LEY 5 Senton Urban District Council ANNUAL HEALTH REPORT FOR 1903, BY A. F. PESKETT, Medical Officer of Health. Senton: Bhelp bros., printers, high road. Leyton Urban District Council. ANNUAL HEALTH REPORT FOR 1903, by A. F. PESKETT, Medical Officer of Health. Gentlemen, I beg to present to you my Annual Report for 1903. Again I have much pleasure in having to report a very healthy year, unusually so in fact, owing to the almost entire absence of Small Pox with which this district was scourged in 1902. I ascribe this favourable state of affairs as almost entirely due to the abnormal rainfall. For some little time now I have pointed out the urgent necessity for a lavish watering of our roads, in order to minimise the baneful effects of pollution through dust, whereby infectious and other diseases are encouraged. Particularly has this been the case with the milk supply during the hottest months in the past, but in 1903 the Clerk of the Weather came to our assistance in this very important particular, and the infantile mortality of 1901.2 has been still further reduced ; especially in regard to diarrhoea, from which 35 infants under 5 years died in 1901, 45 in 1902, and 35 in 1903. In 1902 the total deaths numbered 1183, 60 less than in 1901, while last year there was a further reduction to 1112 of 71 deaths. And this, be it borne in mind, while our total population is all the while increasing. A comparison of the quarterly death.rates is as follows:— First. Second. Third. Fourth. Ley ton, 1902 14.06 11.5 11 10.5 Ley ton, 1903 12.3 11.1 9.7 10.4 London, 1903 17.5 14.7 14 16.4 It is well at this juncture to note that the rainfall tor the year was 34.3 inches, and that the unhealthiest quarter of the year was the finest, from a weather point of view. 4 Nor does our death.rate compare at all unfavourably with that of other urban districts; Tottenham being 10.7 and that of Walthamstow 11. On the whole the temperature was fairly even, rather below the average than usual, except in February and March, when we were visited with several days worthy of a true summer. POPULATION. I estimate the population at 102000. Further notes will be found in the usual place under the heading "Births." 1019 houses have been erected during the year, and certified fit for habitation. BOARD SCHOOLS. The following are the returns of the number of children attending the various Board Schools:— Cann Hall Ward. Boys. Girls. Infants. Total. Cobbold Road Schools mixed 319 Cann Hall Road „ 634 616 523 1773 Downsell Road „ 454 475 599 1428 Trumpington Road „ 394 395 365 1154 Harrow Green Ward. Harrow Green Schools 335 292 321 948 Goodall Road „ 514 511 562 1587 Mayville Road „ 445 449 455 1349 Davies Lane „ 322 309 294 925 Leytonstone Ward. Kirkdale Road Schools 479 463 310 1252 Connaught Road „ mixed 176 Leyton Ward. Church Road Schools 323 321 363 1037 Lea Bridge Road „ mixed 200 Newport Road „ 747 705 607 2059 Ruckholt „ 432 434 356 1222 Capworth Street „ 614 620 566 1800 Farmer Road „ 599 627 595 1751 Sybourn Street „ mixed 92 19042 St. Joseph's Roman Catholic School, Vicarage Road 142 19184 5 Total attending Schools:— In 1899 16133 „ 1900 15246 „ 1901 17674 „ 1902 18175 „ 1903 19184 BIRTHS. During the year 8273 births were registered, that is 121 more than in 1902, and 270 more than the average for the past five years. Of the 3273, 1616 were males and 1657 females. The birth.rate is 32.08, compared with 81.52 in 1902 and 29 63 in 1901. That for England and Wales is 28.4; for Rural England and Wales, 27.8; in 76 great towns, 29.7; and 103 smaller towns, 27.4. In the Union Workhouse 150 births occurred. Table I.— Births for the last 5 years. Males. Females. . 1899 1458 1240 2698 1900 1469 1463 2932 1901 1521 1442 2963 1902 1682 1470 8152 1903 1616 1657 3273 7746 7272 15018 Average for the past five years, 3003. There is nothing particular for me to comment upon under this heading. DEATHS. The total number of deaths was 1976, 992 males and 984 females, or 53 less than last year. Table II.—Deaths for the last 5 years. 1899 1775, of which 1262 belong to the District proper 1900 1867 „ 1179 „ „ „ 1901 2016 „ 1243 „ „ „ 1902 2029 „ 1183 „ „ „ 1903 1976 „ 1112 „ „ „ Excess of births over deaths is 1254, and the average increase for the past five years is 1099, the total increase for the same period being 5496. 6 Table III.— Distribution of Deaths. Master Bakers' Almshouses 2 St. Agnes Orphanage 0 Bethnal Green Schools 1 Union Workhouse and Schools 826 Violence 35 Forest House 0 District, exclusive of above 1112 1976 Estimating the population at 102000, the death.rate for the District is 10.9 per 1000, against 11.8 in 1902, 12.4 in 1901, and ll.8 in 1900. The average death.rate for the past five years is 12.08. The average death.rate for the past ten years is 12.2. The London death.rate is 15.7. The London Zymotic death.rate is 1.7. The District Zymotic death.rate is 1.6. This year's is the lowest death.rate we have had for the past twenty years. By way of comparison the following table is inserted:— Vital Statistics fop England and Wales. Deaths from all Causes. Deaths from Seven Chief Zymotic Diseases. England and Wales 15.4 1.46 Rural England and Wales 14.8 1.08 76 Great Towns 16.3 1.89 103 Smaller Towns 14.6 4.41 Table V.