Lepton Arban District Concil. REPORT OF THE MEDICAL OFFICER FOR THE Year ending December 31st, 1896. Xcptcm : PHELP BROS., PRINTERS, HIGH ROAD. Lepton Arban District Council. REPORT of the MEDICAL OFFICER for the Year ending December 31st, 1896. Xeston: phelp bros., printers, high road. Lepton Arban District Council. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, 1896. Gentlemen, I beg to present to you my Annual Report for 1896. The weather at the commencement of the year was extremely mild, there being very few frosts and no snow. Fine weather and rainy cold days alternated till the end of May, when a long spell of hot and dry weather set in, which, with the exception of a thunderstorm at the end of June, and occasional showers in July, continued to the second week in August. From the latter date until the end of the year the rainfall was in excess of the average. During the latter three months there were occasional frosts, varied with fogs and damp weather. 4 The following is the rainfall for each month in this district:— Inches. January 0.85 deficient. February 1.20 deficient. March 0.98 deficient. April 1.22 May 0.28 June 2.12 July 1.40 August 0.90 September 5.31 excessive. October 3.20 excessive. November 1.20 December 3.07 excessive. Total 21.73 inches. The average yearly rainfall for this district is about 24 inches. At no time has there been an epidemic of any disease, in fact, I shall be able to shew that there has been a decrease both in the amount of sickness and in the rate of mortality The Water Supply of the district again failed, although not to the same extent as during 1895. In June, at one period, the supply was cut off from 9 a.m. to 6 p.m., and in July it was curtailed to a six-hour service, and then limited even more. The most interesting events in the Sanitary History of the district during the year are the construction of the present Isolation Hospital and the completion of the Dust and Sludge Destructor. POPULATION. The district still increases rapidly in population, and I have decided to estimate the total at 77,000 at the middle of the year, exclusive of Public Institutions, which alone have a population of 2,380. During the year there have been 707 houses erected and certified as being fit for occupation. Area 2,500 acres No. of persons per acre 30 The following are the Returns of the number of children attending the various Board Schools and National Schools in the district. 5 Cann Hall Ward— Cann Hall Road Board School 2,013 5,016 Downsell Road ,, 1,648 Trumpington Road „ 1,355 Harrow Green Ward— Harrow Green Board School 1,271 3,036 Goodall Road „ 318 Mayville Road „ 1,447 Leytonstone Ward— Kirkdale Road Board School 1,206 Leyton Ward— Church Road Board School 838 4.401 Lea Bridge Road ,, 177 Newport Road ,, 1,337 Ruckhelt ,, 1,011 Capworth Street ,, 1,038 Total attending Board Schools 13,659 National Schools S50 Total 14,509 There has been an increase in number since last year, and it will be noticed that the Capworth Street School has been finished during the year and provides accommodation for a large number of children. BIRTHS. During the year there were 2,372 births registered, being an increase of 80, and consisting of 1,216 males and 1,156 females. The birth rate is 30.8 per thousand, the rate in 1885 being 30.5 per thousand. The rate for England and Wales for this year is 29.7 per thousand. There were 82 births in the Union Workhouse. 6 Table I.—Births for the last 5 years. Males. Females. Total. 1892 1,137 1,073 2,210 1893 1,148 1,168 2,316 1894 1,113 1,111 2,224 1895 1,200 1,092 2,292 1896 1,216 1,156 2,372 5,814 5,600 11,414 DEATHS. There were 1,339 deaths registered, viz.: 661 males and 678 females. Table II.—Deaths for the last 5 years. 1892 1,340 of which 972 belong to the District proper 1893 1,365 ,, 1.019 ,, ,, 1894 1,221 ,, 825 ,, ,, 1895 1,532 ,, 1,080 ,, ,, 1896 1,339 „ 926 ,, ,, 6,797 4.822 ,, ,, The total number of deaths is 193 less than in last year. INCREASE. The annual increase, or excess of births over deaths is 933, the average for the past five years being 903. The total increase for the past five years is 4,517. Table III.—Distribution of Deaths. St. Agnes' Orphanage 2 Bethnal Green Schools 2 Master Bakers' Almshouses 0 Union Workhouse and Schools 408 Forest House Branch of Union 1 District exclusive of foregoing Institutions 926 Total 1,339 7 In the 926 deaths are included 46 which occurred in the Union Workhouse, but strictly belong to the district. Of the total 1,339, the deaths of people belonging to Public Institutions amount to 413, leaving 926 occurring in the district proper; deducting from this total the 16 deaths from violence, we get 910 as the corrected total for the district, and consisting of 432 males and 478 females. By estimating the population, exclusive of Public Institutions, at 77,000, we get a death-rate of 118 per thousand, that of 1895 being 14.4 per thousand. The death-rate for England and Wales is 17.1. The average death-rate for the past five years is 13.78, and for the past ten years 13.89. Table IV.—Death-rate for each Quarter. 