HAML 7 REPORT OF THE MEDICAL OFFICER OF HEALTH TO THE VESTRY OF ANNUAL REPORT, JUNE, 1859. London: PRINTED BY F. S. NEWELL, ASSEMBLY ROW, MILE END ROAD. 1859. REPORT. Gentlemen, It will doubtless afford you pleasure and satisfaction to learn by the Report which I have now the honor to present to you, that, notwithstanding the mortality of London, and of England generally, was universally great during the past year, yet, that the number of deaths in Mile End Old Town was less than in 1857, the year preceding; and when the numbers are corrected according to a supposed rate of increase of population, it is very evident that we have enjoyed during the period a remarkable immunity from sickness of a mortal character. The rate of mortality in Mile End has been heretofore greater than that of the whole metropolis; last year it was less. It would be assuming too much to attribute this reduction of disease and death to sanitary improvements solely; nor, on the other hand, would it be fair to deny them a considerable share of credit. About November last the mortality of London was very high. Measles, Scarlatina, and Whooping Cough, together with diseases of the respiratory organs produced by sudden and intense cold, combined to cause the number of deaths 4 in the metropolitan districts to be nearly doubled. The first of these diseases, which have long remained amongst us, more annoying by their permanence than severity, became, by some unknown cause dependent on their nature, suddenly mobilised, and more frequently brought under our notice in the Weekly Returns of the Registrar-General. During the whole of this period of prevalent sickness, our district was so far free from unusual morbid influences, that the weekly number of deaths was below their average. Part of this excellent state of general health was doubtless owing to the improvements which have been made at the public expense, part to the better regulation of drainage and matters of general cleanliness, a part also to the spirit which has been thereby imparted to the units which compose the public, who have caught the influence, and have contributed to maintain that position to which the public improvements have led the way. But a part appears to be owing to a power higher than the control of human will; in a word, that we have been less subjected to the influences producing disease than some of the neighbouring districts. The visitations of disease were so far partial, that although the city of London, and some of the suburbs more distant from the city than Mile End, suffered severely, several places, our own Hamlet amongst them, maintained at least their ordinary state of public health. The records of the Registrar-General for the year 1858 make known to us that to the 25th of December, 1511 persons died in our Hamlet, being 33 less than in the previous year. But assuming that the population has increased at the rate of two and a half per cent. annually, in 1857 (a healthy year) one person died during the twelve months to every 41 living, in 1858 the proportion was one person to 43 living. 5 The rate for the whole of the London districts was between 23 and 24 to every 1000 living; that of the eastern division,* of which we form a part, 25.30. The rate for Mile End in the same period was 23, but when corrected according to the supposed increase, 21.35. (See Table No. 2.) When the deaths which have taken place in the Workhouses and other public establishments are added, the rate will be, upon the estimation of 1856,—24.9; upon the same, corrected to Christmas, 1858,—23.3. It has been observed that whenever the mortality of the six months after the summer solstice is much greater than the mortality of the preceding six months, the absolute mortality of the place is high. If we apply this test, which has been founded upon many observations made throughout Europe, to Mile End, we shall have a very favorable result. In 1857, if we take the two first quarters and compare their amount with the two last, the latter is in excess, but not greatly so, and the public health consequently was good. In the first six months of the year we had 761 deaths, and the last 783. In 1858 the amount of the last two quarters was less than that of the first: the first half year 769, the second 742. The comparison is clearly favorable to the state of health of ihe past year. The proportion of zymotic disease to that produced by other causes is much less than was shown last year. But the disproportion is explained by the practice which has been adopted of sending fever cases, which were formerly treated in the workhouse infirmary, and which became a sort of hospital for such diseases, to the Fever Hospital at Islington. * The Eastern Division contains Shoreditch, White chapel, St. George in the East, Stepney, Mile End, Bow, and Poplar. 