Leyton Urban District Council, Town Hall, Leyton. With the Compliments of the Medical Officer of Health. LEY007 Leyton Urban District Council. Annual Health Report for 1905, A. F. PESKETT, Medical Officer of Health. Walthamslow: gillett bros., printers, hoe street. Leyton Urban District Council. ANNUAL HEALTH REPORT FOR 1905, by A, F. PESKETT, Medical Officer of Health. Gentlemen, I beg to present to you my Twentieth Annual Report, that for the year 1905. The year was an exceptionally healthy one, entirely free from epidemics, although in' the early part of the year there was an outbreak of Measles in the Ruckholt, Newport, Farmer, Norlington Road, and Davies Lane Schools, which were followed in the autumn by further slight outbreaks in the Harrow Green and Capworth Street Schools. Just before Christmas, Mumps were prevalent in the Goodall Road and Downsell Road Schools, but otherwise the health of the Schools was excellent, the general attendance being 89 per cent. for the year. The effect of the rainfall upon the general health is again worthy of note. In 1903, as I noted in my last Report, over 35 inches of rain fell, and our Death Rate was 10.9. Last year, 1904, with 17.46 inches of rain our Death Rate was 13.1, and this year with 19.44 inches of rain the Death Rate has gone down again to 11.2 4 The Rainfall for the year was divided up as follows:— Inches. January 1.05 February 77 March 3.03 April 1.71 May 70 June 3.05 July 76 August 2.28 September l.83 October 1.02 November 2.67 December .57 19.44 The heaviest falls recorded during a 24 hours were on August 28th and September 25th, viz., 79 on both occasions. As regards the population, which is estimated at 105000, there were 111 more Births than the 3198 recorded in 1904, and 216 fewer Deaths than the 2270 registered for the same twelve months, 5 There was a most marked decrease from the figures of 1904 in the Infantile Mortality of the District, as the following Table shows:— Table I. Deaths of Infants under 5 years of age. 1901 35 1902 45 1903 35 1904 180 1905 52 In this, my Twentieth Annual Report, I have introduced several new tables of figures for the better elucidation of results, and this has necessitated the re-numbering of the whole series of Tables. POPULATION. Estimated population at the rate of 5 residents in every house, 105000. There is again a marked decrease in the number of houses erected and certified fit for habitation from 749 in 1904 to 496 in 1905. 6 PARTICULARS AS TO WARDS FOR 1905. Division. Area in Acres including Land Inland Water. New Houses Erected Daring Year. Total Number of Houses. Approximate Population. Density of Population in Various Wards Density of Population for the whole District 40-5 per acre. Leyton 432 13 1723 8500 19.6 Lea Bridge 521 80 2705 12500 24.0 Forest 599 171 2761 13000 23.3 Central 233 174 4170 20000 85.8 Leytonstone 326 44 3311 16000 49.0 Harrow Green 139 2 1943 7500 54.0 Grove Green 121 11 1898 7500 62.0 Cann Hall 135 - 2571 12000 89.0 Wanstead Slip 88 1 1645 8000 910 Totals 2594 496 22727 105000 40.5 7 COUNCIL SCHOOLS. The following are the returns of the number of children on the books attending the various Council Schools. Table II. Cann Hall Ward. Boys. Girls. Infants. Total. Cobbold Road Schools mixed 355 Cann Hall Road „ 570 570 513 1653 Trumpington Road „ 340 358 423 1121 Central Ward. Leyton High Road Schools mixed 269 Newport Road „ 553 580 518 1651 Norlington Road „ 458 387 398 1243 Grove Green Ward. Mayville Road Schools 433 462 497 1392 Harrow Green Ward. Goodall Road Schools 503 518 473 1494 Harrow Green „ 327 278 313 918 Downsell Road „ 432 413 476 1321 Leyton Ward. Farmer Road Schools 501 499 515 1515 Ruckholt „ 372 362 338 1072 Leytonstone Ward. Kirkdale Road Schools 394 364 335 1093 Davies Lane „ 368 379 387 1134 Lea Bridge Ward. Capworth Street Schools 494 471 679 1644 Church Road „ 295 273 404 972 Lea Bridge Road „ mixed. 201 Sybourn Street ,, mixed. 227 19275 St. Joseph's Roman Catholic School, Vicarage Road 240 1915 8 Total attending Schools :— In 1899 16133 „ 1900 15246 „ 1901 17674 „ 1902 18175 „ 1903 19184 „ 1904 19748 „ 1905 19515 The abolition of the use of slates in the Schools has, I am glad to be able to report, been followed by the abolition of the use of Plasticine. Instead of this, clay is now used for modelling purposes, with the additional very wise precaution that the clay, when done with for the day, is made into a lump and kept in a cloth damp with Sanitas disinfectant. The disinfectant is also renewed from time to time, and also mixed with the clay. I still hope that the suggestion made in my Report for 1904 will be adopted, and each pupil be given a box in which to keep all his or her pencils, pens, rubber, &c., so that pencils the ends of which have been chewed, besides being handled, by children suffering perhaps from some infectious ailment may not be regularly handed on to the healthy ones to use. AGE OF PUPILS. No children between the ages of 3 and 4 years have been admitted to the Schools this year. Though this is a move in the right direction, I am still of opinion that the age limit of entry is much too young, and that no child under the age of 6 should be allowed to attend the Council's Schools. After the age of 5 children are much less subject to measles, scarlet fever, diphtheria, and whooping cough than before. 