— Deaths Classified with Regard to Sex. Males 992 or 50.2 per cent.of the total deaths. Females 984 „ 49.8 Table IV.— Death.Rate for Each Quarter. First. Second. Third. Fourth. Leyton 12.3 11.1 9.7 10.4 London 17.5 14.7 14 16.4 7 Table VI.— Ages at which Death occurred. Under 1 year 322 1 year and under 5 years 159 5 years „ 15 „ 49 15 years „ 25 30 25 years „ 65 „ 318 65 years and over 234 1112 Table VII.— Death-rate per cent. of Total Deaths Under 1 year 322 28.9 43.2 1 year and under 5 years 159 14.3 5 years „ 65 „ 397 35.7 56.7 65 years and over 234 21.0 The infant mortality i.e., deaths under 1 year, is 322, or 9.8 per cent. of the total number of births, against 10 65 per cent. last year. INFANTILE MORTALITY. Per 1,000 births, the deaths of infants under 1 year of age in England and Wales was 132, in Rural England and Wales 118, in 76 great towns 144, and in 103 smaller towns 135. In our District, for every 1,000 births the deaths of infants under 1 year of age is 99. NOTES ON MILK AND ITS DANGERS. The Committee appointed on November 12th, 1902, to consider the best means to decrease the excessive infantile mortality in those parts of Essex bordering on the metropolis met on December 11th, 1902, and January 22nd, 1903, and on February 27th visited the milk sterilizing depot of the Battersea Town Council and saw the whole process of preparing the milk for infantile consumption and the way in which it is distributed, together with the general management of the depot. After this visit the Committee again met, and were quite agreed that this county ought not to be any longer without similar provision. A doubt arose as to whether District Councils had any power to spend money in providing such depots or in distributing sterilized milk. County Boroughs were known to have done it, and after some discussion the Committee came to the conclusion that the County Borough of West Ham might with advantage establish such a depot but that other District Councils would do better to adopt one of the following alternatives:— 8 1. That local purveyors should be asked to undertake to provide the specially.prepared milk and supply it as at Battersea, the manufacture being supervised by an Officer of the District Council concerned. 2. That local associations having a philanthropic basis should be asked to undertake the manufacture and distribution, under similar supervision. 3. That, if West Ham should establish a depot, arrangements might be made, at least for a time, for a certain quantity of the milk to be provided for adjoining districts. There is no doubt that the milk could be more economically prepared at one large central station than at several smaller ones, but the cost of distribution would be greatly enhanced. Estimates which have been furnished to Dr. Thresh show that a small depot could be established, and provided with the necessary sterilizing apparatus, bottles, baskets, etc., for about £200; and in this case there would be no expense for distribution. A large central station, capable of supplying milk to several branches, might cost £500 for apparatus, etc. ; but besides this. horses and vans would be required for distributing. Probably, therefore, small local depots would be more economical. If in each district a milk purveyor of known standing could be prevailed upon to provide the necessary apparatus, and undertake to prepare the milk under the supervision of the Medical Officer of Health, it seems probable that he would ultimately find it remunerative. Many institutions might be glad to arrange for daily supplies, and medical men would largely recommend a milk having this official guarantee. It is most essential that something should be done, and that as soon as possible, if for no other reason, because no article of diet is so intimately connected with health as milk. It stands alone among the great staple foodstuffs in three respects:—(1) It is consumed by all from the youngest to the oldest; (2) It is the principal, and often the only, form of nourishment taken by the very young and the sick ; (3) It is the only food of first.rate importance that is habitually consumed uncooked. These facts place it in a unique position, and fully explain the increasing attention directed to it by the advance of knowledge, and particularly by the comparatively recent science of bacteriology. From experiments