BET 14 THE Metropolitan Borough of Bethnal Green. REPORT ON THE SANITARY CONDITION AND VITAL STATISTICS DURING THE YEAR 1908. TOGETHER WITH THE Report of the Chief Sanitary Inspector. BY GEORGE PADDOCK BATE, M.D. Fellow of the Royal College of Surgeons and Licentiate of the Royal College of Physicians of Edinburgh ; Fellow of the Royal Society of Medicine ; Fellow of the Royal Microscopical Society; Fellow of the Royal institute of Public Health; Vice-President (past President) of the Incoporated Society of Medical Officers of Health; Examiner in Sanitary Science, &c., to His Majesty's Civil Service Commissioners; Honorary Consulting Physician to Queen Adelaide's Dispensary ; J.P. for the County of London; and Medical Officer of Health for the Borough of Bethnal Green. LONDON: Printed by Furby & Co., Alpha Works, Hampton Road. Forest Gate, E. 1909. The Public Health Committee. (Elected 19th November, 1908.) Councillor W. H. Clark, Chairman. Alderman J. J. Fleming, Vice-Chairman. His Worship the Mayor, Councillor A. F. Barnard, J.P Aldermen J. J. Fleming and J. Merison. Councillors G. Bayley, T. Brooks, W. H Clark, T. A. Dean, J. Durell, J. W. How, R. Larkins, J. Phipps, E. A. Slade, J. W. Ward, EX-OFFICIO MEMBERS. The Chairmen of Standing Committees of the Council: Councillor C. E. Fox, (Finance). Councillor G. Bayley, ( Works and Stows). Councillor F. J. Read (Law and General Purposes). Councillor J. Pullen (Baths). Meetings—Alternate Wednesdays at 6 p.m., at the PUBLIC HEALTH OFFICES, 2, Paradise Row, Cambridge Road, N.E. Synopsis OF MEDICAL OFFICER'S ANNUAL REPORT, 1908. PAGE General Summary 7 Birth and Death Rates in Metropolitan Boroughs 6 Population 8 Table "A" Births. Deaths. 8 Table "B" Public Institutions outside Bethnal Green into which residents have been received and where they have died 11 Sudden or Violent Deaths. 12 Table "C" Public Institutions in Bethnal Green 15 Table "D" Deaths in Sub-districts 16 Table "E" Monthly mortality rates. —London and Bethnal Green 17 Table "F" Quarterly Death rates, London and Bethnal Green 18 Birth Rates 18 Table "G" Birth rates and death rates in sub-districts 18 Table "H." Marriages 19 Deaths of infants 19 Report of Woman Inspector 23 Bethnal Green Health Society 29 Notification of Births Act, 1907. 31 Deaths of young children 32 Elderly persons death rate 32 Weekly mortality chart 32 Table "J." Quarterly Mortalities, London 34 Table"K." do. do. Bethnal Green 34 The principal Zymotic diseases 36 Table "L." Deaths at home and in hospital 36 Table "M." Comparison between 1907 and 1908 37 Table "N." Percentages of Deaths from Zymotic diseases 37 SYNOPSIS.—Continued. PAGE Notification of infectious diseases 37 Do. Certificates 87 Table "O." Details of notifications 39 Scarlet Fever 40 Diphtheria 40 Enteric Fever 41 Typhus and Small Pox 45 Whooping Cough 45 Diarrhœal diseases 45 Measles 46 Do. Schools closed 46 Chicken Pox 47 Tuberculosis 47 Diseases of Parturition 57 Erysipelas and Puerperal Fever 58 Cancer 58 Glanders 59 Inquests 59 Suicides 60 Manslaughter 60 Uncertified deaths 60 Bakehouses 60 Customs and Inland Revenue Acts, 1890 to 1903 61 Housing of Working Classes Acts, 1890 to 1903 62 Staff and Officers 62 Tables— I.—Vital Statistics of Whole District 63 II.—Vital Statistics of Separate Localities in 1908 and previous years 64 III.—Cases of Infectious Disease notified 65 IV.—Causes of, and Ages at Death 66 V, V(a), V(b).—lnfantile Mortality 67,68,69 VI.—Number of deaths from the seven principal Zymotic Diseases in the ten years 1898 to 1907 and in the year 1908 70 SYNOPSIS.—Continued. PAGE VII.—Summary of Statistics on the administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Workplaces and Home work 71-72 VIII.—Fried Fish and Mussels as articles of diet 73 IX.—lnquest Cases. 74 London and the Metropolitan Boroughs. Birth-rates based upon births registered in each Borough, and Death-rates after distribution of Deaths in Public Institutions, of Persons belonging to London and the Metropolitan Boroughs during the 53 Weeks of 1908.* Boroughs. Births Per 1000 Persons Living. Deaths from Pyrex ia† (Origin uncertain). Phthisis. All Causes. Principal Epidemic Dieeases. