HAML 9 REPORT OF THE MEDICAL OFFICER OF HEALTH TO THE VESTRY OF Mile End Old Town ANNUAL REPORT, JUNE, 1861. London: PRINTED BY F. S. NEWELL, ASSEMBLY ROW, MILE END ROAD. 1861. REPORT. Gentlemen, The general Census of the population which was taken a few months ago, has put me in possession of more accurate data on which computation of relative mortality or rate of death may be founded, and the health of the public during the past year be determined with tolerable accuracy. The amount of the population having exceeded by some thousands that which I had assumed it to be, and the number of deaths having been known, year by year, beyond the possibility of error, it is, of course, obvious that the state of the public health, which I have reported to the Vestry as being remarkably good when compared with other districts, and as indicating a prospect of still greater improvement, has been even better than I have in my Annual Reports declared it to be. I have carefully avoided placing you, by my statements, in a position of false security; and in making my various reports to you of the 4 public health, have thought it better to err on the safe side, to remain within a bound which was not certain, rather than to lull you into unjustifiable confidence in the salubrity of the Hamlet and the success of the steps which have been taken to improve the general state of our hygienic condition. One of the results, therefore, of the publication of the Census will be that I shall be able to place before you this year, for the first time, tabular statements deduced entirely from ascertained facts; and the public health of Mile End Old Town will be found, upon examining them, to be in a much higher position than in former years, both in relation to other surrounding districts, and also in comparison with itself at different past periods ; although, with such resources as were at my disposal, I have indicated with pleasure and some amount of pride, a gradual but surely decreasing mortality. POPULATION OF MILE END OLD TOWN. CENSUS 1861. Wards. Houses. Population. Males. Females. Total. North 2,426 7,177 8,235 15,412 East 1,529 4,211 5,362 9,573 West 2,004 7,084 7,722 14,806 Centre 2,998 8,492 9,898 18,390 South 2,286 6,822 8,061 14,883 Total 11,243 30,786 29,278 73,064 5 POPULATION OF MILE END AT THE DIFFERENT PERIODS AT WHICH THE CENSUS HAS BEEN TAKEN. 1801. 1811. 1821. 1831. 1841. 1851. 1861. 9,848 14,465 22,876 33,898 45,308 56,602 73,064 The most considerable addition to our numbers has taken place in the North Ward; and, contrary to expectation, the West Ward, which was always considered to contain as many human beings as it was fit that it should do, and was almost possible for it to do, being second on the list, the East, Centre, and South following in the order of their names. The increase since 1856 is considerable. persons. houses. In the North Ward 3,222 928 West 3,094 84 East 2,311 404 Centre 1,615 248 South 1,372 76 11,614 1,740 The alteration of the number of houses is not correlative with that of individuals. Thus the West Ward receives an addition of 3,094 persons, with but 84 new houses, and the South an increase of 1,372 persons, with only 71 houses. This concentration of individuals in the Wards the least capable of bearing a strain in that direction will, I fear, prove disastrous in the event of a severe epidemic becoming prevalent in the Hamlet, or in those Wards in particular. Unfortunately, I cannot see any method of forestalling by which the evil is to be met. But, as there is so much 6 greater probability of disease which is communicable between individuals becoming grave in a dense population, it will be important always to regard the early appearance of disease in those quarters with jealous watchfulness, and carefully to enforce the ordinary sanitary regulations. At the present moment, the mortality of the Hamlet is too low to warrant any but the most gentle kind of interference. The causes of the unwelcome change, in the disproportion of people to the house accommodation the upper Wards of the Hamlet are able to afford, is undoubtedly to be found in the demolition of houses in London, which has been deemed necessary for the recent extensive local improvemeilts. Clusters of houses, each inhabited by several families, have been replaced by palaces, and their occupants dislodged to seek other abodes. Being mostly operatives, or belonging to the labouring class, and accustomed to live near their place of employment, they were naturally