9 RINGWORM, ITCH, AND KINDRED DISEASES. I wish to draw particular attention to the prevalence of ailments due to nothing but uncleanliness and avoidable dirt and to neglect on the part of parents. At present the discovery of all such infectious disorders as Ringworm and Itch is left a great deal too much to chance. Children who are seen to be in doubtful health are sent down by their Teachers to the Town Hall to be examined by me at 10 a.m. every morning, and during the year I certainly saw a very large number in this manner. But something like a periodical examination of the children by their Teachers should be compulsory, and thus these disagreeable ailments might be treated in time. The majority of those I saw at the Town Hall were suffering from the direct results of filthy habits and neglect at home. We should hear less about sore throats, bronchitis, adenoids, enlarged tonsils, and the like, if parents kept their children's mouths clean and if a little more attention was given to the use of the toothbrush. Again, there is no excuse for the dirty state of the .heads of the children, chiefly girls, who 1 examined. MEASLES IN SCHOOLS. The question constantly arises as to whether it is advisable to close the Infant Schools when an outbreak of Measles occurs. I think it unnecessary to do so. Those children who have not already had Measles should be excluded, but all who have had it, even if they live in a Measles infected house, might be permitted to attend School. At the same time parents should be informed why their children are not allowed to attend School and should be warned not to let them visit infected houses. In such a district as ours, very little good would be done by closing the Schools, as children living in the same street and houses often attend different Schools and the closing of Schools is no guarantee that, during playtime, the healthy are not mixing with those who either have the ailment or are living in infected houses. 10 SWIMMING. The continued success attending the splendid work of theLeyton Schools' Swimming Association is a most encouraging feature in the life of our District. The "Hurry" Cup for the Champion School of the District, presented by Councillor W. A. Hurry, the Challenge Cup, the kind gift of Councillor D. M. Smith for the Champion Boy of the District, and the "Spurgeon" Cup for the Champion Girls' School of the District, the present of Mr. W. Spurgeon to the L.S.S.A., are each playing a big part in the health of our young community by encouraging one of the healthiest sports known. The results of the attendances at the Baths for the year have been excellent. They are as follows:— Boys 36770 Girls 11328 Total 48098 7,957 were admitted on payment of one penny. The chief results for the year were that:— 861 learned to swim. 225 secured 1st Class Certificate. 284 „ 2nd „ „ 94 boys secured ½ mile Medal. 15 girls „ ¼ „ „ 61 boys secured Proficiency Certificate of the Life Saving Society. 8 girls secured Proficiency Certificate of the Life Saving Society. 11 Last year 170 secured the 1st Class, and 251 the 2nd Class Certificate, so that here, as elsewhere, improvement is to be reported. BIRTHS. During the year there were 3209 births, or 111 more than in 1904. Of these 1669 were males and 1540 females. The Birth Rate is 30.5 compared with 30 07 last year, 32.08 in 1903, and 31.52 in 1902. That for London for 1905 is 27.1. In the Union Workhouse 179 births occurred, viz., males 88 and females 91. Table III.—Births for the last 5 years. Males. Females. Total. 1901 1521 1442 2963 1902 1682 1470 3152 1903 1616 1657 3273 1904 1667 I531 3198 1905 1669 1540 3209 8155 7640 15795 The average rate for the past five years 3,159. DEATHS. The total number of deaths is 2054, 1096 males and 958 females, or 216 less than in 1904. Table IV.—Deaths for the last 5 years. 1901 2016, of which 1243 belong to the District proper 1902 2029, „ 1183 „ „ „ 1903 1976 1112 „ „ „ 1904 2270, „ 1370 „ „ „ 1905 2054, „ 1177 „ „ „ 12 The excess of Births over Deaths is 1155 and the average increase for the past five years is 1090. Table V.—Distribution of Deaths. Master Bakers' Almshouses 1 Bethnal Green Schools 0 West Ham Union, Workhouse, Infirmary and Schools 876 District, including violence, exclusive of above 1177 2054 Estimating the population at 105000, the Death Rate for the district is 11.2 against 13.1 per 1000 in 1904; 10.9 in 1903; 11.8. in 1902; and 12.4 in 1901. The average Death Rate for the past five years is 11.8. The average Death Rate for the past ten years is 12.08. The London Death Rate is 15.6. The District Zymotic Death Rate is 1.2. The London Zymotic Death Rate is 1.71. The London Birth Rate is 27.1. The District Birth Rate is 30.5. Table VI.—Vital Statistics of 76 Largest English Towns; during 1905. Birth Rate = 28.2 Death Rate = 15.7 Zymotic Rate = 1.88 13 Table VII.—Death Rate for each Quarter. First. Second. Third. Fourths Leyton 12.3 8.7 10.8 11.3 London 16.6 1.5.2 14.4 16.7 Table VIII.—Deaths Classified with regard to Sex, Males 576 or 48.9 1 Per cent. of the total Deaths. Females 601 or 51.1 Table IX.—Ages at which Death Occurred. Under 1 year 303 1 year and under 5 years 144 5 years „ 15 years 31 15 years „ 25 years 57 25 years „ 65 years 367 65 years and over 275 1177 Table X.