6 The proportions of zymotic cases in the five Wards have varied from last year's statement, being greater in the North and East Wards, and less in the West and Centre, that in the South remaining nearly the same. The numbers will be seen in Table III. In making the estimate I have, as before, only taken six prominent diseases of the zymotic class to represent the whole, several others, less common, being now considered as possessing their peculiarities, and classed with them. It will be a useless occupation of space and time to comment upon the whole of the causes of death, inasmuch as they are completely exhibited in the Table (No. 5). I think it will be sufficient to notice the most important of them. The number of cases of fever,—that is, typhus and typhoid* fever,—is nearly the same as in 1856 and 1857. The little variation, besides showing a slight diminution in 1858, being presumptive proof of the absence of epidemic character. There is nothing, either, worthy of remark, with regard to its localization. Two diseases appear in the Table which did not have a place in it last year,—Diphtheria and Small Pox. The former appears in its character and course to be closely allied to Malignant Scarlatina, and the proportion of cases, as well as deaths, I believe to have been particularly small. It is a very fatal disease, and is developed and intensified by the same causes which influence Scarlatina. But, residing in a district in which there have been so few cases, it may be satisfactory, in regard to the public health, to state that my own experience with regard to the disease has been very limited. It is, however, clear, that it is best * These are two varieties of Fever. Typhus is caused principally by over-crowding of individuals,—Typhoid Fever by effluvia from cesspools and sewers, also by emanations from decomposing organic matter. 7 combated by preventive measures, by employing general means of sanitary purification which can never be effected in vain. My own observation leads me to consider that Scarlatina finds circumstances more favorable to its existence in the unwholesome condition of newly-built houses than other diseases of its class. In several instances I have found that where a new neighbourhood has been formed, and the houses have been rapidly occupied, disease has been for the most part of a light kind, with the exception of Scarlatina, which has not only been frequent but severe. I may instance, in our own district particularly, the new houses between Bow Common Lane and Rhodeswell, and, in a less degree, those in Globe Fields. In Poplar New Town, adjoining Bow Common, and in Old Ford, both of them contiguous, or nearly so, to Mile End, and recently built on and occupied, I am informed by medical men who practise in those parts, the disease has been rife. The mitigation of the disease in this particular respect can scarcely be effected by any exercise of power by the Vestry as a public body, but, perhaps, the recognition of the fact, and the partial publicity it may obtain through notice in this Report, may, in some instances, induce caution in making selection of an abode, when it is considered that the special probability of domestic affliction may be diminished by such an exercise of discretion. The past year has introduced to us a disease which has been so long in abeyance that we had almost ceased to look upon its existence as a matter of moment. There has been undoubtedly a great effort of natural causes, beyond the present power of human knowledge to estimate, to produce Small Pox in an endemic or epidemic form. In the last twelve months this disease has forced itself upon us with a 8 power certainly not equalled within my own recollection. An examination of its history during the time it has been so powerfully exerting its baneful force, must lead us to regard with satisfaction the immense public benefit which has accrued from the general practice of Vaccination. If the exceptions had not occurred to the perfectly general adoption of the introduction of the milder, but, in a preserving sense, not less powerful disease, I firmly believe that Small Pox would have had no place in the death registry. The practice of inoculation, introduced to this country by Lady Mary Wortley Montagu, mitigated the severity of the disease; but every case so treated became a creation of a further means of extending the variolous contagion, so that while private