Ley 3 Lenton Urban District Council. ANNUAL HEALTH REPORT for 1897, by A. F. PESKETT, Medical Officer of Health. Lenton: phelp bros., printers, high road. Lenton Urban District Council. ANNUAL HEALTH REPORT FOR 1897, by A. V. PESKETT, medical officer of health. Gentlemen, I beg to present to you my Annual Report for 1897. The winter months were very variable, rainy days being numerous. Falls of snow occurred in February, and morning frosts were recorded even into May. There were cold easterly winds in the spring, but gradually the very variable weather of June, which consisted of gales, thunderstorms and floods, passed into the brilliant sunshine and great heat of the summer. Hot weather was prolonged beyond the average, and was then followed by a cold, dull and rainy autumn. To the excessive and long continued heat of the summer we must attribute the high death-rate we experienced in August, diarrhoea being the chief result of the unhealthy weather. 4 The following is the rainfall for each month in this District:— January 2.16 February 0.52 deficient. March 0.25 deficient. April 3.45 excessive. May 1.74 June 0.84 July 1.87 August 1.04 September 1.56 deficient. October 4.05 excessive. November 2.66 excessive. December 1.96 excessive. Total 22.10 inches. The average yearly rainfall for this district is about 24 inches. At no time during the year has there been any epidemic, although a sudden increase of scarlet fever took place in September, and a comparatively large number of cases occurred during the remainder of the year. POPULATION. The district continues to increase rapidly in population, and I have decided to estimate the total at 85,000 at the middle of the year, exclusive of public institutions, which alone have a population of 2,130. During the year there have been 662 houses erected and certified as being fit for occupation. Area 2,500 acres. No of persons per acre 34 The following are the Returns of the number of children attending the various Board Schools ano National Schools in the District. Cann Hall Ward — Cann Hall Road Board School 1,950 Downsell Road ,, 1,600 Trumpington Road „ 1,401 4.951 5 Harrow Green Ward— Harrow Green Board School 1,293 3,101 Goodall Road „ 313 Mayville Road „ 1,495 Leytonstone Ward— Kirkdale Road Board School 1,343 Leyton Ward— Church Road Board School 907 Lea Bridge Road „ 166 Newport Road „ 1,672 Ruckholt „ 998 Capworth Street „ 1,335 5,078 Total attending Board Schools 14,473 National Schools 810 Total 15,283 BIRTHS. During the year there were 2,501 births registered, being an increase of 129, and consisting of 1,278 males and 1,223 females. The birth rate is 29.3 per thousand, the rate in 1896 being 30 8 per thousand. The rate for England and Wales for this year is 297 per thousand. There were 95 births in the Union Workhouse. Table I.—Births for the last 5 years. Males. Females. Total. 1893 1,148 1,l68 2,316 1894 1,113 1,111 2,224 1895 1,200 1,092 2,292 1896 1,2l6 1,156 2,372 1897 1,278 1,223 2,501 5,955 5,750 11,705 6 DEATHS. There were 1,425 deaths registered, viz.:—740 males and 685 females. Table II.—Deaths for the last 5 years. 1893 1,365 of which 1,019 belong to the District proper. 1894 1,221 „ 825 „ „ 1895 1,532 „ 1,080 „ „ 1896 1,339 „ 926 „ „ 1897 1,425 „ 1,011 „ „ 6,882 „ 4,861 „ „ The total number of deaths is 86 more than last year. INCREASE. The annual increase, or excess of births over deaths is 1,076, the average for the past five years being 944. The total increase for the past five years is 4,723. Table III.—Distribution of Deaths. St. Agnes' Orphanage 1 Bethnal Green School 4 Master Bakers' Almshouses 0 Union Workhouse and Schools 392 Forest House Branch of Union 2 District exclusive of foregoing Institutions 1,026 Total 1,425 In the 1,026 are included 52 which occurred in the Union Workhouse, but strictly belong to the District. Of the total 1425, the deaths of people belonging to Public Institutions amount to 399, leaving 1,026 occurring in the District proper; deducting from this total 15 deaths which occurred from violence, we get 1,011 as the corrected total for the District, and consisting of 503 males and 508 females. 