Ley 006 Urban District Council. annual health report FOR 1904, BY A. F. PESKETT, Medical Officer of Health. Lenton: phelp bros., printers, high road. Leyton Urban District Gouneil. ANNUAL Health Report FOR 1904, by A. F. PESKETT, Medical Otllcer of Health. Gentlemen, I beg to present to you my Annual Report for 1904. I have much pleasure in reporting a fairly healthy year, as although numerically the deaths were greater than in 1903, this was largely due to the epidemic infantile diarrhoea. It is again a remarkable feature that disease is more rife in a dry season. For example, in 1903 over 35 inches of rain fell, and our death-rate was 10.9, while this year only 17 46 inches of rain fell, and our death-rate has risen to 13.1 per 1,000. Of course there has been a slight increase of population, not so much in the matter of births, which only exceed the deaths by 928 as against the 1,254 excess recorded in 1903, but by influx of residents from other parts, and the weather has more bearing upon the death-rate than the actual larger number of people in the district. Largely on account of the dry weather the infantile mortality increased, as the following brief table clearly shows:— Death of Infants under 5 years of age. 1901 35 19O2 45 1903 35 1904 180 4 Regarding this great increase I have something to say further on, so will leave the subject for the moment with the note that of these 180 no less than 130 died in August, which month fully maintained its evil reputation in this direction, As regards the rainfall and its effect upon infantile mortality this table is not without its noteworthy aspect. Rainfall. Children under 5 died. In June .66 0 In July 1.6 20 In August 1.4 130 In September 1.08 3 February with 2.32 inches was the wettest month. June with .66 the driest. On the whole the temperature was fairly high and dry throughout the year, except for some frost and fogs in November and December. POPULATION. The population is estimated to be 104,000. There has been a marked decrease from 1019 last year to 749 in 1904 in houses erected and certified fit for habitation. COUNCIL SCHOOLS. The following are the returns of the number of children on books attending the various Council Schools:— cann hall ward. Boys. Girls. Infants. Total. Cobbold Road Schools mixed 326 Cann Hall Road „ 650 647 445 1742 Trumpington Road „ 412 431 355 1198 central ward. Leyton High Road Schools mixed 297 Newport Road „ 565 641 533 1739 Norlington Road „ 376 275 291 942 grove green ward. Mayville Road Schools 464 490 459 1413 harrow green ward. Goodall Road Schools 533 519 520 1572 Harrow Green „ 336 289 283 908 Downsell Road „ 479 473 446 1398 leyton ward. Farmer Road Schools 552 515 397 1464 Ruckholt „ 391 415 350 1156 5 Leytonstone Ward. Kirkdale Road Schools 434 424 262 1120 Davies Lane „ 391 346 378 1115 Lea Bridge Ward. Capworth Street Schools 578 573 571 1722 Church Road „ 345 340 350 1036 Lea Bridge Road „ mixed. 212 Sybourn Street „ mixed. 188 19548 St. Joseph's Roman Catholic School, Vicarage Road 200 19748 Total attending Schools:— In 1899 16133 ,,1900 15246 ,, 1901 17674 ,, 1902 18175 ,, 1903 19184 ,,1904 19748 Special notice is necessary on this occasion of the new regulations at these Schools, which are the work of the Educational Committee of the Leyton Urban District Council, which took over charge of the Schools on September 30, 1903. I am glad to be able to observe that they have entirely abolished the use by the scholars of slates throughout the Schools. For slates, paper and pencils have been substituted. The value of this regulation, from a health point of view, cannot be overrated. I feel certain much infection was carried about when slates were used, owing to the interchange of slates and sponges, as it was impossible to be sure of the same pupil using the same slate and sponge every day. Thus the slate used by a child in the early stages of measles, diphtheria or scarlet fever, etc, might be handled on the next occasion by a perfectly healthy child, and illness and misery thus transferred from one home to another. Under the new regulation the paper used is at once destroyed, and much risk of infection obviated. I would like the Educational Committee to go even a step further, and ordain that each pupil should have his or her own box of pens, pencils, rubber, and so forth, thus preventing the interchange of pencils or pens, the ends of which get chewed, perhaps, by an infected pupil, to be handed on to another perfectly healthy one. The giving of a box to each scholar would serve a twofold purpose, viz., that of teaching the child the value of responsibility of other people's property. The box should belong to one scholar right to the 6 end of his school career, and the outlay would be more than