advantage was secured, in the substitution generally of a mild form of the malady for one much more severe, the public health became endangered; and although I have not authentic facts before me in proof, could not possibly have escaped injury. The course and character of the disease is so much altered when occurring after vaccination, that even in the worst cases some of the distinctive features are lost. Small Pox was in former times more exact in its periodical changes, perhaps, than any other eruptive disease; now, it is extremely difficult to prognosticate the changes which take place in its career. But, happily, it is but seldom that we have occasion to foretell any other than a propitious termination. Did we but possess the means of employing a power capable of combating with success other mortal epidemics,—for instance, Cholera, or Scarlatina,—it would be indeed hailed by the whole human race as a boon. Indications of subsidence are already observable, and I expect soon, in my usual reports, to be able to inform you 9 that Small Pox has ceased to be fatal, if not to be extinct, in Mile End. Should it, however, prove otherwise, in addition to careful provision of ventilation, and an early isolation of cases as they occur, the evil would be best met by a general inquiry, with a view to trace out persons who remained unvaccinated, and by an explanation of the provisions of 16th and 17th Victoria, cap. 100, sec. 2, those persons would doubtless see, in default of successful persuasion, the necessity of complying with the statute. The mortality from Diseases of the Chest I take to be, with an allowance by way of exception, rather an indication of prosperity and robustness of constitution, or their reverses, than of conditions obedient to the control of sanitary measures. Few persons who have the means to prevent, will allow themselves to suffer materially from the effects of exposure to inclement or changeable weather, without using personal and domestic precautions to obviate their consequences; so that an increase of mortality from variation of temperature is not to be attributed essentially to an absence of that which constitutes a healthy condition of locality. Deaths among children of a tender age, and from Pulmonary Consumption, are the principal if not the sole exceptions. The deaths from lung diseases in persons above three years of age, in the period to which this Report relates, were 269; that is, 147 from Consumption, and 122 from catarrhal and inflammatory diseases of the air passages, bronchitis, &c. The deaths from these combined causes were, in the previous year, 334. Five deaths from cholera appear in the Table,—none having been recorded in the year 1857. Diarrhoea was fatal in 30 cases (this number is exclusive of children under three years of age); Measles in 40 instances; Whooping Cough in 70; Scarlatina in 88. 10 These numbers, by reference to my last year's Report, will be found to vary very little indeed from the statement then made, the slight variation being in the favor of the past year. The localization of disease in the Hamlet is most important. In many instances the reduction of mortality has followed so closely on street or house improvement, that it can only be looked upon as a direct consequence. But it must be admitted that there is a decided diminution observable also in some places where no material change has been made. That part of the East Ward where, in my last Report, I stated that further reduction in mortality was to be looked for, has realized the expectations then expressed. In three streets (called roads) where the mortality was greatest,* the deaths in 1857 were 49, including 20 of the kind most obedient to sanitary regulation; in 1858, in the same streets or roads, there were 30, including seven deaths only from zymotic causes. One case of Diphtheria occurred, and that in the most unexceptionable part of the Mile End Road. In the North Ward there was a diminution of disease in some of the streets which have been noticed for their high mortality. West Street, for instance, is long and populous, and attracts the eye in a list more than any other, on account of its extent and the greater value of figures attached to it in the tables prepared for statistical purposes. The deaths in that street were reduced from 38 to 19, inclusive of zymotic cases, which also fell from 13 to five. Six deaths from Diphtheria occurred in this Ward, and one from Small Pox. The West Ward also shows improvement in some places * Regent's Road, Ann's Road, and Thomas's Road. 11 in which disease almost threatened to be perpetual. Robert's