HAML 13 REPORT OF THE MEDICAL OFFICER OF HEALTH, to THE VESTRY of the Hamlet of Mile End Old Town. ANNUAL REPORT, JUNE, 1865. LONDON: PRINTED BY THOS, PENNY, 121, LEMAN STREET, WHITECHAPEL. 1865. REPORT. Gentlemen, In accordance with the requirements of the "Metropolis Local Management Act" I present to yon my Annual Report on the sanitary condition of the Hamlet of Mile End Old Town. Before proceeding to the consideration of the facts derived from the experience of the past year, it will be as well, perhaps, to refer to a subject which is just now creating a certain amount of uneasiness in the public mind—namely, the appearance of Cholera in Egypt, Turkey, and Italy. In anticipation of the possibility of its reaching our shores, the Privy Council have issued a circular, similar to that which was put forth by the same authority in 1859. The various hints, rides, and cautions therein contained are easy to be understood, and capable of ready application, by those who value their own health or care for that of their neighbours. They may, indeed, be summed up in a simple sentence —personal and household cleanliness, the employment of disinfectants where there is effluvium, abundant ventilation, the use of wholesome water for drinking, and the persistence in regular habits of life. These regulations, necessary at all times, are especially valuable when there is a dread of coming sickness, besides forming in their practice a sort of education, the importance of which is very great. 4 Ever since the appearance of Cholera in this country in 1830, the principal means to divert or disarm this disastrous epidemic have been in active operation: and we shall profit by the zeal and judgment with which those means were applied, or suffer in proportion to one neglect of sanitary precautions. The repeated epidemics, since that year, on each occasion found out our weak points, and so indicated to us the best defence. There can be no doubt, whatever, that the Country, and London especially, is in a much higher sanitary condition than was its lot at the time abovenamed. Notwithstanding the reluctant removal of pigs, the scanty supply of water to water-closets, and the tenderness bestowed upon landlords and owners of small house property, the state of the Metropolis has maintained a steady progressive improvement. Densely peopled as is the Hamlet, and receiving, as it does, continual additions to its population, not only by the excess of births over deaths, but by immigration, we shall always find examples of infraction of sanitary rules, in which are combined most of the elements favourable to the nurture of any contagious disease. How far these examples have been watched and cared for, will bo seen by the tables which I shall presently place before you. Where there is a redundant and increasing population, there will be generally over-crowding, and where there is over-crowding, we are certain to find disease. If we could distribute the population, carry fresh air to every house, secure the rapid removal of ordure and refuse, find cleanly and regular habits in the lowest ranks of life, and see that every one was well fed, clothed, and sheltered, probably we should be able to enjoy the satisfaction of seeing the last of epidemic 5 disease. People are still, indeed, to be found who tell us that epidemics are indiscriminate in their attacks, and that they can point to instances in support of their assertion; but it is sufficient to refer to the long and unvarying record of medical experience in refutation of this. The well-to-do will, in all probabity, suffer when a district is ravaged by any malady, but the greatest sufferers are found among those who are least kindly treated by fortune, or who are most negligent of their moral and social duties. There is just sufficient catholicity in an epidemic to show us that there is a brotherhood in suffering; that, in fact, if the wealthy man wraps himself up in his selfishness and declares that he is not his "brother's keeper," he, too often, is called on by death to pay for his neglect and indifference. But it is nevertheless true, that the heaviest blow of an epidemic falls on those who are least prepared to meet it, and who, unfortunately, are least able to escape its clutches. The present extraordinary high price of meat, has a direct tendency to expose the labouring classes to disease. With a liberal diet one may, to a certain degree, assume an air of defiant confidence in the presence of infection which would not be reasonable if the system were impoverished by the exhaustion attending a continued short supply of nutritious food. There does not appear any immediate cause for apprehending the invasion of our land by Asiatic Cholera; although, at the same time, it must be recollected that, on former occasions, having its origin in the East it