HAML 20 VESTRY OF THE HAMLET OF MILE END OLD TOWN ANNUAL REPORT upon the PUBLIC HEALTH and Sanitary Condition of the District FOR THE YEAR 1898 BY THOMAS TAYLOR, Medical Officer of Health. london: printed by w.j. hasted & son, 306, mile end road, e. 1898. THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1898. To the Vestry of the Hamlet of Mile End Old Town. Gentlemen, It is now my duty to report to you on the Health and Sanitary condition of the Hamlet during the year 1898. Although much useful work has been accomplished in the past year, there is still a great deal to be done before Mile End is a Health Resort. The most casual observer cannot but be struck with the condition of the district as it is to-day compared with what it was—say, 12 years ago. At that time the Public Health Act was not in existence and the provisions of the Nuisance Removal Act and other statutes were not of such a drastic character as the present Act There were then, I should say, thousands of houses without proper water supply to their closets, and hundreds of houses with their domestic supply of water from the same tank that supplied the W.C. The drainage of the houses was very imperfect, and consequently Sewer gas was constantly being emitted into living rooms. This state of affairs is being gradually altered; proper and separate water supplies for domestic purposes as well as for W.C.'s and a more perfect system of drainage cannot fail to have the effect of raising the health standard of the people, especially that of the rising generation. (4) The restriction of the constant water supply during the hottest months of the year was a source of anxiety to the Sanitary Authorities in the East End, and inflicted serious hardship on the consumers in general. The Vestry gave a free hand to its officers to take all the precautions they could to mitigate the inconvenience. Vital Statistics. The estimated population of Mile End Old Town in the middle of 1898 was 112,538. I have no doubt that this number is rather under than overestimated, but it is calculated on the rate of increase being the same between the present quinquenial Intercensal periods and the last one, which was four years ago. Birth Rate. The number of births registered during the year was 4,275, nearly double the number of deaths, representing a birth rate of 37.9 per 1,000. Deaths and Death Rate. The number of deaths occurring from all causes was 2,229, the death rate being 19.9 per 1,000 for the year. This is slightly higher than last year. The death rate in London generally was higher than it had been in the previous year. It will be seen by Table X that we again compare very favourably with the other Eastern Districts; we have the lowest death rate of any East End district this year, and taking the last five years, whilst the aggregate deathrate ror the Eastern districts was 22.3, that of Mile End was 20.4 per 1,000. In a district like this, with the number of poor people we have always with us, we can never hope to have as low a death-rate as that of the West End districts. TABLE 1. STATISTICS AS REQUIRED BY THE LOCAL GOVERNMENT BOARD. TABLE OF DEATHS during the Year 1898 in the Sanitary District of Mile End Old Town, classified according to DISEASES. AGES and LOCALITIES. Names of Localites adopted for the purpose of these Statistics; public institutions being shown as separate localities. Mortality from all causes, at subjoined ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all ages. under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and upwards 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diptheria. Membranous Croup. fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea & Dysentery. Rheumatic Fever. Phthisis. Bronchitis. Pneumonia, and Pleurisy. Heart Disease. Gastro Enteritis Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) Mile End Old Town 1952 638 371 76 77 519 271 Under 5 6 43 10 2 86 59 101 38 174 4 90 8 388 1009 5 upwds. 2 12 13 6 9 4 1 6 4 133 181 128 5 24 415 943 Mile End Infirmary 282 25 7 4 9 120 117 Under 5 3 2 5 2 20 32 5 upwds. 1 3 4 37 44 33 1 127 250 City of London Union 49 9 49 Under 5 5 upwds. 2 7 4 36 49 South Grove Workhouse 42 9 33 Under 5 5 upwds. 1 1 8 2 1 29 42 Trinity Almshouses 2 2 Under 5 5 upwds. 2 2 Jewish Homes 7 7 Under 5 5 upwds. 1 1 5 7 East End Mothers' Home 15 15 Under 5 15 15 5 upwds. Totals 2349 678 378 80 86 657 470 Under 5 6 43 10 2 86 62 101 40 179 4 92 8 413 1048 5 upwds. 12 13 13 6 12 4 1 11 4 173 241 168 7 24 624 1301 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto. 398 52 79 36 35 149 47 Under 5 4 26 1 6 3 4 26 19 3 39 131 5 upwds. 2 8 10 2 3 28 39 27 1 12 136 267 Deaths occurring within the district among persons not belonging thereto. 105 20 85 Under 5 5 upwds. 1 3 16 7 1 77 105 TABLE 2. STATISTICS AS REQUIRED BY THE LOCAL GOVERNMENT BOARD. Table of Population, Births, and of new Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1898, in the Hamlet of Mile End Old Town Sanitary District; classified according to DISEASES, AGES, and LOCALITIES. Names of Localities adopted for the purpose of these Statistics ; public institutions being shown as separate localities. Population at all Ages. Registered Births. Aged under 5 or over 5 New Cases of Sickness in each Locality coming to the knowledge of the medical officer of health. number of such cases removed from their homes in the several Localities for Treatment in Isolation Hospital i 2 3 4 5 6 7 8 9 to 11 1 2 3 4 5 1 6 7 8 9 10 11 Smallpox. Scarlatina. Diphtheria. Membranous Croup. fevers. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. fevers. Cholera. Erysipelas. Census 1891. Estimated to middle of Typhus. Enteric or Typhoid. Continued Relapsing Puerperal Typhus. Enteric or Typhoid. Continued Relapsing Puerperal (a) (b) (c) (d) (e) Mile End Old Town 111360 112528 4275 Under 5 137 90 12 4 7 61 38 3 2 5 upwds 210 108 1 33 1 9 132 101 39 12 1 2 Mile End Infirmary Under 5 1 5 upwds. 2 9 2 London Hospital Under 5 22 30 1 7 20 30 1 5 upwds 35 27 18 20 35 24 17 Children's Hospital, Shadwell Under 5 3 7 3 7 5 upwds. 