EA S 45 BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report ON THE Health and Sanitary Condition of the Borough BY G. SOWDEN, M.D., D.P.H., MEDICAL OFFICER OF HEALTH, together with the report of the CHIEF SANITARY INSPECTOR For the Year ended 31st December, 1907. South Essex Printing and Publishing Co., Ltd., High Street South, East Ham, E. 1907. TO HIS WORSHIP THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF EAST HAM. Mr. Mayor and Gentlemen,— I have the honour to submit, in compliance with the requirements of the Local Government Board, my third Annual Report dealing with the Health and Sanitary condition of the Borough during 1907. The death rate was the lowest ever recorded in the Borough, being only 11.0 per 1,000, the average rate during the past 10 years being 13.0 per 1000. The Infantile Mortality rate is also the lowest hitherto recorded, while the Zymotic death note shows a considerable decrease. Included in the Report is an account of the work of the Isolation Hospital, and also a record of the work done in connection with the Public Elementary Schools. The Report made to the Council on the Education (Administrative Provisions) Act, dealing with the Medical Inspection of school children, is also included. I am pleased to have this opportunity of expressing my great appreciation of the work and loyal co-operation of the Staff of the Public Health Department, and also of the Matron and Staff of the Isolation Hospital. I am, Gentlemen, Yours faithfully, G. SOW DEN, M.D., D.P.H., Medical Officer of Health. Town Hall, East Ham, March, 1908. BOROUGH.—Birth-rate, 27.0 Death-rate, 11.0 Zymotic Death-rate, 1.77 Infantile Mortality, 105 Density of Population, 41 BOROUGH OF EAST HAM. PUBLIC HEALTH COMMITTEE. Mr. Councillor W. C. Ford, J.P. (Chairman), The Mayor (Alderman H. Osborn, J.P.). The Deputy-Mayor (Mr. Councillor T. Hassan Cowper.) Mr. Alderman Banks-Martin, J.P. Mr. Councillor N. Cakebread. Mr. Alderman Brooks, J.P., C.C. Mr. Councillor H. C. Clover, J.P. Mr. Alderman J. H. Carte, J.P. Mr. Councillor F. G. Cosburn, C.C. Mr. Alderman C. Northfield, J.P. Mr. Councillor A. J. Jones. Mr. Alderman J. Savage, J.P. Mr. Councillor H. Evan Jones, J.P., C.C. Mr. Councillor O. R. Anstead, J.P. Mr. Councillor F. J. McKettrick, M.B. Mr. Councillor H. Barfield. Mr. Councillor Murrell Oakes, J.P. Mr. Councillor G. Pratt, J.P., C.C. STAFF OF THE PUBLIC HEALTH DEPARTMENT. W. J. Worley, Junior Clerk. W. L. Garrett, Junior Clerk. F. J. Kendall, Chief Cleric. Sanitary Inspectors: M. J. Hillyard, J. G. Anderson, G. D. Liu.. 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 1907. Area 3,355 acres, including inland water. Soil and situation:—The subsoil is sand and gravel, except in the south of the Borough where it consists of alluvium, 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 Borough are marshy. Population.—Census 1901, 96,018. Population per acre, 33. Population estimated June, 1907, 136,421. Population per acre, 41. Number of Inhabited Houses.—Census 1901, 16,681. No. per house, 575. Births 3,690. Birth rate, 27.0. Deaths 1,504. Death rate, 11.0. Excess of Births over Deaths 2,186. Zymotic Death Rate, 1.77. Infantile Mortality, 105 per 1,000 Births. Water Supply, Metropolitan Water Board (East London District). Total Rainfall, 20.03 inches. COMPARATIVE STATISTICS. Rates per 1,000 of Population. Rate per 1,000 Registered Births. Births. Deaths. Zymotic Deaths. Infant Mortality. England and Wales 26.3 15.0 1.2 118 76 Great Towns 27.0 15.4 1.5 127 EAST HAM 27.0 11.0 1.7 105 BOR0UGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1907. POPULATION. The estimated Population of the Borough, according to the Registrar-General at the middle of 1907, was 136,421. This represents an increase of 6,535 over the previous year. The excess of Births over Deaths during the year was 2,186, therefore the difference, amounting to 4,349 persons, represents the estimate made for immigration to the Borough. This estimate of the Registrar-General is based on the assumption that the rate of increase at present going on is the same as that which existed between the last two census years, namely, 1891 and 1901. During this period, however, the development of the Borough was phenomenal, and I think it will be agreed that such a rate of increase is not taking place now, therefore the estimate of the Registrar-General is probably somewhat too high. An ever-estimated population renders fallacious the Birth, Death, and other rates calculated on it, causing them to appear unduly low. As a check, therefore, on the Registrar-General's estimate, an enumeration of the occupied houses in the Borough was made during the year, and allowing to each house the same 4 number of inmates as existed when the last Census was taken, the following figures were obtained:— Beckton and North Woolwich Ward 9,288 Central Ward—East 23,817 Central Ward—West 24,339 Manor Park Ward 28,361 Plashet Ward—East 19,946 Plashet Ward—West 25,102 BOROUGH 130,853 According to this calculation the estimate of the RegistrarGeneral is nearly 6,000 too high. I am of opinion, however, that the number of persons per house has, in most of the Wards, increased somewhat since the last Census was taken, and, therefore, the above local calculation rather tends to under estimate the population. The truth, doubtless, lies between these two estimates, but at this length of time from the Census year it is impossible to make any more definite statement. For the purpose of calculating the various rates in this report, the estimate of the Registrar-General has been used, in order that our rates may be compared with other large towns, the populations of which are similarly estimated by the Registrar-General. DENSITY OF POPULATION. The area of the Borough, excluding inland water, is 3,326 acres. The population at the middle of the year was 136,421, the density per acre, therefore, averages 41 persons. At the last Census in 1901 the number per acre was 33. WARD DENSITY OF POPULATION. This varies considerably in the different Wards, depending very largely on the open spaces and amount of undeveloped land which exists. The density of population per acre is lowest in the Beckton and North Woolwich Ward, and yet the density per house in this Ward is the highest in the Borough. Plashet Ward West has no open space, and practically no undeveloped land, and the density 5 of population per acre is there the highest, but the average population per house in this Ward is the lowest in the Borough. The following table gives the area and number of persons per acre in each ward and in the Borough:— Area in Acres. No. of Persons per Acre. Beckton and North Woolwich Ward... 901 9.4 Central Ward—East 622 40.0 Central Ward—West 513 50.4 Manor Park Ward 784 36.9 Plashet Ward—-East 283 76.2 Plashet Ward—West 223 119.3 BOROUGH 3,326 41.0 BIRTHS. The total number of Births registered in the Borough during the year was 3,690—of these 1,878 were boys and 1,812 girls. This is equivalent to a Birth-rate of 27.0 per 1,000 inhabitants. The average Birth-rate of the 76 Great Towns of England and Wales during the year was 27.0 per 1,000, that is, the rate in the Country generally was exactly the same as in East Ham. The Birth-rate, for the third year in succession, is the lowest yet recorded in the Borough, although the decrease last year was not quite so great as during the previous one. The following table gives the Births and Birth-rates for the Borough and for each Ward:— Ward. Births. Rate per 1,000 of Population. Beckton and North Woolwich Ward 296 34.7 Central Ward—East 722 29.0 Central Ward—West 746 28.8 Manor Park Ward 8l0 27.9 Plashet Ward—East 494 22.8 Plashet Ward—West 622 23.3 BOROUGH 3,690 27.0 6 ILLEGITIMATE BIRTHS. These numbered 61, representing 1.6 per cent, of the total births. The number of illegitimate births in 1906 was 75. 12 of these illegitimate births occurred in the Workhouse. The Death-rate among illegitimate children under 1 year was 278 per 1,000, while the Death-rate of legitimate children of the same age was only 100 per 1,000 births registered. DEATHS. The number of deaths which occurred in the Borough was 1280 (males 602, females 678). From this total, 12 must be excluded, being non-residents of the Borough, there were also 236 deaths reported of persons belonging to the Borough, but who had died in Hospitals, Infirmaries, etc., situated outside it; including these, but excluding the former, we have a total number of 1504 deaths belonging to the Borough, which gives a nett death rate of 11.0 per 1,000. As will be seen in the following table, this is the lowest nett death rate yet recorded:— 7 TABLE 1. Vital Statistics of Whole District during 1907 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 belonging to the Borough. Number. Rate.* Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1897 65,000 2,209 34.0 335 151 822 12.6 .. .. 25 847 13.0 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 14.1 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 1905 123,381 3,687 29.8 478 129 1,308 10.5 53 3 220 1,525 12.3 1906 129,886 3,656 28.1 473 129 1,224 9.4 44 15 271 1,491 11.4 Averages for years 18971906. 100,064 3,332 33.5 479 145 1,171 11.8 .. .. 128 1,299 13.0 1907 136,421 3,690 27.0 386 105 1,280 9.4 67 12 236 1,504 11.0 * 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 arc 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. 8 CORRECTED DEATH RATE. The mortality amongst old people and young children being higher than amongst adults, and being also higher among males than females, and as the proportion of these varies in different districts, it is obvious that before any accurate comparison can be made between different towns, correction must be made for these factors. The Registrar General gives a "factor for correction" for the age and sex distribution in each of the 76 Great Towns. For East Ham this factor is 1.0665. The nett death rate multiplied by this factor gives the corrected death rate, which is therefore 11.73 Per 1,000 of population. It is this figure which should be used in making comparison with other towns, the death rate in such towns having been similarly corrected. WARD DEATH RATES. The following table gives the deaths and nett death rates for each ward. The death late for the previous year is also given for purpose of comparison:— WARD. DEATHS. DEATH RATE. DEATH RATE (1906). Beckton & North Woolwich Ward 143 16.7 16.4 Central Ward—East 252 10.1 10.7 Central Ward—West 295 11.4 12.4 Manor Park Ward 342 11.8 11.8 Plashet Ward—East 211 9.7 10.1 Plashet Ward—West 261 9.8 10.3 BOROUGH 1,504 11.0 11.4 9 UNCERTFIED DEATHS. Three were recorded, a similar number occurred in 1906. The following causes of death were stated by the Registrars:— Cerebral Haemorrhage, Male 72 years Bronchitis & Pneumonia, ,, 3 ,, Heart Disease Female 67 ,, INFANTILE MORTALITY. During the year there were 386 deaths in the Borough of Infants under one year of age, as compared with 473 during the previous year. The death rate per 1,000 births was 105, as compared with a rate of 129 in 1906. This decrease is almost entirely due to the great diminution in the number of deaths from Summer Diarrhoea. Owing to the cool and wet weather experienced during the third quarter of the year (July-September) the number of deaths from Diarrhceal diseases, which at this period is usually very high, remained exceptionally low. During the entire year—1907—the deaths of Infants from Diarrhceal diseases of all kinds only numbered 49, while in 1906, with a hot, dry summer, the number was 155. The following table compiled by order of the Local Government Board gives a complete list of the causes of all Infant deaths which occurred during the year:— TABLE V. INFANTILE MORTALITY DURING THE YEAR 1907. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Under 1 Week 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 81 20 25 15 141 37 30 35 19 20 25 16 16 15 15 17 386 Uncertified — — — — — — — — — — — — — — — — i. Common Infectious Diseases. Small Pox — — — — — — — — — — — — — — — — — Chicken Pox — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — 1 1 2 3 2 3 12 Scarlet Fever — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) — — — — — — — — — — — — — 1 — 1 2 Whooping Cough — — 2 — 2 4 6 2 — 5 4 2 1 1 2 4 33 ii. Diarrhœal Diseases. Diarrhoea, all forms — — — — — 1 6 6 7 2 2 1 4 2 1 1 33 Enteritis, Muco-enteritis, Gastro-enteritis — — — — — — 2 2 1 3 3 1 — 1 1 — 14 Gastritis, Gastro-intestinal Catarrh — — — — — 1 1 — — — — — — — — — 2 iii. Wasting Diseases. Premature Birth 36 7 8 1 52 5 — — — — — — — — — — 57 Congenital Defects 10 2 — — 12 — 1 1 — 1 — — — — — — 15 Injury at Birth 1 — — — 1 1 1 — — — — — — — — — 3 Want of Breast Milk, Starvation — 2 — 2 4 — — — — — — 1 — — — — 5 Atrophy, Debility, Marasmus 16 3 4 2 25 9 2 5 2 2— — — — — — — 45 iv. Tuberculous Diseases. Tuberculous Meningitis — — — — — — 1 — 1 — — 2 1 1 1 1 8 Tuberculous Peritonitis: Tabes Mesenterica — — — — — — 1 1 — — 1 2 — — — — 5 Other Tuberculous Diseases — — — — — — — 2 — 1 — — — — — 1 4 v. Other Causes. Erysipelas — — — — — — — — — — — — — — — — — Syphilis — — 1 — 1 — — — — — 1 — — — — — 2 Rickets — — — — — — — 1 — — — — — — — — 1 Meningitis (not Tuberculous) — — — — — — — — — — — — — 3 — — 3 Convulsions 4 1 2 1 8 1 — 1 — — — — — — — — 10 Bronchitis 1 2 2 5 10 4 4 6 — 2 3 1 1 1 1 — 33 Larnygitis — — — — — 1 — — 1 — — — — — — — 2 Pneumonia 1 — 1 — 2 4 3 5 2 2 5 3 6 — 2 4 38 Suffocation (overlying) 1 2 1 — 4 1 — 1 1 1 1 — — — — — 9 Other Causes 11 1 4 4 20 5 2 2 4 1 4 2 1 2 5 2 50 81 20 25 15 141 37 30 35 19 20 25 16 16 15 15 17 386 Births in the year—Legitimate, 3,629 ; Illegitimate, 61. Males 1,878; Females 1,812. Deaths from all Causes at ail Ages, 1,504. Deaths of Infants in the year—Legitimate, 369; Illegitimate, 17. 11 ZYMOTIC DEATH RATE. The number of deaths from the seven principal Zymotic diseases was 242. This compares favourably with the previous year, when, with a smaller population the number of deaths was 259. The following table gives the number of deaths from each of the seven chief Zymotic diseases during the past five years:— Disease. 1903 1904 1905 1906 1907 Small Pox — — — — — Scarlet Fever 13 10 22 18 22 Diphtheria 14 47 38 27 42 Enteric Fever 15 14 16 8 2 Measles 36 56 48 32 70 Whooping Cough 38 24 57 24 62 Diarrhoea and Epidemic Enteritis 58 189 97 150 44 Totals 174 340 278 259 242 Rate per 1,000 of population 1.57 2.91 2.25 1.99 1.77 It will be noticed that there was an increase in the number of deaths from all these diseases, with the exception of those due to Enteric Fever and Diarrhoea. The diminution, however, in the deaths due to the two latter diseases, but especially in those attributed to Diarrhoea was so great that the increase in the others is more than counteracted. Diphtheria, Measles and Whooping Cough were all at one time or another during the year, very prevalent, and caused an exceptionally large number of deaths. 12 It is unfortunate that all these diseases should have been so prevalent during the same year, otherwise, owing to the marked decrease in Diarrhœal mortality, the Zymotic death rate this year would have been a phenomenally low one. INFECTIOUS DISEASES. The number of cases of Infectious disease notified during the year was 1,617. This equals a notification rate of 11.8 per 1,000 of population, which is a higher rate than prevailed during the previous year. The increase is due to the prevalence of both Scarlet Fever and Diphtheria during the last four months of the year, an exceptionally large number of cases of both these diseases being notified during this period. The following table gives the total number of cases notifiec and the rate per 1,000 of population during each of the past five years:— 1903. 1904. 1905. 1906. 1907. No. of cases 1,069 1,256 1,473 1,230 1,617 Rate per 1,000 of population 9.7 10.7 11.9 9.4 11.8 It will be noticed that although the number of cases of Infectious disease varies somewhat each year, when the figures for a number of years are taken the attack rate per 1,000 of population shows no real diminution. It becomes necessary, therefore, to inquire into this, and to ask how it is that despite the large sums of money spent on disinfection and on Isolation Hospitals, these measures have apparently failed to effect any reduction in the prevalence of Infectious diseases. This question has been receiving attention during the past few years in many parts of the country, and figures have been produced in support of a statement that, chiefly as regards Scarlet Fever, towns not providing Isolation Hospital accommodation for this disease have either no more or even have less cases per 1,000 of population, than towns where a very large proportion of these cases are admitted to hospital. TABLE SHEWING NOTIFICATIONS OF EACH INFECTIOUS DISEASE FOR THE PAST FIVE YEARS—1903-1907:— Scarlet Fever. Diphtheria. Membranous Croup. Typhoid Fever. Continued Fever. Erysipelas. Puerperal Fever. Small Pox. Totals. 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 January 66 43 60 80 76 21 38 31 32 20 .. 1 3 2 1 6 8 5 2 5 4 .. .. .. .. 7 8 17 13 14 4 2 1 2 1 .. .. .. .. .. 108 100 117 131 117 February 64 31 51 68 47 19 32 24 34 20 .. 3 2 2 .. 3 5 .. .. .. .. .. .. .. .. 5 14 6 20 12 .. .. .. 1 1 .. .. .. .. .. 91 85 83 125 80 March 116 22 43 53 44 27 41 20 19 15 1 1 1 .. 2 6 4 6 1 .. .. .. .. .. .. 13 10 9 11 7 1 1 2 1 .. 2 1 .. .. .. 166 80 81 85 68 April 47 50 26 54 49 8 10 23 8 13 .. .. .. 2 3 4 1 3 .. 6 1 .. .. .. 10 14 14 6 8 .. 2 .. .. 1 1 1 .. .. .. 70 79 66 70 80 May 40 58 54 66 78 10 20 14 11 15 .. 2 .. 1 1 2 3 5 1 4 .. .. .. .. .. 4 12 6 10 11 .. .. .. .. .. 1 .. .. .. .. 57 95 79 89 109 June 43 76 58 35 55 7 16 15 11 9 .. .. .. .. 1 4 .. 7 5 3 .. .. .. .. .. 13 6 9 9 6 1 .. .. .. .. .. .. .. .. .. 68 99 89 60 74 July 55 70 75 60 86 11 24 21 19 20 .. 2 .. .. 4 2 3 2 3 4 .. .. 1 .. .. 11 8 4 7 5 1 1 .. .. .. .. .. .. .. .. 80 108 103 89 119 August 42 68 72 50 73 17 16 25 17 17 .. .. 4 .. 1 9 4 17 4 5 .. .. .. .. .. 9 9 10 9 7 2 1 .. .. .. .. .. .. .. .. 79 98 128 80 103 September 49 87 138 49 117 12 25 31 24 55 2 .. .. .. .. 9 12 10 9 2 .. .. .. .. .. 12 8 19 10 12 1 1 1 .. 1 .. .. .. .. .. 85 133 199 93 187 October 50 81 186 108 157 16 26 28 29 68 1 .. 1 1 3 10 10 15 8 2 .. 1 .. .. .. 6 14 7 15 8 1 1 1 1 .. .. .. .. .. 84 132 238 162 239 November 54 70 138 94 184 16 43 19 19 51 .. 3 2 1 6 6 5 2 3 .. .. .. .. .. 9 18 15 22 14 .. .. 1 .. .. 1 .. .. .. .. 86 140 180 138 252 December 33 55 67 73 114 42 36 26 14 54 1 .. .. 2 3 5 2 2 4 3 .. .. .. .. .. 13 11 13 14 14 1 3 2 1 1 .. .. .. .. .. 95 107 110 108 189 Totals.. 659 711 968 790 1080 206 327 277 237 357 5 12 13 12 19 66 59 77 39 37 4 2 1 .. .. 112 132 129 146 118 12 11 8 6 6 5 2 .. .. .. 