7 By estimating the population, exclusive of Public Institutions, at 85,000, we get a death-rate of 1189 per thousand, that of 1896 being 11 8 per thousand. The death-rate for England and Wales is i7-4 per thousand. The average death-rate for the past five years is 13.06. The average death-rate for the past ten years is 13 6. Table IV.—Death-rate for each Quarter. 1 St. 2nd. 3rd. 4th. Leyton District 12.1 10.8 14.6 10.9 London 18.5 15.5 19.5 19.3 Table V.—Deaths Classified with regard to Sex. Males 49.75 Females 50.25 per cent, of the total deaths. Table VI.—Ages at which Death occurred. Under one year 356 One year and under five years 118 Five years „ 15 „ 46 15 „ „ 25 „ 44 25 „ „ 65 „ 263 65 ,, and over 184 Total 1,011 Table VII.—Death-rate per cent, of Total Deaths. Under one year 35.2 46.9 One year and under five years 11.7 Five years „ 65 „ 35.0 53.1 65 ,, and over 18.1 The infant mortality, or deaths of infants under one year, per thousand births is 142, the infant mortality last year being 137. In England and Wales the infant mortality is 156. 8 Table VIII.—Chief Causes of Death. Under 5 years 5 years and over. Total. Small-Pox 0 0 0 Scarlet Fever 8 9 17 Diphtheria 11 9 20 Membranous Croup 0 1 1 Typhoid Fever 0 14 14 Erysipelas 0 2 2 Puerperal Fever 0 1 1 Simple Continued Fever 0 0 0 Influenza 2 7 9 Croup 1 0 1 Measles 5 1 6 Whooping Cough 23 1 24 Diarrhoea 114 7 121 Heart Disease 6 63 69 Phthisis 4 77 81 Diseases of Respiratory Organs 59 94 153 Premature Births 49 0 49 Rheumatic Fever 0 7 7 Cancer 0 40 40 All other Diseases 196 200 396 478 533 1,011 Of these deaths, 43 were registered by the Coroner's notification. Table IX.—Number of Deaths and Death-rate per 1,000 of Population from certain causes. Phthisis. PneuTnonia and Bronchitis. Heart Disease. Violence. Pt emature Birth. Number of Deaths 81 153 69 15 49 Death-rate per 1,000 .95 1.8 .8 .17 5.7 INFECTIOUS DISEASES (NOTIFICATION) ACT, 1890. The following table shews the number of cases of Infectious Disease notified during the year :— Table X.—Number ok Cases notified. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Small Pox – – – – – – – – – – – – – Scarlet Fever 34 28 30 34 28 17 46 40 87 82 43 41 510 Diphtheria 12 11 16 9 8 9 7 8 27 14 29 6 151 Membranous Croup — 2 2 4 1 — 2 — 3 — 3 3 18 Typhus Fever — – – — — — — — — — — — — Typhoid Fever — 4 3 1 7 9 6 7 26 14 9 16 102 Simple Continued Fever – – – – – 1 – – – 2 2 1 6 Relapsing Fever – – – – – – – – – – – – – Puerperal Fever 1 – – – – – – – – – – – 1 Erysipelas 8 9 1 9 6 13 8 7 9 10 8 12 100 55 52 52 57 50 49 69 62 152 122 94 79 893 9 Table XI.—Shewing the Number of Cases of Infectious Disease as thev occurred in the Four Chief Wards of the District. Leyton. Leytonstone. Harrtnv Green. Cannhall. Total. Scarlet Fever 168 97 128 117 510 Diphtheria 67 32 28 29 156 Membranous Croup 9 2 5 2 18 Typhoid Fever 41 25 23 13 102 Simple Continued Fever 2 3 1 — 6 Puerperal Fever — — 1 — 1 Erysipelas 50 23 15 12 100 337 182 201 173 893 Percentage of Cases 37.8 20.3 22.5 19.3 „ „ in 1896 24.8 23.5 20.1 31.6 10 Table XII.—Deaths per cent, of Cases Notified (exclusive of Public Institutions). Number of Cases Notified. Number of Deaths. Percentage Mortality 1896. 1897. 1896. 1897. 1896. 1897. Small Pox — — — — Scarlet Fever 501 510 6 .17 1.1 3.3 Diphtheria 187 156 25 20 13.3 12.8 Membranous Croup 26 18 1 1 3.8 5.5 Typhus Fever — – — – — — Typhoid Fever 61 102 7 14 11.5 13.5 Simple Continued Fever 11 6 0 0 0.0 0.0 Relapsing Fever — — — – — — Puerperal Fever 3 1 0 1 0.0 100.0 Erysipelas 122 100 6 2 4.5 20 911 893 45 55 4.9 6.1 ii Table XIII.—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. 1893 1894 1895 1896 1897 Small Pox 1 0 0 0 0 Measles 4 36 50 20 6 Scarlet Fever 24 11 12 6 17 Diphtheria and Membranous Croup 47 34 69 26 21 Whooping Cough 25 21 26 52 24 Fevers Typhus 0 0 0 0 0 Typhoid 17 11 11 7 14 Diarrhoea 94 36 72 87 121 Deaths from the Seven Chief Zymotic Diseases 212 149 240 198 203 Deaths from all other Diseases 797 663 840 612 808 1009 812 1080 810 1011 Death-rate from Seven Chief Zymotic Diseases 3.3 2.1 3.2 2.5 2.3 Death-rate from all other Diseases 12.4 9.5 11.2 9.3 9.5 General Death-rate 15.7 11.6 14.4 11.8 11.8 Of the 203 deaths from Zymotic Diseases 151 (over 77%) were due to the three non-notifiable Diseases : Measles, Whooping Cough, and Diarrhoea. The Zymotic Death-rate for England and Wales for 1897 is 2.15 per thousand. 