HAML 12 REPORT of the MEDICAL OFFICER OF HEALTH to THE VESTRY of Mile End Old Towm. ANNUAL REPORT, JUNE, 1864. London: PRINTED BY F. S. NEWELL, 78, MILE END ROAD. 1864. REPORT. Gentlemen, In presenting my accustomed Annual Report, some few words of introduction are necessary. I may, perhaps, be allowed to repeat, that the main value of documents of this character must be found in the deductions we are enabled to draw from a comparison of the statistics of one year with those of another; and hence it is that the series of these Annual Reports should be examined concurrently with the present, in order to lead to a full comprehension of the sanitary state of our Hamlet, existent and progressive. In these comparisons and deductions, indeed, we discover the secret of sanitary science; and it is by the application of truths, so evolved, to the circumstances of each particular case, that we acquire the power to provide remedies for existing evils, and furnish such information as enables us to combat, with some chance of success, probable causes of sickness and death. The sanitary condition of the Hamlet of Mile End Old Town has considerably improved during the last decade, and the rate of mortality has, year by year, approached nearer and nearer to that of the most favoured districts of the 4 metropolis. This improvement can be attributed, humanly speaking, but to one cause,—the official recognition of the truths of science, and the consequent attention exercised in cases to which those truths are applicable. The Vestry have shown great and commendable zeal in the promotion of all means which tend to the general improvement in the condition of the Hamlet; but there is still room for improvement. It is barely sufficient that the governing body in a parish acknowledge the value of scientific data, as applied to health and mortality. It is necessary to disseminate such knowledge as widely as possible, before we can take full advantage of experiences we purchase, often very dearly. Every individual in the community should be thoroughly impressed with the value of sanitary contrivances, and so informed concerning them, that, instead of regarding the examinations as inquisitorial and the means adopted as arbitrary, he should be entirely willing to co-operate in every measure that tends to promote the general well-being of himself, his family, and his neighbours. So far as regards atmospheric and social influences, there is really no reason why the poorest districts could not be made as healthy as the wealthiest. Certainly the rich have the advantage of a plentiful supply of nourishing food and comfortable clothing, but sins against sanitary regulations are not confined either to the wealthy or the indigent; for, if in a single family are neglected the precautions modern sanitary science considers indispensable to the well-being of the people, a whole district may possibly suffer. An untrapped drain, an overcrowded house, an unventilated alley, a rotting dung-heap, or a foul privy, may spread disease and sorrow in an entire neighbourhood, while the real 5 tors may possibly escape. There is such a thing, you are aware, as acclimatization; and persons, by a similar process, may become accustomed to almost anything noxious, so as to defy its worst influences. People may live, and do live, in the midst of noisome stenches and foul accumulations of miasm without perceptible danger to themselves, but such stews and hovels are the pregnant centres of epidemic disease. I need not ask you to agree with me in condemning as absurd, the notion that, because individuals have lived to old age while exposed hourly and daily to such baleful influences, the influences themselves are innocuous; yet similar remarks are frequently made by men who ought to, and I am inclined to believe do, know better. We cannot too persistently proclaim that dirt and disease are inseparable, nor forget that cleanliness does not consist altogether in drainage and public improvement of highways. The houses and persons of the people must be kept under the wholesome influence of that virtue which is truly said to be next to godliness; then would be effected that comparative immunity from preventible disease which the sanitary reformer hopes in time to realize. But to descend from generalities