made in St. Petersburg some remarkable results have been obtained. "Farmhouse milk" was found to contain, roughly, from half a million to ten million bacteria, "creamery milk" from four million to eleven hundred million, and "milk delivered at house" from ten to eighty.two million bacteria 9 per cubic centimetre. Similar results have been obtained elsewhere, and in London some milk from "good class shops" examined last May contained nearly five million bacteria. It is obvious from these figures, which the mind fails to grasp, that mere numbers cannot be of very much practical importance; but they are evidence of pollution which may or may not be harmful. Milk, as secreted in a healthy cow, is a perfectly sterile fluid, and with sufficient precautions it can be obtained from the animal and kept in a sterile condition. But in actual life it never is. The enormous number of organisms commonly present is due to the many channels by which they gain access, and to their rapid multiplication in the fluid. They enter at the time of milking, during treatment and preparation. during transit, and after delivery. Many, indeed, are the pitfalls by the way, and the state of the milk described is not surprising when the circumstances are considered. In the first place, disease of the udder, and notably tuberculosis, may be the source of pathogenic bacteria in the milk ; then the orifice of the ducts is open to the air and the fluid remaining in them after milking constitutes a first.rate hotbed for micro.organisms, so that the "fore milk," or that first drawn, always contains some and often an enormous number. If these dangers are escaped. the dust and dirt from the animal's coat, from the air of the byre, and from the hands of the milker are all prolific sources of contamination. Then there are the vessels in which it is drawn and which, as I have always pointed out, are, under the prevailing system of milk delivery, viz.: the leaving of cans on the doorstep, peculiarly susceptible to dust contamination in hot, dry weather. In preparation, again, similar dangers arise from the air of the dairy and the utensils used. Transit is very important. The milk travels in churns, which are probably never clean and are often very dirty, and the great distances covered allow ample time for the growth and multiplication of organisms. The average distance from which the seven great railways bring milk to London is two hundred miles, and some of it travels over four hundred miles. It reaches the customer, at the earliest, twelve or fourteen hours after milking, which is sometimes extended to twenty.four or thirty.six hours. Finally, the chances of pollution in the shop and after delivery from added water, dust, and dirty jugs are, perhaps, the greatest of all. A recent estimate, based on the study of six hundred and thirty outbreaks, attributes 17 per cent. of the typhoid epidemics to polluted milk. The infective material is most commonly derived from polluted water, which may be used to wash out the vessels or to dilute the milk. Numerous cases are on record in which this connection has been proved. Other probable channels of infection are dust conveyed by the clothes and hands of persons in attendance on some one suffering from the disease, or possibly by flies. Too much care cannot be expended by all, especially where there are infants, in attaining a spotless cleanliness wherever milk is concerned, 10 Table. VIII.— Chief Causes of Death. Under 5 years. 5 years and over. . Small Pox 0 0 0 Scarlet Fever 6 7 13 Diphtheria 18 9 27 Membranous Croup 0 0 0 Croup 4 0 4 Premature Births 74 0 74 Influenza 3 8 11 Typhoid Fever 0 10 10 Puerperal Fever 0 3 3 Erysipelas 1 2 3 Measles 85 2 37 Whooping Cough 38 2 40 Diarrhoea 35 1 36 Rheumatic Fever 0 2 2 Phthisis 1 98 99 Diseases of the Respiratory Organs 81 72 153 Heart Disease 4 98 102 Cancer 0 55 55 Tubercular Diseases other than Phthisis 27 12 39 All other Diseases 164 240 404 491 621 1112 Table IX.- Number of Death and Death-rate per 1000 of Population from Certain Causes. Phthisis and Tubercular Diseases. Respiratory Diseases. Heart Disease. Violence. Premature Birth. Diarrhœa. Number of Deaths 138 153 102 35 74 36 Death Rate per 1000 1.8 1.5 1 .3 .7 .3 Deaths in 1902 120 211 104 29 45 125 11 Table X.— INFECTIOUS DISEASES (NOTIFICATION) ACT, 1890. The following Table shows the number of cases of Infectious Diseases notified during the year:— Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Total. Small Pox 0 0 0 1 1 0 1 0 0 0 0 0 3 Scarlet Fever 27 44 38 36 19 29 27 30 36 39 30 42 397 Diphtheria 26 19 12 8 16 21 9 12 19 19 11 13 185 Membranous Croup 0 0 0 0 0 1 0 0 0 0 0 0 1 Typhoid Fever 8 4 5 0 2 2 3 2 9 5 12 2 54 Simple Continued Fever 0 0 0 0 0 0 1 0 0 0 1 0 2 Relapsing Fever 0 0 0 0 0 0 0 0 0 0 0 0 0 Puerperal Fever 0 1 0 0 0 0 0 1 2 0 0 0 4 Erysipelas 13 4 6 7 8 4 9 6 5 12 8 6 88 Cholera 0 0 0 0 0 0 0 0 0 0 0 0 0 74 72 61 52 46 57 50 51 71 75 62 63 734 12 Table XI.