travelled by "fitful steps and slow" Westward until it reached Europe; that the scourge has at the present moment completed a portion of a similar course, and that no preventive quarantine laws or cordons sanitaires 6 appear capable of commanding its stay. But, I use the term cholera, rather as the type of epidemic and preventible disease—disease that if it appears at all in places which are thoroughly wholesome, and are well prepared beforehand for its repulsion, its effects are comparatively feeble and its visit transient; thus, as it were, inviting a recognition, as I hope it will be found to do, that the sanitary attention to our district and London generally has been such, that at any time the conditions which foster the existence and spread of epidemic disease will be found to have belonged to a by-gone period. It is rather to the sanitary improvements which have been made, that I look to as a means to foil and turn aside the bitter scourge of so terrible a malady, than to extraordinary exertions proposed to be undertaken should occasion arise to require them. All that the circular of the Privy Council advises and recommends has been before advised and recommended, and, better still, acted on by the local officers of the various districts. From so powerful a source as the Privy Council it is devoutly to be wished that, something beyond advice and persuasion had been allowed to emanate, something which would have added to the force already freely exercised. If it were necessary to publish a document of any kind, it is to be regretted that it had not assumed the form of direction and command. Still, it is my firm opinion, that we are in a better condition to receive, and we may hope avert, the threatened attack, than we have been, when, on other other occasions the alarm has been sounded. It is beyond doubt that, for the last three years we have been under the influence of certain conditions which would, with circumstances more favorable to the development of fever, have been attended by a serious amount 7 of mortality from that disease. How is it that our death-rate from Fever has been so moderate ? The same causes which moderate the violence of one disease, will, I trust, be found to offer an equally effective opposition to any other which may present itself. Upon that which has already been done, as I have stated, I rely rather than upon hurried exertions made in the presence of pestilence. It must afford the public agreeable assurance to know that, fearful as are the ravages of Cholera in the East, the disease is eminently under the controlof sanitary exertion. Eastern cities are notoriously deficient in those arrangements for the preservation of the public health, of which the smallest towns in Europe, but especially those in England, can generally boast. It is not wonderful, therefore, that disease of a zymotic kind should spread rapidly during the hot season, with sanitary defects so enormous that it is only surprising human existence can at any time be properly maintained. Ordinary rules for the promotion and maintenance of health have been so repeatedly placed before the educated portion of the public, that it is to be hoped and expected they will, to a great extent, take care of themselves, not only as matter of self-interest, but of comtort. The windows of their houses are made to open in some form or other, they have a free supply of water, and it is any easy thing to cause the removal of refuse from their own premises. But it is different in the poorer localities. There the inhabitants have less time, less means, and do not possess the knowledge of the best methods of keeping them clear of febrile and contagious disorders. 8 These remarks will introduce us to the particular state of the sanitary condition of the Hamlet as will be shown by a series of tables mainly founded upon the mortality and the information elicited in connection with it. It will be seen from the figures of the following table, that in the year last past, there were in the Hamlet of Mile End Old Town 3193 births to 1977 deaths, showing an excess of births over deaths of no fewer than 1216. TABLE I. BIRTHS AND DEATHS 1864. Births. Deaths. Excess of Births over Deaths. First Quarter 806 542 264 Second Quarter 745 419 326 Third Quarter 792 495 297 Fourth Quarter 850 521 329 Total 3193 1977 1216 These figures do not compare unfavourably with those of former years. The deaths in 1861 were 1556 and the births 2719; in 1862 the deaths numbered 1836 and the births 2769; and in 1863 the deaths were 1746 and and the births 3015. The gradual increase in both births and deaths must, of course, be attributed to the increase of population—there being now, according to the nearest estimates, about 8000 more persons living in the Hamlet than there were in 1861, when the Government census was taken. In the next table we have the details of the mortality of the Hamlet. Here again, we find but a slight variation TABLE II. Wards. POPULATION. Acres. Number of Persons to the Acre. DEATHS, 1864. Rate of Deaths per annum to every 1000 persons living Census. 