ROMR 6 Romford Rural District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. 1 9 0 2 . To the Romford Rural District Council. Gentlemen, I have the honour to put before you my Annual Report on the Sanitary Condition of the Romford Rural District, for the year ending December 31st, 1902. In accordance with the plan adopted in previous Reports, this Report is arranged in the following divisions:— I. Summary of Action taken during the year or Preventiny the Spread of Disease. II. An account of the Sanitary Condition of the District generatty. III. Statement of Enquiries made into Conditions Injurious to Health, and Proceedings thereon. 1V. Table of Sickness and Mortality. 1. Summary of Action taken to prevent the spread of Disease. No. Date. Locality. Disease. Soarce of Disease. Action taken. Result. 1 Jan. 8 Dagenham Enteric Fever One case. Removed to Hospital. 2 „ 4 South Hornchurch Smallpox One case. Source of infection supposed to be the Dagenham Smallpox Hospital. Removed Contacts re-vaccinated and isolated for 10 days. No other ease. 3 „ 4 Rainham Smallpox Two cases in different parts of village. Removed. Precautions as above. No other case in either house. 4 „ 8 Rainham Smallpox One case (Melville road). As before. No other case. 5 „ 8 North Hornchurch Smallpox Two cases in two adjacent houses. Infection brought by a woman from an infected house in the Urban district. No other case. 6 „ 8 Rainham Smallpox One case. Supposed to have been contracted at Purfleet. No other case. 7 „ 9 Dagenham Diphtheria One case. Local sanitary defect. Removed to Isolation Hospital. No other case. 8 „ 13 Dagenham Scarlet Fever One case. Contracted at Barking. Removed to Hospital. No other case. 9 „ 13 North Hornchurch Enteric Fever One case. Supposed to have been contracted in London. Instruction, &c. No other case. 10 „ 13 Hornchureh Scarlet Fever Two cases. Infection obscure. Instruction, &c. Disinfected. No other ease. 11 „ 13 Hornchurch Scarlet Fever One case. Ditto. No other case. 12 „ 20 North Hornchurch Smallpox One case. Contracted in London. Removed. No other case 4 No Date. Locality. Disease. Source of Disease. Action taken. Result. 13 Jan. 17 Dagenham Scarlet Fever Three cases in two adjacent houses Isolated at home. Instructions Disinfected. No other case. 14 „ 19 Beacontree Heath Diphtheria Three cases. Local insanitary condition. Removed to Hospital. No other case. 15 „ 19 Green Lane Diphtheria Two eases. Ditto. No other case. 16 „ 22 Hacton Smallpox One case. Source of infection obscure. Removed. No other case. 17 „ 22 Dagenham Smallpox Ditto. No other case. 18 „ 25 Dagenham Diphtheria One case. Local insanitary conditton. Removed. No further case. 19 „ 25 Upminster Smallpox One case. Obscure source. Removed. No further case. 20 „ 29 Great Warley Scarlet Fever One case. Isolation at home. instructions. Disinfected. No further case. 21 „ 29 Hacton Smallpox One case. Husband of Case No. 11. Removed. No further case. 22 „ 29 Dagenham Smallpox One case. Removed. No further case. 23 Feb. 1 Dagenham Enteric Fever Ditto. No further case. 24 „ 1 Dagenham Diphtheria Ditto. No further case. 25 „ 1 Green Lane Scarlet Fever Ditto. No further case. 26 „ 1 Dagenham Enteric Fever Ditto. No further case. 27 „ 1 Rainham Smallpox Ditto. No further case. 28 „ 16 Corbets Tey Enteric Fever One case. Instructions, &c. No further case. 29 „ 18 Hornchurch Enteric Fever Ditto. No further case. 30 „ 20 Rainham Enteric Fever Ditto. No further case. 31 „ 23 Dagenham Smallpox One case. Contracted in visiting an infectious house. Removed. No further case. 32 „ 23 Dagenham Smallpox Ditto. No further case. 33 „ 23 Corbets Tey Enteric Fever One case. Instructions, &c. No further case. 34 „ 28 Chadwell Heath Scarlet Fever One case. Removed. No further case. 5 No. Date. Locality. Disease. Source of Disease. Action taken. Result. 35 Feb. 28 North Hornchurch Smallpox One case. Caught in London. Removed. No further case. 36 Mar. 1 Chadwell Heath Diphtheria One case. local sanitary defect. Removed. No further case. 37 „ 4 Hornchurch Smallpox One case. Contracted in London Removed. No further case. 38 „ 4 Dagenham Smallpox One case. Supposed to have been contracted at Purfleet. Removed. No further case. 39 „ 7 Dagenham Scarlet Fever One case. Patient just recovering after confinement. Infection supposed to have been conveyed by air from Smallpox Hospital. Removed. No further case. 40 „ 7 Hornchurch Scarlet Fever One case. Instruction. Disinfected No further case. 41 „ 8 Chadwell Heath Scarlet Fever Ditto No further case. 42 „ 10 South Hornchurch Scarlet Fever Two cases. Removed. No further case. 43 „ 10 Dagenham Smallpox One case. Infection supposed to have been brought from Smallpox Hospital. Removed. No further case. 44 „ 11 North Hornchurch Diphtheria Three cases in one house. Local sanitary defect. No further case. 45 „ 11 Dagenham Smallpox One case. See No. 43. No further case. 46 „ 14 Chadwell Heath Scarlet Fever Two cases. Instructions. Disinfected. No further case. 47 „ 15 North Hornchurch Smallpox One case. Contracted in London. No further case. 48 „ 16 Dagenham Smallpox One case. Contracted by visiting No. 4. No further case. 49 „ 17 Dagenham Smallpox One case. see No. 43. No further case. 50 „ 19 Dagenham Smallpox One case in same house as No. 49. Removed. No further case. 51 „ 22 Dagenham Enteric Fever One case. Removed. No further case. 52 „ 26 Rainham Smallpox One case. Supposed to have been contracted at Purfleet. Removed. No further case. 53 „ 27 Dagenham Smallpox One case. Contracted in London. Removed. No further case. 6 No. Date. Locality. Disease. Source of Disease. Action taken. t. 54 Mar. 27 Rainham Smallpox One case Contracted in London. Removed. No further case. 55 April 1 Dagenham Smallpox One case. Caught in London. Removed. See Nos. 57 and 43. 