EAS 44 BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report ON THE MOH-1707 BY THE MEDICAL OFFICER OF HEALTH, TOGETHER WITH THE REPORT OF THE CHIEF SANITARY INSPECTOR For the Year ended 31st December, 1905. South Essex Printing and Publishing Co. Ltd., High Street South, East Ham, E. 1906. To His Worship the Mayor, Aldermen, and Councillors of the Borough of East Ham. Mr. Mayor and Gentlemen, I have the honour to present the Annual Report on the state of the Public Health, and the record of Sanitary work done during the year 1905. The report of the late Medical Officer of Health is, in accordance with the suggestion of the Local Government Board, incorporated with this. The year has, on the whole, been a healthy one, the corrected Deathrate, 13.2, comparing very favourably with that of the previous year, when it was 14.69. The Zymotic Death-rate was also lower, and this notwithstanding the fact that more cases of Infectious Disease were notified. The Infantile Mortality Rate was considerably lower than that of the previous year, the figures being 129 and 154 respectively. With two exceptions, this is the lowest rate for the past 10 years. The Birth-rate shows a further diminution, and is the lowest ever recorded in the Borough. A short account of the Borough Isolation Hospital has been given, and, for the first time, a brief chapter is devoted to the Public Elementary Schools. This latter subject should in futnre receive more detailed consideration, but as I only entered on my duties in November, I am unable this year to discuss it at the length its importance deserves. In conclusion I wish to express my thanks to the Members of the Public Health and Education Committees for their courtesy and consideration of my suggestions, while to the members of the Staff of the Public Health Department and the Hospital I am indebted for the most loyal and hearty co-operation. I am, Gentlemen, Yours faithfully, G. SOWDEN, Medical Officer of Health. Town Hall, East Ham E. March, 1906. BOROUGH OF EAST HAM. PUBLIC HEALTH COMMITTEE. Councillor F. W. Hill (Chairman), The Mayor (Alderman J. H. Bethell, M.P.). The Deputy-Mayor (Councillor G. Pratt, C.C.). Mr. Alderman Brooks, C.C. Mr. Alderman Edwards. Mr. Alderman Carte. Mr. Alderman Savage. Mr. Councillor Anstead, C.C. Mr. Councillor Ford. Mr. Councillor Banks-Martin. Mr. Councillor Howlett. Mr. Councillor Clover, C.C. Mr. Councillor Northfield. Mr. Councillor Cosburn. Mr. Councillor Murrele Oakes STAFF OF THE PUBLIC HEALTH DEPARTMENT. W. J. Worley, Junior Clerk. W. L. Garrett, Junior Clerk. F. J. Kendall, Chief Clerk. Sanitary Inspectors: M. J. Hillyard, J. G. Anderson, G. D. Lill. Sister in Charge of Convalescent Home: Miss Bartlett. Matron of Isolation Hospital: Miss Wilson. Chief Sanitary Inspector: Joseph G. Banks, A.R. San. I. Medical Officer of Health : G. Sowden, M.D., D.P.H. SUMMARY OF REPORT FOR 1905. Area 3355 acres, including inland water. Soil and Situation :—The subsoil is sand and gravel, overlying the London clay. The altitude is not great, the highest point above ordnance datum being about 50 feet, while the valley of the Roding in the East, and some parts of the South of the District are marshy. Population.—Census 1901, 96,018. Population per acre, 33. Population estimated June 1905, 123,381. Population per acre 3677. Number of Inhabited Houses.—Census 1901, 16,681. No. per house, 575. Number of Inhabited Houses, January, 1906, 21,533. Births, 3687. Birth Rate, 29.86. Deaths, 1528. Death Rate, 12.3. Zymotic Death Rate, 2.3. Infantile Mortality, 129. Water Supply, Metropolitan Water Board (East London District). Total Rainfall, 20.30 inches. BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR YEAR 1905. POPULATION. The Population of the Borough at the Census in 1901 was 96,018. The Registrar-General's estimate of the population for the middle of 1905 was 123,381. This estimate is of great importance, as it forms the basis of calculation for many of the rates in this report. It is essential, therefore, to obtain it with some degree of accuracy, since an over-estimated population would be unduly favourable by giving death and other rates lower than was actually the case, while the reverse would occur if the population was under-estimated. As a check on the figures given by the Registrar-General another method has been adopted. An enumeration of all the houses in the Borough has been made, and assuming the number of persons per house remains the same as at the census in 1901, viz., 5.75, the number of occupied houses multiplied by this figure will give the estimate required. By this method the population in June, 1905, was 122,620. There is, therefore, only a difference of 761 between the two estimates. Therefore, for practical purposes the Registrar General's figures may be taken as correct. 4 WARD POPULATION. In June, 1905, as estimated from enumeration of the houses in January, 1905 and 1906:— Beckton & North Woolwich Ward 1,299 109 42 7,469 Central Ward—East3,634 259 90 20,895 Central Ward—West 3,978 236 26 22,873 Manor Park Ward 4,789 657 49 27,540 Plashet Ward—East 3,406 203 4 19,581 Plashet Ward—West 4,220 216 — 24,262 21,326 1,680 211 122,620 DENSITY OF POPULATION. The area of the Borough is 3355 acres, the number of persons per acre is, therefore, 36.7. At the Census of 1901 the density of population was 33 persons per acre. BIRTHS. The Births registered during the year numbered 3687, of which 1862 were males and 1825 females. This gives a birth-rate of 29.88 per 1,000 as compared with 27.9 for England and Wales. The birth rate of the Borough for the pact year is the lowest ever recorded. This is not exceptional, for the birth-rate of the entire country has been steadily declining for the past 50 years. 5 The following tables give the birth-rate of the Borough for the past 10 years, and that of England and Wales for the past 50 years:— England and Wales. 1860-1870 35.2 1871-1880 35.4 1881-1890 32.5 1891-1900 29.9 1901-1904 28.3 East Ham. 1896 35.0 1897 34.0 1898 34.8 1899 34.4 1900 35.8 1901 36.4 1902 36.5 1903 34.4 1904 31.7 1905 29.8 BIRTHS DISTRIBUTED INTO WARDS. Births. Birth-rate. Beckton & N. Woolwich Ward 279 37 3 Central Ward—East 656 31.3 Central Ward—West 793 34.6 Manor Park Ward 801 29.1 Plasliet Ward—East 514 26.2 Plashet Ward—West 644 26.5 ILLEGITIMATE BIRTHS. These numbered 77, giving a rate of 20 per 1,000 births. The illegitimate Birth-rate for England and Wales from 1891 to 1900 was 42 per 1,000 births. 6 DEATHS. During the year 1308 deaths were registered in the Borough, 771 males and 757 females. The deaths registered outside the district of persons belonging to it numbered 220, giving a total of 1528 deaths. There were also 3 deaths registered in the district of persons not belonging to it. Excluding these, we have a total of 1525 deaths for the year and a Death Rate of 12.3 per 1000. Corrected for age and sex distribution the rate is 13.2 per 1000. The following table gives the Deaths and Death Rate of the Borough for the past five years. For purposes of comparison the rate for England and Wales is also given :— Year. Deaths. Rate. England and Wales. 1901 1457 15.1 16.9 1902 1242 11.9 16.3 1903 1265 11.4 15.4 1904 1612 13.7 16.2 1905 1525 12.3 15.2 It will be seen that the rate for the year is very satisfactory, being 1.4 less than last year, and 2.9 less than that of England and Wales. WARD DEATH RATES. Deaths. Death Rate. Beckton and North Woolwich Ward 149 19.9 Central Ward—East 285 13.6 Central Ward—West 298 13.0 Manor Park Ward 337 12.2 Plashet Ward—East 194 9.9 Plashet Ward—West 262 10.9 It will be noticed that the Death-rate in the different Wards varied considerably, Plashet Ward East heading the list with the very low death-rate of 9.9, while Beckton and North Woolwich had a rate more than twice this, namely, 19.9. 7 I am at present unable to offer any explanation of this. The age and sex distribution of the Beckton and North Woolwich Ward may be more favourable to a high death-rate, but this cannot be the sole explanation. The Death-rate of the Beckton and North Woolwich Ward is also remarkable from another point of view. The number of cases of Infectious Disease notified in proportion to population was the lowest in the Borough, and yet the death-rate from the seven principal zymotic diseases was the highest, in fact, was more than twice as great as that of the Borough as a whole. This also is difficult to explain. It is impossible to assume that the type of disease was in every case more severe. Is the physique and condition of the population worse in this Ward than in any other, or is there more poverty and want of food, and therefore lowered resistance to disease? These questions are important, and will receive my attention, for if this marked difference is maintained in future years, it merits investigation. UNCERTIFIED DEATHS. Only 3 were recorded during the year, as compared with 6 in 1904. The following causes of death were given by the Registrars : Chronic Bronchitis Female, 70 years. Consumption Female, 31 years. Epilepsy Male, 18 years. This reduced number is satisfactory, though I am of opinion there should be no uncertified deaths. If a medical certificate cannot be obtained an inquest should be held, otherwise there is certainly a risk, sooner or later, of a case of homicide escaping detection. INFANTILE MORTALITY. This is measured by the proportion of deaths under one year of age to 1000 births. 