HAML10 REPORT OF THE MEDICAL OFFICER OF HEALTH TO THE VESTRY OF Mile End Old Town. ANNUAL REPORT, JUNE, 1862. London: PRINTED BY F. S. NEWELL, ASSEMBLY ROW, MILE END ROAD. 1862. REPORT. Gentlemen, The essential part of the Report I have now the honour to present to you, is, as in those which have been made in former years, to be found in the Tables contained in it; and as you are in possession of those Reports, you will have an opportunity to compare them with the present one, and from such comparison, you will be able from the facts, to form an opinion of the health of the Hamlet, as it existed during the year 1861—to determine whether the power given to the district, to resist disease by the sanitary improvements which have been extensively made, has been equal to the occasion; and also whether the results as shown by the mortality, warrant the conclusion, that the palpable reduction of mortality which has taken place year after year, is directly or indirectly a consequence of the efforts which have been 4 made with the distinct view and intention of producing such an effect. For my part, in extracting the material of this Report from those which have been from time to time made and read to you, I am pleased to find that I am again justified in congratulating the Vestry of Mile End Old Town upon the state of the public health, as it existed during the twelve months, ending December, 1861. That improvement as exemplified by a diminished and diminishing mortality is still in progress—the limit to improvement, having, not yet, so far as can be seen, been reached. TABLE I. BIRTHS, 1861. Births. Deaths. Excess of Births over Deaths. First Quarter 700 408 292 Second Quarter 714 380 334 Third Quarter 702 368 334 Fourth Quarter 603 400 203 Total 2719 1556 1163 The number of births in 1861, is less by 18 than it was in 1860, and the excess is less by 41. The proportional increase of the population by births alone continues to be great, and although it was exceeded at one 5 period of last year, yet the general ratio of addition appears to be very similar. In one quarter of the year 1860, it may be remembered, that the births outnumbered the deaths in one of the quarters in the proportion of 2 to 1; this, as will presently be shown, does not comprise the total increase of population, the addition being composed of fresh adult inhabitants, most likely removed from some of the more thickly populated parts near the water side, as well as Whitechapel. The population of Mile End Old Town has become increased since this time last year, by from 1500 to 2000 persons, or, to be as exact as a computation founded partly on probabilities can enable us to be, the number appears to be 1825. If the 1825 be added to the population as ascertained by the Census, the rate of death per 1000 per annum will be lower than it was in 1860, but only by a small number. The rate for Mile End Old Town per annum to every 1000 persons living in 1860, was 20.9. Without making any addition to the population as shown by the Census tables in 1861, it was 21, but when the addition is made, the rate becomes reduced to 20.7. In London the death rate per 1000 per annum, was in 1860, 21.9, and in 1861, 23 1 per 1000. In the Eastern Division, containing Shoreditch, Whitechapel, St. George in the East, Stepney, Bethnal Green, Mile End, Bow, and Poplar, the rate was in 1860, 23.2, and in 1861, 24 per thousand. 6 The increase of 1825 persons can be tolerably correctly ascertained, but it is not so easy to apportion the increase in the different Wards; therefore, for this year at least, I have left the population untouched. The Tables which form part of this Report, have been calculated on the numbers of the last Census Returns as a basis, and without the addition of the above-named number of persons, which is made up in part by immigrants, and the rest by a continual excess of births over deaths. Table No. 2 is an important one, and I think requires no explanatory remark. The proportionate healthiness of the Wards, compared with each other, is about what might, by a previous knowledge of the places, have been expected. The rate of deaths per 1000 persons living, is nearly in the same ratio as the distribution of the population; whereever the relative number of persons to a given space is great, there must surely be a higher death return. The West Ward is thickly populated, its area is something like one half of that of the other Wards, it cannot and it does not possess to an equal extent the advantages of cleanliness and ventilation, and a high rate of deaths is clearly the consequence. It must suffer more than other Wards, not from contagious disease alone, but from many others; for example, Pulmonary Consumption, and most of the diseases which have a tubercular origin. L TABLE II. Wards. Population. (Census 1861.) Acres. Number of Persons to the Acre. deaths, 1860. Rate of Deaths per annum to every 1000 persons living. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. total. M. F. M.