MID 1 ANNUAL REPORT ON THE SANITARY CONDITION OF THE DISTRICT OF THE MIDDLE TEMPLE FOR THE YEAR 1984 BY THE MEDICAL OFFICER OF HEALTH 1 ANNUAL REPORT ON THE SANITARY CONDITION OF THE DISTRICT OF THE MIDDLE TEMPLE BY THE MEDICAL OFFICER OF HEALTH To the Sanitary Authority for the Middle Temple. Sir, Herewith I hare the honour to submit to you my Annual Report for 1894 prepared in accordance with the provisions of "The Pablic Health (London) Act , 1891.* The Middle Temple, as you are aware, is one of the eight places mentioned in Schedule of the Metropolis Local Management Act, 1855, as forming a separate Snaitary District. The Sanitary Authority few the execution of the provisions of the Health Act of 1891, within the Middle Temple, is defined by Section 99 (1) (e) of the Act, as the Overseer of the Poor for the district, Since the Under-Treasurer becomes, by virtus of his office, "ex-officic" Overseer of the Poor, it 2 follows that he is also the Sanitary Authority. Sections 106 and 107 of the Public Health (London) Act enjoin that every Sanitary Authority shall appoint:- (a) One or more Medical Officers of Health for their district; and, (b) An adequate number of fit and proper persons as Sanitary Inspectors, and every each Inspector shall be a parson qualified and competent by his knowledge and experience to perform the duties of his office. The following facts may be gleaned from a perusal of the table given in the Appendix:- Area. The Middle Temple covers 4 acres. Houses. At the Census of 1891 there were 30 inhabited and 16 uninhabited houses, containing an average of 3.1 ents to each house. According to the 1881 Census the number of houses Inhabited and population was exactly the same as in 1891.Ths Middle Temple has a population density of 23.7 persons to an acre as against 57.1 par acre for the whole of tendon. Population. As in 1801, so in 1891, the masher of those occupying residential chambers in the Middle Temple was 95. The diurnal or visiting population, however, is a much larger one than that made up of those who pass both day and night in the Inn. 3 VITAL STATISTICS By the Act, 20 Vict. c.19. s.3., it is provided that the Middle Temple shall not be added to any Union. In other words it is extra-parochial and for purposes of registration - of births, deaths and marriages - is Joined to the sub-district of St. Clement Danes, which again forms part of the Strand registration district. There have been no births during the years 1893 and 1894: Neither has any marriage been solemnised in the Temple Church during the same period or indeed for that matter for many years past. Too deaths occurred in 1894, namely - (1) A male, aged 59, whose death was due to congestion of the longs followed by perforation of the stomach; and, (2) A female, aged 68, whose death was caused by heart disease diabetes. No deaths were recorded during 1893. The fewness of residents in the Middle Temple, coupled with the a absence of births, and comparative freedom from infectious disease, renders it unnecessary for me to fill up the two elaborate tables furnished by the Local Government Board. Of these printed forms, the one marked A., is a Table of Deaths, during the year 1894, classified according to 4 Diseases, Ages, and Localities. Table B., on the other hand, is not concerned with Mortality, but with Population, Births, and Infectious sickness. It goes without saying that it would be absurd for me to calculate the death-rates in the manner indicated by the Local Government Board. These printed forms are doubtless valuable to Medical Officers of Health in areas larger and more thickly populated than is the case with your "Township" of the Middle Temple. Any deductions drawn from such a source would merely furnish fallacious and misleading figures. THE NOTIFICATION OP INFECTIOUS DISEASES Certain infectious diseases have been made notifiable in London since the passing of the Infectious Diseases (Notification) Act, 1889. They comprise:- Small-pox, cholera, diphtheria, membranous croup, erysipelas, the diseases known as scarlatina or scarlet fever, and the fevers known by any of the following names:- typhus, typhoid, enteric, relapsing, continued, or puerperal. With the single exception, in 1894, of a case of scarlatina, which ended in recovery, no notifications of any of the mentioned diseases have been received by me during the years 1898 and 1894. Neither have there been any deaths recorded 5 from the other preventable children's "zymoties" known as measles, whooping cough, and diarrhoea. These latter deadly diseases are - at present - unnotifiable in London and, therefore, outside the knowledge and control of the Medical Officer. However, the Middle Temple is not much concerned with these facte owing to the smallness of its Juvenile papulation. The case of scarlatina (in a male adult) already referred to was mowed to a paying ward of the London Fever Hospital, in Liverpool Street. The infected chambers were efficiently cleansed and disinfected by the Officers of the Commissioners of Sewers of the City of London, and there was no subsequent spread of the disease. It may interest your Authority to learn the fewer vac in all probability contracted outside the precincts of the Temple. Whilst treating the subject of infection, it may be convenient to remind your Authority of a former report, submitted in compliance with your instructions, on - (a) Disinfection; and (b) Mortuary Accommodation. In that