LEY 004 Leyton Urban District Council. ANNUAL HEALTH REPORT for 1898, by A. F. PESKETT, Medical Officer of Health. Leyton: E R. ALEXANDER & SONS, PRINTERS, ERA PRESS. Leyton Urban District Council. annual health report For 1898, by A. F. PESKETT, medical officer of health. Gentlemen, I beg to present to you my Annual Report for 1898. The weather during the past year has presented several features of more than average interest. The most striking of these have been the persistent absence of rain, and the mild weather which occurred in those months when we generally experience cold weather. The Rainfall was some 8 inches deficient during the year, the driest months being January, April, August, and September, when the rainfall each month was less than 1 inch. The 'weather experienced in September was almost phenomenal, being exceptionally free from rain and being excessively hot; this excessive temperature being the more noticeable on account of the hot and dry weather it succeeded. 4 The Temperature during the year was also noteworthy, as the mean temperature for each month was in excess of the average, excepting March, May, and June. The warmest month was August, and the coldest was March. 1 he mean temperature for the whole year was 2 degrees above the average for the previous 50 years. The highest shade temperature, 92.1 deg., was recorded on September 8th, and is the highest reading on record for so late a period in the year. The lowest temperature, 26.1 deg., was recorded on February 21st, and is the highest winter record for the past 16 years. In the early and late months of the year the immunity from frost was most exceptional. There has been also a remarkable freedom from fogs. Two important points in the year's record—namely, the severe epidemic of Diarrhoea, and the serious water-famine—may be in a great measure ascribed to the long-continued drought. In addition to Diarrhoea, there was a severe epidemic of Measles during the early part of the year, and Whooping Cough was somewhat prevalent in May. Typhoid Fever increased suddenly in October, but never assumed epidemic proportions. POPULATION. The District still increases rapidly in population, and I have decided to estimate the total at 90,000 at the middle of the year, exclusive of Public Institutions, which alone have a population of 2,380. During the year there have been 757 houses erected and certified as being fit for occupation. Area 2,500 acres. No. of persons per acre 36 5 The following are the Returns of the number of children attending the various Board Schools and National Schools in the District. Cann Hall Ward— Boys Girls Infants Total Cann Hall Road Board School 635 691 598 1924 Downsell Road „ 490 513 595 1598 Trumpington Road „ 441 425 521 1387 Harrow Green Ward— Harrow Green Board School 407 502 406 1315 Goodall Road „ 301 — — 301 Mayville Road „ 535 536 493 1564 Leytonstone Ward— Kirkdale Road Board School 568 455 336 1359 Leyton Ward— Church Road Board Schools 346 380 311 1037 Lea Bridge Road „ 56 49 52 157 Newport Road „ 637 671 546 1854 Ruckholt „ 279 432 312 1023 Capworth Street „ 513 504 484 1501 Total attending Board Schools 5208 5158 4654 15020 National Schools 316 246 230 791 Total attending All Schools 5523 5404 4884 15811 The total in 1897 was 15,283. BIRTHS. During the year there have been 2,560 births registered, being an increase of 59, and consisting of 1,306 males and 1,254 females. The Birth-rate is 28.4 per thousand, the rate in 1897 being 29.3 per thousand. There were 113 births in the Union Workhouse. 6 Table 1.— Births for the last 5 years. Males. Females. Total. 1894 1,113 1,111 2,224 1895 1,200 1,092 2,292 1896 1,216 1,156 2,372 1897 1,278 1,223 2,501 1898 1,306 1,254 2,560 6,113 5,836 11,949 DEATHS. There were 1,627 deaths registered, viz.:—844 males and 783 females. Table II.—Deaths for the last 5 years. 1894 1,221, of which 825 belong to the District proper 1895 1,532, „ 1,080 1896 1,339, „ 926 1897 1,425, „ 1,011 1898 1,62", „ 1,125 7.144, „ 4,967 „ „ The total number of deaths is 202 more than last year. INCREASE. The annual increase, or excess of births over deaths, is 933, the average for the past five years being 961. The total increase for the past five years is 4,805. Table III.