1st. 2nd. 3rd. 4 th. Ley ton District 12.1 10.2 13.1 12.1 London 19.4 17.7 18.8 18.4 Table V.—Deaths Classified with regard to Sex. Males 47.47 per cent of the total deaths. Females 52.53 Table VI.—Ages at which Death occurred. Under one year 326 439 One year, and under five years 113 Five years ,, 15 ,, 43 471 15 ,, ,, 25 ,, 38 25 „ „ 65 „ 211 65 ,, and over 179 Table VII.— Death-rate per cent. of Total Deaths. Under one year 35.9 48.3 One year and under five years 12.4 Five years ,, 65 32.1 51.7 65 ,, and over 19.6 The infant mortality, or deaths of infants under one year, per 1,000 births registered is 137. 8 Table VIII.—Chief Causes of Death. Under 5 years. 6 years & over. Total. Small-Pox 0 0 0 Scarlet Fever 3 3 6 Diphtheria 15 10 25 Membranous Croup 1 0 1 Typhoid Fever 1 6 7 Erysipelas 3 3 6 Puerperal Fever 0 0 0 Simple Continued Fever 0 0 0 Influenza 2 8 10 Croup 4 0 4 Measles 18 2 20 Whooping Cough 47 6 52 Diarrhoea 83 4 87 Heart Disease 4 58 62 Phthisis 2 79 81 Diseases of Respiratory Organs 70 78 148 Premature Births 46 0 46 Rheumatic Fever 0 5 5 Cancer 0 37 37 All other Diseases 140 173 313 Totals 439 471 910 Of these deaths, 33 were registered by the Coroner's notification. Table IX.—Number of Deaths and Death-hate per 1,000 of Population from certain causes. Phthisis. Pneumonia #Bronchitis. Heart Disease. Violence. Premature Birth. Number of Deaths 81 148 62 16 46 Death-rate per 1,000 1.05 1.9 .8 .2 5.9 9 INFECTIOUS DISEASES (NOTIFICATION) ACT, 1890. The following table shews tbe number of cases notified during the year:— Table X.—Numbeb of Cases notified. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Small Pox — — — — — — — — — — — — — Scarlet Fever 38 49 26 29 49 27 39 50 47 65 36 46 = 501 Diphtheria 15 17 9 12 11 13 18 15 14 26 16 21 = 187 Membranous Croup 4 2 1 1 1 3 3 — 1 2 4 4 = 26 Typhus Fever — — — — — — — — — — — — — Typhoid Fever 5 2 3 2 5 4 4 9 8 12 5 2 = 61 Simple Continued Fever 1 3 — — 2 — 1 3 1 — — — = 11 Relapsing Fever — — — — — — — — — — — — = — Puerperal Fever — — — — — 1 — 2 — — — — = 3 Erysipelas 6 18 6 11 6 9 6 8 16 15 9 12 = 122 69 91 45 55 74 57 71 87 87 120 70 85 = 911 – – 10 Table XI.—Shewing the Number of Cases of Infectious Disease as they occurred in the Four Chif.f Wards of the District. Leyton Ward. Leytonstone Ward. Harrow Green Ward. Cann Hail Ward. Total. Scarlet Fever 93 113 90 205 = 501 Diphtheria 47 40 44 56 = 187 Membranous Croup 1 15 6 4 = 26 Typhoid Fever 26 11 12 12 = 61 Simple Continued Fever 3 4 1 3 = 11 Puerperal Fever 1 2 — — = 3 Erysipelas 55 29 30 8 = 122 226 214 183 288 911 In addition to the above are the following cases of Infectious Disease which occurred in Public Institutions— with the Mortality. TABLE XII. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Total. Mortality. Percentage Mortality. Union Workhouse and Schools 22 5 24 13 = 64 6 9.3 Forest House Branch of Union — — — 2 = 2 — 0.0 Bethnal Green Schools 7 1 — 0 = 8 — 0.0 St. Agnes' Orphanage 34 2 2 2 = 40 1 2.5 Master Bakers' Almshouses — — — — — — — 114 7 6.0 11 Table XIII.—Deaths per cent, of Cases notified (exclusive of Public Institutions). Number of Cases Notified. Number of Deaths. Percentage Mortality. 1895 1896 1895 1896 1895 1896 Small Pox 6 — — — — — Scarlet Fever 507 501 12 6 2.3 1.1 Diphtheria 348 187 63 25 18.1 13.3 Membranous Croup 30 26 6 1 20.6 3.8 Typhus Fever — — — — 11.5 Typhoid Fever 74 61 11 7 14..8 11.5 Simple Continued Fever 14 11 — — — — Relapsing Fever — — — — — — Puerperal Fever 6 3 — — — — Erysipelas 95 122 3 6 3.1 4.5 1080 911 95 45 8.7 4.9 12 Table XIV.—Deaths from the Seven Chief Zymotic Diseases for the last Five Years, together with the Zymotic Death Rate and Rate of Mortality from all other Diseases. 1892 1893 1894 1895 1896 Small Pox 0 1 0 0 0 Measles 33 4 36 50 20 Scarlet Fever 19 24 11 12 6 Diphtheria and Membranous Croup 33 47 34 69 26 Whooping Cough 57 25 21 26 52 Fevers Typhus 0 0 0 0 0 Typhoid 9 17 11 11 7 Diarrhoea 45 94 36 72 87 Deaths from the Seven Chief Zymotic Diseases 197 212 149 240 198 Deaths from all other Diseases 776 797 663 840 612 972 1009 812 1080 810 Death Rate from Seven Chief Zymotic Diseases 3.1 3.3 2.1 3.2 2.5 Death Rate from all other Diseases 12.3 12.4 9.5 11.2 9.3 General Death Rate 15.4 15.7 11.6 14.4 11.8 Of the 198 deaths from Zymotic Diseases 159 (over 80%) were due to the three non-notifiable Diseases:— Measles, Whooping Cough and Diarrhoea. The Zymotic Death Rate for England and Wales for 1896 is 2.18 per thousand 13 SMALL POX. I am glad to be able to report that not a single case of Small Pox has occurred during the year, although there were at the beginning of the year, a few isolated cases in the neighbouring districts. In my Monthly Report for March, I remarked that there were a very great number of unvaccinated children in our district, and that in view of the Gloucester epidemic, it would be a serious thing for this district, should this disease break out, and I wish again to emphasize the importance of the Vaccination Act being rigidly enforced. The West Ham Borough have proposed building a Small Pox Hospital at Dagenham, and would admit cases from this and