4 3 1 4 3 St. Bartholomew's Hospital Under 5 5 upwds. 1 1 1 Eastern Hospital, Homerton Under 5 2 1 2 1 5 upwds. 6 2 6 2 Tower Hamlets Dispensary Under 5 5 upwds. 1 South Grove Workhouse Under 5 2 5 upwds. 2 / Under 5 5 upwds. Totals Under 5 164 128 12 5 17 86 76 3 3 5 upwds. 255 143 1 52 1 9 165 146 71 29 1 2 TABLE 3. Shewing the Death-rate per 1000 persons living, from the undermentioned causes in London, the Eastern Districts of London, and Mile End Old Town, 1894 to 1898. LONDON. EASTERN DISTRICTS. MILE END OLD TOWN. 1894. 1895. 1896. 1897. 1898. Average for the Five Years. 1894. 1895. 1896. 1897. 1898. Average for the Five Years. 1894. 1895. 1896. 1897. 1898. Average for the Five Years. Principal Zymotic Diseases 2.6 2.6 3.1 2.5 2.7 2.7 3.5 4.0 3.6 3.2 3.5 3.5 4.0 3.9 3.6 2.6 3.5 3.5 Small Pox ... .02 .01 .002 ... .01 .03 .01 ... .7 ... ... .03 ... ... ... ... ... Measles .7 .6 .8 .4 .6 .6 1.1 1.1 .9 .1 .8 .8 1.1 1.0 .7 .5 .8 .8 Scarlet Fever .2 .2 .2 . I .1 .1 .2 .2 .2 .6 .1 .2 .3 .2 .3 .1 .2 Diphtheria ... .6 .6 .5 .3 .3 .4 .8 .7 .6 .4 .4 .5 .7 1.0 .8 .5 .5 .7 Whooping Cough ... .4 .3 .6 .4 .4 .4 .6 .4 .8 .9 .8 .7 .6 .4 .7 .4 .6 .5 Typhoid Fever .1 .1 .1 .1 .1 .1 .1 .1 .1 .1 .1 .1 .1 .1 .1 .1 .1 .1 Diarrhoea .4 .8 .7 .9 .9 .7 .5 1.0 .9 1.5 1.2 1.0 .6 1.0 .8 .7 1.2 .8 Deaths from all causes 17.4 19.4 i8.2 17.7 18.3 i8.1 21.8 24.3 21.7 21.9 22.0 22.3 21.1 22.5 19.9 18.7 19.9 20.4 Deaths under one year to 1000 Births registered 142 165 160 158 166 158 161 180 164 173 181 171 155 165 157 149 155 156 TABLE 4. TABLE 4—continued. RETURNS OF MORTALITY IN THE HAMLET OF MILE END OLD TOWN FOR 1898. Including the Deaths occurring in the Workhouse Infirmary and excluding the Deaths of Parishioners of Mile End old in the Jewish Home, Stepney Green; Moses Alms Houses, Devonshire Street; Trinity which occurred in Public InstiAlms Houses; City of London Union; The East End Mothers Hom; and South Grove tntions outside the Hamlet, such as Workhouse. Hospitals, Asylums, Ac. Total Deaths from all causes. DISEASES. AGES. AGES. AGES. 0 1 5 15 25 65 0 1 5 15 25 65 0 1 . 5 15 25 65 1 5 15 25 65 90 1 5 15 25 65 90 1 5 15 25 65 90 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina 1 1 ... ... ... ... 1 3 2 ... ... ... 2 4 2 ... ... ... Diphtheria 4 13 4 1 ... ... 1 25 8 ... ... ... 5 38 12 1 ... ... Membranous Croup 2 8 ... ... ... ... ... ... ... ... ... 2 8 ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... ... 2 1 ... ... ... 3 4 3 ... ... ... 3 6 4 ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing do. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal do. ... ... ... 3 1 ... ... ... ... ... 2 ... ... ... ... 3 3 ... Gastro Enteritis 41 32 ... ... 4 1 14 5 ... ... 1 ... 55 37 ... ... 5 1 Erysipelas 1 ... ... ... 7 2 1 ... ... 1 2 ... 2 ... ... 1 9 2 Measles 16 64 4 ... ... ... 1 5 ... ... ... ... 17 69 4 ... ... ... Whooping Cough 25 34 1 ... ... ... ... 3 ... ... ... ... 25 37 1 ... ... ... Diarrhæa and Dysentery 101 ... ... ... 4 6 ... ... ... ... ... ... 101 ... ... ... 4 6 Rheumatic Fever ... ... ... 1 3 ... ... ... ... ... ... ... ... ... ... 1 3 ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis 19 17 5 19 117 1 ... 4 4 6 17 1 19 21 9 25 134 2 Bronchitis, Pneumonia and Pleurisy 78 75 8 2 83 93 9 17 2 5 24 8 87 92 10 7 107 101 Heart Disease 1 3 8 8 76 42 ... ... 6 4 14 3 1 3 14 12 90 45 Injuries 2 3 1 1 2 8 : ... 3 1 2 7 2 2 6 2 3 9 10 All other Diseases 320 49 13 14 190 185 25 14 10 13 79 33 345 63 23 27 269 218 611 299 44 51 488 338 52 79 36 35 149 47 663. 378 80 86 637 385 TABLE 6. Table shewing Deaths from all causes, and also from the principal Zymotic Diseases, in the various Metropolitan Districts as well as Mile End Old Town, during the year 1898. Name of District. Deaths from all causes. Small-pox. Measles. Scarlet Fever. Diphtheria. * Whooping Cough. Typhus Fever. Enteric Fever. Other continued Fevers. Diarrhoea. Annual Rate per 1,000 living. rate per 1000 living. Registration London 82031 1 3069 581 1756 2157 3 554 9 4352 2.77 18.3 Paddington 2041 ... 93 8 61 44 ... 17 1 83 2.41 16.1 Kensington 2809 ... 120 24 26 52 2 13 ... 110 2.02 16.4 Hammersmith 1964 ... 129 22 73 36 ... 12 ... 120 3.19 18.3 Fulham 2155 ... 59 35 61 41 ... 18 1 180 3.16 17.2 Chelsea 1752 ... 92 15 41 26 ... 14 ... 74 2.73 18.2 St. George, Hanover Sq. 1059 ... 35 4 10 16 ... 9 ... 29 1.29 13.2 Westminster 1090 ... 52 5 22 43 ... 3 ... 32 3.00 20.8 St. James, Westminster 411 ... 15 2 5 1 ... 1 ... 9 1.31 18.6 Marylebone 2565 ... 129 13 45 43 ... 22 ... 79 2.36 18.3 Hampstead 917 ... 26 3 19 27 ... 10 1 24 1.40 11.7 St. Panci as 4651 ... 111 63 96 87 ... 41 ... 214 2.49 19.2 Islington 5712 ... 334 26 90 180 ... 36 ... 291 2.78 16.6 Stoke Newington 475 ... 10 1 5 9 ... 2 ... 27 1.56 13.7 Hackney 3588 ... 111 30 120 94 ... 41 ... 180 2.64 16.4 St. Giles, Bloomsbury.. 756 ... 26 2 6 9 ... 5 ... 23 1.88 20.2 St. Martin-in-the-Fields- 192 ... 1 1 3 1 ... 1 ... 4 0.88 15.5 Strand 532 ... 13 2 4 4 ... 4 ... 14 1.76 22.9 Holborn 747 ... 35 2 22 12 ... 2 ... 28 3.37 24.9 Clerkenwell 1432 ... 61 13 36 35 ... 7 ... 94 3.75 21.7 St. Luke, Middlesex .. 1054 ... 37 15 24 24 ... 2 ... 63 4.04 25.7 City of London 555 ... 8 2 10 2 ... 6 1 5 1.17 19.1 Shoreditch 2737 ... 108 21 44 98 ... 17 ... 192 3.95 22.3 Bethnal Green 2872 ... 152 11 62 119 ... 17 ... 142 3.90 22.3 Whitechapel 1622 ... 45 8 20 24 ... 9 ... 63 2.10 20.2 St. George in-the-East.. 1192 ... 33 6 14 39 ... 7 ... 60 3.31 24.8 Limehouse 1390 ... 57 5 26 62 ... 8 1 90 4.26 23.8 Mile End Old Town 2229 ... 90 8 63 63 ... 13 ... 142 3.51 19.9 Poplar 3605 ... 130 22 89 120 ... 30 1 237 3.72 21.2 St. Saviour, Southwark 577 ... 17 1 15 14 ... 4 ... 25 3.09 23.6 St. George, Southwark 1470 ... 43 20 36 34 ... 9 ... 99 3.99 24.4 Newington 2520 ... 55 24 72 45 ... 10 ... 182 3.17 20.5 St. Olave, Southwark 282 ... 6 1 3 11 ... 1 ... 5 2.31 20.6 Bermondsey 1771 ... 59 19 44 47 ... 9 ... 80 3.02 20.7 Rotherhithe 773 ... 33 10 11 15 ... 1 ... 21 2.24 19.0 Lambeth 5422 ... 135 30 114 159 ... 35 1 281 2.50 17.9 Battersea 2897 ... 114 28 120 68 ... 