covered by the immunity from infection each pupil would derive, and the valuable lesson he or she would learn in the taking care of articles given to his or her care. Lesson books might be similarly treated, and I hope before my next Annual Report is made that the necessary steps in this direction will have been taken. USE OF PLASTICINE. I take this opportunity to inveigh against the careless use of the stuff known as Plasticine. Used for modelling, at present the custom is to give each child a piece, and at the end of the lesson all these little pieces, that have been well fingered and handled by children, perhaps some of them recovering from scarlet fever or measles, or any disease in which desquamation is dangerous, are rolled up together in one ball and put aside for the next lesson. The possibilities of such action need not be dilated upon. AGE OF PUPILS. While on the subject of the Schools I wish to state my conviction that the age of entry. viz., 4 to 5 years, is much too young. The age limit should be advanced to 6. This would keep child-life out of much danger of infection during that period, under 5, when such illnesses as measles, whooping cough, scarlet fever, diphtheria, etc., are generally so fatal to it. The difference in age is great from the health point of view, but not nearly of so much account from that of education. At present there are between 1500 and 1600 children aged between 3 and 5 years attending these Schools. SWIMMING. It is a pleasure to be able to report how the life and future of Council School children has been brightened by the especial interest taken by the Educational Committee in the matter of swimming. There were no fewer than 50518 attendances of boys and girls recorded in 1904 at the Baths, for each of which the Council paid. 39120 of these were made by boys and 11398 by girls, while 7068 more were admitted by scholars' tickets on payment of 1d. each. These ticketholders must be accompanied by a master and may not go during school hours. With the others the Baths have become a part of the curriculum, and they are quite rightly taught to swim as they are to read and write. The direct result of this valuable innovation is that 846 pupils learnt to swim in 1904. 170 secured a first class certificate —two lengths of the Baths, which are 80 feet long. 251 achieved second class certificate—one length of the Baths. 65 boys obtained ½-mile medal, and 17 girls the ½-mile medal, while 51 boys received 7 the certificate of the Life Saving Society. The value of this cannot be over-estimated. In the matter of health, cleanliness, exercise, and the future of those who visit the Baths there is everything to recommend the Council's action. In hardly any athletic sport are all the muscles called into play as in swimming, and if the Baths were universally adopted as part of Council School curriculum it would be of immense value to the whole nation. BIRTHS. During the year 3198 births were registered, that is 75 less than in 1903, and 95 more than the average for the past five years. Of the 3198, 1667 were males and 1531 females. The birth-rate is 30.07, compared with 32.08 last year, and 31.52 in 1902. That for England and Wales is 27-9; for Rural England and Wales, 26.8; in 76 great towns, 29.1; and 142 smaller towns, 27.5. In the Union Workhouse 162 births occurred. Males, 89; females, 73. Table I.—Births for the last 5 years. Males. Females. Totals. 1900 1469 1463 2932 1901 1521 1442 2963 1902 1682 1470 3152 1903 1616 1657 3273 1904 1667 1531 3198 7955 7563 15518 Average rate for past five years is 3103. DEATHS. The total number of deaths is 2270, 1192 males and 1078 females, or 294 more than in 1903. Table II.—Deaths for the last 5 years 1900 1867, of which 1179 belong to the District proper 1901 2016 ,, ,, 1243 ,, ,, ,, 1902 2029 ,, ,, 1183 ,, ,, ,, 1903 1976 ,, ,, 1112 ,, ,, 1904 2270 ,, ,, 1370 ,, ,, ,, 8 Excess of births over deaths is 928, and the average increase of the past five years is 1072. Table III.—Distribution of Deaths. Master Bakers' Almshouses 3 Bethnal Green Schools 0 West Ham Union, Workhouse, Infirmary, and Schools. 844 Violence 53 District, exclusive of above 1370 2270 Estimating the population at 104000, the death-rate for the District is 13.1 per 1000, against 10.9 per 1000 in 1903; 11.8 in 1902; 12.4 in 1901; and 11.8 in 1900. The average death-rate for the past five years is 12.0. The average death-rate for the past ten years is 12.4. The London death-rate is 16.6. The London Zymotic death-rate is 2.18. The District Zymotic death-rate is 2.7. By way of comparison, I again give the England and Wales Statistics, which are as follows:— Annual Birth-Rates and Death-Rates from the Seven Chief Epidemic Diseases. Annual Rates per 1000 Living. Infant Mortality. Births. Deaths from all causes. Deaths from Seven Chief Epidemic Diseases. Annual Death-rate of Infants under 1 year per 1000 Births. England and Wales 27.9 16.2 1.94 146 Rural England and Wales 26.8 15.3 1.28 125 76 Great Towns 29.1 17.2 2.49 160 142 Smaller Towns 27.5 15.6 2.02 154 Leyton 30.7 13.1 2.7 138 Table IV.