certain other districts, provided that a seven years' agreement can be concluded with all these districts upon the following terms:—each district should contribute £1 per thousand of its estimated population, and £2 2s. per week, per case sent in. I have advised your Council that considering we could not erect a Small Pox Hospital in this district, which would meet the requirements of the Local Government Board, it would be beneficial if such an agreement could be entered into, and negotiations to that effect are now pending. SCARLET FEVER. There have been 501 cases notified, as compared with 507 in 1895. The mortality is markedly diminished, being 1.1 per cent. as compared with 2.3 in the previous year, and thus pointing to the conclusion that the disease was of a milder type. It seems to have been more or less prevalent during the whole year, as seen in Table X., the greatest number of cases occurring in one month being 65 in October, and the smallest 26 in March. It will be seen from Table XI., that 40 per cent. of the cases occurred in the Cann Hall Ward. DIPHTHERIA. There has been a considerable decrease in the number of cases notified as compared with the previous year, and the rate of mortality has also decreased, though not to such a marked degree. Of the 25 deaths, 15 were under 5 years of age. The disease seems to have been rather more prevalent during the latter half of the year, and 26 cases occurred in October. 14 It seems to have been fairly universally distributed, although a greater number of cases were notified in the Cann Hall Ward, than in any of the other Wards of the district. Now that accommodation for cases of this disease is provided in the New Isolation Hospital, I hope that every advantage will be taken by parents availing themselves of such a means of isolation, and of checking the spread of this serious disease. ISOLATION HOSPITAL. Accommodation has been provided during the whole of the year for the treatment of Scarlet Fever, and in the new Isolation Hospital we were enabled to devote a ward to the treatment of Diphtheria. As the past year has been somewhat eventful as regards Hospital accommodation, I propose giving a history of the various means we have had at our disposal for the past six years in combating with Infectious Diseases in our district. Before February, 1890. when the Infectious Diseases (Notification) Act came into force, no statistics of the occurrence of Infectious Diseases can be given, but in— Oct. 1889.—In consequence of Scarlet Fever assuming epidemic proportions, I strongly recommended the opening of a temporary Cottage Hospital, and a building at Ruckholts (on the site of the present Board School) was opened in November, and 5 of the most urgent cases were treated therein. 1890.—The Act above-mentioned now became of great service in enabling us to gauge with accuracy the amount of Infectious Disease in our district. The Temporary Cottage Hospital continued to be of considerable service, and 18 cases of Scarlet Fever were treated during the year. There was no actual epidemic of this disease, although 250 cases occurred. 1891.—As the site of the building now in use was required, it was found necessary to shift the quarters, but from March to November no suitable building could be found. In the latter month the residence on the Sewage Works Estate was fitted up with nine beds, for the reception of Scarlet Fever patients, and 3 cases were admitted at the end of the year. 1892.—The accommodation thus provided was available during the whole year, and it was found necessary to increase the number of beds to 15. 15 1893 1894 1895 For the next three years this Temporary Hospital, with an additional bed was the only means of isolation. 1896.—At the beginning of the year representations were made to your Council by the Medical Officer of Health to the Essex County Council, proposing that this district should combine with Walthamstow in building a joint Permanent Hospital, for the treatment of Infectious Diseases in both districts. The site suggested was at Chingford, at least 5 or 6 miles distant from our most crowded and populous Wards. Meetings were held conjointly by the two Councils, but no definite result was obtained. In accordance with instructions I presented a Report on the Amalgamation Scheme, in which I most strongly disapproved of any such scheme, as being disadvantageous to our district. I was also instructed to report on the necessary accommodation required by such a district as this, should it be found necessary to build a Permanent Hospital. April, 1896.