— Number of Cases of Infectious Diseases as they occurred in the Four Chief Wards of the District. Leyton. Leyton stone. Barrow Green. Cann Hall. Total. Small Pox 8 0 0 0 3 Scarlet Fever 147 84 78 88 397 Diphtheria 57 40 49 89 185 Typhoid 85 8 6 5 54 Erysipelas 48 10 18 17 88 Membranous Croup 1 0 0 0 1 Puerperal Fever 5 2 2 8 12 291 144 153 152 740 Percentage of Cases 40.9 19.4 18.0 22.5 „ in 1902 42.8 25.4 14.8 17.4 „ in 1901 47.1 21.0 11.5 20.3 The reason I give for the Leyton Ward percentage being so much higher than the other Wards is because of the greater number of Board Schools in the Ward, and the resultant larger infantile population. 13 Table XII.— Deaths per cent, of Deaths notified (exclusive of Public Institutions). Cases. Deaths. Percentage Mortality. 1902 1903 1902 1903 1902 1903 Scarlet Fever 393 397 7 13 1.78 3.2 Diphtheria 236 185 35 27 14.83 146 Typhoid 110 54 16 10 14.54 18.5 Simple Continued Fever 2 2 0 0 0.0 0.0 Puerperal Fever 1 4 1 3 100.00 75.00 Erysipelas 74 88 2 3 2.7 8.4 Membranous Croup 1 1 1 0 100.00 0.0 Small Pox 86 3 2 0 1.16 0.0 14 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. 1899 1900 1901 1902 1903 Small Pox - - - 2 — Measles 23 13 31 15 37 Scarlet Fever 4 7 13 7 13 Diphtheria 31 27 36 36 27 Membranous Croup Whooping Cough 34 47 45 59 40 Typhus — — — — — Typhoid 8 14 14 16 10 Diarrhœa 169 113 125 48 36 Total 269 221 264 183 163 Deaths from all other Diseases 993 958 979 1000 949 Death-rate from Seven Chief Zymotic Diseases 2.9 2.21 2.64 1.88 1.5 Death-rate from all other Diseases 10.6 9.5 9.7 10.0 9.8 General Death-rate 13.5 11.8 12.34 11.8 10.8 Of the 163 deaths from Zymotic Diseases, 113, or 69.3 per cent., were due to the non-notifiable Diseases, Measles, Whooping Cough, and Diarrhoea. 15 SCARLET FEVER. Four more cases than last year have been reported, 397 against 393; but there has been an appreciable increase in the mortality, as 13 cases had a fatal termination, against 3 last year. This is very largely due to the fact that the type of disease was unquestionably severer than it was in 1902, and more like that which prevailed in 1901, with which year this year's figures almost precisely coincide. Table XIV.—Notified Cases of Scarlet Fever during the past Five Years, with the Percentage Mortality. Cases Notified. Number of Deaths Percentage Mortality. 1899 315 4 1.3 1900 243 7 2.8 1901 396 13 3.29 1902 393 3 .76 1903 397 13 3.27 Of these 397, 147 or 37 per cent. occurred in the Leyton Ward, 84 or 21.1 per cent. in the Leytonstone, 78 or 19.6 in the Harrow Green and 88 or 22.1 per cent. in the Cann Hall Ward. DIPHTHERIA. The number of cases notified is 185, and the deaths 27 or 14.6 per cent. This compares favourably with last year's figures. then the rate of mortality was 14.8, the very slight decease being quite in keeping with the general improvement in regard to the other ailments. In January, when most cases, 26, occurred, the disease was of a very serious character, and one of the deaths was due to Paralysis after Diphtheria. In the following month though there was a decrease, to 19, in the number of cases, two were fatal, one, that of a child, owing to exhaustion following Tracheotomy on admission, and the other due to heart failure after a severe attack of the disease. Then the fatal case in hospital, of the 12 cases in March, was also due to heart failure in a boy of 4½ years of age. Most of the 27 deaths were therefore as much due to the sequelae of the disease as to its malignancy. TEMPORARY ISOLATION HOSPITAL. The following tables give the details of numbers of patients that have been under treatment during 1903:— 16 Scarlet Fever. Under Treatment at beginning of year 85 Admitted 206 Discharged 200 Died 10 Under Treatment at end of the year 31 Diphtheria. Under Treatment at beginning of year 11 Admitted 48 Discharged 44 Died 8 Under Treatment at end of the year 7 SCARLET FEVER. Number of cases notified. Number of cases treated in Hospital. Percentage of cases treated in Hospital. Number of beds available. Mortality per cent. of cases notified. Mortality per cent. of cases treated in Hospital. 1899 315 133 42.2 40 1.3 2.2 1900 243 142 58.4 40 1.8 2.1 1901 896 158 39.8 40 3.2 1.9 1902 393 176 44.7 40 .76 1.7 1903 397 206 51.8 40 8.27 4.8 DIPHTHERIA. 1899 200 62 31.0 10 15.0 24.1 1900 201 63 31.3 10 11.9 15.8 1901 255 101 25.1 10 14.1 18.8 1902 236 71 30. 