—Death-Rate for Each Quarter. First. Second. Third. Fourth. Leyton 12.4 9.9 16.9 13.1 London 18.2 14.9 16.3 17.1 9 Table V.—Deaths Classified with regard to Sex. Males 1192 or 52.5 per cent of the total, deaths. Females 1078 ,, 47.5 Table VI.—Ages at which Death occurred. Under 1 year 444 1 year and under 5 years 176 5 years „ 15 34 15 years „ 25 „ 46 25 years „ 65 „ 395 65 years and over 275 1370 Table VII.—Death-Rate per cent, of Total Deaths. Under 1 year 444 32.4 45.2 1 year and under 5 years 176 12.8 5 years „ 65 „ 475 34.7 54.8 65 years and over 275 20.1 The infant mortality, i.e., Heaths under 1 year is 444, or 13 8 per cent. of the total number of births, against 9.8 per cent. last year. INFANTILE MORTALITY. Per 1000 births, the deaths of infants under 1 year of age in England and Wales was 146, in Rural England and Wales 125, in 76 great towns 160, in 142 smaller towns 154. In our District for every 1000 births, the deaths of infants under 1 year of age rose from 99 last year to 138 this. Frequent inspections were made in all the poorer localities in order to, as far as possible, see that the sanitary surroundings were proper and no refuse allowed to accumulate. I ascribe the increase as much to the usual causes of infantile ailments, viz, impure milk, heated sub-soil, dust infection, etc., as to the ignorance and lack of cleanliness of young mothers, especially with regard to the utensils used for baby's food. Too much care it is not possible to exercise in these all-important matters, but this fact appears to be beyond the comprehensive powers of many residents in these parts to grasp. Added to the above, the dry weather already alluded to was, as it always will be, a factor in the mischief. Diarrhcea was very fatal among infants particularly in August. 10 Table VIII.—Chief Causes of Death. Under 5 years. 5 Years. and over Total. Small Pox 0 0 0 Scarlet Fever 1 5 6 Diphtheria 12 2 14 Membranous Croup 0 0 0 Croup 0 1 1 Premature Births 49 0 49 Influenza 1 5 6 Typhoid Fever 0 10 10 Puerperal Fever 0 1 1 Erysipelas 1 2 3 Measles 25 0 25 Whooping Cough 43 1 44 Diarrhœa 180 6 186 Rheumatic Fever 0 3 3 Phthsis 2 123 125 Diseases of the Respiratory Organs 90 129 219 Heart Disease 8 89 97 Cancer 0 61 61 Tubercular Diseases other than Phthsis 38 7 45 All other Diseases 170 305 475 620 750 1370 Included in the above under the heading " All other diseases," was a case of that very rare disease Glanders. The man who died of it in the London Hospital, was employed in a local stable. Table IX.—Number of Deaths 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 170 219 97 53 49 186 Death Rate per 100 1.6 2.1 .9 .5 .4 1.7 Deaths in 1903 138 153 102 35 74 36 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 2 2 0 1 1 0 0 0 0 0 6 Scarlet Fever 31 25 32 27 36 25 27 33 66 78 32 33 445 Diphtheria 18 22 13 13 13 12 11 9 13 5 14 7 150 Membranous Croup 0 0 0 1 0 0 1 0 0 0 0 1 3 Typhoid Fever 4 2 1 1 2 4 3 4 5 7 6 4 43 Simple Continued Fever 1 0 0 0 1 0 0 0 1 0 0 0 3 Relapsing Fever 0 0 0 0 0 0 0 0 0 0 0 0 0 Puerperal Fever 4 0 0 0 0 0 1 0 0 0 2 0 7 Erysipelas 10 3 5 5 6 7 14 6 8 19 8 8 99 Cholera 0 0 0 0 0 0 0 0 0 0 0 0 0 68 52 53 49 58 49 58 52 93 109 62 53 756 12 Table XI.—Number of Cases of Infectious Diseases as they occurred in the Four Chief Wards of the District. Leyton. Leytonstone. Harrow Green. Cann Hal!. Total. Small Pox 3 0 0 3 6 Scarlet Fever 148 89 127 81 445 Diphtheria 72 18 29 31 150 Typhoid 18 8 10 7 43 Erysipelas 48 12 19 20 99 Membranous Croup 1 0 2 0 3 Puerperal Fever 2 0 4 1 7 Continued Fever 0 1 2 0 3 292 128 193 143 756 Percentage of Cases ... 38.6 16.9 25.5 18.9 „ „ in 1903 40.9 19.4 18.0 22.5 „ „ in 1902 42.8 25.4 14.8 17.4 13 Table XII.—Deaths per Cent of Deaths notified (exclusive of Public Institutions). Cases. Deaths. Percentage Mortality. 1903. 1904. 1903. 1904. 1903. 1904. Scarlet Fever 397 445 13 6 3.2 1.3 Diphtheria 185 150 27 14 14.6 9.3 Typhoid 54 43 10 10 18.5 23.2 Simple Continued Fever 2 3 0 0 0.0 0.0 Puerperal Fever 4 7 3 1 75.0 14.2 Erysipelas 88 99 3 3 3.4 3.0 Membranous Croup 1 3 0 0 0.0 0.0 Small-Pox 3 6 0 0 0.0 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. 