—It was not, however, until April that any definite steps were taken. At this time there was a constant demand upon the resources of the Hospital, which was evidently becoming quite inadequate, and as the Sewage Destructor was approaching completion, it was necessary to do away with the then existing Hospital. Consequently, it was resolved by your Council that an iron structure should be erected on the adjoining land, of larger capacity, and providing accommodation for more than one infectious ditease. July. Objections were made to the site, and I drew up a Report upon the subject, and eventually the present building was erected, and was opened for the reception of patients on September 26th. September. The whole buildings were thrown open to the public during the week previous to the latter date, and a very large number of ratepayers and others took the opportunity to inspect the building, and a great deal of satisfaction was expressed. The following is a description of the Hospital:— The buildings, the sites of which are all covered with 6-ins. of Portland Cement Concrete, comprise three large WARD BLOCKS 16 for the accommodation of 43 Scarlet Fever Patients, one ward block for the treatment of Diphtheria and accommodating 10 beds, a LAUNDRY BLOCK with BATH and DISCHARGE ROOM and MORTUARY, and an ADMINISTRATIVE BLOCK. The Wards throughout are well lighted and ventilated by means of windows opening at the top, louvres in the roof and ridge ventilators. All the buildings are constructed of corrugated galvanized iron with timber framings on brick foundations, and lined inside with inodorous felt and matchboarding, varnished. Each ward block has, at the end, a WARD KITCHEN with water supply, washing up sinks and other conveniences, and a PROBATION ARY ROOM for doubtful cases. At the other end, in an annexe apart from the ward, is a bath room supplied with hot and cold water, and a w.c. The blocks are kept 40.feet apart, and all wards 40 feet from the boundaries of the site. The ADMINISTRATIVE BLOCK, which is close to the entrance of the premises, gives accommodation for a Matron and Staff of Nurses, with bath room, kitchen, scullery, and the usual offices. The LAUNDRY BLOCK, in addition to wash house and ironing room, provides a bath room (with hot and cold water) and a DISCHARGE ROOM for convalescent patients. There is also a fumigating room and a mortuary, and coal store and w.c. The whole of the Drainage of the buildings has been executed in the best possible manner, with good gradients, and water-tight cement joints, and well ventilated throughout. The wards are heated with Tortoise stoves. The premises are enclosed with a 6.ft. unclimbable galvanized iron fence at back and sides, and in front by a 6.ft. brick wall. The buildings were designed and erected, under the supervision of Mr. Dawson, Surveyor to the Council, by Messrs. Humphreys & Co., of Knightsbridge. November. In this month the County Council again referred to the desirability of this district having a permanent hospital, and on November 26th a Public Inquiry was held for the purpose of investigating into the need of 17 erecting such a permanent structure, and, also, the reasons for erecting the present iron building, its site, its capacity, and its capability for coping with the amount of infectious disease with which this district was credited. A variety of evidence for and agaiust the temporary hospital was brought forward, and the Committee of Inquiry, including the Medical Officer of Health to the County Council, visited the present building. Finally it was approved as being a temporary measure accelerated by matters of emergency, the site was still left open to doubt, and the County Council considered that our District Council should, nevertheless, look out for another site on which to build a Permanent Hospital. Of the usefulness of the building there can be no question, but whether it is capable of dealing adequately with our infectious disease is a matter which time alone will show. The enquiry made by the County Council was, in my opinion, somewhat premature, for at that time the Hospital was only in its infancy, bavins; been opened but a few weeks, and it was therefore impossible to tell the extent of its usefulness in checking the spread of infectious disease. It will be seen from the following Table that, as regards Scarlet Fever, the number of cases treated and the percentage of treated cases as compared with the total number notified has increased, with the exception of the years 1891 and 1895. In 1891 the hospital was only opened for about four months; and in 1895 it was found necessary to close the Hospital for a short time, owing to the occurrence of a case of Small Pox. There was no accommodation provided for Diphtheria cases until the present Hospital was opened, and during the two months that remained in the year six cases were admitted. Of the 408 cases of Scarlet Fever that have been treated, only four deaths have occurred, being a mortality less than one per cent., a fact which speaks well for the site of the Hospital. There was one death from Diphtheria of the six cases admitted at the end of the year. The child was admitted in a moribund condition, and never rallied. The effect of the additional accommodation afforded by the new hospital was especially marked in the subsequent number of cases of Scarlet Fever notified, there being G5 in October, and 86 and 46 in November and December respectively. 