3 2 . 5 Rheumatic Fever . 2 1 . . 3 Disease of Spleen Erysipelas 4 . . . 1 . 5 VIII. Kidneys, &c. : Sypbils 1 .. .. .. .. .. 1 Noma Nephritis .. .. .. 1 .. .. 1 Hydrophobia Nephria (Bright's Disease) .. .. 1 2 .. .. 3 Ischuria Diabetes II.

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Dropsy, &c. Stone Hæmorrhage 2 1 I 2 2 .. 8 Cystitis .. .. .. 1 1 .. 2 Dropsy 2 .. .. 2, 2 1 7 Abscess .. 1 .. 1 .. .. 2 Disease of Kidneys, &c .. 2 .. 3 1 .. 6 Ulcer Fistula IX. Childbirth : Mortification 2 .. l .. 1 .. 4 Paramenia Cancer .. .. .. 1 2 .. 3 Ovarian Dropsy .. .. .. 1 .. .. 1 Gout Childbirth (see Metria) Disease of Uterus, &c .. .. .. 1 .. .. 1 III.

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Tubercular Class: X. Joints, Bones, &c. : Scrofula Arthritis Tabes Mesenterica 31 .. 1 .. .. .. 32 Rheumatism Phthisis (Consumption) 6 12 25 20 1 .. 64 Disease of Joints, &c Hydrocephalus (Water on the Brain) 9 1 .. .. .. •. 10 XI. Skin, Cellular, Tissue, &c.: Carbuncle IV. Brain, Nerves, &c.: Phlegmon Cephalitis 6 .. .. .. .. .. 6 Disease of Skin, &c Apoplexy 1 .. 1 2 5 .. 9 XII.

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Malformation : Paralysis .. .. .. 5 6 1 12 Delirium Tremens Spina Bifida Chorea Other Malformations 3 .. .. .. .. •• 3 Epilepsy 1 .. .. .. 2 .. 3 Tetanus XIII. Premature Birth and Debility . Insanity .. .. .. .. 2 .. 2 19 .. .. .. .. .. 19 Convulsions 21 .. .. .. .. .. 21 XIV. Atrophy : 4 .. .. .. .. .. .. Disease of Brain, &c. 1 .. .. .. .. .. 1 XV. Age: .. .. .. .. 31 11 42 Y. Heart and Blood Vessels : XVI. Sudden Death : 1 1 .. 1 .. .. 3 Pericarditis .. .. 1 .. .. .. 1 XVII.

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Violence, Privation, &c.: Aneurism Intemperance .. .. .. 1 .. .. 1 Disease of Heart, &c. 1 1 2 3 1 .. 8 Privation of Food Want of Breast Milk 2 .. .. .. .. .. 2 Neglect VI.

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Respiratory Organs : Cold Laryngitis 3 1 1 1 .. .. 6 Poison Bronchitis 10 1 5 19 21 3 59 Burns and Scalds .. .. .. 1 .. .. 1 Pleurisy 1 .. .. .. 1 Hanging, .. .. .. .. 1 .. 1 Pneumonia 48 1 .. 5 2 56 Suffocation, 1 .. .. .. .. .. 1 Asthma .. i 15 8 2 26 Drowning .. .. .. 2 .. .. 2 Disease of Lungs, &c 2 1 1 .. 1 .. 5 Fractures and Contusions .. 1 .. .. .. .. 1 Wounds Other Violence .. .. .. .. .. 1 1 Not Specified.

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9 1 .. 1 4 .. 15 Totals carried forward 225 27 46 81 60 7 446 Totals 288 33 47 101 105 19 593 23 APPENDIX TO TABLE 1. Showing the Causes of, and the Ages at Death, in each of the Sub-districts of Bethnal Green during the 13 weeks ending March 28th, 1857. Sub-Districts. CAUSES. | Zymotic or Epidemic Class. Tubcrcular Class. Brain, Nerves, &c. | Heart, &c. Respiratory Organs. Digestive Organs. Violence, Privation, &c. j All other Diseases. General Total.

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Hackney Road 23 21 15 3 40 8 12 23 145 Green 23 40 19 5 47 10 5 58 207 church 29 28 12 1 34 11 6 13 134 Town 25 17 8 — 32 8 2 15 107 Totals 100 106 54 9 153 37 25 109 593 AGES. Sub-Districts. -1 1-5 5-10 10-20 20-40 40-60 60-80 80-100 Gen.

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Total 46 36 3 3 8 31 16 2 145 43 29 5 10 21 35 52 12 207 33 39 4 1 12 18 25 2 134 Town 33 29 4 3 6 17 12 3 107 Totals 155 133 16 17 47 101 105 19 593 TABLE 2. Classifying the Causes of, and Ages at Death, in the Workhouse, Bethnal Green, during the 13 Weeks ending March 28, 1857. CAUSES. Zymotic or Epidemic Class. Tubercular Class. Brain, Nerves, &c. Heart, &c. Respiratory Organs. Digestive Organs. Violence, Privation, &c. All other Diseases. General Total.

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6 16 1 — 9 3 1 31 67 AGES. -1 1-5 5-10 10-20 20-40 40-60 60-80 80-100 General Total. 8 3 1 — 6 12 30 7 67 London: Printed j:y J. S. FORSAITH, 118, Bethnal Green Road.

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3 BET 73 REPORT of the MEDICAL OFFICER OF HEALTH, on the SANITARY HISTORY of BETHNAL GREEN, DURING 1857. LONDON: PRINTED BY ORDER OF VESTRY. 1858. THIS REPORT on the SANITARY HISTORY OF BETIINAL GREEN DURING. 1857, IS RESPECTFULLY DEDICATED by the OFFICER OF HEALTH TO THE GREAT PIONEER OF HYGIENIC REFORM DR. THOMAS S0UTHW00D SMITH, BY WHOSE AID THE AUTHOR WAS RESCUED FROM TETANIC CONVULSIONS,* AND RESTORED TO HEALTH. * Strychnine prescribed by a medical friend was the cause, and Camphor the antidotal means. 135, Bethnal Green Road, February, 2bth, 1858. " Hygiene substitutes men for children."

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Gentlemen, I have the honor to present my Report on our Sanitary History, during 1857. In my First Annual, I had the pleasure of recording, that in 1856 the health of Bethnal Green, as of all London, was unusually good. It is now my less pleasing task to report that the year 1857 proved less genial and more destructive to life. The mortality of London rose from 56,786 to 60,150; that of Bethnal Green from 1905 to 2291.* As the meteorological conditions of years vary, so, more or less, they affect and tell on life. Hence, health must be measured by the average mortality of several yearsf—not by the returns of a single twelvemonth.