8 I am pleased to report a considerable improvement compared with the previous year. The figures being 129 per 1,000 in 1905 as compared with 154 per 1,000 in 1904. Despite this improvement, the Infantile Mortality rate still remains far too high. It is subject to considerable variation year by year, the variations being largely due to the amount of summer Diarrhoea, but if the figures for a number of years are taken, it will be seen that no real improvement has taken place. The following table, which has recently been published, shews that while the general Death-rate of the country has steadily declined, the rate of Infantile Mortality has practically remained stationary :— ENGLAND AND WALES. General Death Rate. Infantile Mortality per 1,000 Births. Birth Rate. 1861-70 22.5 154 35.2 1871-80 21.3 149 35.4 1881-90 19.1 142 32.5 1891-1900 18.2 154 29.9 The subject is rendered more serious from the fact that the Birth-rate of the country is also steadily declining, as the above table also shews. The chief registered causes of infantile mortality are Diarrhoea, Enteritis, Marasmus, Debility and Convulsions. Altogether 204 deaths of infants under one year were ascribed to the above causes. These are very largely preventible diseases, so that 42% of the mortality should not have occurred. DIARRHœA AND ENTERITIS 'Chiefly occur in the summer and autumn, particularly during a hot, dry season. Contaminated milk given in filthy bottles is largely responsible for these deaths, for breast fed children suffer but little from these diseases. 9 MARASMUS, DEBILITY AND CONVULSIONS. These are mainly due to improper feeding. Owing to the lamentable ignorance of mothers, infants are far too early in life fed either with patent foods, consisting chiefly of starch or they are given solid food such as the parents have, and these things an infant stomach cannot possibly digest. Statistics show that amongst the more educated classes the infantile mortality from these causes is low. It is therefore obvious that ignorance of the management and feeding of infants is largely responsible for these diseases. Recent work on the subject of Infantile Mortality has, however, disclosed another important factor. It is found that the the death-rate of infants is increasing chiefly during the first three months of life. Conditions in the parents must therefore be largely responsible for this, and evidence seems to point to the fact that excessive indulgence in alcohol is the chief cause. This leads to physical degeneration in parents, inability in the mother to suckle her child, and consequently feeble offspring is the result. Knowing, then, the chief causes of this high mortality, our efforts must be directed towards removing them. Great improvement would, doubtless, follow could we but secure :— (1) More breast feeding, (2) Purer milk supply, (3) Cleanliness both of children and their homes, (4) Education of women in the feeding and management of children. (5) Diminished indulgence in alcohol. Progress, however, in these things is slow and difficult. 10 ZYMOTIC DISEASES. The number of deaths from the seven principal zymotic diseases was 278, distributed as follows :— Small Pox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Measles. Whooping Cough. Diarrhœa. Total. - 22 38 l6 48 57 97 278 The death-rate from these seven zymotic diseases was 2-25 per 1,000, as compared with 2.91 in 1904. The following Table gives the Zymotic Death-rate in each Ward, in the Borough as a whole, and in England, and Wales :— t Beckton and N. Woolwich. Central East Ward. Central West Ward. Manor Park Ward. Plashet East Ward. Plashet West Ward. Whole District. England and Wales. Deaths 42 70 65 44 25 32 278 Rate per 1,000 of Population J 4.0 2.6 2.5 1.2 1.2 1.2 2.2 1.5 The zymotic mortality during the past 5 years has been as follows:— 11  1901 1902 1903 1904 1905 Scarlet Fever 0.07 0.08 0.11 0.08 0.17 Enteric 0.17 0.21 0.13 0.12 0.13 Diphtheria and Membranous Croup 0.36 0.31 0.12 0.40 0.30 Whooping Cough 0.28 0.46 0.34 0.20 0.46 Diarrhœa 1.12 0.49 0.52 1.61 0.18 Measles 0.17 0.25 0.32 0.47 0.39 Seven Principal Zymotic Diseases 2.17 2.05 1.57 2.91 2.25 General Death Rate 15.1 11.9 11.4 13.7 12.3 12 ENTERIC (OR TYPHOID) FEVER. 77 cases were notified during the year, as compared with 89 in 1904. The deaths from this disease numbered 16, which equals a death-rate of 0.13 per 1000 of population. The death-rate for England and Wales was 0.09 and for the 76 large towns 0.08 per 1,000 of population. The case mortality for the Borough was 207, as compared with 23.7 in 1904. Both the number of cases notified and the death-rate from the disease were therefore lower than during the previous 12 months. The following table shows the attack rate per 1000 of population, and the case mortality per cent. during the past five vears:— Attack Rate per 1000 Population. Case Mortality per cent. 1901 1.65 10.6 1902 1.50 14.0 1903 0.58 22.7 1904 0.76 23.7 1905 0.62 20.7 SCARLET FEVER. This disease was very prevalent, more especially during the latter part of the year—968 cases were notified, as compared with 711 in 1904. The death-rate was also higher, being 0.18 per 1000 living as compared with 0.08 in 1904. The case mortality of those treated at the Isolation Hospital was 1.95 per cent. Of those treated at home the rate was 2.45 per cent. During the past five years the attack rate per 1,000 of population and the case mortality per cent, have been as follows: Population. Attack Rate per 1000 Population. Case Mortality, per cent. 1901 96,000 4.72 1.5 1902 104,023 5.60 1.5 1903 110,451 5.99 1.9 1904 116,902 6.12 1.4 1905 123,381 7.84 2.2 13 DIPHTHERIA. 290 cases were notified during the year, of which 38 proved fatal. This gives a case mortality of 13.10 percent., a compared with 339 cases, 47 deaths, and a mortality of 13.82 during the previous year. During the latter part of the year the Council decided to equip a bacteriological laboratory for the diagnosis of this disease. It is hoped, therefore, that the statistics as to the prevalence of Diphtheria will in future be more accurate, and also that by the recognition of mild cases which previously escaped detection, it will ultimately be the means of material y lessening the incidence of this disease in the Borough. SMALL POX. No cases of this disease occurred during the year. I was informed of a very suspicious case during December, and at the request of the doctor in attendance, immediately visited the patient, but after a careful examination I decided that it was not Small Pox, and this decision was confirmed by the subsequent history, for no other cases occurred. DIARRHœA. The deaths from Diarrhœa numbered 97, or 0.70 per 1000 of population. In the previous year the number was 189, and 1.61 per 1000. There were also 22 deaths from Enteritis and Gastro Enteritis. This gives a total of 119 deaths, 96 of these were of children under one year of age. This subject is more fully discussed under Infantile Mortality. MEASLES. 48 deaths were certified as being due to Measles. Probably no disease is more neglected than this. Parents almost without exception thinking it an illness of very little consequence. Statistics prove that this view is quite erroneous, but the delusion is difficult to eradicate. B 14 The death-rate per 1000 of population from this cause was 0.39, while that from Scarlet Fever was only 0.17. The deathrate therefore from Measles was more than twice as great as that from Scarlet Fever. Death-rate from Measles for England and Wales (1905) 0.32 do. do. do. 76 Great Towns do. 0.39 do. do. do. 141 Smaller Towns do. 0.31 Measles is not a notifiable disease in this Borough, but the School Attendance Officers and Head Teachers forward particulars of all children excluded from school in consequence of Measles, and during the year I have been informed of 555 cases. It was necessary to close the Infants' Department of Sandringham Road School for a period of 21 days, in consequence of an outbreak of this disease during the year. WHOOPING COUGH. This was the cause of 57 deaths. Like Measles this is considered to be of little importance, and very little care is taken of patients suffering from the disease. The death-rate was 0.46 per 1000; the death-rate for England and Wales being 0.25. The combined death-rate for Whooping Cough and Measles was 0.85 per 1,000 while the death-rate from all the other notifiable diseases put together was only 0.61 per 1000. TUBERCULAR DISEASE. 158 deaths were recorded, classified as follows :— Pulmonary Phthisis (Consumption) 106. Other forms of Tuberculosis 52. This gives a death-rate of 1.28 per 1000, that is, tuberculosis caused more deaths than Scarlet Fever, Diphtheria, Typhoid Fever and all the other notifiable diseases put together. The death-rate of the Borough from all causes for the year was 12.3. It is therefore seen that Tuberculosis was responsible for one-tenth of the entire deaths of the Borough. 15 The following table gives the number of deaths and the death-rate from Tubercular diseases and the death-rate from all causes for the past five years :— Deaths from Tubercular Dis. Death-rate per 1,000 population. Total death-rate from all causes per 1,000. 1901 125 1.30 15.1 1902 84 0.93 11.9 1903 137 1.24 11.4 1904 197 1.68 13.7 19.5 158 1.28 12.3 The death-rate for the different Wards for 1905, was as follows:— Beck. & N. W'ch. Cent. East. Cent. West. Manor Park. Plash. East. Plash. West. Total Av. Phthisis 1.29 0.88 1.0 0.82 0.69 0.71 0.89. Other Tubercular Diseases 0.59 0.42 0.31 0.44 0.32 0.31 0.39. In England and Wales about 60,000 deaths are due every year to Tubercular diseases. It is therefore obvious that no apology is needed for discussing at length so important a subject, especially as Consumptions a preventible disease, and should therefore be prevented. The disease is caused by a germ, the tubercle bacillus, this is contained in the expectoration of all consumptives. A patient in the advanced stage will throw off millions daily. The filthy habit of promiscuous spitting is largely responsible for the spread of the disease, for when dry, the germs in the expectoration are blown about in dust, get inhaled, and so cause the disease. The more stringent regulations now being made against spitting in public places and vehicles are therefore quite justifiable, and I think locally some similar steps might with advantage be taken to limit the amount of expectoration in our tram-cars, and public places. At present we have no knowledge as to the number of cases existing in the Borough, though should the medical practitioners care to voluntarily notify them, as is done in some districts, the 16 information will be welcomed and any help that this department can give will willingly be afforded. The disinfection of the premises at the termination of the case will also be undertaken. The following copy of a leaflet prepared for circulation to consumptive patients, gives in simple language some particulars of the disease, and also the regulations they should observe to prevent the spread of infection :— PUBLIC HEALTH DEPARTMENT. Suggestions for the guidance of consumptive patients:— 1. In the early stages, many cases of consumption are curable. 