—Distribution of Deaths. Master Bakers' Almshouses 4 St. Agnes' Orphanage 1 Bethnal Green Schools 0 Judge Fuller's Almshouses 1 Union Workhouse and Schools 468 District exclusive of foregoing Institutions 1,153 Total 1,627 7 In the 1,153 are included 86 which occurred in the Union Workhouse, but strictly belong to the District. Of the total 1,627, the deaths of people belonging to Public Institutions amount to 474, leaving 1,153 occurring in the District proper: deducting from this total 28 deaths which were caused through violence, we get 1,125 as the corrected total for the District, and consisting of 549 males and 576 females. By estimating the population, exclusive of Public Institutions, rit 90,000, we get a death-rate of 12.5 per thousand, that in 1897 being 11.89 per thousand. The average death-rate for the past 5 years is 12.4. The average death-rate for the past 10 years is 13.4. Table IV.—Death-rate for each Quarter. 1st. 2nd. 3rd. 4th. I.eyton District 13.5 11.13 14.3 11.5 London 21.9 16.5 19.1 17.0 Table V.—Deaths Classified with regard to Sex. Males 48.8 Females 51.2 per cent, of the total deaths. Table VI.—Ages at which Death occurred. Under dne year 374 One year and under five years 167 Five vears „ 15 „ 49 15 ' „ „ 25 „ 41 25 „ „ 65 291 65 „ and over 203 Total 1,125 Table VII.—Death-rate per cent of Total Deaths. Under one year 33.2 One vear and under five years 14.9 1 48.1 Five years „ 65 „ 33.9 65 „ and over 18.0 51.9 8 The infant mortality, or deaths of infants under one year, per thousand births is 146, the infant mortality last year being 142. Table VIII.—Chief Causes-of Death. Under 5 years 5 years and over Total Small-Pox 0 0 0 Scarlet Fever 3 2 5 Diphtheria 15 13 28 Membranous Croup 0 0 0 Typhoid Fever 0 17 17 Erysipelas 1 2 3 Puerperal Fever 0 3 3 Simple Continued Fever 0 0 0 Influenza 3 12 15 Croup 5 0 5 Measles 41 4 45 Whooping Cough 22 3 25 Diarrhoea 125 14 139 Heart Disease 3 64 67 Phthisis 2 68 70 Diseases of Respiratory System 85 91 176 Premature Births 40 0 40 Rheumatic Fever 1 5 6 Cancer 0 50 50 All other Diseases 192 239 431 Totals 538 587 1125 Of these deaths, 65 were registered by the Coroner's Notification. Table IX.— Number of Deaths and Death-rate per 1,000 of Population from certain causes. Phthisis Pneumonia and Bronchitis Heart Disease Violence Premature Birth Number of Deaths 70 176 67 28 40 Death-rate per 1,000 .61 1.9 .74 .31 .44 INFECTIOUS DISEASES (NOTIFICATION) ACT, 1890. The following table shows the number of cases of Infectious Disease notified during the year :— Table X.—Number of Cases notified. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Small Pox — 1 — — — — — — — — — — 1 Scarlet Fever 44 34 28 36 44 30 27 13 20 33 15 27 351 Diphtheria 12 16 23 17 11 7 11 11 14 8 11 21 162 Membranous Croup — — — 1 1 1 — 4 — — 5 — 13 Typhus Fever — — — — — — — — — — — — 0 Typhoid Fever 9 5 3 2 2 2 1 6 17 18 9 7 81 Simple Continued Fever — 1 — — — — — 1 — 2 4 — 8 Relapsing Fever — — — — — — — — — — — — 0 Puerperal Fever — — 1 2 1 1 1 1 — — — — 7 Erysipelas 9 6 8 2 7 9 5 7 12 9 6 6 86 74 63 64 60 66 5° 45 43 63 70 50 61 709 9 Table XI.— Showing the Number of Cases of Infectious Disease as they occurred in the Four Chief Wards of the District. Leyton. Leytonstone. Harrowv Green. Cannhall. Total. Small Pox 1 0 0 0 1 Scarlet Fever 82 61 69 138 351 Diphtheria 58 38 39 27 162 Membranous Croup 1 8 4 — 13 Typhoid Fever 28 16 11 26 81 Simple Continued Fever — 1 2 5 8 Puerperal Fever 3 — 2 2 7 Erysipelas 41 22 15 8 86 Totals 214 147 142 206 709 Percentage of Cases 30.2 20.8 20.0 29.0 „ „ 1897 37.8 20.3 22.5 19.3 „ „ 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. 1897. 1898. 1897. 1898. 1897. 1898. Small Pox 0 1 0 0 0.0 0.0 Scarlet Fever 510 251 17 5 3-3 1.4 Diphtheria 156 162 20 28 12.8 17.2 Membranous Croup 18 13 1 0 5.5 0.0 Typhoid Fever 102 81 14 17 13.5 20.8 Simple Continued Fever 6 8 0 0 0.0 0.0 Puerperal Fever 1 7 1 3 100.0 42.8 Erysipelas 100 86 2 3 2.0 3.5 893 709 55 56 6.1 7.8 11 Table XIII.— Death 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. 