to particulars. It will be seen from the following Table that the Hamlet is improving with respect to its mortality. In 1863 there were 246 births more than in the previous year, while the deaths were fewer by 90,—the excess of births over deaths being 1269, or 336 more than in 1862. The death rate for the whole metropolis in 1863 was 2.45 per cent., while for Mile End we see that it was 2.21 per cent. Our comparison with other districts is not, therefore, unfavourable; for in the Western districts it was 2.32, 6 TABLE I. BIRTHS AND DEATHS, 1863. Births. Deaths. Excess of Births over Deaths. First Quarter 771 483 288 Second Quarter 761 423 338 Third Quarter 721 419 302 Fourth Quarter 762 421 341 Total 3015 1746 1269 in the Northern 2.38, in the Southern 2.66, and in the Eastern it was 2.65. Compared with the previous year, a sensible decrease may be observed in the death rate. In plain figures, we find that for every 10,000 persons in the Hamlet there were 221 deaths. Thus, if we take account of the natural increase to the population, we find that the percentage of mortality during 1863, compared with that of the entire metropolis, was as 9.2 to 10.2. The next Table gives the details of mortality in the Hamlet, as in former years. And here, again, we may congratulate ourselves on an evident improvement; the general average of mortality for every 10,000 persons living being 221 in 1863, against 239 in 1862. The increase of population I have estimated at 2,300, the actual figures employed being—1862, 76,825; 1863, 79,124. It will be seen that the greater proportion of this increase has taken place in the East Ward, where the number of inhabitants to the acre has risen from 54 in 1862 to 68 in 1863. 7 TABLE II. Wards. population. Acres. Number of Persons to the Acre. deaths, 1863 Rate of Deaths per annum to every 1000 persons living. Census 1861. Estimated. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. total. M. F. M.&F. North 15413 16482 162 102 94 65 64 79 150 152 302 18.32 East 9573 13013 193 68 49 61 54 50 103 111 214 16.43 West 14806 14836 78 190 98 78 86 55 167 150 317 21.37 Centre 18390 19420 135 144 121 119 119 134 246 247 493 25.3 South 14883 15373 113 136 69 50 66 62 131 116 247 16. Workhouses - - - - 51 49 29 40 64 105 169 - Hospital - - - - 1 1 1 1 2 2 4 - Total 73064 79124 - - 483 423 419 421 863 883 1746 - Rate of Deaths per annum to every 1000 persons living, (including Workhouse and Jew's Hospital) 22.19 8 It will be observed, as usual, that the per centuge of mortality was higher in the first and last quarters of the year than in the other two ; though the general average is sensibly less than hitherto. The following Table gives the weekly averages of death from 1857 to 1863. Here we find that, taking the increase of population into account, our statistics are still of a satisfactory character ; the numbers being 33 per week in 1863, against 35 in 1862, and 29 in 1857. The months of January, March, April, and August, seem to have been most TABLE III. WEEKLY AVERAGES OF MORTALITY. Weekly Average Number of Deaths in 1857. 1858. 1859. 1860. 1861. 1862. 1S63. January .... 33 35-2 31-8 41 37-75 35-25 38 February. . . . 32 30-25 27-5 40 26-5 36 33 March .... 31-75 34-25 30-25 38 30-2 35-4 40-25 April 28 31-5 28-4 34 30 45 35-5 May 24-6 22-2 24-25 29-25 34 27-4 28-4 June 26-5 24-25 22 26-2 24-8 32-2 34-75 July 33-5 27-2 36 21-5 31-25 28-25 32-25 August .... 33-02 29-75 31-5 24 27-2 32-4 39-2 September , . . 28-5 23-75 24 24-6 26-75 34-5 23-5 October .... 27-4 26 25-2 21-75 29-5 36-25 29-2 November . . . 28-75 35 25-2 23-5 22-4 43-6 34-75 December . . . 29-25 30-5 37-2 27-4 30 37-75 34 Annual >\ eekly Averages . . 29-5 2903 28-4 29-35 29-83 35-3 33-56 9 fatal. Little, however, can be at present calculated from these figures, in consequence of the comparatively limited area of observation, beyond general proof of addition to the term of human existence. But, if we can arrive at no definite results from the Table of Weekly Averages, we can at least draw positive conclusions from the Table of Deaths at stated ages. Here we find that nearly half of the whole number of deaths takes place in infancy; though even these figures show favourably in comparison with 1862. In the latter year 846 children TABLE IV. DEATHS AT PARTICULAR AGES. AGES. deaths. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Under 5 years 211 184 202 207 804 From 5 to 10 years 17 23 38 19 97 „ 10 „ 15 years. 7 9 8 5 29 „ 15 „ 20 years 6 13 9 9 37 „ 20 „ 30 years 25 29 22 28 104 „ 30 „ 40 years 32 37 18 13 100 „ 40 „ 50 years 38 28 33 35 134 „ 50 „ 60 years 39 25 22 28 114 „ 60 „ 70 years 46 29 20 36 131 70 and upwards 62 46 47 41 196 483 423 419 421 1746 10 under five years of age died; but in 1863, with an increased population, the infant deaths were 804, or 42 fewer. On the other hand, the longevity of the inhabitants was somewhat lower than the average; 149 persons having lived to between 50 and 60 in 1862, and but 131 in 1863; while at the age of 70 and upwards, the figures for the latter year show 196, as against 207 in the former. These variations are, however, not of much importance. The great fact is, that the mortality of the llamlet has steadily decreased. In the next Table, the deaths from the six principal zymotic diseases are specified. Here, again, we have improvement, more particularly evident if we take the total figures. The proportion of fatal zymotic disease in the five Wards does not sensibly differ from those laid before you in the 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 302 93 3.23 East 214 54 4 West 317 78 4 Centre 493 134 3.68 South 247 48 5.14 Workhouses. 169 31 5.4 Hospital 4 1 - Total 1746 439 3.97 11 previous year, except as regards the South Ward, where only 48 deaths from zymotic disease are recorded, as against 104 in 1862; but in the Centre Ward we find that 134 deaths are shown to have taken place, as against 112 in the previous twelve months. The particular character of the diseases from which death occurred is seen in Table VI. Here we find several special deviations. Fever decreased by 29 cases; Measles by no fewer than 98; while Small Pox rose from 8 cases to 46, and Scarlatina from 70 to 154. The prevalence of Small Pox in the whole metropolis last year was a cause of great anxiety. It in some degree caused the confidence in the protecting power of vaccination to totter for a brief space of time. The sensible abatement of the disease appears, however, to have restored the confidence before placed in this invaluable preventive agent. The greater care which has been exercised in its performance, and the activity used in securing its almost universal application, have been followed by the most satisfactory results. Whooping Cough decreased, and Diarrhoea slightly increased. Five cases of Cholera were recorded, possibly of that kind recognised as an aggravated form of Diarrhœa; most of them were certified "Cholera Infantum." Deaths from Natural Decay were fewer by 38 cases, and diseases of the brain and heart were slightly in excess of the previous return. But on the whole, the mortality, as I have already stated, was less in the past statistical period than in that which immediately preceded it. 12 TABLE VI. CAUSES OF DEATH. DISEASES. DEATHS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4 th Quarter. Total. Fever 26 29 24 25 104 Small Pox 5 22 16 3 46 Measles 5 3 3 1 12 Scarlatina 23 34 53 44 154 Cynanche Maligna and Diphtheria 6 6 2 3 17 Diarrhoea of Adults. - 5 5 1 11 Do. Children under 3 yrs. - 6 43 2 51 Cholera - - 5 - 5 Dysentery 1 - 1 - 2 Whooping Cough 6 16 3 15 40 Croup 14 14 8 10 46 Erysipelas 2 1 1 3 7 Diseases of Abdominal Organs 8 7 5 6 26 Bronchitis, Pneumonia, &c., of Children under 3 years 36 23 13 38 110 Do. of Adults 47 24 21 27 119 Pulmonary Consumption 54 48 42 50 194 Water on the Brain and Convulsions of Infants 26 17 14 23 80 Teething 18 12 8 5 43 Dropsy 13 8 12 10 43 Cancer 5 3 6 3 17 Hernia - 1 - 1 2 Diseases of Heart and large Bloodvessels 23 12 8 13 56 Apoplexy, Paralysis, and other Diseases of the Brain 36 27 28 41 132 Puerperal Fever 2 4 2 1 9 Premature Birth and Debility from Birth 43 27 31 36 137 Violence, Privation, and Poison 19 11 8 11 49 Other Diseases, chiefly Chronic 29 28 27 22 108 Natural Decay 36 35 30 27 128 Total 483 423 419 421 1746 13 We come now to the Quarterly Summary of Births and Deaths for the first quarter of the present year, that is, to March 26th, in accordance with the demands of the Act of Parliament regulating the Metropolitan Vestries. It is not necessary to go into any detail