—Death Rate per cent. of Total Deaths. Under 1 year 303 25.7 38.0 1 year and under 5 years 144 123 5 years and under 65 years 455 38.6 62.0 65 years and over 275 23.4 The infant mortality, i.e., deaths under I year is 303 or 9.4 per cent. of the total number of births against 13.8 per cent. last year and 9.8 per cent. in 1903. 14 INFANTILE MORTALITY. Per 1000 births the deaths of infants under 1 year of age in London was 129, in 76 great towns 149, and in 142 smaller towns 154. I am glad to he able to report an improvement on last year's figures, and should have been able to present better figures still but for the occurrence of infantile diarrhœa, brought about by avoidable causes. It has frequently been found during our inspections that condensed milk is the food of infants, and in some cases we have found that cheap tinned milk of a very inferior quality is in use. This is sold as machine-skimmed milk, and I have had samples submitted to the Public Analyst with the result that whereas unskimmed or whole milk contains about 10 per cent. of fat or more, the samples I sent for analysis contained only 1.3 per cent. of fat. The parents use this tinned milk obviously because it is cheap and also in ignorance, but the effect of its use must be to lower the child's vitality to an extent bordering on starvation, which renders the little sufferers quite unable to resist an attack of illness such as diarrhoea when that supervenes. In my monthly Report for June I advised, as a precautionary measure, that the roads in the poorer parts of the District be well watered in order to allay the dust in which are to be found many of the germs provocative of infantile diarrhcea. This was done and I am sure the District benefited thereby. Table XI.—Chief Causes of Death. Under 5 years. 5 years and over. Total. Small Pox 0 0 0 Scarlet Fever 5 4 9 Diphtheria 6 3 9 Membranous Croup 3 0 3 Croup 0 0 0 Premature Births 42 0 42 15 Table XI. (Cont.)—Chief Causes of Death. Under 5 years. 5 years and over Total Influenza 1 7 8 Typhoid Fever 0 9 9 Puerperal Fever 0 2 2 Erysipelas 2 5 7 Measles 27 4 31 Whooping Cough 23 1 24 Diarrhoea 52 1 53 Enteritis 7 1 8 Rheumatic Fever 0 4 4 Phthisis 1 94 95 Diseases of the Respiratory Organs 96 128 224 Heart Disease 5 94 99 Cancer 0 84 84 Tubercular Diseases other than Phthisis 17 12 29 Violence 19 19 38 All other Diseases 140 258 398 446 730 1176 Included in the 53 deaths from Diarrhoea are those of 9 illegitimate children, the ignorance of whose mothers or foster mothers was perhaps a contributory cause. Table XII.—Number of Deaths and Death-Rate per 1000 of the Population from Certain Causes. Phthisisand Tubercular Diseases. Respira- tory Diseases. Heart Disease. Violence. Premature Birth. Diarrhoea. Number of deaths 133 224 99 38 42 53 Death-rate per 1000 1.3 2.2 .9 .3 .4 .5 Deaths in 1904 170 219 97 53 49 186 16 Table XIII.—INFECTIOUS DISEASES (NOTIFICATION) ACT, 1890. The following table shows the number of cases of Infectious Diseases per month notified during the year:- Jan. Feb. Mar. April May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Small Pox 0 0 o o 0 0 0 o o o 0 0 0 Scarlet Fever 31 31 28 21 32 24 65 56 48 78 51 40 505 Diphtheria 8 8 7 7 14 16 12 12 7 9 12 6 118 Membranous Croup 0 0 0 1 4 1 0 1 0 0 0 1 8 Typhoid Fever 4 4 2 2 4 o 5 10 8 7 4 1 51 Simple Continued Fever 0 1 0 0 0 0 0 0 0 0 0 0 1 Relapsing Fever 0 0 0 0 0 0 0 0 1 0 0 0 1 Puerperal Fever 0 1 1 0 2 1 0 0 0 0 0 0 5 Erysipelas 9 6 13 5 13 3 9 11 6 10 18 8 111 Cholera 0 0 0 0 0 0 0 0 0 0 0 0 0 52 51 51 36 69 45 91 90 70 104 85 56 800 17 Table XIV.—Number of Cases of Infectious Diseases as they occurred in the Nine Wards of the District, and, the Percentages. Leyton. Lea Bridge. Central. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip Total. Small Pox - - - - - - - - - - Scarlet Fever 45 90 87 34 31 49 60 44 65 505 Diphtheria 6 21 24 18 16 4 14 6 9 118 Typhoid 12 4 6 1 7 2 12 2 5 51 Erysipelas 7 12 23 12 11 8 15 11 12 111 Membranous Croup 0 0 1 1 2 1 3 0 0 8 Puerperal Fever 0 2 1 0 0 0 0 1 1 5 Continued Fever 0 0 0 0 0 0 1 0 0 1 Relapsing Fever 0 0 0 0 0 1 0 0 0 1 Total 70 129 142 66 67 65 105 64 92 800 Percentage of Cases 8.8 16.1 17.8 8.2 8.4 8.1 13.1 8.0 11.5 - 18 Table XV.—Number of Cases Removed to Hospital from each Ward, including cases OCCURRED in West Ham Infirmary, but NOT those imported. Disease. Leyton. Lea Bridge. Central. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Small Pox 0 0 0 0 0 0 0 0 0 Cholera 0 O O 0 0 0 0 0 0 Diphtheria 1 7 12 13 7 2 5 2 3 Removed to London Hospital, 1. „ Homerton „ 2. „ North-Eastern „ 3. Membranous Croup 0 0 0 0 0 1 1 0 0 Erysipelas 0 1 3 0 0 0 1 1 1 Of these 4 were removed to London Hospital, 2toWest Ham Infirmary, and 1 to West Ham Hospital. Scarlet Fever 33 53 47 21 16 37 33 23 32 Removed to Homerton Hospital, 7. „ West Ham Infirmary, 3. „ London Hospital, 4. „ North-Eastern Hosp., 1. Typhus Fever 0 0 0 0 0 0 0 0 0 Enteric Fever 11 4 3 1 2 2 9 1 4 Of these cases 30 were removed to West Ham Inf., 5 to the London Hosp., and 2 to W'stow Hosp. Relapsing Fever 0 0 0 0 0 1 0 0 0 This case removed to London Hosp. Continued Fever 0 0 0 0 0 0 0 0 0 Puerperal Fever 0 0 1 0 0 0 0 1 0 Both of these cases removed to West Ham Infirmary. Plague 0 0 0 0 0 0 0 0 0 45 65 66 35 25 43 49 28 40 All these cases are not removed to Isolation Hospital, Leyton, unless otherwise stated. 