12 13 SMALL POX. I am again able to report that not a single case of Small Pox has occurred during the year. There are still a large number of unvaccinated children in the District and, until the Vaccination Act is rigidly enforced, I consider that we are in danger of a serious spread of this disease, should a few cases be imported into our midst. I am glad to say, however, that the authorities are about to sanction the use of calf lymph at the Public Vaccination Stations, and I hope a great many prejudices against the process of vaccination will be overcome and that the danger of having so many unvaccinated children in our District will be considerably lessened. I am able to report that the Council has agreed to unite with the West Ham Borough and other Districts in providing accommodation for cases of Small Pox for the next seven years, according to a fixed agreement. SCARLET FEVER. It is interesting to notice that the number of cases of this disease notified during each of the past three years is almost the same. The mortality is, however, more marked, shewing that the disease in 1897 was rather more severe than in the previous two years. Table XIV.—Notified cases of Scarlet Fever during the past three years, with the mortality per cent. Cases Notified. No. of Deaths. Death-rate per cent. 1895 507 12 2.3 1896 501 6 1.1 1897 510 17 33 There appears to have been less than the average number of cases per month during eight months of the year (as seen from Table X.) but a sudden and large increase occurred in September and was maintained in October, a third of the total number being notified in these two months. 14 At this time the resources of the Isolation Hospital were taxed to the uttermost, and a large number of cases being promptly removed, any more serious outbreak was checked. It will be noticed that the disease has been more evenly distributed afnongst the four Wards than was the case in 1896, when the Cannhall Ward was responsible for about 40 per cent, of the cases. There are still a number of cases occasionally discovered where the patients are in the stage of desquamation, the disease having been overlooked, and these children allowed to play in the streets or even attend the Board Schools. DIPHTHERIA. It will be seen from Table XII. that there has been a decrease of 31. The number of deaths were fewer, the death-rate being correspondingly diminished. Eleven of the deaths were under 5 years of age. In four months only the number of cases exceeded the average. In September, October and November, there were 70 cases and 12 deaths. The diminution in the disease was very marked in December, the number of notifications falling from 29 to 6. Nearly 43 per cent, of the cases occurred in the Leyton Ward. TEMPORARY ISOLATION HOSPITAL. Accommodation has been provided for cases of Scarlet Fever and Diphtheria during the whole year, and the following statistics show the number of patients that have been under treatment Scarlet Fever. Males. Females. Total. Admitted 87 90 177 Died 3 0 3 Diphtheria. Admitted 9 21 30 Died 2 0 2 15 Ages of Patients. Scarlet Fever. Diphtheria. Under one year 1 0 One year, and under five years 26 12 Five years „ 15 „ 134 14 15 „ „ 25 „ 14 3 25 „ and over 2 1 177 30 The following table will shew the advantages that have been obtained by the increased accommodation that has been provided since October, 1896. Scarlet Fever. 1895. 1896. 1897. Number of cases notified 507 501 510 „ „ treated 61 103 177 Percentage of cases treated 12.0 20.5 347 No. of beds available 16 Jan. to Sep. 16 40 Oct. „ Dec. 40 Total number of Deaths 12 6 17 No. of Deaths in Hospital 1 1 3 Diphtheria. N umber of cases notified 348 187 156 „ „ treated No accommodation 6 30 Percentage of cases „ „ 3.0 191 No. of beds available „ 8 10 Total number of Deaths „ 26 20 No. of Deaths in Hospital „ 1 2 SCARLET FEVER. Throughout the year there has been constantly a large number of beds occupied, but in the autumn the somewhat sudden increase of this disease in the District put a severe strain on the resources of the Hospital, and every bed has been occupied on several occasions and for varying periods of time. The average time these patients were detained in the Hospital was 65 days. 16 Nearly all these cases have been removed from their houses