1894 1895 1896 1897 1898 Small Pox 0 0 0 0 0 Measles 36 50 20 6 45 Scarlet Fever 11 12 6 17 5 Diphtheria and Membranous Croup 34 69 26 21 28 Whooping Cough 21 26 52 24 25 Fevers Typhus 0 0 0 0 0 Typhoid 11 11 7 14 17 Diarrhoea 36 72 87 121 139 Deaths from the Seven Chief Zymotic Diseases 149 240 198 203 251 Deaths from all other Diseases 663 840 612 808 874 812 10.80 810 1011 1125 Death-rate from Seven Chief Zymotic Diseases 2.1 3.2 2.5 2.3 2.8 Death-rate from all other Diseases 9.5 11.2 9.3 95 9.7 General Death-rate 11.6 14.4 11.8 11.8 12.5 Of the 251 deaths from Zymotic Diseases 209 (over 83%) were due to the three non-notifiable Diseases : Measles, Whooping Cough, and Diarrhoea. 12 13 SMALL-POX. One case only has occurred during the year. The patient was an adult, and the only likely source of infection that could be traced was that he had been handling documents from Middlesboro', where at that time this disease was very severe. VACCINATION. During the year the Royal Commission on Vaccination published their Report, which gave rise to the introduction of a new Vaccination Bill in Parliament. This new Act made three important alteration; in the previous Vaccination Laws. Of these the first was the extension of the age limit for the primary operation from three to six months ; the second abolished repeated convictions for non-compliance with the provisions of the Vaccination Act; and the third made provision for the Public Vaccinator to perform gratuitous vaccination at private houses, instead of compelling the children to be taken to the Public Vaccination Station. The fact that the new Act was based upon the findings of the Royal Commission makes it a matter of great surprise, not to say regret, that no provision was made for the enforcement of re-vaccination, especially as this was a point strongly dwelt upon by the Royal Commission. » Perhaps the most prominent feature of the new Bill was the introduction of a clause enabling those who have conscientious scruples to evade prosecution by making a declaration to that effect before a magistrate. One can hardly believe that this concession, although apparently giving support to the biassed opinions of anti-vaccinators, will actually reinstate vaccination in the favour of the public by thus lessening the opposition to it. To exemplify this idea, let us consider the question of vaccination in other countries. In Holland, where vaccination is optional, and, on that account, neglected, the mortality from Small-pox is six hundred times greater than in Germany, where vaccination is rigidly enforced. In oui district, over 20 per cent, of the children born escape vaccination, and as, moreover, we are in close proximity with districts where there exists a still greater percentage than this, it is only too obvious that should Small-pox break out in this district, with its hundreds of unvaccinated children, that we must expect and be prepared to meet an exceptionally severe epidemic. 14 It is, therefore, to be fervently hoped that we are not going to wait for any such epidemic to show us the value of compulsory vaccination, and the obligation which rests on us all to obtain the speedy repeal of this pernicious Conscience Clause in the new Vaccination Act. SCARLET FEVER. There has been a very marked decrease in this disease since last year, the number of cases notified being less by 159. The mortality has also diminished from 3.3% to 1.4%, showing that the disease has been of a milder type. Table XIV.—Notified Cases of Scarlet Fever during the past Five Years, with the percentage of mortality. Cases notified No. of Deaths Death rate per cent 1894 — 11 - 1895 507 12 2.3 1896 501 6 1.1 1897 510 17 3.3 1898 351 5 1.4 On referring to Table X. we see that the disease appears to have been more prevalent during the first half of the year, when over 61% of the total cases were notified. In August and November the amount of disease was extremely little. It will be seen from Table XI. that over 39% occurred in the Cann Hall Ward, which is about the proportion that this Ward was responsible for in 1896. DIPHTHERIA. It will be seen from Table XII. that six more cases have been notified this year as compared with last. The deaths are more in proportion, and consequently the mortality per cent, is increased. The Leyton Ward seems to have been more affected than the other Wards, and over 35% were notified from there. Of the 28 deaths, 15 were under five years of age. 15 TEMPORARY ISOLATION HOSPITAL. Accommodation has been provided during the whole year for the reception of cases of Scarlet Fever and Diphtheria, and the following statistics show the number of patients that have been under treatment : — Scarlet Fever. Males Females Total Admitted 64 75 139 Died 0 1 1 Diphtheria. Admitted 12 28 40 Died 2 3 5 Ages of Patients. Scarlet Fever Diphtheria Under one year 0 0 One year, and under five years 37 10 Five years „ 15 „ 86 26 15 „ „ 25 „ 13 1 25 „ and over 3 3 139 40 The following table will show the advantages that have been obtained by the increased accommodation which has been provided since October, 189G6 Scarlet Fever. 