Place has been so much improved in general cleanliness since it has been paved with York Stone, that it might serve as an inducement to benefit other places, as defective as Robert's Place was, by giving them similar advantages of sanitary improvement. The street was filthy; it is now clean; and I believe there is a better consequent disposition in the occupiers of the houses, to maintain more perfect order in their homes, as well as in the public thoroughfare. The mortality in the street in 1858 was little more than one-half of that in 1857. The deaths in York Street, although high, from some cause at present not easily explained, were less also; in 1857 they were 28, including 7 from zymotic causes, in 1858, 22, inclusive of 3 belonging to the latter class. The mortality in the Centre Ward, besides being low, is so distributed, and so similar to that of last year, that I can pass it with little comment. One case of Small Pox, and one of Diphtheria, were registered ; the former in Redman's Row, and the latter in Bancroft's Place. A material improvement is commenced in that part of the Ward, to the south of Stepney Church, called Clare Hall Gardens, in the erection of houses of a superior class to those which formerly, we may almost say, encumbered the ground; for, from their numerous defects as habitations, as well as from the poverty of their inhabitants, they kept the parochial surgeons continually supplied with severe cases of febrile and correlative diseases. In the South Ward two cases of Diphtheria appear in the returns. Both occurred in Lucas Street. The two Hospitals, so called, both devoted to and supported by members of the Jewish religion, are not places devoted to the treatment of sick persons. The deaths are but few, and confined to persons of advanced years. 12 The deaths in the City of London Workhouse last year were much greater than in the year 1857, when only four deaths came under my notice. In 1858, 30 deaths were registered, including one from zymotic disease. Upon inquiry, I learn that the greater mortality is not owing to any increase of sickness in the establishment, but to certain changes in the distribution of the aged inmates, the building being intersected by the boundary line of the Hamlet. The Workhouse belonging to Mile End has been less burdened with sick, through the removal of fever cases, than in previous years, and those who were there under medical treatment were consequently placed in circumstances more calculated to promote recovery. There is a reduction of deaths from 96 to 69, and from 15 from zymotic causes, to one. I have, as in my last year's Report, and for the reason there given, annexed the Quarterly Summary of mortality for the first quarter of the present year, ending March 26th. QUARTERLY SUMMARY OF THE MORTALITY RETURNS IN MILE END OLD TOWN, FOR THE QUARTER ENDING MARCH 20, 1859. Births716 Deaths 390 Excess of Births over Deaths 326 Of the 390 deaths, 188 were males, and 202 females. The Weekly Average of Deaths was, 1858. 1859. 1857. In January 31.8 35.2 33 In February 27.5 30.25 32 In March 30.25 34.25 31.75 13 The mortality of the five Wards of the Hamlet will be shown by the following statement:— North. East. West. Centre. South. Workhouses. Hospitals. 74 42 70 92 84 26 2 In this quarter four deaths from Small Pox took place, and four also from Diphtheria. The number of deaths was less than in the corresponding quarter of the years 1857 and 1858. In the former year 420 died in the first quarter, in the latter 435. In 1859, 390. The value of statistical observation is far greater than can be credited by those who have only contemplated the surface of so deep a mass of accurate knowledge. In this Hamlet statistics of disease are yet but young, and it is necessary, for them to have their full value, that they should extend over a considerable period of time. In business, when a man keeps good accounts, he without fail discovers the real state of his affairs; and if they be good, he begins to save; and if not, he is enabled to rectify the error discovered by attention to figures, and to place himself, by degrees, in the former more prosperous condition.* So it is with a record, correctly kept, of the loss of human life through disease. By records we ascertain the existence, character, locality, and clustering of various maladies; and by the application of the knowledge so afforded, can select and apply remedial sanitary measures, which effect a saving in mortality, and a prolongation of human existence. * The same idea, clothed in better language, appeared in a leading article of the "Times," while this Report was in the hands of the printer. 