within a few hours after the receipt of the notification, and the infected rooms have been thoroughly disinfected the same day; this prompt action only being possible when we have a certain number of Hospital beds at our disposal. DIPHTHERIA. The Diphtheria Ward has been available during the year and 30 cases have been treated. Twenty of these have been very severe cases, two of which died. In most instances it was found advisable to treat the patients with the anti-diphtheritic serum, and, as far as the limited number of cases treated can show, the injection of this anti-toxin has been most beneficial. In one case the symptoms, in spite of anti-toxin being injected, became so serious that tracheotomy was performed, the patient being ultimately discharged perfectly well. The average time these patients were under treatment was 29 days. The fees paid for the maintenance of patients in the Isolation Hospital amounted to £37 9s. 6d. I wish to point out two things in connection with our Temporary Hospital. The first is, that the appliances needed in case of any outbreak of fire are by no means adequate. I recommend that suitable connections with the hydrant should be made, and the necessary appliances obtained as soon as possible. Not only is the building largely composed of wood, and contains a quantity of inflammable material, but there is a large quantity of lamp-oil used for illuminating and heating purposes, and I am strongly of opinion that the necessary precautions should be taken as soon as possible. This brings me to the second point, which is, that I think it would be a great boon to our Hospital if we could have the Electric Light installed there. I understand that there is sufficient power wasted in connection with the sewage works to suit the purpose; and of course the risk to the building from fire would be minimised. 17 MEMBRANOUS CROUP. There have been only 18 cases notified as compared with 26 last year, but there has been the same number of deaths, and consequently the mortality is slightly increased. TYPHOID FEVER. There has been an increase of 41 in the number of cases notified as compared with last year, and the number of deaths is twice as great. The largest number of cases notified in any one month was 26 in September, and in the latter four months of the year over 63% of the total number were notified. It will be seen from Table XI. that 40% of the cases notified occurred in the Leyton Ward, and that in the Cannhall Ward only 13 were notified. There were 92 houses infected, and sanitary defects were found in 53 of these. Of the above total 11 cases were imported into the District. Two cases occurred through nursing Typhoid patients. I shall refer later in the Report to a series of cases that occurred in adjacent houses, where the combined system of drainage existed. PUERPERAL FEVER. There was only one case notified during the year, and only one death occurred. It is worthy of mention that this death was not that of the case notified, and this points to the fact that the notification of this disease is likely to give rise to many discrepancies in the yearly statistics. The reason for this is, in my opinion, due to the fact that in the new edition of the authorised "Nomenclature of Diseases," issued by the Royal College of Physicians of London, the common term "Puerperal Fever" has been expunged, and the affection called by one or more of three names, none of which is, strictly speaking, mentioned in the scheduled list of notifiable diseases. Consequently a medical practitioner, acting strictly upon the letter of the law, may refuse to notify any puerperal affection on account of the obsolete wording of the Notification Act. 18 MEASLES. There has been no epidemic of this disease, and only six deaths have occurred, this being the smallest number of deaths for four years. ERYSIPELAS. There has been a decrease in both the number of cases notified and also in the mortality. Most of the cases occurred during the wet, cold weather of spring and late autumn. WHOOPING COUGH. There has been a considerable decrease in the number of deaths. Of the 24 deaths, 23 were under five years of age. DIARRHŒA. I have to report a very large increase of this complaint, the number of deaths, 121, being quite exceptional. As is