1900 1901 1902 1903 1904 Small Pox 0 0 2 0 0 Meales 13 31 15 37 25 Scarlet Fever 7 13 7 13 6 Diphtheria 27 36 36 27 14 Membranous Croup 0 0 0 0 0 Whooping Cough 47 45 59 40 44 Typhus 0 0 0 0 0 Typhoid 14 14 16 10 10 Diarrhœa 113 125 48 36 186 Total 221 264 183 163 285 Deaths from all other Diseases 958 979 1000 949 1085 Death-rate from Seven Chief Zymotic Diseases 2.21 2.64 1.83 1.5 27 Death-rate from all other Diseases 9.5 9.7 10.0 9.3 10.4 General Death-rate 11.8 12.34 11.8 1.08 13.1 15 TYPHOID. A perusal of the following table is of interest:— Causes of Infection. Imported 5 Eating Oysters 2 Complained after cleaning out dirty gully 1 Eating Ice Cream 1 In contact with previous cases 6 Untraceable causes 23 Cases removed from our District to West Ham Infirmary suffering from various complaints, but developing Typhoid within a fortnight of admission 3 In West Ham Infirmary. Imported 40 Occurred in Institution 3 West Ham Union 1 West Ham Union Schools 1 In Bethnal Green Schools. Case occurred. 1 On inspection it was discovered that sanitary work was necessary in 16 of the houses where Typhoid had occurred, and in 5 houses repairs were necessary to defective drains. These are statements of facts and are not given as being necessarily the cause of the illness, though they doubtless had something to do with it. SMALL POX. The outbreak which commenced in 1902 never really quite left the District until about the end of July, 1904, as is shown by the fact that last year we had 3 cases and this year 10. The first case this year was in February, that of a student at Livingstone College, who contracted it while pursuing his studies at Poplar Hospital. In March, a man is said to have contracted the disease while attending the funeral of a friend who is supposed to have died of blood poisoning. In April, there were three cases—first, that of a woman said to have contracted it while attending a funeral at Plaistow ; secondly, that of a boy who had been playing with children outside our District who ultimately developed the disease; and thirdly, a case was notified to me which on investigation, 1 certified was not one of Small Pox. In June, the next case occurred, that of a resident of Ramsay Road, Forest Gate, of which we were quite unable to trace the source of infection. In July, another case; caught it from her brother, who had a very mild attack of the disease which had not been diagnosed. Four other cases 15 occurred in the West Ham Workhouse. Of the above, 5 were vaccinated in infancy and 2 unvaccinated. Three of these were contact cases who had been vaccinated a few days before being notified. VACCINATION. The objection to having infants vaccinated was not so noticeable this year, but there is still an inexplicable and wholly absurd reluctance on the part of some of the populace to come forward to subject themselves and their infants to this highly-necessary operation. Let me give a few brief facts. Germany is freer from Small Pox than any country in Europe. Why? we may legitimately ask ourselves. Simply because vaccination and re-vaccination is compulsory in that country, not, as has falsely been stated to be the case, because of a more perfect system of isolation existing there. Small Pox would be almost unknown in this world if everybody was properly vaccinated and re-vaccinated, just as the famous Gloucestershire Dr. Jenner noticed 100 years ago, there were some milkmaids who never caught Small Pox. Those who, from constantly milking the cows, had got sore places on their fingers and had thus become inoculated. SCARLET FEVER. Forty-eight more cases than last year were reported, viz., 445 against 397, but against this I can report a very appreciable decrease in the mortality, as only 6 cases ended fatally as against 13 last year. This was doubtless largely due to the milder form of the disease, which was most prevalent in September, especially in the Leyton Wards. Table XIV.—Notified Cases of Scarlet Fever during the past Five Years, with the Percentage Mortality. Cases Notified. Number of Deaths. Percentage Mortality. 1900 243 7 2.8 1901 396 13 3.29 1902 393 3 .76 1903 397 13 3.27 1904 445 6 1.3 Of the 445 cases, 148, or 33.2 per cent. occurred in the Leyton Ward, 89, or 20 per cent., in the Leytonstone, 127, or 28.5 per cent., in the Harrow Green, and 89, or 18.2 per cent., in the Cann Hall Ward. DIPHTHERIA. The number of cases notified is 150, and the deaths 14, or 9.3 per cent. This compares very favourably with last year's figures, when the rate of mortality was 14.6, the decrease being chiefly due, as in Scarlet Fever, to the milder form of the disease prevalent. 