14 The Tables at the end of this Report will convey the substance of my observations in a form more convenient for reference, and contain facts more in detail. The means which have been adopted to effect such an obvious improvement in the health of the place as that I have reported to you, have been accomplished by public as well as private expenditure. The paving of the footways, by your Surveyor's Report, will be seen to have been carried to three times the extent of the considerable amount of such work in 1857. Theextensive drainage and road-making there reported to the Vestry, have contributed, perhaps, more than any other direct means, to the present healthy state of the Hamlet. The returns of the Inspector of Nuisances, which have usually before passed through my hands, and been so brought before you, have, I find, this year been related in the Report of the Clerk to the Vestry, to which I beg to refer you. It does not appear to me that the account there given describes all the work done by him; in his, as in my department, much being done, in addition, by persuasion and private influence,—in many cases the most agreeable as well as the most effective of means. The condition of the water supplied by the different London Companies is ascertained periodically by analysis by Dr. Robert D. Thomas, F.R.S., of St. Thomas's Hospital. I have before me four of those analyses; three of them were made in the winter season of 1858 and 1859, and one in May last. I have placed them in a single Table for more convenient examination and reference. The water supplied by the East London Company, it will be seen, contained a larger quantity of inorganic impurity than the water of most of the others; while the amount of organic impurity, in a sanitary sense by far the more important of the two, has proved small in each of the examinations. 15 ANALYSIS OF THE METROPOLITAN WATERS. Oct., 1858. Novem.,1858. Jan., 1859. May, 1859. Total Impurity per gallon. Organic Impurity per gallon. Total Impurity per gallon. Organic Impurity per gallon. Total Impurity per gallon. Organic Impurity per gallon. Total Impurity per gallon. Organic Impurity per' gallon. grsor° grsor° grs. or° grsor° grsor° grsor° grs. or° grsor° Pure Distilled Water 0.0 0.0 Loch Katrine Water(new supply to Glasgow) 2.14 0.80 2.14 0.8 2.1 0.8 2.14 .80 Well,in MaryleboneLane 86.24 12.96 Well, in Newman Street, Oxford Street 126.32 12.96 Well, in Broad Street, Soho 92.06 7.8 Well, in Castle Street, Oxford Street 110.80 8.96 Thames Companies. Chelsea 17.52 1.76 17.72 1.72 20.48 1.60 18.08 1.28 Southwark 16.52 1.84 18.28 1.36 20.72 1.04 18.40 1.16 Lambeth 17.44 1.16 18.24 1.52 18.20 1.60 16.52 1.20 West Middlesex 17.56 1.12 18.32 1.32 20.64 1.84 17.88 1.24 Grand Junction 18.80 1.72 19.20 1.48 19.52 1.52 18.08 1.56 Other Companies. New River 17.60 .96 19.16 1.32 21.60 1.88 17.88 1.28 East London 19.20 .80 21.32 1.40 23.52 1.60 16.08 1.84 Kent 22.76 1.40 19.32 1.88 25.12 3.0 22.56 1.36 It is desirable that the much greater amount of impurity contained in the water of surface wells should be set forth in plain terms; also that the danger of their contamination through percolation of poisonous filth through the subsoil, should be clearly understood. Cesspools and drains are often made of porous and destructible materials, and of a kind subject to rather speedy decay. It is very easy for a surface well (from 12 to 16 feet would be the ordinary depth in our Hamlet) to become contaminated by the escape of the contents of a decayed cesspool or sewer, and that the laws 16 of gravitation might direct the escaped fluid with rapid descent to a well most prized generally for the sparkling brilliancy of its water. So subtly have wells been so poisoned, that disease has, in several instances, been established, has become unusually mortal, and that mortality alarmingly aggravated, before it has occurred to any one to look to the pollution of the favorite well as the cause. In truth, in a populous neighbourhood, where, if well drained, the subsoil is fully charged with destroyed cesspools, existing cesspools with porous sides, and other sources of pollution, it is highly injudicious at any time, but more especially in summer, to drink water from wells which are filled with water filtered through all the filth which must collect on the surface of the earth, where, even if the people who occupy the houses are cleanly, it is impossible but that the ground must contain, on its surface and at some depth from it, the debris of organic substances in a state of putrefactive change. The products of the changes which