18 The following Table shows the number of cases of Scarlet Fever and Diphtheria that have occurred since February, 1890, with the number of deaths, and the number of cases that have been Ireated in the various Temporary Hospitals. Table XV. SCARLET FEVER. DIPHTHERIA. No. of Cases Notified. Deaths Treated in Hospital Hospital at Beds. No. of Cases Notified. Deaths. Treated in Hospital. Position of Hospital. Beds. Percentage of Cases Treated in Hospital. Oct., 1889 to Feb. 1890 No Record — 5 Euckholts 6 No record No accommodation 1890 250 3 16 „ 6 200 5 „ Scarlet Fever, 6.4 1891 148 2 5 „ (3 mths.) 6 258 63 „ „ 5.4 3 Sewage Works (1 mth.) 9 1892 646 19 71 „ 9-15 226 33 „ „ 10.0 1893 541 24 72 „ 15 252 38 „ „ 13.3 1894 486 11 72 „ 15 304 24 „ „ 14.8 1895 507 12 61 „ 16 348 63 „ „ 12.0 1896 501 6 Jan.-Sep 55 „ 16 187 26 Sep. to Dec. 6 Iron Building 8 Scarlet Fever 20.5 Oct.-Dec. 48 Iron Building 40 Diphtheria 3.0 Totals 3079 77 408 6.40 1775 252 6 8 19 MEMBRANOUS CROUP. There have been fewer cases notified this year, and the mortality has been considerably less. Of the 26 cases, 15 were notified as occurring in the Leytonstone Ward. There was only one death, that of a child under five years of age. TYPHOID FEVER. There has been a decrease both in the number of cases notified and in the rate of mortality. Of the 61 cases that were notified, six were imported into the district. 10 cases occurred in four houses, 4 cases being in one house. In 26 houses the Sanitary arrangements were found to be defective. The greatest proportion of cases, viz., 26, occurred in the Ley ton Ward (Table XI.), in 19 roads, and the infected houses in six of these roads have only recently been built. PUERPERAL FEVER. There have been only three cases notified, and no deaths have occurred. MEASLES. There has been no serious epidemic such as we experienced in 1895, but there was a considerable amount of this disease prevalent during the first five months of the year. Of the 20 deaths, 18 were under five years of age. Eighteen of the total deaths took place during the last five months of the year. ERYSIPELAS. There has been an increase in the number of cases notified, and the rate of mortality is slightly increased. 20 The majority of the cases occurred towards the end of the year, partly attributable, no doubt, to the excessive damp weather we experienced. Three of the six deaths were under five years of age. WHOOPING COUGH. There has been a great deal of Whooping Cough in the district, and deaths have been recorded every month. In April alone there were 11 deaths. Of the 52 deaths, 47 were under five years of age. DIARRHCEA. There have been a larger number of deaths this year than in the previous two years (Table XIV.) The disease was most prevalent in July and August, at the end of the spell of hot summer weather, In these two months there were 44 and 22 deaths respectively, out of 87 deaths during the year. It chiefly attacked very young children, 83 being under 5 years of age, and in July alone, 40 of the 44 deaths recorded were actually under 1 year of age, the remaining 4 being under 2 years of age. In a great measure, this disease could be kept in check, were parents sufficiently careful in dieting their children during the hot weather, and in scrupulously keeping feeding-bottles clean and sweet. I feel confident that the serious nature of this complaint is not sufficiently realised by the poorer classes. The symptoms are generally attributed, through ignorance, to teething, or "consumptive bowels," and many children are brought for medical aid when almost moribund, the triviality of diarrhoea from teething, or the supposed hopelessness of "consumptive bowels," dulling the parents' senst of danger. INFLUENZA. There has been no epidemic of this infectious complaint, though there have been numerous isolated cases at different times during the year. There were 10 deaths, 2 of which were one month and two months of age respectively. PHTHISIS. The mortality is not quite so great as in 1895. 21 It will be seen that 54 deaths occurred in the Union Workhouses, or a mortality of 13 per cent, so that the total mortality in the whole district is high. I wish to point out that the fact that this disease may be communicated by the breath is commonly over-looked by those in attendance on such cases. I am strongly of opinion that nurses or attendants should adopt precautions, somewhat similar to those which are recognised in cases of well-known infectious disease. I do not wish, for a moment, to insist upon strict isolation and disinfection, but I think some milder degrees of precaution should be recommended, and such recommendations distributed among the poorer classes. It so often happens that a consumptive is attended up to the last by some near relative, such as a daughter or sister, who is predisposed by heredity to the complaint, and who so lowers the resistive power of the organism to disease by constant attention to the sick bed, that she sooner or later succumbs to the same terrible complaint. I hardly expect that we can take such steps as have been taken in New York City, where the notification and registration of consumptives is compulsory, and the most rigid precautions insisted upon. Still, what we can do is to insist on the proper disinfection of rooms, in which consumptives have lived and died, when it appears that such disinfection would not be otherwise carried out. I would lay special stress upon the absolute necessity of perfecting, as far as possible, the hygienic surroundings of such sick rooms; fresh air, light, and air space being of the greatest importance, combined with the thorough disinfection of the sputum, and the strict personal cleanliness of the patient. 