56 „ 1 South Hornchurch Smallpox One case. Been working in field adjacent to Smallpox Hospital. Removed. No other case. 57 „ 3 Dagenham Smallpox One case. See No. 43. Removed. No other case. 58 „ 4 North Hornchurch Smallnox One case. Contracted in London. A very mild case. Isolation at home. No other case. 59 „ 8 Dagenham Smallpox One case. Removed. No other case. 60 „ 9 Dagenham Smallpox Ditto. No other case. 61 „ 9 Dagenham Smallpox One case. Infection by No. 54, who had been going about with the eruption on him, and infected another family at Hornchurch. Removed. No other case. 62 „ 10 Wennington Scarlet Fever One case. Instruction. Disinfected. No other case. 63 „ 11 North Hornchurch Smallpox One case. Supposed to have been contracted from a friend. Removed. No other case. 64 „ 14 South Hornchurch Smallpox One case. See No. 61. Removed. No other case. 65 „ 15 Dagenham Smallpox One case. Removed. No other case. 66 „ 16 Rainham Smallpox One case. Removed. No other case. 67 „ 16 Dagenham Smallpox One case. See No. 56. Removed. No other case. 68 „ 17 Upminster Enteric Fever One case. No other case. 69 „ 17 Dagenham Smallpox One case Removed. No other case. 70 „ 23 South Hornchurch Smallpox Five cases in one family. Infection by case No. 61. Removed. House in a filthy coudition and dilapidated. Restored and cleansed, Are. No other case. 71 „ 25 Hornchurch Cottage Homes Smallpox A. series of cases occured in these homes, 15 altogether, during the next two weeks. The infection was supposed to have been brought by a visitor from London. All were removed at once to the Metropolitan Hospital. No other case. 7 No. Date. Locality. Disease. Source of Disease. Action taken. Result. 72 April 27 Hornchurch Smallpox One case. An old inmate of almshouses. Source of infection obscure. Removed. No other case. 73 27 Dagenbam Smallpox One case. See No. 43. Removed. No other case. 74 „ 27 Dagenham Diphtheria One case. Local Sanitary defect. No other case. 75 „ 28 Dagenham Smallpox One case. See No. 43. Removed. No other case. 76 „ 28 Dagenham Smallpox Ditto No other case. 77 „ 28 Dagenham Smallpox Ditto No other case. 78 „ 28 South Hornchurch Smallpox One case. Removed. No other case. 79 „ 29 Dagenham Smallpox One case. See No. 43. Removed. No other case. 80 „ 30 Kainham Smallpox One case. Removed. No other case. 81 „ 36 Dagenham Smallpox One case. Contracted in London. Removed. No other case. 82 May 1 Dagenham Smallpox One case. Removed. No other case. 83 „ 1 Rainham Smallpox Ditto No other case. 84 „ 1 South Hornchurch Smallpox Ditto No other case. 85 „ 4 Hornchurch Smallpox One case. Infection by No. 72. No other case. 86 „ 5 Great Warley Diphtheria One case. Local sanitary defect. Remedied. No other case. 87 „ 5 Rainham Smallpox One case. Contracted at Purfleet. Removed. No other case. 88 „ 5 Chadwell Heath - Smallpox Three cases in one family. Father and two children. Father went about with the disease and infected several persons. Removed. Sec No. 97 and 104. 89 „ 6 South Hornchurch Smallpox One case. Had been working near Smallpox Hospital. Removed. No other case. 90 „ 7 Dagenham Smallpox One case. Removed. No other case. 91 „ 9 Wennington Smallpox Ditto No other case. 92 „ 9 South Hornchurch Smallpox One case. Live near Hospital. Removed. No other case. 8 No. Date. Locality. Disease. Source of Disease. Action taken. Result. 93 May 10 Wennington Smallpox One case. Removed. No other case 94 „ 10 Dagenham Smallpox Ditto No other case. 95 „ 12 Dagenham Enteric Fever - Ditto No other case. 96 „ 12 Green Lane Diphtheria One case. Loeal Sanitaty defect. Remedied. No other case. 97 „ 11 Chadwell Heath. Smallpox One case. Infected by No. 88. Removed. No other case. 98 „ 11 Dagenham Smallpox One case. See No. 43. Removed. No other case. 99 „ 11 Hornchurch Smallpox One case. Source obscure. Removed. No other case. 100 „ 11 Hornchurch Smallpox Ditto No other case. 101 „ 22 Dagenham Smallpox One case. Contracted in London. No other case. 102 „ 24 Dagenham Smallpox One case. See No. 43. Removed. No other case. 103 „ 24 Dagenham Smallpox Ditto No other case. 104 „ 24 Chadwell Heath Smallpox One case. Infection by No. 88. No other case. 105 June 2 Dagenham Diphtheria One case. Local sanitary defect. Remedied. No other case. 106 „ 2 Dagenham Diphtheria One case. Contracted at a Romford School. No other case. 107 „ 2 Dagenham Smallpox One case. Source obscure. Removed. No other case. 108 „ 2 Dagenham Smallpox Two cases. Ditto. No other case. 10S „ 2 Rainham Smallpox One case. Removed. No other case. 110 „ 2 Chadwell Heath Enteric Fever Ditto No other case. 111 „ 8 Chadwell Heath Smallpox One case. Contracted at Dartford. Removed. No other case. 112 „ 10 Beacontree Heath Enteric Fever One case. Local sanitary defect. Instructions. &c. No other case. 113 „ 16 Rainham Enteric Fever Ditto. Removed. No other case. 114 „ 19 Rainham Enteric Fever Ditto No other case. 9 No. Date. Locality. Disease. Source of Disease. Action taken. Result. 