CHIN 031 ANNUAL REPORT OF THE Medical Officer of Health For THE Urban District of Chingford. CHAS. SMITH, SON & GOWLAND, Printers, 11, Jewry Street, Crutched Friars, E.C., London and Chingford. ANNUAL REPORT. Area and Population of District. The Urban District of Chingford comprises 2,809 acres, and the population was found to be 2,737 at the date of the last Census, viz., in the year 1891. The estimated population up to the middle of the year 1898 was about 3,682, or 1.3 inhabitants per acre. The number of inhabited houses had increased from 534 in 1891 to 722 in 1898. Judging from the number of new houses that have been built since the last Census year, the population has not increased so rapidly during the present decade as it did in the previous one. On the other hand, there is very good reason for believing that a considerable number of new houses are likely to spring up in Chingford before the next Census takes place in the year 1901. Births. Ninety-one births were registered in the district during the past year, comprising 45 male and 46 female children, and giving an annual birth-rate of 24.4 per 1,000, against 23.1 per 1,000 in the previous year, and 25.2 per 1,000 in 1896. The average annual birth-rate of the past four years, viz., 24.6 per 1,000, is almost identical with the birth-rate of 1898. In the last annual report of the Registrar General of Births, Deaths and Marriages, it appears that the average annual birth-rate during the decennium 1886-95 was 31.0 per 1,000 for all England, and 32.1 per 1,000 for the Registration County of Essex. It is manifest, therefore, that the annual birth-rate in Chingford is habitually much below the average birth-rate of the county in which it is situated. 4 The returns received by the Medical Officer of Health do not specify the number of illegitimate births that occurred during the year. Deaths. The number of deaths registered in the Urban District last year was 35, including 21 males and 14 females, and giving an absolute annual death-rate of 9.55 per 1,000. Deducting three deaths affecting persons not belonging to this district and adding four deaths which occurred outside the district, viz., in the Epping Workhouse, the corrected annual death-rate is found to be 9.77 per 1,000, against 7.04 per 1,000 in the previous year, and 14.6 per 1,000 in 1896. Although the annual death-rate was somewhat higher than in 1897, when the mortality was exceptionallv low, it cannot be considered otherwise than satisfactory, when compared with the much higher rates that prevail in most other suburban districts, and notably in our great metropolis, which is justly considered one of the healthiest cities in the world. During the decennium 1886-95 the mean annual death-rate for all England was 18.8 per 1,000, and 16.5 per 1,000 for the Registration County of Essex. Two persons not belonging to this district committed suicide in the Forest, whilst the body of an unknown infant was found in the river Lea. Only one illegimate infant figured on the death register. Coroner's inquests were held in four cases of sudden death. All the deaths were certified by medical men. Seasonal Mortality. Ten deaths occurred during the first quarter of the year, six during the second quarter, eleven during the third and nine during the last quarter of the year. 5 Average Duration of Life. The average age of the 36 deceased inhabitants was 43.4 years, against 32.7 years in 1897 and 40.7 years in 1896. Mortality at Different Ages. Under 1 year 7 deaths 1 to 5 years 2 „ 5 to 15 years 1 „ 15 to 25 years — „ 25 to 65 years 15 „ 65 and upwards 11 „ 36 There is no exceptional feature in these figures. Infantile Death-Rate. The number of deaths under one year of age per 1,000 births was 88 last year, against 97 in the previous year and 93 in 1896. During the decennium 1886-95 the mean annual infantile death-rate was 148 deaths of infants under one year of age per 1,000 births for all England and 130 per 1,000 births in the Registration County of Essex. The low infantile mortality which recurs regularly from year to year in Chingford, is one of the most satisfactory features in these annual reports. It cannot be denied that the climatic and other surroundings in our Urban District seem more favourable to the infantile organism than they are in many less favoured localities. 