22 PUBLIC INSTITUTIONS. WEST HAM UNION WORKHOUSE AND SCHOOLS. Births.—During the year there were 82 births. Deaths.—There were 408 deaths, viz., Males, 219; Females, 189. The following were the chief causes of death:— Under 5 Tears. 5 Years and over. Total. Typhoid Fever — 5 0 Erysipelas — 1 1 Measles 3 — 3 Whooping Cough 2 — 2 Diarrhoea 4 2 6 Phthisis — 54 54 Diseases of Respiratory Organs 2 63 65 Heart Disease 1 40 41 Premature Birth 3 — 3 Cancer — 23 23 Violence — 4 4 All other Diseases 26 175 201 Totals 41 367 408 Of these deaths six were registered by the Coroner's notification. ages at which death occurred. Under 1 year 26 1 year and under 5 years 15 5 years and under 15 years 6 15 ,, ,, 25 ,, 18 25 ,, ,, 65 ,, 176 65 ,, and over 167 Total 408 INFECTIOUS DISEASES. The number of cases notified may be seen in Table XII. There were fewer cases, and a lower rate of mortality. There was no serious epidemic, as in 1895, the 22 cases of Scarlet Fever occurring in February, March, and April, and with no fatal results. 23 BETHNAL GREEN SCHOOLS. This Institution has been remarkably free from epidemic disease this year, and it will be seen from Table XII. that seven cases of Scarlet Fever and one of Diphtheria were notified, comparing most favourably with the returns of 1895. Two cases—one of Scarlet Fever and one of Diphtheria—were sent to Homerton. There were only two deaths during the year. ST. AGNES' ORPHANAGE. There have been about 30 cases of Measles and three or four of Whooping Cough during the year. There were 34 cases of Scarlet Fever, mostly occurring at the end of the year. The severer cases were removed to Hospital, the milder ones receiving treatment in the Infirmary belonging to the Orphanage. It was impossible to discover the source of the infection. There were no fatal cases. There were two cases of Typhoid Fever, one of which, an adult, terminated fatally. The only other death during the year was that of a boy with Spinal Disease. FOREST HOUSE. There were two cases of Erysipelas and about nine cases of Epidemic Skin Disease. There was only one death during the year. 24 SANITARY WORK. The following is the Report of the Sanitary Inspector:— Houses Inspected 3666 Houses disinfected, walls stripped, and lime-whitened 334 Orders by notices and letters served on owners and occupiers 3265 Complaints received 264 Nuisances caused by fish offal, manure and other refuse 85 Defective drains remedied 231 Sink and bath wastes and rain pipes made to discharge in open air over properly trapped gullies 758 Gullies supplied, and defective connections of same remedied 889 Ventilating shafts to soil-pipes and drains 714 Flushing cisterns supplied to W.C.'s with inch flushing pipes 117 Flushing cisterns repaired 259 W.C.'s in defective state—new traps and straight back pans, traps concreted to top, with cement floors and open risers 1419 New sink waste pipes provided 67 Pan-closets with iron containers and leaden D-traps replaced by approved arrangements 25 Defective soil pipes 69 Houses properly paved around the back additions 342 Intercepting syphons and manholes provided between house-drains and sewer with proper air inlets and outlets 15 Houses with defective roof guttering and general insanitary and filthy conditions repaired and cleaned 193 Drains tested 3155 Floors of sculleries repaved 31 Houses entirely re-drained 33 Stagnant water under dwellings remedied 39 25 Houses without water supplied by the East London Service 50 Overcrowding 10 Wells closed 2 Animals kept in an insanitary state 81 Pig-keep nuisances abated 2 Watercourses in a foul state 5 Cesspools overflowing 10 Houses closed .. . 8 Houses closed and afterwards put in habitable repair 38 Nuisances with caravans, squatters, &c. 5 It is interesting to notice the benefit of house-to-house inspection in a district like Leyton. Out of 3,666 houses inspected, sanitary defects were found in 2,796 of these houses. Notices were served on the owners and defects remedied. I append a few cases of bad drainage discovered by such inspection showing the undoubted benefit derived from the Council's action:— Sanitary State. 21 houses in one road inspected were found to be in such a condition as to render same unfit for habitation; drains defective; water closets improperly constructed; sink-waste gullies impioperly conuected; yards unpaved; and houses in a filthy, dilapidated and overcrowded condition. A quantity of stagnant sewage water was found in basement of a house. The drains were tested and found to be effective. On further investigation, however, it was found that a detached building used as a stable, though it had what appeared to be a drain, was not connected with the sewer. As a consequence the sewage matter was percolating into the basement of the adjoining house, and causing the nuisance as stated. 