10 14.8 28.1 1903 185 48 25.9 10 14.6 16.6 I am glad to be able to notice the increase in number of cases of Scarlet Fever treated in hospital. Whereas last year 176 of the 393 cases notified were brought to hospital, this year 30 more cases were brought to hospital, although the increase in the number of cases notified was only four. It is well, therefore, that we were able to accommodate more patients, though there is still room for improvement in this matter. It is regrettable that there is not the same improvement to report in regard to diphtheria cases brought to hospital, but as accommodation has been limited and further decreased by desultory outbreaks of Measles, Chicken Pox, etc., necessitating closing and quarantining of wards, there is good ground for the decrease in admissions to hospital. 17 PERMANENT ISOLATION HOSPITAL SITE. Throughout the year the present Hospital having been inadequate to deal with all the cases of Scarlet Fever and Diphtheria that had to be removed, I had to draw attention, in several of my Monthly Reports, to this most important matter, hoping to get an early reply from the Local Government Board. On March 10th the latter wrote, leaving the Council to weigh any objections which they might consider to attach to the suggested advantages of the alternative sites proposed, and to decide with due regard for all the circumstances which of the sites it would be most expedient to acquire for the Hospital. The same letter conveyed the intimation that if the Council decided upon the Oliver Road Site the Local Government Board would not decline to sanction the loan applied for, subject to the site not being used for Small Pox Hospital. To this the Council made the following resolutions and amendments : — "Moved by Councillor Trumble and seconded by Councillor "Chew. That the Council, having given due consideration to 'the letter of the Local Government Board of the 10th March, "1903 (24,275 M. 1903), in reference to site for an Isolation "Hospital, is of opinion that the Oliver Road Site, as proposed "by the Council, should be utilised for the purpose, and "request the Local Government Board to issue Sanction for "Loan, the Council undertaking that it will not erect a Small"pox Hospital thereon, or within a quarter of a mile of the site, "and further, that the Surveyor be instructed to prepare the "necessary specification and estimate for fencing and planting "a belt of trees, etc., on site. "Amendment: Mover—Councillor Alexander. Seconder— "Councillor Bond. That the letter of the Local Government "Board be referred to a Special Committee for consideration "and report. "Amendment put to the vote and declared lost." A debate thereupon ensuing, and the hour of 10.30 having arrived, it was resolved that the Standing Orders be suspended, for the purpose of enabling the Motion now before the Council to be disposed of and for completing the other business on the Agenda. The debate thereupon proceeded, and the motion was put to the vote. Then followed the amendment: Mover —Councillor Alexander. Seconder—Councillor Cox. That the letter of the Local Government Board be referred to the Public Health Committee for consideration and report. 18 This amendment was put to the vote and declared lost, after which the motion, viz., "That the Council, having given due consideration to the letter of the Local Government Board of the 10th March, 1903 ('24,275 M.. 1903), in reference to site for an Isolation Hospital, is of opinion that the Oliver Road Site, as proposed by the Council, should be utilised for the purpose, and request the Local Government Board to issue Sanction for Loan, the Council undertaking that it will not erect a Small Pox Hospital thereon, or within a quarter of a mile of the site, and further that the Surveyor be instructed to prepare the necessary specification and estimate for fencing and planting a belt of trees, etc., on site," was again put to the vote, and, the Council having divided, 17 voted for and 4 against the motion, which was thereupon declared carried. On April 27th the Local Government Board forwarded sanction to the borrowing of £3625 for 50 years by the Council to defray cost of the Oliver Road Site, which sanction was followed by a letter from the Local Government Board, 4th May, 1903, intimating that, in view of representations made to the President, the Board had instructed one of their Inspectors to attend the next Meeting of the Council in reference to the suggestions set out in the latter part of the Board's letter of the 10th March last, and requesting that in the meantime the District Council take no action in respect of the Sanction, upon which it was resolved by the Council that a Special Meeting of the Council in General Purposes Committee be held on Wednesday, the 20th instant, at 7.30 o'clock p.m., to meet the Inspector to be appointed for this purpose by the Local Government Board. This Meeting was duly held, and for a full report of the statement of the Hospital Sites Committee, in reply to Dr. E. Petronell Manby's observations at the General Purposes Committee