1895 1896 1897 1898 No. of cases notified 507 501 510 351 „ „ treated in Hospital 61 103 177 139 Percentage of cases treated 12.0 20.5 34.7 39.6 No. of beds available 16 Jan. to Sep. 16 40 40 Oct. „ Dec. 40 Mortality per cent ot notified cases 13.6 1.1 3.3 1.4 Do. do. cases treated 1.6 5.8 1.7 0.7 There have been 692 cases of Scarlet Fever treated in your Hospitals, of which 362 have had the benefit of the new Buildings. 16 Diphtheria. 1895 1896 1897 1898 No. of cases notified 348 187 156 162 „ „ treated in Hospital No accommodation. 6 30 40 Percentage of cases treated 3.0 19.1 24.6 No. of beds available 8 10 10 Mortality per cent, of notified cases 13.3 13.4 17.2 Do. do. cases treated 16.6 6.6 12.5 SCARLET FEVER. There have not been so many cases in the Hospital this year, due to the great decrease in the disease throughout the District. It is satisfactory to note, however, from the preceding table that the percentage number of cases treated has increased, and that the mortality per cent, of those cases which had Hospital treatment, is considerably less than the percentage mortality of all the cases notified. The fatal case was that of a girl of 14 years, who had severe nasal symptoms, and died after eight days' treatment in the Hospital. DIPHTHERIA. « There^have been 10 more cases admitted during this year. The percentage of notified cases is increased, as compared with last year, and the mortality per cent, of those admitted, though not so low as in 1897, compares very favourably with the general mortality of this disease, and this latter fact is the more striking when we consider the serious condition in which most of the patients were admitted. The fatal cases may be briefly alluded to thus: — Male, 5 years, in Hospital 3 days. Sudden and severe nasal symptoms. Female, 10 years, „ 8 ,, . Heart-failure. Female, 15 mos., „ 20 hrs. Male, 7 years, „ 14 days. Paralysis. Female, 5i years, „ 12 hrs. The two who were only in the Hospital a few hours were severely attacked, and no treatment—even tracheotomy in one case—relieved the symptoms. 17 On two occasions during the year has the accommodation of the Hospital been curtailed. In June, owing to the occurrence of Measles in the Male Scarlet Fever Ward, no further admissions were made until the danger of infection had ceased. In August the disastrous fire which occurred in the Laundry Block necessitated the use of the smallest Scarlet Fever Block as a Temporary Laundry, and as the Discharge-Room had been damaged by the fire, neither the admission nor discharge of patients could be freely carried out. It fortunately happened, however, that the Wards were not at that time fully occupied, and although the repairs were not completed until October, a number of the more urgent cases of Scarlet Fever were admitted in the meantime. The Laundry Block has been re-built in brick, and is now a very substantial building. A new Ambulance, having the latest improvements, is now at the Hospital, and is to be put into use when the state of the roads adjacent to the Hospital will permit. I may mention that at an early date in the coming year, the electric light is to be installed throughout the buildings, thus minimising the risk of fire, and also adding considerably to the convenience of such a building. Investigations are being made as to the form of Disinfector that would be most suitable to this District, and I hope that we shall soon have one established at the Hospital. MEMBRANOUS CROUP. There have been only 13 cases notified, as compared with 18 last year, and no deaths have occurred. TYPHOID FEVER. There have been 21 fewer cases notified this year than last. There have, however, been