3 houses in a terrace were found to have at least 10 inches of stagnant water in basement of same. The occupiers stated that during their tenancy this state of affairs had always existed, and that they had constantly suffered from recurring sore throats. Remedt. Preliminary notices were served on the owners that the houses in their present condition were unfit for human habitation, and that a closing order would be applied for. Houses were then closed; but have since been placed in habitable repair. Stable entirely re-drained, and properly connected with sewer. Nuisance abated. Cellars raised with 12 inches of concrete, and properly drained into surface water. Nuisance abated. 26 9 houses in Harrow Green district were found, on inspection, to have very defective sanitary arrangements. The landloid, under notice, has entirely re-drained same, with intercepting manhole; provided proper air inlets and outlets to same; reconstructed W.C.'s with open risers, straighthacked pans, concrete floors, efficient flushing cisterns, and paved around back additions. The drainage of a private school, having a daily attendance of 50 pupils, on testing was found to be in a most defective state. The soil pipe in the house was found to be in a most defective condition. On further investigation it was discovered that formerly a water closet existed in cellar, and the apparatus had been removed, including the trap, and the drain had been closed with a mortar joint, which had become defective allowing bad gases to escape. The drain was entirely reconstructed on the most approved principle, tested with the water test. The soil pipe built on the external wall; the sink, bath, and lavatory wastes made to discharge over earthenware gullies, and properly trapped under each arrangement. In a private school having a daily attendance of some 40 pupils, the connections of W.C. werefound to be most defective, the sink waste-pipe being in direct communication with the drain, which had no other means of ventilation; also, the water cistern was being used for both flushing and drinking purposes. Water closet entirely reconstructed with open riser and concrete floor. The branch drain relaid in concrete; sink waste disconnected from drain and made to discharge in open air over an earthenware gully, also a ventilating shaft provided for drain. Two houses draining into cesspool were found to be in a most insanitary condition. The cesspool was overflowing into an adjacent ditch, and the drains were choked, settlement having taken place in same in consequence of imperfect laying. Earthenware pipes inside house in lieu of soil pipes; joints leaking; pan closets with iron containers and leaden D-traps, pans being broken away; sink and lavatory waste pipes and rain pipes connected directly with drain. General ill-health prevailed amongst the inmates. Cesspool emptied, and properly reconstructed and ventilated. The house drain was relaid on concrete, and properly intercepted from cesspool; air inlets and outlets provided; soil pipes of galvanized iron provided and built on external walls and carried full bore above eaves of main buildings; the defective closets replaced by approved arrangements, and efficient syphon flush cistern provided. Sink wastes and rain water pipes disconnected, and yards properly paved. The Sanitary Inspector recommends that all ground floor waterclosets should be properly constructed with straight back pans, cement floors and open risers—that, also, first floor water-closet traps should be connected with cement joints and yarn with a brass ferule wiped on to the lead junction or leaden traps. 27 The wastes from sinks, lavtories, &c., should be properly trapped under the arrangement, with an access screw for cleansing purposes, thus preventing the many complaints that occur from the waste pipes becoming foul. It will be seen from the above that a very large amount of work has been done during the year by the Sanitary Department of your Council, and the appointment of assistants, early in the year, has been most beneficial, and I think that it is most important that the staff of this department should continue to be kept sufficiently large to cope with the increasing work caused by the growth of population. COWSHEDS AND DAIRIES ACT. The number of cowsheds in the parish is 18, and they have been periodically examined. There have been 11 new applications to sell milk, which after examination of the premises, were registered. SLAUGHTER-HOUSES. All these have been inspected once a month, and have been found in a satisfactory condition. A carcase of a beast was found on unlicensed premises, prepared and dressed, apparently for sale; it was found to be in a diseased state being affected by tuberculosis, and was condemned by me, and subsequently destroyed, by order of a magistrate. I wish to impress upon the Council the absolute necessity of reforming the Bye-Laws relating to the Licensing of SlaughterHouses. The present Bye-Laws were, possibly, adequate for the time when they were made, but, considering the rapid growth of the district they are not now sufficiently stringent. At present, a Slaughter-House is licensed for an indefinite time, but I certainly think that the licenses should only hold good for a year, and be renewable on application, and inspection of the premises. PETROLEUM ACT. Seven licenses have been renewed. 