19 Table XVa.—Cases Notified in Whole District (including Cases OCCURRED in West Ham Infirmary), but not THOSE IMPORTED. At Ages—(Years). At all Ages. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small Pox 0 0 0 0 0 0 0 Cholera 0 0 0 0 0 0 0 Diphtheria 118 1 39 53 16 9 0 Membranous Croup 8 0 7 1 0 0 0 Erysipelas 125 4 9 9 18 70 15 Scarlet Fever 526 3 207 258 36 22 0 Typhus Fever 0 0 0 0 0 0 0 Enteric Fever 54 0 3 21 10 19 1 Relapsing Fever 1 0 0 0 0 1 0 Continued Fever 1 0 0 1 0 0 0 Puerperal Fever 5 0 0 0 1 4 0 Plague 0 0 0 0 0 0 0 838 8 265 343 81 125 16 20 Table XVI.—Deaths per Cent. of Deaths notified (exclusive of Public Institutions). Cases. Deaths. Percentage mortality. 1904. 1905. 1904. 1905. 1904. 1905. Small Pox 6 0 0 0 0 0 Scarlet Fever 445 505 6 9 1.3 1.7 Diphtheria 150 118 14 10 9.3 8.4 Typhoid 43 51 10 9 23.2 17.6 Simple Continued Fever 3 1 0 0 0 0 Puerperal Fever 7 5 1 2 14.2 40.0 Erysipelas 99 111 3 6 3.0 5.4 Membranous Croup 3 8 0 3 0 37.5 Relapsing Fever 0 1 0 0 0 0 21 Table XVII.-Deaths from the Nine Chief Zymotic Diseases for the last Six Years together with the zymotic death-rate and rate of mortality from all other disease. 1900 1901 1902 1903 1904 1905 Small Pox - - 2 - - - Measles 13 31 15 37 25 26 Scarlet Fever 7 13 7 13 6 9 Diphtheria 27 36 36 27 14 10 Membranous Croup - - - - - 3 Whooping Cough 47 45 59 40 44 28 Typhus - - - - - - Typhoid 14 14 16 10 10 9 Diarrhoea 113 125 48 36 186 55 Total 221 264 183 163 285 148 Deaths from all other Diseases 958 979 1000 949 1085 1029 Death-rate from Seven Chief Zymotic Diseases 2.21 2.64 1.83 1.5 2.7 1.2 Death-rate from all other Diseases 9.5 9.7 10.0 9.3 10.4 10.0 General Death-rate 11.8 12.34 11.8 10.8 13.1 11.2 22 TYPHOID. Table XVIII.—Probable Causes of Infection. Imported 2 Eating Shell Fish 5 Complained of bad smells from ditches on marshes 2 Drinking water obtained from filthy cistern 1 In contact with previous cases 10 Untraceable Causes 29 Suspected Sources of Infection:— Bathing in Highgate Pond 1 Eating Watercress 1 In West Ham Infirmary:— Imported 45 Occurred in the Institution 2 West Ham Union Schools 1 Of the cases occurring outside the Infirmary 30 were moved into it, five into the London Hospital, and two into Walthamstow Hospital. Sanitary work was found on inspection to be necessary in 12 of the houses where Typhoid had occurred, and in six repairs were necessary to defective drains. The severest outbreak of Typhoid occurred during September and October in Temple Mills Crescent, where eight cases occurred in Nos. 19 and 20, four in each house, and one case at No. 15. Investigation of the original case, that of a boy of 8 years of age, proved that both water and milk supply to be perfectly pure. But I observed that the houses wherein these cases occurred were infested with flies, and fancy that herein lies the solution of the mystery. Probably the food supply was entirely unprotected from these pests, and though it may be an open question whether this disease can be fly-borne, still more care in the matter of protecting 23 food everywhere in hot weather from flies should always be taken. All these nine cases were removed to the Whipps Cross Infirmary, and one proved fatal. SMALL POX. There were no cases during the year. With reference to the Report dated December 20th, 1904, of the Committee. I communicated with the Metropolitan Asylums Board on the subject of Hospital Accommodation for Small Pox patients, and the reply of the Clerk to the Board intimated that the Board was prepared to receive cases upon these terms and conditions: — (a) The charge to be 85. per patient per diem with the addition of the actual out of pocket expenses incurred by the Board for funerals, clothing on discharge, and the use of the Board's Ambulance Services. (b) The arrangement to be terminable at short notice. After some correspondence a letter was received from the Clerk to the Metropolitan Asylums Board, intimating that the Board had sanctioned the reception into their Hospitals of cases of Small Pox from the Leyton District under the above conditions. VACCINATION. It will be seen at a glance from the following Table, that the objection to this operation is not so great as it used to be, although there are still some misguided people who apply for Exemption Orders. This, in spite of the overwhelming facts in favour of the treatment and in proof of the many lives saved by it. A glance will also reveal that in a large number of cases the child has been removed from the address where it was registered. It is to be hoped their parents or guardians are not joining the ranks of the objectors. Every endeavour is made to trace them, but many do not trouble to have the child vaccinated, although they have no objection to the operation. 