more deaths, and the rate of mortality is consequently increased. September and October were the months when the disease was most evident, and over 70% of the total cases occurred during the last five months of the year. 18 As during last year most of the cases were notified from the Leyton Ward—being responsible for 40% of the total cases—this year the percentage is only 34%. The following causes have been assigned to the cases that have occurred in the District: — Imported 18 Defective drainage 38 Drinking pond water 1 Eating ice-cream 1 Falling into pool of stagnant water 1 Drinking water at Southend 1 Eating oysters 1 Cause untraceable 24 Six cases were removed to the Leyton and Walthamstow Genera! Hospital. PUERPERAL FEVER. There have been seven cases notified, and of these three terminated fatally. MEASLES. This disease became epidemic in March, and for three months was very severe throughout the district, affecting chiefly children attending the Board Schools. There were 41 deaths under five years of age, and four over that age. ERYSIPELAS. There have been fewer cases notified this year, but there has been one more death. WHOOPING COUGH. This disease, as so frequently happens, followed the outbreak of Measles, and a large number of cases occurred in May, and it appeared to be somewhat prevalent during the whole summer. There were 25 deaths, 22 of which were under five years of age. 19 I wish to draw attention to the ignorance of the general public as to the infectious nature of this disease. Children suffering from it, and liable to acute spasmodic attacks, are heedlessly sent out into our public streets and allowed to use tramcars and other public vehicles. DIARRHCEA. This disease has been very severe this year, and 18 more deaths were registered than during last year. The epidemic commenced rather suddenly in August, when 00 deaths occurred, and was continued through September, when 57 deaths occurred. In these two months there were 117 deaths, or over 84% of the total deaths. Of the 139 total deaths, 125 were under five years of age. During August printed leaflets were distributed throughout the District, warning parents against the danger of allowing this complaint to continue without seeking advice, and suggesting the care to be taken with milk and water during the extreme heat. INFLUENZA. At no time has there been any epidemic, although occasionally isolated cases have occurred. There were 15 deaths, 12 being over five years of age. PHTHISIS. There were 70 deaths registered, being 11 fewer than last year. TUBERCULOSIS. As considerable attention has been recently directed to the important question of the spread of Tuberculosis, I have ventured to make some special remarks in this Report. There is no doubt that the deaths from Tuberculosis are considerably on the increase each year. It is difficult to obtain accurate records of such deaths, for it is only when the disease affects one or two special organs that we learn that death is caused by Tuberculosis. The number of deaths from Phthisis, or Tubercular Disease of the Lungs, is very great, and this is especially noticeable in the Returns from such an Institution as the Union Workhouse, where the sufferers have been previously exposed to all weathers, and have been ill-clad and badly nourished. 20 In addition to these deaths from Phthisis, we must take into account the vast number of cases of Tuberculosis which affects other organs, and which are not specifically classed in our statistics, and amongst these we must put the many wasting diseases of childhood. It becomes incumbent, therefore, on every public body, to whose care the Sanitary Health of the District is entrusted, to endeavour to check "by every available means the progress of any disease which is tending to become a scourge. This endeavour should, moreover, be the more zealously carried out in such a district as ours, where the population is rapidly increasing, and where the dangers arising from over-crowding and insanitary houses are most likely to occur. It is urgently needed that every provision should be made for the better ventilation of dwellings and other buildings, and care should be taken that they should have proper access of light, and that the cubic space allowed per head should