1069 1256 1473 1230 1617 13 It has been assumed from this that Isolation Hospitals are a failure. Probably what such statistics really prove is that they have little or no bearing on the case at all, and the real reason for the continued prevalence of Infectious diseases must be differently explained. I am inclined to the opinion that the ordinary recognised cases of Infectious disease, whether removed to hospital or treated at home, are not chiefly concerned in this continued prevalence, but that the greatest sources of infection are the mild and unrecognised cases, coupled with compulsory school attendance. It is no uncommon occurrence to find a child in school desquamating from Scarlet Fever, and yet the symptoms have been so mild that the parents have been quite unaware of the illness ; or a child with a mild sore throat or slight running from the nose is occasionally found to be really suffering from unrecognised Diphtheria, and has been distributing widely the bacteria of this disease. The potentialities for evil of such cases are enormous. The number of these, no doubt, not only varies widely in different schools and localities, but the other factors on which infection depends, such as susceptibility to infection, degree of overcrowding, etc., also vary, and so tend to make comparison between different towns exceedingly difficult. If these views as to the chief causes of this continued prevalence are correct, the next step is to suggest a remedy. I think the new Act dealing with the Medical Inspection of School Children will, if thoroughly carried out, tend to discover many of these mild, but to the community, dangerous cases of infectious disease, and therefore, will ultimately tend to do much to lessen their prevalence. There are, however, other points which should be mentioned in discussing the value or otherwise of Isolation Hospitals, apart from any statistics as to their effect on the community in limiting the prevalence of disease, B 14 In poor districts many sick children derive obvious benefit by removal from dirty, unhealthy surroundings, with unsuitable or insufficient food, to the proper diet with skilled nursing and attention that is obtained in a well-managed hospital ward. In many other instances also, by removal of the patient to hospital the bread-winner is enabled to continue at work, a condition which often would not be permitted if a case of Infectious disease was being kept at home. He is therefore enabled to support the rest of his family, and so prevent much additional hardship and suffering. The 1,617 cases notified are in Table III, page 45, distributed into wards, and the number of cases of each disease is also given. The total notification rate per 1,000 of population for each Ward during the past three years has been as follows:— 1905. 1906. 1907. Beckton & North Woolwich Ward 9.2 7.2 9.9 Central Ward-East 11.2 8.2 10.5 Central Ward-West 16.1 10.8 13.3 Manor Park Ward 12.7 8.5 16.1 Plashet Ward-East 10.1 8.2 9.5 Plashet Ward-West 10.1 11.8 9.0 SMALL POX. There were no cases of Small Pox in the Borough during 1907. On two occasions suspicious cases were reported to me, and I at once visited and examined the patients, but in both instances decided they were not cases of this disease. The first occasion was in February, when no less than six persons in the same house were affected, the disease, however, proved to be only Chicken Pox, but of a rather severe type in one or two of the patients attacked. 15 The cases of Small Pox in the Borough during the past ten years have been as follows:— Year. No. of Cases. No. of Deaths. 1898 1 — 1899 — — 1900 2 — 1901 31 — 1902 211 24 1903 5 — 1904 2 — 1905 — — 1906 — — 1907 — — Total 252 24 SCARLET FEVER. There was a considerable increase in the number of cases of this disease, as compared with the previous year. The number notified being 1,080, while in 1906 the total was only 790. The increase was occasioned by the large number of cases which occurred in the last four months of the year. Of the 1,080 cases notified, 508 were reported in the first eight months of the year, and 572 in the last four months. 22 deaths occurred from the disease. Although, as previously stated, the chief cause of the continued prevalence of certain Infectious diseases, particularly Scarlet Fever, is probably due to mild, unrecognised cases, this is not the only cause. Patients who are nursed at home, in this district at all events, more often give rise to other cases in the family than occur when the first patient is promptly removed to hospital. This is what one would naturally expect, but, as stated on page 12, statements have been made to the contrary, and the value of Isolation Hospitals doubted. 16 In East Ham during the past year 1,080 cases of Scarlet Fever were notified. Of this number, curiously enough, 540 were removed to hospital, and 540 were treated at home. In the houses of those who were not removed to hospital 61 other cases occurred, while in the houses of those removed to hospital 31 other cases occurred within a period of 14 days. But of these latter cases no less than 16 were taken ill within two days of the removal of the first case, and therefore were already infected before the first patient was taken away. These, therefore, cannot be counted in the argument against hospital isolation. Therefore only 15 legitimate cases occurred in one instance, compared with 61 cases in the other. This evidence, I am aware, is incomplete, as it does not give the number of susceptible persons in each case not protected by a previous attack of the disease. It is, however, unlikely that the proportion varied much in the two cases, and therefore, as far as the figures go, they give considerable support in favour of the utility of hospital isolation. In some of the cases nursed at home, very gross carelessness was occasionally shown as regards isolation, and in some instances it was possible to trace other cases of infection due to this want of care. It was therefore decided to take proceedings in two rather flagrant instances, as a warning to others. In one case, while two patients were suffering from Scarlet Fever, rooms in the house, used by the patients, were let to teams of football players for use as dressing rooms. In the second case, despite warnings, a child while suffering from the disease, was repeatedly allowed to play in the street with other children, and a case of infection was traced from this. Fines, with costs, were inflicted in both instances. The majority of the cases of this disease occurred in the Manor Park and Central West Wards, the rest of the Borough showing no abnormal increase. The Death-rate from the disease was somewhat higher, being 0.16 per 1,000 of population, compared with a rate of 0.13 in 1906. The Death-rate from this disease in England and Wales was 0.09, and in the 76 Great Towns 0.12 per 1,000 of population. 17 The following table gives the number of cases notified, the attack rate per 1,000 of population, and the Case Mortality of this disease during the past five years:— Population. Cases Notified. Attack rate per 1,000 of Population. Mortality per 100 Cases Notified. 1903 110,451 659 5.99 1.9 1904 116,902 711 6.12 1.4 1905 123,381 968 7.84 2.2 1906 129,886 790 6.08 2.2 1907 136,421 1,080 7.91 2.0 DIPHTHERIA. This disease, like Scarlet Fever, was chiefly prevalent during the latter part of the year. Of the total of 376 cases notified, 142 occurred during the first eight months and 234 in the last four months of the year, the greatest number of cases being in the Central East Ward. Include 1 in this number of 376 were 19 cases of Laryngeal Diphtheria or Membranous Croup. 42 deaths occurred from Diphtheria, including five from the Laryngeal form of this disease. During August and September, 13 cases of this disease occurred in children residing in Brooks Avenue, affecting eight separate houses. This row of houses faces the main Northern Outfall Sewer of the London County Council, and the smell from this had been very offensive about this time of the year. This may have predisposed to the disease, for no definite source of infection could be traced, and no reason found why so many Children should have been attacked in these houses. In connection with this disease, legal proceedings were taken in one instance for transmitting infected clothing. The circumstances were as follows:— 18 A child suffering from this disease was being nursed at home, and the father and mother were found in the intervals of nursing to be engaged in tailoring work. This was at once stopped and arrangements made for the articles to be disinfected. Before this could be done, however, the garments were all deliberately sent off to London to the firm employing them. Information was immediately sent to the Health Authorities concerned, and disinfection of the articles performed. The result of the legal proceedings here was the infliction of a fine and costs. The Death-rate from Diphtheria was slightly higher than during the previous year, being 0.31 per 1,000 of population, as compared with 0.20 in 1906. In England and Wales the Deathrate was o.16, and in the 76 Great Towns 0.17, per 1,000 of population. The following table gives the number of cases notified, the attack rate per 1,000 of population, and the Mortality per cent. notified of this disease during the past five years:— Population. Cases Notified. Attack rate per 1,000 of Population. Mortality per 100 Cases Notified. 1903 110,451 211 1.87 6.63 1904 116,902 339 2.89 13.86 1905 123,381 290 2.35 13.10 1906 129,886 249 1.90 10.8 1907 136,421 376 275 11.17 ENTERIC FEVER. Only 37 cases of this disease were notified during the year. This is the lowest number yet recorded in the Borough in any year for which statistics are available. Twenty-three cases were removed to the Isolation Hospital, and of these no less than 11 subsequently proved not to be Enteric Fever. Assuming that the cases treated at home were all Enteric Fever, with the exception of one in which the diagnosis later in the illness was reported to be doubtful, there remained 22 cases needing investigation. 19 The following particulars as to the probable sources of infection were obtained: — Number of Cases. PROBABLE SOURCES OF INFECTION. 3 Personal contact with previous cases. These three patients lived in the same house, and were taken ill early in January. Some few weeks prior to this, a sister had been ill and died, the cause being attributed to Pneumonia. This diagnosis was no doubt incorrect, for soon afterwards the father was taken ill, and following him, the three present cases occurred. All were typical attacks of Typhoid Fever, and Widal's test for the disease was positive in every case. (These patients were admitted to Hospital and all recovered.) 1 Contracted outside the Borough. The patient was a seaman, he was ill on arrival, and was brought home. 1 Attributed to bad fish eaten a few weeks before illness. 2 Oysters had been taken within incubation period. 5 Due to eating winkles. 2 Contact with other cases. Visited a house for 14 days, where three other cases had occurred. 1 Had only resided here nine days before the illness. Was unwell before coming to the Borough. 7 Origin doubtful, and could not be ascertained. The Death-rate from this disease was only 0.01 per 1,000 of population. The rate for England and Wales being 0.07, and that of the 76 Great Towns 0.07 per 1,000 of population. The following table gives the cases notified, the attack rate per 1,000 of population, and the Mortality per cent notified during the past five years:— Cases Notified. Attack rate per 1,000 of Population. Mortality per 100 Cases Notified. 1903 66 0.58 22.7 1904 59 0.76 23.7 1905 77 0.62 20.7 1906 39 0.32 22.8 1907 37 0.27 5.4 20 MEASLES. This disease was very prevalent during the months of February and March. The actual number of cases is unknown as the disease is not a notifiable one. The teachers in the schools inform me of all cases coming to their notice, and from this source 791 cases were reported during the year. 70 deaths were registered as being due to Measles. This equals a Death-rate of 0.49 per 1,000 of population; in the previous year the deaths numbered 32, with a Death-rate of 0.24 per 1,000. The Death-rate from this disease in England and Wales during 1907 was 0.36 per 1,000 of population. Of the 70 deaths registered in the Borough during the year, 62 were of children under five years of age. WHOOPING COUGH. This disease also was more prevalent than during the previous year, and there were 62 deaths registered attributed to this cause. As this, too, is not a notifiable disease, we can only gauge its prevalence and severity by means of the death returns, and by information of the cases coming to the notice of the school teachers. From the latter source, only 41 cases were reported during the year. The Death-rate was equal to 0.44 per 1,000 of population, compared with a rate of 0-18 in the previous year. The Death-rate of England and Wales from this cause during 1907 was 0.29 per 1,000. Of the 62 deaths occurring in the Borough from this disease no less than 58 were of children under five years of age. The two diseases, Measles and Whooping Cough, are usually considered to be "trifling ailments," a doctor is rarely called in, and children suffering from these complaints are not generally given sufficient care and attention ; the result is a very high mortality. 21 From the figures given on page 46 of this report, it will be seen that more deaths occurred from Measles and Whooping Cough than from all the other fevers and infectious diseases combined. The remedy is obviously in the hands of parents and those having charge of children. If the erroneous impression that these ailments are trifling and may be neglected can only be dispelled, and if each case is carefully nursed and as far as possible isolated, there will soon be a considerable decrease in the mortality arising from these diseases. Printed instructions giving the necessary particulars relating to the disease and the precautions that should be taken, are sent to all cases that are reported. DIARRHCEA. 46 deaths were registered as being due to Diarrhoea and Epidemic Enteritis, and of these 35 were of children under one year of age. There were also 23 deaths attributed to Enteritis, and of these 14 were under one year of age. This gives a total of 69 deaths due to diarrhceal diseases, of which 49 occurred in children under one year of age. This is a considerable decrease compared with the. previous year, when the total deaths from diarrhceal diseases numbered 179, of which 155 were of children under one year of age. The number of deaths, therefore, from this cause in 1907 was considerably less than half those in the previous year. The decrease is almost entirely due to the cool and wet weather experienced during the third quarter of the year. At this time (July to September) there is usually a sudden and very considerable increase in Infant Mortality due to Summer Diarrhoea, and the hotter and drier the weather, the greater is this increase. The following table gives the number of Births and the Rate of Infantile mortality for each quarter of the year for the past five years:— 22 YEAR. PERIOD. NUMBER OF BIRTHS. INFANTILE MORTALITY RATE. 1903 January—March 984 104 April—June 973 87 July—September 946 118 October—December 895 139 1904 January—March 890 121 April—June 974 90 July—September 901 277 October—December 938 134 1905 January—March 1001 107 April—June 947 83 July—September 871 181 October—December 852 133 1906 1907 January—March 935 88 April—June 963 73 July—September 877 222 October—December 854 114 January—March 941 136 April—June 939 103 July—September 879 76 October—December 931 113 In the above table the years in which the weather was hot and dry during the third quarter, are easily recognised by the sudden and heavy rise in the rate of Infant Mortality. This increase, as stated, being due to Epidemic or Summer Diarrhoea, which under these conditions becomes very prevalent. 23 As this disease chiefly attacks artificially fed Infants, a printed card giving advice and instructions as to the feeding and management of Infants, is sent during the summer, to every house in the Borough, in which during the year a birth has been registered. As the law only demands that Births shall be registered within six weeks of their occurrence, it sometimes happens that a child dies before its birth has been registered, therefore, any card of advice or instruction sent to these cases is too late to be of any value. To remedy this defect, the Notification of Births Act (1907) was passed. This is an adoptive Act, but where in force notification of all births must be sent to the Medical Officer of Health within 36 hours of their occurrence. The Public Health Committee decided to recommend the Council not to adopt the Act. It is, however, no doubt one of considerable value, more especially during the third quarter of the year, when Infantile Mortality from Summer Diarrhoea, which is largely a preventible disease, is often lamentably high. TUBERCULOUS DISEASE. 175 deaths were registered from various forms of Tuberculosis. This is equal to a rate of 1.28 per 1,000 of population. During the previous year the number of deaths recorded in the Borough from this cause was 169, and the rate was 1.3 per 1,000. Of the 175 deaths registered from all forms of Tuberculosis, 106 were due to Phthisis, i.e., Tuberculosis of the lungs. This form is not only by far the most common, but is also, from the point of view of Public Health, the most dangerous. The expectoration of these patients contains millions of the germs of this disease, and unless great care is taken in disposing of it, other people are certain to become infected. The system of voluntary notification instituted two years ago has not been very successful, only nine cases being notified in the first year (1906) and 18 cases during 1907. 24 As in previous years, cards giving information as to the infectious nature of the disease and rules for the prevention of infection, were sent to all cases that were reported. Disinfection of the room or house occupied by consumptive patients has also been undertaken, this being most often desired after the death of a case. In addition to the above, during the summer months, opportunity was taken to use an empty ward at the Isolation Hospital as a sanatorium for the treatment of cases of this disease. From June 1st, when the first case was admitted, to the end of September, when the ward was needed for other purposes, 12 cases were under treatment. Details as to these patients will be found in the report on the work of the Isolation Hospital on page 58. The method adopted was to admit suitable cases for a short time, not so much with the idea of curing the patient as for educational purposes, to teach them correct methods of living, both as regards food and fresh air, also to inculcate careful habits as regards disposal of expectoration. They could then, when discharged, carry out these methods at home in order to complete their own cure. Such patients would also be able to do good by teaching others similarly afflicted to adopt the same habits. 