24 These are precisely the classes of people who endanger the Public Health in the matter of an outbreak of Small Pox. We are, happily, at present free of the dread scourge, but we shall not always be so, and when it re-appears, then will be put to the test whether the district generally has availed itself of the one and only protection, viz., Vaccination. Births. Vaccinated. Insusceptible. Exempted. Dead. Postponed. Gone. 3208 2344 6 62 204 58 376 WHOOPING COUGH. This ailment was more prevalent than usual, and the Harrow Green School suffered mostly. VIOLENCE. Of the 38 deaths registered under this heading 11 were due to overlaying, 2 to murders, 3 to suicide from poisoning, 6 to other suicides, 3 to accidental drowning, 2 to accidental burns, 2 to want of attention at birth, and 9 to various accidents. CONSUMPTION. Bills have been distributed throughout the District warning the people of the possible consequences of expectoration in public places, &c., and wherever fatal cases have occurred the houses have been disinfected. 25 SCARLET FEVER. Table XIX.—Notified Cases of Scarlet Fever during the Past Five Years, with the Percentage Mortality. Cases Notified. Deaths. Percentage Mortality. 1901 396 13 3.29 1902 393 3 .76 1903 397 13 3.27 1904 445 6 1.3 1905 505 9 1.7 Sixty more cases were reported than last year, viz., 550 against 445, and there were 3 more fatal cases, viz., 9, as against 6 in 1904. The character of the disease was slightly more severe than in 1904. Of the total number of cases— 45 or 8.9 per cent. occurred in the Leyton Ward 90 „ 17.8 „ „ Lea Bridge „ 87 „ 17.2 „ „ Central „ 34 „ 6.7 „ „ Forest „ 31 „ 6.1 „ „ Leytonstone „ 49 „ 9.7 „ „ Grove Green „ 60 „ 11.8 „ „ Harrow Green „ 44 „ 87 „ „ Cann Hall „ 65 „ 7.2 „ „ Wanstead Slip „ DIPHTHERIA. The number of cases notified was 118 and the deaths 10, or 8.4 per cent. This compares favourably with the 9.3 percentage of 1904, and the decrease in the number of fatal cases may fairly be ascribed as largely due to the early application of the anti-toxin treatment. 26 TEMPORARY ISOLATION HOSPITAL. SCARLET FEVER. Under Treatment at beginning of year 42 Admitted 281 Discharged 260 Died 5 Under Treatment at end of year 50 DIPHTHERIA. Under Treatment at beginning of year 9 Admitted 48 Discharged 47 Died 6 Under Treatment at end of year 2 SCARLET FEVER. Five cases proved fatal during the past year as against one in 1904. The causes of death were as follows:— i. A male aged 18 was in Hospital three days, the actual cause of death being an Epileptic Seizure, ii. A boy aged 4 was in Hospital two days. Cause of death Broncho-Pneumonia. iii. A girl aged 5 was in Hospital 15 days. Acute Meningitis was the cause of death. iv. A boy aged 8 was in Hospital only 15 hours before he died of Scarlet Fever and Bronchitis. v. A boy aged 3 was in Hospital 11 days when he died of Scarlet Fever and Cardiac Failure. The mortality rate of 1.7 per cent. is a very satisfactory one, although not so low as the .45 of 1904. 27 DIPHTHERIA. There was six deaths from this disease—one notified as Membranous Croup being included—in Hospital, and the following details show that four of them were in a hopeless state on admission. i. A male aged 2, died immediately on admission. ii. A female aged 2 was in Hospital 10½ hours. Cause of death Laryngeal Diphtheria with lung complications. iii. A male aged 4 was in Hospital three days before death ensued from Heart Failure. iv. A female aged 3 was in Hospital months when she died of Paralysis. v. A baby aged 5 months died 6 hours after admission. vi. A girl aged 2 was admitted in a state of collapse. Tracheotomy was performed shortly after admission, but the patient succumbed during the operation from collapse, the result of Membranous Croup. With the admission of more than half of the above cases in a hopeless condition it is only natural that the rate of mortality, 12.5 per cent., should this year be higher than the exceptionally low 8.0 per cent, of 1904. In four cases the operation of tracheotomy was completely successful. It is well worthy of note that the gradual decrease in the number of Diphtheria cases dates from the institution of careful house-to-house inspection. The following figures are eloquent of the splendid work done by the Sanitary Staff during the past few years in the improvement of the general health of our district. 28 Table XIXa.—Diphtheria and Membranous Croup. The number of notifications received since the adoption of The Infectious Diseases (Notification) Act, 1890, and Deaths and Percentages. Year. Population. Number. Deaths. Percentage Mortality 1890 64,000 210 47 22.3 1891 (Census) 63,000 301 65 21.5 1892 63,000 252 36 14.2 1893 64,000 277 49 17.6 1894* 70,000 310 34 167 1895* 75,000 410 72 17.5 1896 77,000 195 25 12.9 1897 85,000 156 20 12.8 1898 90,000 162 28 17.2 1899 93,000 216 31 14.3 1900 100,000 224 28 12.5 1901 (Census) 100,000 261 36 13.7 1902 100,000 245 36 14.6 1903 102,000 187 27 14.4 1904 104,000 154 15 9.7 1905 105,000 126 12 9.5 House-to-House Inspection started on the 18th June, 1895. *1894. Outbreak in the Bethnal Green Schools, 96 cases occurring therein, all of which were removed to Homerton Fever Hospital. As I had no information of how many of these proved fatal, therefore, the percentage rate of mortality is probably much higher than herein mentioned. *1895. Outbreak in the West Ham Union Schools. 29 scarlet fever. Table xx. N amber 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 capes treated in Hospital. 1900 243 142 58.4 40 2.8 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 1905 505 281 55.6 40 1.7 1.7 DIPHTHERIA. 