14 2 157 2.93 16.9 Wandsworth 2902 ... 111 16 89 86 ... 16 ... 166 2.40 14.4 Camberwell 4261 ... 117 18 87 128 ... 26 ... 252 2.41 16.4 Greenwich 3336 ... 108 21 44 122 ... 38 ... 222 3.08 18.5 Lewisham (exclu.Penge) 1350 ... 35 10 26 32 ... 6 ... 112 2.50 15.3 Woolwich 844 ... 58 5 19 27 ... 8 ... 54 4.13 20.4 Lee 592 ... 6 7 14 14 ... 7 ... 30 1.97 14.9 Plumstead 1016 ... 58 12 15 33 ... 3 ... 57 2.85 16.3 *Including deaths from membranous croup TABLE 6—continued. Cases of Infectious Disease notified to the several Metropolitan Medical Officers of Health, under the provisions of the Public Health (London) Act, 1891, in the Fifty-two weeks ending 30th December, 1898. Name of District. Small-pox. Scarlet Fever. Diphtheria. * Typhus Fever. Enteric Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Cholera. Totals. Estimated Population in the middle of 1898. Registration London 30 16894 11855 16 3024 55 247 5169 23 37315 4504766 Paddington ... 304 260 ... 74 2 5 131 ... 776 127480 Kensington ... 472 222 8 104 4 11 180 1 1002 172174 Hammersmith ... 461 164 ... 61 5 3 93 ... 787 107370 Fulham ... 811 476 ... 71 1 8 121 ... 1488 125275 Chelsea ... 336 273 ... 55 1 4 94 ... 763 96713 St. George, Hanover Sq. 1 221 111 ... 39 1 3 43 ... 419 80608 Westminster 1 99 127 ... 46 1 2 50 ... 326 52574 St. James, Westminster ... 31 43 ... 6 ... ... 20 ... 100 22200 Marylebone 1 312 235 ... 101 2 10 181 ... 842 140483 Hampstead ... 242 135 ... 47 ... 1 41 ... 466 78755 St. Pancras 2 980 499 ... 220 2 18 321 4 2046 243416 Islington ... 1336 545 2 237 1 19 280 ... 2420 344616 Stoke Newington ... 149 54 ... 18 ... 3 28 ... 252 34660 Hackney 2 1024 874 ... 219 3 14 300 ... 2436 219630 St. Giles, Bloomsbury ... 65 41 ... 23 ... 1 70 ... 200 37519 St. Martin-in-the-Fields ... 11 9 ... 12 ... ... 8 ... 40 12424 Strand ... 47 48 ... 9 ... ... 10 ... 114 23284 Holborn 1 97 147 ... 9 ... 2 41 1 298 30056 Clerkenwell ... 331 265 ... 42 1 2 69 ... 710 66120 St. Luke, Middlesex ... 196 192 ... 15 ... 2 58 ... 463 41076 City of London 1 79 46 ... 20 ... 19 ... 165 29088 Shoreditch ... 421 265 ... 91 1 7 173 1 949 121485 Bethnal Green ... 433 340 ... 102 2 3 324 ... 1204 129027 Whitechapel 2 252 187 ... 41 ... 5 147 ... 634 80559 St. George-in-the-East ... 143 113 ... 55 ... 3 74 ... 388 48241 Limehouse ... 190 137 ... 43 1 1 89 ... 461 58661 Mile End Old Town ... 419 271 ... 57 1 9 182 ... 939 112528 Poplar 4 646 468 ... 160 3 5 226 2 1514 170220 St. Saviour, Southwark ... 79 116 ... 14 ... ... 35 ... 243 24562 St. George-the-Martyr ... 309 245 3 40 1 6 71 3 677 60466 Newington ... 619 465 ... 90 1 11 156 ... 1342 123183 St. Olave, Southwark ... 67 16 ... 5 ... ... 24 ... 112 11288 Bermondsey 1 458 268 ... 51 ... 4 88 ... 870 85738 Rotherhithe ... 145 42 ... 24 ... 3 89 ... 303 40849 Lambeth 1 998 823 1 164 13 14 284 7 2305 304073 Battersea 4 806 800 1 94 ... 10 189 ... 1904 171921 Wandsworth 1 706 602 ... 123 1 20 235 ... 1688 202526 Camberwell 5 954 695 ... 117 3 11 233 ... 2018 261189 Greenwich ... 650 555 1 187 3 10 208 ... 1614 180441 Lewisham (exclu.Penge) ... 203 283 ... 45 ... 4 54 1 590 88562 Woolwich ... 204 109 ... 22 ... 8 43 ... 381 41478 Lee 3 158 162 ... 23 ... 4 43 ... 393 39717 Plumstead ... 422 111 ... 28 1 7 47 3 619 62531 * Including membranous croup. 18 Small Pox. Small Pox has again been conspicuous by its absence in this district; only thirty-two cases have been notified in the whole of the Metropolis during the year. The question of Vaccination has been prominently brought forward by the passing of the Vaccination Act of 1898. This Act will be a huge experiment. It provides for the exemption from vaccination of any child whose parents have a conscientious objection to Vaccination. A more retrograde measure in the cause of scentific teaching and research was never passed; it remains to be seen what will be the outcome of the next five years, as the Act is limited to that time. It is a notorious fact that we have at the present day some thousands of children in this district whose parents have evaded having their children vaccinated. Diphtheria. Unfortunately this disease tends to steadily increase. Although in our district there has been a sensible decrease during the year, in various parts of the country diphtheria has been a source of much concern to Sanitary Authorities, particularly in London. A great responsibility rests with the sanitary advisers to leave no stone unturned to check such increase, and with such an object in view—to make use of the more recently proved methods, bacteriological or otherwise. Reports upon the continual use of Antitoxin in various parts of the world are in the main favourable. The number of cases notified in this district during the year was 294, as against 445 in 1897—a considerable decrease—the mortality being 14.1 per cent. There was, and always has been, a marked diminution of this disease during that part of the summer when the schools are closed, tending to shew that school attendance has a marked influence as to its spread. We take all the precautions we are able to prevent its spread, and with that in view I have suggested that the children from any infectious house should not be allowed to return to school until one month after the case is removed to the Hospital, or at least fourteen days after the patient has recovered if treated at home. I am quite convinced that many children convey infection to school if sufficient interval is not allowed to elapse between the notification and school attendance. 