Meeting, I must refer to pages 134 to 139 of the Minutes of Council and Reports for June, presented at the Monthly Meeting of the Council on July 7th, as the proceedings are too voluminous for reproduction here. The next stage of the matter was a letter from the Local Government Board, 24th June, 1903, intimating that the Board had decided to leave with the Council the responsibility for erecting an Infectious Diseases Hospital on the Oliver Road Site, and for carrying on their Sewage Farm and Refuse Destructor, so as to prevent any nuisance arising therefrom to the detriment of the proposed Hospital or its occupants, and that the Council might now proceed on the sanction to the borrowing of the sum of £3,625, which accompanied the Board's letter of the 27th April. Following which, after an interval, came the decision of the Committee to appoint a Sub-Committee to visit two or three towns where hospitals have recently been erected, in order to obtain information as to accommodation, designs, etc. 19 Meanwhile tenders for fencing in and planting the site with trees had been asked for, and were received and considered in Council on October 6th, 1903, that of Mr. White for fencing (£403 12s. 3d.), and planting trees Mr. J. Russell (£60 8s. 6d.) being accepted. An application was made to the Local Government Board for sanction to loan for fencing and planting trees on October 15th, and sanction for same received on November 3rd. The fencing and planting of 740 trees was completed in January, 1904. PUBLIC INSTITUTIONS. WEST HAM UNION WORKHOUSE AND SCHOOLS. Births:—There were 150 births—83 males and 67 females—a total 22 more than last year. Deaths:—There were 719 deaths. Chief Causes of Death. Total. Scarlet Fever 2 Measles — Typhoid 11 Erysipelas 2 Rheumatism 2 Diarrhœa 33 Phthisis 128 Tubercular Diseases other than Phthisis 9 Respiratory (Diseases of Organs) 77 Heart Disease 104 Premature Birth 2 Influenza 1 Whooping Cough 1 Cancer 57 Violence 12 Diphtheria — Puerperal Fever — All other 278 Total 719 Cases of Infectious Disease occurring in the Union. Scarlet Fever 31 cases, of which 3 were imported. Diphtheria 2 ,, 1 „ Typhoid 100 „ 56 „ Erysipelas 48 „ 18 „ Puerperal Fever 2 „ 1 „ 20 BETHNAL GREEN SCHOOLS. There is nothing to report beyond the very satisfactory fact that the children were in 1903 a remarkably healthy lot. THE INFIRMARY, WHIPPS CROSS ROAD. This year the Infirmary, in which the Medical Superintendent is Dr. E. Vallance, commenced taking in patients on July 1st, and from that date to the end of the year there were— 2051 Admissions. 1140 Discharged. 274 Deaths. There are in the Infirmary 672 beds, all of which, except 40, being occupied. There are also 56 beds for male phthisis and 24 for female phthisis patients, and the former have always been full. The staff consists of 90 nurses and a hundred other officials, while no pauper help is allowed in the establishment. I am very pleased to be able to note that phthisis is receiving special treatment, the accommodation for patients being of an exceptionally up-to-date kind. There is one point I desire to emphasise while dealing with this most up-to-date institution, and that is the immediate need for an isolation block. There is at present no place in which to isolate infectious cases, such as scarlet fever, diphtheria and similarly infectious diseases. It is most surprising, considering the area of the site, that no provisions were specially made for the treatment of such cases. DISINFECTION—STEAM DISINFECTOR. In addition to the bedding from infected houses, several lots of bedding have been disinfected from houses where deaths have occurred from Phthisis, Dropsy and Cancer, also several public and private schools, public conveyances such as cabs that have been inadvertently used to remove cases to public Hospitals, which have afterwards proved to be infectious cases. The STEAM DISINFECTOR has been in use now for some years and is still working in a most satisfactory manner. I am still of opinion it is the best in the market. ARMY BLANKETS. Army blankets that had been exposed to infection from Typhoid in South Africa found their way to the Home of the Good Shepherd, Leytonstone. Not a very large quantity, but some twenty-five of them. They were removed, disinfected, and afterwards returned by the Home authorities to the dealers. 