usual, it followed the hot, dry summer weather, and was especially fatal to young children. Of the 121 deaths, 114 were under five years of age. In August alone there were 96 deaths, of which 90 were under five years of age, 80 being under one year of age. I can only repeat the words of caution I gave in my last year's report, that mothers should, during the hot summer weather, pay particular attention to the dieting of their children, and be scrupulously careful in the cleansing of infants' feeding bottles, and should, also, never neglect to seek advice in cases where troublesome diarrhoea has become established. INFLUENZA. There has been no epidemic, although isolated cases have occurred throughout the year. There were nine deaths, seven of which were over five years of age. 19 PHTHISIS. There were exactly the same number of deaths as last year. Of the 81 deaths, four were under five years of age. STEAM DISINFECTOR. I wish to point out that this District stands in great need of a Steam Disinfector. At present, clothes, bedding, etc., are fumigated with sulphur in the rooms where infectious cases have been dwelling, and, although this method of disinfection is excellent in its way, I think the time has arrived when we should endeavour to perfect our method of disinfection, and avoid every possible risk by obtaining one of the numerous machines which disinfect by steam. At the Hospital alone there is a large amount of disinfecting done, every precaution being taken with the patients' clothes to prevent any risk of contagion. In addition to this there are some hundreds of cases where the Sanitary Staff of your Council have to fumigate the clothes after infectious disease. All this entails a vast amount of work in both departments, and the establishment of a Steam Disinfector would prove to be a great boon to the Hospital, to the Sanitary Staff, and to the public at large. During the past year, occasion arose when I was requested by your Council to visit and report on a certain Steam Disinfector, but the arrangements for purchasing it were not completed. I will not now suggest any particular variety of the many Steam Disinfectors that are in the market, but I hope that the very best one may be obtainable, and that, too, without loss of time. 20 PUBLIC INSTITUTIONS, WEST HAM UNION WORKHOUSE AND SCHOOLS. Births.— During the year there were 96 births. Deaths.—There were 392 deaths, viz.: Males, 227; Females, 165. The following were the chief causes of death:— Under 5 Years. 5 Years and over. Total. Typhoid Fever — 3 3 Erysipelas — 1 1 Measles 2 — 2 Whooping Cough 2 — 2 Diarrhoea 4 4 8 Phthisis - 64 64 Diseases of Respiratory Organs 3 66 69 Heart Disease — 32 32 Premature Birth 2 - 2 Cancer - 31 31 Violence 1 5 6 All other Diseases 32 140 172 Totals 46 346 392 Of these deaths one was registered by the Coroner's notification. ages at which death occurred. Under one year 28 One year and under five years 18 Five years „ 15 „ 6 15 „ „ 25 „ 13 25 „ „ 65 185 65 „ and over 142 Total 392 21 INFECTIOUS DISEASE. During the year there were 16 cases of Typhoid Fever, and one of Puerperal Fever notified. BETHNAL GREEN SCHOOLS. These large Schools have again been very free from infectious disease, only one case of Diphtheria having been notified during the year. Four deaths took place, one from Influenza, and three from Phthisis. ST. AGNES' ORPHANAGE. There have been four cases of Scarlet Fever, and one of Diphtheria notified. All these cases were at once removed to Homerton. One death from Meningitis occurred during the year. The general health of the inmates has been very satisfactory. FOREST HOUSE. There were two deaths, both being old men who were found drowned in the pond. 22 SUMMARY OF SANITARY WORK DURING 1897. The following is the Report of the Sanitary Inspector:— Houses inspected 3310 Connections of drains tested 2478 Orders by notices, etc., served on owners or occupiers 2336 Complaints received 272 Defective drains remedied 370 Houses entirely redrained with intercepting syphons and manholes provided between house-drains and sewer, with proper air inlets and outlets 87 W.C.'s in defective state — new traps and straight backed pans provided where necessary—traps concreted to top, with cement floors and open risers 950 Sink and bath