19 Scarlet Fever. The number of cases of Scarlet Fever notified during the last twelve months was 419 and the number of deaths 8, a remarkably small mortality, clearly shewing the disease was of a very mild character. In all cases the schools which children from an infected house attended, were at once advised, a copy of each certificate being sent to the Head Master and the children excluded from school. Before the children were allowed to return, the parents were required to shew that the premises had been properly disinfected; this is done by a card being left at the homes as soon as disinfection has been carried out by your officers. I have reason to believe that this method has done good and made parents more careful in preventing the spread of infection. vVe had one case in which the parents shewed an utter disregard for the precautions given to them, and allowed a child in the peeling stage, the most infectious period, to run about the streets. This was reported to your Sanitary Committee, and it was felt that an example ought to be made in order to protect others. A summons was taken out against the father of the child, for "exposing an infectious child in the public streets," and was fined 10s. and costs. Typhoid or Enteric Fever. During the last few years this disease has shewn a sign of steady decrease; in 1896 the number of cases occurring in this district was 115; in 1897, 82 cases; and in 1898,. only 58 cases. As this disease is readily disseminated by means of discharges getting into defective drains, the remedying of defects in house drains will tend to still further decrease the number of cases. As the mortality of the disease is still large, every means that can be taken to prevent its spread ought to be taken; the drains in all cases have been tested, and where found defective, have been remedied. 20 Measles. The difficulty of becoming aware of the existence of any epidemic of this disease is considerable, owing to it not being a notifiable disease under the Infectious Diseases Act. The fact has been recognised by the School Board, and in order that the Sanitary Authorities should become acquainted with any marked absence of scholars owing to this disease, the school teachers have been requested to inform Medical Officers of Health from time to time ; in this way in the early part of the year we became aware that there was an epidemic of measles in the neighbourhood of South Grove Schools. The Sanitary Inspector and myself visited the houses of the children who were away from school, and such a large proportion of these children were suffering from this disease that I reported to the Sanitary Committee the advisability of closing the school for a time, with the view to stopping the spread of the disease. The Committee resolved to act upon Article 88 of the Educational Code, which states: " The Managers must at once comply with any notice of the " Sanitary Authority of the district in which the school is " situated, or any two members acting on the advice of the " Medical Officer of Health, requiring them for a specified time, " with a view to preventing the spread of disease, either to close " the school or to exclude any scholar from attendance, but after " complying they may appeal to the Department if they consider " the notice to be unreasonable." The necessary report was made to the Educational Department and the school was closed for some weeks. Some months after another epidemic broke out in the neighbourhood of St. Paul's School, which necessitated the closure of this school for a time. The Infants' department of Redman's Road school was also closed for a time for the same purpose. From observation and enquiry the promptness of closing these schools stopped the spread of the disease. The number of fatal cases occurring during the year was 90, a much larger number than in previous years; the greater part of these died from chest complaints following measles. CHART SHEWING WEEK BY WEEK THE NUMBER OF CASES OF DIPHTHERIA AND TYPHOID FEVER. Notified by Medical Practitioners as having occurred in the HAMLET OF MILE END OLD TOWN DURING THE YEAR 1898. CHART SHEWING WEEK BY WEEK THE NUMBER OF CASES OF SCARLET FEVER. Notified by Medical Practitioners as having occurred in the HAMLET OF MILE END OLD TOWN DURING THE YEAR 1898. 21 Sanitary Work Carried on during the past Year. Some few years ago it may be remembered I reported to you that a House to House inspection of the district was being made, it being our endeavour at that time to cover the district as rapidly as possible. During the past year the house to house inspection has been proceeded with. The first inspection was directed chiefly to such matters as ensuring a proper domestic supply of water, efficient sanitary conveniences, and the cleanliness of dwellings. In a large number of streets we have been enabled to make a secondary inspection which has been directed principally to the condition of the drainage of each particular house. This has been done by applying a powerful smoke test by means of the "asphixiator," and although not very much area may have been covered, the work has been of a permanent character. Where defects in the drainage were found to exist they have been remedied under the direct supervision of the inspector. The drains were not allowed to be covered in before examination, and in cases of new drains the water test was applied. The number of complaints received from all sources was 345. This number, in a thickly populated district like ours, was very small. Each complaint was investigated forthwith, and in not more than 50 per cent. of the cases was it found necessary to take any proceedings ; many of them were of a frivolous nature. The number of workshops is increasing, and it has been found necessary to keep them under constant supervision as the occupiers are frequently changing. The inspection of the workshops of the Hamlet has been carried out thoroughly —the number of inspections being 589. It will be seen from table 7 that in no less than 97 cases it has been found necessary 22 to order the cleansing and purifying of the workshops. In only one case was it found necessary to take proceedings with regard to the cleansing of a workshop, the occupier being fined £2 10s. for his default., I am glad to say the overcrowding of workshops has been found to be much less than in previous years. The occupier of one workshop was summoned for this offence and fined. The complaints received from the Factory Inspectors were very few and were promptly dealt with. The "drain versus sewer" question has been constantly cropping up, and the fact that so much work has been