21 SMALL POX. Three cases were notified during the year in the Leyton Ward. On April 18th the sufferer was a man employed by one of the London daily papers, and whose duty had been the taking of a religious census in the Hackney District and in visiting newsagents all over London. The second case was that of his father-in-law, residing in the same house. The third case was notified on July 12th, and was that of a female, aged 28. In her case no trace could be obtained of source of infection. She had not visited anybody or been visited by anybody for some time previous. She was living with her husband and five children, but owing to the prompt measures taken and the revaccination of the family the disease did not spread. FACTORY AND WORKSHOP ACT, 1901. The above Act, which came into operation in 1902—3, has placed increased duties upon the Council. In case of Factories it specially places the duty of enforcing the provisions, as regards the providing of proper means of escape in case of fire on the Council, who have instructed their Surveyor to carry out this portion of the Act; and, under the provision of Section 22 of the Public Health Amendment Act, 1890, the Council have power to enforce the provision of suitable and sufficient sanitary conveniences and separate accommodation for the sexes. WORKSHOPS AND WORKPLACES. The portion of the Act referring to the above is dealt with by the Public Health Department. The number of Workshops on our Register is 97. The above premises, also the homes of 143 Outworkers, have been visited during the year and inspected as to their sanitary condition, special attention being given to the cleanliness of the workrooms, the prevention of overcrowding and the condition of the sanitary arrangements. In 31 cases overcrowding and filthy conditions were found to exist, and in 33 instances sanitary defects found. Notices have been served on the owners or occupiers and the nuisances abated. 22 I consider that this Act is one which confers great benefits on the workers and the community at large. The conditions under which the work is done are improved, and, in cases of infectious disease, immediately on receipt of a notification, the Register is referred to, and in many instances it has been found that work was being done at the houses ; the material has in every case been removed and disinfected at the Council's Disinfector, and the owners of the work notified of the occurrence. The Public Health Authorities of the district in which the latter resided, or had business premises, were also informed. The principal work carried out in our district under these conditions are Blouse-making, Dressmaking, Tie-making, Mantlemaking. Tailoring, and the various branches of Underclothing, etc. BAKEHOUSES. The portion of the Act which relates to Underground Bakehouses has been dealt with by the Council, and 8 of these have been closed as unfit for the purpose and 4 new Bakehouses have been erected. The remainder were capable of such alteration which, on completion of same, they were, in the opinion of the Committee, entitled to a Certificate from the Council, as required under the Act. There are also 33 retail and 2 wholesale bakehouses in the district. These have been visited and important improvements carried out. I am of opinion that the Bakehouses of this great district are in a satisfactory condition. PUBLIC HEALTH DEPARTMENT. During the year 104 vent shafts have been erected, and the sewers from Baker's Avenue Estate diverted into the Rosebank Road sewer, and the old sewer across the site of the Baker's Almshouses was stopped up. The following houses have been connected to the new low level sewer in the Lea Bridge Road which was completed in November 1902:—Nos. 1 to 8, Alpha Cottages; 1 and 2, Hope Villas; Meadow Lodge; Crofton Cottage; 1 to 3, Greyhound Terrace; the "Greyhound" public-house; the Lea Bridge Gas Company's house; Nos. 1 to 17, Nursery Cottages, and the Board Schools. A new 9-inch sewer has been put in Elm Park Road and all the houses in that road connected up. The sewer in Lonsdale Road was extended 77 yards in order to take the drainage of three houses erected at the farther end of the road. The sewer in Leyton Green Road was extended 100 yards towards Knott's Green to drain the Cedar Lawn Estate. Nos. 50-72, Oakdale Road were re-drained 23 at the Council's expense. The Council's specification for combined drainage was altered to allow 12 houses to drain into a 6-inch drain, doing away with the use of 9-inch combined drains and 9-inch syphon traps. The following Sanitary Work has been carried out under the supervision of the officers of the above department, and the following details are from the reports of the Chief Sanitary Inspector. Houses inspected 3434 Connections of drains tested 3386 Notices served 2410 Complaints received 531 Defective drains remedied 298 VV.C.'s in defective state, new traps and straight backed pans provided where necessary 680 Sink, bath and lavatory wastes, and rain pipes made to discharge in open air over trapped gullies 392 Defective gullies replaced, and defective connections of . gullies remedied 601 New sink and bath waste pipes provided and repaired 127 New salt-glazed stoneware sinks provided 52 Bath, waste and lavatory