HAML 11 REPORT OF THE MEDICAL OFFICER OF HEALTH TO THE VESTRY OF Mile End Old Town. % ANNUAL REPORT, JUNE, 1863. London: PRINTED BY F. S. NEWELL, ASSEMBLY ROW, MILE END ROAD. 1863. REPORT. Gentlemen, The deaths in Mile End Old Town in the year 1862 numbered 1836—895 males and 941 females. For several years past it has happily been in my power, in my annual reports, to congratulate the Vestry upon the low state of the mortality of the Hamlet. So low, indeed, has it been on certain occasions, that I have been frequently induced to question the accuracy of my arithmetic; and, when that has been proved to have been correct, the desirable condition of the public health has been regarded by me as exceptional, and too good to continue at the same rate. And hence I have anticipated a less favourable return for the year following. The accuracy of my calculations as to the ratio of mortality in the Hamlet is now proved. The expected augmentation in the death rate has now arrived. By comparing the figures here given with those contained in my 4 Report for the previous year, it will be seen that in the number of deaths recorded by the District Registrars there is an increase of 280. The Tables appended, as in former Reports, contain all the essential portion of the Report, which I now beg to submit to you; but they will scarcely go so far as to fully explain the causes of the increased mortality. Zymotic disease is generally considered as in a great measure preventible; or, if not preventible, capable of considerable control by sanitary improvement and discipline. In the year just past I am sorry to report to you that the latter consequences only have followed the unabated attention given by those appointed for the purpose, to the improvement of the condition of the Hamlet. Nearly 200 of the whole number of increased deaths are to be attributed to the epidemics from which we have suffered, namely, Fever and Measles. It may occasion surprise that Small Pox is not added as one of the most prominent of contagious diseases; but, in fact, in Mile End we have suffered less from that disease than have most other London parishes or districts. Indeed, the deaths registered from Small Pox are less in number by one than those of the previous year. This subject is only now mentioned in passing; it will be reverted to in explanation of Table No. 6. If we may venture to estimate the population by the number of houses newly occupied, an increase of inhabitants must be acknowledged, greater than that which, according to usual calculation, might be anticipated. The excess of the number of births over that of the deaths does not, indeed, point in that direction; but adults, and not infants, occupy the newly built houses, and they must come from 5 other parts of London, or, perhaps, from places still more distant. In this way only can I account for the great increase of houses recently erected and occupied. TABLE I. BIRTHS, 1862. Births. Deaths. Excess of Births over Deaths. First Quarter 734 462 272 Second Quarter 737 447 290 Third Quarter 658 413 245 Fourth Quarter 640 514 126 Total 2769 1836 933 The number of births is more by 60 than in 1861; the number of deaths, as before stated, is 1836; and the excess of births over deaths is fewer by 230. The death rate for London was 2.349 per cent.; for Mile End Old Town I find it was 2.39. In the Northern districts the rate was 2.196; in the Western, 2.221; in the Southern, 2.261; in the Central, 2.578; and in the Eastern, 2.592 per cent. The rate for Mile End is not only higher than it was in the year previous to the one now reported on, but it also exceeds that of London generally. In the following Table there is but little to explain; and as the same forms are from year to year adopted, the Vestry are tolerably familiar with them, and, I have no doubt, can gather from them more facts than from my description. 6 TABLE II. Wards. POPULATION. Acres. Number of Persons to the Acre. DEATHS, 1862. Rate of Deaths per annum to every 1000 persons living. By Census taken 1861. Corrected to present time. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. TOTAL. M. F. M.