CHIN 030 Annual Report of the Medical officer of Health to the URBAN SANITARY DISTRICT OF CHINGFORD, For the Year 1897. ■ ANNUAL REPORT OF THE Medical Officer of Health TO THE Urban Sanitary District of Chingford. CHAS. SMITH, SON & GOWLAND, Printers, 11, Jewry Street, Crutched Friars, E.C., London and Chinqford. ANNUAL REPORT OF THE Medical Officer of Health TO THE urban sanitary district OF chingford. SUPPLEMENTED BY THAT OF THE SANITARY INSPECTOR. Area and Population of District. The Urban Sanitary District of Chingford comprises 2,809 acres, and the population at the Census of 1891 was found to be 2,737. The population in the middle of 1897 is computed to have been about 3,547. The density of population was therefore 1.3 inhabitants per acre. The number of inhabited houses, which was 534 in 1891, has now increased to 651. Births. During the past year 82 births were registered in the district, including 44 male and 38 female children. The annual birth-rate was therefore 23.1 per 1,000, against 25.2 per 1,000 in the previous year and 25.6 per 1,000 in 1895. It is manifest from these figures that the birth-rate of 1897 was below the average. 4 In the last annual report of the Registrar General of Births, Deaths and Marriages, we are informed that the average annual birth-rate during the decennium 1885-94 was 31.2 per 1,000 for all England and 92.5 per 1,000 for the Registration County of Essex. The annual birth-rate in Chingford is therefore considerably below the average birth-rate of the whole county. The number of illegitimate births is not specified in the returns received by the Medical Officer of Health. Deaths. Only 26 deaths were registered in the Urban District last year, against 37 in 1896 and 53 in 1895. The absolute annual death-rate was therefore 7.33 per 1,000. Three of these deaths, however, affected persons not belonging to the district, whilst on the other hand two of the inhabitants died outside the district, the one in the Epping Isolation Hospital and the other in the Epping Workhouse, so that the corrected annual death-rate is only 7.04 per 1,000. The corresponding rates in 1895 and 1896 were 14.6 and 11.13 per 1,000. These remarkable figures furnish unimpeachable evidence of the habitual heathiness of Chingford, whilst the decreasing death-rate during the past three years points to the conclusion that the strenuous efforts of the Urban District Council and their sanitary officials to improve the health of the district committed to their charge have not been wholly unsuccessful. At the recent parish dinner, the chairman, the Rev. A.. F. Russell, adopted the rather novel view that we are mainly indebted to our Chingford mud for our natural salubrity. Without entirely endorsing his opinion in this respect, it must be frankly admitted that, inasmuch as sanitation is by no means a perfect science, it is quite impossible to know beforehand what the sanitarian of the future may have to say on this subject, so after all there may be more sanitary virtues in our Chingford mud than we are prepared to admit at the present moment. On the other hand there can be little doubt that our somewhat isolated position, cut off, as it were, to a great extent from 5 the rest of the world by the Epping Forest and the valley of the Lea, is not only favourable to our general health, but greatly diminishes our liability to the invasion of epidemic disease. During the decennium 1885-94 the mean annual death-rate for all England was 18.9 per 1,000, and 16.7 per 1,000 for the Eegistration County of Essex. One of the deceased strangers committed suicide in the forest, whilst three other deaths were due to accidental violence. All the deaths were certified by medical men. Coroner's inquests were held in seven cases of sudden death. No illegitimate children figured on the death-roll. Seasonal Mortality. Six deaths were registered during the first quarter of the year, five during the second quarter, ten during the third, and tour during the last quarter. The death-rate was much below the average during the first, second, and fourth quarters of the year. Average Duration of Life. The average age of the 25 deceased inhabitants was 32.7 years, against 40.7 years in 1896, and 37.3 years in 1895. Mortality at Different Ages. Under 1 year 8 deaths 1 to 5 years 2 „ 5 to 15 years 2 „ 15 to 25 years — „ 25 to 65 years 8 n 65 and upwards 5 ,, 25 6 The senile deaths and those between 25 and 65 years were both about half the average number, which accounts for the rather low average age of the deceased. Infantile Death-Rate. The number of deaths of children under one year of age per 1,000 births was 97, against 93 in the previous year, and 71 in 1895. During the decennium 1885-94 the mean annual infantile death-rate was 146 per 1,000 births in all England, and 128 per 1,000 in the Registration County of Essex. It may be taken for granted, therefore, that the infant mortality in Chingford was by no means excessive last year. Zymotic Sickness and Mortality. Only nine cases of infectious disease were notified during the past year, against 12 cases in 1896, and twenty-four in 1895. The mortality too from causes of this kind was wholly insignificant, comprising a fatal case of diphtheria, one of whooping cough, and one of diarrhoea, whereas in 1896 there were six, and in 1895 twelve deaths from diseases of this class. The zymotic deathrate for the year was only 0.84 per 1,000, against 1.7 per 1,000 in 1896, and 3.6 per 1,000 in 1895. The only unsatisfactory feature about these figures is that they may induce many people to think an Isolation Hospital a perfectly needless luxury for Chingford, in the face of such a trifling epidemic mortality as the above. Unfortunately, our propinquity to such populous centres as Walthamstow and London, renders it extremely improbable that we shall always enjoy our present immunity from zymotic disease. In the Register General's last annual report, we are informed that the mean annual zymotic mortality during the 7 decennium 1886-95, was 2.6 per 1,000 for all England. In 67 medium-sized towns the mean zymotic death-rate in 1896 was 2.5 per 1,000. Zymotic Diseases. Notifications. Deaths. Scarlet Fever 6 Diphtheria 3 1 Whooping Cough 1 Diarrhoea 1 Total 9 3 Scarlet Fever. —The six cases of this fever occurred in the months of January, May, October and December. They were, all of them, sporadic cases, affecting four different households in different parts of the parish, and in all but one case there was clear evidence of importation. The habitations of the poor were not affected by this visitation. There was no spread of the malady in any instance, beyond the family first affected. In one case the disease seems to have been imported from Germany, through the medium of a book, which had escaped disinfection. In all the houses affected disinfection was carried out by Mr. Griffin. One of the patients was removed to the Epping Isolation Hospital. Diphtheria.