2. It is certain that the material (or " phlegm ") coughed up by persons suffering from consumption contains the seeds of the disease. 3. The phlegm, therefore, should not be swallowed, such a habit may lead to consumption of the bowels. 4. Consumptives should not, when indoors, spit on the floors, but should spit into special spitting cups (or pots) half full of water. The phlegm is most dangerous when it dries and becomes dust. 5. The spitting cups should be emptied into a bright fire or into the pan of the water closet, but never anywhere else, and especially not into the dust heap. Out of doors a pocket handkerchief may be used, but all soiled handkerchiefs should be boiled for at least five minutes when they are being washed. 6. The room in which a consumptive lives by day or night should be well aired, and the windows should be thrown wide open as soon as the patient leaves it. The windows should always be kept a little open at the top, both day and night. The chimneys should not be stopped up, but should be freely open for the passage pf air. The floors of the room should be kept very clean, and great care should be taken that no dust 17 remains upon them. They should be cleaned with a wet cloth. 7. Consumptive patients ought to sleep by themselves. 8. Mothers who are consumptives should not suckle their children, and should not themselves make use of the children's cups, spoons, etc. 9. Rooms that have been occupied by consumptive people can be disinfected free of charge on application to the Medical Officer of Health. These suggestions are not made for the benefit of the sufferers from consumption alone, but also in the interests of the family, for by adopting these means the spread of consumption may be prevented. Although much has been done in the past by general sanitary work to lesson the disease, much more remains to be done. As will have been seen a consumptive is only dangerous through bad habits, much good will therefore follow the dissemination of information concerning the disease. The isolation of advanced cases in Sanatoria should also be undertaken. The tendency in the past has been to treat chiefly early curable cases in Sanatoria, this is certainly good, but I think it much more important to provide isolation for advanced incurable cases, for these are the most deadly in spreading the disease. This is particularly the case among the poor, they have no means of providing isolation and it is among the overcrowded, underfed poor, that the germ finds the most suitable soil for its growth and development. CANCER. 84 deaths were due to cancerous disease. This is equal to a death-rate of 0.68 per 1,000 living, as compared with 71 deaths and a death-rate of 0.61 per 1,000 for the previous year. The following table gives the death-rate from cancer for the past five years :— 1901 0.56 per 1,000 1902 0.34 „ 1903 0.54 1904 0.61 „ 1905 0.68 „ 18 The number of deaths from Cancer appears to be increasing not only in the Borough, but also in the Country generally. It is however, at present difficult to say how much of this increase is real, and how much is due to more accurate diagnosis and also to more accurate returns concerning the disease. PUERPERAL FEVER. Two deaths were registered during the year. Every case is investigated, and I usually at once interview the Nurse attending the case, and give full instructions as to disinfection. ALCOHOLISM AND CIRRHOSIS OF THE LIVER. Eight deaths from Alcoholism and 10 from Cirrhosis of the Liver were registered during the year. It is, however, highly probable that these numbers by no means represent the actual mortality due to the immoderate use of alcohol. Many diseases are caused, directly or indirectly, by alcoholic excess, and deaths are frequently registered as being due to these diseases, instead of being attributed to the primary cause, that is, alcohol. There is therefore a large mortality really due to excessive drinking which escapes registration. NOTIFICATION OF INFECTIOUS DISEASE. 1,473 cases were notified during the year. This equals a rate of 11.9 per 1,000 of population. The following table gives the number of notifications and the rate per 1,000 of population during the past five years :— 1901. 1902.* 1903. 1904. 1905. No. of cases notified 1068 1953 1069 1256 1473 Rates per 1,000 of population 11.1 18.7 97 10.7 11.9 * Including 554 cases of Chicken Pox. 19 Cases notified in each Ward during the year 1905 :— Beckton and N. W'lwich. Central East. Central West. Manor Park. Plashet East. Plashet West. Total. Small Pox - - - - - - - Scarlet Fever 35 129 255 212 149 188 968 Diphtheria 20 49 49 84 38 37 277 Membranous Croup 1 3 6 2 1 — 13 Typhoid Fever 7 21 23 8 5 13 77 Continued Fever — — — 1 — — 1 Erysipelas 10 22 37 31 11 18 129 Puerperal Fever — 3 1 3 — 1 8 Totals 73 227 371 341 204 257 1473 Rates per 1,000 of Population 9.2 11.2 i6.1 12.7 10.1 10.1 11.9 20 Cases notified during each month of the year:— Scarlet Fever. Diphtheria. Membranous Croup. Continued Fever. Typhoid Fever. Erysipelas. Puerperal Fever. Total. JANUARY 60 31 3 - 5 17 1 117 FEBRUARY 51 24 2 - — 6 — 83 MARCH 43 20 1 — 6 9 2 81 APRIL 26 23 — — 3 14 — 66 MAY 54 14 — — 5 6 — 79 JUNE 58 15 — — 7 9 — 89 JULY 75 21 — i 2 4 — 103 AUGUST 72 25 4 — 17 10 — 128 SEPTEMBER 138 31 — — 10 19 1 199 OCTOBER 186 28 1 — 15 7 1 238 NOVEMBER 138 19 2 — 5 15 1 180 DECEMBER 67 26 — — 2 13 2 110 968 277 13 1 77 129 8 1473 21 INQUESTS. During the year, 111 inquests were held on the bodies of persons dying either suddenly or by violence. The following were the chief causes of death as certified by the Coroner:— Under 1 1 5 5 15 15 25 25 65 65 & over. Total. Apoplexy — — — — 4 — 4 Accident 2 2 3 — 7 4 18 Suicide - — — 1 6 — 7 Convulsions 10 2 — — — — 12 Syncope 3 1 — 1 6 1 12 Heart Disease — — — - 10 1 11 Overlaying 8 - - - - - 8 Improper feeding 2 - - - - - 2 Murder 2 - - - - - 2 Shock (from burns) — 8 1 — 1 — 10 Other causes 6 4 — 4 7 3 24 Neglect and exposure 1 - - - - - 1 34 17 4 6 41 9 111 22 Annual Report of the Medical Officer of Health for the year 1905 for the Borough of East Ham on the administration of the Factory & WorkshopAct, 1901, in connection with Factories, Workshops, Laundries, Workplaces & Homework. 1.—INSPECTION. Including Inspection made by Sanitary Inspectors. Premises. Number of Inspections. en Notices. Factories (Including Factory Laundries) 37 1 Workshops (Including Workshop Laundries) 237 16 Workplaces 5 - Homeworkers’ Premises 125 2 Total 404 19 2— DEFECTS FOUND. Premises. Number of Defects Found. Remedied. Nuisances under the Public Health Acts Want of cleanliness 47 47 Want of ventilation 6 6 Overcrowding 4 4 Want of drainage of floors 1 1 Other Nuisances 54 54 Sanitary accommodation insufficient 2 2 unsuitable 2 2 not separate for sexes 3 2 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse(s.lOl) - - Breach of Special sanitary requirements for bakehouses (ss. 97 to 100). - - Failure as regards lists of outworkers (s. 107). - - Giving out work to be done in premises which are unwholesome (s. 108 - - infected (s. 110) - - Allowing wearing apparel to be made in premises infected by scarlet fever or small pox (s. 109) - - Other Offences - - Total 119 118 23 3.—OTHER MATTERS. Class. Number. Matters referred to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133). - Action taken in matters referred to H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (s. 5). Notified by H.M. Inspectors 2 Reports (of action taken) sent to H.M. Inspectors. - Other - Underground Bakehouses (s. 101):— Certificates granted during the year Nil In use at the end of the year 12 Homework:— Number of Lists of Outworkers (s. 107):— Lists. Outworkers Lists received 7 30 Addresses of Outworkers forwarded to other Authorities 17 received from other Authorities 360 Homework in unwholesome or infected premises:— Wearing Apparel Other Notices prohibiting homework in unwholesome premises (s. 108) - Cases of infectious disease notified in homeworkers premises. 1 Orders prohibiting homework in infected premises (s. 110). - Workshops on the Register (s. 131) at the end of the year. - Laundries 49 Wearing apparel Makers 75 Bakehouses 51 Other workshops 51 Total number of workshops on Register 226 24 FACTORY AND WORKSHOP ACT. The preceding tables give a summary of the work done under this Act during the year. FACTORIES. These have been inspected with regard to the means of escape in case of fire and (under the Public Health Acts Amendment Act) as to the provision of suitable and sufficient sanitary conveniences. WORKSHOPS & WORKPLACES. The condition of these was on the whole fairly satisfactory. Ventilation is often defective, but is usually due to neglect on the part of the workers to make use of the means of ventilation provided, they so often appear to have a quite unnecessary dread of fresh air. LAUNDRIES. Many of the smaller laundries are ordinary dwelling houses used for this purpose. It is difficult to keep these in a perfectly satisfactory condition, and the workers are liable to suffer in health from wet floors, steam, and insufficient ventilation. The larger laundries specially built or adapted for this work are generally in a more satisfactory condition. BAKEHOUSES. There are 51 on the register and of these 12 are underground. 