115 June 21 Hornchurch Scarlet Fever One case. Removed. No other case. 116 „ 25 Wennington Smallpox Ditto No other case. 117 „ 26 Beacontree Heath Diphtheria Ditto No other case. 118 „ 30 Dagenham Smallpox Oue case. See No. 43. No other case. 119 July 6 Hornchurch Smallpox One case. Contracted in London. Removed. No other case. 120 „ 6 Beacontree Heath Diphtheria One case. Local sanitary defect. No other case. 121 „ 11 Dagenham Smallpox One case. See No. 43. No other case. 122 „ 14 Chadwell Heath Scarlet Fever One case. Imported. Instructions. Disinfected. No other case. 123 „ 15 Harold Wood Enteric Fever One case. Instructions. &c. No other case. 124 „ 24 Chadwell Heath Enteric Fever One case. Removed. No other case. 125 „ 24 Rainham Scarlet Fever One case. Instructions. Disinfected. No other case. 126 „ 24 Dagenham Scarlet Fever One case. Removed. No other case. 127 „ 24 Great Warley Diphtheria One case. No other case. 128 „ 28 Dagenham Scarlet Fever One case. Source of infection obscure. Removed. No other case. 129 „ 29 Harold Wood Diphtheria One case. No other case. 130 Aug. 1 Dagenham Enteric Fever One case. Local sanitary defect. Removed. No other case. 131 „ 2 Dagenham Scarlet Fever One case. Imported. Removed. No other case. 132 „ 2 Rainham Enteric Fever One case. Local sanitary defect. Removed. No other case. 133 „ 5 Rainham Diphtheria One case. Ditto. No other case. 134 „ 11 Harold Wood Scarlet Fever Ditto No other case. 135 „ 13 North Hornchurch Diphtheria One case. No other case. 136 „ 21 | Dagenham Enteric Fever One case. Removed. No other case. 137 „ 21 Rainham Scarlet Fever Ditto No other case. 10 No. Date. Locality. Disease. Source of Disease. Action taken. Result. 138 Aug. 25 Dagenham Enteric Fever One case. Supposed to have been contracted by eating Southend cockles. Removed. No other case. 139 Sept. 7 Beacontree Heath Diphtheria One case. Local sanitary defect. No other case. 140 „ 7 Dagenham Enteric Fever Ditto. Removed. No other case. 141 „ 8 Dagenham Scarlet Fever Ditto No other case. 142 „13 Chadwell Heath Scarlet Fever One case. Instruction. Disinfected. No other case. 143 „ 13 Hornchurch Enteric Fever One case. Cause obscure. No Other case. 144 „ 15 South Hornchurch Scarlet Fever One case. Removed. No other case. 145 „ 15 Dagenham Diphtheria One case. Local sanitary defect. No other case. 146 „ 15 Dagenham Enteric Fever Ditto No other case. 147 „ 24 Chadwell Heath Scarlet Fever Ditto No other case. 148 „ 29 South Horuchurch Scarlet Fever Ditto No other case. 149 „ 29 Dagenham Enteric Fever Ditto No other case. 150 „ 29 Chadwell Heath Enteric Fever Ditto. Removed. No other case. 151 Oct. 2 3 Chadwell Heath Diphtheria Two cases. Instructions. Disinfected. No other ease. 152 „ 4 Hornchurch Scarlet Fever One case. Ditto. No other case. 153 „ 7 North Hornchurch Diphtheria Ditto. No other case. 154 „ 13 Hornchurch Scarlet Fever Ditto. Removed. No other case. 155 „ 19 Hornchurch Scarlet Fever Ditto No other case. 156 „ 19 Beacontree Heath Enteric Fever One case. Contracted away from home. Instructions, &c. No other case. 157 „ 20 Beacentree Heath Diphtheria Four cases in one house. Local sanitary defect. No other case. 158 „ 25 Chadwell Heath Scarlet Fever One case. Instructions, &c. Disinfected. Removed. No other case. 159 „ 25 Beaeontree Heath Enteric Fever One case. Local sanitary defeet. Instructions, &c. No other case. 11 No. Date. Locality. Disease. Source of Disease. Action Taken. t. 160 Not. 8 Hornchurch Enteric Fever One case. Local sanitary defect. Instructions, &c. No other case. 161 „ 16 Romford Common Diphtheria Ditto No other case. 162 „ 16 North Hornchurch Diphtheria Ditto No other case. 163 „ 24 Harold Wood Scarlet Fever Ditto No other case. 164 „ 24 Harold Wood. Scarlet Fever Ditto No other case. 165 „ 26 Upminster Scarlet Fever Ditto No other case. 166 „ 29 Beacontree Heath Scarlet Fever Ditto. Removed. No other case. 167 Dec. 2 Harold Wood Scarlet Fever One case. Instructions, &c. No other case. 168 „ 11 Hornchurch Diphtheria One case. Local sanitary defect. No other case. 169 „ 16 Rainham Enteric Fever One case. Instructions, &c. No other case. 170 „ 17 Rainham Diphtheria Ditto No other case. 171 „ 20 Green Lane Diphtheria Five cases in one house. Local Sanitary defect. Remedied. No other case. 12 I received notification of 327 cases of infectious diseases during the year. The different diseases are thus tabulated:— Chicken Pox 101 Erysipelas 24 Diphtheria 34 Scarlet Fever 40 Small Pox 98 Enteric Fever 29 Puerperal Fever 1 Total 327 Fifty of these cases were removed to the Isolation Hospital and 97 cases of Small Pox to the Small Pox Hospital. The following is a succinct account of the different infectious diseases requiring action by your sanitary officials during the year. My practice is to request the Sanitary Inspector to visit each house as soon as I receive notification of the existence of infectious disease there, visiting myself subsequently all those cases which I consider require my doing so. Small-Pox.