carried out with so little cost to the Vestry is principally due to the tact and discretion exercised by your inspectors. Houses Let in Lodgings The number of houses under these regulations is now 313. Sixty-six additional ones have been placed under them during 1898. These houses are all let to two or more families and are of a class that require considerable supervision. These houses are required to be cleansed and whitewashed at least once every twelve months, and the amount of cubic space required for each adult is specified. The person who takes the rent from each tenant is responsible for the maintenance of these regulations. In some cases we have found that the landlords seek to shirk their responsibility by letting the house to one of the tenants, who collects the rent from the others and thus becomes the person responsible under these regulations. In spite of this we have succeeded in having much necessary work carried out, such as cleansing. and proper system of drainage, etc. These houses generally are in a much better condition than formerly. 23 Housing of the Working Classes Act. The houses that I have placed under the influence of this Act have been steadily getting fewer in number each year, the reason being that owners of property do not allow their houses to get into the same dilapidated condition they did formerly, and the fact that their property is becoming more valuable may have something to do with it. The houses that I have reported under the Act were in such a dilapidated and insanitary condition that considerable structural work was required to make them habitable, and in all the cases reported the necessary work was carried out without resorting to extreme measures. Disinfection. The disinfection of clothing after infectious disease is a question in which all sanitary officers are interested, and no medical officer would be doing his duty if he did not bring home to his Vestry or district board the necessity for proper apparatus to carry this out During the last few years I have on many occsions pointed out to the Board the necessity for more modern apparatus, and the Sanitary Committee and the Vestry have so far felt the necessity as to pass a resolution that modern apparatus should be purchased. I have publicly, on more than one occasion, repudiated any responsibility for the present mode of disinfection as I do not consider that it can be properly carried out with the apparatus now in use. The matter of finance was, of course, the primary difficulty. It was sought to borrow the money—about £800—from the Local Government Board, but the restrictions made by the Board were such as to necessitate the purchase of a new site. The Committee have, however, recommended that the old site should be utilized and the expense borne directly by the rates; but, at present, this recommendation has not been adopted. TABLE 7. SUMMARY OF WORKS CARRIED OUT DURING THE YEAR BY THE SANITARY INSPECTORS IN THEIR RESPECTIVE DISTRICTS. No. 1 District. North Ward, North East Ward, South East Ward. C. COX. No. 2 District. North West Ward and East and West Centre Wards. F. H. LYON. No. 3 District. The whole of the South and West Wards. J. TWAITS. TOTALS. Houses and premises inspected 1770 1542 1955 5267 „ ,, reinspected 2571 2462 2467 7500 „ „ cleansed 49 112 52 213 Bakehouses inspected and reinspected 27 20 19 66 Bakehouses cleansed 4 2 3 9 Workshops inspected and reinspected 76 124 389 589 Workshops ventilated 1 0 5 6 „ cleansed 4 21 72 97 „ overcrowding in, abated 1 1 9 11 Workshops, sanitary conveniences provided for use of workpeople 3 20 7 30 Intimations of Nuisances served under Public Health Act 337 298 502 1137 Statutory notices served re Sanitary amendments 107 148 231 486 Notices re infectious diseases 253 235 215 703 Drains tested 343 270 314 927 ,, found defective 109 97 99 305 „ reconstructed 57 161 143 361 „ cleansed and repaired 133 111 54 298 „ trapped (new stoneware gullies) 103 162 192 457 Drains provided to areas 38 13 46 97 „ „ stables and stable yards 3 4 6 13 Sanitary closets provided in accordance with London County Council Bye Laws 128 304 191 623 W.C.'s provided with water and water supplies to closets reinstated 16 97 26 139 W.C.'s ventilated and lighted 41 16 8 65 „ new provided 6 26 8 40 ,, water supply disconnected from domestic cistern 14 0 2 16 W.C.'s removed from unsuitable positions 1 1 2 4 TABLE 7-continued SUMMARY OF WORKS CARRIED OUT DURING THE YEAR BY THE SANITARY INSPECTORS IN THEIR RESPECTIVE DISTRICTS. No. 1 District. North Ward, North East Ward, South East Ward. C. COX. No. 2 District. North West Ward and East and West Centre Wards. F. H. LYON. No. 3 District. The whole of the South and West Wards. J. TWAITS. TOTALS. New soil pipes fixed and ventilated 3 3 5 11 Cisterns cleansed 4 2 19 25 Yards paved 81 147 98 326 Washhouses paved 9 29 12 50 Areas paved 9 15 36 60 Forecourts paved 21 3 15 39 Sanitary dust receptacles provided 31 27 91 149 Manure receptacles provided in accordance with London 1 0 3 4 County Council Bye Laws Sink waste pipes disconnected from direct connection with drains 10 18 33 61 Rain water pipes disconnected from direct connection with drains 4 39 16 59 Houses ventilated under floors 14 67 15 96 Separate occupation of underground rooms discontinued 0 0 3 3 Overcrowding in dwellings abated 3 2 9 14 Offensive accumulations removed 2 2 8 12 Miscellaneous repairs, floors, roofs, gutters, &c. 32 124 64 220 Removal of animals improperly kept 0 1 2 3 Cowhouses and slaughterhouses inspected 7 7 18 32 Smoke observations 6 20 8 34 Summonses taken out under Public Health Act 2 22 13 37 Magistrates' orders obtained 2 15 11 28 POLICE COURT PROCEEDINGS. 1898. Situation of Premises. Nature of Complaint. Date of Vestry's Order. Date of Summons Result. Name of Inspector. 31, Ernest Street The foul, offensive, and defective condition of the drains. 