&F. North 15412 162 95 77 62 65 89 133 160 293 19 East 9573 193 49 29 41 50 41 78 83 161 16.8 West 14806 78 180 76 89 84 89 157 181 338 24 Centre 18390 135 136 82 89 86 72 153 176 329 18 South 14883 113 131 103 67 60 86 153 163 316 21.2 Workhouses — — — 39 29 22 23 50 63 113 — Hospital — — — 2 3 1 — 2 4 6 — Total 73064 681 — 408 380 368 400 726 830 1556 — Rate of Deaths per annum to every 1,000 persons living in the whole Hamlet 21 8 The next Table will show the actual number of deaths in each month of the last five years, but for the sake of convenience, placed in the form of weekly average in each month. No better proof could be placed before you of the unquestionable value of the sanitary measures which have been used in the Hamlet. The population in 1856, was supposed to be 61448; in 1861 it had become increased to 73064, upwards of one sixth, yet a glance at the bottom line of the Table will convince any one interested in these matters, that there has been an immense saving of human life, for the averages of death remain nearly the same with the large population, as they were with the smaller. TABLE III. WEEKLY AVERAGES OF MORTALITY. Weekly Averages of Death. 1857. 1858. 1859. 1860. 1861. January 33 35.2 31.8 41 37.75 February 32 30.25 27.5 40 26.5 March 31.75 34.25 30.25 38 30.2 April 28 31.5 28.4 34 30 May 24.6 22.2 24.25 29.25 34 June 26.5 24.25 22 26.2 24.8 July 33.5 27.2 36 21.5 31.25 August 33.02 29.75 31.5 24 27.2 September 28.5 23.75 24 24.6 26.75 October 27.4 26 25.2 24.75 29.5 November 28.75 35 25.2 23.5 22.4 December 29.25 30.5 37.2 27.4 30 Total 29.5 29.03 28.4 29.35 29.83 9 The mortality among young children is even greater than it was last year, but there is no great numerical difference. In 1860 the deaths under 5 years of age were 674—in 1861, they amounted to 716. In a few of the past years they have been about 700. TABLE IV. DEATHS AT PARTICULAR AGES. AGES. DEATHS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Under 5 years 157 189 196 174 716 From 5 to 10 years 12 9 11 12 44 ,, 10 ,, 5 ,, 7 7 10 6 30 ,, 15 ,, 20 „ 5 9 9 8 31 ,, 20 ,, 30 ,, 21 20 17 28 86 ,, 30 ,, 40 ,, 15 17 25 32 89 ,, 40 ,, 50 ,, 30 23 23 27 103 ,, 50 ,, 60 ,, 27 22 16 26 91 ,, 60 ,, 70 „ 47 28 30 39 144 70 and upwards 87 56 31 48 222 408 380 368 400 1556 Zymotic disease in 1861, appears to have been rather more fatal than in the previous year. The epidemic of Fever, which had, since the commencement of the present year been sustained, had not sensibly begun to affect us, and consequently does not form a portion of this Report. The whole appearance of the Table of Zymotic diseases is satisfactory. 10 The number in the total is small compared with the number of deaths, and the proportion of deaths from Zymotic disease to those from ordinary causes, is equally pleasing to examine. TABLE V. DEATHS FROM THE SIX PRINCIPAL ZYMOTIC DISEASES. Wards. Deaths from all causes. Deaths from Zymotic Diseases. Or in the proportion of 1 to North 293 53 5.5 East 161 35 4.6 West 338 73 4.6 Centre 329 74 4.4 South 316 65 5 Workhouses 113 15 7.5 Hospital 6 — — 1556 315 The higher the numbers in the third column of the Table relating to Zymotic disease, the greater will be shown the effect of sanitary measures in the suppression of those diseases which are amenable to such influence. The relative proportionate liability of the five Wards to engender or support contagious disease, has a much smaller range than could be easily credited; for, upon extending the average over a longer period, namely the last five years, I find that there is a difference of five tenths only between the highest and the lowest numbers. 11 TABLE VI. CAUSES OF DEATH. diseases. deaths. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Fever 9 9 15 23 56 Small Pox 3 — 1 5 9 Measles 4 1 2 — 7 Scarlatina 5 19 16 19 59 Cynanche Maligna and Diphtheria 3 4 4 6 17 Diarrhœa of Adults 2 — 5 3 10 Do Children under 3yrs. 1 3 38 4 46 Cholera - - 2 1 3 Dysentery 2 - 1 1 4 W hooping Cough 15 38 17 21 91 Croup 7 6 5 8 26 Erysipelas 4 2 1 3 10 Diseases of Abdominal Organs 17 10 10 12 49 Inflammation of Lungs 51 23 22 39 135 Bronchitis, Pneumonia, &c., of Children under three years of age 34 30 19 30 113 Pulmonary Consumption 36 43 34 37 150 Water on the Brain and Convulsions of Infants 27 28 21 14 90 Dentition 10 15 6 13 44 Dropsy 7 4 7 11 29 Cancer 3 5 6 6 20 Hernia 1 1 - 2 4 Diseases of Heart and large Bloodvessels . 20 16 15 23 74 Apoplexy, Paralysis, and other Diseases of the Brain 27 28 22 26 103 Puerperal Fever - 2 3 3 8 Premature Birth, and Debility from Birth. 21 17 32 26 96 Violence,Privation,and Poison 12 10 8 8 38 Natural Decay 53 38 19 36 146 Other Diseases, chiefly Chronic 34 28 37 20 119 408 380 368 400 1556 12 Although there appears in the Table of the causes of death (No. 6), considerable variation in the numbers of deaths from particular diseases, such variation is confined mainly to diseases of the Zymotic class. Thus, Fever, though but little in excess of the average, contributed 56 deaths to the list; 44 cases having been registered last year. Deaths from Small Pox were reduced from 15 to 9; Measles, a much greater reduction—from 64 to 7. Scarlatina was more fatal than in the previous year; last year 59 deaths were recorded, and 46 in the year before. It will be almost a waste of time to go through the whole Table. The figures of the Table will speak for themselves, perhaps more intelligibly than language, especially if the Report of the former year or years are laid open at the same time, and the figures examined and compared. There are two or three diseases which, in the Table, have been separated from the others,—Diarrhoea of infants, Pneumonia, etc., and also from the same disease occurring in adults, affections of the mucous membranes of children having a somewhat different significance to similar symptoms when they occur in mature age. It is necessary for me to make this observation, otherwise the numbers might be understood to show a great reduction in some of the most important