54 rooms were disinfected during the year, either on removal of the patient to hospital or at the termination of the case. In addition to the 106 deaths from Pulmonary Tuberculosis (Phthisis) there were 69 deaths from other forms of this disease, occurring chiefly from Tuberculosis of Intestines and Meninges. MALIGNANT DISEASE. 77 Deaths were registered during the year, eight being due to Sarcoma and 59 to various forms of Carcinoma, In the previous year 74 deaths were recorded from these diseases. The parts of the body principally attacked and the age and sex distribution of the cases are shown in the following tables :— 25  MALES. 25-65 65 and over Total Under 1 year. 1-5 5-15 15-25 Liver — 1 — — 3 1 5 Stomach and Alimentary Canal 8 1 9 Prostate — — — — 2 — 2 Larynx — — — — 2 '— 2 Tongue — — — — 2 — 2 Various parts — — 1 — 11 — 12 — 1 1 — 28 2 32 FEMALES. Under I year. 1-5 5-15 15-25 25-65 65 and over Total Breast — — — — 2 2 4 Uterus — — — — 5 3 8 Ovaries — — ' — — 2 — 2 Stomach and Alimentary Canal 3 4 12 Various parts — I — — 4 4 9 — I — — 26 18 45 It is frequently stated that during recent years Malignant disease has become increasingly prevalent, the figures (though they are too small to be of much value) relating to the Borough during the past five years do not bear out this statement, the Death-rates per 1,000 of population for the past five years being as follows:— 1903 0.54 per 1,000 of population. 1904 o.61 do. 1905 o.68 do. 1906 0.057 do. 1907 0.56 do. 26 PUERPERAL FEVER. During the year six notifications were received of Puerperal Fever, and five deaths occurred. Four of the cases had been attended by Midwives and two by medical men. In all instances where a Midwife had been in attendance the cases were reported to the County Council, who have the supervision of these under the Midwives Act of 1902. In other cases instructions were given to the Nurse as to the proper cleansing and disinfection to be carried out before any fresh cases could be attended by her. EPIDEMIC CEREBRO—SPINAL MENINGITIS (SPOTTED FEVER). During the early months of the year, in nearly every part of the country, a large number of cases of this disease occurred and in many places attained Epidemic prevalence. In some districts this was temporarily added to the list of compulsorily notifiable diseases, and although this course was not adopted in the Borough, any suspicious cases were reported to me, and I at once visited these patients. The assistance of the Bacteriological Laboratory was made full use of for the purpose of diagnosis, and in every suspicious case, fluid taken from the Spinal Canal was examined for the special micro-organism of this disease. I am pleased to report that in no case was the specific germ found, but the great value of the Laboratory was again demonstrated, as without the assistance thus afforded, the nature of these cases might have remained doubtful, and needless expenditure and inconvenience would have been caused by unnecessary isolation. ERYSIPELAS. 118 notifications were received, as compared with 145 during the previous year. Three deaths were registered from this disease. 27 Patients suffering from Erysipelas are almost invariably treated at home, but in one instance a man was admitted to the Isolation Hospital, as the attack was a severe one and the home conditions rendered it undesirable that he should remain there. ALCOHOLISM. During 1907 four deaths were registered as due to either Acute or Chronic Alcoholism. As stated in previous reports, these figures only represent a small proportion of the deaths really due to this cause. Cirrhosis of the Liver, a condition most often due to chronic alcoholic excess, caused during the year the deaths of 11 persons. There were also nine deaths of Infants registered as being due to " overlaying " in bed. Many of these deaths are really caused indirectly by alcoholism. Of the above 15 adults /whose deaths were due to either Alcoholism or Cirrhosis of the Liver, five were males and ten females. INQUESTS. 114 Inquests were held during the year. The following were the causes certified by the Coroner:— 28  Under 1 year. 1 — 5 5 — 15 15 — 25 25 — 65 65 and over. Total. Burns and Scalds 3 4 4 — — — 11 Falls 1 1 1 2 3 2 10 Syncope 1 1 1 — 2 4 9 Suffocation (overlaid in bed) 9 — — — — — 9 Pneumonia 3 4 — — 1 1 9 Heart Failure — — — 1 6 1 8 Suicides — — — — 7 — 7 Apoplexy — — 1 — 5 1 7 Convulsions 5 — — — — — 5 Want of proper attention at Birth.. 4 — — — — — 4 Alcoholism — — — — 3 — 3 Drowning — — — — 3 — 3 Peritonitis — — — — 2 — 2 Bronchitis 1 1 — — — — 2 Pleurisy — — — — 1 — 1 Diphtheria — — 1 — — — 1 Rupture of Aneurism — — — — 1 — 1 Narcotic Poisoning.. — — — — 1 — 1 Cancer — — — — 1 — 1 Under Chloroform — — 1 — — — 1 Other causes 8 4 — 2 2 3 19 29 COWSHEDS, DAIRIES AND MILKSHOPS. There are seven registered Cowsheds in the Borough and 138 Dairies and Milkshops. A very thorough inspection of all these premises was made in 1906, a special report was made on them, many defects were remedied, and improvements in the storage of milk obtained. During the past year frequent inspections have been made to see that the improved conditions were maintained. Only one case of polluted milk occurred during the year, this was in November, when a churn of milk just delivered by rail was reported to have a very unpleasant odour, and apparently was unfit for food. It was brought to the Town Hall and examined in the Laboratory, where it was found to contain an enormous number of germs in the form of Streptococci; even a single drop showed large numbers of these micro-organisms. The milk was condemned and destroyed, and accompanied by a Veterinary Surgeon, the farm supplying the milk was visited and a thorough inspection of the premises and the cows, 55 in number, was made. No satisfactory explanation of the occurrence could be found. It was stated that all the milk obtained from this large number of cows was mixed ; if this was the case, it seems impossible for the infection to have been derived either from the cows or from the water supply, for in either case the whole of the milk should have been affected. As only one churn out of a large number was polluted, it seems to indicate that this particular churn had received some chance infection. In the course of the investigation it was discovered that one of the milkers was absent owing to " blood poisoning" following an injury to his hand; it is possible that this may have been the source of infection of the particular churn, though impossible to prove it. Although the actual source could not be traced, visits to these farms are of value and tend to cause more care to be taken in maintaining the cleanliness of the cows, utensils and surroundings, a high standard of which is absolutely necessary in dealing with so important a food as milk. c 30 BAKEHOUSES. There are 52 Bakehouses in the Borough, including 12 underground and 4 factory bakehouses. The latter term is applied to those using mechanical power, and they are under the supervision of H.M. Inspector of Factories. The others are regularly visited by the Sanitary Inspectors and occasionally by myself. The majority are clean and well kept, in others there is occasionally a general want of cleanliness, but no serious defects have been reported. CUSTOMS AND INLAND REVENUE ACT. By the Authority of Section 26, 53, and 54 Vic., c. 8, and Section 11, 3, Edward VII, c. 46, exemption from Inhabited House Duty is granted to owners of tenements of an annual value of less than £40, if the Medical Officer of Health is satisfie 1 that they afford suitable accommodation for each of the families or persons dwelling therein, and that due provision is made for their sanitary requirements. During the year, 166 tenements were visited and examined, certificates were granted in connection with 60 of these, and to 82 others after certain ntcessary improvements were carried out. In four cases, affecting 24 tenements, certificates were refused. DISEASED AND UNSOUND FOOD. In addition to the unsound food condemned and destroyed during the year, details of which are given in the Report of the Chief Sanitary Inspector, a carcase of diseased meat was seized in the shop of a local butcher. The animal was extensively infected with Tuberculosis, practically every part of the body showing signs of this disease. As such a condition must have been obvious at the time of slaughter, little excuse could be offered for exposing such food for sale. Proceedings were taken, and a fine of £10 and costs inflicted. 31 DISINFECTION. 1,591 houses were disinfected during the year, the method adopted being a Solution of Formalin, applied by means of a spray. A steam disinfector has been installed during the year. This is a large size " Thresh " Disinfector, it is situated at the Hospital, and is work d by steam obtained from the laundry boiler. This will enable a more thorough disinfection of bedding, etc., to be made than has hitherto been practicable. BACTERIOLOGICAL LABORATORY. 483 examinations were made during the year. The following table gives a list of the diseases or materials investigated, and for whom the examinations w re made Medical Practitioners Hospital &M.O.H. Schools. Totals. Sputum for Tubercle Bacilli 27 24 — 51 Diphtheria 277 119 22 4l8 Ringworm — 1 I 2 Cerebro—Spinal Meningitis I 7 — 8 Anthrax I — — 1 Maaria — 2 — 2 Milk 1 — 1 Totals 306 154 23 483 ARTIZANS' DWELLINGS. House accommodation for the working classes is adequate, and that erected during recent years is satisfactory. The 32 Corporation also own 220 tenement houses. The majority of these are occupied, 52 at present being let to the West Ham Guardians for the accommodation of boarded-out children. NEW BUILDINGS. Plans have been passed during the year for the following:— 563 Single Tenements 8 Double do. 18 Shops 2 Factories a total of 591 for the year, compared with 552 during 1906. FACTORY AND WORKSHOP ACT. This Act passed in 1901, placed a number of additional duties on the Public Health Staff of Local Authorities. The Home-work Order of 1905 further added to these duties. Sec. 132 of the Act requires that the Medical Officer of Health shall report specifically every year on the administration of the Act in all Workshops and Work-places in his district, and transmit a copy to the Secretary of State for the Home Department. The following tables prepared by the order of the Home Office, give a summary of the work done in connection with the Act:— 33 Annual Report of the Medical Officer of Health for the year 1907 for the Borough of East Ham on the administration of the Factory & Workshop Act, 1901, in connection with Factories, Workshops, Laundries, Workplaces & Homework. 1.—INSPECTION. Including Inspections made by Sanitary lnspec???s. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 68 1 — Workshops (Including Workshop Laundries) 315 15 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 1 — — Total 384 16 — 2—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector Nuisances under the Public Health Acts :— Want of cleanliness 27 27 — — Want of ventilation 10 10 — — Overcrowding 2 2 — — Want of drainage of floors — — — — Other Nuisances 31 31 — Sanitary accommodation insufficient 2 2 — — unsuitable or defective 3 3 — — not separate for sexes 2 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). 10 10 — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 87 87 — — 3 HOME WORK. nature of work. outworkers' lists, section 107. Inspections of Outworkers' Premises OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109 & no. Lists received from Employers. Addresses of Outworkers. Prosecutions. Twice in the Year. Once in the Year. Instances Notices Served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, no.) Received from other Councils Forwarded to other Councils. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. Wearing Apparel— 121† 121† 217* (1) making, etc. 12 5 90 14 2 77 519 64 — — 287 — — — 6 — — (2) cleaning & washing — — — — — — 1 — — — 1 — — — — — — Lace, lace curtains and nets Artificial Flowers Nets, other than wire nets Tents Sacks Furniture& Upholstery Fur pulling Feather Sorting Umbrellas, &c. — — — — — — 1 — — — 1 — — — — — — Carding buttons, &c. Paper Bags and Boxes — — — — — — 1 3 — — 1 — — — — — — Basket Making Brush making- Racquet & tennis balls Stuffed Toys File making Electro Plate Cables and Chains Anchors and Grapnels Cart Gear Locks Latches & Keys Pea Picking Total 12 5 90 14 2 77 644 188 — — 508 — — — 6 — * Incorrect addresses work *given ??? removals † Received in error 4.—REGISTERED WORKSHOPS. 5.—OTHER MATTERS. Workshops on the Register (s. 131) at the end of the year. Number. Class Number. Laundries 41 Matters notified to H.M. Inspector of Factories :— Wearing apparel Makers 103 Failure to affix Abstract of the Factory and Workshop Act (s. 133) 26 Bakehouses 52 Action taken in matters referred by H.M. Irispector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 5 Other workshops 48 Reports (of action taken) sent to H.M. Inspector. 3 Other 1 Underground Bakehouses (s. 101) :— Certificates granted during the year Nil Total number of workshops on Register 244 In use at the end of the year 12 36 The duties of the Local Authority in the case of Factories, only relate to Sanitary Conveniences and means of escape in case of fire. As will be seen in the previous tables, the greatest part of work is in connection with Workshops and Home-workers. During the year a Home-worker was prosecuted fur transmitting clothing from infected premises, without previous disinfection, after being warned not to do so. The proceedings had to be taken under the Public Health Act, as the Factory and Workshop Act does not provide for this. As mentioned in last year's Report, much annoyance and considerable additional work is entailed owing to the large number of incorrect addresses of Home-workers received. Of a total of 644 addresses received from various Councils, no less than 339 were incorrect, including wrong addresses, work given up, removals, or sent in error, i.e., not belonging to the Borough. This may be due to the employees removing to another address, and failing to notify their employer, or to carelessness on the part of the latter, but it tends very materially to minimise the value of the Act, and also causes much additional work to the Public Health Staff. FOOD AND DRUGS ACT. The analysis of samples and proceedings in connection therewith, and the general working of the Act is performed by the County Council. During the year ended 31st December, 1907, the number of samples taken and the results of analysis were as follows:— Article. Number Submitted. Number Genuine. Number Adulterated. Butter 134 100 34 Milk 90 86 4 Coffee 2 2 — Margarine 17 — Whisky I I — Gin I I — 245 207 38 37 Proceedings were instituted in 32 cases, with the following results:— Article. Extent of Adulteration. Court. Penalty. Butter .. Consisted of margarine Stratford .. Fined £2 & 14/6 costs ,, ,, ,, ,, • • Do. ,, 50 % foreign fat ,, • • Do. ,, 2o % ,, ,, • • Do. ,, 25% ,, ,, • • Do. ,, 20% ,, ,, • • Fined £1 & 14/6 costs ,, Consisted of margarine ,, • • Dismissed (faulty service). ,, ,, ,, Not served Defendant absconded ,, ,, ,, East Ham Fined £2 & £1 0s. 6d. costs. ,, ,, ,, ,, .. Fined £2 & 18/6 costs ,, 20 % foreign fat ,, • • Fined £1 and 17/6 ,, ,, Consisted of margarine ,, • • Fined £1 and 15/6 „ Margarine Sold in unlabelled wrap. ,, • • Fined 10/-and 17/6 ,, ,, ,, ,, ,, • • Fined 10/-and 15/6 „ Butter Consisted of margarine ,, • • Fined £3 and 14/6 ,, ,, ,, ,, ,, • • Fined 50/-and 14/6 „ ,, ,, ,, ,, • • Do. ,, ,, ,, ,, • • Do. ,, ,, ,, ,, • • Fined £2. ,, ,, ,, ,, • • Do. ,, ,, ,, ,, • • Do. ,, ,, ,, ,, • • Fined 30/-. ,, ,, ,, ,, • • Fined 20/- & 19/- costs ,, ,, ,, ,, • • Fined 20/-and 16/6 ,, ,, ,, a mixture ,, • • Fined 50/-and 14/6 ,, ,, ,, 40 % foreign fat ,, • • Fined £3 and 14/6 „ Margarine Sold in unlabelled wrap. ,, • • Fined 20/-and 14/6 ,, ,, ,, ,, ,, • • Fined 10/- and 14/6 ,, ,, ,, ,, ,, • • Dismissed on payment of 14/6 costs. Milk 26 % deficiency in fat .. ,, • • Fined 20/- & 14/6 costs ,, 20 % ,, • • Fined 20/- and 17/6 „ Obstruction .. .. .. .. ,, • • Fined 20/- and 4/- „ 38 MORTUARIES. During the year 5 bodies were received at the Mortuary at North Woolwich, and 100 at the Wakefield Street Mortuary. The latter building is inadequate, and the accommodation unsatisfactory for dealing with the large number of bodies now annually brought there. A new and suitably equipped building is badly needed, both for the proper reception of bodies and for the convenience of those having to perform the unpleasant duties that are necessary. SEWAGE WORKS. The additions to the Sewage Disposal Plant, mentioned in last year's Report, have given every satisfaction, and are working well. During the year a Bacterial Filter Bed has been formed, composed of clinker from the Refuse Destructor. When completed, this will be about an acre in extent, at present a third of it is finished and in working order. The effluent from the tanks is distributed over the filter bed, and is being much improved in character by this additional treatment. The Works continue to be conducted in a cleanly and satisfactory manner, though the practice of disposing of the sludge from the precipitation tanks, by enclosing it in lagoons, built up of house refuse, is not altogether a satisfactory method, from the point of view of public health, though it has the merit of economy. REFUSE DESTRUCTOR. This apparatus continues to do its work in a satisfactory manner. In addition to burning the house refuse, diseased animals, such as Glandered horses, pigs dying of Swine Fever, together with all the stray dogs killed in the lethal chamber, are cremated in the combustion chamber of the Destructor. The following table give a list of the carcases so destroyed during the year:— 6 Horses and Mules 28 Pigs 938 Dogs 39 PARKS AND OPEN SPACES. The following list gives the Parks and chief Open Spaces in the Borough, and their acreage:— Beckton & North Woolwich Ward Beckton Park 12 acres. Central East Ward Barking Road creation Ground 8 ,, Do. do. Vicarage Lane Ground 2 „ Central West Ward Central Park 30 „ Manor Park Ward Wanstead Flats 92 „ Plashet East Ward Plashet Park 15 „ In addition to these, at the north of the Borough, and rendered easy of access by the Council's trams, is the beautiful open space of Wanstead Park. It will be noticed that the only ward not possessing any public open space is the Plashet West Ward, but as Plashet Park, though nominally included in Plashet East Ward, is practically situated between the two wards, it is equally valuable to both these districts. SWIMMING BATH. The only Public Bath in the Borough is that in the Central Park. As this is an open-air bath, it is only available during the summer months. The question of providing a suitable and wellequipped covered bath has been considered by the Council; from the point of view of public health, there can be no doubt as to its value, not only for the purpose of teaching the children to swim, but also as a means of promoting cleanliness, health, and vigour in the population generally. NEW STREETS AND BUILDINGS BYE-LAWS. The revised code of Bye-laws for the construction of new streets and buildings is still receiving consideration, but has not yet received the sanction of the Local Government Board. An important provision in the new code is that no house can be occupied until a written certificate has been obtained from the Council's responsible officers. 