1898 Feb. 16 1898 Mar. 11 Order to do works in 7 days. Mr. Lyon 33, „ „ Ditto ditto „ „ Ditto ditto „ 53, „ „ Ditto ditto „ „ Order to abate nuisance within 14 days. „ 31 & 33, „ Non-compliance with Magistrate's Order of March 18 th, 1898. - Apr. 2 Fined £2. „ 31 & 33, „ Ditto ditto - Apr. 16 Owner fined £4. „ 23, Old Church Rd. Premises unfit for human habitation by reason of the want of a proper water supply. May 4 June 2 Order to close premises. Mr. Twaits 36, Arbour Square Drain defective; sink waste untrapped; rain-water pipe defective; yard paving defective. May 11 „ Order to abate nuisance within 14 days. „ 113, Rutland Street Drain defective ; the yard paving insufficient; the dust receptacle defective. May 4 „ Ditto ditto „ 33, Greenfield Street Overcrowding of workshop so as to be injurious to the health of the persons employed. Apr. 20 „ Occupier fined £2 10s. and order made prohibiting currence of nuisance. „ 13, Knott Street W.C. defective and unsuitable; the yard paving defective; the walls damp. June 1 „ Nuisance abated, summons withdrawn. Mr. Lyon 17, „ „ W.C. defective and unsuitable; the yard paving defective; no proper dust receptacle. „ „ Ditto ditto „ 57, „ „ W.C. defective and unsuitable and without a water supply; the yard paving defective. „ „ Order to abate nuisance within 7 days. „ 59, „ „ Ditto ditto „ „ Ditto ditto „ 365, Commercial Rd. The paving of forecourt defective; the floors defective ; ground floor dilapidated and damp. June 15 June 28 Work done, summons withdrawn. Mr. Twaits 197, „ „ Drains defective. June 1 „ Order to abate nuisance within 14 days "„ Rear of No. 42, Old Church Road An offensive accumulation. June 15 „ Nuisance abated, summons dismissed. „ 10, Russell Street An animal improperly kept. Oct. 5 Oct. 20 Prohibition Order. „ 77, Plumbers Row Insufficient sanitary conveniences for use of workpeople employed in workshop. „ „ Fined £2. „ POLICE COURT PROCEEDINGS. 1898. Situation of Property. Nature Complaint. Date of Vestry's Order. Date of Summons Result. Name of Inspector. 1, Lomas Buildings House dirty and dilapidated; floors defective; yard improperly paved; no proper dust receptacle. Sep. 21 Octobr. Order to close premises. Mr. Lyon 2, „ „ Ditto ditto „ „ Ditto ditto „ 3 „ „ Ditto ditto „ „ Ditto ditto „ 4, „ „ House dirty and dilapidated; floors defective. „ „ Ditto ditto „ 5, „ „ Ditto ditto „ „ Ditto ditto „ 6, „ „ Ditto ditto „ „ Ditto ditto „ 6 King John Street Defective drains. „ „ Summons adjourned and quently withdrawn, the work having been completed. „ 20, Garden Street W.C. defective and unsuitable; yard gully improperly trapped; no proper dust receptacle; drains defective. Oct. 19 Nov. 11 Order to abate nuisance within 21 days. „ 22, „ „ Ditto ditto „ „ Ditto ditto „ 24, „ „ Ditto ditto „ „ Ditto ditto „ 26, „ „ Ditto ditto „ „ Ditto ditto „ 376, Commercial Rd. The drains defective; the W.C. defective; yard gully improperly trapped; the rain-water pipe directly connected to drain; no proper dust receptacle. Oct. 26 „ Order to abate nuisance within 7 days. Mr. Twaits 15, Varden Street The drains defective. „ „ Order to abate nuisance within 10 days. „ 14, Bromhead Street House overcrowded so as to be injurious to the health of the inmates. Oct. 19 „ Fined £1. „ 40, Bedford Street Workshop not kept in a cleanly state. „ Dec. 9 Ditto ditto „ 26, Carlton Road The house in a dirty and dilapidated condition; the yard improperly paved; the closet defective and unsuitable; the waste pipe of sink directly connected; the washhouse without proper guttering and roof defective: the drains defective. Dec. 21 Dec. 31 Order to abate nuisance within 21 days. Mr. Cox 30, Carlton Road The house in a dirty and dilapidated condition; the yard gullies improperly trapped; the flushing apparatus to closet defective; the roof of washhouse defective. „ „ Ditto ditto „ (30) The Water Question. The shortness of the supply of water which occurred at the hottest period of last year, was a source of very great inconvenience to the inhabitants, and anxiety to the members of the Vestry and your officials. Almost without any preliminary warning, we were informed in August last that the daily supply would be curtailed to a few hours; this information came to us as a surprise, especially after being told that the East London Reservoirs were full in June. The Sanitary Committee, however, lost no time in meeting and directing that everything that was possible should be done to mitigate the inconvenience which would of necessity be experienced by householders, and also to avert as far as we might be able the consequences that were likely to arise from insufficiently flushing the drains, etc. The district was placarded, asking the inhabitants to flush the drains as frequently as possible and also informing them in the various parts of the district the probable time when the water would be turned on. I may say this first direction was of very great service, as we found on inspection that it was being carried out throughout the Hamlet. The number of stopped drains was very small, compared with what might have been expected had the precaution been neglected. I placed myself in communication with the Water Company, and I think as far as they were able they carried out my suggestions, and did what they could to help us short of giving us more water. Your inspectors and myself were daily inspecting large areas of the district, and particular attention was paid to the supply to model dwellings and schools, and to the more thickly populated parts. We found that many of the schools were getting a very indifferent supply, as were also the model dwellings above the second floor. (31) In consequence of our representation to the Company, the schools were placed on a constant service during school hours, and stand pipes were placed close to all model dwellings in the district. I suggested that stand-pipes should be placed in the crowded parts of the district. This the Company did. We found that in many of these parts the inhabitants had no means of storage from day to day. We therefore applied to the Water Company for storage jars, and the Company sent about 3,000, which were distributed. After the first month the emanations from the sewers was very offensive from want of proper