sink pipes trapped immediately under arrangement 56 Ventilating shafts repaired, also provided to soil pipes and drains 166 Defective soil pipes remedied 16 Flush cisterns supplied to w.c.'s with efficient flush pipes 83 Pan closets with iron containers and leaden D traps replaced by approved arrangement 10 Flush cisterns and flush pipes repaired 230 Yards paved around back additions of houses and forecourts paved 188 Yards cleansed 46 New manhole covers provided and sealed 41 Manholes rendered and repaired 11 24 Ventilation provided under flooring 13 Floors of sculleries paved and repaired 56 House roofs and guttering repaired and renewed 395 Houses in a general insanitary, dilapidated, or filthy condition, repaired and cleansed 815 Walls of back addition properly rendered 59 Plots of land in an insanitary condition 22 Nuisances abated arising from stagnant water in basements of houses 167 Cellar floors drained and concreted 22 Air inlets provided to drains and repaired 30 Stables paved and drained 4 Mews in filthy condition paved, drained and cleansed 13 Manure receptacles provided 8 Houses entirely redrained with intercepting syphons and . manholes provided between the house drains and sewer, and with efficient air inlets and outlets 95 Houses without water supplied by the East London service and water supplies to houses restored and improved, water fittings repaired 156 Domestic water cisterns repaired and cleansed 22 Covers to domestic water cisterns provided 695 Domestic water cisterns removed from improper positions 132 Nuisances by overcrowding 38 Nuisances caused by fish, offal, manure and other refuse deposits 66 Animals kept in an unsanitary state 41 Houses disinfected, walls stripped, limewashed, &c. 535 Books disinfected 68 Cesspool closed and emptied 1 Smoke nuisances abated 13 Pig nuisances abated 2 Offensive trades 2 25 COWSHEDS AND DAIRIES ACT. The number of cowsheds in the district are 11, two having been closed during the year. These have been periodically inspected during the year, and special attention has been given as to the cleanliness of the cowsheds, milking utensils, and the provision for prompt removal of manure and efficient receptacles for the same. There have been 7 applications for registration by milk dealers, and after inspection these were registered. Several cases occurred during the year where infectious disease had broken out in the homes of persons engaged in this business—the cowkeepers and dairymen were communicated with, and the men compelled to remain away from their employment until the risk of spreading the infection was over. I may here state that I have received every assistance from the employers in carrying out this Act. SLAUGHTER-HOUSES. The slaughter-houses of the district have been visited from time to time, and the cleansing of the walls and renewal of receptacles for offal have been insisted upon. The methods of slaughtering have been enquired to, and from time to time the organs have been examined before leaving the slaughter house. There are 19 slaughter houses in the District. Two licenses have been transferred during the year, 1 new one granted, and 2 slaughter houses closed. PETROLEUM LICENSES. Ten licenses have been renewed, 2 new ones granted, and 1 license transferred. UNSOUND FOOD. Since my last report 342 lbs. weight of fish and a large quantity of fruit consisting of tomatoes, apples, etc., and over 3000 eggs were found on inspection to be unfit for human consumption and destroyed. HOUSING OF THE WORKING CLASSES ACT. Seven houses were closed as unfit for habitation, 2 have since been repaired by their owners and are now occupied and the other 5 finally closed. DUST COLLECTION. 14347 loads of house refuse have been deposited at the works of the Destructor during the year, the work having again been satisfactorily carried out. 26 MEWS. I strongly recommend that all roadways at the rear of shops should be properly paved and drained before the premises are passed as fit for occupation. During the past years numerous complaints have been made by occupiers of adjacent houses owing to the insanitary state of these roadways. Many of these nuisances have been abated, but I am of opinion that the paving should always be done in the first instance by the owner, and not, as at present is the case, by the occupier under compulsion. In conclusion, little remains to be said. The health of the District is, generally speaking, good, these wet seasons not being without their advantages. But I cannot close without expressing my thanks to Mr. Miller and his able staff for the very prompt and most efficient manner in which they have invariably carried out the multifarious duties of the Sanitary Department. I am, Gentlemen, Your obedient servant, A. F. PESKETT, Medical Officer of Health. March, 1904.