—This disease was very prevalent and caused a very considerable increase to the work of your sanitary officials. Every case was visited as soon as possible, either by the Sanitary Inspector or myself, after notification of the disease was received by me, and all cases (with one exception) were removed as speedily as possible to the Small-pox hospital at Dagenham. The contacts were cautioned to keep themselves isolated for a period of 10 days or a fortnight, the Sanitary Inspector, as far as possible, seeing that this was done, and they were maintained in most instances by the Council during their period of quarantine. The houses, &c., were disinfected as soon as the patient was removed, bedding, &c., which could not be disinfected and washed were burnt and replaced by the Council. Re-vaccination of all unprotected inmates of all infected houses was done in by far the larger number of instances, always in fact, except in a few cases where the refusal of persons to be re-vaccinated 13 could not be altered by persuasion on the part of their doctor or myself. I am glad to be able to say that the means taken to prevent the spread of the disease were most successful, not a single case of personal infection from infected members of a family having occurred, except in a few instances where re-vaccination was absolutely refused. With regard to the source of the disease, I endeavoured to trace it in each case, with the result shown in the above summary. Some were infected in London, some in the neighbourhood of Purfleet or locality within the zone of air-borne infections from the hospital ship on the river, and some from infectious zone of the West Ham hospital at Dagenham. I am afraid also that some cases were caused by actual infection carried from the hospital bv visitors and others having occasion to go there. Especially was this so, I think, at one period when extensive additions were being made to the hospital owing to the large number of patients received there, many of the work people there employed going to and from their work at the hospital, and presumably carrying infection in their clothes. The last case notified was on July 12th, since which date no case has occurred in the district. I wish to take this opportunity of thanking the Council for their efforts to stamp out the disease, every suggestion made by me having been most willingly adopted. The advice to the public to be re-vaccinated (in widely diffused hand bills and posters) on the part of the Council and of the Guardians) was very extensively followed, and I have every reason to believe that this had a considerable influence in stamping out the disease. It is possible that in the present session of Parliament, when the Vaccination Act has to be renewed or re-enacted in some other form it will be proposed to make compulsory the re-vaccination of every child before the expiration of its school age. It is the practically universal opinion cf all experts in sanitary science, that if this could be ensured, Small-pox would become as uncommon a disease in this country as it is in Germany where re-vaccination is enforced, and where Small-pox practically never appears unless it is brought into the country from countries less protected. May I suggest, that if such a provision is made on any subsequent Vaccination Act, this Council should present a petition to Parliament in its favour. 14 Chicken Pox.—This disease, owing to the possibility of its being mistaken for Small-pox was made notifiable, and 101 cases were notified. In the absence of any case of Small-pox for more than six months past, I do not think it is necessary for Chicken Pox to be any longer notifiable. Scarlet Fever.—Forty cases of this disease were notified. It did not assume an epidemic zone in any locality. Twenty-seven of these patients were removed to the Isolatior hospital. The disease was of a mild type, not a single case ending fatally. Enteric Fever.—Twenty-nine cases were notified. Six deaths were caused by this disease. Of the twenty-nine cases (sixteen of which were treated at the Isolation Hospital), fifteen occurred in Dagenham parish, five in Hornchurch, and six in Rainham. Diphtheria.—Thirty-four cases were notified, three deaths. Eight cases were treated in Hospital. The Council decided, in cases of diphtheria to provide anti-diphtheritic serums gratuitously to medical men attending cases of this disease amongst the poor, and this privilege has been made use; of by several medical men of the district. Measles prevailed extensively in various parts of the district, but, as it is not a notifiable disease, I cannot estimate the number of cases. Eight deaths were caused by this disease. I have no doubt that this disease becomes so generally epidemic through school attendance. If the disease were a notifiable one we should have a chance (which we have not now) of limiting its extension by seeing to the exclusion from school of children from infected houses. It will be seen from the subjoined table the degree in which infectious disease prevailed in the various parishes of the district, Dagenham being by far the greatest source of infectious diseases, a condition which I hope will be altered when the system of sewerage, now in course of arrangement, is completed. 15  Dagenham. Beacontree and Chadwell Heaths Havering. Hornchurch. Upminster, Cranham, and Corbets Tey. Great Warley. Rainham and Wennington. Smallpox 48 - 24 - - 48 Scarlet Fever 14 - 19 1 2 11 Diphtheria 19 - 10 - 1 6 Enteric Fever 15 - 5 3 - 12 Erysipelas 12 1 7 3 - - II.—An account of the Sanitary condition of the district at the end of 1902. In complying with this section of the Local Government Board's instruction to Medical Officers of Health, I procced to give, as in previous years, a short account of the sanitary state of the district, under the same heads of localities as are given in the statistical tables. Dagenham, Beacontree Heath, and Chadwell Heath.