40 WATER SUPPLY. The Borough is supplied by the Metropolitan Water Board, the quality is therefore good, and the supply constant. Attention has been paid during the year to the position of the drinking-water cisterns in all new houses that have been erected. These have often been placed in unsuitable positions, and frequently so near the ceiling that inspection and cleaning of the interior was impossible. They are now, in every case, being placed not less than 18 inches from the ceiling, and in a suitable and accessible position. SUMMARY OF IMPROVEMENTS. In various parts of the Report are mentioned improvements which have been effected during the year, others are also mentioned as still required for the benefit of the Public Health. For convenience, a summary of these is given here:— During the year the additional buildings at the Hospital, mentioned in last year's Report, were opened, these include a Ward for Scarlet Fever patients, Hospital Laundry, Porter's Lodge, and Steam Disinfector. In addition to these, Stables and Ambulance House have also been erected, and are now in occupation. Plans have also been sanctioned by the Local Government Board, and tenders have been invited for the erection of an additional Scarlet Fever Ward to take the place of the Convalescent Home. This Ward is to be of two storeys, the upper floor being for the accommodation of the Scarlet Fever Staff. A ward containing 12 separate cubicles for the isolation of various cases needing observation is also being provided, and it is also proposed to erect a new Mortuary at the Hospital. The Scarlet Fever Convalescent Home (Rancliffe House) has been closed, as it was considered unsafe, and the patients have been transferred to the old Scarlet Fever Ward on the Hospital site, pending the erection of the new Ward. From both an administrative and financial point of view, the centralization on one site should prove to be a distinct advantage. 41 A new Mortuary in a central position in the Borough is still needed. At the Sewage Works, a Bacterial Filter Bed, formed of clinker from the Refuse Destructor, has been provided, and is working satisfactorily, the effluent being much improved in character. The new Building Bye-laws still await the sanction of the Local Government Board. 42 METEOROLOGICAL RECORD—YEAR 1907. Rain Gauge 5-in. in diameter, placed I-foot above ground, 12.5-feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5-feet from the ground. Months. Temperature of Air during the Month. Moan Temperature of Air. Rainfall. Highest. Lowest. Mean of No. of Days on which Rain fell, 0.01 inches and over. Total fall in inches. Mean rate of fall for Rainy Days. Greatest fall in 24 hours Date of greatest fall. All Highest. All Lowest January 51° 22° 43°.2 34°.3 38°.7 9 0.76 0.08 0.38 1st February 52° 25° 42°.7 32°.7 37°.7 11 0.90 0.08 0.25 10th March 70° 26° 53°.3 34°.6 43°.3 11 0.82 0.08 0.16 5th April 71° 30° 54°.3 39°.7 47°0 18 2.84 0.16 0.62 6th May.. 80° 35° 60°.9 45°.3 53°. 1 20 2.42 0.12 0.33 7th June 740 45° 64°.8 50°.6 57°.7 10 1.77 0.17 0.80 1st July 78° 38° 67°.5 51°.6 59°.5 7 1.38 0.20 0.93 22nd August 770 45° 69° 0 53°.0 61°'0 10 1.33 0.13 0.32 17th September.. 81° 34° 68°.6 48°.8 58°.7 5 0.72 0.14 0.29 30th October 67° 35° 58°.4 44°.7 51°.6 21 2.73 0.13 0.33 15th November 61° 30° 50°.9 39°.8 45°.3 12 1.94 0.16 0.43 28th December 57° 32° 46°.3 37°.3 41°.8 12 2.42 0.20 0.57 12th Means and Totals for the Year. 81° 22° 56°.6 42°.7 49°.6 146 20.03 0.14 0.93 July 22nd The Rainfall for the Year was 2.34 inches below, and the number of days on which rain fell 14 below the year 1906, at East Ham. 43 TABLE 1. Vital Statistics of Whole District during 1907 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 belonging to the Borough. Number. Rate°. Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1897 65,000 2,209 34.0 335 151 822 12.6 .. .. 25 847 13.0 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 14.1 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 1905 123,381 3,687 29.8 478 129 1,308 10.5 53 3 220 1,525 12.3 1906 129,886 3,656 28.1 473 129 1,224 9.4 44 15 271 1,491 11.4 Averages for years 18971906. 10,064 3,332 33.5 479 145 1,171 11.8 .. .. 128 1,299 13.0 1907 136,421 3,690 27.0 386 105 1,280 9.4 67 12 236 1,504 11.0 * 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. TABLE II. Vital Statistics of separate Wards in 1907 and previous years : Whole District. Beckton & North Woolwich Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. YeaR. Population estimated to middle of each year Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. 1897 65,000 2209 847 335 1898 75,000 2614 1004 428 1899 88,000 3028 1245 529 1900 92,000 3297 1303 549 1901 96,000 3503 1457 549 1902 104,023 3805 1242 446 1903 110,451 3805 1265 430 1904 116,902 3717 1612 575 1905 123,381 3687 1525 478 7469 279 149 49 20,245 656 285 98 22,931 793 298 84 27,242 801 337 115 20.147 514 194 54 25,347 644 262 78 1906 129,886 3656 1491 473 7593 254 125 36 22,895 737 247 99 24,873 772 309 107 28,540 826 338 116 20,581 483 208 56 25,404 584 264 59 Averages of Years 1897 to 1906. 100,064 3332 1299 479 1907 136,421 3690 1504 386 8523 296 143 40 24,895 722 252 82 25,873 746 295 72 28,940 810 342 86 21,581 494 211 48 26,609 622 261 58 TABLE III. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1907. 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 Wool wich 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. plashetWard Total. Small pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 376 4 111 242 12 7 .. 28 111 52 70 79 36 376 21 74 38 43 31 23 230 Erysipelas 118 2 .. 13 12 81 10 1 21 31 27 22 16 118 .. .. .. 1 .. 1 2 Scarlet Fever 1080 10 273 669 90 38 .. 53 125 253 366 102 181 1080 31 66 140 180 32 106 555 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 37 .. .. 12 8 17 .. 2 8 11 8 2 6 37 1 5 7 6 1 4 24 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 6 .. .. .. 2 4 .. 1 .. 1 .. 1 3 6 .. .. .. .. .. 2 2 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1617 16 384 936 124 147 10 85 265 348 471 206 242 1617 53 145 185 230 64 136 813 46 TABLE IV. Schedule Number. Causes of Death in East Ham during year ending December 31st, 1907. Deaths at the subjoined Ages of "Residents" whether occurring in or beyond the Borough, Deaths of all Ages of "Residents" belonging to Wards, whether occurring in or beyond the Borough. Total Deaths in Public institutions in the Borough. All ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Beckton & N. W'wich. central East. Central West. Manor Park. Plashet East. Plashet West. Residents. Non- Residents. 1 Small Pox (a) Vaccinated - - - - - - - - - - - - - - - (b) Unvaccinated - - - - - - - - - - - - - - - (c) No Statement - - - - - - - - - - - - - - - 2 Measles 70 15 47 8 — - - 13 10 9 21 9 8 2 3 3 Scarlet Fever 22 - 10 8 2 2 — 2 2 5 6 3 4 15 1 4 Typhus Fever - - - - - - - - - - - - - - - 5 Epidemic Influenza 19 4 - 1 1 9 4 1 4 6 5 2 1 — — 6 Whooping Cough 62 35 23 3 - 1 - 7 11 11 16 7 10 — 2 7 Diphtheria, including M. Croup 42 2 25 15 — - - 3 16 10 7 2 4 22 — 8 Enteric Fever 2 - - - — 1 1 — — — — 2 — 1 — 9 Asiatic Cholera - - - - - - - — — — — — — — — 10 Diarrhoea, Dysentery 32 27 5 - - - - 7 8 7 3 2 5 — — 11 Epidemic Enteritis 14 8 4 1 — 1 — 2 1 5 3 2 1 — — 12 Other Allied Diseases - - - - - - - - - - - - - - - 13 Hydrophobia - - - - - - - - - - - - - - - 14 Glanders - - - - - - - - - - - - - - - 15 Tetanus 1 - - - - 1 - 1 - — - — — — — 16 Anthrax - - - - - - - - - - - - - - - 18 Syphilis 2 2 - - - - - - 1 1 - - - - - 19 Gonorrhoea - - - - - - - - - - - - - - - 21 Erysipelas 3 - - - - 2 1 - — — 1 2 — — — 22 Puerperal Fever 5 - — - 1 4 - 1 — — — 2 2 — — 28 Pyæmia 7 3 - 3 - 1 - - 2 2 1 2 — 1 — 24 Infective Endocarditis 1 - — - 1 - - - - - - - 1 — — 25 Other Allied Diseases 3 — — — 1 2 — 1 1 1 — — — 1 — 26 Malarial Fever - - - - - - - - - - - - - - - 27 Rheumatic Fever 4 - - 2 1 1 - - - 2 1 1 — — — 28 Rheumatism of Heart - - - - - - — — — — - - — — — 29 Tuberculosis of Brain 33 8 12 13 - - - 4 5 4 8 6 6 1 - 30 Tuberculosis of Larynx 2 - - - - 2 - - 1 - — 1 — — — 81 Tuberculosis of Lungs 106 1 1 5 21 75 3 13 17 21 21 14 20 - - 32 Abdominal Tuberculosis 13 4 3 1 - 5 - 4 2 2 2 - 3 - - 33 General Tuberculosis 12 3 4 4 - - 1 3 3 1 2 — 3 — _ 34 Other forms Tuberculosis 9 1 2 1 1 4 - 1 2 — 3 — 3 — — 86 Thrush - - - - - - - - - - - - - - - 37 Actinomycosis - - - - - - - - - - - - - - - 38 Hydatid Disease 1 — — — — 1 — — — 1 — — — — — 39 Scurvy - - - - - - - - - - - - - - - 40 Ptomaine Poisoning 2 - — - 1 1 - - — — — 1 1 — — 41 Acute Alcoholism 1 - - - - 1 - 1 - - — — — - — 42 Chronic Alcoholism 3 - - - - 3 - - 2 - 1 - - - - 43 Chronic Industrial Poisonings - - - - - - - - - - - - - - - 44 Other Chronic Poisonings - - - - - - - - - - - - - - - 45 Osteo-arthritis 7 - - 1 - 4 2 1 - 1 2 3 - - - 46 Gout 2 - - - - - 2 — — 1 — - 1 — — 47 Cancer 77 — 2 1 — 54 20 10 16 14 16 10 11 — — 48 Diabetes Mellitus 7 - - 1 - 5 1 - 1 1 - 2 3 - - Carried forward 562 1ll 138 68 30 180 35 75 105 105 117 73 87 43 6 47 Schedule Number. Causes of Death in East Ham During year ending December 31st, 1907. Deaths at the subjoined Ages of "Residents" whether occurring in or beyond the Borough. Deaths at all Ages of "Residents" belonging to Wards. whether occurring in or beyond the Borough. Total Deaths in Public Tnstitu- tions in the Borough. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards Beckton & N W'wich. Central East. Central West. Manor Park. Plashet East. Plashet West. Residents. Non- Residents. Brought forward 502 111 138 08 30 180 35 75 105 105 117 78 87 43 6 49 Purpura Hæmorrhagica - - - - - - - - - - - - - - - 50 Haemophilia 2 2 - - - - - - - 1 - - 1 - - 51 Anæmia 9 — — — 6 8 1 — 4 2 2 — — — 52 Lymph adenoma 1 - - - - - 1 - - 1 - - - - - 53 Premature Birth 57 57 - - - - - 6 17 8 10 12 4 - - 54 Injury at Birth 3 8 — — — — - - - — 1 1 1 — — 55 Debility at Birth - - - - - - - - - - - - - - - 56 Atelectasis 8 7 1 — — - 1 1 2 1 1 2 — — 57 Congenital Defects 8 8 — — — — 1 1 2 1 3 — — — 58 Want of Breast Milk 5 5 — — — — — 1 — 3 — 1 — — 59 Atrophy, Debility, Marasmus 50 47 - 1 — — 3 6 12 16 3 10 — 2 60 Dentition 12 9 8 — — — 1 2 3 3 1 - — - 61 Rickets 1 1 — — — — — — — 1 — — — — 62 Old Age, Senile Decay 72 - - - - - 72 2 5 13 18 12 22 - - 63 Convulsions 12 10 1 1 - - - 2 2 1 2 2 3 - - 64 Meningitis 7 8 2 — - 2 — — 1 — 5 — 1 — — 65 Encephalitis 1 — — — 1 — — — — — 1 — — — 66 Apoplexy 12 — — — 4 8 1 3 — 3 5 — — — 67 Softening of Brain 3 — — — — 8 — 1 — 1 1 — — — 68 Hemiplegia 5 — — — — 8 2 — 2 — 2 — 1 — — 69 General Paralysis of Insane 1 — — — 1 - — — — — 1 — — — 70 Other forms of Insanity - - - - - - - - - - - - - - - 71 Chorea - - - - - - - - - - - - - - - 72, Cerebral Tumour 2 - — — - — — — — 1 1 — — — 73 Epilepsy 4 — - — 3 1 — — — 4 — — — — 74 Laryngismus Stridulus - - - - - - - - - - - - - - - 75 Locomotor Ataxia 2 — - — 2 — — — — — 2 — — — 76 Paraplegia 2 - 1 — - — 1 — — — 1 1 - - — 77 Other forms, Drain Diseases 6 — - — 4 2 — 2 - 2 1 1 — — 78 Otitis, Otorrhœa - - - - - - - - - - - - - - - 79 Diseases of Nose 1 1 - - - - - - - 1 - - - - - 80 Diseases of Eye - - - - - - - - - - - - - - - 81 Pericarditis 2 - 1 - - 1 - 1 - - - - 1 - - 82 Endocarditis, Valvular Dis. of Heart 102 2 2 11 9 52 26 8 17 19 2b 13 20 — — 83 Hypertrophy of Heart — — — — — — — — — — — — — — — 84 Angina Pectoris 1 - - - - 1 - - - - - - 1 - - 85 Aneurism 4 — — — — 3 1 1 1 1 1 — — — — 86 Senile Gangrene 2 — — — — — — — — — 2 — — — 87 Embolism, Thrombosis 5 — — — 1 2 2 — — — 2 — 3 — - 88 Phlebitis - - - - - - - - - - - - - - - 89 Varicose Veins — — - - - - - - - - - - - - - 90 Other Diseases, Heart and. Vessels 73 2 1 2 3 32 33 5 9 13 21 9 16 - - Carried forward 1038 267 152 83 43 300 193 108 176 185 244 147 178 43 8 48 Schedule Number. Causes of Death in East Ham during year ending December 31st, 1907. Deaths at the subjoined Ages of "Residents" whether occurring in or beyond the Borough. Deaths at all Ages of " Residents " belonging to Wards, whether occurring in or beyond the Borough. Total Deaths in Public Institutions in the Borough. All Ages. Under 1. 1 and under 5. 5 and under 15, 15 and under 25, 25 and under 65. 65 and upwards. Beckton & N. W'wich. Central East. Central West. Manor Park. Plashet East. Plashet West. Residents. Non- Residents. Brought forward 1038 267 152 83 43 300 193 108 176 185 244 147 178 43 8 91 Laryngitis 2 2 - - - - - - 1 - - - 1 - - 92 Croup 2 — 2 - - - - - 1 — — — 1 — — 94 Acute Bronchitis 56 33 13 1 - 4 5 6 12 14 10 7 7 - - 95 Chronic Bronchitis 62 — 1 — 1 21 39 4 10 13 11 11 13 — — 96 Lobar Pneumonia 13 2 2 — 2 4 3 — 1 6 4 1 1 — - 97 Lobular Pneumonia 65 23 28 4 1 6 3 3 14 15 18 7 8 — - 98 Pneumonia 57 14 9 4 1 20 9 4 5 16 11 9 12 - 1 99 Emphysema, Asthma 4 - - - - 4 - - - 1 1 - 2 - - 100 Pleurisy 10 1 1 1 1 6 - 3 3 3 - 1 - — — 101 Other Diseases, Respiratory System 1 - - - - 1 — - - 1 - - - - - 103 Diseases of Pharynx - - - - - - - - - - - - - - - 104 Diseases of Esophagus - — — — — - - - - - - - - - - 105 Ulcer of Stomach and Duodenum 7 — — — 3 4 - - 1 1 1 2 2 - - 106 Other Diseases of Stomach 9 3 2 - - 3 1 1 3 2 - 1 2 - - 107 Enteritis 23 14 4 — 1 1 3 1 6 3 8 4 1 - - 108 Appendicitis 6 — 1 3 — 1 1 - - 1 2 3 — — 109 Obstruction of Intestine 11 4 — — — 5 2 1 2 4 1 2 1 — — 110 Other Diseases of Intestine 2 — — — — 2 - — - 1 — — 1 - - 111 Cirrhosis of Liver 11 — — — — 10 1 1 2 1 5 2 - - - 112 Other Diseases of Liver 9 2 1 — — 4 2 — - 1 2 1 5 - - 113 Peritonitis 4 — — — — 4 — - — 1 — 2 1 — — 114 Other Diseases, Digestive System 4 1 1 — — 1 1 1 — — 1 — 2 — — 115 Diseases, Lymphatic System and Glands 1 - - - - 1 - - 1 - - - - - - 116 Acute Nephritis 8 — 1 1 — 5 1 1 2 2 2 1 — - - 117 Bright's Disease 19 - - - 1 11 7 2 1 4 1 3 8 - - 118 Calculus - - - - - - - - - - - - - - - 119 Diseases of Bladder and Prostate 1 — - — — 1 — - — — 1 — — — - 120 Other Diseases, Urinary System 2 - — - — 1 1 - 1 - 1 - — - - 121 Diseases of Testis and Penis - - - - - - - - - - - - - - - 122 Diseases of Ovaries 1 - - - - - 1 - 1 - - - - - - 123 Diseases of Uterus and Appendages 3 - - - - 3 - - - - 1 - 2 - - 124 Diseases of Vagina and External Genitals - - - - - - - - - - - - - - - 125 Diseases of Breast - - - - - - - - - - - - - - - 126 Abortion, Miscarriage 2 - - - - 2 - - - 1 1 - - - - 127 Puerperal Mania - - - - - - - - - - - - - - - 128 Puerperal Convulsions 1 - - - 1 - - - 1 - - - - - - 129 Placenta Prævia, Flooding 2 — - - - 2 — — — 1 — 1 — - - 130 Puerperal Thrombosis - - - - - - - - - - - - - - - 131 Other Diseases, Pregnancy and Childbirth ... 7 3 - - 2 2 - 2 2 - 3 - - - - Carried forward 1445 371 218 97 57 429 273 138 246 276 330 204 251 43 9 49 Schedule Number. Causes of Death in East Ham during Year ending December 31st, 1907. Deaths at the subjoined Ages of "Residents" whether occurring in or beyond the Borough. Deaths at all Ages of "Residents" belonging to Wards, whether occurring in or beyond the Borough. Total Deaths in Public Institutions in the Borough. All ages. Under 1. 1 and under 5 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Beckton & N. W'wich. Central East. Central West. Manor Park. Plashet East. Plashet West. Residents. Non. Residents. Brought forward 1445 371 218 97 57 429 273 138 246 276 330 201 251 43 9 132 Arthritis, Osteitis, Periostitis — - — — — — — — — — — — — — - 133 Other Diseases, Osseous System 1 - - - - 1 - - - - - 1 - - - 134 Ulcer, Bedsore - - - - - - - - - - - - - — — 135 Eczema 2 1 — — — — 1 — — — 1 — 1 — — 136 Pemphigus — — - - - - - - - - - - - - - 137 Other Diseases, Integumentary System - - - - - - - - - - - - - - - Accidents and Negligence. 138 In Mines and Quarries — - - - - - - - - - - - - - - 139 In Vehicular Traffic 3 — 1 — — 1 1 — — 1 — 1 1 1 — 140 On Railways 3 — — — - 1 — — — 2 1 — - - - 141 On Ships, Boats, &c. (not drowning) - - - - - - - - - - - - - - - 142 In Building Operations 2 - - — 1 1 — — 1 1 — — — - — 143 By Machinery 1 — — - - 1 - - 1 - - - - - - 144 By Weapons and Implements 1 - - - 1 - - 1 - - - - - - - 145 Burns and Scalds 11 3 4 4 — — — 1 — 5 5 — — 10 — 146 Poisons Poisonous Vapours 1 - - - - 1 - - - - 1 - - - - 147 Surgical Narcosis 1 - - 1 - - - - 1 - - - - - - 148 Effects of Electric Shock - - - - - - - - - - - - - - - 149 Corrosions by Chemicals - - - - - - - - - - - - - - - 150 Drowning 3 - - - - 3 - - - - 1 - 2 - - 151 Suffocation, Overlaid in Bed 9 9 - - - - - 2 1 4 — 1 1 - - 152 „ Otherwise 2 2 - - - - - - - 1 1 — — - — 153 Falls, not specified 14 2 1 2 — 5 4 1 1 2 3 2 5 1 3 154 Weather Agencies - - - - - - - - - - - - - - - 155 Otherwise, not stated 4 3 — — — — 1 1 1 1 - - 1 - - 156 Homicide - - - - - - - - - - - - - - - Suicides, 157 By Poison 1 - - - - 1 - - - - 1 - - - — 158 By Asphyxia 1 — — — — 1 — — — — — — 1 — — 159 By Hanging and Strangulation 3 — — — — 3 — — — — — 1 2 — — 160 By Drowning - - - - - - - - - - - - - - - 161 By Shooting - - - - - - - - - - - - - - - 162 By Cut or Stab 2 — — — — 2 — - 1 1 - - - - - 163 By Precipitation from Elevated Places — - - - - - - - - - - - - - - 164 By Crushing - - - - - - - - - - - - - - - 165 By other and unspecified methods - - - - - - - - - - - - - - - 166 Execution — - - - - - - - - - - - - - - 167 Sudden Death, cause not ascertained - - - - - - - - - - - - - - - 168 Ill defined and unspecified causes 5 2 - - - 3 - 1 1 1 1 1 - - - Total 1516 394 224 104 61 453 280 145 254 297 344 213 263 55 12 TABLE V. INFANTILE MORTALITY DURING THE YEAR 1907. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Under 1 Week. 