wastes and rain pipes made to discharge in open air over properly trapped gullies 697 Defective gullies replaced and defective connections of gullies remedied 708 New sink waste pipes provided 109 New salt-glazed stoneware sinks provided 28 Bath, lavatory and sink waste pipes trapped immediately under arrangements 30 Pan-closets with iron containers and leaden D-traps replaced by approved arrangements 9 Ventilating shafts (4-in ) provided to soil pipes and drains 475 Defective soil pipes remedied 32 Flushing cisterns supplied to W.C.'s with efficient flushing pipes 125 Flushing cisterns repaired 230 Yards properly paved around back additions of houses 534 Floors of sculleries properly paved 50 Stagnant water under dwellings remedied 22 Houses with defective roofs, guttering and general insanitary, dilapidated and filthy conditions repaired and cleansed 247 Houses disinfected, walls stripped and limewhitened 421 Walls of back additions of houses properly rendered 32 Houses without water, supplied by the East London Service, and water supplies to houses restored 91 Domestic water cisterns repaired 13 Covers provided to domestic water cisterns 109 23 Overcrowding 5 Nuisances caused by fish offal, manure and other refuse 98 Animals kept in an insanitary state 21 Pig-keep nuisances abated 2 Nuisances with caravans, squatters, &c. 3 Smoke nuisances abated 3 HOUSE INSPECTION. 1. General House Inspection: Houses inspected during year, including house-to-house inspection, complaints, etc., but excluding infectious diseases 2537 Number of these houses in which defects were found (as per monthly Reports) 2007 2. Systematic House-to-House Inspection: Wards—Principally confined to Cannhall, Wanstead Slip, and Harrow Green Wards. Roads—The following roads were included in house-to-house inspection, in addition to which, however, certain portions of other roads not mentioned here were inspected: Acacia Road, Argyle Street, Ashlin Road, Ashville Road, Avenue Road, Beechcroft Road, Burgess Road, Cecil Road, Cobbold Road, Cobden Road, Downsell Road, Dunmow Road, Ellingham Road. Elm Road, Gilbert Road, Gladstone Street, Granville Road, Harrow Road. Holloway Road, Kingsdown Road, Manby Road. Melrose Road, Newcomen Road, Oakdale Road, Pearcroft Road, Sansom Road, Stewart Road, Temple Mills Lane, Temple Street, Thornton Road, and Woodhouse Road. It will be seen from the above that the house inspection, both systematic and general, has been very extensive, and entailed a large amount of work on the part of the Sanitary Department. I must draw special attention to the results of the careful systematic inspection of houses in the Cannhall Ward. 24 It will be seen from Table XI. that whereas in 1896 this Ward was over 31% of the infectious diseases in our District, in 1897 only 19.3% of the cases of infectious disease occurred in this Ward, shewing that the careful survey of this particular district has resulted in the remedying of many sanitary defects, and the noticeable reduction of the amount of infectious disease. COWSHEDS AND DAIRIES ACT. The Cowsheds in the parish have been periodically inspected. There have been 13 new applications to sell milk, which, alter examination of the premises, were registered. One application was refused. SLAUGHTER-HOUSES. All these have been inspected once a month, and have been found in a satisfactory condition. One new application has been granted, the license being renewable yearly—and one license has been transferred. I wish again to impress upon the Council the necessity, mentioned in my last year's Report, of reforming the Bye-Laws relating to the licensing of Slaughter-houses. There are many Slaughter-houses in the District, where a large slaughtering business is carried on, making them, in fact, small Public Slaughter-houses. In our large and increasing District, I think it would be a great boon if the Council would establish Public Slaughter-houses under their control, such as many towns, smaller than Leyton, can boast of. Such Public Slaughter-houses would be a considerable help to the Sanitary Authority, and also on the ground of Public Health, I think they are to be strongly recommended. In the meantime, I would repeat my suggestion made last year that all licenses should hold good for one year only, and be renewable only on application and inspection of the premises. PETROLEUM ACT. Six licenses have been renewed, after inspection of the premises as to storage, etc. BAKEHOUSES. The whole of the Bakehouses in the District have been visited, and are now in a good sanitary state. 