unwilling to travel further than necessary, and so have accepted the readiest accommodation for their families. I believe, however, that it is a sort of centrifugal action, which, by continuing, will prove its own remedy, and the overplus of people in the upper Wards will gradually avail themselves of the freer atmosphere of the lower parts of the Hamlet. It will be well to remember that this immigration is almost confined to persons who are particularly benefited by local sanitary improvement, among whom disease is most rife, when it occurs, and from the paucity of their means and continual occupation when they have employment, are less able to defend themselves from various maladies which are sure to be in excess when there is over occupation of space by living beings. The births exceeded the deaths last year by a considerable 7 number, 1204. It is remarkable that last year, even to a unit, the same number of deaths occurred, the same number of births, and consequently the number of births in excess is the same, while the amounts are made up of numbers which present much variation in detail. The relative mortality of the past year is, notwithstanding, much more favorable than its predecessor, since by births alone the population has received an addition of 1204, and by immigration a still greater number. TABLE I. BIRTHS, 1860. Births. Deaths. Excess of Births over Deaths. First Quarter 774 514 260 Second Quarter 656 384 272 Third Quarter 632 305 327 Fourth Quarter 675 330 345 Total 2,737 1,533 1,204 In the third and fourth quarters, it may be observed that the number of births in the Hamlet have more than doubled the number of deaths. The excess of births over deaths is scarcely less deserving of notice, than the considerable mortality among young children which will be seen further on in Table III. It is possible, however, that there may be a connection between these two prominent facts; for although the Table (No. 3) shows only the number of deaths between birth and the age of five years, yet a great proportion of those deaths take place at less than a twelvemonth, many even a few days or 8 weeks after birth, leaving the mother in a natural condition more likely to add to the number of her family than if the infant had been reared to the age of twelve months or more; so that an excess of births, and a great return of infant mortality, may have a very close relation with each other. The next table I have preserved in its original form, and I think that it will repay the trouble of collation and comparison with the tables of former years contained in the Annual Reports I have had the honour of presenting to you. But the most gratifying and satisfactory portion of it, is that contained in the last column. It will be there seen that the rate of deaths in two Wards is as low, within a fraction, as it is in the most favoured parts of the kingdom; that in those Wards which exceed that moderate number the rate of death is still very low ; and that the death rate for the whole Hamlet is much less than that of the metropolis itself. In London the rate of deaths per annum to every 1,000 persons living, was 22; in Mile End Old Town, 20.9. In the eastern districts the rate was 23.3. The reduction of mortality in Mile End may be easily seen when the numbers are placed beside those of the metropolis generally during the last five years. The great fall in the scale which may be observed between 1860 and 1859 is not so much owing to the superiority of the state of public health during 1860, as to the correction of the account of population, the Census giving us a greater number than had been adopted as a basis. in mile end old town. in london. 1856 24.2 21.7 1857 25 22.2 1858 23 23.5 1859 23.1 22.2 1860 20.9 22 TABLE II. Wards. Population. (Census 1861.) Acres. Number of Persons to the Acre. DEATHS, 1860. Rate of Deaths per annum to every 1,000 persons living. 1st Quarter. 2nd Quarter 3rd Quarter. 4th Quarter. TOTAL. m. F. M.&F. North 15,412 162 95 95 90 63 52 168 132 300 19.46 East 9,573 193 49 52 42 36 41 74 97 171 17.86 West 14,806 78 180 107 73 60 67 136 171 307 20.73 Centre 18,390 135 136 102 68 73 86 162 167 329 17.89 South 14,883 113 131 125 88 53 55 158 163 321 21.56 Workhouses — — — 29 23 19 28 40 59 99 — Hospital — — — 4 — 1 1 2 4 6 — Total. 