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 81 20 25 15 141 37 30 35 19 20 25 16 16 15 15 17 386 Uncertified — — — — — — — — — — — - — — - — — Common Infectious Diseases. Small Pox - - - - - - - - - - - - - - - - - Cicken Pox - - - - - - - - - - - - - - - - - Measles — — — — - - - - - - 1 1 2 3 2 3 12 Scarlet Fever - - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) - - - - - - - - - - - - - 1 - 1 2 Whooping Cough — — 2 — 2 4 6 2 — 5 4 2 1 1 2 4 33 ii. Diarrhœal Diseases. Diarrhoea, all forms — — — — — 1 6 6 7 2 2 1 4 2 1 1 33 Enteritis, Muco-enteritis, Gastro-enteritis — — — — — — 2 2 1 3 3 1 — 1 1 - 14 Gastritis, Gastro-intestinal Catarrh — — — — — 1 1 — — — — - - - - - 2 iii. Wasting Diseases. Premature Birth 36 7 8 1 52 5 - - - - - - - - - - 57 Congenital Defects 10 2 — — 12 — 1 1 - 1 - - - - - - 15 Injury at Birth 1 - — - 1 1 1 - - - - - - - - - 3 Want of Breast Milk, Starvation — 2 — 2 4 — — - - - - 1 - - - - 5 Atrophy, Debility, Marasmus 16 3 4 2 25 9 2 5 2 2 - - - - - - 45 iv. Tuberculous Diseases. Tuberculous Meningitis — — — — — — 1 — 1 - - 2 1 1 1 1 8 Tuberculous Peritonitis: Tabes Mesenterica — — — — — - 1 1 - - 1 2 - - - - 5 Other Tuberculous Diseases — — — — — — — 2 — 1 — — - - — 1 4 v. Other Causes. Erysipelas - - - - - - - - - - - - - - - - - Syphilis — — 1 — 1 — - - - - 1 - - - - - 2 Rickets - - - - - - - 1 - - - - - - - - 1 Meningitis (not Tuberculous) - - - - - - - - - - - - - 3 - - 3 Convulsions 4 1 2 1 8 1 - 1 - - - - - - - - 10 Bronchitis 1 2 2 5 10 4 4 6 - 2 3 1 1 1 1 - 33 Larnygitis - - - - - 1 - - 1 - - - - - - - 2 Pneumonia 1 — 1 — 2 4 3 5 2 2 5 3 6 - 2 4 38 Suffocation (overlaying) 1 2 1 - 4 1 - 1 1 1 1 - - - - - 9 Other Causes 11 1 4 4 20 5 2 2 4 1 4 2 1 2 5 2 50 81 20 25 15 141 37 30 35 19 20 25 16 16 15 15 17 386 Births in the year—Legitimate, 3,629; Illegitimate, 61. Males 1,878; Females 1,812. Deaths from all Causes at all Ages, 1,504. Deaths of Infants in the year—Legitimate, 369; Illegitimate, 17. 51 APPENDIX I. Report on the Borough Isolation Hospital. HOSPITAL SUBCOMMITTEE. The Mayor (Alderman H. Osborn, J.P.) The Deputy-Mayor (Councillor T. Hassan Cowper). Mr. Alderman J. Savage, J.P. Mr. Councillor Cakebread. Mr. Councillor Ford, J.P. Mr. Councillor A. J. Jones. Mr. Councillor Evan Jones, J.P., C.C. Mr. Councillor McKettrick, M.B. 52 Report on the Borough Isolation Hospital. The work at the Hospital during the past year has been particularly heavy, the number of patients treated having exceeded that of any previous year. The new Ward for Scarlet Fever patients, the Laundry, Lodge, and Disinfector were declared open for use by the Chairman of the Public Health Committer on June 17th. These buildings are proving of the utmost value. During the prevalence of Scarlet Fever at the latter part of the year the new Ward enabled many cases to be admitted which otherwise would have had to remain at home, though even its resources proved inadequate. The Disinfector and Laundry machinery are also working in a satisfactory manner and enable the work to be carried out in a more efficient way than formerly. During the year electric light was installed, not only in the new buildings, but also in the existing Administrative Blocks and in the Typhoid and Diphtheria Wards. This has proved of the utmost value, more particularly in the latter Ward, where urgent operations have often to be performed at night. Private telephonic communication between the various Wards, Lodge, Laundry, etc., has also been established. Stables and Ambulance House have also been erected during the year on the Hospital site, and were completed and came into use in December. The old stables were at Clock House, some distance from the Hospital, and therefore increased the work of both men and horses owing to the many journeys necessary between the two places. The new buildings obviate all this and are also more commodious and convenient. 53 The following table gives the total number of patients under treatment during the year and the Death-rate from each disease:— DISEASE. In Hospital, Dec. 31st, 1906. Admitted, 1907. Total under treatment, 1907. Discharged. Died. Mortality per cent, of completed cases. Remaining in Hospital, Dec. 31st, 1907. Scarlet Fever 27 545 572 515 14 2.6 43 Diphtheria 6 238 244 201 19 9.4 24 Enteric — 12 12 10 — — 2 Tuberculosis — 12 12 11 1 8.3 — Erysipelas — 1 1 1 — — — Other Diseases 1 27 28 23 5 17.9 — Total 34 835 869 761 39 — 69 SCARLET FEVER. 572 cases were under treatment during the year. The type of disease was rather more severe than during the previous year, and there was also an unusually large number of cases found on admission to be suffering from Diphtheria combined with Scarlet Fever. This double infection tending, of course, to cause a higher Death-rate. In five cases the diagnosis was incorrect, the patients on admission being found not to have Scarlet Fever. In 529 completed cases there were 14 deaths, which equals a case mortality of 2.6 per cent., as compared with a rate of 1.84 per cent. in 1906. The following complications occurred amongst the. 572 cases of Scarlet Fever under treatment during the year:— 54 Complications. Number of Cases. Operations Performed. Adenitis 201 - Abscess 15 15 Albuminuria 13 — Nephritis 11 — Otorrhoea 71 — Rheumatism (Joint Pains) 24 — Laryngitis 1 1 Mastoid Disease 4 4 Empyema 1 1 Bronchitis, Pleurisy and Pneumonia 8 — Cellulitis 1 1 In many instances patients were admitted who were either suffering from or incubating some other affection or disease in addition to the one notified. The following table gives particulars of the diseases and conditions associated with Scarlet Fever which were admitted during the year:— 55 Scarlet Fever associated with Diphtheria 23 cases. „ „ Chicken Pox 7 „ „ „ Chorea 2 „ „ „ Whooping Cough 2 „ „ „ Erysipelas 1 „ „ „ Ringworm 2 „ „ „ Measles 5 „ „ „ Erythema Nodosun 1 „ „ „ Scalds and Burns 2 „ „ „ Heart Disease 4 „ „ „ Crushed Hand 1 „ „ „ Psoriasis 1 „ „ „ Verminous Heads 236 „ 327 Scarlet Fever patients were transferred during the year from the Hospital to the Convalescent Home, and 20 cases were admitted direct to the Convalescent Home. This building has recently been closed owing to its dilapidated condition, and the old Scarlet Fever Ward on the Hospital site has been re-opened for use as a Convalescent Ward pending the erection of the new building. DIPHTHERIA. This disease was also more prevalent during the year, 244 cases being under treatment compared with 143 in the previous year. 21 cases sent in as Diphtheria were found on admission not to be suffering from this disease. 10 of these proved to be mild cases of Scarlet Fever in which the rash had faded and only the 56 throat condition remained. These were transferred to the Scarlet Fever Ward, and are included in the number of cases reported there. In 220 completed cases 19 deaths occurred. This equals a case ortality of 9.4 per cent. This rate is based on cases of actual Diphtheria alone and excludes those sent in incorrectly diagnosed. Of the above deaths 6 occurred within a few hours of admission to Hospital. Such cases tend to unfairly increase the Hospital death-rate, they are nearly moribund on admission, usually due to neglect in not obtaining Medical advice earlier. The number of cases treated in Hospital and the death-rate from this disease during the past five years have been as follows: — Year. No. of Cases Treated. Mortality per cent. of completed Cases. 1903 130 6.9 1904 219 14.6 1905 176 11.9 1906 143 10.9 1907 244 9.4 The decrease in the death-rate is really greater than the above figures indicate; during the past two years, since the Bacteriological Laboratory was established all doubtful cases have by its assistance been excluded and the rates for this period are based on cases of actual Diphtheria only. Of the 244 cases under treatment during the year, 33 had received an injection of Antitoxine before admission to Hospital. A very noteworthy feature during the year concerning this disease was the frequency with which the Larynx was attacked, constituting what is termed Laryngeal Diphtheria or Membranous Croup, the operation of Tracheotomy being required on no less than 23 occasions. Of the 23 cases operated on 19 57 recovered, the recovery rate therefore after this operation was 82.6 per cent. Such a high percentage of recoveries is very exceptional and is most creditable to the Staff. Three of the cases operated on were under two years of age, while one was a baby of twelve months. The complications arising amongst the 244 cases of Diphtheria under treatment during the year were as follows:— Complications. Number of Cases. Operations Performed. Abscess 2 2 Paralysis 8 — Albuminuria 8 — Laryngeal Obstruction — 23 Antitoxine Rashes 48 — 33 Patients were admitted suffering from Diphtheria associated with some other affection or disease. The following table gives particulars of these:- Diphtheria associated with Measles 1 case „ „ „ Whooping Cough 1 „ „ „ „ Broncho Pneumonia 1 „ „ „ „ Verminous Heads 22 cases „ „ „ Scarlet Fever 8 „ ENTERIC (TYPHOID) FEVER. During the year 23 patients were admitted who had been notified to be suffering from this disease. The subsequent course of the illness showed that 11 of these had been incorrectly diagnosed and were not suffering from Enteric Fever, 58 Of the 12 remaining cases, which were undoubtedly Enteric Fever, all recovered, Although the number of cases treated was small, it is a matter for congratulation that not a single death occurred. The number of cases treated and the death-rate per cent, for the past five years is as follows:— Year. No. of Cases Treated. Case Mortality per cent. 1903 40 15.0 1904 37 16.2 1905 53 19.2 1906 31 13.3 1907 12 0.0 Of the 12 cases of Enteric under treatment several were seriously ill, and the following complications occurred:— Complications. Number of Cases. Operation Performed. Hæmorrhage 2 — Abscess (Axillary) 1 1 Diarrhœa 2 — Otitis 3 — Relapse 1 — PULMONARY TUBERCULOSIS. During the early part of the summer, as no cases of Enteric Fever existed, instead of allowing the Wards to remain empty 59 and the Staff idle, it was decided to utilise some of this accommodation as a Sanatorium for the treatment of Consumption. From June 1st to the end of September, 12 cases of Pulmonary Tuberculosis were under treatment. The intention was not so much to cure, if possible, each patient, but to educate them in the management of their expectoration, so as to lessen the danger to others living or working with them, to instruct them as to diet, and also by practical illustration to teach the necessity for constant fresh air both day and night. These patients could then, when discharged, not only continue the treatment, but could advise others similarly afllicted. While the patients were in Hospital, the rooms they had occupied before admission were disinfected, and the other members of the family were thus, for a time, given a rest from infection. The benefits obtained were, therefore, by no means confined to the actual patients admitted. The cases were selected from those notified, under the system of voluntary Notification by various Medical Practitioners. The following particulars are given of these cases:— 60 Sex. Age. Days in Hospital. NOTES. Case 1. Male 27 112 Gained 7 lbs. 12 oz. in weight. Great improvement. „ 2. Female 39 68 Improved, and also gained 7 lbs. 12 oz. in weight. „ 3. Female 33 112 Also had Heart Disease. Not greatly benefited. „ 4. Male 35 65 Very marked improvement and gain in weight. „ 5. Male 28 28 Left at own request. Larynx also affected. Not greatly benefited. „ 6. Female 31 14 Died. Very advanced case, and should not have been sent to hospital. „ 7. Female 15 44 Greatly improved, and no sign of disease when discharged. „ 8. Female 18 71 Spine also affected, and was in plaster jacket for some time. Greatly improved and no sign of disease when discharged. „ 9. Female 56 35 Gained 4 lbs., and showed fair improvement. „ 10. Female 36 8 Discharged. Ward required for Diphtheria patients. „ 11. Male 28 7 „ 12. Male 51 7 61 In October, owing to the prevalence of Diphtheria, the Ward accommodation for this disease proved inadequate. It was, therefore, decided to discharge the Tuberculous patients, and after disinfection of the Ward they had occupied this was also used for the treatment of Diphtheria cases. The admission of these patients is often urgently required, as immediate operation in some cases is absolutely necessary. By the above arrangement it was found possible to accommodate every case desiring admission, and from October to the end of the year 24. Diphtheria cases were nursed in this Ward. Although these cases of Diphtheria were nursed in the Enteric Ward, they are for convenience all included in the list given on page 17 dealing with Diphtheria patients. In addition to the above a case of Erysipelas was admitted to the Hospital, and also treated in the Enteric Ward. It will, therefore be seen that although very few cases of Enteric Fever required nursing during the year, very valuable use was made of the Enteric Ward and its Staff. OTHER DISEASES. Under this heading are grouped all cases which on admission to Hospital were found to have been incorrectly diagnosed. The following table gives particulars of these:— Notified as suffering from:— 62 Scarlet Fever. Diphtheria. Enteric. Hospital Diagnosis. 5 ? 5 Tonsillitis. 1 Whooping Cough. 1 Sarcoma of Naso Pharynx. 2 Stomatitis. 2 Quinsy. *l Malignant Endocarditis. *1 Pneumonia and Pericarditis. *1 Carbuncle and Meningitis. *2 Tubercular Meningitis. 2 Pneumonia. 1 Malaria. † 1 Parametritis. 1 Appendicitis. † 1 Cancer of Rectum. *These cases were fatal, and post-mortem examination proved the correctness of the diagnosis. †These were sent to the London Hospital for operation. HOSPITAL ACCOMMODATION. Despite the additions made during the past year, further accommodation is still required in order to adequately meet the demands of our large population. Plans for the following have been prepared and have received the sanction of the Local Government Board, viz.:— 63 1. Scarlet Fever Ward (20 beds). 2. Isolation Cubicles (12 beds). 3. Accommodation for Scarlet Fever Staff. 4. Mortuary. Tenders for these have been invited, and I hope the work of erection will soon begin. HEALTH OF STAFF. During the year the following illnesses occurred:— Scarlet Fever 1 Sister 1 Probationer Nurse 1 Ward-Maid. Tonsilitis 2 Ward-Maids. Anæmia 1 Probationer Nurse. The Nurse and Ward-Maid who contracted Scarlet Fever, had only just been appointed, and were attacked by the disease after being only two days in the ward. PAYING PATIENTS. An arrangement has recently been made with the West Ham Guardians to admit when required, and if accommodation permits, cases of Infectious Disease occurring in their Workhouse, Infirmary, etc. 2 cases had been admitted up to December 31st last. HOSPITAL STAFF. The following list gives the total Staff at present engaged in addition to the Matron:— ADMINISTRATIVE. Cook, 7 House and Kitchen Maids, 4 Laundresses, 1 Boiler Attendant, 2 Porters, 1 Gardener, 2 Ambulance Coachmen. 64 WARDS.  Enteric. Diphtheria. Scarlet Fever. Sisters 1 1 1 Staff Nurses 2 2 3 Probationers 3 3 6 Ward Maids 1 1 2 The following were the principal alterations in the senior Staff during the year:— Miss May, who was Sister-in-Charge of the Enteric Ward, was transferred to Rancliffe House Convalescent Home to take the place of Miss Bartlett, who resigned. Miss Campbell, Sister-in-Charge of the Diphtheria Ward, also resigned. The vacancies in the above two Wards have been filled by the appointment of Miss King and Miss Munro, respectively. Both these ladies are fully trained nurses from the London Hospital, and in securing their services the Corporation have obtained officers of exceptional merit and ability. I should like to take this opportunity of recording the very willing and ungrudging service given at all times by every member of the Staff during a year of exceptionally heavy work. Establishment and Maintenance Charges, 1st April, 1906, to 31st March, 1907. ESTABLISHMENT CHARGES. £ s. d. Salaries 1,460 0 10 11¼ d. average per person per day. Repairs to Hospital and Mainteance of Grounds 143 3 2 Proportionate cost (1/5th) of Linen, Bedding, Furniture (£132 18s. 7d.) 26 11 8 Rent of Telephone 26 0 0 £1,655 15 8 65 PATIENTS' EXPENSES. £ s. d. Provisions 1,269 0 11 1/10 average per person per day. Clock House Laundry 704 4 5 Lighting, Heating and Water 473 15 6 Disinfectants and Drugs 199 7 3 Horsing Ambulance 262 3 6 Chandlery and Sundries 263 16 6 Rates, Taxes and Insurance 76 7 0 £3,248 15 1 Total cost of upkeep 2/9¼ per person per day. Days. Avrerage days each in Hospital. Scarlet Fever. Balance of unexpired cases in Hospital, 1/4/06 552 — 393 Recovered Scarlet Fever cases 9,536 24 10 Fatal Scarlet Fever cases 96 10 Balance of unexpired cases in Convalescent Home, 1/4/06 799 — 283 Convalescent Home cases 6,335 22 17,318 Diphtheria. Balance of unexpired cases in Hospital, 1/4/06 117 - 107 Recovered Diphtheria cases 2,520 23 8 Fatal do. 99 12 2,736 Typhoid Fever. 27 Recovered Typhoid cases 1,236 46 5 Fatal do. 29 6 1,265 Staff. 29 Hospital Staff 10,585 305 9 Convale cent Home Staff 3,285 365 0 13,870 Total 35,189 66 APPENDIX II. Report on Elementary Schools. With a rapidly increasing population, work in connection with the schools naturally becomes heavier each year. It has been found impossible during the past year to devote the amount of time to school work that is really necessary, and additional assistance has for some time been needed. The very heavy duties imposed by the recent Act relating to the Medical Inspection of School Children will render it necessary to provide this assistance at an early date. The following is a summary of some of the chief duties performed during the year:— INFECTIOUS DISEASES. 1. Scarlet Fever.—This disease was more prevalent than during the previous year, the cases being particularly numerous during the last four months of the year. The schools chiefly affected were visited as often as possible, and on several occasions children were found to be present who were suffering from the disease. 2. Diphtheria.—This disease was also more prevalent, and at about the same period of the year. The bacteriological laboratory has been of the utmost value in enabling an accurate diagnosis to be made in mild or doubtful cases of this disease, and by the exclusion of the children found to be affected I am of opinion that on several occasions the closing of a school or department has been obviated. The schools chiefly affected by the above two diseases were as follows, arranged in order according to the number of cases occurring in each:— 67 Scarlet Fever. Diphtheria. Walton Road Kensington Avenue Fourth Avenue High Street Essex Road Lathom Road Plashet Lane Napier Road Manor Park Essex Road Kensington Avenue Central Park Hartley Avenue The majority of the above schools are those in which the number of children on the books is in excess of the accommodation, there is, therefore, more or less overcrowding, which of course favours the spread of infection whenever a case of either disease is introduced into such a school. The schools in which the accommodation is in excess of the number on the books, that is, where no overcrowding exists, suffered the least from all infectious illnesses. In nearly every instance the Infants' department has been the one chiefly affected, the Boys' and Girls' suffering to a much less extent. 