be sufficient, the present allowance of 800 cubic feet per head being too small. Before considering the special measures I would advocate, I might mention the chief sources of infection. I. From the direct infection of one person to another in various ways. II. Through tuberculous meat. III. From tuberculous milk. I. The first of these causes may be dealt with by educating people to realise that Tuberculosis is an infectious disease, to be treated by them accordingly. This process of education may be carried by the distribution of printed leaflets in accordance with the suggestion made by the Royal Commission on this subject. These leaflets should point out the infectivity of Consumption, and should suggest the measures to be taken to improve the general hygienic condition of dwelling rooms, and should lay stress on the important fact that fresh air and sunlight are direct enemies of the bacillus of this disease. Then I am of opinion that the Sanitary Department should be authorised to take such steps with regard to Tuberculosis as it is now empowered to take with regard to cases of infectious disease which are now notifiable. 21 This might even result in some registration of Tuberculosis being adopted, though it is very difficult to see at present how this could be effectually managed. Considerable service could be done by the offer of the Sanitary Authority to undertake, free of cost, the disinfection of any room, bedding, etc., where a fatal case has occurred. II. The second cause, that of tuberculous meat, can be attacked by giving the Sanitary Authority more power over the inspection of meat. A duly qualified Inspector should be appointed, and a Public Slaughter-House should be forthwith established. III. The third cause is the one to which I wish to draw special attention. To milk obtained from tuberculous cows is undoubtedly due the prevalence of tubercular disease in childhood, and the danger of allowing such milk to be sold in such a District as ours, should urge us to contemplate some more stringent measures than exist at present in the inspection of dairies and cowsheds. By your recent Bye-Laws, much has been done to obtain considerable control over the supply of milk, especially when infectious disease is epidemic, but, unfortuntely, Tuberculosis is not counted as an infectious disease, otherwise more stringent precautions would be taken. All dairies and cowsheds should be periodically and systematically visited by a Veterinary Surgeon acting in conjunction with the Sanitary Authority, and he should be empowered to take samples of milk, and examine the cows with the tuberculin test, free of charge. Such measures as these would, no doubt, be eventually welcomed bv dairymen, as helping them to keep their dairies in the most hygienic condition possible, and as guaranteeing the purity of their milk. An alternative suggestion is to supply tuberculin to any owner who will undertake to isolate reacting animals from healthy ones, thus guarding against its formal use as an advertisement, with the neglect of any subsequent precaution necessary to give it any practical value. Of course, all infection from tuberculous milk may be destroyed by boiling, or only sterilized milk could be used; but I think it would be more satisfactory to know that the milk was guaranteed tuberculefree, and this could only be done by ascertaining that the cows are free from disease. 22 I may take this opportunity of giving a word of warning against the habit that is becoming so popular of obtaining milk " from one cow," or, as it is sometimes called, " nursery milk," for the use of infants. Although this milk may frequently be of the best, yet it too often happens that it is obtained from one special cow, which is confined in a shed in a populous neighbourhood, under conditions which preeminently favour tuberculosis, and is usually fed on dry food, and deprived of the fresh air and pasturage enjoyed by cows in the country. 23 PUBLIC INSTITUTIONS. WEST HAM UNION WORKHOUSE AND SCHOOLS. Births.—During the year there were 117 births. Deaths.—There were 468 deaths, viz., Males 276, Females 192. The following were the chief causes of death: — Under 5 Years. 