— Villages and scattered groups of houses, all situate in the parish of Dagenham, and occupying a very wide area, standing on gravel and on London clay, some (part of Dagenham village and immediate neighbourhood) on alluvium. Population, 6,250 Agricultural. Water supply mainly from South Essex Company. The village of Dagenham is in a bad sanitary condition, owing to the ground oeing saturated by years' overflowing cesspools and slop-water. Most of the cottages supplied with pail closets, emptied once a week by the Sanitary Authority. A system of scavenging is in force. Dust-bins are periodically emptied by the Authority. There still exists a condition of soil sodden by sewage overflow from cesspools, and which nothing but some system of drainage will relieve, and until this is done the village must continue to be in a bad sanitary condition. 16 Birth-rate, 358. Death-rate, 11.08. Death-rate from zymotic disease, 1.5 per 1,000 of the population. A complete system of sewage removal has been decided upon, and now rests with the Local Government Board. Noak Hill stands high on London clay. Population, 250. Birth-rate, l6. Death-rate, 16. Death-rate from zymotic diseases, Nil. Water supply from private wells. Havering stands high on pebble sand, bounded by London and boulder clay. Population, 508. Agricultural. Privies. Water supply from wells and from South Essex Company. Some of the out-lying parts of the parish badly supplied, the source in these instances being from ponds. Birth-rate, 137. Death-rate, 114. Death-rate from zymotic disease, 1.9. Hornchurch.—Large village and scattered groups of houses extending over a large parochial area. Part of the parish adjoining the town of Romford, and really constituting a portion of that town. Stands mostly on gravel and partly on London clay, some small portion of the parish running down to the Thames and alluvial. Population, 6,400, principally agricultural, foundry works and a brewery in the village. A very extensive system of sewerage for the village is now completed (March, 1903), and when all connections are made which is now (March) being done, a sanitary improvement of great value will have been effected. A system of sewerage for the outlying locality of Harold Wood is also nearly in operation. Birthrate, 27.6. Death-rate, 12.19. Death-rate from zymotic disease, 1.2. Upminster, Chanham, and Corbets Tey.—Adjacent villages, standing on high ground, mostly brick earth, some gravel. Population, 1,900. Agricultural. Water supply mostly from South Essex Company; some wells. Birth-rate, 22.1. Death-rate, 10.0. Deathrate from zymotic disease, 21. Great Warley stands high on London clay. The most thickly populated part of the parish joins the town of Brentwood, in the Billericay Union, the larger area of the parish having scattered houses 17 and groups of houses. Population, 1940. Agricultural. A system of sewerage has been recently adopted for the populous portion of this locality, the sewage being taken at a distance and treated on the septic principal of purification. This, so far, is a great success, there is not the least nuisance in the locality of the Sewage Works, and the effluent, after running over land in furrows, is perfectly clear and inodorous. Water supply for the locality mainly from the South Essex Works; some wells. The more sparsely-populated rural part of the locality is badly supplied, ponds being a main source of supply in some parts. Birth-rate, 29.3. Death-rate, 8.7. Deathrate from zymotic disease, 1.03. Rainham and Wennington lie low on gravel and alluvium at the edge of the Thames. Marshy. Village of 2,100 inhabitants. Agricultural and river traffic. Tidal stream runs through Rainham to the Thames, about one mile distant. No system of sewage removal. Privies and cesspools. Foul state of atmosphere frequent from factories on river bank (manure, candles, glue, &c.), some on the Essex, most on the Kent side of the river. Water supply mostly from South Essex Company; some wells. Birth-rate, 35.2. Death-rate, 17.1. Death-rate from zymotic disease, 2.3. N.B.—The death-rate from zymotic disease was augmented in several localities by the smallpox epidemic. III.— An account of the enquiries as to the conditions injurious to health existing in the district, and of the proceedings relating to such conditions in which advice has been given, &c., &c. In addition to the cases of infectious diseases recorded in Section 1 of this report, the following insanitary conditions, &c., necessitated official interference by the Sanitary Inspector, who called in my assistance when necessary. These instances of nuisances, &c., are included iu the list detailed in a later part of this report. 18 Several reports when necessary were submitted by me to the Council with regard to conditions inimical to the public health. Dagenham, Beacontree Heath, and Chadwell Heath.— Jan 2nd.—Bennett's Castle Lane.—Foul ditch close to cottages. Notice served by Sanitary Inspector. Remedied ultimately. Jan. 15th.—Beacontree Heath.—Foul ditches. Report to Council. Remedied temporarily. Jan. 16th.—New Road, Dagenham.—Foul ditch close to houses. Notice. Cleaned. Jan. 29th.—Chadwell Heath.—Swine kept contrary to bye-laws. Notice. Removed. Feb. 14th.—Beacontree Heath.—Foul ditch. Notice. Cleansed. Feb. 15th.—Ditto Ditto Feb. 15th.—Ditto Ditto Feb. 15th.—Ditto Ditto Feb. 17th.—Dagenham. Station Road.—Foul cesspool. Notice. Cleansed. Feb. 17th. — Dagenham, Kittle's Cottage.—Five closets foul. Notice. Cleansed. Feb. 17th.—Dagenham, Main Road. — Foul ditch. Notice. Cleansed. Feb. 25th.—Dagenham Smallpox Hospital.—Report to Council on unsatisfactory arrangement for disposal of sewage. Feb. 27th.—Beacontree Heath.—Cottage with no water supply. Notice. South Essex water laid on. Feb. 28th.—Chadwell Heath.—Two houses dilapidated and unfit for habitation. 