3. Measles.—Information concerning 791 cases was received from the schools during the year. A rather large number of cases of this disease occurred in the early part of the year, chiefly during February and March. School closure is more often required for Measles than for any other disease, owing to the fact that it is infectious for several days before the rash appears, also from the fact that all young children not protected by a previous attack are very susceptible to it. 68 The schools chiefly affected were the Infants' Departments of the New Beckton and Fourth Avenue Schools, and the former was closed for a period of 21 days in consequence of this disease. The circumstances in this case indicated that benefit might be expected from school closure, the children attending this school came from several districts, such as Cyprus, Savage Gardens, Roman Road, etc., and, therefore, would not intercommunicate to any extent except for school attendance. In the neighbourhood of Fourth Avenue, the children, if not at school, would, without doubt, in most cases spend their time together at play, therefore little or no benefit could be expected in this instance from school closure, and exclusion of affected children had to be depended on, consequently the outbreak here was of rather longer duration. 4. Other Infectious Diseases.—The following cases were reported to me by the school teachers:— Whooping Cough 41 Mumps 13 Chicken Pox 124 Ringworm ... 23 A printed form giving information concerning the disease, and the precautions to be adopted, was sent to the parents in all these cases. A conference was called in March, by the Essex Education Committee, to consider the question of Infectious Disease in Public Elementary Schools. Most of the Medical Officers of Health in the County attended, and, as a result, a Memorandum on the subject was prepared. 69 The majority of the recommendations were already in force in East Ham, and are contained in the Regulations of the Education Committee. 5. Physically and Mentally Defective Children.—Fifty cases were either visited at their homes or seen at my office, and reports made to the Committee. 6. Truant and Industrial School Cases.—Eleven boys were examined, and certificates given for admission to Industrial Schools. 7. Suspected Contagious or Infectious Disease.—In addition to children examined in school, 39 special examinations were made of children sent to me by teachers for the above reasons. 8. Police Court Cases.—Four children were examined, and reports sent to the Magistrate. 9. Special Examination of Teachers.— Thirty-four examinations were made, and reports given on the health of teachers who were either absent on account of illness, or who had applied for leave owing to ill-health. 10. Examination of Teachers and Pupil Teachers for Appointment.—146 examinations were made of teachers who had been appointed by the Authority subject to their passing a satisfactory Medical Examination. This work at certain times of the year occupies a very considerable time. In addition to the above, very many children were inspected during visits to the various schools, and other examinations were also made of special cases difficult to classify. SCHOOL BUILDINGS. The majority of these are satisfactory, and the premises well kept. During the year from time to time various defects in different schools were reported, the most important being at Silvertown Roman Catholic (Non-Provided) School. The sanitary arrangements here were not satisfactory, and the premises were not kept in a proper state of cleanliness. There was some 70 delay before the improvements suggested were carried out, and even at present all the defects have not been remedied. The premises also are not always maintained in a satisfactory state of cleanliness. MEDICAL INSPECTION OF SCHOOL CHILDREN. During the past year, the Education (Administrative Provisions) Act was passed, and came into force on January 1st, 1908. It compels all local Education Authorities to provide for the Medical Inspection of Children in all Public Elementary Schools. The Act imposes everywhere a duty of very considerable magnitude, but in a populous district like East Ham, with its large child population, the task must necessarily prove exceptionally heavy. A report on the Act was presented to the Council, and suggestions made for the carrying out of the obligations imposed. In framing this, every care was taken to make the fullest possible use of the existing Staff, and to limit as far as possible additional appointments and increased expenditure. The following is a summary of the report:— MEDICAL INSPECTION OF SCHOOL CHILDREN. For the information of the members of the Council and of the Education Committee, I beg to submit the following particulars of the Act recently passed dealing with this subject:— The Education (Administrative Provisions) Act, 1907, states that after January 1st, 1908, local authorities shall:— " Provide for the medical inspection of children, immediately before, or at the time of, or as soon as possible after their admission to a public elementary school, and on such other occasions as the Board of Education direct, and also gives power to make such arrangements as may be sanctioned by the Board of Education for attending to the health and physical condition of the children educated in public elementary schools." 71 The necessity for the Act was recognised by all political parties, as it had been proved to the satisfaction of Parliament that physical defects and remediable diseases were very prevalent among school children and were leading to physical deterioration in the people. Extent of the Inspection. A memorandum issued by the Board of Education states that the examination shall take account of the following matters :— (1) Previous disease, including infectious diseases. (2) General condition and circumstances:— (a) Height and weight. (b) Nutrition. (c) Cleanliness. (d) Clothing (sufficiency, cleanliness, etc.) (3) Throat, nose and articulation (mouth breathing, adenoids, etc.) (4) Eye disease and vision testing. (5) Ear disease and deafness. (6) Teeth and oral sepsis. (7) Mental capacity. (8) Present disease or defect:— (a) Deformities or paralysis. (b ) Rickets. (c) Tuberculosis. (d) Diseases of skin and glands. (e) Diseases of heart and lungs. (f) Anaemia. (g) Epilepsy. (h) Chorea. (i) Rupture. (j) Spinal disease. (k) Any weakness or defect unfitting the child for ordinary school life. The Board state that " the effectiveness of medical inspection will in future be one of the elements to be considered in determining the efficiency of each school as a grant aided school." 72 Frequency of Inspection. Under Section 13 of the Act, the Board of Education have decided that not less than three inspections during the school life of each child will be necessary ; these should be undertaken:— (1) As soon as possible after admission. (2) At about the seventh year. (3) At about the tenth year. A further inspection immediately before the departure of the child into working life is desirable where practicable. In the first year (1908) it may prove impracticable to attempt more than the inspection of the children newly admitted and those leaving school. In the second year (1909) the Board will be satisfied with the inspection of those newly admitted and those leaving, with the addition of those who have matured for their second examination. Some such adjustment "will tend to equalise the burden over successive years." Number of Children to be Examined. From information supplied by the Secretary of the Education Committee, it is estimated that the number of children to be examined during the first year (1908) will be at least 5,000 ; this will include only the children joining and those leaving school. In the following year (1909), in addition to the above, those children in the schools who have reached the age fixed for the second inspection, will also have to be examined ; these will increase the number for this year to more than 7,000. While in succeeding years the numbers will further increase until the whole of the children in the schools have been examined. It is important to bear in mind the fact that this systematic examination of children will be in addition to much of the work already done in the schools, and cannot take the place of it. For instance, an outbreak of any infectious disease in a class or school will necessitate for a time frequent visits to the 73 class or school affected. The special examination of physically and mentally defective children and of children for admission to truant and industrial schools will still have to be done. There is also a considerable amount of work to be performed in the examination of teachers on appointment, or absent on account of illness. All these points have to be borne in mind in considering the questions of staff required and method of administration. Staff and Organisation. The Memorandum of the Board of Education states that " the Administration of the Act should rest on a broad basis of Public Health, and that local authorities should use to the utmost extent the existing machinery of Medical and Sanitary administration. The work of inspection should be supervised by the Medical Officer of Health, and when the work is obviously more than he can undertake unaided, it should be entrusted to one or more Medical Officers, working under his supervision." This is obviously the correct view to take, for school hygiene does not differ from general hygiene, and the conditions and defects discovered by medical inspection will have to be followed up in the homes in order that they may be remedied, for as the Memorandum observes: " it is in the home that both the seed and the fruit of public health are to be found." In considering the Staff required for this work the following figures must be borne in mind. The School year consists of 200 days and the School day of about four hours. Therefore, in 800 hours, over 5,000 children have to be examined in the first year. If one person does this work alone and nothing else, it means that about seven children per hour, or one child every nine minutes, must be examined on every day throughout the either School year. It must, however, be remembered there is other work to be done in connection with the Schools, as stated on pages 6669, therefore, the Staff suggested in a previous report to the Sub-Committee, namely, one Medical Assistant and a Nurse, certainly errs on the side of moderation, and even with very constant work I consider will only just suffice for the present. 74 It may be suggested that local medical practitioners can be employed for this work; there are, however, many drawbacks to this. The demands of a general practice may at any time require their attendance, and further, for practitioners to examine the children of other medical men's patients would lead to friction, and this should, if possible, be avoided. I think also the employment of one or two full time officers will be less expensive than a number of part time practitioners. The employment of one or more School Nurses I consider to be of the highest importance, if this work is to have any •practical value. The mere compilation of a mass of statistics should not be the object in view ; the chief aim must be that the defects discovered should be explained by the Nurses to the parents, in order that the disease or condition which either renders the child dangerous to its fellows, or prevents it obtaining full benefit from the teaching provided, may be remedied. By this means, as the Memorandum states, " the increased work undertaken by the state for the individual will mean that the parents will not have to do less for themselves and their children, but more. And if rightly administered the new Act is economical in the best sense of the word. Its justification is not to be measured in terms of money, but in decrease of sickness and incapacity among children, and in the ultimate decrease of inefficiency and poverty in after life, arising from physical disabilities." The expense of working the Act as outlined above and on the lines of the Report to the Sub-Committee will, I think, including all necessary equipment, be easily covered by a ½d. Rate. In view of the great benefit which must ensue, this amount cannot well be considered an excessive expenditure. (Signed), G. Sowden, M.D., D.P.H., Medical Officer of Health and Medical Officer to the Education Committee. 75 A Sub-Committee had previously considered the matter, and recommended that the work be carried out on the lines suggested in the above report. The Council, however, decided in view of the expense that would be incurred, to take no steps in the matter for the present. I would here respectfully point out that as the effectiveness of Medical Inspection is in future to be a factor in determining the grant, it may not be wise to defer the matter for too long a period. Since the foregoing report was presented, the Board of Education have issued a Schedule of Medical Inspection which they suggest be used by all authorities, as tending to secure uniformity in the method adopted. This Schedule is reproduced below, as it gives a clear impression of the extent and character of the work. 76 SCHEDULE OF MEDICAL INSPECTION. I.—Name Surname first. Date of Birth Address School II.—Personal History: (a) Previous Illnesses of Child (before admission). Measles Scarlet Fever Whooping Cough Diphtheria Chickenpox Other Illnesses (b) Family Medical History (if exceptional). General Observations. Directions to Parent or Teacher. 77 I. II. III. IV. 1. Date of Inspection 2. Standard and Regularity of Attendance 3. Age of Child 4. Clothing and Footgear 5. Height 6. Weight 7. Nutrition 8. Cleanliness and condition of Skin Head Body 9. Teeth 10. Nose and Throat Tonsils Adenoids Submax. & Cervical Glands 11. External Eye Disease 12. Vision R. L. 13. Ear Disease 14. Hearing 15. Speech 16. Mental Condition 17. Heart and Circulation 18. Lungs 19. Nervous System 20. Tuberculosis 21. Rickets 22. Deformities, Spinal Disease, &c. 23. Infectious or Contagious Disease 24. Other Disease or Defect F 78 There is no item in the above which could well be omitted. Some, probably, might have hoped for more detail, but the Board have, doubtless for reasons of economy, refrained from adding items possessing only interest from an anthropometrical point of view. What is really required is an inspection to determine the fitness of the child for school life, and from this aspect the Schedule is a throughly practical one. REPORT of the CHIEF SANITARY INSPECTOR. 8o 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 have the honour to present to you my thirteenth Annual Report upon the work accomplished by the Sanitary Inspectors during the year ended 31st December, 1907. Inspection of the Borough and Abatement of Nuisances.—In investigating complaints lodged, notification of Infectious Diseases received, house-to-house inspections, &c., 4410 primary inspections were made as under:— Beckton and N. Woolwich Ward. Central East Ward. Central West Ward. Manor Park Ward. Plashet East Ward. Plashet West Ward. Total. January 26 44 92 84 19 61 326 February 20 43 66 85 34 72 320 March 21 79 68 56 30 55 309 April 43 70 89 98 37 68 405 May 34 50 148 106 36 94 468 June 15 98 78 82 51 81 405 July 19 49 87 97 16 46 314 August 41 43 73 112 28 67 364 September 18 55 79 118 38 69 377 October 21 89 74 118 46 60 408 November 21 76 62 102 32 50 343 December 20 88 103 74 34 52 371 Totals 299 784 1019 1132 401 775 4410 These figures do not include the re-inspection of premises to ascertain if the insanitary conditions discovered at the primary inspection had been remedied, and that the structural work often necessary was being efficiently performed. The greater part of the Inspectors' time is occupied in supervising works in progress essential to the abatement of nuisances 81 As a result of the inspections made 3522 nuisances were discovered. The following table sets forth their nature:— Beckton & N. Woolwich Ward Central East Ward Central WestWard Manor Park Ward Plashet East Ward Plashet WestWard Total. Premises found in a sanitary condition 140 288 413 452 208 368 1869 Walls and ceilings dirty and dilapidated 25 62 124 120 29 77 437 Yards improperly paved and dilapidated 4 45 58 72 15 55 249 Forecourts unpaved 2 20 47 26 14 62 171 Defective drains and connections 12 66 109 73 10 78 348 Defective w.c. traps 2 5 1 11 — 1 20 Defective flushing apparatus, or no water to w.c. 8 18 20 37 10 17 110 Foul and broken soil pans 8 21 56 59 20 59 223 Defective drain ventilating shafts 2 21 12 20 10 14 79 Defective rainwater pipes and eaves-gutters 13 12 45 42 6 21 139 Rainwater pipes directly connected to drains 1 — 2 1 — 7 11 Leaky roofs 13 11 28 24 6 19 101 Defective sink waste pipes 3 18 12 28 6 8 75 Houses without water (M.W. Board) 1 2 5 13 5 7 33 Drinking-water cisterns without covers 6 89 41 112 8 20 276 Drinking-water improperly stored and dirty cisterns 3 38 18 32 7 12 110 Dilapidated floors 4 9 9 24 — 6 52 Iusufficient under-floor ventilation 3 28 34 46 9 37 157 82  Beckton & N. Woolwich Ward Central East Ward Central WestWard Manor Park Ward Plashet East Ward Plashet WestWard Total. Dampness 2 3 6 18 6 9 44 Accumulations 12 27 20 49 15 25 148 Inundations — — 3 6 1 1 11 Overcrowding 1 3 3 12 — 3 22 Unsound food — — 6 2 — 4 12 No dust bins — 5 3 23 3 7 41 No manure bins — — 2 4 1 2 9 Animals improperly kept — 1 1 5 2 2 11 Breaches of Bye-laws — 2 2 11 2 4 21 Gipsies removed 41 2 — 225 — — 268 Other nuisances 26 44 89 87 19 79 344 Drains tested and proved sound 87 205 271 312 132 134 1141 To effect the remedying of the sanitary defects referred to in the foregoing table, it necessitated serving 935 Preliminary Notices, 91 Statutory Notices, 23 Water Notices, 209 Dust Bin Notices and the writing of a large number of letters. In reviewing the nature of the nuisances dealt with, it will be observed that internal cleansing of walls and ceilings occupies the foremost position in the table, for in 437 premises this work has been performed, the number for the year 1906 being 338. Defective drains and connections have been discovered in 348 houses, as compared with 379 for the previous year. In every case notices were served, and the defects remedied either by the owner, or by the Council at the owner's request and expense. The system of drainage that is general throughou the Borough is the combined system, which works very satisfactorily, for in designing and constructing the drains manholes have been provided, affording facilities for inspecting and clearing when necessary. 