5 Years and over. Total. Typhoid Fever 0 11 11 Erysipelas 0 1 1 Measles 15 2 17 Whooping Cough 6 0 6 Diarrhoea 6 6 12 Phthisis 0 52 52 Diseases of the Respiratory Organs 8 70 78 Heart Disease 1 57 58 Premature Birth 1 0 1 Influenza 0 1 1 Cancer 0 39 39 Violence 0 3 3 All other Diseases 45 144 189 Totals 82 386 468 One of these deaths was registered by the Coroner's Notification. AGES AT WHICH DEATH OCCURRED. Under one year 39 One year and under five years 43 Five year „ 15 „ 8 15 „ „ 25 „ 14 25 „ „ 65 „ 213 65 „ and over 151 Total 468 24 Infectious Disease. The following cases were notified: — Scarlet Fever 10 Of these 28 were imported from outside this District. Diphtheria 3 Typhoid Fever 52 Simple Continued Fever 2 Of which 3 were imported. Erysipelas 9 Total 76 Of which 31 were imported. BETHNAL GREEN SCHOOLS. There has again been a marked freedom from infectious disease in these Schools, only one case of Scarlet Fever and three of Diphtheria being notified. No deaths occurred during the year. ST. AGNES' ORPHANAGE. No cases of notifiable infectious disease have occurred. Only one death took place during the year. The general health of the inmates has been very satisfactory. MASTER BAKERS' ALMSHOUSES. Four deaths took place, all being inmates of advanced age. 25 SANITARY WORK. The following is the Report of the Sanitary Inspector: — Houses inspected 3209 Connections of drains tested 2701 Notices served 2235 Complaints received 486 Defective drains remedied 749 W.C.'s in defective state, new traps and straight-backed pans provided where necessary 1196 Sink and bath wastes and rain pipes made to discharge in open air over trapped gullies 671 Defective gullies replaced, and defective connections of gullies remedied 435 New sink waste pipes provided 66 New salt-glazed stoneware sinks provided 62 Rath, waste, and lavatory sink pipes trapped immediately under arrangement 69 Pan closets with iron containers and leaden D traps replaced by approved arrangement 19 Ventilating shafts provided to soil pipes and drains 441 Defective soil pipes remedied 88 Flush cisterns supplied to w.c.'s with efficient flush pipes 86 Flush cisterns repaired 240 Yards paved around back additions of houses 315 Floors of sculleries paved 26 Stagnant water under dwellings remedied 15 Houses with defective roofs, and general insanitary, dilapidated, or filthy conditions, repaired, and cleansed 216 Walls of back addition properly rendered 10 26 Houses entirely re-drained with intercepting syphons and manholes, provided between the house drains and sewer, with efficient air inlets and outlets 58 Houses without water supplied by the East London service, and water supplies to houses restored 73 Domestic water cisterns, repaired and cleansed, and covers provided 74 Nuisances by overcrowding 5 Nuisances caused by fish offal, manure, and other refuse deposits 73 Animals kept in an insanitary state 26 Houses disinfected, walls stripped, lime-whited, etc. 353 Cesspools closed 3 Wells closed 1 Nuisance with caravans, squatters, etc. 2 Smoke nuisances abated 5 Offensive trades 1 COWSHEDS AND DAIRIES ACT. The number of cowsheds in the parish is 18; they have been periodically examined. Theie have been four new applications to sell milk, which, after examining the premises, weie registered. SLAUGHTER-HOUSES. The slaughter-houses throughout the District have been inspected, and are in a fairly satisfactory condition. Two prosecutions have taken place during the year, for killing on unlicensed premises, and the defendants were fined 40s. and costs in the one case, and 20s. and costs in the other. The average number of animals slaughtered weekly in the District is 276. 1 wish again to draw the attention of your Council to the advantages to be obtained by the institution of Public Slaughter-houses,, from the public health point of view. 27 BAKEHOUSES. The whole of the Bakehouses in the District have been visited, and notices have been served where necessary, and they are now in a good sanitary condition. PETROLEUM LICENSES. Seven licenses have been renewed. WATER SUPPLY. We have again been visited by a severe and serious Water Famine. The long-continued summer drought following on an exceptionally dry spring resulted in the gradual depletion of the Reservoirs of the East London Watenvorks Company, and the almost total failure of the supply of water