1900 201 63 31.3 10 11.9 15.8 1901 255 101 25.1 10 14.1 18.8 1902 236 71 30.0 10 14.8 28.1 1903 185 48 25.9 10 14.6 16.1 1904 150 50 33.3 10 9.3 8.0 1905 118 48 24.4 10 8.4 12.5 It is with great satisfaction I notice that in spite of the great opposition made about three years ago to erecting a Permanent Hospital in the vicinity of the present one, parents have not been unwilling to allow their children to be removed there. In fact, the past year has been a record one for admissions, and the record would have been a much greater one had we been able to accommodate all who applied for admission. The number treated in the Scarlet Fever Hospital exceeded that of 1904 by no fewer than 61, 30 viz., 281 as against 220. It is gratifying to notice that after all the dreadful objections raised against our present Hospital, it can still hold its own, as its records, which are, in my opinion, as good as those of any other Hospital in the United Kingdom, clearly prove. SCARLET FEVER. Table XXI. Year. Notified. In District Deaths In Hospital. Admissions to Hospital. 1897 510 17 3 177 1898 350 5 1 139 1899 315 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 1905 505 9 5 281 3554 81 36 1632 The District Death Rate over this period is 2.2 per cent. The Hospital Death Rate over this period is 1.01 „ 31 DIPHTHERIA. Table XXII. Year. Notified. In District Deaths In Hospital Admissions to Hospital. 1897 156 20 2 30 1898 162 28 5 40 1899 200 31 15 62 1900 201 27 10 63 1901 255 36 19 101 1902 236 36 20 71 1903 185 27 8 48 1904 150 27 4 50 1905 118 10 6 48 1663 242 89 513 The District Death Rate over this period for Diphtheria is 14.5 per cent. The Hospital Death Rate over this period for Diphtheria is 17.3 „ 32 Cases of Infectious Diseases Removed to Hospital During the Year 1905. Notifiable Disease. At Ages—(Years). At all Ages. Under 1. 1 to 5. 5 to 15- 15 to 25. 25 to 65. 65 and upwards. Scarlet Fever 281 0 63 194 19 5 0 Diphtheria 47 3 16 23 5 0 0 Membranous Croup 1 0 1 0 0 0 0 Totals 329 3 80 217 24 5 0 33 PERMANENT ISOLATION HOSPITAL. As I mentioned in my last Report, the question of erecting athoroughly up-to-date Isolation Hospital was again under consideration, and plans had been drawn up which, if carried out, meant an expenditure of between thirty and forty thousand pounds. But owing to a doubt whether the benefits to be derived would compensate the outlay of such a. sum, as also to the fact that rates Tire deemed sufficiently high at present, the Council do not feel disposed to embark upon such an expenditure at the present moment. This being the case, and owing to the diffkculty I have in coping with the demands for cases requiring immediate removal owing to the inadequate accommodation at my disposal, I am asking that a Convalescent Block be erected, also further dormitory accommodation. This is simply an imperative necessity in order that I may be able to deal with some measure of success with the pressure that hasbeen especially great during the past five months. Pressure, too, which does not appear at all likely to diminish with a steadily increasing population. I can only manage at the present time with the very greatest difficulty in urgent cases. With the erection of this new Block, I shall be able to accommodate all cases of Scarlet Fever requiring isolation. As I have hinted in the past, the desire of parents to have their children removed to the Hospital speaks well for the past working of that establishment. MORTUARY. A Sub-Committee was appointed to inquire into the matter asto whether a new and larger Public Mortuary was not necessary for the District. The Sub-Committee were unable to recommend a more suitable site than the present one. Owing to the construction of a "viewing room" with glass panels, relatives and others wishing to see the body are now 34 •enabled to do so without the discomfort of having to go into the Mortuary itself where other bodies may be lying. Other alterations have been made of much benefit to those who have to make Post-Mortem Examinations. The number of bodies moved to the Mortuary during the year were 62, and 14 Post-Mortems were made. ST. MARY'S CHURCHYARD EXTENSION. An application having been made by the Vicar of Leyton to the Home Office for the extension of the Parish Churchyard to include some of the adjoining land, the Local Government Board held an enquiry on February 9th and the application was not opposed by the Council. The Home Office sanctioned the extension, but I do not know under what conditions they have done so. On my applying to the Home Office for an excerpt from the permission accorded to the Vicar of Leyton, they did not see their way to grant me, as Medical Officer of Health to the Council, the desired information. 35 PUBLIC INSTITUTIONS WEST HAM UNION WORKHOUSE, INFIRMARY, AND SCHOOLS, INCLUDING FOREST HOUSE. Births:—There were 179 births, 88 males and 9.1 females, a total of 3 less than in 1904. Deaths :—There were 876 deaths, viz., males 522 and females 354. Causes of Death. Under 5. Over 5. Total. Small Pox 0 0 0 Measles 1 0 1 Scarlet Fever 1 0 1 Typhoid 1 10 11 Erysipelas 0 7 7 Rheumatic Fever 0 2 2 Diarrhoea 16 0 16 Enteritis 9 0 9 Phthisis 0 137 137 Tubercular Diseases other than Phthisis 8 22 30 Respiratory (Diseases of Organs) 17 118 135 Heart Disease 0 114 114 Premature Births 8 0 8. Influenza 0 1 1 Whooping Cough 4 0 4 Cancer 0 74 74 Violence 1 19 20 Diphtheria 0 0 0 Puerperal Fever 0 5 5. Simple Continued Fever 0 1 1 All other Diseases 51 249 300 117 759 876 36 Cases of Infectious Diseases occurring in the Union. Scarlet Fever 18 cases, of which 6 were imported Diphtheria 2 „ 2 „ Typhoid 47 „ 45 „ Erysipelas 53 „ 39 „ Puerperal Fever 6 „ „ 6 „ THE INFIRMARY, WHIPPS CROSS ROAD. During the year there were:— 5230 Admissions. 