25 DRAINAGE. VENTILATORS. For several years I have insisted both in monthly and annual Reports upon the importance of improving the ventilation of our Sewers. and I have laid special stress upon the advisability of establishing more upright ventilating-shafts. I regret to say that this mode of ventilation is carried out with tardiness, and only four have been erected during the year making a total of five in two years! I trust that this matter may be considered as being of great importance, and that many more of these ventilators may be erected—I do not mean six or seven, but some hundreds. I would specially mention the Leytonstone, Harrow Green and Cannhall Wards as being the part of the District where they are most required. We are told by a recent Report on the Drainage of the District, that the main sewer leading from these Wards is quite inadequate in times of flood, when a considerable portion of sewage escapes by the Wanstead culvert. This, I think, points to some urgency in the matter of ventilation. If the storage capacity of the sewer is at fault, then in times of flood, the sewer gas is forced back, collecting at the highest point and escaping into houses where sanitary defects exist. This serious condition may be considerably alleviated by allowing the gas to escape through properly constructed ventilating shafts, situated at many points of this locality, and especially at the higher levels. GULLIES. Numerous complaints have been received throughout the year of bad smells arising from road-gullies, and there is no doubt that these gullies should be thoroughly overhauled. Some of them have defective traps, and many of the gullies themselves are defective and will not hold water. All gullies should be properly constructed to hold water, and efficiently trapped. I would suggest that there should be a regular system of periodical cleansing of these gullies. The men who cleanse them should, in addition to being provided with disinfectants, be accompanied by a water-cart, which should be used for flushing and re-charging the traps. The deposit should also be removed from the road immediately afterwards, 26 DRAINS IN HOUSE CELLARS. Attention has been recently drawn to complaints of bad smells arising from cellars, where it has been found necessary by the builders to make a communication with the sewer for the purpose of drainage. On inspection of these houses, where complaints have arisen, and also in a large number of others, I have found that the mischief arises from the fact that the drain has become untrapped. I would caution householders that the traps of these drains must, to be effective, contain water, and I trust that they will see the necessity of frequently examining them to see that is the case. I may add that in some roads the depth of the cellar precludes any drainage into the surface-water drain, and therefore it must be drained into the sewer. COMBINED DRAINAGE. As this subject has assumed very considerable importance, I wish to take this opportunity of saying that, to my mind, the system of combined drainage, so commonly used in the houses being erected in our district, is open to considerable doubt. The following points appear to me to be of great importance in discussing the problems connected with this question:— 1.—The difficulty of investigating and abating of nuisances. In some cases many owners are implicated, one being willing to rectify the defects, and a neighbour refusing to assist in the matter. This necessitates stringent measures, which, unfortunately, cannot legally be carried out without considerable delay, the nuisance in the meanwhile being a source of danger to the health of the inmates of the house. Moreover, this investigation by the Sanitary Staff does not only apply to the nuisance, but also is directed to determine the ownership of the various houses whose drains are combined, a matter of considerable delay, and really a necessary proceeding to be gone through before any legal process can be taken. 2.