report, I pointed out that under Section 59 of the Public Health (London) Act - (1) Every Sanitary Authority sha11 provide either within or without their district, proper premises with all necessary apparatus and attendance for the destruction and for the 6 disinfection, and carriages or vessels for the removal of articles (whether bedding, clothing, or ether) which have become Infected by any dangerous infectious disease. (2) Any Sanitary Authorities may execute their duty under this Section by combining for the purposes thereof, or by contracting for the use by one of the contracting authorities of any premises provided for the purpose of this Section by another of such contracting authorities, and may so combine or contract upon such terms as may be agreed upon. In accordance with these provisions, I advised your Authority to seek to combine or contract with the Commissioners of Sewers of the City of London. This was done with the effect that the Commissioners gave a favourable consideration to the proposal and offered to disinfect free of charge, which offer was accepted by your Authority. The Disinfector in use by the Commissioners is the modern and very excellent one invented by Mr. Lyon. It may be described as a large iron cylinder filled with steam, which is super-heated by means of a steam jacket. It is further supplied with a vacuum apparatus, by means of which the disinfection of such articles as thick mattresses is rendered certain and thorough. With regard to Mortuary Accommodation, I called your attention to the following Sections of the Health Act:attention to the following Sections of the Health Act:- 7 88. Every Sanitary Authority shall provide and fit up a proper place for the reception of dead bodies before interment (in this Act called a Mortuary); and, 91. Any Sanitary Authorities may, with the approval of the County Council, execute their duty under this Act with respect to mortuaries, by combining for the purposes thereof, or by contracting for the use by one of the contracting authorities of any such authority provided by another of such contracting authorities, and may so combine or contract upon such terms as may be agreed upon. After searching in vain throughout the Temple for a suitable place for use as a mortuary, I advised your Authority to ask permission of the Commissioners of Sewers to utilise theirs. This request was readily granted, but happily, there has been, so far, no occasion to five practical effect to the offer of the City Commissioners. THE WATER SUPPLY The water in use in the Temple is applied by the New River Company, and is derived from the Lea. the water is "hard." It is, therefore, wasteful of soap. It is also unsuitable for use in steam and kitchen beilers and hot-water pipes, in which it produces incrustations and deposits. The 8 hardness of the water is almost entirely due to the presence of bi-carbonate of lime in solution. This is easily reducible by treatment with lime before delivery, a practice already successfully carried out by the Colne Valley Company. The water la under fair pressure and the supply is a constant one. In those buildings, where such is not already the case, I would strongly urge your Sanitary Authority to supply water for domestic use direct from the rising main. This could easily be effected, at a trifling cost, by the addition of a screw-down tap connected with the main in each set of chambers. Where drinking-water cisterns exist they are often badly placed, as for instance, directly over or in close proximity to W.Cs; However well situated, there is always more or less liability of their becoming foul and a danger to health, hence the value of an uncontaminated supply from the rising main. With the arrangement suggested, the cisterns might continue to supply the water-waste preventors which flush ths W.Cs. BYE-LAWS UNDER THE PUBLIC HEALTH ACT This Act provides that every Sanitary Authority in the Metropolis shall Make bye-laws under the following Sections:- Section 16. For the prevention of particular nuisances. 9 Soction 39. Water-Closets to be sufficiently supplied with water; Section 50. The cleansing of cisterns. Your Sanitary Authority has made such bye-laws, which have received the approval of the Local Government Board. DRAINAGE I am pleased to be able to report that as plana of construction proceed the complicated and dangerous form of closet known as the "pan" is gradually disappearing. It is being replaced by the more cleanly and modern "pedestal" with siphon trap in lieu of D trap and "container.* The chief disadvantages of the "pan" form of closet are, that there is always a collection of foul water in the D trap; foul air collects in the iron box or container and escapes into the house when the handle is pulled and the contents of the pan discharge; and the Interior of the container, too, gets foul from the splashings on the sides. All cash closets should, in my opinion, bo removed as speedily as possible. From a perusal of the list compiled by year Sanitary Inspector, and given in the Appendix, it will be seen that 10 20 new Pedestal W.Gs. have replaced these of the "Pan and Container" form during the past year With a view to a lessening of the danger of such waterborne diseases as typhoid fever and cholera, I would suggest that every W.C. within the district should be furnished with a cistern of adequate capacity for the purpose of flushing. Also that such cistern should be separate and