97 inspections were made, several were dirty or otherwise unsatisfactory, and orders were given to clean or whitewash. The majority were clean and well kept. OUTWORKERS. These are chiefly women, and the work consists principally in the manufacture of wearing apparel (blouse, dress, tie-making, etc.) 25 The work is done in their own houses and usually under satisfactory conditions. Constant supervision of these workers is necessary in case any infectious disease occurs in the house. When this happens their employers are immediately notified and further work is prohibited until the house is free from infection. Any work on the premises is also disinfected before being returned. Much clerical work is entailed in keeping these lists of outworkers up to date, and considerable trouble is also caused by incorrect addresses being often sent, or addresses of outworkers not belonging to the Borough. AREAS & BOUNDARIES. The Thames forms the southern, the River Roding the eastern boundary (both rivers being tidal), Wanstead Park is the northern, and West Ham the western boundary. The area of the Borough in statute acres is 3,355, including 53 acres of Inland water, 20 acres tidal and 9 acres foreshore. WATER SUPPLY. The Water Supply is from the Metropolitan Water Board's mains. The consumption is about 30 gallons per head per day. In no instance has the constant service been suspended save temporarily in small local areas for the purpose of repairs. CEMETERIES. The four large Cemeteries covering over 250 acres, situated in the northern part of the Borough, and also the Churchyards 26 attached to the two churches of St. Mary Magdalene, East Ham, and St. Mary the Virgin, Little Ilford, have been inspected and found to be satisfactory. ARTIZANS' DWELLINGS. The Corporation own 220 tenement houses replete with every convenience, situated in close proximity to Beckton Gas Works, and Royal Albert Docks. They are of the greatest service to those for whom they were erected. LOCAL INDUSTRIES. The principal local industries are Beckton Gas Works, and the Product Works in connection with the same, the Royal Albert Docks, the Bus and Tramway Depots, together with a number of Factories and Workshops detailed on page 23. BUILDING OPERATIONS. Plans for 456 single tenements, 50 double tenements and 20 shops, a total of 526 have been submitted and approved during the year, as compared with 699 for the previous year. INLAND REVENUE AND CUSTOMS ACT. A number of inspections have been made under the Customs and Inland Revenue Act, 1890, on application from owners for exemption from Inhabited House Duty. These were granted to 42 tenements where they were constructed so as to afford suitable accommodation. DISINFECTION. During the year 1,220 houses were disinfected. The method employed being fumigation by sulphur di-oxide. A number of books from infected houses were also disinfected before being returned to the Public Libraries, the agent here used being Formalin vapour. 27 OPEN SPACES, SWIMMING BATHS, &c East Ham has some five Parks and Pleasure Grounds comprising 160 acres, used for Cricket, Football, Lawn Tennis and other sports, and are, in my opinion, an important factor in East Ham's low death-rate. The Council have apportioned seven acres of land for allotments which are much appreciated by the workmen of the Borough. In the Central Park there is an open-air Swimming Bath, go feet long by 30 feet wide, supplied from the mains of the Water Board. REFUSE DESTRUCTOR. The Refuse Destructor for the cremation of domestic and trade refuse consists of two refuse cells with flues, bye-pass etc, to chimney ranges. Two boilers, each capable of evaporating 7,000 lbs of water per hour, feed water pumps, economiser, and all necessary pertinents to a perfect plant. The heat of combustion is applied to the generation of steam for sewage pumping, so that a substantial saving in the annual coal bill is effected. The refuse itself supplying practically all the fuel necessary. The resultant clinker and ash from the thorough cremation of the refuse is a valuable bye-product of refuse cremation. SEWERAGE. The Council are still giving much time and attention to the perfecting of the Main Sewerage of the district and new Main Sewers are still being constructed. The rapid growth of the Borough and the developement of new estates making immense demands upon the present system. The purity of the effluent and the general conduct of the operation of sewage purification are subject to the control and jurisdiction of the Conservators of the River Thames, whose inspectors regularly visit the Sewage Works, taking away with them samples of the effluent. 28 RAINFALL, 1904.5. Time of Observation, 9 a.m. Month. Total fall in inches. No. of days on which rain fell 0.01 inches and over. Mean rate of fall for rainy days. Greatest fall in 24 hours. Date of greatest fall. 1904. 1905. 1904. 1905. 1904. i9o5. 1904. 1905. 1904. 1905. Inches. Inches. Inches. Inches. January 1.87 1.12 23 10 0.08 0.11 0.30 0.49 12th 16th February 2.52 o.68 23 10 0.11 0.07 0.45 0.17 9th 20th March 1.22 3.00 17 20 0.07 0.15 0.22 0.64 2nd 15th April 0.96 1.57 11 16 0.09 0.09 0.23 0.43 1st&22nd 9th May 1.66 1.00 16 8 0.10 0.12 0.46 0.36 31st 30th June 1.53 3.47 7 18 0.22 0.19 0.46 0.82 1st 5th July 1.58 0.51 10 10 0.15 0.05 0.78 0.18 25th 22nd August 0.65 2.32 9 17 0.07 0.14 075 0.57 31st 28th September 1.31 2.43 9 15 0.14 0.16 0.14 0.88 1st 25th October 1.65 0.89 13 13 0.12 0.07 0.27 0.18 21st 30th November 1.43 2.53 12 21 0.12 0.12 0.37 0.51 10th 1st December 1.94 0.51 17 12 0.11 0.03 0.93 0.10 6th 29th Total Averages 18.32 20.03 167 170 0.11 0.12 0.93 0.88 Dec. 6th Sep. 25th N.B.—The Rainfall is registered by a Rain Gauge 5 ins. in diameter, placed 1 ft. above the ground and 12 5 ft. above sea.level. 29 TABLE 1. Vital Statistics of Whole District during 1905 and ten previous Years :— Year Population estimated to Middle of each Year. BIRTHS. Total Deaths Registered in the Borough. Total Deaths in Public Institution in the Borough. Deaths of Non.residents registered in Public Institutions in the Borough. Deaths of Residents registered in Public institutions beyond the Borough. Nett Deaths at all Ages belong ng to the Borough. Number. Rate.* Under 1 Year of Age. At all AgeB. Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1895 50,000 1,834 36.6 257 140 706 14.1 .. .. 22 728 14.5 1896 57,500 2,015 35.0 299 148 707 12.3 .. .. 22 729 12.6 1897 65,000 2,209 34.0 335 151 822 12.6 .. .. 25 847 130 1898 75,000 2,614 34.8 428 163 964 12.8 .. .. 40 1,004 13.3 1899 88,000 3,028 34.4 529 174 1,201 13.6 .. .. 44 1,245 141 1900 92,000 3,297 35.8 549 166 1,255 13.6 35 .. 48 1,303 14.1 1901 96,000 3,503 36.4 549 156 1,279 13.3 34 .. 178 1,457 15.1 1902 104,023 3,805 36.5 446 117 1,120 10.7 44 .. 122 1,242 11.9 1903 110,451 3,805 34.4 430 113 1,133 10.2 37 .. 132 1,265 11.4 1904 116,902 3,717 31.7 575 154 1,406 12.0 54 2 208 1,612 13.7 Averages for years 1895. 1904. 85,437 2,982 34.9 439 148 1,059 12.5 .. .. 84 1,143 13.3 1905 123,381 3,687 29.8 478 129 1,308 10.5 53 3 220 1,525 12.3 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the Borough. The deaths included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non.residents" is meant persons brought into the Borough on account of sickness or infirmity, and dying in public institutions here; and by the term "Residents" is meant persons who have been taken out of the Borough on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public institutions" taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses, and lunatic asylums. C TABLE II. Vital Statistics of separate Wards in 1905 and previous years: Year. Whole District. Beckton & North Woolwich Ward. Central Ward East. Central Wtard West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Population estimated to middle of each year Births registered. Deaths under 1 vear. j Deaths at all Ages. Population estimated to middle of each year. Births registered. Deaths under year, Deaths at all Ages. Population estimated to middle of each year. Births registered. Deaths under year. Deaths at all Ages. Population estimated to middle of each year. Births registered. Deaths under year. Deaths at all Ages. Population estimated to middle of each year. Births registered. Deaths under 1 year. Deaths at all Ages. Population estin ated to middle of each year. Births registered. Deaths under 1 year. Deaths at all Ages. Population estimated to middle of each year. Births registered. Deaths under 1 year. Deaths at all Ages. 1895 50,000 1834 257 728 1896 57,500 2015 299 729 1897 65,000 2209 335 847 1898 75,000 2614 428 1004 1899 88,000 3028 529 1245 1900 92,000 3297 549 1303 1901 96,000 3503 549 1457 1902 104,023 3805 446 1242 1903 110,451 3805 430 1265 1904 116,902 3717 575 1612 Averages of) Years 1895 to 1904. ! 85,437 2982 439 1143 1905 123,381 3687 478 1525 7870 279 49 149 20,245 656 98 285 22,931 793 84 298 26,841 801 115 337 20,147 514 54 191 25,347 644 78 262 TABLE III. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1905. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in Each Ward. No. of Cases removed to Hospital from each Ward. At all Ages. Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Beckton and North Woolwich Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Total. Beckton and North Woolwich Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Total. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 277 6 92 131 22 26 .. 20 49 49 84 38 37 277 15 28 29 47 15 18 152 Membranous Croup 13 1 7 5 .. .. .. 1 3 6 2 1 .. 13 1 1 2 2 .. .. 6 Erysipelas 129 4 9 15 17 78 6 10 22 37 31 11 18 129 .. .. 1 1 1 1 4 Scarlet Fever 968 9 281 601 55 22 .. 35 129 255 212 149 188 968 22 48 96 89 47 81 383 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 77 .. 5 28 14 29 1 7 21 23 8 5 13 77 5 17 25 4 4 5 60 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever 1 .. .. 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. Puerperal Fever 8 .. .. .. .. 8 .. .. 3 1 3 .. 1 8 .. .. .. 1 .. .. 1 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1473 20 394 781 108 163 7 73 227 371 341 204 257 1473 43 94 153 144 67 105 606 32 TABLE IV. CAUSES OF, AND AGES AT, DEATH DURING YEAR, 1905. Causes of Death. DEATHS AT THE SUBJOINED AGES OF RESIDENTS" WHETHER OCCURRING IN OR BEYOND THE BOROUGH. Deaths at all ages of "Residents" belonging to the Wards, whether oc- cubrrng in ob beyond the Borough. Total Deaths whether of " Residents " or non" Residents "in Public Institutions in the Borough. All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Beckton & North Woolwich Ward, Central East. Central West. Manor Park Waid. Plashet East. Plashet West, Measles 48 7 37 4 .. .. .. 1 19 14 4 6 4 .. Scarlet Fever 22 .. 11 10 1 .. .. 1 3 7 5 2 4 9 Whooping Cough . 57 25 30 2 .. .. .. 13 8 13 10 3 10 .. Diphtheria & Mem branous Croup 38 4 21 13 .. .. .. 4 10 8 10 4 2 19 Croup 2 .. 2 .. .. .. .. 1 .. .. .. 1 .. .. Enteric Fever 16 .. .. 3 3 10 .. 3 1 2 6 1 3 12 EpidemicInfluenza 12 .. .. .. .. 7 5 1 2 1 6 .. 2 .. Diarrhoea 97 84 8 1 .. 1 3 20 29 21 9 9 9 .. Enteritis 22 13 4 1 .. 2 2 2 8 2 4 4 2 .. Puerperal Fever 2 .. .. .. .. 2 .. 1 1 .. .. .. .. .. Erysipelas 6 3 .. .. .. 3 .. 1 1 2 2 .. .. .. Other Septic Dis 3 .. 2 .. .. 1 .. .. 1 .. 2 .. .. .. Phthisis 106 4 6 8 13 73 2 11 18 23 22 14 18 .. Other Tubercular Diseases 52 15 24 9 1 3 .. 5 11 8 13 7 8 1 Cancer, Malignant Disease 84 .. 1 .. 2 53 28 6 10 16 15 14 23 1 Bronchitis 133 45 10 .. 1 31 46 14 26 26 27 20 20 .. Pneumonia 136 33 32 5 7 38 21 9 20 29 30 18 30 2 Pleurisy 5 .. .. 1 .. 3 1 .. I 2 1 .. 1 .. Other Diseases of Respiratory Organs 6 .. .. .. 1 4 1 .. 3 .. 1 .. 2 .. Alcoholism 8 .. .. .. .. 8 .. 1 .. 2 4 1 .. .. Cirrhosis of Liver 10 .. .. .. .. 9 1 1 4 1 .. 1 3 .. Venereal Diseases 2 1 .. .. .. 1 .. .. 1 .. .. .. 1 .. Premature Birth 61 61 .. .. .. .. .. 4 21 9 14 8 5 .. Diseases and Accidents of Par turition 13 4 .. .. 1 8 .. 3 3 3 2 1 1 .. Heart Diseases 111 8 3 7 9 64 20 8 22 21 24 14 22 .. Accidents 36 12 7 4 .. 8 5 1 8 11 6 7 3 6 Suicides 8 .. .. .. 1 7 .. 1 1 2 3 .. 1 .. Inanition and Marasmus. . 67 63 4 .. .. .. .. 3 4 8 21 14 17 .. Convulsions 31 24 7 .. .. .. .. 6 4 2 8 1 10 .. Senility 72 .. .. .. .. .. 72 8 7 11 15 13 18 .. Nephritis and Bright's Disease 23 1 .. 2 2 13 5 3 2 3 7 3 5 .. Hemiplegia and Apoplexy 48 .. .. .. .. 29 19 4 5 11 10 7 11 .. Murder 2 2 .. .. .. .. .. .. .. 1 .. .. 1 .. All other causes 186 69 16 11 9 50 31 13 31 39 56 21 26 2 All causes 1525 478 225 81 51 428 262 149 285 298 337 194 262 53 TABLE V. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Under 1 Wreek. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under 1 Year. All Causes- Certified 82 22 15 28 147 48 43 34 30 32 24 26 21 25 28 20 478 Uncertified - - - - - - - - - - - - - - - - Common Infectious Diseases. Measles - - 1 - 1 - - 1 - - - 1 1 1 - 2 7 Diphtheria: Croup - - - - - - - - - 1 1 - - - 1 1 4 Whooping Cough - - - - - - 5 2 3 3 4 2 2 2 2 - 25 Diarrhœal Diseases. Diarrhoea, all forms - - 1 4 5 8 8 7 5 7 8 9 9 9 6 3 84 Enteritis (not Tuberculous) - - - - - 1 - 4 3 2 - - 1 2 - - 13 Gastritis, Gastro-intestinal Catarrh - - 1 - 1 2 - - - - - - - - - - 3 Wasting Diseases. Premature Birth 38 8 5 5 56 4 - 1 - - - - - - - - 61 Congenital Defects 15 2 1 1 19 2 2 - - - - - - 1 - - 24 Injury at Birth 4 - - - 4 - - - - - - - - - - - 4 Atrophy, Debility, Marasmus 17 7 4 6 34 16 14 5 6 - 1 3 1 1 1 1 83 Tuberculous Diseases. Tuberculous Meningitis.. - - - - - - 1 - - 2 - - - 1 - 2 6 Tuberculous Peritonitis: Tabes Mesenterica - - - - - 2 - 2 - 1 1 - - - 2 1 9 Other Tuberculous Diseases - - - 1 1 - 1 - - - 1 1 - - - - 4 Erysipelas 1 - - 1 2 1 - - - - - - - - - - 3 Syphilis - - - - - 1 - - - - - - - - - - 1 Rickets - - - - - - - - - - - - - - - 1 1 Meningitis (not Tuberculous) - - - - - - - - - 1 1 - - - 4 1 7 Convulsions - 2 - 3 5 3 2 3 1 2 1 1 2 1 2 1 24 Bronchitis 1 1 1 4 7 3 5 4 6 7 1 3 2 3 3 1 45 Larnygitis - - - - - - - - - - - - - 1 - - 1 Pneumonia 1 2 - 2 5 3 2 1 4 3 2 5 1 2 3 2 33 Suffocation (overlaying) 1 - 1 1 3 1 - 3 - - 2 - - - - 1 10 Other Causes 4 - - - 4 1 3 1 2 3 1 1 2 1 4 3 26 82 22 15 28 147 48 43 34 30 32 24 26 21 25 28 20 478 Births in the year-Legitimate, 3613; Illegitimate, 77. Deaths from all Causes at all Ages, 1,525. 34 APPENDIX I. REPORT ON THE ISOLATION HOSPITAL HOSPITAL SUB-COMMITTEE. The Mayor (Alderman J. H. Bethell, J.P., M.P.) The Deputy Mayor (Councillor G. Pratt, C.C.) Mr. Alderman J. Brooks, C.C. Mr. Councillor Ford. Mr. Councillor Hill. Mr. Councillor Northfield. 35 THE ISOLATION HOSPITAL. The present accommodation consists of the Hospital at Roman Road, the Convalescent Home at Rancliffe House, and the Laundry and Ambulance Station at Clock House. THE HOSPITAL. This consists of:— An Administrative Block Two Diphtheria Wards (20 beds) Two Typhoid Fever Wards (20 beds) Three Scarlet Fever Wards (35 beds) These are situated on a site of about eight acres of ground, enclosed by a fence 6ft. 6in. high. Adjoining this and belonging to the Hospital are nine additional acres to provide for future extension. The above are wood and iron buildings on brick foundations. The Administrative Block is a building of two storeys, and contains good accommodation for the Matron and staff, there is also a well equipped kitchen and a dispensary. The Diphtheria and Typhoid Wards are situated at either end of the Administrative block. Each ward is 40 feet by 24 feet and contains ten beds. The buildings are excellent of their kind, they are well equipped and for the present give good accommodation for the needs of the Borough. The Scarlet Fever Block is a separate building, and the accommodation for the staff is also separate from the rest of the Hospital. This is an old building and though it has done good service in the past, it is now quite inadequate for the needs of the Borough. The work in this part of the Hospital has been heavy throughout the year, and I think the staff are deserving of praise for the 36 cheerful manner in which they have worked under conditions of considerable discomfort. The scheme for the new Scarlet Fever block has now been sanctioned, and by the time this report is in the press, I sincerely hope the work of erecting it will have commenced. The Disinfector for the Hospital is a Thresh emergency one. This has been of great value, but in the new scheme a permanent building with steam disinfector is to be provided. This will be a great improvement, the work will be done in less time and more thoroughly. The Hospital Mortuary is a small corrugated iron building and is not well adapted for the purpose. I hope the next extension at the hospital will include a more convenient and suitable building. Rancliffe House. This is a large brick building situated in the Central Park. It is used as a Convalescent Home for Scarlet Fever patients who are kept there for a few-weeks before being sent home. It serves a useful purpose, and gives an additional 27 beds for treating this disease. 1 hope however, in the near future that an additional ward will be built for this purpose on the Isolation Hospital site. It would effect a great economy in the working expenses to have the whole under one management, and the constant transference of patients would be avoided. The Laundry for the use of both Hospital and Convalescent Home is situated at the Clock House. This is by no means well adapted for the large amount of work now required. The extension scheme now in hand provides for a new and well equipped laundry on the Hospital Site, this will be a most welcome and much needed improvement. 37 WORK OF THE HOSPITAL. With the growth of population the work of the Hospital naturally increases year by year, and the past twelve months has probably been more arduous than any of its predecessors. The total number of patients treated, that is the number admitted during the year, added to those remaining in the Hospital on December 31st was 567. They were distributed as follows:— Scarlet Fever In Hospital, 31st Dec., 1904. Admitted 1905. Total. Discharged. Transferred to C.H. Died. Case Mortality per cent. Remaining in Hospital, 31st Dec., 1904. 34 358 392 41 307 9 2.5 35 Diphtheria 23 153 176 147 - 20 11.9 9 Typhoid Fever 2 56 58 42 - 10 19.2 6 Total 59 567 626 230 307 39 67 50 Average daily number of patients in Hospital, 45. „ „ Convalescent Home, 23. SCARLET FEVER. During the year 392 cases were treated. Many of them were of a severe type, and complications were somewhat frequent. These chiefly consisted of Albuminuria, Nephritis, Otorrhœa and Adenitis. There were also several cases of combined Scarlet Fever and Diphtheria. 38 The following table gives the chief statistics as compared with the previous year:— 1904. 1905. Cases treated in Hospital 355 392 Deaths 5 9* Case Mortality per cent. 1.4 2.5 *Including two deaths in the Convalescent Home. The case mortality is higher than during the previous year probably indicating a more severe type of disease. Owing also to the increased number of cases the Wards were on many occasions very full, and any overcrowding of fever cases invariably results in a higher rate of mortality. DIPHTHERIA. 