on these figures, as they will be embodied in my next Report, as those for 1863 are in my present statement. Compared, however, with the like Report for 1863, some increase will be observable; perhaps not inconsistent, however, with the increase of population. QUARTERLY SUMMARY OF THE MORTALITY OF MILE END OLD TOWN, FOR THE QUARTER ENDING MARCH 26, 1864. Births 806 Deaths 542 Excess of Births 264 Of the 542 deaths, 277 were males, and 265 females. The weekly averages of deaths were, in January 48.4 February 41.5 March 33.5 The relative mortality of the five Wards may be seen in this Table. North. East. West. Central. South. Workhouses Hospital. 94 56 99 149 67 75 2 From the Inspector of Nuisances I have received the 14 following report of work done. Besides this, much that cannot be specified falls to the lot of the officers, to keep the Hamlet as free as possible from the proximate causes of ill health. INSPECTOR'S RETURN OF NUISANCES REMOVED UNDER HIS SUPERVISION DURING THE YEAR ENDING MARCH, 1864. Privies emptied 147 Drains cleansed 136 Privies connected with sewer, panned, and trapped. 198 Cesspools emptied 46 Removals of swine 47 Removals of accumulations of offensive matter 117 Houses cleansed 48 Total 739 In conclusion, Gentlemen, allow me to again congratulate you on the favourable state of the Hamlet. Attention cannot be too persistently or too frequently called to the means adopted to preserve health and decrease mortality. We know the causes which promote them, and can scarcely do better than spread, as widely as possible, the knowledge of those causes among the ratepayers, particularly in those parts of the Hamlet used especially by the poor. Every one should know that fever is the child of dirt, and that an unventilated room or a close alley teems with disease. Every one should be made acquainted with the fact that the 15 atmosphere is the medium through which vapours are carried from house to house, and that it diffuses the miasm of fever as readily as it does the perfume of flowers or the freshness of the morning. Every one should know that clean and pure water is as much a necessary of life as food or raiment, and that the sun which cheers us with its light and warmth promotes evaporation and putrefaction, and so causes every little cinder-heap and dunghill to become an active centre of dangerous disease. To the combination of the products of a number of these small nuclei are to be attributed the origin of contagious maladies in many defined instances, attended, of course, with their accustomed mortality. Nothing in nature is destroyed, but only undergoes change; but during that change, certain causes of disease are at the same time generated ; the principal among them are the result of disorganisation of animal and vegetable matter. Therefore, if no pains were taken to render innocuous the refuse of our homes, the sewage of our streets, etc., we could not wonder if we found contagion flying on the wind, and carrying death into every corner of our streets and houses. In our day very much has been done to promote the health of the people. Efforts are being continually made to render the vast congregation of cities known as London as pure and cleanly as possible. The intercepting drainage scheme, the ample supply of water (which is capable of some extension), the improvement in cottage homes, the opening up of narrow thoroughfares, the improvement of highways, the regular inspection of lodging houses, the removal of nuisances, the inspection of factories, the Thames embankment, the establishment of baths and washhouses, the closing of churchyards, and the supervision of markets and slaughter 16 houses,—these public improvements, with many others, have done much to render the England of our day a more desirable and healthy country than the England of our forefathers. Whatever has been lost in picturesqueness has been gained in health and extended longevity, with their attendant comforts and advantages. Hoping, desiring, and expecting, that a perseverance in the promotion of sanitary measures, and an extension of acquaintance with their doctrincs, may produce the results which almost inevitably follow their adoption, 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, 15th July, 1864. Newell, Printer, 78, Mile End Road.