&F. North 15412 16277 162 100 84 75 86 98 153 190 343 21.4 East 9573 10543 193 54 44 53 31 58 95 91 186 17.6 West 14806 15002 78 192 90 97 86 99 186 186 372 24.7 Centre 18390 19350 135 143 100 109 114 119 213 229 442 22.8 South 14883 15653 113 136 102 75 66 96 185 154 339 21.6 Workhouses — — — — 39 35 27 41 56 86 142 — Hospital - — — — 3 3 3 3 7 5 12 — Total 73064 76825 681 — 462 447 413 514 895 941 1836 — Rate of Deaths per annum to every 1000 persons living in Mile End Old Town 23.9 7 In the statement of weekly averages the deaths will be seen to have been greater in seven months of the year, —namely, April, June, August, October, November, and December,—than in any other year since the passing of the Metropolis Local Management Act. This may, again, be in part ascribed to the gradual and continual increase to our population. Nevertheless I feel satisfied that the average of disease and death is higher than in former years; and this, too, from causes not to be traced with precision. The mortality in the Hamlet has steadily diminished since 1856, little deflection having been observed during the several years, taken one with another, and allowing for the natural increase of population. Like causes ought, according to good reasoning, to produce like effects; but this, though true with regard to general conclusions, is not absolutely correct when we come to deal with vital statistics on a small scale. It is only by the adoption of a very wide area of observation that we can obtain results which may be assumed to be approximately true. It has hitherto happened that the death rate in the Hamlet has been rather below than above the average to be expected in a population consisting, as does that of Mile End Old Town, of persons engaged in various occupations not altogether favourable to longevity. Compared with districts having a population of manufacturers, our mortality has certainly been lower than might have been premised. It is the nature of disease to fluctuate in its kind, character, and severity ; and when we remember the habits, the modes of life, and the sort of dwellings of a considerable proportion of our resident population, we may fairly congratulate ourselves on the favourable aspect of life and 8 health within the limits under the supervision of the Vestry. We must also add something to the average on account of the influx of inhabitants consequent on building, and, perhaps, certain manufacturing operations. And it is to be hoped that, by careful attention to, and adoption of sanitary measures, we shall be able to show, in another year, a mortality return which will place us in a better—indeed, in our own—position, which I believe to be above, and not below the average of the metropolitan districts. TABLE III. WEEKLY AVERAGES OF MORTALITY. Weekly Average Number of Deaths. 1857. 1858. 1859. 1860. 1861. 1862. January 33 35.2 31.8 41 37.75 35.25 February 32 30.25 27.5 40 26.5 36 March 31.75 34.25 30.25 38 30.2 35.4 April 28 31.5 28.4 34 30 45 May 24.C 22.2 24.25 29.25 34 27.4 June 26.5 24.25 22 26.2 24.8 32.2 July 33.5 27.2 36 21.5 31.25 28.25 August 33.02 29.75 31.5 24 27.2 32.4 September 28.5 23.75 24 24.6 26.75 34.5 October 27.4 26 25.2 21.75 29.5 36.25 November 28.75 35 25.2 23.5 22.4 43.6 December 29.25 30.5 37.2 27.4 30 37.75 Annual Weekly Average. 29.5 29.03 28.4 29.35 29.83 35.3 9 TABLE IV. DEATHS AT PARTICULAR AGES. AGES. DEATHS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Under 5 years 200 216 188 242 846 From 5 to 10 years 21 16 26 22 85 „ 10 „ 15 „ 5 12 5 6 28 „ 15 „ 20 „ 11 13 9 8 41 „ 20 „ 30 „ 27 20 27 34 108 „ 30 „ 40 „ 35 30 33 22 120 „ 40 ,, 50 „ 32 30 26 26 114 „ 50 „ 60 „ 28 33 31 46 138 „ 60 „ 70 „ 43 34 30 42 149 70 and upwards 60 43 38 66 207 462 447 413 514 1836 There is little variation of importance in the period of life at which death occurred. There are certainly fewer deaths of aged persons, and more among young children, but the numbers are not excessive, or of such magnitude as to call for special notice. In 1861, the deaths of young children under five years, that is, those who had not entered their fifth year, were 716; in 1862 they were 846. Last year there were 15 fewer deaths of aged persons than in the year before. 10 TABLE V. DEATHS FROM THE SIX P1RINCIPAL ZYMOTIC DISEASES. Wards. Deaths from all causes. Deaths from Zymotic Diseases. Or in the proportion of 1 to North 343 103 3.3 East 186 40 4.65 West 372 89 4.32 Centre 442 112 3.94 South 339 104 3.26 Workhouses 142 36 4 Hospital 12 2 — Total 1836 480 3.76 By the above Table, as well as in Table No. 2, it will be seen that the average in the five Wards is by no means equal; the death rate in the East Ward being only 17.6 persons to the 1000, while in the West Ward it is 24.7. In the North, the South, and the Centre Wards, the mortality is nearly alike in ratio. This is in strict accordance with that which might be expected, for, while in the East Ward there are only 54 persons to the acre, in the West there are 192. That Zymotic disease has been not only prevalent but mortal, may easily be seen by examining Table No. 5. The special character of such disease which has so invaded us, will be seen in the next Table, No. 6. 