172 cases of Diphtheria were treated during the year, and 4 cases of Membranous Croup. It is satisfactory to report that, despite the increase in population, both the number of cases notified and the number admitted to Hospital was less than that of the previous year. I am glad to report the death-rate was also considerably less, although the type of disease was of quite average severity. In carrying out the treatment, the unremitting care and attention of the Sister and Nurses in charge contributed materially to the good results obtained. 1904. 1905. Diphtheria 232 172 Deaths 31 20 Membranous Croup 5 4 Deaths 1 - Total cases 237 176 Case Mortality per cent. 13.5 11.9 ENTERIC (TYPHOID) FEVER. 56 cases were admitted, and with* two cases remaining in from the previous year, gives a total of 50 cases treated during the year. 19 more cases were admitted than in the previous year, and the type of disease was also rather more severe. 39 1904. 1905. Enteric cases treated 44 58 Deaths 6 10 Case Mortality per cent. 13.6 19.2 The following table gives the age and sex distribution of the cases admitted, and ages of the fatal cases:- ENTERIC FEVER. MALES. FEMALES. Age Admitted. Died. Admitted. Died. Under 5 2 - 2 - 5 to 10 2 - 2 1 10-15 8 2 7 - 15-20 1 - - - 20-25 6 2 4 - 25-30 3 - 2 1* 30-35 3 1 2 1 35-40 1 1 2 - 40-45 3 1 1 - 45-50 3 - 1 - 50 and over - - 1 - Total 32 7 24 3 *This patient was a Nurse in the Typhoid Ward. She had a very severe attack, which, I regret to state, soon had a fatal termination. RANCLIFFE HOUSE. 322 convalescent cases of Scarlet Fever were treated here during the year. 308 cases were transferred from the hospital and 14 admitted direct from their homes. Complications frequently arise during convalescence from Scarlet Fever, and 2 deaths occurred among the patients here. 40 HOSPITAL STAFF. This consists of:— AT HOSPITAL. Matron, 3 Sisters, 8 Staff Nurses, 6 Probationers, 2 Cooks, 7 Maids, 2 Male Attendants, AT CONVALESCENT HOME. Sister-in-charge, 2 Staff N urses, 2 Probationers, 1 Cook, 2 Ward-maids, 1 Boy. AMBULANCE STATION. I Coachman and assistant. LAUNDRY. 9 Laundresses. HEALTH OF THE STAFF. With the exception of two Nurses at the Hospital, who contracted Enteric Fever, the health of the staff was good, and no other case of Infectious Disease occurred among them. 41 APPENDIX II. REPORT TO THE EDUCATION COMMITTEE. This report refers only to the last two months of the year. I commenced my duties in the Borough on November 1st, 1905, and the work of Medical Officer to this Committee was added to the existing duties of Medical Officer of Health and Medical Superintendent of the Isolation Hospital. The duties of the office have not been defined, but the experience so far shows that they cover a very wide range, and occupy a considerable portion of my time. They also have added much to the work of my chief clerk, Mr. Kendall. The following paragraphs briefly indicate the nature of the work so far done:— (1) The examination of scholars excluded for suspected Infectious Disease. (2) The inspection of schools or particular classes, owing to prevalence of Infectious Disease. (3) Visiting and examining mentally or physically fective children. (4) Examining teachers absent from duty, owing to prolonged illness. (5) The examination of truant children, and the signing of certificates for their admission to Truant Schools. (6) The examination of school buildings. (7) Attending Committees and Sub-Committees. In addition to these, there have been almost daily consultations with the Secretary on minor matters impossible to classify. A few of the more important of the above duties will now be mentioned in more detail. INFECTIOUS DISEASES. Scarlet Fever, Measles, and Mumps, were all very prevalent during November and December. 42 With regard to Scarlet Fever, neither parents nor teachers sufficiently realize that many cases of this disease are very mild in character. The popular opinion that Scarlet Fever must always be a severe illness is quite incorrect, for it is not at all uncommon to find a child "peeling" from this disease who has not been absent from school a day. I have found several such cases during the past two months. These mild, unrecognised cases are the chief causes of school epidemics. MEASLES. Despite frequent statements to the contrary, people will persist in regarding this disease as a trifling matter, and yet the death-rate is much higher than that from Scarlet Fever. For the ten years, 1881-1890, the death-rate from the two diseases in England and Wales was as follows :— Measles 44 per 10,000 people. Scarlet Fever 30 per 10,000 people. Measles in a school is very difficult to check, for it is highly infectious several days before the appearance of any rash. Owing to this, school closure is more often necessary for this disease than for Scarlet Fever. On 16th October, the Infants' Department of Sandringham Road School was closed for Measles for a period of three weeks. This was the only school closed for Infectious Disease during the year. PREVENTION OF INFECTIOUS DISEASES. In consequence of the fact that Infectious Diseases are scarcely ever absent from the schools, and as the attendance of the scholars is often considerably diminished from these causes, I have had a number of cards printed, giving the symptoms of onset of all the commoner Infectious Diseases, and one of the cards has been placed in every classroom. I trust by this means many cases will be recognised by the teachers, and so enable them to be promptly isolated. 43 The subject of Infectious Diseases in schools is from a Public Health standpoint closely allied with the attendance of children under five years of age, and merits discussion from this point of view. Statistics prove that children under five are not only more liable to be attacked by Infectious Disease, but if attacked there is a far greater risk of the attack proving fatal. The following figures for England and Wales for the ten years 1881 to 1890, clearly show this:— Under Five. All ages. Death-rate from Measles 3.1 per 1000 0.4 per 1000 That is, the death-rate of children under five is nearly eight times as great as that at all ages. The death rate from Scarlet Fever during the same period was:— Under Five. At all ages. 1.7 per 1000. 0.3 per 1000 In this case the death-rate of children under five is nearly six times as great. Dr. Whitelegge has well expressed this, as follows:— "In shielding a child against infection during the first few years of life, there is a double gain; every year of escape from Scarlet Fever renders him less and less susceptible, and secondly, even if he should ultimately take the disease, every year that the attack is deferred reduces the danger to life which it brings." The same applies with almost equal force to Measles, Whooping Cough and other Infectious Diseases of children. The statistics of East Ham are interesting from this point of view. I find that from April, 1900 to December, 1905, the closing of schools for Infectious Diseases has been enforced on 20 occasions. Once only has an entire school been closed, but on every other 44 occasion it was the Infants' Department alone that was affected. This clearly shows the great preponderance of Infectious Disease in the Infants Department. The frequent occurrence of illness amongst infants is also serious from another point of view, for when an infant is attacked by Infectious Disease, its brothers and sisters have also to be excluded from school. They therefore frequently lose many weeks of valuable time, and there is moreover a considerable loss of grant owing to the diminished school attendance. From an educational point of view there is also no advantage in admitting children under five, for children commencing at the age of six or seven soon overtake those commencing earlier. In Switzerland, which Sir John Gorst has described as "probably the best educated country in the world," children are not admitted under 7, while in no other country in Europe are children admitted under 6. The too early stimulation of the imperfectly developed brain of a young child may also lead to premature arrest of its growth, while eye defects may be seriously increased or even caused unless care is taken to avoid "near" work, or work with very small objects. If, therefore, there is no educational advantage and if the presence of these young children in elementary schools is associated with an increased amount of Infectious Disease, it follows that it must also be financially unsound, as it causes a waste of funds in providing buildings and staff without any corresponding advantages. Therefore, speaking solely from the point of view of Public Health, children under 5 should certainly be excluded. Personally, I should be glad if the age for admission was raised to 6 or even 7 years of age. 45 EXAMINATION OF SCHOOLS AND SCHOOL BUILDINGS. Pressure of other work has prevented this being done systematically, but it is highly desirable that every school should be thoroughly examined, at least once or twice a year. In most of those visited the subject of ventilation did not appear to receive the attention it deserves, closed windows being the rule rather than the exception. A wise Legislature fixes the minimum amount of air-space in a common lodging-house at 300 cubic feet, while in a Public Elementary School the average air space per child is only 120 cubic feet, often less. This is very inadequate. The air in a class-room is foul within 5 minutes, unless some inlet for fresh air is provided. In a foul atmosphere neither good health nor good educational results are possible, for it is difficult to get knowledge into brains rendered dull and sleepy by carbonic acid poisoning. Carnelly recently investigated the results in 3 schools, after the installation of improved methods of ventilation, as compared with 15 schools badly ventilated. The increase in passes was as follows:— Reading 95.6 to 99.6 