diseases. To bring the statement of the mortality of this Hamlet to that period of the year which has been fixed as the end by the Local Management Act, I have as usual added the Quarterly Summary of the first quarter of the present year, such as I am in the habit of presenting to you, as part of my ordinary Reports at the end of each quarter. For statistical 13 comparison and reference, I find it much more advantageous to observe the same distinction of time, with the Registrar General; the year 1860 can be then compared with 1861, or 1859; the year becomes, apparently, at least, better defined. QUARTERLY SUMMARY OF THE MORTALITY RETURNS OF MILE END OLD TOWN, FOR THE QUARTER ENDING MARCH 29, 1862. Births 734 Deaths 462 Excess of Births 272 Of the 462 deaths, 224 were males, and 238 females. The Weekly Averages of Death were— In January 35.25 In February 36 In March 35.4 The mortality in the five Wards of the Hamlet may be thus seen and compared. North East. West. Centre. South. Workhses. Hospital. 84 * 44 90 100 102 39 3 It may not be considered absolutely correct to make a statement as to the condition of the gas of the Commercial Company in this place; but as I hold the appointment of Examiner of that gas, I may be permitted to mention, that the gas has, 14 throughout the year, held a very steady rate of illuminating power, equal to about 15 sperm candles, which is 25 per cent. above the standard described in the Statute. It has also been free from complaint with regard to its condition of purity. The ordinary constituents of crude coal gas, which are regarded as noxious, and to which attention is always carefully directed by makers of gas for illumination, having been very successfully removed. The observations upon the gas were mostly made in the evening, at the time when the gas was being either consumed or was in a state ready for use. The observations were also made with Sugg's Lava Argand Burner. These remarks are necessary to account for the apparently high illuminating power recorded; the same observations made early in the forenoon, and with a burner not so well adapted for combustion of gas of the specific gravity issued, would doubtless give results less favourable. We have not so many manufacturing establishments as formerly. From various causes they have become placed elsewhere. I have met with no hesitation on the part of any individual to adopt reasonable means of improving his process, where complaints have been made of annoyance being occasioned by it. It would be scarcely proper to notice particular cases, but some still remain in a state which could not fairly be permissible if the ground about them were more closely built on, such a change in the existing state with regard to building houses becoming continually more probable. Many persons, under a mistaken notion of what is meant 15 by a nuisance, have endeavoured at various times to set the power of the Vestry in action for the suppression of that which might have been a serious personal annoyance, but not, either in its character or degree, fairly to be considered "injurious to health", and I have no doubt that some disappointment may have been experienced that the offence or nuisance was estimated by the officers of the Vestry in a lower degree of importance than by those who have been annoyed, and have so become complainants. To bring cases of nuisance within the circle of the power of the Vestry to suppress them by proceedings by law against the perpetrators, it is a necessary condition that the manufacture or process should be conducted in such a manner as to be injurious to health, or likely to promote or aggravate disease. If it be but personally offensive, and not poisonous in its nature, nor capable of generating disease, or aggravating it when it already exists, it is beyond the power of the Vestry to put an end to it. I am aware that some eminent men consider almost every odour to be an impurity, even on the ground of the occupation of space in the atmosphere, and so occupying the place of that which is more fit for respiration. I must confess that I cannot go to the same extent in belief that they do. In Mile End Old Town at the present time may be found many of the most important conditions for the maintenance and enjoyment of health, to the fullest extent which could be reasonably desired. We have a system of drainage very little short of being complete; stone paving has been spread on the footpaths from one end of the Hamlet to the other, we have good water, an excellent natural position of moderate elevation, a stratum of gravel of considerable depth 16 lying near to the surface to carry off moisture from the surface; and with this combination of natural and artificial advantages, we ought to expect a low mortality. The Report of the present year will show that such an expectation is fairly realized. For a further reduction of the number of deaths, and otherwise to secure the advantages already obtained, it will be necessary to extend the exercise of the power of the Vestry still further to improve the house accommodation of the poor, to make them clean and wholesome in spite of themselves and their prejudices. When this can be fully effected, we may look with confidence for a mortality list which may bear advantageous comparison with the most healthy parts of the kingdom. I have the honour to be, Gentlemen, Your most obedient servant, J. H. FREEMAN, Medical Officer of Health for Mile End Old Town. Newell, Printer, Assembly Row, Mile End Road.