6 Zymotic Sickness and Mortality. Twenty cases of infectious sickness were notified during the past year, against nine in the previous year and twelve in 1896. Scarlet Fever and Diphtheria were responsible for fifteen of these cases, as will be seen in the subjoined table. The infectious sickness-rate was 5.4 per 1,000 of the population. The zymotic deaths were five in number, constituting a zymotic death-rate of 1.35 per 1,000, against 0.84 in the previous year and 1.7 per 1,000 in 1896. Only two deaths, however, resulted from the more serious forms of epidemic disease. In the Registrar General's last annual report we find that the mean annual zymotic mortality during the decennium 1887-96 was 2.61 per 1,000 for all England. In 67 mediumsized towns the mean zymotic death-rate in 1897 was 2.41 per 1,000. Zymotic Diseases. Notifications. Deaths. Scarlet Fever 8 Diphtheria 7 1 Typhoid Fever 3 1 Erysipelas 2 Diarrhoea 3 Total 20 5 Scarlet Fever.—Cases of this fever were notified during the months of February and March, and again in July, August, October and November. As many as five cases occurred in a 7 Home for little girls, where great difficulty was experienced in preventing the spread of the malady in consequence of the number of children living in the establishment. Disinfection was carried out and four children were removed to the Epping Isolation Hospital, where they all recovered. No insanitary condition was discovered beyond slight overcrowding. It was deemed advisable to close the High School for a fortnight in November on account of this malady. No deaths resulted from Scarlet Fever. Diphtheria.—This disease affected seven persons during the past year. The child first attacked seems to have contracted the malady through kissing another child on a visit at a neighbouring house that had been discharged four weeks previously from an Isolation Hospital, where she had been treated for Diphtheria. This child succumbed to the disease. Her mother meantime had caught the infection and was removed to the Epping Isolation Hospital, where she recovered. Two other children living in a neighbouring house were subsequently laid up with the same malady, which, however, terminated favourably in both instances. Some drainage defects were noticed in these cases, which were afterwards remedied by the owner of the property. In the month of August two children were affected with diphtheria in a low-lying cottage in close vicinity to water, both of whom recovered. The last case occurred in an isolated house in November, and was unaccompanied by any insanitary condition. In spite of antitoxin injections and the absence of the diphtheria bacillus in the throat of the patient, another member of this family was affected with the same malady, though in a very mild form, in the beginning of the new year. 8 Typhoid Fever.—The three cases of this fever were notified during the months of July, August and September. Two of the persons affected lived in Willow Street, where the drainage is apt to become defective at times from partial blockage of the sewer. In one of these cases, however, the patient had recently returned from a visit at Southend, where she had partaken of oysters. In the High Street case, which terminated fatally 48 hours after notification, the mouth of the soil-pipe ventilator was in close proximity to the bedroom window of the patient. This defect was subsequently remedied. Measles.—The National and Infant Schools were closed for three weeks on May 10th on account of Measles. No deaths, however, resulted from this disease. Whooping Cough. — This complaint was prevalent during the month of May, but caused no fatalities. Diarrhoea.—Three infants succumbed to this malady in September. Influenza.—Three deaths from Influenza were registered during the months of February, March and August, but the cases that occurred of this disease seem to have been of a sporadic rather than an epidemic type. Isolation Hospital. Four persons suffering from Scarlet Fever and one from Diphtheria were removed to the Epping Isolation Hospital during the course of the year, where they all recovered. The 9 average duration of each patient's sojourn in the Hospital was forty days, and the average cost per day in each case, including ambulance charges, was 5s 6½d. In the Diphtheria case the charge per day was as high as 17s 9d, but this circumstance was evidently due to the fact that there were no other Diphtheria cases in the Hospital at the time, so that the nursing expenses were necessarily rather heavy. One of the chief disadvantages of small isolation hospitals is that the administrative charges must of necessity under certain circumstances be much higher than in larger institutions. The Epping Rural District Council have recently entered into a contract with the Chingford Urban Council to receive infectious cases from Chingford in their Isolation Hospital at Theydon Garnon for a term of three years, commencing on November 11th, 1898, on certain conditions. First a sum of £25 has to be paid annually for the use of the