4206 Discharged. 839 Deaths. 4 Births. There are now 741 beds in this Infirmary, of which 56 are used for male, and 28 for female Phthisis cases. Two wards containing 22 and 20 beds respectively are set apart for the reception of female and male cases of persons alleged to be insane. These are kept long enough to enable their disease to be correctly diagnosed and to determine the necessity for sending them to an Asylum, and many cases are eventually discharged. The nurses in both wards are specially trained. 253 surgical operations were performed under general anaesthaesia during the year. BETHNAL GREEN SCHOOLS. The general health of the children at these Schools has again been very good. There were three cases of Diphtheria in June and November. The cases of Scarlet Fever notified in November originated in the Receiving Wards from the children coming in contact with a freshly admitted child, who was afterwards found to be desquamating. 37 The whole of the cases referred to were removed to Homertorr Hospital. No deaths occurred. There are 274 boys and 209 girls in the above Schools. SANITARY WORK. Under the most capable supervision of Capt. Miller and his energetic staff the following sanitary work has been properly carried out. Details are as usual culled from Capt. Miller's Report:— Houses inspected 3018 Connections of drains tested 3004 Notices served 1784 Complaints received 380 Defective drains remedied 246 W.C.'s in defective state, new traps and straight backed pans provided where necessary 478 Sink, bath and lavatory wastes, and rain pipes made to discharge in open air over trapped gullies 286 Defective gullies replaced, and defective connections of gullies remedied 383 New sink and bath waste pipes provided and repaired 88 New salt-glazed stoneware sinks provided 50 Bath, waste and lavatory sink pipes trapped immediately under arrangement 41 Ventilating shafts repaired, also provided to soil pipes and drains 132 Defective soil pipes remedied, &c. 6 Flush cisterns supplied to w.c.'s with efficient flush pipes 37 Flush cisterns and flush pipes repaired 209 Yards paved around back additions of houses and forecourts paved or repaired 249 Yards cleansed 40 38 New manhole covers provided and sealed 26 Manholes rendered and repaired 5 Ventilation provided under flooring 11 Floors of sculleries paved and repaired, and cellars and floors drained and concreted 61 House roofs and guttering repaired and renewed 181 Houses in a general insanitary, dilapidated, or filthy condition, repaired and cleansed 731 Walls of back additions properly rendered 15 Plots of land in an insanitary condition 23 Nuisances abated arising from stagnant water in basements of houses 17 Air inlets provided to drains and repaired 49 Stables paved and drained 14 Mews in filthy condition paved, drained ,and cleansed 8 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 97 Houses without water supplied by the Metropolitan Water Board and water supplies to houses restored and improved, water fittings repaired 119 Covers to domestic water cisterns provided 503 Domestic water cisterns removed from improper positions, or cleansed or repaired 118 Nuisances by overcrowding 10 Nuisances caused by fish, offal, manure, and other refuse deposits 60 Animals kept in an insanitary state 29 Houses disinfected, walls stripped, limewashed, &c. 588 Books disinfected 103 39 Receptacles for fish offal 1 Smoke nuisances abated 9 Pig nuisances abated 4 Plots of land fenced in 7 Squatters removed 2 Cesspool closed 1 COWSHEDS AND DAIRIES' ACT. During the year the Cowsheds of the District have been visited periodically, and where overcrowding was found, notices were served, and the nuisances abated. In some cases it was found necessary to have alterations carried out to provide efficient ventilation, drainage, paving, &c. Fifteen dealers were registered during the past year, and in two cases, where infectious diseases occurred, immediate steps were taken to remove the patients, and to carry out the requisite disinfection, as well as to have the milk found on the premises destroyed. SLAUGHTER-HOUSES. Periodical and systematic visits were paid to the Slaughter Houses, and in three cases, nuisances against cleanliness were found to exist. The occupiers were made to remedy these. There are 19 Slaughter-Houses in the District. Four licenses have been transferred during the year and one surrendered. ANTHRAX. Notices of warning with regard to this very dangerous and fatal disease having been received from the Local Government Board, have been posted up in all the Slaughter-Houses of the District. UNSOUND FOOD. During the year, 12 cwt. of tinned food, fruit, and fish was found on inspection to be unfit for human food. It was at once destroyed. 