83 At the following houses drainage works have been executed : 329 to 339, Barking Road. 37, High Street, North Woolwich. 107, Elizabeth Street. 75 to 93, Ranelagh Road. 1, 3, 5, Barnard Terrace, Albert Road. 27, High Street. 19, Creighton Avenue. 90 to 96, Albert Road. 2 to 14, Holloway Road. 1, 2, 3, Holloway Terrace. 4, 5, 6, 7, Holloway Terrace. 3, 4, 5, 6, 7 and 8, Salt Box Row. 28 and 30, Durham Road. 23, Warwick Road. 8, Durham Road. 14, Cumberland Road. 212-226 (8), Parkhurst Road. 1 to 25 (25), Gloucester Road. 29, 31, 33, 35, 37, 39, 41, 43, 45 and 47, Station Road. 160, 162, 164, 166, 168, 170, 172, 174, 176 and 178, Katherine Road. 397, Katherine Road. 39, Florence Road. 38, Parr Road. 5, Walpole Road. 17 and 19, Plashet Grove. 90, York Road. York Cottage, Wakefield Street. 365, Green Street. 43 and 45, Holme Road. 53, Elizabeth Road. 90, 92 and 94, Cleves Road. 17, Woodstock Road. It is the policy of the Council to unstop choked drains by their own men, who are well acquainted with the positions of the Inspection Chambers and Interceptors, and speedily remove the 84 cause of trouble, while men without an intimate knowledge of the positions of the manholes and line of drains will often do irreparable damage, without removing the obstruction or remedying the nuisance. Owners and occupiers are encouraged to inform the Sanitary Inspector when the drains are stopped ; but there are some owners who are reluctant to send for fear the Inspector may discover some other sanitary defects necessitating remedial measures being taken, hence the " handy man " is brought in. Drain Testing.—There have been 1,509 house drains tested with chemicals, smoke or water ; 1,141 proved sound (being equal to 76.5 per cent.). In 368 instances defects were discovered, either in the drain traps or connections. Comparing these figures with the previous year, when the drains tested were 1,140, drains in which no defects were discovered being 761, or 66.7 per cent. of the number tested. Summary proceedings were instituted for non-compliance with Sanitary Notices, exposing unsound and diseased food for sale, contraventions of the Contagious Diseases of Animals Act, and Public Health Act. Convictions and fines amounting to £47 18s. 6d. were obtained as under:— 85 Date. Address. Offence. Result of Proceedings. 7th Jan. 11, Lloyd Road No water for drinking and domestic purposes. Magistrate made order for work to be done forthwith, and payment of 6s. 6d. costs. 12th March Langdon Cres. Breach of the East Ham Allotments (Swine Fever) Order, 1906. Fined £5 and 17s. 6d. costs. 12th March Langdon Cres. Breach of the East Ham Allotments (Swine Fever) Order, 1906. Fined £2 10s. and 9s. costs. 5th July High Street N., E. Ham Exposing for sale diseased meat. Fined £20 and £3 9s. 6d. costs. 5th July Katherine Road Exposing unsound tomatoes for sale. Fined £1 and 5s. costs. 5th July Katherine Road Obstructing Inspector in discharging his duty. Fined 2s. 6d. and 5s. costs. 19th July Langdon Cres. Breach of the East Ham Allotments (Swine Fever) Order, 1906. Fined £6 and 4s. 6d. costs. 19th July Langdon Cres. Breach of the East Ham Allotments (Swine Fever) Order, 1906. Fined £2 and 11s. costs. 16th August Barking Road Exposing for sale unsound tomatoes. Fined £1 and 5s. costs. 16th August Langdon Cres. Breach of the East Ham Allotments (Swine Fever) Order, 1906. Fined 10s. including costs. 29th Oct. Alverstone Road Exposing infected person to the danger of the public. Fined 10s. and 8s. costs. 29th Oct. Dore Road Letting infected rooms, contrary to the provisions of the. Public Health Act. Fined £1 and 5s. costs. 20th Dec. Sibley Grove Transmitting infected articles, contrary to the provisions of the Public Health Act. Fined 15s. and costs. 86 Overcrowding.—The number of cases dealt with under this heading was 22. This is a slight increase on the previous year (17). Overcrowding may be considered amongst the most difficult and serious forms of nuisance that an Inspector has to deal with, as it is invariably accompanied with misery, actuated by poverty. Misfortune frequently forces poor people to a condition that they are compelled to reduce the number of rooms which they occupy, and crowd their families into insufficient accommodation. It often happens that when a Notice is served to abate overcrowding, the people vacate the premises to comply with the Notice, but one knows that the premises to which they go will soon be as bad, and perhaps worse, than those vacated. It is a form of nuisance that must ever exist among workmen whose income is precarious and who have large families dependent upon them. Cheap rent is the best remedy for this evil. Dirty Preinises.—The cleansing of internal walls and ceilings has been carried out in 437 houses, as compared with 338 for the year 1906. This work includes stripping, cleansing, and making good dilapidations upon the premises, such as broken floors, walls, and ceilings. Paving of Yards and Forecourts.—Closely associated with the sanitary condition of the interior of the dwelling house and drainage system is the paving of the ground immediately abutting the front and rear of the premises. It is an important factor in preventing dampness, which often means preventing illness, if the ground immediately abutting the houses is not paved, or the paving is permitted to get broken and dilapidated, the soil becomes polluted, and especially is this the case where animals such as fowls, rabbits, and even goats, are allowed to roam about the yard, depositing filth and creating a nuisance. Where the yards are properly paved it is an inducement to the tenants to wash and cleanse the yards. One cannot but regret to observe, in visiting the backs of premises, that there is not the same enthusiasm displayed by the present tenants for the cultivation of flowers that existed ten years back, and that fowl-houses and 87 poultry-sheds have displaced many little greenhouses and flowerbeds. One has discovered outhouses that were formerly used for forcing plants now being used as incubators for forcing chickens. It may be more profitable to cultivate poultry than flowers, but the latter is cleaner and a more healthy occupation. Dairies and Cowsheds.—There are 7 registered Cowsheds and 138 Dairies in the Borough. These have all been regularly inspected and the provisions of the Dairies and Cowsheds Regulationsen forced. 256 Inspections have been made and details entered in the Dairies Register. The general condition of the Dairies and Milk Shops may be considered good, although there is still room for improvement. The suggestions of the Medical Officer of Health made last year to the milk vendors have been almost universally adopted, especially the request to provide a properly-ventilated metal cover to the Counter Pan. A large number of small general shops have ceased to sell milk. The following is a list of Cow-houses:— Forest View Farm. 316, High Street North. Shaftesbury Road. 55, Woodstock Road. Fifth Avenue. Little Ilford Lane. Unsound Food.—The market places have been regularly inspected, and on 12 occasions unsound food has been discovered by an Inspector exposed for sale, on three occasions seizures were effected, and in the remaining g cases the food was destroyed in the Inspector's presence and the offenders cautioned. The three seizures comprised two parcels of tomatoes and the carcase of a tuberculous cow. In all three instances the food was taken before a magistrate, condemned, destroyed, and summary proceedings instituted, convictions obtained and penalties inflicted. The case of the tuberculous cow was considered by the magistrate to be a very serious matter for the general public, and after patiently hearing the case at length, fined the responsible person Twenty Pounds. 88 There would have been a fourth seizure to report, but for the Inspector being prevented by the offender pitching the unsound food into a passing mud cart. He (the offender) was proceeded against and convicted for obstructing the officer in the discharge of his duties. A large quantity of unsound food has been surrendered by persons who had purchased it from the wholesale merchants for the purpose of sale. These consignments comprised mackerel, hake, skate, codlings, rabbits, turkeys, beef and milk. This last case presented some peculiarities, and although the milk was surrendered by the owner it was deemed advisable to have it condemned by a Justice of the Peace. This was accordingly done, the milk and sediment were microscopically examined by the Medical Officer of Health and the beasts on the farm from which the milk came were subsequently inspected, but it was found impossible to take any action. The inspection of foods is one of the difficult duties an Inspector has to perform ; a thoroughly unsound or obviously diseased article is clearly unsaleable, and one never sees such exposed for sale; the slightly unsound article then becomes very largely a matter of opinion, one expert having no hesitation in condemning, while another would refuse. There can be no doubt that the practice of giving certificates of destruction for unsound food which has been surrendered by the owner prevents a large quantity of unsound food being exposed for sale. Tradesmen recognise that it is to their advantage to submit for examination any article of food of which they have any doubt. Gipsies.—These troublesome visitors still continue to annoy. On 268 occasions, visits to their caravans and tents were made. The interior of these dwellings may be generally described as dirty and overcrowded, but as they practically exist in the open air, the occupants do not seem to suffer by the conditions under which they live. They are a pest to the inhabitants residing near vacant land where they encamp, for they are continually begging for water, etc. 89 On several occasions I have had to forcibly remove them, with the assistance of horses and men under police protection; but the gipsy is a man who is accustomed to suffer a few inconveniences, and endures ejectment with good humour, and to prove that he is in no way offended he quickly returns, frequently bringing with him a few friends. Factories and Workshops.—There are 244 Factories and Workshops on the register, including Laundries, as compared with 213 for the previous year. They comprise principally Tailors, Blouse-makers, Shirt-makers, etc. During the year 1907 some 384 inspections were made and 16 Notices served to abate nuisances and improve the general sanitary condition of the premises. The chief nuisances are defective ventilators, internal cleansing, insufficient water-closet accommodation, and drainage of floors. On 30 occasions the Home Office has been informed of breaches of regulations. Slaughter Houses.—There are 13 registered and licensed Slaughter Houses in the Borough, situated as under:— Forest View Farm. Rear Greenhill Grove. 363, Green Street. 14, High Street North. 170, High Street North. 330, Katherine Road. 89, Plashet Lane. 32A, Plashet Lane. 638, Romford Road. 28, Station Road. Shaftesbury Road. 24, Wakefield Street. 65, Whitta Road. 80 Inspections have been made in order to see that the provisions of the Slaughter House Regulations were complied with, 90 The majority of the owners and occupiers of these premises carry out the work of limewashing, but in some instances it has been necessary to serve Notices for cleansing. Schools.—The Public and Private Schools have been regularly inspected, and have generally been found in a cleanly and satisfactory condition, the drains, manholes and gullies of the public elementary schools have been systematically cleansed and disinfected by the Council's men, the urinals, lavatories and sanitary appliances being attended to by the Caretakers. Disinfectants.—There are three distributing stations in the Borough for issuing disinfectants—Central Station (Town Hall Depot), the Northern Station at the Church Road Depot and the Southern Station at Cyprus. It is a great convenience to the public who require disinfectants in consequence of having infectious disease in the house to be able to obtain it from these stations. They are open every morning from g to 11 and in the afternoon from 2 till 3. Some 36 tons of powder and 1940 gallons of fluid have been given to Ratepayers ; the greater part of the Carbolic Powder has been used in connection with disinfecting Dust-bins. Collection of House Refuse.—During the year under review, 13,656 loads of refuse have been collected, as compared with 13,380 for the previous year. The disparity in these figures would be greater but for the fact that two carts have been displaced by two vans. The whole of the refuse has been conveyed to the destructor, where it is used as fuel for generating steam utilized in connection with the Sewage Works. 210 Notices have been served upon responsible persons to furnish houses with suitable galvanised iron dust bins. 160 were complied with, but in 50 cases the Council supplied the bins and the Borough Treasurer recovered the cost under the powers contained in the East Ham Improvement Act, 1903. The following table gives the number of loads of refuse collected during the year:— DUST COLLECTION. NUMBER OF LOADS COLLECTED DURING 1907 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 73 180 212 243 234 345 1287 FEBRUARY 58 185 206 215 169 254 1087 MARCH 63 232 246 213 156 265 1175 APRIL 69 177 210 262 202 266 1186 MAY 58 205 248 236 175 315 1237 JUNE 54 166 195 201 159 245 1020 JULY 70 176 215 272 213 266 1212 AUGUST 54 201 239 197 152 266 1109 SEPTEMBER 58 166 196 240 153 234 1047 OCTOBER 63 177 191 216 194 291 1132 NOVEMBER 55 216 250 206 161 242 1130 DECEMBER 71 165 193 241 182 182 1034 746 2246 2601 2742 2150 3171 13,656 92 Temporary Buildings.—There are many nuisances for which occupiers of houses are responsible, such as the keeping of fowls, ducks, rabbits and goats, penned in small wooden structures in back yards, which are frequently allowed to get into a most filthy condition. It often happens that these animals are allowed to roam about the yard and the refuse and waste food of the house deposited upon the ground close to the dwelling. The practice of erecting wooden out-houses is very common. The question of ventilation is never considered by some occupiers who are desirous of keeping their favourite pets. Every thought is given to keeping animals warm, but the supply of fresh air for the children is disregarded. Frequently buildings have been erected encasing both the window and back door, including the ground floor water closet, which under the circumstances has to ventilate into the dwelling-house. During the year some 21 of these erections have been reported to the Borough Engineer, who deals with them under the Building Bye-laws. Back Passages.—The business premises in the Borough and many of the private residences are provided with secondary means of access at rear of the premises. The passages are generally kept in a dirty condition ; joint ownership or occupation incurs the difficulty in fixing the person causing the nuisance, although in many instances the offender is an itinerant hawker who avails himself of a dark passage to deposit his garbage. Many complaints have been made and much time given to inspecting and serving Notices for the abatement of nuisances arising in connection with these passages. Urinals.—There are eight Public Conveniences in the Borough. Special men are employed by the Council, whose duty it is to maintain them in a proper state of cleanliness. The urinals aattched to the Public Houses are, with few exceptions, kept in a satisfactory condition. 93 Trade Refuse.—The collection of fish offal and butchers' refuse is largely carried out at night, with as little annoyance to the public as possible. Special attention is given by the Inspectors, particularly during the summer months, to see that the collecting vans and receptacles are kept clean. Very little difficulty is experienced in getting trade refuse that is of commercial value removed, but it is the trade refuse that is not which gets dumped upon vacant land and back passages to become a nuisance. It has been the practice of the Public Health Department to cause to be picked up by the Dustmen any objectionable accumulation deposited about the Borough. Petroleum Licenses.—The premises licensed by the Council for the storage of petroleum have been systematically visited, and the requirements incumbent upon the Licensee for the storage of petroleum insisted upon. Mortuaries.—Inspections of the Council's Mortuaries have been frequently made, and they have always been found in a creditable condition; especially does this apply to the Wakefield Street Buildings, considering the disadvantages that have to be encountered owing to the character of the building. Complaints.—For the twelve months under consideration there have been 919 complaints received, 598 written and 321 verbal, in respect to alleged nuisancer. Many of the complaints were frivolous, and others outside the duty of an Inspector to deal with, but in every case where nuisances existed within the meaning of the Public Health Act, immediate action was taken for their abatement. Complaints were received in the different wards as follows:— Beckton and North Woolwich Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Total. 1906 1907 1906 1907 1906 1907 1906 1907 1906 1907 1906 1907 1906 1907 52 51 182 144 200 192 333 264 137 77 196 191 11oo 919 G 94 House to House Inspection.—As much time as possible has been given to this important branch of the work, but in consequence of the large increase in the number of infectious diseases that had to be investigated, and the ever increasing number of domestic workshops and outworkers, the time for house to house inspection has been limited. There is no more important part of an Inspector's work than that of systematic house to house inspection, for it is only by this means that many serious nuisances are disclosed. There still exist many people who patiently endure nuisances without complaining, whilst on the other hand there is a large number who write long letters complaining of imaginary bad smells, or of something they consider ought to be done which is being left undone. The method adopted for the inspectorial work is to utilise the mornings for visiting infectious diseases and matters of urgency, and the afternoons for supervision of structural works and house to house visitation. More useful and beneficial work could be done if much of the Inspectors' time was not wasted by making fruitless journeys in search of outworkers who do not exist, but whose names and addresses have at some time been on the register of a City house, and carelessly returned as being still in their employ. During the past year some 217 visits have been to no purpose. Contagious Diseases Animals Act (1886).