—The three cases of this malady occurred in the months of January and March in different parts of the district. In one of these cases the drinking water had been obtained from the cistern supplying the water-closet, a defect which was subsequently remedied. A case of diphtheria occurred also in this house a year or two since. Disinfection was carried out in each case, and the disease did not spread. One patient was removed to the Epping Isolation Hospital and died 8 there. This child lived at Chingford Hatch, a locality which is more subject to outbreaks of a virulent form of diphtheria than other parts of the district, perhaps in consequence of its lowlying situation and somewhat defective drainage. Typhoid. Fever.—The complete absence of this serious form of fever from Chingford is a very satisfactory feature of the year. In previous years we have not escaped without four or five cases of it. Influenza.—Although this malady prevailed somewhat during the last quarter of the year, happily no deaths resulted from it. Isolation Hospital. The temporary arrangement entered into with the Epping Rural District Council for the reception of Chingford infectious cases in their Isolation Hospital at Theydon Garnon will shortly come to an end, in consequence of the refusal of that body to renew the compact at the expiration of the term for which it held good. Meanwhile, the Urban District Council have been negotiating with the neighbouring Urban Districts of Woodford, Buckhurst Hill, Epping and Waltham Cross, with the view of constructing an Isolation Hospital, to supply the wants of themselves and one or more of these districts, as may seem most convenient. Of course, no vital objection can be urged against this project. At the same time, it must not be forgotten that there is an alternative scheme, which is certainly worthy of some consideration. The Walthamstow Urban District Council will very shortly build an Isolation Hospital in Chingford, which in all 9 probability will be a much larger and more perfect institution than the conjoint Hospital which it is proposed to erect. It is a well-known fact, that the cost of construction per bed is greater in a small than it is in a large Hospital, whilst the administrative charge per bod are also more excessive. An Isolation Hospital some miles distant from Chingford cannot possibly be so convenient as one in our midst. The cost of transporting patients to and fro must necessarily be more expensive, whilst the patients themselves would be entirely removed from the supervision of your Medical Officer of Health. When we consider that the two sexes must be separated, and each form of infectious disease rigidly isolated from all other forms in such an institution, it is obvious that a small Hospital labours under serious disadvantages where patients of different sexes and different infectious diseases have to be treated at the same time. Drainage- There is good reason to believe the pollution of the Ching by drainage from the houses at Chingford Hatch will soon be a thing of the past. Mr. Walter Stair, the Surveyor, has, at the instance of the Urban District Council, drawn up a comprehensive drainage scheme for the district in question, which in all probability will be carried out during the present year, to the no small advantage of the least healthy locality in Chingford. Should the Ching continue impure after the completion of this work, our Woodford and Buckhurst Hill neighbours cannot allege we are ourselves the cause of the pollution, which we have attributed to their sewage effluent in times past. As some of the sewers are rather flat, energetic flushing in dry weather is very necessary to prevent those occasional blockages, which are somewhat difficult to remove, besides exercising a prejudicial influence upon the health of persons living in their vicinity. 10 Scavenging. The Urban District Council have at length adopted that system of scavenging which is most in vogue elsewhere, with greatly improved results, judging from the experience of the Sanitary Inspector. Dairies, Cowsheds and Milk Shops. These have all been periodically inspected and found satisfactory on the whole. Slaughter Houses. There are but two slaughter houses in Chingford, the arrangements in both of which "have called for no interference on the part of the Sanitary Authority. Magisterial Interference. It has not been found necessary to invoke magisterial assistance in the removal of any nuisance during the past year. Periodical Inspection of the District. The Medical Officer of Health has been in the habit of periodically inspecting the district and making himself acquainted with its sanitary requirements. 11 Sanitary Inspector. Mr. J. T. Griffin, the Sanitary Inspector, has fulfilled the various duties of his office in the most satisfactory manner possible. His zeal is always tempered with discretion and he carries out his work with such tact, that little or no friction subsists between himself and those persons against whom he is called upon to act. SHEPHARD T. TAYLOR, M.B. Lond. Chingford, March 22nd, 1898. 12 CHINGFORD URBAN DISTRICT COUNCIL. Summary of work done through the Sanitary Inspector in the Urban Sanitary District of Chingford during the Year, ending Dec. 31st, 1897. Being a copy of the Report annually forwarded to the Clerk of the County Council of Essex. Totals for Year. Complaints received 18 Nuisances detected 110 Nuisances abated 110 Notices served 10'4 Cottages inspected 365 Slaughter-houses inspected 2 Bakehouses inspected 2 Dairies and Milk Shops inspected 2 Cowsheds inspected 14 Houses disinfected 5 Overcrowding abated 2 Privies and W.C.'s repaired ; W.C.'s supplied with water 18 Cisterns cleansed, repaired, or covered 6 Animals improperly kept removed 3 (Signed) JNO. T. GRIFFIN, F.I.S.E. Sanitary Inspector. .