district from any cistern liable to be used or likely to be used for drinking or domestic purposes. The great danger of supplying a water- closet direct from a water main instead of through the Inter- vention of a cistern has been shewn by numerous outbreaks of enteric (typhoid) fever which have resulted from the adoption of the former practise, a method of supply which during tional or unavoidable Intermissions in the water-service facilitates and ensures the forcible suction of foul air and, at times, other matters into the mains of the water-service. Hence the provision of service-eisterns for water-closets should be insisted en, so as to ensure a complete break between the interior of the closet basin and the water-main; but even when such a cistern id provided, there still remains a tendency for the escape of foul air from the basin of the closet up the service-pipe and through the body of water in the cistern itself, thus leading to contamination of the water. It is, therefore, further important that water-closet cisterns 11 should supply water-closets only, and that no other supply pipes should bo carried from them. The ordinary water waste-preventing cistern answers the purpose effisiently. Much good work has boon carried out during the past 18 months in the shape of alterations whereby buildings have been rendered proof against the entry into them of drain and sever air. Your Authority, however, should not rest content until the three following rules have in all eases, whenever possible, been put into practice- (1) The provision of soil pipes four inches in diameter, fixed outside the buildings, and carried up full bore to the tops of the houses so as to afford, by swans of their open ends, a safe outlet for foal air. (2) The disconnection of house drains from the sowers, by swans of suitable traps with fresh air inlets, at a point . as near the severs as possible. (3) The prevision of anti-siphonage ventilating pipes in all cases where one soil-pipe receives the discharges of two or more W.Cs. placed on different floors; and the carrying up of such anti-siphonage pipes form each W.C. branch pipe to join the veatilaters to the soil pipes. The scavenging of the Inn, including the removal of house refuse, has been efficiently done daily (Sundays excepted) during the past year. 12 In the summer months especially the gullies and sewers were frequently flushed with a plentiful supply of water, and disinfectants were likewise freely used. This precaution is the more needful in view of the small resident population in the Temple and consequent comparative disuse of the drains and sewers. During 1894 the electric light has taken the place of gas In the Hall, Library, Kitchens, Corsnon Rooms, and many other of the buildings. In conclusion, I would bear testimony to the value of the Gardens as an open space for the inhabitants of the neighbourhood not lest than to those of the Inn itself. All members of the Inn have free entry to the gardens and others by orders given by the Matters ef the Bench. For seme years past the Bench has thrown open the Gardens to the children of the neighbouring slumns during the sunnier tenths from 6 p.m. to sweet. It may be of interest to note that wood-pigeons have rested in the plane tree above the fountain In Garden Court, My report would be incomplete without am acknowledgement of the uniform kindness and courteous assistance received at the hands of all those I have been brought Into contact with 13 in the performance of my duties. I have the honour to be, Your Obedient Servant, F.J.Waldo, M.A.,M.D,,Cantab,,D.P.H. ) Medical Officer of Health. 1.Plowden Buildings, Temple, B.C. 14 APPENDIX A. The following table - copied from the Census Returns of 1891 - gives (a) the area in acres; (b) the number of houses; and, (c) the population as enumerated for the years 1881 and 1891 - of the Middle Temple. HOUSES Area Inhabd Uninhabd Buildings Inhabd Uninhabd Building in 1881 1891 ... Statute Acres. 4 30 10 - 30 16 - POPULATION Persons Males Females 1881 1891 1881 1891 1881 1891 95 95 74 75 21 20 15 B. THE REPORT OP THE SANITARY INSPECTOR List of W.Cs, in the Middle Temple. 1893 August 1 Brick Court 2 pair East New Pedestal W.C. 2 Brick Court 3 pair South New Pedestal W.C. 5 Pump Court 3 pair North do• do• October 6 Pump Court 1 pair West New Pedestal W.C. December 32 Essex Street W.C. on Ground Floor in place of old. New Pedestal 1894 February 3 Plowden Buildings Around Floor South Nov Pedestal W.C. 3 Essex Court 2 pair North New Pedestal W.C. in place of old. 2 Plowden Buildings 1 pair North do. do. April Goldsmith Buildings 1 pair West Nov Pedestal W.C. In place of old. May 3 Plovden Buildings 2 pair North & 1 pair North. 2 Nov Pedestal W.Cs. & Nov soil Pipe. Lamb Buildings 3 pair South Nov Pedestal W.C. August 6 Pump Court 3 pair Bast New Pedestal W.C, May 4 pump Court New Pedestal W.C. put on 2nd. Floor. August 2 Brisk Court 2 pair South Nov Pedestal W.C. in place of old. 16 Lamb Buildings 2 pair South New Pedestal W.C. Goldsmith Buildings Ground Floor West . New Pedestal W.C. in place of old. September 6 Pump Court Ground Floor East do. do. Goldsmith Buildings Basement East New Pedestal W.C. in place of old. 3 Essex Court 3 pair South do. do. October Goldsmith Buildings Ground Floor East New Pedestal W.C. in place of old. Goldsmith Buildings 1 pair Bast do. do. November 2 Brick Court 3 pair North do. do. December 2 Brick Court 1 pair North New Pedestal W.C.