take place from such a process are all, I believe, soluble, and are carried, in varying proportions, to the lowest level, which is probably the hollow into which the well has been sunk. I have been principally induced to place the Table of the Water Analysis in the Report, that the great amount of impurity of well water might be understood thoroughly, and that the evils which at any time, and without intimation, might attend its use for beverage, may be evaded by using for the purpose other water. In concluding my Annual Statement to the Vestry, I cannot but express a hope that in each succeeding year I may be warranted in laying before its members a statement equally favorable to the present. It certainly will not be in my power to do so if we remain satisfied with the 17 tages hitherto gained. The improvements before alluded to have been extensive, and the statistics of disease prove them to have been distinctly productive of an extension of the term of human life. Much, however, remains yet undone, and, I believe, in a quarter from whence greater results are immediately attainable,—I mean in the more complete purification, repair, and improvement of dwellings occupied especially by the poor. That examination into these particulars is in a measure unpopular and repulsive to the owners of house property, I am fully aware; and this objection constitutes the principal obstacle to the rendering the Ilamlet of Mile End Old Town as desirable a place for residence, as far as a healthy condition can make it, as is possibly consistent with a full, or nearly full, amount of population and occupation of space. The large manufactories and establishments of a similar kind are not numerous, are conducted with care, and, I believe, contribute but little, if anything, to destruction of life. In a populous place the absolute purity desirable for the most perfect condition of atmosphere cannot be obtained; an approximation to it is all that can be reasonably attempted. Nothing can lead to a state of proximate purity so desirable as a general improvement of defective habitations, which I consider to be by far the most potent force at our command to diminish, and sometimes even to extinguish the scourge of disease. I have the honor to be, Gentlemen, Your most obedient servant, J. H. FREEMAN, Medical Officer of Health for Mile End Old Town. Town House, June 28, 1859. APPENDIX TO REPORT. TABLE I. BIRTHS, 1858. First Quarter 701 Second Quarter 599 Third Quarter 592 Fourth Quarter 657 2549 Deaths in 1858 1511 Excess of Births over Deaths 1038 TABLE II. WARDS. Population as estimated in 1856. Number of Persons to the Acre. DEATHS, 1858. Rate of Deaths per annum to every 1000 persons living. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. M. F M.&F. North 12188 75 76 56 64 70 135 131 266 21.8 East 7262 37 35 32 46 37 67 83 150 20.6 West 11712 150 112 84 75 74 171 174 345 29.4 Centre 16775 124 84 80 63 92 154 165 319 19. South 13511 119 86 65 80 98 167 162 329 24.3 Workhouses — — 41 16 21 19 32 65 97 — Hospitals — — 1 1 1 2 4 1 5 — Totals 61448 435 334 350 392 730 781 1511 Mean rate for1858 23. 19 TABLE III. PROPORTION OF ZYMOTIC DISEASE. WARDS. Deaths from all Diseases. Dths. from Zymotic Diseases. Or in the proportion of 1 to— North 266 68 3.9 East 150 41 3.6 West 345 61 5.6 Centre 319 56 5.7 South 329 77 4.27 Workhouses 97 1 — Hospitals 5 — — Total 1511 304 TABLE IV. DEATHS AT PARTICULAR AGES. AGES. DEATHS. Under 5 years 705 From 5 to 10 years 63 „ 10 „ 15 „ 24 „ 15 „ 20 „ 26 „ 20 „ 30 „ 67 „ 30 „ 40 „ 78 „ 40 „ 50 „ 108 „ 50 „ 60 „ 104 „ 60 „ 70 „ 127 70 and upwards 209 Total 1511 20 TABLE V. CAUSES OF DEATH, 1858. DISEASES. DEATHS. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total. Fever 11 8 7 21 47 Small Pox 1 1 2 Measles 22 8 7 6 43 Scarlatina and Cynanche Maligna 13 21 19 35 88 Diarrhœa 4 4 18 4 30 Cholera 5 5 Dysentery 1 1 Diphtheria 1 1 5 4 11 Whooping Cough 13 23 23 11 70 Croup 6 10 3 11 30 Erysipelas 5 2 1 8 Diseases of Abdomenal Organs 10 11 15 8 44 Pulmonary Consumption 35 29 41 42 147 Inflammation of the Lungs 62 21 13 26 122 Diarrhœa, Bronchitis, and Pneumonia of Children under 3 years 44 27 20 48 139 Water on the Brain, and Convulsions of Infants 25 35 30 29 119 Dropsy 6 9 8 4 27 Cancer 4 3 7 2 16 Hernia 2 2 4 Diseases of the Heart and large Bloodvessels 22 10 16 11 59 Apoplexy, Paralysis, and Diseases of the Brain 34 14 21 16 85 Puerperal Fever 2 2 2 6 Premature Birth, and Debility from Birth 21 19 17 16 73 Violence, Privation, and Poison 8 9 9 5 31 Natural Decay 43 37 22 47 149 Other Diseases, chiefly Chronic 43 33 37 42 155 Total 435 334 350 392 1511