1861. Present Estimated. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. TOTAL. M. F. M.&F. North 15412 17500 2 108 94 59 92 99 163 181 344 19. East 9573 14060 193 73 56 53 56 75 112 128 240 17. West 14806 14836 78 190 99 106 87 92 201 183 384 25.8 Centre 18390 19520 135 145 149 123 138 146 292 264 556 28.4 South 14883 15384 113 136 67 53 82 72 132 142 274 17.8 Workhouses — — — — 75 23 39 134 78 93 171 — Hospital — — — — 2 2 1 3 5 3 8 — Total 73064 81300 — — 542 419 495 521 983 994 1977 — Rate of Deaths per annum to every 1000 persons living, (including Workhouses and Jews' Hospital) 24.3 10 from the experience of the previous year. In 1863 the proportion of deaths to every 10,000 living in the Hamlet was 221; and 1864, 243. Compared with the per centage of mortality throughout the entire metropolis, these results are not unfavourable. I have estimated the increase of population during the year at about 2000; the figures for 1862 being 76,825; for 1860 79,124; and for 1864, 81,300. The principal increase in the population has taken place in the North and East Wards; in the latter the number of inhabitants to the acre having risen from 68 in 1863 to 73 in 1864. The per centage of mortality has not varied greatly in either of the quarters of the year, though, as usual, we find the first and last quarters show the highest figures. The next table gives us the weekly averages of death from the year 1857 to that of 1864 inclusive. This is TABLE III. WEEKLY AVERAGES OF MORTALITY. Weekly Average lumber of Deaths in 1857. 1858. 1059. 1860. 1861. 1802. 1863. 1864. January 33 35.2 31.8 41 37.75 35.25 38 48.4 February 32 30.25 27.5 40 26.5 36 33 41.5 March 31.75 34.25 30.25 38 30.2 35.4 40.25 33.5 April 28 31.5 28.4 34 30 45 35.5 33.4 May 24.6 22.2 24.25 29.25 34 27.4 28.4 33 June 26.6 24.25 22 26.2 24.8 32.2 34.75 30 luly 33.5 27.2 30 21.5 31.25 28.25 32.25 38.2 August 33.02 29.75 31.5 24 27.2 32.4 39.2 43.75 September 28.5 23.75 24 24.0 26.75 34.5 23.5 32.25 October 27.4 26 25.2 24.75 29.5 30.25 29.2 34.2 November 28.75 35 25.2 23.6 22.4 43.6 34.75 39 December 29.25 30.5 37.2 27.4 30 37.75 34 38.6 Annual Weekly Averages. 29.5 29.03 28.4 29.35 29.83 35.3 33.56 37.15 11 an instructive table, as it shows at a glance what is the mortuary rate in the Hamlet. But it must not be supposed that, because an average of 37 persons died every week in 1864 and only 29 in 1857 that our deathRate has materially increased; because with these figures must be taken the regular progress in the population during the intervening years, in which period has become augmented by one half. TABLE IV. DEATHS AT PARTICULAR AGES. AGES. DEATHS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Under 5 years 224 199 269 236 928 From 5 to 10 years 28 19 26 33 106 „ 10 to 15 years 3 7 8 6 24 „ 15 to 20 „ 4 4 9 12 29 „ 20 to 30 „ 2ti 22 29 26 103 „ 30 to 40 „ 33 39 33 33 138 ,, 40 to 50 „ 50 23 26 30 129 „ 50 to 60 „ 34 34 19 39 126 „ 60 to 70 „ 54 23 35 44 156 70 and upwards 86 49 41 62 238 542 419 495 521 1977 Table 4 gives us further details as to the ages at which the deaths stated took place. In accordance with previous experience we find that the early years of infancy present the greatest number of deaths. Out of the 1977 persons dying from all causes in 1864 no fewer than 928, or nearly one half of the whole number were under five years of age. This great mortality 12 among infants is in accordance with the experience of the Registrar General, and does not differ much in ratio from the figures of the mortality of the principal towns. The gradual increase in numbers year by year is strictly in accordance with the increase in the population ; and we may fairly congratulate ourselves on the fact that up to the present time the mortality of our Hamlet does not compare unfavorably with that of the whole metropolis. The following table gives us still further details of the mortality of 1864; for in it w.e can compare the whole number of deaths with those which were the the result of the six principal zymotic diseases. Here, TABLE Y. DEATHS FROM THE SIX PRINCIPAL ZYMOTIC DISEASES. Wards. Deaths from all causes. Deaths from Zymotic Diseases. Or in the proportion of 1 to 2. North . 344 88 3.9 East 240 62 3.87 West . 384 93 4.1 Centre . 556 162 3.4 South . 274 64 4.28 W orkhouses 171 18 9 Hospital 8 — — Total . 