11 TABLE VI. CAUSES OF DEATH. DISEASES. DEATHS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4 th Quarter. Total. Fever 34 35 29 35 133 Small Pox 2 1 - 5 8 Measles 26 45 19 20 110 Scarlatina 21 5 26 18 70 Cynanche Maligna and Diphtheria 4 6 5 8 23 Diarrhœa of Adults 2 1 3 2 8 Do. Children under 3 yrs. 2 3 28 16 47 Cholera - 1 1 1 3 Dysentery 2 10 1 1 5 Whooping Cough 23 20 10 14 67 Cramp 8 10 6 10 34 Erysipelas 3 2 - 1 6 Diseases of Abdominal Organs 11 12 8 18 49 Inflammations of Lungs 34 17 25 35 111 Bronchitis, Pneumonia, &c., of Children under 3 years of age 32 37 24 38 131 Pulmonary Consumption 46 58 43 61 206 Water on the Brain and Convulsions of Infants 17 26 23 25 91 Teething 12 11 6 18 47 Dropsy 6 11 4 11 32 Cancer 7 9 3 2 21 Hernia - - - - - Diseases of Heart and large Bloodvessels 17 15 21 13 66 Apoplexy, Paralysis, and other Diseases of the Brain 45 27 22 32 126 Puerperal Fever 3 2 3 3 11 Premature Birth and Debility from Birth 19 17 36 42 114 Violence, Privation, and Poison 14 19 9 4 46 Natural Decay 40 22 30 49 141 Other Diseases, chiefly Chronic 32 34 28 32 126 Total 462 447 413 514 1836 12 Small Pox has affected us but little, whereas Fever, of various descriptions, has been severe. The number of deaths registered as having taken place from Fever was doubled; and more than fifteen times the number from a disease much less regarded, namely, Measles. The deaths from Measles nearly equalled those from Fever. Most other diseases will be seen to have increased considerably, so that the heavy mortality is not alone to be attributed to Fever, nor even to the greater amount of Zymotic disease, since it is shared so generally, and in the face of exertion on the part of those interested and occupied in endeavouring to annul and turn aside, as far as possible, causes of disease. For instance, there was an increase of more than one fourth in the number of deaths from Pulmonary Consumption. Scarlatina has declined in severity, the average of four quarters being only 17½ persons; but the diseases peculiar to children,—Measles, Whooping Cough, Convulsions, Teething, &c.,—are beyond the average. Deaths from privation and poison form a comparatively large item, namely, fortysix persons; while from Cholera three deaths were registered during the year; and from Old Age and Natural Decay we have 141 deaths, many of them occurring within the Workhouse. The following is a summary of the Births and Mortality of the Hamlet to March 28th, 1863, thus bringing the report to Lady-day. The further particulars of this period will form the first part of the Report for next year, as that which was so given last year forms the first part of my present Report. 13 QUARTERLY SUMMARY OF THE MORTALITY RETURNS OF MILE END OLD TOWN, FOR THE QUARTER ENDING MARCH 28, 1863. Births 771 Deaths 483 Excess of Births 288 Of the 483 deaths, 230 were males, and 253 females. The weekly average number of deaths were— In January 38 In February 33 In March 40.25 The comparative mortality of the different Wards may be seen in this Table. North. East. West. Central. South. Workhouses Hospital. 94 49 98 121 69 51 1 The following statement of the Inspector of Nuisances will show to the Vestry that strong efforts have been made and are being made to effect the object for which the Sanitary Inspector was appointed. It is necessary to observe that the statement does not comprise the whole of that which has been effected in the shape of sanitary improvement; only that which has passed the formal routine of notice serving, orders from magistrates, etc. Much more has been and is continually being done by persons who 14 prefer following reasonable advice and suggestion, rather than subject themselves to any description of legal process. INSPECTOR'S RETURN OF NUISANCES REMOVED UNDER HIS SUPERVISION DURING THE YEAR ENDING MARCH 25, 1863. Privies emptied 107 Drains cleansed 121 Privies connected with sewer, panned, and trapped 167 Cesspools emptied 43 Removal of swine 28 Removal of accumulations