flushing in most parts of the district. Your Committee therefore authorised your Surveyor to purchase two large tanks in which canal water was used to augment the flushing of the subsiduary sewers, with good effect. A number of samples of water were sent to me from various parts of the district, some of which were forwarded on to the analyst. They were all found to be free from organic contamination. It must be remembered that during the drought it was extremely hot weather, we had a very large number of deaths from diseases of the gastro-intestinal tract, and how far these were the consequences of the short supply of water or to the excessive heat and the consuming of over-ripe fruit it is impossible to say. I do not think in a report of this kind it is my duty to go into the matter of the cause of the drought, but one cannot help being struck with the fact that since the last serious drought in 1895, the population has enormously increased in the Eastern portion of Middlesex, and the question arises as to whether the Water Company has made sufficient provision for that increase, because it was expressly stated in the Report of the Commissioners who enquired into the drought in 1895 that such provision had been made at that time so as to prevent any future repetition of the trouble. (32) Slaughterhouses. The slaughter-houses in the district have been systematically inspected, and in three cases the licenses were opposed by the Vestry on account of their dirty condition, etc. At the adjourned meeting of the Licensing Committee the opposition was withdrawn, the necessary work having been completed in the meantime. The question of public versus private slaughter-houses has been engaging the attention of the London Sanitary Authorities, and the Committee of the County Council have gone so far as to recommend the Council to provide public abbatoirs and to abolish private slaughter-houses, but the sweeping reform was not adopted by the Council. Other Sanitary Authorities have expressed their objection to this reform, although most Authorities are favourable to an alteration of some kind whereby means could be taken to prevent the sale of diseased meat. New Houses. Seventeen houses have been newly erected or rebuilt in the district in the course of the past year in addition to model dwellings. The Public Health Act states: "A house which after the " commencement of the Act is newly erected or is pulled down "below the ground floor and rebuilt shall not be occupied as " a dwelling house until the Sanitary Authority have certified " that it has a proper and sufficient supply of water, either from " a Water Company or by some other means." In each of the cases above the owners were communicated with, and this part of the Act brought to their notice before their house, were occupied. Each house was inspected by the Sanitary Inspector and myself, and we took the opportunity of seeing that the drains were properly laid and other sanitary requirements effected, besides a proper water supply, before recommending the Vestry to grant the certificate of occupation. By this means we have had many improvements carried out that otherwise would not have been done. (33) Model Dwellings. As practically all the land in Mile End Old Town is built over, we are beginning an era of Model Dwellings. The death rates of districts in the main, vary according to the density or otherwise of the population, and it is to be anticipated that as more model dwellings are built, there will be proportionately a greater density of population, and so the death rates may be expected to increase. During the last few years a number of " models " have been erected, and more are in course of construction. The Model Dwellings called " Rothchild's 4 per cents.," were built on a site previously occupied by a number of small houses, which contained about 14 families; these models now house about 875 persons. Another block is that of " Cressy Houses," which is being extended at the present time, and will, when finished, be occupied by about 540 persons. The site on which these buildings stand was previously occupied by small houses, whose population was not one-eighth of the present occupants. Another large block of dwellings has been erected in Newark Street, and one is about to be completed in Sidney Street. I am very doubtful whether these barrack-like structures are conducive to the health of any district Although I would say these particular buildings are equipped with modern sanitary improvements, at the same time, one must not lose sight of the fact that density of population is being increased. (34) Unsound Food. Notwithstanding the fact that your officers are always on the look-out to detect the sale of unwholseome food, we have only made one important seizure in 1898; it was a large part of the stock of a butcher, including several emaciated sheep that had been suffering from tubercular disease, and other large pieces of meat unfit for human consumption. Some parts of the tubercular carcass had undoubtedly been sold prior to the seizure. The whole of this meat was conveyed to the Thames Police Court and condemned by the Magistrate and afterwards destroyed. The facts of the case were investigated by your Committee and a prosecution decided on. The owner, when he was made aware of the intention of the Vestry, absconded. A warrant was applied for his arrest, but he has not been heard of up to the present time. This case, gentlemen, was a most flagrant one, as the offender had been warned by your officers twelve months previously, and judging by the low prices paid for these animals together with their emaciated appearance and loss of weight in the sheep, it was clear to my mind he was aware of their diseased condition. Although the offender escaped unpunished, we have the satisfaction of knowing that the meat was destroyed instead of endangering the lives of would-be purchasers. I am happy to report that there are now no manufacturers of doubtful tinned meat goods in our district. (35) Phthisis or Consumption. This disease has recently