19 March 18th.—Chadwell Heath.—Seven houses without dustbins. Notice. Supplied. March 18th.—Dagenham, Station Road.—Sixteen houses without dustbins. Notice. Supplied. March 18th—Ditto.—Foul closet-pan, difficulty having arisen owing to owner of adjacent land refusing access to the closet. Arranged by Sanitary Inspector. March 24th.—Ditto.—Foul drains and cesspools. Notice. Cleansed. March 24th.—Ditto Ditto March 24th.—Dagenham, New Road.—Seven houses unfit for human habitation. Notice. Closed. Ultimately repaired and reoccupied. April 14th.—Dagenham, Station Road.—Two houses with no dnstbins. Notice Supplied April 25th.—Five Elms.—Foul ditch. Notice. Cleansed. April 25th.— Beacontree. Heath.—Ditto Ditto April 25th.—Ditto Ditto Ap ril 25th.— Ditto—Foul accumulation of manure near house. Notice. Ultimately removed. April 25th.—Bennett's Castle Lane.—Overflow of ceaspool into ditch near houses. Notice. Remedied by cutting off overflow, and constructing additional cesspools. April 26th.—Chadwell Heath.—Four houses with bad water supply. Notice South Essex water laid on. April 26th.—Dagenham, New Road.—One house ditto. May 18th.— Wood Lane.—Foul ditch. Notice. Cleansed. May 18th.—Ditto Ditto. 20 May 18th.—ChadweU Heath.—Four houses with bad water supply. Water condemned. Notice. May 22ltd.—Bennett's Castle Lane.—Nine houses with insufficient water supply. Notice. South Essex water supplied. May 2'\rd—Dagenham.—Fnnl cesspool. Notice. Cleansed. May 23rd.— Ditto Ditto May 2 W.—Ditto—Two houses dilapidated. Notice. Repaired. May 23rd. — New Road.—Ditch polluted with sewerage. Notice. Remedied. May 24th.—Dagenham.— Foul cesspool. Notice. Cleansed. June 4th.—Dayenham Station Road.—Ditto Ditto Jane oth.—Dagenham. Kittle's Cottages.—Ditto Ditto June 6th.—Dagenham, Wood Lane.—Ditto Ditto June 6th.—Dagenham, Station Road.—Ditto Dittc June 6th.—Ditto Ditto June 6th.—Ditto Ditto June 6th.—Ditto—.No dustbins to 3 houses. Notice. Supplied. Juite28th.—ChadicellHeath.—Obstructed drain. Notice. Remedied. June 28th.—Ditto Ditto July 9th—Chadwell Heath.—No duttbins to 4 houses. Notice. Supplied. Aug. 1 st.—Dagenham, New Road.—Swine kept so as to be a nuisance. Notice. Removed. Aug. 1st.—Ditto Ditto 21 Oct. 9th.—Beacontree Heath.—Foul ditch. Nov. 22nd.—Ditto Ditto Havkking. — Oct. 17th. — Havering.— Foul cesspool. Notice. Cleansed. Hjrnchurch, &c.—Jan. 18th—Lower Richmond Street.—Defective sanitary appliances to cottages. Notice. Remedied. Feb. 8th.—Douglas Road.—Blocked drains. Notice. Cleansed. March 24th.Ditto Ditto March 26th.—Hwy Green.—Cottages with no water supply. Notice. South Essex water laid on. April 4th.—South Hornchurch.—Foul drains and cesspool. Notice. Cleansed. April 7th.— Ditto—Foul ditoh. Notice to cleanse and cut ofi cesspool overflow. Complied with. April 8th.—Park Lane.—Houses without dustbins. Notice. Supplied. April 23rd.—High Street.—Defective earth closet. Notice. Remedied. March 12th th.—Sutton's Lane.—Defective sanitary appliances. Notice. Remedied. March 22nd.—Ard/ey Green.—Dirty and overcrowded cottage. Notice. Remedied. March 22nd.—Ditto—Foul oesspool and dilapidated cottage. N otice. Remedied. Match 22nd.— Ditto—Foul ditch—Ditto March 26th.—Harold Wood.—Ditto Ditto 22 June 16th.—Kyme Road.—Blocked drains. Notice. Cleansed. June 30th.—Douglas Road.—Ditto Ditto June 30 th.—Ardley Green.—Foul accumulation. Notice. Removed. July 7th.—Rush Green.—Blocked drain. Notice. Cleansed. July 11th.—South Hornchurch.—Ditto Ditto July 14th.— Vicarage.—Defective sanitary appliances, bad water supply. Remedied. July 16th.—Harold Wood.—Foul cesspool. Notice. Cleansed. July 23rd.—Hornchurch.—Ditto Ditto July 23rd.—Ditto—Foul urinal. Ditto Sept. 8th.—On Station.—Foul drain. Ditto Oct. 13.—Douglas Road.—Defective sanitary appliances. Notice. Remedied. Oct. 16th.—Harold Wood.—Ditto Ditto Oct. 20th. —Douglas Road.—Blocked drain. Ditto Oct. 23rd.—Squirrels Heath.—Foul cesspit. Ditto Nov. 2nd.—North Street.— Ditto Ditto Nov. 12th.—Park Lane.—Blocked drain. Ditto Nov. 12th.—North Hornchurch.—Complaint of resident of nuisance caused by fat boiling work in adjoining Urban district. Nuisance abated by Urban Council. Dec. 2nd.—Rush Green.—Cottages with foul drains and dilapidated so as to be unfit for habitation. Notice disregarded. Special report to Council. Proceeding threatened. Defects now (March) in course of being remedied. 23 Dec. 18th.—Harold Wood.—Foul ditch. Notice. Cleansed. Dec. 29th. — Hornchurch. — Manure accumulation near house. Notice. Removed. Noak Hill.—Sept. 13th.—Dilapidated closets. Notice. Remedied. Nov. 16th.—Complaint from Bow Sanitary Authority that meat condemned by Authority had been taken from Bow to Noak Hill, and supposed to be exposed for sale. Visited by Inspector, who found meat was not exposed for sale, but purchased for pigs' food. Upminster, &c.—Jan. 1st..— Upminster.—Blocked drains. Notice. Cleansed. Jan. 13th.— Ditto—Foul drain overflowing into ditch. Notice to cleanse drain and connect with sewer. Complied with. Jan. 17th.—Corbetn Tey.—Ditto Ditto Jan. 25th. — Upminster Hill.—Dirty cottages. Notice. Cleansed. Jan. 31 st.— Ditto — Defective sanitary appliances. Notice. Remedied. May 30th.—Cranham Lane.—Foul ditch. Notice. Cleansed. June 3rd.—Upminster Common.—Cottage with foul cesspool and dilapidated closets. Notice to cleanse and provide new closets. Former part of notice only complied with. June 3rd.—Ditto Ditto June 2 Ist.—Cranham School.—Defective sanitary appliance. Notice to re-construct drain, &c. Complied with. Great Warlf.y.