73,064 681 — 514 384 305 330 740 793 1,533 — Rate of Deaths per annum to every 1,000 persons living in the whole Hamlet 20.9 10 In Table No. 3 will be observed a mortality among young children which is at first likely to strike us with surprise. The deaths of infants, less than five years of age, amounted to nearly one half of the mortality of the whole population. Upon referring to past years, I find the numbers to be so nearly alike, that it will be quite unnecessary to search for a special cause to account for the apparent excessive number of deaths. TABLE III. DEATHS AT PARTICULAR AGES. AGES. DEATHS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Under 5 years 228 166 147 133 674 From 6 to 10 years 21 24 8 7 60 ,, 10 „ 15 „ 6 3 3 1 13 „ 15 „ 20 „ 8 5 7 6 26 „ 20 „ 30 „ 27 25 11 16 79 „ 30 ,, 40 „ 29 25 19 24 97 „ 40 „ 50 „ 32 30 22 25 109 „ 50 ,, 60 „ 37 20 24 31 112 „ 60 „ 70 „ 51 37 31 38 157 70 and upwards 75 49 33 49 206 514 384 305 330 1,533 A great reduction is happily observable in Zymotic or preventible disease, the greatest improvement being noticeable in the West Ward, where, for reasons before expressed, 11 it would have been perfectly consistent to have expected an increase of diseases of a class which depends on decay of organic matter for its principal promotion and support. The general proportion of Zymotic diseases to those of an ordinary kind, in Mile End, was nearly 1 to 6. TABLE IV. DEATHS FROM THE SIX PRINCIPAL ZYMOTIC DISEASES. Wards. Deaths from all causes. Deaths from Zymotic Diseases. Or in the proportion of 1 to North 300 52 5.7 East 171 26 6.5 West 307 43 7 Centre 329 65 5 South 321 64 5 W orkhouses 99 9 11 Hospitals 6 — 1,533 259 The six principal Zymotic diseases here used for calculation are, Fever, Measles, Small Pox, Scarlatina, Diarrhoea, and Whooping Cough. It would be very easy to add to their number, but the means of comparison would, by such addition, become impaired. The number of deaths being exactly the same for the two years, we have only to compare the actual number of deaths from Zymotic diseases: this year the number was 259; last year it was 403. 12 TABLE V. CAUSES OF DEATH. diseases. deaths. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Fever 13 7 12 12 44 Small Pox 7 2 3 3 15 Measles 14 28 13 9 64 Scarlatina 16 15 7 8 46 Cynanche Maligna and Diphtheria 3 3 2 5 13 Diarrhoea of Adults — 1 6 1 8 Cholera — — 1 — 1 Dysentery — — — 1 1 Whooping Cough 23 11 13 6 53 Influenza — 2 — — 2 Croup 4 5 2 2 13 Erysipelas 3 2 1 1 7 Dentition — — — 6 6 Diseases of Abdominal Organs 14 11 13 19 57 Inflammation of Lungs 71 41 19 28 159 Diarrhoea, Bronchitis, and Pneumonia of Infants under three years of age 67 28 33 35 163 Pulmonary Consumption 47 59 31 38 165 Water on the Brain and Convulsions of Infants 45 31 19 24 119 Dropsy 5 4 6 6 21 Cancer 12 2 8 4 26 Hernia 1 — — — 1 Diseases of Heart and large Bloodvessels 19 11 18 16 64 Apoplexy, &c. 24 29 22 29 104 Puerperal Fever 1 - 1 1 3 Premature Birth, and Debility from Birth. 24 17 17 17 75 Violence,Privation,and Poison 14 11 11 6 42 Natural Decay 44 34 17 34 129 Other Diseases, chiefly Chronic 43 40 30 19 132 514 384 305 330 1,533 13 The diminution of mortality from Zymotic diseases has already been remarked; and as the number of deaths was precisely the same as in the previous year, it is natural that some inquiry should be instituted as to the manner in which the number was made up—what other diseases have been in such excess, that, with a reduced mortality from disease which is more or less controllable, the number of deaths has been maintained—allowance having been made for a year's growth of population. Fever, to begin with special contagious diseases, has been fatal in 44 instances—54 such cases having been registered in the previous year—the average number of the preceding three years being within a fraction of 51. The localization of Fever is always a matter of interest, no less than its type. In the South Ward it was predominant, the Centre next, the North and West having an equal number, and the East being the lowest. It will be remembered that some uneasiness was created by a statement some months since in a local newspaper that Fever was prevalent and rife in the East Ward. There were, doubtless, some cases of Fever in the portion of the district which was named; but the account I have here given will point out the advantage of relying on the actual returns rather than on individual observation or experience. A sensible diminution in the deaths from Small Pox will be observed on examining the Table, the reduction being from 33 to 15. The disease itself, without regarding the mortality attending it, I think I am justified in