—As the law now stands it is distinctly advisable to have a separate drain to each house. This throws the responsibility upon the proper party, and makes the rectification of sanitary defects a much quicker process. I am certainly of opinion that these single drains, laid in accordance with your Bye-laws and those of the Local Government Board, being properly supervised by your 27 officers, being intercepted from the sewer, and having proper air-inlets and outlets, make it absolutely impossible for any danger to arise to the health of the inmates. 3.—In instances of Combined Drainage when the drains have not been properly laid, cases of infectious diseases may occur (and I allude especially to Typhoid Fever), and prove a great danger to the health of the inmates in adjoining houses. I may quote a case, which was brought to my notice, in illustration of this:— Nos. 1, J, 5, Albert Road, Leyton. These houses are drained under the combined system. A lad was taken ill with Typhoid Fever, at No. 1, on or about August 28th. The disease rapidly spread to the two adjoining houses, Nos. 3 and 5, with the result that by September 6th five cases had been notified from these three houses as suffering from Typhoid Fever! The subsequent inspection showed that the drains were in a very defective condition, the defects being remedied as soon as possible. DUST REFUSE. The "Pail System" continues to work satisfactorily. It has been foupd necessary to increase the number of carts and men employed on the work, and there are now II carts and 15 men. I again draw attention to the practice of depositing trade refuse and other material in the roadway. As nothing has been done in the matter, I wish again to emphasize the fact that this refuse, if left in the roadway any length of time, may become a nuisance. DUST DESTRUCTOR. The Destructor has now been working the whole of the year, and the results have been most satisfactory. The quantity of sludge and house refuse has been very large, being something like 68 tons of combined sludge and house refuse daily. The Destructor has been thoroughly tested by eminent scientists, and their conclusions are very interesting, and are therefore appended:— "From a consideration of the results of this trial we have "arrived at the following conclusions:— "1 The Destructor is capable of consuming wet sewage "cake and house refuse of poor character in a complete " and satisfactory manner. 28 "2. The oxidation of the combustible matter in the "material fed into the Destructor is complete, and the "gaseous products of combustion are inoffensive. "3. The gaseous products of combustion are sensibly "free from any suspended matter by the time they pass "into the flue to the chimney. "4. The clinker is well burnt and free from offensive "half-charred carbonaceous matter. "Even when working with a wet sewage cake and poor "house refuse, the Destructor generates more heat than can "be used with the present plant at Leyton. "We examined one of the cells in its cold condition, and " were unable to discover any signs of wear or abrasion. "We therefore consider that your Destructor provides an "efficient and economical method of destroying the refuse "of towns without injury to the neighbourhood. So far as "we are aware, it is the only form of furnace yet adopted "capable of burning a considerable proportion of Sewage "Sludge—even when containing, as in this case, a high "percentage of moisture." In conclusion, Gentlemen, I think I may safely say that the Health of the District is fairly satisfactory. The Death-rate remains about the same; the amount of sickness does not increase out of proportion to the population ; the Fever Hospital is working satisfactorily and has been a great boon, and we have been free from any serious epidemic. I hope that the points I have urged in this Report, especially those dealing with the Drainage, may have the best attention of your Council, for I am anxious that every help should be afforded to our Sanitary Department in view of the thickly-populated District we are rapidly becoming, and the corresponding increase of the amount of sickness, infectious or otherwise, that must necessarily be expected. I am, Gentlemen, Your obedient servant, A. F. PESKETT, March, 1898. Medical Officer of Health.