1977 487 4 again, there is comparatively little to remark either in exultation or regret; as the figures, though higher than might have calculated are only such as are due to, and 13 those of previous years, from, the increase of population —the figures for 1863 being 1 to 3.97 and 1 to 4 in 1864; the total number of those who died from zymotic diseases being comparatively small when set against those arising from ordinary causes. It may be explained that the higher the numbers in the third column of the table relative to zymotic diseases, the more apparent becomes the effect of sanitary measures in the suppression of ailments of this character. The proportional share of contagious diseases borne by each of the five Wards offers no occasion for particular remark : for, by comparing the figures of Table 5 with the corresponding figures for previous years I find but very slight variations in the general averages of the several Wards; of course, I mean so far as regards the proportion of zymotic disease to that of an ordinary kind. In Table 6 is seen the especial character of the diseases to which the 1977 death in 18G4 were due. Here we find that the mortality from Fever was absolutely numerically less by 15 cases than it was in 1863; while Small-pox, which was fatal in 46 instances in 1863, carried off only 7 victims in 1864. But Measles increased from 12 cases to 115; while, on the other hand, Scarlatina fell from 154 to 115. Cholera, so-called, was fatal in 7 cases, though not a single instance of adult death occurred from diarrhœa. Whooping-cough was slightly more fatal than in the previous year, the figures being 67 in 1864 against 40 in 1863. The other diseases which commonly attack children present no material variation in number which call for particular remark; nor do the other figures in the Table present sufficient deviation to render special reference to them necessary. TABLE VI. CAUSES OF DEATH. DISEASES. DEATHS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Fever 21 12 26 30 89 Small Pox 2 2 2 1 7 Measles 3 41 51 20 115 Scarlatina 36 13 25 48 122 Cynanche, Maligna, and Diphtheria 3 5 4 3 15 Diarrhœa of Adults . - - - - - Do. Children under 3 yrs. 1 6 52 8 69 Cholera — 2 4 1 7 Dysentry — 2 1 — 3 Whooping Cough 36 15 11 5 67 Croup 10 12 8 11 41 Erysipelas 3 1 2 5 11 Diseases of Abdominal Organs 13 4 10 8 35 Bronchitis, Pneumonia &c., of Children under 3 years 38 38 28 53 157 Do. of Adults 90 23 15 45 173 Pulmonary Consumption 37 49 58 44 88 Water on the Brain and Convulsions of Infants 24 20 18 24 86 Teeting 14 9 14 11 48 Dropsy 12 6 8 15 41 Cancer 7 5 7 4 23 Hernia 1 - - 1 2 Diseases of Heart and large Bloodvesels . 27 18 19 31 95 Apoplexy, Paralysis, and other Diseases of the Brain 28 27 31 43 129 Puerperal Fever 1 6 — 1 8 Premature Birth and Debitity from Birth 34 32 46 34 146 Violenee, Privation and Poison 14 12 10 7 43 Other Diseases, Chiefly Chronic 52 35 27 45 159 Natural Decay 35 24 18 23 100 Total 542 41.9 495 521 1977 15 On the whole, therefore, the examination of this table gives us ground for congratulation on the fact, as there represented, of the generally healthy condition of the Hamlet during the past year. The Act of Parliament requiring that my report shall be made up to a certain date, I give in the same form as usual, the figures relating to the mortality in the Hamlet from January 1st to March 28th, of the present year. QUARTERLY SUMMARY Of the Mortality of Mile End Old Town, for the Quarter ending 25th, March, 1865. Births 799 Deaths 523 Excess of Births 276 Of the 523 deaths, 253 were males, and 270 females. The weekly averages of death were, in January 47.5 February 37 March 6 The relative mortality of the several Wards into which Hamlet is divided, may be seen in the following table: N. E. W. C. s. Workhouses Hospital. 93 64 108 127 67 63 1 16 From the Inspector of Nuisances, I have received the following Report, by which it will be observed that, in conjunction with my own special labours, much real work is necessary to keep the Hamlet in a state of comparative good health :— Inspector's Return of Nuisances, &c., Removed under his Supervision, during the Year ending March, 1865. Privies emptied. 157 Drains cleansed. 139 Privies connected with sewer, panned and trapped 306 Cesspools emptied 45 Removals of swine 131 Removals of accumulations of offensive matter 114 Houses cleansed 49 Total . 941 In conclusion, Gentlemen, I think we may fairly congratulate ourselves on the fact, that the hygienic state of the Hamlet is nearly equal to that of the whole metropolis. Mile End Old Town having long enjoyed, through the activity and intelligence of the Local Authorities, the benefit of careful sanitary supervision, there is not, perhaps, much to fear from the ravages of Epidemic disease; but still, it behoves us to neglect no precaution, and to fail in no particular which seems likely to further so desirable an object, and to prove beneficial to the whole body of the inhabitants. I have the honour to be, Gentlemen, Your most obedient Servant, Vestry Hall, J. H. FREEMAN. Midsummer, 1865.