Hospital, whether patients are sent from Chingford or not in any given year. Secondly, the charge for each Scarlet Fever case will be 7s 6d per day; for each Typhoid Fever case l2s 6d per day; and for each Diphtheria case 17s 6d per day. The use of the ambulance will be included in these charges. Patients will only be admitted provided there is room for them in the Hospital. Drainage. Although the Chingford Hatch drainage scheme has not yet been carried out in consequence of some minor objections on the part of the Local Government Board, there is every reason to believe it will be commenced very shortly, as soon as the London authorities have given their final sanction to the undertaking. It would be difficult to exaggerate the insanitary condition of this part of the parish during the year that has just expired, and therefore it is all the more gratifying to know that this most unsatisfactory state of things will soon be numbered with the 10 Lea Valley Drainage Scheme. The proposed Lea Valley Drainage Scheme is one that has a very important bearing on the future of Chingford from a sanitary point of view. Indeed, it is difficult to conceive how it can ever become a large and populous place in the absence of some such undertaking as the one proposed. The pumping station on Mansfield Hill, and the sewage farm on Chingford Road have been sources of grave anxiety to the Urban Council from the very first moment they assumed the reins of office. As time rolls on and the population of the place increases, as it certainly will do, the present arrangements are very likely to prove quite inadequate, and it is quite possible that a deadlock may ensue in both institutions. With the adoption of the abovementioned scheme, all these difficulties looming ahead would disappear and no additional burden would be imposed on the ratepayers, as the sewage farm could certainly be sold for much more than it cost, as a building area. It is satisfactory to know that the Urban Council have given the proposed scheme their very favourable consideration. Proposed Waterworks Reservoir on Chingford Marsh. One rather serious objection to the carrying out of this scheme by the East London Waterworks Company is that the Urban Council would be debarred from acquiring land on the Chingford Marsh, should it be deemed advisable at any time to have a small subsidiary sewage farm there for the Low Street district, instead of pumping up the sewage into the high level sewer, as is now the case. It seems probable, too, that the natural drainage of this part of the parish would be obstructed to some extent by the construction of this huge reservoir, whatever precautions the Company might take to carry off the surface water descending from the high ground on the East side of Low Street. 11 Scavenging. Mr. Griffin, the Sanitary Inspector, gives speaks favourably of the new system of scavenging introduced in 1896, which seems to give more general satisfaction than the system previously in force, judging from the diminished number of complaints. Dairies, Cowsheds and Milk Shops. The dairies, cowsheds and milk shops were all regularly inspected during the year, and no serious infringement of the bye-laws came under notice. Slaughter Houses. The two slaughter-houses were also kept in good sanitary order. Overcrowding. Only two cases of overcrowding came under observation during the year, both of which were abated. Magisterial Interference. In no case was it found necessary to invoke magisterial assistance in procuring the abatement of any insanitary condition. Periodical Inspection of the District. The Medical Officer of Health has kept himself well acquainted with the health and sanitary state of the district by frequent periodical inspections. Sanitary Inspector. As usual, the district was much indebted during the past year to the very valuable services of Mr. J. T. Griffin, the Sanitary Inspector. SHEPHARD T. TAYLOR, M.B., Lond Chingford, January 23rd, 1899. 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, 1898, Being a copy of the Report annually forwarded to the Clerk of the County Councii of Essex. Totals for Year. Complaints received 30 Nuisances detected 76 Nuisances abated 74 Notices served 76 Inspections made 286 Slaughter-houses inspected 2 Bakehouses inspected 2 Dairies and Milk Shops inspected 3 Cow Sheds inspected 11 Houses disinfected 11 Overcrowding abated 2 Improved supply of Water 1 New connections with Sewer 24 Privy accommodation improved 8 W.C.'s supplied with water or repaired 12 Cisterns cleaned, etc. 3 Animals improperly kept removed 2 Compensation paid for destruction of Infected Bedding £1 5s. (Signed) JNO. T. GRIFFIN. F.I.S.E., Sanitary Inspector.