—Feb. 16th—Woodman Row.—Foul accumulation. Notice. Removed. Feb. 10th.—Great Warley.— Ditto March 6th.—Ditto Ditto 24 May 15th.— Great War/ey.—Foul cesspool. Notice. Cleansed. June 5th.—Ditto - Foul cesspool and dilapidated closet. Notice. Cleansed. July 2nd.— Ditto.—Foul ditch. Notice. Cleansed. July 25th.—Ditto.—Foul accumulation. Notice. Removed. Oct. 10th.— Ditto.—Defective sanitary appliances. Notice. Remedied. Rainham and Wennington.—Jan. 10th.—Devonshire Street, Rainham.—Foul drain. Notice. Cleansed. April 12th.— Wennington.—Defective closet, allowing sewage pollution in kitchen. Notice. Remedied. May 30th.— Wennington.—Foul cesspool. Notice. Cleansed. May 30th.— Wennington.—Five houses with defective closets (Diphtheria here). Notice. 1'ail closets provided. June 4th.— Ditto.—Foul drain and closet. Notice. Cleansed. June 5th.—Rainham.—Ditto Ditto June 6th.— Wennington.—Cottage with no drainage. Notice to provide cesspool. Complied with. Jane V)ih.— Ditto.—Foul cesspool. Notice. Cleansed. July 7th..—Rainham.—Accumulation of refuse. Notice. Removed. July 8th.— Ditto.—Four houses without dustbins. Notice. Provided. July 3lst.— Ditto.—Foul cesspool. Notice. Cleansed. July 31st.—Ditto Ditto 25 The following is a complete list of the nuisances, &c., reported by the Sanitary Inspector in which action was taken by them, my aid being called in in those instances which were considered necessary. Nuisances abated 140 Notices served 155 Filthy houses cleansed 2 Overcrowded dwelling 1 Houses dilapidated. Repaired 3 Privies and w.o.'s repaired, &c. 21 Swine removed 7 Total 329 Several samples of water were submitted to me by the Inspector for analysis, and when found to be impure, the South Essex Water was supplied. Sanitary dustbins (galvanised iron) have been supplied in many instances on the notice from Sanitary Inspector. A system of sewage for the village of Rainham is awaiting the sanction of the Local Government Board. The system of sewerage for Harold Wood and Hornchurch is now completed, and will be a vast improvement in the sanitary condition of these localities. The system proposed for Dagenham, so much required, is still, I understand, awaiting the sanction of the Local Government Board. The Isolation Hospital (in combination with the Urban District of Romford) is proving an immense boon to those cases of infectious disease which cannot satisfactorily be treated at their own homes. The two Authorities have spared no necessary expense in the working of the Hospital, and they may congratulate themselves that the Hospital has not only been the means of saving lives, which must have undoubtedly been lost if the patients had had home nursing, but is a potent assistant to their Sanitary Officials in preventing the spread of infectious diseases. 26 The slaughter.houses, bakehouses, dairies, and cow.sheds, have been inspected. All were in good order with the exception of one slaughter.house which is now in process of being repaired, drained, &c. Tables of mortality. &c., compiled according to the requirements of the Local Government Board are inoluded with this report. The Birth and Death Rates are shown in the following table for the last five years. Locality. 1898. 1899. 1900. 1901. 1902. BirthRate. DeathRate. BirthRate. DeathRate. Birthrate. DeathRate. BirihRate. DeathRate. BirthRate. DeathRate. Dagenham, Beacontree and Chadwell Heaths 31.9 16.5 35.3 12.3 34.7 16.8 35.9 14.3 35.8 11.08 Havering 26.0 10.0 14.0 10.0 15.7 9.8 26.9 9.8 13.6 11.4 Hornchurch. 27.8 12.9 33.8 15.8 33.6 14.0 25.7 11.8 27.6 12.9 Upminster, Cranham, and Corbets Tey. 21.6 15.5 10.0 12.0 25.4 5.3 25.7 10.6 22.1 10.0 Great Warley 32.8 11.05 31.18 9.8 35.5 15.2 29.4 20.0 29.8 8.7 Rainham & Wennington 31.3 7.3 20.4 10.4 33.4 9.06 31.2 18.7 35.2 17.1 27 Diseases of a zymotic character proved fatal in 29 instances. The death-rate from this class of disease for the entire district having been 1-4 per 1,000. The following table shows the nature and distribution of fatal zymotic disease in the different localities of the district. Dagenham. Havering. Upminster. Hornchurch Kainbam. Great Warley. Smallpox 4 1 2 3 3 - Measles - - - 2 - - Whooping Cough - - - 1 1 - Diphtheria - - - - 2 1 Enteric Fever 3 - - 3 - - ISOLATION HOSPITAL The following cases were admitted into the Isolation Hospital from the Rural district during the year. Recovered. Died. Scarlet Fever 27 27 — Diphtheria 8 8— Enteric Fever 16 13 3 The nursing and general treatment of the patients in the Hospital has been most satisfactory, and I am able to assure the Council that they possess a most valuable help in fighting infectious disease in the existence of such a well-appointed Hospital. In every case the patients' friends have expressed themselves as most grateful for the treatment received in that Institution. 28 I have, as in previous reports much pleasure in testifying to the sasisfactory way in which, as far as I know, the duties of inspection, &c., are carried out by the Sanitary Inspectors. Area and population of district: Area, in acres 32,245 Population 19,515 General death-rate, 11.9 per 1,000. Infant death-rate (under 1 year) 3.1 per 1,000. I am, Gentlemen, Your obedient Servant, ALFRED WRIGHT. The Lodge, Romford. March 24th, 1903. 29 TABLE I. Vital Statistics of Whole District during 1902 and Previous Years. ROMFORD RURAL DISTRICT. Yrar. Population estimated to Middle of each Year. Births. Total Deaths Rrgistkrkd in the District. Total Deaths in Public Institutions in the District. Deaths of Non-residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all ages belonging to the District. Number. Rate. Under 1 yr. of age At all Apes. Number. i Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1892. 