stating to be at an end, so far as regards its epidemic form, possibly from the field of its influence being restricted by many of the unvaccinated having been attacked by the disease, and also perhaps by the remainder having taken just alarm, and 14 availed themselves of the protection of vaccination, which may have been trifled with, owing to the long absence of Small Pox, or, perhaps, from disbelief in its value or capability of preventing the graver disease. Re-vaccination has been very frequently adopted in persons of mature age, and more generally than could have been expected, it has proved successful, the characteristic vesicle of Cow Pox having been produced. This will lead to two important deductions;—one, that the effect of vaccine disease may become impaired through lapse of time, and the other, that it is possible that sufficient care might not have been bestowed in distinguishing the true vesicle from a spurious one,—one of modified common inflammation, which has often followed the puncture and insertion of the vaccine virus. Measles proved fatal in 64 cases, showing an increase of 25 on last year's numbers; while Scarlatina declined largely,—from 128 to 46. The cases of Diphtheria being so few and having so strong a resemblance to Cynanche Maligna, I have placed them together in the same column, in which a reduction will be noticed from 18 to 13 deaths, notwithstanding the combination. Whooping Cough was fatal in 53 instances, showing an increase of 17 in the year. Diseases of the Lungs were much more fatal, with the exception of Consumption, which destroyed about the same number as in the previous year. The inclemency of the weather during the whole of 1860 will not only be long remembered on account of its singular intensity, but will point readily to a cause for the prevalence and mortality of the several diseases affecting the air passages. The following summary of the mortality of the first quarter of the present year will bring the observations to 15 the 30th March, that being the time to be taken as the end of the period on which I have to report to you. QUARTERLY SUMMARY OF THE MORTALITY RETURNS FOR THE QUARTER ENDING MARCH 30, 1861. Births 700 Deaths 408 Excess of Births over Deaths. 292 Of the 408 deaths, 189 were males, and 219 females. The Weekly Average of Deaths* was— 1857. 1858. 1859. 1860. 1861. In January 33 35.2 31.8 41 37.75 In February 32 30.25 27.5 40 26.5 In March 31.75 34.25 30.25 38 30.2 The mortality in the different Wards may be seen in the following Table. North. East. West. Centre. South. Workhses. Hospital. 77 29 76 82 103 39 2 The various work of the Inspector of Nuisances has been placed before you in the Report of the Vestry, so that it will be unnecessary for me here to repeat the detail. I * This must not be confused with the rate of deaths to every 1000 persons living; the numbers are those of the actual deaths, in 73,000 persons. Monthly averages are taken to avoid repetition of figures. 16 trust it will appear to you that the sanitary department of the Hamlet has been conducted with perseverance and activity. In no instance since the formation of the Yestry has it been considered necessary to have recourse to proceedings by indictment at the Sessions, and the rare appearance of the Officers of the Vestry at the Police Courts will, I think, prove to the Yestry and to the ratepayers generally, that coercion by legal process is never contemplated while any more moderate means remain open. Certain trade nuisances, and offensive accumulations of disagreeable refuse matter, have been complained of, and have, through the instrumentality of the Officers, been either put an end to altogether, or so far moderated as to cease to occasion peril to the public health, while some offensive trades have admitted of such improvement in the mode of conducting them that they have ceased to be sources of complaint. The good result of the whole year's exertions has been testified to by the reduction in the amount of mortality, which may be seen in the Tables I have had the pleasure to present to you; and as there is, of course, a limit to such reduction, to which limit we are fast approaching, I hope that at least the present favorable state of public health may long be preserved in our Hamlet. I have the honour to be, Gentlemen, Your most obedient servant, J. H. FREEMAN, Medical Officer of Health for Mile End Old Town. Vestry Hall, Mile End, July 15th, 1861. Newell, Printer, Assembly Row, Mile End Koad.