17 TEMPORARY ISOLATION HOSPITAL. Scarlet Fever. Under Treatment at beginning of year 37 Admitted 220 Discharged 209 Died 1 Under Treatment at end of year 42 It is particularly gratifying to be able to record the fact that only 1 death occurred in the Scarlet Fever Hospital throughout the year. As it was, we nearly got through the year with a clean sheet in this respect, as the deceased, a young man, died from lung complication supervening on Scarlet Fever about Christmas time. Diphtheria. Under Treatment at beginning of year 7 Admitted 50 Discharged 45 Died 4 Under Treatment at end of year 9 Three cases of Tracheotomy were performed almost immediately upon admission, and each was successful. The details of the four deaths are—(i.) 6 years of age, in Hospital 12 days; (ii.) 4 years of age, in a hopeless condition when admitted, died in 2 hours; (iii.) 3 years of age, in Hospital 12 days, died of heart failure; (iv.) 7 years of age, was in Hospital 4 days, and had disease in most severe form. 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. 19OO 243 142 58.4 40 1.8 2.1 1901 396 158 39.8 40 3.2 1.9 1902 393 176 44.7 40 .76 1.7 1903 397 206 51.8 40 3.27 4.8 1904 445 220 49.4 40 1.3 .45 DIPHTHERIA. 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 16.1 1904 150 50 33.3 10 9.3 8.o 18 It is a pity that this year I cannot report a great improvement in the number of admissions to the Scarlet Fever Hospital, but at the same time, nearly 50 per cent. were treated there. There is still room for improvement in the matter of accommodation, particularly in the period August to October, during which present arrangements are insufficient adequately to cope with the applications for admission. While on this subject I should like to emphasise the fact that with more admissions to the Scarlet Fever Hospital than had ever been the case before, but a single fatal case occurred, while in the Diphtheria Hospital. the extremely satisfactory record of only 4 deaths out of 50 admissions has to be noticed, and 2 out of these were admitted in an almost moribund condition, one living but two hours and the other four days. Most of these cases under both headings came from the poorer and less healthy classes, who were therefore much less able to fight disease than individuals of greater stamina would have been. As regards Diphtheria, the cases were generally several days advanced before they were brought to our ken; a most vital point this, as antitoxin to be of the first service must, as I have pointed out before, be used at the earliest possible opportunity. Indeed, if Diphtheria cases were at once treated with anti-toxin, it is my opinion that hardly any cases would end fatally. Regarding Diphtheria however, I am glad to be able to notice an improvement in the number of cases treated in Hospital. Whereas last year 48 out of 185 notified cases were brought to Hospital, this year 50 out of 150 were sent for treatment. The most valuable addition to the appurtenances of each ward has been the addition of six appliances in the shape of a chemical Extinctor, known as "the Perfection," which can easily be worked by the nurses, and is very valuable as a first aid machine. In concluding my remarks upon Scarlet Fever and Diphtheria, I give a table showing number of cases notified, and number admitted into the Hospital during the eight years of its most valuable existence. SCARLET FEVER. Year. Notified, Deaths Admission to Hospital In District. In Hospital. 1897 510 I7 3 177 1898 35° 5 1 139 1899 3!5 4 3 133 1900 243 7 3 142 1901 396 13 7 158 1902 393 7 3 176 1903 397 13 10 206 1904 445 6 1 220 3050 72 31 1351 19 The District Death Rate over this period for Scarlet Fever is 2.4 percent. The Hospital „ „ „ ,, 2.2 ,, DIPHTHERIA. Year. Notified. Deaths Admission to Hospital. In District. In Hospital. 1897 156 20 2 30 1898 162 28 5 40 1899 200 31 15 62 1900 201 27 10 63 19O1 255 36 19 101 1902 236 36 20 71 1903 185 27 8 48 1904 150 14 4 50 1545 219 83 465 The District Death Rate over this period for Diphtheria is 12.7 per cent. The Hospital „ „ „ „ 15.4 „ „ It must be borne in mind that in the vast majority of Diphtheria cases, patients are not sent to Hospital until they are in a very advanced stage of the disease, so that comparison between percentage of deaths inside and outside the Hospital walls is not fair unless due weight is given the above fact. PERMANENT ISOLATION HOSPITAL. A Sub-Committee was nominated this year with a view to visiting several Hospitals in our neighbourhood in order to decide upon the best plans to be adopted when building our own Hospital. As a result of their deliberations plans have now been drawn up by the Surveyor, Mr. W. Dawson, and for the moment this important matter lies in abeyance. It is noteworthy that a great diversity of opinion exists among medical authorities nowadays as to the advisability of erecting expensive isolation Scarlet Fever Hospitals, as the benefit to be derived from a costly edifice is considered to be not quite proportionate to the outlay involved. It is my opinion this District cannot possibly do without accommodation of this sort, especially when one ponders for a moment over the chief class of resident in our midst. For example, if a case of scarlet fever occurs in the house of an employe of the G.E.R. Works he is debarred from going to work for at least 6 weeks. If a Hospital was at his elbow he would be able to resume work in less than a week. This single example suffices to show the immense utility of a Hospital in a district teeming with an artisan and labourer class population. 