Writing 90.4 to 97.8 Arithmetic 84.2 to 92.4 Grant earned 19/6 to £1/1/8 The necessity for the constantly open window is, therefore, obvious, not only from a hygienic, but also from a pecuniary point of view. Several physically or mentally defective children have been examined and reported on. The provision of a centre for the instruction of these children has been mentioned, but their number at present is small. Much additional work might and should be done, if time or more help were forthcoming. At present it is impossible D 46 without assistance to undertake the work of systematically examining the eyes, ears, and throats of children, and yet this is very important, for defects in the sight or hearing, or the presence of adenoids in the throat, prevent the child obtaining the benefit it otherwise would derive from school attendance, and such defects also handicap the teachers in their efforts. The aim of school hygiene is to improve educational results, by discovering and remedying any defects which prevent a child getting full value for the money spent on it. To thoroughly examine the enormous number of children in our schools would occupy almost the whole of my time, and is therefore impracticable. It is, however, very desirable that this should be done. It would be of incalculable benefit to the children, it would materially help the teachers, and would also be of very great assistance in checking infectious disease, for cases would be promptly discovered and isolated. As children are a National asset, it should be a National care to see that the children are rendered of the utmost value. More help, therefore, should undoubtedly be forthcoming, from National sources, to assist a district with such a heavy educational burden as ours. I therefore hope that some assistance will soon be given, and so enable this necessary and important work to be done. REPORT OF THE CHIEF SANITARY INSPECTOR. 49 Annual Report of the Chief Sanitary Inspector. To His Worship the Mayor, the Aldermen and Councillors of the Borough of East Ham. Mr. Mayor and Gentlemen, I herewith beg to submit for your consideration my eleventh Annual Report of the work accomplished by the Sanitary Inspectors during the year ended 31st December, 1905. INSPECTION OF THE BOROUGH AND REMOVAL OF NUISANCES. In investigating complaints lodged, notifications of Infectious Diseases received, house-to-house inspections, etc., 3404 primary inspections were made as under:— Beckton and . Woolwich Ward. Central East Ward. Centra West Ward. Manor Park Ward. Plashet East Ward. Plashet West Ward. Total January 11 42 59 79 17 56 264 February 42 55 55 60 12 32 256 March 17 78 57 77 24 31 284 April 13 70 28 70 18 37 236 May 52 73 50 69 53 61 358 June 69 29 42 62 36 53 291 July 30 44 45 51 24 86 280 August 19 46 44 43 37 24 213 September 52 40 60 82 28 57 319 October 36 59 54 113 43 56 361 November 40 44 46 90 39 64 323 December 12 25 37 72 24 49 219 Totals 393 605 577 868 355 606 3404 There have been 3407 nuisances discovered in the course of the inspections made. 1065 Preliminary Notices were served, and in cases where the provisions were not complied with, the service of 98 Statutory Notices was necessary. 168 Dust Bin Notices, and 50 Notices to provide a Water Supply have also been served. 50 In only 2 cases has it been necessary to institute legal proceedings for non-compliance with the Council's Statutory Notices. In one case the owner was fined £6 and costs for allowing two houses to be occupied without water, and in the second case the owner was summoned to pay the costs incurred in re-constructing the drains of two houses, but before the case was heard the money was paid and the case settled out of Court. It will be noticed from the following table that the nuisances discovered are in excess of the Notices served. This is owing to the fact that one Notice will call for the abatement of several nuisances, and in many instances personal interviews were obtained and the required works executed by the respective persons liable without the service of a Notice. The following Table sets forth the details of work done:-— Beckton & N. Woolwich Ward Central East Ward Central West Ward ManorPark Ward Plashet East Ward Plashet West Ward Total. Premises found in a sanitary condition 59 237 250 354 125 219 1244 Walls and ceilings dirty and dilapidated 6 54 108 116 70 101 455 Yards improperly paved and dilapidated 14 33 49 57 21 85 259 Forecourts unpaved 2 10 53 13 21 70 169 Defective drains and connections 155 73 78 44 19 116 485 Defective w.c. traps — 1 1 7 1 2 12 Defective flushing apparatus, or no water to w.c. 12 29 23 44 23 18 149 Foul and broken soil pans 9 24 65 44 31 84 257 Defective drain ventilating shafts 2 13 10 14 9 13 61 Defective rainwater pipes and eaves gutters 2 15 15 26 11 11 80 Rainwater pipes directly connected to drains - 2 1 2 — 13 18 51  Beckton & N. Woolwich Ward. Central East Ward Central West Ward Manor Park Ward Plashet East Ward Plashet West Ward Total. Roofs leaky — 22 19 21 16 92 Defective sink waste pipes 3 15 5 8 4 2 37 Houses without water (M.W. Board) 2 7 4 33 15 25 86 Drinking water cisterns without covers 2 74 48 120 43 36 323 Drinking water improperly stored and dirty cisterns 2 19 3 17 7 8 56 Dilapidated floors 1 11 4 9 2 5 32 Insufficient under- floor ventilation 2 18 12 38 17 31 118 Dampness 1 2 6 17 5 8 39 Accumulations 16 10 19 29 11 13 98 Inundations — — — 2 2 2 6 Overcrowding 2 4 1 15 4 2 28 Unsound food — 4 1 2 1 — 8 No dust bins — 2 12 17 4 15 50 No manure bins — — — 1 1 1 3 Animals improperly kept - 4 2 19 2 3 30 Breaches of Byelaws 7 10 5 30 4 17 73 Gipsies removed 66 73 — 16 — — 155 Other nuisances 8 37 30 74 27 52 228 Drains tested and proved sound... 134 184 186 211 140 123 978 OVERCROWDING. In previous reports I have referred to overcrowding as an inevitable consequence of high rents. With the great bulk of working men with a precarious income it is impossible for them to provide as much air space as is essential for the health of their 52 families, and they have to choose between overcrowding or underfeeding. In nearly every case that I have investigated during the year poverty has been the primary cause. INFECTIOUS DISEASES. The infected houses are immediately visited by an Inspector upon receipt of the notification from the Medical Practitioner. The origin of the disease is as far as practicable traced, and a detailed report prepared for the Medical Officer of Health. The premises are inspected, sanitary appliances examined, and drains tested, and where defects are discovered, the necessary steps are taken to have them remedied. URINALS. There are eight Public Urinals, exclusive of those in the Schools, which are cleansed daily by a man, whose duty it is to maintain them in a clean and proper manner. The external urinals attached to public-houses, have been regularly inspected, and the necessary steps taken to keep them in proper condition. DAIRIES & COWSHEDS. There are three registered cow-sheds and 151 dairies in the Borough. During the year 35 dairymen and purveyors of milk have been added to the Register. 161 inspections were made and the work of cleansing, limewhiting, etc., has been carried out. The general condition may be said to be satisfactory. The following is a list of cow-houses:— Forest View Farm, Rear, 316, High Street North, Shaftesbury Road. 53 SLAUGHTER HOUSES. There are 15 licensed and registered slaughter-houses which have been periodically visited and kept under regular supervision. Cleansing and lime-whiting have been done twice during the year, in accordance with the Bye-laws. The following is a list of Slaughter-houses:— Forest View Farm, Greenhill Grove, Rear, 363, Green Street, Rear, 14, High Street North, Rear, 170, High Street North, Rear, 330, Katherine Road, Rear, 89, Plashet Grove, Rear, 32A, Plashet Lane, Rear, 638, Romford Road, Rear, 626, Romford Road, Rear, 28, Romford Road, Rear, 24, Wakefield Street, Shaftesbury Road, Whitta Road. BACK PASSAGES. The secondary means of access at the rear of business premises are frequently allowed to get into an insanitary condition. These passages are used in common by the several frontagers and that which is generally everybody's work to keep clean seldom gets performed. Much useful work has been done during the year under the East Ham Improvement Acts, to abate nuisances in connection with these passages by calling upon the responsible person to have them paved and drained. PETROLEUM LICENSES. In consequence of the demand for petrol, more Petroleum Licenses have been granted, necessitating more inspections and supervision. 54 In every case the strictest care is taken to enforce the provisions of the Act and conditions upon which the licenses are granted. FACTORIES & WORKSHOPS. Factories, Workshops, Laundries, Domestic Workshops are increasing every year and at present there are 179 on the Register. These premises are regularly inspected and Notices served calling for the abatement of nuisances when found to exist. HIGHWAY REFUSE. The removal of Trade Refuse is not an obligatory duty falling upon the Local Authority, but the policy of the Council has been for many years to collect Tradesmen's Refuse free of charge when placed in a receptacle and put in a convenient place outside the premises ready for collection by the scavenger. This method works well and is a great factor in keeping the streets clean and pieces of vacant land from becoming dumping grounds for all kinds of offensive Trade Refuse. I am still of opinion that the Council's policy is an economical, efficient, and sanitary method of dealing with an untidy source of annoyance, and notwithstanding criticism from inexperienced persons, I hope in the interest of Public Health the present system will continue. GIPSIES. East Ham has always been the happy hunting ground for these undesirable visitors, and no doubt will continue to be so until the vacant land is covered with houses. Some 155 caravans or tents have been dealt with during the year. Notices are served upon these van dwellers and squatters to furnish their dwellings with a domestic supply of water; as this is impracticable, they take their departure rather than incur the penalties under the East Ham Improvement Act. 55 UNSOUND FOOD. 8 consignments of food have been destroyed as being unfit for human food. COMPLAINTS. 