of offensive matter 110 Houses cleansed 43 Total 619 Permit me to draw a few general conclusions with regard to the facts here submitted. It should never be lost sight of, that it is less the object of a Sanitary Board to relieve sufferers from disease, or even to arrest the disease where established, than it is to nullify the conditions in which disease can exist. Quarantine laws, the gigantic drainage of ancient Rome, and the recognition of the essential causes which occasion the spread of sickness, succeeded the ravages of plague and pestilence. Thus these scourges of mankind became, as it were, great public instructors. That which was true in ancient times is equally true in our own day. Few persons complain of the activity of sanitary officers during the prevalence of a severe epidemic, or profess to regard their labours as useless or inquisitorial 15 while the results of their arduous duties are apparent in staying the attacks of disease; but, present evils once counteracted, it is by no means rare to hear the utility of sanitary measures questioned, and their adoption ridiculed. It is true that famine, one of the principal causes of the epidemics that formerly decimated cities and devastated kingdoms, is not likely again to afflict us. The commercial relations of civilised countries towards each other, and their rapid and ready means of intercourse, almost precludes the possibility of that great precursor of pestilence doing extensive mischief. But, while it is idle to ascribe the prevalence of disease entirely to a scarcity in the supply of food, it is equally futile to deny that plenty is an active and important agent in preserving the health of the people. When bread is cheap and employment abundant, the hospital beds lack tenants; we must seek, then, in other causes, for an explanation of our increased mortality. Among some of these may be noted the irregularity of seasons, a prevailing east wind, a temperature either excessively hot or cold, a superabundance of moisture in the atmosphere. All these are pregnant with danger to the aged or the sickly. But, as these are utterly beyond control, we must seek in matters within our own reach for means to stay mortality; and it is fortunate for us that science has pointed out some of those means in the observance of sanitary laws, not only by the constituted authorities, but also by every individual in the community. It is true that the power of local legislation is somewhat circumscribed by popular prejudice; but then it becomes our bounden duty to educate the public mind to the truth by plainly showing the disasters that inevitably attend neglect of cleanliness, and inattention to personal and domestic purification. Everybody should 16 know that a foul privy, a dirty house, an untrapped sink or drain, or a stench from a pig sty, is fraught with danger to all in their neighbourhood, to say nothing of noxious vapours from certain manufacturing processes, and some other more palpable sources of infection. It is mistaken lenity to shut our eyes to our neighbour's misdoings in sanitary matters till Typhus or Cholera knock at our gates. The paving, lighting, and draining of this Hamlet have been carried out in a most excellent manner, and will soon, doubtless, leave but little to be desired. Cesspools, however, yet remain in abundance, in streets, even, where new and convenient drainage has been constructed. I humbly submit that the time has arrived for the absolute abolition of cesspool drainage, and for the carrying out so essential a portion of sanitary discipline in perfect integrity. No mastership of science is necessary to accomplish all necessary sanitary reforms, the leading principles of which are now universally known and appreciated among the governing classes. Good food, water, clothing, and shelter, are the first requirements of man ; but civilisation has some penalties to pay in exchange for its advantages ; and to preserve health and life under the several conditions attending congregation, other necessities arise, and, probably, will continue to arise, involving some perplexity in detail. The principles of sanitary science, however, remain unchanged, and their adoption cannot fail to be rewarded by improved public health and a prolongation of human life. I have the honour to be, Gentlemen, Your most obedient servant, J, H. PRE EM A N, Medical Officer of Health for Mile End Old Town. Vestry Hall, June 23, 1863.