1893. 1894. 1895. 1896. 1897. 1898. 16,400 551 33.5 66 4.02 250 15.2 12 262 15.9 1899. 16,770 593 35.3 84 5.008 256 15.2 9 265 15.3 1900. 17,380 476 27.3 26 1.4 255 14.6 11 266 15.3 1901. 18,990 569 29.9 0 4.7 266 14.007 16 7 5 2 1 14.2 Averages for vears 18921901 1902. 19,500 585 3.0 62 3.1 435 22.3 201 201 7 241 12.3 * Rates in columns 4, 8, 13, calculated per 1,000 of estimated population. Area of District in acrts (exclusive of area covered by water), 32,245. Total population at all ages, 18,990 Number of inhabited houses, 3.955 At Census of 1901. Average number of persons per house, 4.7 30 1 Institutions within the District receiving Sick and Infirm persons from outside the District. 2 Institutions outside the District receiving Sick and Infirm persons from the District. III. Other Institutious, the deaths in wnich have been distributed amont the several localities in the District. West Ham Smallpox Hospital, Dagenham. Union Workhouse, Romford Union. Isolation Hospital. TABLE II. Vital Statistics of Seperate Locamtieh in 1902 and previous years. ROMFORD RURAL DISTRICT. Names of Localities. Dagenham. Beacontree and Chadwei.i. Heaths. Noak Hill. Havering. Hornchurch. Upminster, Cranham, and Coruets Tey Great Warlet. Rainkan and Wennington. Year. Population estimated to middle of each year. Births registered. ' Deaths at all Ages. Deaths under 1 year. | Population esti, mated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle oi each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. e. d. a. b. c. d. a. b. c. d. 1892 1893 ... 1S94 1895 ... 1896 ... 1897 1898 5,020 160 83 33 500 7 3 4,700 131 61 13 1,990 43 31 4 1,890 62 22 3 2,300 72 17 4 1899 5,200 184 64 23 500 13 1 4,800 166 76 27 2,000 40 24 5 1,930 60 19 1 2,340 62 33 14 1900 5,500 181 90 31 508 8 5 3 5,000 168 70 15 2,020 51 31 4 1,970 30 30 12 2,390 79 25 10 1901 6,070 228 87 41 259 5 2 407 11 4 6,400 165 74 25 1,874 39 20 3 1,900 56 38 11 2,080 65 39 14 Averages of Tears 1892 to 1901 1902 6,300 223 69 18 259 4 406 7 6 1 6,600 177 83 24 1,900 42 19 5 1,940 58 17 3 2,100 74 36 13 •12 TABLE III. Cases of Infectious Disease notified during the Year 1902, in the Romford Rural District. Notifiable Disease. Ca jes notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from e vch Locality. A tall Ages. At Ages— Years. Dagenham. Beacontree and i (had well Heaths Noak Hill. Havering. Hornchurch. Upminster, Cranham. and Corbets Tey. Great Warley. i Rainham and ! Wennington. Dagenham, Beacontree and ChadweU Heaths j Noak Hill. be c > <A Hoinchuich. Upminster, Cranham, and I Corbets Tey. Great Warley. Rainham and Wennington. Under 1. 1 I to 5. 1 5 to 15. 15 to 25. 25 to 65. 65 and upwards. ( Small-pox 98 4 ,3 43 38 18 24 2 21 48 23 2 24 Cholera ... Diphtheria 34 13 15 2 ! 1 1) 10 1 4 (5 1 Membranous Croup ... ... Erysipelas 21 1 12 11 12 1 7 3 1 Scarlet Fever 40 1G 23 1 11 19 1 2 4 11 10 6 Typhu* Fever ... ... Enteric Fever... 29 ... 3 16 10 li 5 3 6 12 2 2 Relapsing Fever Continued Fever Puerperal Fever 1 ... 1 I ... Plague ... Totals 1 1 § i 36 54 73 62 108 1 65 10 3 39 77 36 2 1 32 Isolation Hospital—Kush Green, Dagenham. 33 TABLE IV. Causes of, and Ages at, Death during Year 1902, Romford Rural District. Causes of Death. Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Localities (at all Ages.) Total Deaths in Public Institutions in District. All Ages Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Dagenham, Beacontrt e ar.d Chad well Heaths Havering. Upminster, Cianbam, and Corbets Tey. Rainham and Wennington. Noak Hill. Hornchurch. Great Warley. Small-Pox 14 1 4 ... 2 5 2 5 1 2 3 ... 3 ... 195 Measles 4 2 1 ... ... 1 ... 2 ... ... ... ... 2 ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough 2 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... Diphtheria and Membranous Croup 3 ... 2 1 ... ... ... ... ... ... 2 ... ... 1 ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... Enteric 6 ... ... 1 2 3 ... 3 ... ... ... ... ... ... ... Other contin'd ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 3 ... ... ... ... 1 ... 2 ... ... ... ... 1 ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea 4 1 3 ... ... ... ... 2 ... ... ... ... 2 ... ... Enteritis 3 3 ... ... ... ... ... ... ... ... 2 ... 1 ... ... Puerperal Fever 2 ... ... ... ... 2 ... ... ... 1 ... ... ... 1 ... Erysipelas 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... Other septic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis 12 ... ... ... 4 7 1 4 ... ... 2 1 4 1 ... Other tubercular Diseases 13 6 4 2 1 ... ... 6 ... ... 3 ... 3 1 ... Cancer, Malignant Disease 13 ... ... ... 9 4 2 ... 1 1 2 5 2 ... Bronchitis 25 7 6 ... ... 3 9 4 3 2 5 ... 13 1 ... Pneumonia 10 1 6 1 2 4 2 2 ... 2 4 ... 7 1 ... Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Respiratory Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 16 16 ... ... ... ... ... 5 ... 2 3 ... 5 1 ... Diseases and Accidents of Parturition 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Heart Diseases 23 2 ... 2 2 12 5 10 ... 1 2 1 8 1 ... Accidents 12 3 1 ... 2 3 3 3 ... 2 2 ... 5 ... ... Suicides 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... All other Causes 60 12 7 ... ... 9 26 18 2 5 6 ... 22 7 6 All Causes 231 62 35 7 15 61 51 69 6 19 36 4 83 17 201 printed at the "essex times" office, romford.