to the East End of London. Although during this time there was a vast amount of inconvenience caused throughout the District, yet among the poorer classes the limited supply does not appear to have given rise to such extreme distress as was the case in other parts of East London. A large amount of work was done by your Sanitary Staff on this occasion. The houses in the poorer districts were visited, some 1,150 houses being inspected. It was noteworthy that amongst the houses inspected only 160 had no provision for the storage of water, and these were supplied with jars from the Town Hall. The districts comprising the Oakdale, Pearcroft, and Ashville Roads were found, on September 9th, to be without water, and the storage cisterns were found to be empty, pointing to the fact that the supplymust have been cut off some considerable time before that date. The Water Company was, thereupon, communicated with, and a supply was promptly provided. Complaints were received from the Trumpington Road and Harrow Green Board Schools and the National Schools, and a constant service was provided by the Water Company after the facts had been represented to them. 28 Very few complaints were received from Ratepayers as to the scarcity of water, and no nuisance was directly traceable to this scarcity. Special attention was paid to the Bakehouses at this time, and, with two exceptions, the means of storage of water was found to be satisfactory. VENTILATION OF SEWERS. There have been 12 ventilating shafts erected during the past year. 29 TREATMENT OF SEWAGE. The question of better treatment of Sewage has, during the past year, attracted considerable attention throughout the country, and it has been my privilege to accompany some of your Members and officials to various places to see different schemes in working order. Without entering into any detailed Report on these schemes, I may here mention the two methods which appear to me to produce the most satisfactory results. They are— 1st. The Septic Tank Process, or the Exeter process. 2nd. The Dibdin Process, or the Sutton Process. In both processes bacterial agency is the important factor. These microbes act on crude sewage, so that some liquify the solid organic matter, and others act on it when liquified. Both these classe-. of microbes exist in ordinary sewage, and whilst some act to advantage when exposed freely to atmospheric oxygen, others do their work when the atmospheric oxygen is rigidly excluded. On these latter facts depends the working of the two processes I have mentioned. At Exeter the sewage is allowed to fall into a sealed tank, where the atmospheric oxygen is excluded, whilst in the Sutton process the sewage is conducted through carefully prepared filter beds, where the air is freely admitted. In comparing the respective merits of these two interesting processes, I may say that as a great deal depends on the local conditions, such as the available fall of the sewage, and the nature of the soil, it would be unfair to decide which was the better process unless a particular locality was specifier!. In the septic-tank process there is no sludge—an important point from a financial aspect—the residue being merely a black sediment of very slow formation. Both processes are remarkable for their simplicity and economical working, and after initial construction, the cost of which is much less than that of constructing Precipitation Works such as we have at Leyton, the working expenses are extremely small. 30 In conclusion, I may say that the health of the District continues to be fairly satisfactory. The special point to be noted is the diminution of the amount of infectious disease that has occurred, especially as regards Scarlet Fever. And I think we may consider that the boon conferred on our district by the increased accommodation afforded by our Fever Hospital has been in no small way responsible for this result. I hope that the points I have mentioned concerning Tuberculosis may have the best attention of your Council in order that this District may be among the first to take measures to prevent the spread of this disease. I am, Gentlemen, Your obedient servant, A. F. PESKETT, Medical Officer of Health. March, 1899. E. R. Alexander & Sons, Printers, The ERA Press, Leyton.