20 PUBLIC INSTITUTIONS. WEST HAM UNION WORKHOUSE, INFIRMARY, AND SCHOOLS. Births :— There were 182 births—89 males and 73 femalrs—a total of 32 more than last year. Deaths:— There were 866 deaths. Chief Causes of Death. Total. Small Pox 0 Measles 20 Scarlet Fever 0 Typhoid 17 Erysipelas 4 Rheumatism 1 Diarrhœa 18 Phthisis 150 Tubercular Diseases other than Phthisis 14 Respiratory (Diseases of Organs) 125 Heart Disease 88 Premature Birth 5 Influenza 1 Whooping Cough 7 Cancer 95 Violence 22 Diphtheria 1 Puerperal Fever 4 All other 394 866 Cases of Infectious Disease occurring in the Union. Scarlet Fever 60 cases, of which 8 were imported. Diphtheria 1 „ 0 „ Typhoid 49,, 44,, Erysipelas 54,, 44,, Puerperal Fever 10 „ 10 „ Small Pox 4 ,, 0,, THE INFIRMARY, WHIPPS CROSS ROAD. During this year there were— 4042 Admissions. 3271 Discharged. 705 Deaths. 21 These deaths are included in the 866 mentioned in the foregoing list There are now in the Infirmary 743 beds, all of which are occupied including 56 beds for male phthisis, and 28 for female phthisis cases. both of which have always been full. Additional Wards have been provided for alleged lunatics, 24 female and 22 male beds. Owing to the pressure on the male wards, there are now 25 extra beds. A great want is the absence of an isolation block for suspicious cases. There certainly should be some provision made as soon as possible in this direction. Also I have to report that the smoke nuisance, arising from the chimney shaft, which could be largely abated by the use of Welsh Steam Coal or Anthracite, still exists. Attached to this Institution is Forest House, in which is accommodation, under the excellent supervision of Mr. and Mrs. Riley, for 390 old men. Of the series of cottages, originally intended for married couples only, a very few have been used, the remaining beds being occupied by 90 old ladies. The occupants of these two Institutions are carefully selected by the Guardians, and they get privileges not usually granted to inmates of Workhouses. BETHNAL GREEN SCHOOLS. The general health has again been very good. One case of Typhoid and one of Scarlet Fever. There are 260 boys and 218 girls in these Schools, and beyond the above I have only to report that the Schools were slightly affected by a short epidemic of Influenza in a mild form. DISINFECTION. The Steam Disinfector has become more and more useful, and it is now quite the general practice to resort to its services in the matter of disinfecting bedding, clothing, etc., from houses where any illness, not only infectious ones as heretofore, have occurred. FACTORY AND WORKSHOP ACT. The number of Workshops is 97. These premises, as well as the dwellings of 241 Outworkers, an increase of 98 on last year's work have, as usual, been subjected to periodical systematic inspection, and everything done that it was possible to do in the matter of preventing overcrowding, and abating sanitary nuisances generally. Only 8 cases of overcrowding, as against 31 last year, were found, but sanitary defects discovered rose from 33 in 1903 to 76 this year. These were duly dealt with, and in case was prosecution necessary. 22 BAKEHOUSES. A small deputation of the South Essex Master Bakers' Association waited on me to obtain my opinion as to the danger, if any, to public health entailed by the custom of changing stale loaves for fresh. I strongly deprecate the practice, certainly with regard to the poorer quarters of the district. When the loaves arrive fresh on Saturday, the chances are the occupier is busy, and sends her children to bring in the supply, which is thereupon handled sometimes by the dirtiest of hands, and placed anywhere in the house, few, indeed, being able to afford the luxury of a bread pan. There the loaves are allowed to lie about, when not wanted, collecting dust germs, and on Monday are handed back to the baker. One such case occurred where there was a case of typhoid in the house, and I trust some measures may be taken to stop the custom, which might at any time convey disease in the above manner from one house to another. PUBLIC HEALTH DEPARTMENT. We have been greatly assisted this year by the passing by the Council of the three Acts dealing with the Sale of Ice-creams, the Milk Supply, and Infectious Diseases. Much illness, especially diarrhoea, might be brought about