28 BAKEHOUSES. The whole of the Bakehouses in the district have been visited, and are now in a good sanitary state. DRAINAGE. There have been numerous complaints during the summer months of foul smells arising from the sewers, and I wish again to emphasize the importance of having more ventilating shafts erected. Only one ventilator has been erected during the year, and I think that orders should be issued at once for the erection of a great many more before the hot weather arrives. DUST REFUSE. The "Pail System" continues to work with every satisfaction. There are now 10 carts and 14 men employed on the work, and I hope the number of carts and men will be increased according to the increase in population. I wish to draw attention to the practice adopted by many tradespeople, of depositing in the roadway, at all times, trade refuse and other material. A great deal of this refuse is of a vegetable nature, and, if left in the roadway any length of time, would tend to become a nuisance. DUST DESTRUCTOR. The Destructor, to which I allude in my last Yearly Report, has been completed and has been working for about two months and proved great success. The type of Destructor is that of the Beaman and Deas Syndicate, and has been used in Bradford and elsewhere with excellent results. The one in Leyton is the first of its kind in England that is burning pressed sludge, and is consequently worthy of special attention. It is capable of burning, when working at full capacity, about 24 tons of unscreened house refuse, or 14 tons of mixed sludge and house refuse, per cell per day. There are eight cells but only four are in use at present. The incombustible material averages about 15 per cent., according to the nature of the refuse, and forms a very hard clinker, which is of great service in road foundations, making mortar, &c. The heat of the combustion chambers is kept constantly at a 29 temperature of 2,000 deg. P., and inasmuch as all the products of combustion have to pass through this chamber, it is quite impossible for any undecomposed vapours to escape into the flue beyond, and thus any nuisance is absolutely avoided, a matter of great importance in considering the disposal of refuse. It is worthy of notice that a very small quantity of smoke issues from the chimney. In addition to its primary uses, this type of Destructor excels all others in steam generating, and this steam is used for driving a dynamo to light with electricity the whole of the Sewage Works. It is probable that this power may be further utilized in the electric lighting of the district. INSPECTION OF CANN HALL WARD. The systematic inspection of this Ward, to which I alluded in my Report of 1895, has been continued. A large number of houses have been visited and drains tested. The principal faults were defective connections in the W.C.'s, defective flushing apparatus, bad condition of paving around the back additions, and want of proper ventilation to the house drains. CHIMNEY FIRES. I wish to draw the attention of the Council to the nuisance caused by the neglectful or wilful firing of chimneys in some of our most crowded streets. UNDEDICATED ROADS. I am glad to say that many of the undedicated roads have been taken over by the Council and put in proper repair. However, as a large amount of building still goes on in our district, there are constantly new roads being made, and houses built therein, and a considerable time elapses before a new road is taken over, so that the subject is constantly being brought to my notice. It appears that new houses are occupied very rapidly, so that the new road is soon used for traffic, and I am of opinion that when such a road becomes a nuisance from a sanitary point of view, steps should be taken to keep it in a good state, either by the Council or by the owner. 30 In conclusion, it will be seen from the above Report, that the health of the district may be considered as fairly satisfactory. The Mortality is considerably less than the average, and compares most favourably with London. The Death-rate is lower than any of the past 18 years, excepting 1894. The Zymotic Death-rate is also diminished, and is lower than any of the past four years' record, except 1894, but is identical with the average for the previous 18 years. The amount of sickness is difficult to gauge, but there has been a considerable decrease in the infectious disease, which I think is a matter for congratulation, and I hope in my next year's Report, to be able to record a further improvement in that respect, considering the valuable help we shall be afforded by the Isolation Hospital. I am, Gentlemen, Your obedient servant, A. F. PESKETT, Medical Officer of Health. Ley ton, Februai-y 16th, 1896.