"A year of exceptional mortality.... Death rate 29·74 per thousand, or, if the deaths of parishioners in hospitals be included, 31·10.... Tubercular diseases, of which consumption affecting the lungs is the most important, were as usual intensely fatal in our district." The Medical Officer of Health for Whitechapel drew attention to the increase of mortality in his district. He was evidently puzzled and perplexed by it, and "candidly confessed" his inability to account for it. "I may, however, venture a few conjectures." Among them was this very suggestive one--"that a change has taken place in the constitution of the people so that they are now less able to bear the effects of disease than formerly." Suggestions and recommendations for ameliorating this appalling condition of things poured in upon many of the local authorities from their Medical Officers of Health. Upon several points there was an absolute consensus of opinion. One of these was that all houses let out in separate tenements and inhabited by many families should be registered by the local authorities--that rules and regulations should be made for their management, and that constant inspection by the sanitary authority was an absolute necessity if the proper conditions of health were to be maintained. The Medical Officer of Health for Bethnal Green wrote:-- "All sanitary evils fall with greatest force upon those who are unable to quit the scene of their misery or to provide the means for its alleviation. "Nothing but adaptation of the present houses to the necessities of healthy existence and the demolition of those houses that are unfit for human habitation can contribute so much to life and strength." A Committee of the District Board in Poplar wrote (1866):-- "It would be a satisfactory alteration of the law if no houses were allowed to be tenanted unless a certificate that these premises were fit for habitation were first obtained from the District Board of Works." And the necessity of constant inspection was even more vigorously expressed. The Medical Officer of Health for Hackney wrote (1861):-- "The experience of the past year again shows the necessity of keeping up a regular and efficient supervision of the interior of houses.... "It is only by repeated and careful inspection of the dwellings of the poor, and an inculcation at these visits of the necessity for keeping clean their rooms that epidemic diseases can be kept in check." The Medical Officer of Health for St. James' wrote (1862):-- "The nuisances which are removed, are constantly recurring. It is only by constant inspection and by supervision repeated systematically from day to day, and week to week, that those nuisances can be kept down which are ever ready to destroy the life, and at one and the same time sap the health and undermine the morality of the community." The Medical Officer of Health for Whitechapel wrote:--