—Since my appointment by the Council, early in 1906, to the office of Inspector under the Contagious Diseases of Animals Act, one has had a busy time, for in May of that year Swine Fever broke out in the Allotments situated in Langdon Crescent, Wall End, and there has been a continuity of these outbreaks from that date. The situation has become so serious that the Board of Agriculture issued a Special Order, known as the East Ham Allotment (Swine Fever) Order, which enforces restrictions upon pig-keeping within the area affected. It also necessitates a considerable amount of work for the Inspector and Deputy-Inspectors, for no pigs can be removed in or out of the Allotments without the Inspector's License. Pigs for market must be conveyed to a Licensed Slaughter House in the Borough, be marked in a 95 special way (provided for by the Order) and notice given to the Inspector when it is to be killed, so that the carcase and viscera can be examined. Before a License is issued for pigs to be brought into the area, declarations have to be made, and countersigned by the Chief Constable of the District from where the pigs are being removed, as to their being free from disease, and not having been in contact with an infected animal. During the year 1907, 28 declarations have been made affecting 340 pigs, and 130 Licenses have been issued for moving 726 pigs in and out of the Borough. Glandered Horses.—There have been three outbreaks of Glanders during the year, necessitating the slaughter of four horses, the carcases being subsequently cremated in the Council's Destructor, the buildings and mews being disinfected and stable utensils destroyed. The origin could not be ascertained in any one of these cases, beyond that it was the practice of the owners to permit the horses to drink from public water troughs. Compensation was paid by the Council, in accordance with the Glanders and Farcy Order, where in the opinion of the Public Health Committee there was a legal claim. Dogs' Home.—1121 stray and lost dogs have been picked up by the police in the streets within the Borough of East Ham during the year 1907. Of this number 1,008 have been painlessly destroyed in the Lethal Chamber and the carcases cremated, 85 dogs have been sold and 28 returned to their owners. The following is the total number of animals killed and destroyed during the year:— Dogs 1,008 Horses 4 Cats 2 Donkeys 2 Pigs 28 1,024 96 Table showing the Localities in which certain Diseases of a Zymotic character occurred during the year 1907. LOCALITY. No. of Occupied Houses. June, 1507. Scarlet Fever. Diphtheria. Membranous Croup. Typhoid Fever. Erysipelas. Puerperal Fever. Albert Road 118 .. 2 .. .. .. 1 Alexandra Road 74 8 6 .. .. 1 .. Arthur Road 11 1 1 .. .. .. .. Altmore Avenue 189 1 1 .. .. .. .. Ashford Road 51 1 .. .. .. .. .. Aintree Avenue 65 1 .. .. .. .. .. Arragon Road 110 8 .. .. 2 .. .. Abbotts Road 63 3 1 .. .. 1 .. Aldersbrook Lane 1 .. .. .. .. .. .. Aldersbrook Road 25 2 1 .. .. .. .. Albany Road 43 1 1 .. .. 1 .. Alverstone Road 147 23 .. .. .. 1 .. Ashley Road 28 4 .. .. .. .. .. Ann's Cottages 9 .. .. .. .. .. .. Brooks Avenue 67 2 14 .. .. .. .. Beaconsfield Street 20 .. 1 .. .. .. .. Beckton Road 108 2 .. .. .. .. .. Bridge Road 39 .. 1 .. .. .. .. Becket Avenue 57 2 .. .. .. .. .. Brighton Road 60 1 .. .. .. .. .. Bonny Downs Road 60 1 .. .. .. .. .. Burges Road 222 5 .. .. Burges Road South 12 .. .. .. .. .. .. Bartle Avenue 61 3 .. .. .. .. .. Bendish Road 47 .. 1 .. .. .. .. Boleyn Road 95 4 1 .. .. .. .. Barking Road 279 10 .. .. .. .. .. Boundary Road 66 2 1 .. .. .. .. Brancaster Road 3 .. .. .. .. .. .. Barrington Road 29 2 .. .. .. .. .. Browning Road 231 4 12 .. .. 1 .. Benson Avenue 63 14 1 .. .. 1 .. Bath Road 6 .. .. .. .. 1 .. Byron Avenue 232 6 10 .. .. .. .. Berkeley Road 35 4 1 .. .. .. .. Bristol Road 136 2 1 .. .. .. .. Balmoral Road 1 .. .. .. .. .. .. Birchdale Road 72 .. .. .. .. .. .. Creek Terrace 35 .. .. .. .. .. .. Cyprus Place 38 3 .. .. .. .. .. Cameron Street 19 .. .. .. .. .. .. Church Street 15 1 .. .. .. .. .. Claremont Street 54 1 .. .. .. .. .. Cranmer Avenue 61 .. .. .. .. .. .. Calverton Road 37 2 3 .. .. .. .. Charlemont Road 118 11 8 .. .. .. .. 97 LOCALITY. No. of Occupied Houses, June, 1907 Scarlet Fever. Diphtheria. Membranous Croup. Typhoid Fever. Erysipelas. Puerperal Fever. Caulfield Road 163 3 1 .. .. 1 .. Caledon Road 132 6 1 .. .. .. .. Clements Road 126 1 .. .. .. .. .. Compton Avenue 73 3 1 .. 1 1 .. Campbell Road 33 4 .. .. .. .. .. Castle Street 38 3 .. 1 .. .. .. Cleves Road 89 7 .. .. .. 2 .. Colvin Road 61 4 .. 1 .. 1 .. Creighton Avenue 75 5 1 .. .. 1 .. Central Park Road 236 19 7 .. .. 2 .. Charlotte Terrace 5 .. .. .. .. .. .. Chesterford Road 93 3 4 .. .. .. .. Carlton Road 46 .. 1 .. .. .. .. Clarence Road 27 .. .. .. .. .. .. Cumberland Road 15 3 .. .. .. .. .. Capel Road 67 2 .. .. .. .. .. Carlyle Road 118 5 1 .. .. 2 .. Colchester Avenue 58 4 1 .. .. .. .. Church Road 132 6 3 .. .. .. .. Colston Road 41 3 1 .. .. .. .. Clifton Road 31 1 .. .. .. .. .. Coleridge Avenue 70 3 1 .. .. .. .. Crescent Road 46 4 1 .. .. .. .. Cowper Avenue 22 1 .. .. .. .. .. Cromwell Road 63 7 .. .. .. .. .. Chester Road 67 3 .. .. .. .. .. Claremont Road 55 1 .. .. .. .. .. Denbigh Road 14 2 .. .. .. .. .. Drew Road 6 .. .. .. .. .. .. Dukes Avenue 3 .. .. .. .. .. .. Dickens Road 54 4 .. .. .. .. .. Dore Road 33 6 1 .. .. .. .. Dersingham Avenue 134 12 3 .. .. .. .. Durham Road 94 2 1 .. .. .. .. Dorset Road 68 .. .. .. 1 .. .. Elizabeth Street 131 5 .. .. .. .. .. Eastbourne Road 51 .. .. .. .. .. .. Eversleigh Road 68 5 .. .. .. Ernald Avenue 66 2 1 .. .. .. .. Empress Avenue 30 .. .. .. .. .. .. Eighth Avenue 38 5 .. .. .. .. .. Elsenham Avenue 29 3 1 .. .. .. .. East Avenue 61 4 2 .. .. .. .. Essex Road 110 8 5 .. .. .. .. Elizabeth Road 111 7 2 .. .. .. .. Edith Road 30 .. .. .. .. .. .. 98 locality. No. of Occupied Houses, June, 1907. Scarlet Fever. Diphtheria. Membranous Croup. Typhoic Fever Erysipelas. Puerperal Fever. Frinton Road 14 .. .. .. .. .. .. Factory Road 1 .. .. .. .. .. .. Francis Street 21 1 .. .. .. .. .. Ferndale Street 10 .. .. .. .. .. .. Fabian Street 27 .. .. .. .. .. .. Folkestone Road 20 6 .. .. .. .. .. Friars Road 94 5 .. .. .. 1 .. Florence Road 33 .. Fifth Avenue 33 12 .. .. .. .. .. Fourth Avenue 105 12 1 .. .. .. .. First Avenue 126 9 .. .. .. .. .. Forest View Road 26 .. .. .. .. .. .. Forest Drive 36 2 .. .. .. .. .. Fry Road 15 .. .. .. .. .. .. Finden Road 17 1 .. .. .. 1 .. Glenister Street 32 .. .. .. .. .. .. Gooseley Lane 35 1 1 .. .. 1 .. Gillett Avenue 58 2 1 .. .. .. .. Grosvenor Road 29 .. .. .. .. .. .. Greenleaf Road 14 .. .. .. .. .. .. Gainsborough Avenue 34 4 .. .. .. .. .. Grantham Road 126 19 2 1 1 .. .. Gordon Road 10 .. .. .. .. .. .. Gladding Road 12 1 .. .. .. .. .. Gloucester Road 49 11 1 .. .. .. .. Greenhill Grove 89 8 1 1 .. 1 .. Goldsmith Avenue 112 2 1 .. .. .. .. Gladstone Avenue 93 2 1 .. .. 2 .. Green Street 189 2 3 .. .. .. .. Haldane Road 8 1 .. .. .. .. .. Hennikers Gardens 4 1 .. .. .. .. .. Hatherley Gardens 54 8 1 1 .. .. .. High Street, N. Woolwich 45 1 2 .. 1 .. .. Hall Road 26 .. .. .. .. .. .. Hertford Road 5 .. .. .. .. .. .. Holloway Road 7 .. 1 .. .. .. .. Holland Road 8 .. 1 .. .. .. .. Howard Road 10 1 .. .. .. .. .. Henry Road 13 .. .. .. 1 .. .. Holme Road 59 1 2 .. .. .. .. Harrow Road 39 1 3 .. .. .. .. Heigham Road 131 1 1 .. .. .. .. Hartley Avenue 43 4 .. .. .. .. .. Hockley Avenue 67 10 1 .. .. 3 .. High Street South 164 3 4 .. .. .. .. Herbert Road 136 6 5 .. .. 1 .. Harcourt Avenue 105 7 .. .. .. 1 High Street North 340 10 2 .. .. 2 1 99 LOCALITY. No. of Occupied Houses, June, 1907. Scarlet Fever. Diphtheria. Membranous Croup. Typhoid Fever. Erysipelas. Puerperal Fever. Halley Road.. 359 12 5 .. .. 1 .. Henderson Road 85 .. 1 .. .. .. .. Hilda Road 28 .. .. .. .. .. .. Hampton Road 27 2 .. .. .. .. .. Johnstone Road 21 .. .. .. .. .. .. Jephson Road 55 1 .. .. .. 1 .. Johnson's Place 6 • • .. .. .. .. .. Kennard Street 2 .. .. .. .. .. .. Keppel Road 87 .. 4 .. .. .. .. Kempton Road 109 5 6 .. .. 2 .. Kimberley Avenue 2 .. .. .. .. .. .. Kings Road 31 4 .. .. .. .. .. Katherine Road 375 17 .. .. .. .. .. Kensington Avenue 153 6 .. .. 1 3 .. Lonsdale Avenue 13 1 .. .. .. .. .. Livingstone Street 17 .. .. .. .. .. .. Lichfield Road 16 .. 1 .. .. .. .. Leigh Road 92 2 .. .. .. .. .. Lydeard Road 19 .. .. .. .. .. .. Latimer Avenue 71 5 3 .. .. .. .. Langdon Road 15 .. .. .. .. .. .. Lloyd Road 43 .. 1 .. .. .. .. Lathom Road 165 7 3 .. 1 1 .. Langton Avenue 40 2 1 .. .. .. .. Ladysmith Avenue 36 3 1 .. .. 1 .. Loxford Avenue 40 8 3 .. .. .. .. Lawrence Road 71 5 1 .. .. .. .. Leader Avenue .. .. .. .. .. .. .. Landseer Avenue 61 5 4 .. .. 1 .. Little Ilford Lane 124 7 2 .. .. .. .. Little Ilford Avenue 22 1 .. .. .. .. .. Lawrence Avenue 216 16 1 .. .. .. .. Lancaster Road 85 4 2 .. .. 2 .. Lansdowne Road 67 1 .. .. .. .. .. Milk Street 10 .. .. .. .. .. .. Muir Street 18 .. 1 .. .. .. .. Manor Way 12 Montpelier Gardens 26 .. .. .. .. .. .. Mountfield Road 76 1 1 .. .. .. .. Market Street 91 1 3 .. .. 1 .. Melbourne Road 105 3 .. .. .. .. .. Mafeking Avenue 10 .. .. .. .. .. .. Myrtle Road 7 .. .. .. .. .. .. Malvern Road 48 1 2 .. .. 1 .. Macaulay Road 68 11 3 .. 1 3 .. Meanley Road 129 12 2 .. 1 .. .. Morris Avenue 53 3 2 .. .. .. .. 100 LOCALITY. No, of Occupied Houses. June, 1997. Scarlet Fever. Diphtheria. Membranous Croup. Typhoid Fever. Erysipelas. Puerperal Fever. Michigan Avenue 20 .. .. .. .. .. .. Manor Park Road 52 1 .. .. .. .. .. Merlin Road 27 2 .. .. .. .. .. Monega Road 263 9 8 1 .. .. .. Marlborough Road 61 5 .. 1 .. 1 .. Milton Avenue 163 7 1 .. .. 1 .. Newland Street 6 4 .. .. .. .. .. Northfield Road 48 1 .. .. .. .. .. Nelson Street 35 .. 3 .. .. .. .. Norman Road 23 4 .. .. .. .. .. Napier Road 83 6 1 1 .. .. .. Navarre Road 21 .. .. .. .. .. .. Nigel Road 74 3 .. .. .. 1 .. Outram Road 75 5 .. .. .. .. .. Oakfield Road 111 6 .. .. .. 4 .. Oregon Avenue 18 2 .. .. .. .. .. Osborne Road 38 2 .. .. .. .. .. Pulleyns Avenue 53 2 1 .. .. 1 .. Plevna Street 12 .. .. .. .. .. .. Poulet Road 53 3 2 .. .. 1 .. Park Avenue 30 .. 1 .. .. 1 .. Parr Road 84 12 2 .. .. .. .. Priory Road 61 5 2 .. .. 1 .. Parkhurst Road 210 32 5 .. 1 .. .. Plashet Lane 146 10 .. .. .. .. .. Prestbury Road 70 4 .. .. 1 .. 1 Park Road 63 3 1 .. .. .. .. Plashet Grove 156 8 .. 1 .. .. .. Robert Street 26 .. .. .. .. .. .. Roman Road 172 9 1 .. .. .. .. Rancliffe Road 37 2 .. .. .. .. .. Ranelagh Road 72 2 .. .. .. .. .. Redclyffe Road 55 5 .. .. .. .. 1 Romford Road 475 10 3 .. .. 2 .. Rabbits Road 10 .. .. .. .. .. .. Rectory Road 40 4 2 .. .. .. .. Reynolds Avenue .. .. .. .. .. .. .. Rosebery Avenue 160 3 5 .. .. .. 2 Ruskin Avenue 144 2 2 .. .. .. .. Rixsen Road 29 .. 1 .. .. 1 .. Rosedale Road 74 1 .. .. .. .. .. Rothsay Road 48 2 .. .. .. .. 1 Ratcliffe Road 45 .. .. .. .. .. .. Rutland Road 82 3 1 .. .. 1 .. 101 LOCALITY. No. of Occupied Houses, June, 1907. Scarlet Fever. Diphtheria. Membranous Croup. Typhoid Fever. Erysipelas. Puerperal Fever. Station Street 11 .. .. .. .. .. .. Shepstone Street .. .. .. .. .. .. .. Savage Gardens 120 1 .. .. .. .. .. Stanley Street 17 .. .. .. .. .. .. Staveley Street 7 .. .. .. .. .. .. Storey Street 50 .. .. .. .. .. 1 Saxon Road 7 1 .. .. .. .. .. Southchurch Road 31 .. .. .. .. .. .. Stevenage Road 39 1 .. .. .. .. .. Springfield Road 27 1 .. .. .. 2 .. St. Olaves Road 37 1 .. .. .. .. 1 St. Albans Avenue 78 2 2 .. .. .. .. Southend Road 87 2 3 .. .. .. .. Skeffington Road 98 4 6 .. .. 1 .. Shoebury Road 22 .. .. .. .. .. .. Streatfield Avenue 61 3 2 .. .. 1 .. Sussex Road 5 .. .. .. .. .. .. St. Bartholomew's Road 39 .. .. .. .. .. .. Stamford Road 101 3 .. .. .. .. .. St. John's Road 75 1 1 .. .. 1 .. Spencer Road 43 2 1 .. .. .. .. St. Bernard's Road 91 7 .. .. .. .. .. Seymour Road 77 2 1 .. 1 .. .. St. Martin's Avenue 35 9 .. .. .. .. .. Station Road 41 1 .. .. 1 .. .. St. Margaret's Road 53 .. .. .. .. .. .. Salisbury Road 66 6 .. .. .. .. .. Second Avenue 140 8 1 .. 1 1 .. Selborne Avenue 22 1 1 .. .. .. .. Sixth Avenue 144 11 3 .. .. 2 .. Seventh Avenue 112 9 .. .. .. .. .. Sheringham Avenue 194 18 4 .. .. 1 .. School Road 21 .. 1 .. .. .. .. Sebert Road 1 .. .. .. .. .. .. Sheridan Road 89 1 .. .. .. 2 .. Sibley Grove 104 3 3 .. .. 1 .. Shelley Avenue 142 2 7 .. .. .. .. Stanley Road 52 1 2 .. .. .. .. Swinburne Avenue 22 .. 2 .. .. .. .. Shakespeare Crescent 218 6 3 .. .. .. .. Strone Road 397 18 6 1 1 2 .. Sherrard Road 376 5 4 .. 2 3 1 Shrewsbury Road 259 16 .. .. 1 2 .. St. Stephen's Road 132 9 .. 1 .. 1 .. Shaftesbury Road 48 .. .. .. .. .. .. South Esk Road 197 10 1 .. .. .. .. St. Dunstan's Road 22 .. 1 .. .. .. .. Sandringham Road 32 .. 3 .. .. .. .. Stafford Road 103 2 .. .. .. .. .. 102 LOCALITY. No. of Occupied Houses, June, 1907. Scarlet Fever. Diphtheria. Membranous Croup Typhoid Fever. sipelas. Puerperal Fever. Tilbury Road 3 .. .. .. .. .. .. Telham Road 87 2 .. .. .. 1 .. Talbot Road 105 .. 7 .. .. 3 .. Thorpe Road 46 1 2 .. .. 1 .. Thackeray Road 58 4 .. .. .. .. .. Tudor Road 75 8 .. .. .. .. .. Temple Road 16 .. .. .. .. .. .. The Chase 3 .. .. .. .. .. .. The Warren 22 2 .. .. .. .. .. Toronto Avenue 12 .. 1 .. .. .. .. Third Avenue 144 9 2 1 .. .. .. Trevelyan Avenue .. .. .. .. .. .. .. Tennyson Avenue 46 1 .. .. .. .. .. Vicarage Lane 30 1 1 .. .. .. .. Victoria Avenue 73 4 1 .. .. .. .. Vernon Avenue 10 9 .. .. .. .. .. Wolsey Avenue 89 3 3 .. .. 1 .. Wall End Road 16 .. .. .. .. .. .. Wellstead Road 88 10 5 .. .. 1 .. Wellington Road 70 1 .. .. .. .. .. Winter Avenue 36 1 .. .. .. .. .. Wakefield Street 154 5 .. .. .. .. .. Wilson Road 39 4 .. .. .. .. .. Worcester Road 50 7 2 .. .. 1 .. Wanstead Park Avenue 100 .. .. .. .. 2 .. Walton Road 131 18 5 1 .. 3 .. Washington Avenue 42 2 .. .. .. .. .. Whitta Road 44 .. 2 .. .. .. .. Wentworth Road 31 .. .. .. .. 2 .. Wolferton Road 4 1 .. .. .. .. .. Warwick Road 26 .. .. .. .. .. .. Woodhouse Grove 41 .. .. .. .. .. .. Wordsworth Avenue 53 4 2 .. .. .. .. Washington Road 9 .. .. .. .. .. .. Waterloo Road 25 .. .. .. .. .. .. Walpole Road 39 2 .. .. .. .. .. Whitfield Road 46 12 .. .. .. .. .. Whittaker Road 41 .. 1 .. .. .. .. Wyndham Road 40 2 .. .. .. .. .. Wortley Road 34 1 .. .. .. 1 .. Woodstock Road 58 8 .. .. .. .. .. Windsor Road 64 1 .. .. .. .. .. York Road 98 4 1 .. .. 2 .. 103 INDEX. A page. Abatement of Nuisances 80 Accidental Suffocation 27, 28, 49, 50 Acreage 5 Air Temperature 42 Alcoholism 27, 48 Alleys 92 Anthrax 31 Artisans' Dwellings 31 B Back Passages 92 Bacteriological Laboratory 26, 31 Bakehouses 30, 35 Births 5, 22, 50 Birth-rate 7 Births, Illegitimate 6 Building Operations 32 Bye-Laws 39, 41 C Cancer 24, 46 Cerebro-Spinal Meningitis 26, 31 Chicken Pox 68 Children, Physically and Mentally Defective 69 Children, Medical Inspection of 70 Cisterns 40, 81 Complaints 93 Contagious Diseases (Animals) Act 94, 95 Cost of Upkeep of Isolation Hospital 65 Cowsheds 29, 87 Customs and Inland Revenue Act 30 104 INDEX—continued. D page. Dairies 29, 87 Deaths 6 Death-rate, Illegitimate Children 6 Death-rate, Zymotic 11 Death-rate, Corrected 8 Death-rate, General 7 Deaths of Non-Residents 7 Deaths, Uncertified 9 Density of Population 4 Diarrhoea 9,11,21,46,50 Diphtheria 17, 46, 50, 56, 66 Dirty Premises 81, 82, 86 Disinfectant Stations 90 Disinfection 24, 31 Dogs Home 95 Drainage Work 82, 83 Drain Testing 84 E Enteric Fever 18, 46, 57 Erysipelas 26, 46, 61 F Factory and Workshops Acts 32, 89 Fish Offal Collection 93 Filter Bed 38, 41 Food and Drugs Act 36 Food, Unsound 30 Forecourts 81, 86 Food Inspection 88 G Gipsies 88 Glanders Outbreaks 95 105 INDEX—continued. H page. House Refuse Removal 90 House to House Inspection 94 Hospital Accommodation 62 Hospital Additions 52, 63 Hospital Disinfector 31, 40 Hospital Establishment Charges 64 Hospital Laundry 40, 65 Hospital Paying Patients 63 Hospital Staff 63 Hospital Staff, Health of 63 I Improvements 40 Infantile Mortality 7, 9 Infectious Diseases 12, 66 Inhabited Houses, Number of 2 Inhabited House Duty Exemption 30 Inquests 27 Inspection of Borough 80 Isolation Hospital 52 L Laboratory Work 26, 29, 31, Legal Proceedings 16, 18, 30, 36, 84, 87 M Malaria 31 Measles 11,20,46,50,67 Meat, Diseased 30, 87 Membranous Croup 17 Milkshops 29 Milk, Polluted 29 Mortuaries 38, 93 Mumps 68 106 INDEX—continued. N page. Notices Served 82 Notification of Infectious Diseases 12 Notification of Births Act 23 O Open Spaces 39 Outworkers 36, 94 Overcrowding 34, 36, 82, 86 Overlaying 27, 28, 49, 50 P Parks and Open Spaces 39 Petroleum Licenses 93 Phthisis 23, 31, 46, 58 Population 2, 3, 7 Population, Density of 4 Puerperal Fever 26, 46 Pulmonary Tuberculosis 46, 58 R Rainfall 42 Refuse Destructor 38, 41, 90, 95 Ringworm 31, 68 S Scarlet Fever 15, 46, 53, 66 Scarlet Fever Convalescent Home 40, 55 Schools 66, 69, 90 Sewerage and Sewage Disposal 38 Slaughter Houses 89 Small Pox 14, 46 Soil and Situation 2 Spotted Fever 26, 31 Swimming Baths 39 Swine Fever Outbreaks 95 107 INDEX—continued, T page. Table—Average Stay of Hospital Patients 65 „ Bacteriological Examinations 31 „ Births 5 „ Cancer Mortality 25 „ Comparative Statistics 2 ,, Complaints Received 93 „ Cost of Up-keep of Isolation Hospital 64, 65 „ Deaths 46, 47, 4.8, 49 „ Diphtheria, Hospital Patients 57 „ Diphtheria Mortality 18, 56 „ Diarrhoea 22 „ Drainage Work 83 ,, Dust Collection 91 ,, Enteric Fever, Hospital Patients 58 „ Enteric Fever Mortality 19, 58 „ Factories and Workshops 33, 35 „ Food and Drugs Act 36, 37 „ Hospital Staff 64 „ Hospital Patients, Scarlet Fever 54, 55 „ Hospital Patients, Diphtheria 57 „ Hospital Patients, Enteric Fever 58 ,, Hospital Patients, Pulmonary Tuberculosis 60 „ Infantile Mortality 10, 50 „ Infectious cases removed to Hospital 45 „ Inquests 28 „ Inspections made 80 „ Isolation Hospital 53 „ Legal Proceedings 85 ,, Meteorological Record 42 ,, Notifications 45 „ Notification Rate 14 ,, Nuisances Discovered 81 „ Other Diseases Treated in Hospital 62 „ Outworkers 34 „ Population 4 108 INDEX—continued. page. Table—Population; Density of 5 „ Pulmonary Tuberculosis, Hospital Patients 60 „ Scarlet Fever Mortality 17 „ Scarlet Fever, Hospital Patients 54, 55 „ Small Pox 15 „ Ward Death Rates 8 „ Vital Statistics (10 years) 7, 43 „ Zymotic Case Rate 12 ,, Zymotic Mortality 11 Temperature 42 Temporary Buildings 92 Truants 69 Tubercular Disease 23, 46 Teachers, Medical Examination of 69 Trade Refuse, Removal of 93 U Unsound Food 30, 87 Urinals 92 W Ward Acreage 5 Ward Death Rates 8 Ward Density of Population 5 Ward Population 4 Water Supply 40 Whooping Cough 11, 20, 46, 50 Y Yards 81, 86 Z Zymotic Death Rate 11 Zymotic Diseases 12