among young children by the absorption by them of impure ice-cream, and the following Act has certainly awakened vendors to a sense of their responsibility to their many small customers in this matter. The Act provides that:— "Any person being a manufacturer or vendor of or merchant "or dealer in ice-creams or other similar commodity who within "the district (A) Causes or permits ice-creams or any similar "commodity or any materials used in the manufacture thereof to "be manufactured sold or stored in any cellar room or place "which is in a condition likely to render such commodity injurious "to health or in which there is an inlet or opening to a drain; "or (B) In the manufacture sale or storage of any such commodity "does any act or thing likely to expose such commodity to "infection or contamination or omits to take any proper pre"caution for the due protection of such commodity from infection "or contamination; or (C) Omits on the outbreak of any infectious "disease amongst the persons employed in his business to give "notice thereof to the Medical Officer of Health shall be liable "for every such offence on summary conviction to a penalty not "exceeding forty shillings. Power is also given to the Medical "Officer of Health in the event of any inmate suffering from "infectious disease in any building in which any ice-cream or "commodity is manufactured or stored to seize and destroy all ice"cream or similar commodity or materials for the manufacture of "same in such building, the Council compensating the owner, 23 "Power is given to any duly authorised officer of the Council "to enter and inspect the premises of any manufacturer or vendor "of or merchant or dealer in ice-creams or other similiar com"modity and any person refusing entry or obstructing such "officer in the execution of his duty shall be liable to a penalty "not exceeding forty shillings for each offence. "Every dealer in ice-creams or other similar commodity "vending his wares from any cart barrow or other vehicle or "stand must have his name and address legibly painted or "inscribed on such cart barrow or stand. Penalty on default not "exceeding forty shillings." Concerning the Milk Supply, the Act is rightly very stringent with regard to sale of milk at all likely to be infected with tuberculosis germs. Though this Act is bound to work for the public weal, it is early yet to comment upon its operativeness. Exigencies of space preclude much reference to the Infectious Diseases Act within the narrow confines of an Annual Report, and I only refer to it again to welcome it as a much needed measure that can but tend to still further safeguard the Public Health without acting harshly on the individual. SANITARY WORK. Under the most capable supervision of Mr. Miller and his energetic staff the following sanitary work has been properly carried out. Details are as usual culled from Mr. Miller's Report:— Houses inspected 3305 Connections of drains tested 3035 Notices served 1986 Complaints received 402 Defective drains remedied 214 W.C.'s in defective state, new traps and straight backed pans provided where necessary 518 Sink, bath and lavatory wastes, and rain pipes made to discharge in open air over trapped gullies 260 Defective gullies replaced, and defective connections of gullies remedied 492 New sink and bath waste pipes provided and repaired 108 24 New salt-glazed stoneware sinks provided 46 Bath, waste and lavatory sink pipes trapped immediately under arrangement 43 Ventilating shafts repaired, also provided to soil pipes and drains 121 Defective soil pipes remedied, etc 8 Flush cisterns supplied to wc.'s with efficient flush pipes 86 Flush cisterns and flush pipes repaired 239 Yards paved around back additions of houses and forecourts paved or repaired 350 Yards cleansed 32 New manhole covers provided and sealed 29 Manholes rendered and repaired 6 Ventilation provided under flooring 18 Floors of sculleries paved and repaired, and cellars and floors drained and concreted 79 House roofs and guttering repaired and renewed 281 Houses in a general insanitary, dilapidated, or filthy condition, repaired and cleansed 684 Walls of back addition properly rendered 30 Plots of land in an insanitary condition 7 Nuisances abated arising from stagnant water in basements of houses 10 Air inlets provided to drains and repaired 65 Stables paved and drained 12 Mews in filthy condition paved, drained and cleansed 8 Manure receptacles provided 12 Houses entirely redrained with intercepting syphons and manholes provided between the house drains and sewer, and with efficient air inlets and outlets 97 Houses without water supplied by the East London service and water supplies to houses restored and improved, water fittings repaired 66 25 Covers to