40 In one instance a quantity of tinned milk in a blown and putrified state was discovered on some premises in Harrow Green. The milk was seized and, by order of the Magistrate, destroyed, while the owner was convicted, and sentenced to pay a fine of 405. and costs. SEWERS. During the year several alterations and additions to the sewers and surface water drains have been carried out. The principal items being a new sewer in Ferndale and Montague Roads, where 270 yards of new sewer was laid to improve the gradient, constant complaints having being received. The cost of this work was £92 4s. 6d. An extension, 110 yards in length, of the surface water drain in Ferndale Road was put in to drain the Wanstead Flats. The cost of this work was £17 3s. 9d. 220 yards of new sewer was put in in Blue Row, owing to numerous complaints having being received. The cost of this work was about £200. A new length of sewer was put in at the end of Stewart Road to improve the drainage of seven houses in Manby Road and seven in Stewart Road. The cost of this work was about £22 8s. A commencement has been made on a new sewer in Cann Hall Road to replace existing broken sewer. The contract amount for this work is £2,771 19s. SEWER VENTILATORS. Forty-eight ventilators have been provided to the Council's sewers from January to December, 1905, distributed in the different Wards, as follows Forest. Leytonstone. Lea Bridge. Leyton. Central. Grove Green. Cann Hall. Harrow Green, Wanstead Slip. Total. 14 8 5 4 13 2 0 2 O = .48 41 POSITIONS OF DOMESTIC WATER CISTERNS. It is often found in inspecting houses that very little attention has been paid to the suitable position of domestic water cisterns. Frequently these cisterns have been found placed beneath the flooring of first floor rooms (usually bedrooms), without covers other than the flooring itself, and in some cases quite inaccessible for cleansing purposes. Water in such cisterns must necessarily become seriously polluted. Also, in many of the new houses the cisterns are placed immediately over the coppers, which are often used for the purpose of boiling dirty clothes, &c. I am of opinion that emanations from the same would be likely to contaminate the water. I recommend in all new buildings that this matter should receive attention. The Public Health Department, during their inspections, are requesting that in the older houses the cisterns should be more suitably located. FACTORY AND WORKSHOP ACT. The number of Workshops is 97. These premises, as well as the dwellings of 222 Outworkers, 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. It was necessary to serve 62 notices to remedy defects found. PETROLEUM LICENSES. Eleven licenses have been renewed, and two transferred. 42 INFECTED BEDDING. The Committee have recommended that in future a charge of Ios. be made, my discretion to govern any questions on the point, for disinfecting Bedding in connection with cases of non-notifiable Infectious Disease, such charge to include removal and return by the Council of the articles disinfected. DIRTY PAVEMENTS. I wish to draw attention to the very inadequate manner in which our pavements are cleansed. They should be tended with even more scrupulous care than the roadways for the reason that pedestrians make more use of the pavement than the road. They are therefore more likely to run risk of infection from expectoration and excreta often left lying for days and days on the public path. Especially is this so in the angle formed by the wall of a house and the pavement. This I might almost say is never touched and most certainly is never really clean. URINALS. The public lavatory accommodation for our growing District is quite inadequate. In my Annual Report three years ago I drew particular attention to this, but still there is no suitable accommodation for males between the Leyton and Hoe Street Stations of the Great Eastern Railway, and none whatever for females. With so many tram and 'bus lines converging upon the "Bakers' Arms" that site is a very good one, in fact the best for the immediate construction of suitable premises. In the summer months large crowds pass that locality, and much inconvenience and not a little nuisance are caused by the want I have alluded to. DUST COLLECTION. 20169 tons 2 cwts. of house refuse, comprising 15546 loads, have been deposited at the works of the Destructor this year, 43 CONCLUSION. Again it is my pleasant duty to be able to place on record the expression of my thanks to Captain Miller and Messrs. Gray and Forsyth, and the very able and industrious Sanitary Staff under them, for the unflagging energy with which they have at all times carried out their duties in supervising and safeguarding the interests of the Public Health. In this particular matter I wish to draw attention to the figures relating to Diphtheria, which conclusively prove the value of the unremitting labours of Captain Miller's department. Speaking generally, the past has been a very healthy year; but, bearing in mind the maxim "Forewarned is forearmed," we can best ward off outbreaks of disease, that must inevitably occur, by minute attention to details to which, wherever I have considered it my duty to do so, I have drawn attention. I am, Gentlemen, Your obedient servant, A. F PESKETT, Medical Officer of Health. Leyton, March, 1906.