been brought before the public in many ways. Scientific men of the present day have declared that Consumption is a preventible disease, and the means to prevent it spreading cannot be too widely circulated. The returns from the Registrar General state that nearly 60,000 deaths occur in England and Wales every year from this disease. I find that, in this district during the last 10 years, over 1,800 persons have died from it ; these facts are sufficient to make every individual member of the community pause to consider if he cannot do something towards its prevention. This æsease is a contagious one and should be treated as such. The principal means by which it is conveyed to a healthy person is the expectoration from consumptive patients which contains enormous numbers of the tubercular bacilli, which on drying become suspended in the atmosphere, and so are inhaled. Another way is by means of the consumption of milk from cows infected with Tubercular disease. This disease is much more common in cows than people imagine, and in order to guard against it, milk should be boiled or sterilized, especially that given to young children. Another method—a minor one compared to the other two—is by eating meat from diseased cattle, but fortunately the cooking of meat practically destroys the bacillus. With regard to the first means—the expectoration from diseased persons—I feel sure that it cannot be too widely known (36) amongst tubercular patients and their friends that the habit of expectoration in public vehicles and public places should be repressed. I understand that in America notices are posted up in railway carriages and other vehicles requesting the passengers not to expectorate. If this were done in this country it would bring the matter home to the lay mind and so have a beneficial effect The second means—that of infection by milk—is a matter which the ordinary individual can guard against to a large extent by boiling or sterilizing the milk before being consumed. The Vestry may remember that some time ago I submitted a report dealing generally with the Report of the Royal Commission which has been occupied for some considerable time on the question of Tuberculosis. With regard to the question of Tuberculosis as affecting the milk supply, the Commission states: " No doubt the largest part of the tuberculosis which man obtains through his food is by means of milk containing tuberculous matter." This is a serious condition of things and calls for a remedy. Public opinion is prepared to endorse the fact, that every precaution should be taken to prevent milk being contaminated in this way. It has been found that if a substance called Tuberculin is injected into a cow which is suffering from Tuberculosis, although there is no outward sign, the disease can be detected; in one herd of milk-cows in Edinburgh which were inoculated, 64 per cent were found to be suffering from this disease. (37) The Danish Government have attempted to grapple with eliminating the disease by the method based on the value of Tuberculin as a means of diagnosis, with marked success, and no doubt our own government will watch with interest the result of their labours. I am convinced that this method of detection of disease in Cows deserves the serious consideration of stockbreeders and dairymen generally. They would find that the public would greatly appreciate their efforts to keep their stock free from this disease, and it would thus be to their own interests to be able to show a guarantee to their customers as to the health of their cows. The Royal Commission recommended that all disease of the udder of cows should be notified and also that local authorities should be empowered to take samples of milk and make analysis from time to time and that all milk received from foreign countries should be examined at the various ports when it arrives. I do not think this is a fitting place to comment upon the fresh-air treatment of the disease, which is being so largely advocated by scientific men, but what I do wish to bring home to you all and through you to as large a section of the community as possible, is the fact that it is possible to a large extent to prevent the means by which the infection is spread. The notification of Phthisis is the only logical solution of the Tubercular problem, but at the present time it is too premature as public opinion is not sufficiently formed to admit of its being pressed forward at the present time. (38) High Rents and Overcrowding. It is common knowledge that during the past year there has been an enormous increase in Rents in various parts of the Hamlet. I find that it is more particularly confined to houses which have changed hands comparatively recently—chiefly to Jewish owners. It is a common practice in these cases to raise the rents from 20 to 50 per cent. In some streets large numbers of families have been displaced and foreigners, mostly Jews take their place. It is only to be expected that this will result in overcrowding. We are paying particular attention to the matter of overcrowding, which is a very difficult one to deal with, as the right of entry of Sanitary Officers to houses is debarred at the very time when it would be possible to detect the nuisance. The right of entry is restricted by statute to be between six o'clock in the morning and nine o clock in the evening, except by warrant, and before applying for this, one must shew some special grounds in each case for the application. During the past year we have been able to abate overcrowding in a number of cases ; usually when a notice has been served by your officers, the nuisance has been abated. One case was of such a flagrant character that the occupier was taken before the Magistrate and fined. In conclusion,I thank the members ofthe Sanitary Committee and also the Vestry for their support and co-operation during the past year, and I take this opportunity in testifying to the able manner in which the Inspectors have carried out their duties. I am, Your obedient servant, THOMAS TAYLOR, Medical Officer of Health.