domestic water cisterns provided 630 Domestic water cisterns removed from improper positions, or cleaned or repaired 102 Nuisances by overcrowding !3 Nuisances caused by fish, offal, manure and other refuse deposits 69 Animals kept in an insanitary state 29 Houses disinfected, walls stripped, limewashed, etc. 572 Books disinfected 65 Receptacles for fish offal 5 Smoke nuisances abated 9 Pig nuisances abated a Offensive trades 2 Plots of land fenced in 5 Schools disinfected 6 Squatters removed 2 SEWERS. Several alterations and additions to the sewers have during the past year been carried out by or under the supervision of your Surveyor's Department, chief among which may be mentioned the construction of a Low-level Sewer, to which 259 new houses on Mr. Courtenav Warner's Estate have been connected; also 73 existing houses in other parts of the Lea Bridge District. A new 1-ft 9-in Sewer was also constructed in Downsell Road; also a 2 - ft. Sewer in Union Road, to relieve the Leytonstone District. Other work included the covering in of the open water course from West End Avenue by means of a 2-ft. 6-in. surface water culvert. SEWER VENTILATORS. Sixty-six Ventilators have been provided to the Council's sewer from January to December, 1904, distributed in the different wards as follows:— Sewer Vents fixed from Jan. to Dec., 1904 (inclusive). Forest. Leytonstone. Lea Bridge. Leyton. Central, G, Green. Cann Hall. Harrow Green. Wanstead S. 13 10 ii 4 20 3 3 1 1 = 66 26 I cannot too greatly impress upon the Council the advisability of continuing to erect these shafts on every available opportunity. FLOODING. In consequence of the abnormal rainfall during the summer of 1903, considerable flooding of dwelling-houses occurred in different parts of the District, owing to the overcharged condition of the sewers. The lower portion of Sidmouth Road, also some basement houses in Wallwood Road were especially affected, being flooded on several separate occasions. In each case steps were at once taken to counteract the evils which might otherwise have arisen from the deposits of filth left on subsidence of the water. Notices were served on the respective owners of the property to remove the saturated earth and filih from beneath the flooring, and to concrete the site. This work was carried out, and it is highly satisfactory to report that no illness, infectious or otherwise, has since broken out, which could be attributed to the flooding. The sewers of these districts have since been enlarged, and it is hoped that this will prevent similar trouble arising in future from this source. COWSHEDS AND DAIRIES ACT. The number of cowsheds is 11. During the year two cowsheds were found to be overcrowded. There were 45 applications for registration by milk dealers, and as is usual in cases where infectious diseases have occurred during the year in the homes of persons engaged in the milk trade, the keepers and dairymen were communicated with and the men compelled to relinquish work until all danger of infecting others was over. SLAUGHTER-HOUSES. Periodical and systematic visits have been paid to these, and only 7 nuisances found to exist, while 19 slaughter-houses exist in the District. Three licenses have been transferred during the year. PETROLEUM LICENSES. Eleven licenses have been renewed, 3 new ones sanctioned; and 1 transferred. 27 UNSOUND FOOD. During the year the amount of tinned meat, fruit and fish found unfit for human consumption and duly destroyed was 23 tons 15 cwt. 1 qr. 26 lbs. HOUSING OF THE WORKING CLASSES ACT. Thirteen houses were closed as unfit for human habitation ; 8 of these have since been repaired by their owners. DUST COLLECTION. 19,655 tons 18 cwt. of house refuse, comprising 15,040 loads, have been deposited at the works of the Destructor this year. ROADWAYS. I feel constrained again to emphasize the early necessity for the Council to insist upon the Roadways at the rear of shops being properly paved and drained by the builder. Existing conditions constitute an injustice to the occupier and to subsequent owners, for if the premises are found insufficiently paved and drained, the builder and not the subsequent owner should have to bear the cost of repair. As it is the builder who has built the premises on maiden and inadequately prepared soil gets off scot free. In conclusion, I have once more to tender my thanks to my staff for their cordial co-operation, without which the proper supervision of the affairs of the Public Health would not run smoothly. The District is, I am entitled to consider, in a healthy state, and I trust the few improvements I consider necessary, will not be long forthcoming. I am, Gentlemen, Your obedient Servant, A. F. PESKETT, Medical Officer of Health. Leyton, March, 1905.