871 were received during the year, 545 written and 326 verbal, each of which received early attention. The nature of the complaints was varied, as some inhabitants had peculiar notions of the powers of the Sanitary Inspector, but most of the complaints received refer to bad smells which emanate from foul sink waste pipes, gullies, water closet traps and the " alleged " fresh air inlets. DRAIN TESTING. During the year 1475 drains have been tested with chemicals, smoke, and water and in 497 instances defects were proved to exist in the drains, traps or connections. The usual sanitary notices were served, dealing with the defects. RE-CONSTRUCTION OF DRAINS. A very great deal of work has been performed by re-constructing drains. In the North Woolwich Ward new sewers have been constructed in nearly all the streets, which afforded opportunities of obtaining more efficient falls to the house drains, which have been in an unsatisfactory condition for some years past, but in consequence of the shallowness of the sewers it was impracticable to improve matters, until the new sewerage scheme was effected. It will be seen from the following statement that some 200 house drains have been re-constructed:— 1 to 9 Storey Street, 2 to 6 Storey Street, 18 to 32 Storey Street, 21 to 31 Storey Street, 14 to 16 Storey Street, 61 to 63 Storey Street, 56 65 to 73 Storey Street, 26 Claremont Street, 118 to 126 Elizabeth Street, 11 to 22 Francis Street, 41 to 55 High Street, North Woolwich, 118 to 136 Elizabeth Street, 36 and 38 High Street, North Woolwich, 128 and 136 Elizabeth Street, 66 to 76 Claremont Street, 47 to 61 Claremont Street, 41 Claremont Street, 78 to 80 Albert Road, 76 Albert Road, 74 Albert Road, 75 to 97 Elizabeth Street, 29 and 31 Glenister Street, 22 to 32 Glenister Street, 50 to 60 Claremont Street, 9 Elizabeth Street, 22 to 38 Albert Road, 98 to 100 Albert Road, 106 Albert Road, 108 Albert Road, 110 Albert Road, 112 Albert Road, 102 and 104 Albert Road, 36 Albert Road, 1 to 9 Arthur Street, 371 to 379 Barking Road, 88 Wellington Road, 2, 3, 4, 5, 6 and 7 Market Place, Barking Road, 31 to 45 Bartle Avenue, 16 to 32 Market Street, 94 to 96 Talbot Road, 79 and 81 Telham Road, 96 to 108 Talbot Road, 690 to 694 Romford Road, Forest Cottage, Forest View Road, 79 to 99 Elizabeth Road, 57 11 to 25 Waterloo Road, 19 to 25 Cleves Road, 2 to 18 Sherrard Road, 64 to 70 Plashet Lane, 31 to 41 Whittaker Road, Golden Fleece Public House, Capel Road. COMBINED DRAINS. As nearly the whole of the drains which have been re-constructed are old properties, the cost of carrying out the work would have fallen upon the District but for the passing of the East Ham Improvement Act, 1903, which defines a drain so as to include all combined drains within its meaning. It will be seen that this Section is a great financial boon to the Borough for considerably over £1,000 worth of work of this character has been executed during the past year. In the event of stoppage, the Council send two men who are wholly employed for this special work of drain clearing, and are intimately acquainted with the construction of the drains, knowing exactly the position of the Inspection Chambers, and in the event of the drains becoming stopped, they know where to open to clear, while strangers usually commence by breaking pipes to unstop a drain. In the interest of Public Health, the Council's system of clearing drains is to be highly commended, for if the work is left to the individual owner to do, he usually calls in a person whom he thinks to be a "cheap man," with the result that permanent damage is done and covered up, and not until perhaps disease necessitates the drains being tested is the work of the jobber disclosed. During the year 2703 house drains have been cleared by the Council's men, and it is essential to all concerned that stoppages should be cleared speedily and efficiently. 58 HOUSES WITHOUT WATER. There have been 86 official intimations from the Metropolitan Water Board of the water supply being cut off from inhabited houses. Inspections were at once made, and a 48 hours' Notice served upon the persons liable, to re-instate the water supply. Under the provisions of Section 57 of the East Ham Improvement Act, 1898, there is a penalty of £5 for permitting a house to be occup ed without water. Two convictions were obtained under this section in December, and fines amounting to six pounds and costs imposed. REMOVAL OF HOUSE REFUSE. The work of collecting the House Refuse has been for many years vested in the Public Health Department. The Borough is divided into six sub-districts for this purpose, being a division of the Borough for each working day of the week, so that each householder knows the day and approximately the hour to expect the Dustman. During the year very few complaints have been received in respect to non-collection of dust. The Council's regular Dustmen are trustworthy servants and experienced at their work which has been performed satisfactorily. Four more roller-top vans have been purchased, bringing the number of these vans to 14. They are a great improvement on the old style of carts, holding considerably more and making the number of journeys to the shoot less. Being constructed so that only one quarter of the top cover is open at a time, reduces the possibility of dust and paper 59 blowing about to a minimum, and the spilling of the refuse on the highway when nearly full, an evil unavoidable by the old method of collecting in open carts. The policy of the Council has been to gradually replace the old carts, by purchasing new vans out of current rate. There are 27 men and a responsible foreman engaged in this work. 168 Notices have been served on Owners to supply portable iron dust bins. In 145 cases they have been complied with, but in 23 cases the Borough Council did the work of providing them and recovered the cost. The following table shows the number of loads of refuse collected for the past year:— DUST COLLECTION. NUMBER OF LOADS COLLECTED DURING 1905 FROM Beckton and North Woolw'h Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Total Loads Collected per Month. JANUARY 70 174 207 278 214 277 1220 FEBRUARY 53 158 209 218 169 263 1070 MARCH 51 171 255 227 182 324 1210 APRIL 51 187 213 217 167 254 1089 MAY 67 166 204 276 221 291 1225 JUNE 49 173 215 208 168 287 1100 JULY 55 178 204 250 166 245 IO98 AUGUST 57 142 173 200 184 273 1029 SEPTEMBER 52 194 224 200 159 237 1066 OCTOBER 68 173 203 26l 203 256 1164 NOVEMBER 53 170 196 222 175 318 1134 DECEMBER 53 212 246 219 158 252 1140 679 2098 2549 2776 2166 3277 13,545 61 DISINFECTANT DEPOTS. For the convenience of the inhabitants there are three depots for the distribution of disinfectants situated in convenient positions and open daily from 9 a.m. to 11 a.m. From these stations during the period under consideration 37 tons of powder and 2,500 gallons of disinfecting fluid were distributed to persons applying for it with an order from the Department. SCHOOLS. The Sanitary arrangements of both the Public and Private Schools have been regularly inspected, and were usually found to be in a satisfactory condition. The refuse is collected weekly by the Council's staff. TEMPORARY BUILDINGS. The Sanitary Inspectors in visiting the rear of premises have opportunities of observing Temporary Buildings erected contrary to the Council's Bye-laws, and in cases where they do not constitute a sanitary nuisance capable of being dealt with by the Public Health Department, it is the practice to report them to the Surveyor for his attention. (Signed), Joseph G. Banks, A.R. San. I., Chief Sanitary Inspector, 63 INDEX. * * * A page. Alcoholism 18 Area 2, 25 Artisans' Dwellings 26 B Back Passages 53 Bakehouses 24 Births 2, 4 Boundaries 25 Building Operations 26 C Cancer 17 Cemeteries 25 Cirrhosis of Liver 18 Complaints 55 Consumption 14 Convulsions 9 Cowsheds 52 Customs and Inland Revenue Act 26 D Dairies 52 64 INDEX— continued,. Deaths 2, 6, 32 Debility 9 Density of Population 4 Diarrhœa 8, 13 Diphtheria 13, 38 Disinfectant Depots 61 Disinfection 26 Drain Testing 55 Drains 55 Dust Collection 58 E Enteric Fever 12, 38 Enteritis 8, 13 Examination of Schools 45 F Factories 22, 54 H Highway Refuse 54 House Refuse Removal 58 Houses without Water 58 I Illegitimate Births 4 Infantile Mortality 7, 33 Inquests 21 Inspection of the Borough 49 Isolation Hospital 35 65 INDEX— continued. L Laundries 24 Legal Proceedings 50 Local Industries 26 M Marasmus 9 Measles 13, 42 N Notification of Infectious Diseases 18, 31 Number of Empty Houses 4 Number of Houses in Course of Construction 4 Number of Inhabited Houses 2, 4 O Open Spaces 27 Outworkers 24 Overcrowding 51 P Passages 53 Petroleum Licenses 53 Phthisis 14 Population 2,4 Prevention of Infectious Diseases 42 Puerperal Fever 18 66 INDEX— continued. R Rainfall 228 Rancliffe House 36, 39 Refuse Destructor 27 Removal of Nuisances 49 Report to Education Committee 41 S Scarlet Fever 12, 37 Schools 61 Sewerage 27 Slaughter Houses 53 Smallpox 13 Soil and Situation 2 Summary of Report 2 Swimming Bath 27 T Temporary Buildings 61 Tubercular Diseases 14 Typhoid Fever 12, 38 U Urinals 52 Uncertified Deaths 7 Unsound Food 55 V Vital Statistics 29, 30 67 INDEX— continued. W Ward Death Rates 6 Water Supply 25 Whooping Cough 14 Workshops 22, 54 Z Zymotic Diseases 10