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Enteric Fever. Diarrhœa. Crude 13.8 Corrected. 14 .5 1.35 0.31 0.11 0.15 0.20 0.05 0.00 0.53 1.32 25.2 COUNTY OF LONDON 22.1 18-S 0.87 West. Paddington 0.10 12.4 0.23 0.10 0.07 0.03 ... 0.34 Kensington 19.2 12.9 13.9 0.92 0.17 0.05 0.15 0.04 0.03 0.98 Hammersmith 25.4 14.0 14.5 1.09 0.12 0.09 0.10 0.15 0.04 1.26 27.0 12.9 Fulham 12.4 1.59 0.41 0.10 0.18 0.19 0.06 0.65 1.14 Chelsea 20.4 14.5 15.0 1.18 1.10 0.16 0.47 0.16 0.22 0.07 1.27 City of Westminster 16.7 12.6 12.2 14.2 0.58 0.13 0.04 0.09 0.05 0.03 0.24 1.23 North. 20.6 15.1 St. Marylebone 0.85 0.19 0.10 0.11 0.10 0.05 0.30 1.16 Hampstead 14.9 8.5 9.6 0.40 0.05 0.07 0.05 0.05 0.05 0.13 0.78 24.6 14.7 15.4 1.06 0.19 0.23 0.08 0.09 0.29 0.04 0.37 St. Pancras 1.51 Islington 24.7 13.2 13.7 12.9 1.01 0.09 0.10 0.16 0.05 0.32 1.24 Stoke Newington 19.7 12.3 0.82 0.18 0.09 0.02 0.11 0.07 0.35 1.07 Hackney 23.3 13.2 13.7 1.52 0.31 0.13 0.19 0.68 1.22 0.18 0.03 Central. ... Holborn 19.6 16.4 17.6 1.07 0.20 0.13 0.09 0.14 0.09 0.42 2.11 18.6 Finsbury 31.1 19.3 2.09 0.45 0.13 0.16 0.26 0.12 0.97 2.15 City of London 14.9 17.7 19.4 0.40 0.15 0.10 0.05 0.10 1.79 East. SHOREDITCH 18.3 32.0 17.4 2.09 0.44 0.25 0.11 0.20 0.09 1.00 2.00 BETHNAL GREEN 32.6 17.1 17.3 2.48 0.78 0.30 0.21 0.32 0.10 0.77 1.61 Stepney 32.1 17.1 2.53 0.24 0.24 0.04 ... 0.00 16.4 0.84 0.17 0.41 0.83 POPLAR 31.5 15.9 16.3 2.26 0.47 0.21 0.42 0.08 0.89 1.34 South. 1.88 Southwarrk 29.2 16.3 17.0 1.76 0.11 0.15 0.23 0.17 0.15 0.21 0.03 0.09 0.88 Bermondsey 32.5 18.8 19.2 2.30 0.19 0.18 0.82 0.01 0.84 1.89 Lambeth 24.6 13.3 13.7 1.18 0.31 0.13 0.14 0.02 0.03 0.43 1.45 Battersea 24.9 12.2 13.1 1.19 0.26 0.13 0.12 0.44 1.19 Wandsworth 25.2 11.6 12.2 0.93 0.15 0.07 0.13 0.21 0.19 0.02 0.02 0.35 0.96 Camberwell 24.2 12.7 13.1 1.06 0.19 0.08 0.14 0.44 1.12 DEPTRORD 26.4 13.8 14.5 1.32 0.28 0.06 0.08 0.20 0.28 0.19 0.07 0.08 0.63 1.16 Greenwich 23.5 12.6 12.9 1.25 0.14 0.05 0.16 0.54 1.10 23.0 11.0 11.4 1.25 0.40 0.85 Lewisham 0.29 0.07 0.27 0.03 0.02 Woolwich 11.4 12.1 0.92 0.07 0.07 0.16 0.24 0.36 1.20 In this Table 0.00 indicates that the deaths were too few to give a rate of 0.005 ; where no death occurred, ... is inserted. † Called Simple Continued Fever previous to 1901. No deaths from Small Pox or Typhus 0.59 ... 0.48 23.8 0.36 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... SUMMARY. 1907 1908 Estimated Population of Bethnal Green — Young Children, under 5 years Old People, over 65 years Area—755 Acres. Number of Inhabited Houses Rateable Value Average number of Persons to each House (1901 London Census 9.2). Average number of Persons to each Acre (1901 London Census 170.8). Total number of Deaths in the year Total number of Births in the year Total number of Marriages Marriage Rate —Bethnal Green Marriage Rate—London Death Rate-Bethnal Green Death Rate—London Birth Rate—Bethnal Green Birth Rate—London Infantile Death Rate (on Births) —Bethnal Green ... Infantile Death Rate (on Births)— London Young Children's Death Rate (on estimated number of Young Children) Old People's Death Rate (on estimated number of Old People) Zymotic Death Rate—Bethnal Green Zymotic Death Rate—London Inquest Cases Uncertified Deaths (no Inquests held) ... 130,831 17,850 57,100 15,882 £550,500 8.79 173.3 2,281 4,152 992 15.16 17.0 17.43 14.60 31.74 25.80 138.23 116.00 49.90 94.70 1.92 1.42 258 4 131,006 17,900 57,250 14,888 £549,991 8.8 173.5 2,275 4,341 927 14.15 15.9 17.10 13.80 32.64 25.20 131.80 113.00 50.5 75.9 2.46 1.35 277 0 Metropolitan Borough of Bethnal Green. REPORT To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Bethnal Green. Sir and Gentlemen, I have the honor to submit for your consideration my thirty-third Annual Report on the vital statistics and sanitary condition of the Borough of Bethnal Green. The year with which the Report deals includes fifty-three weeks and runs from December the 28th, 1907, to January the 2nd, 1909. POPULATION. The Registrar General estimates the population of Bethnal Green in the middle of the year 1908, at 131,066 —an increase of 235 over 1907. TABLE A. 1907. 1908 130.831 Estimated population in the middle of the year 131,006 Total Births 4,152 4,341 2,281 Total Deaths 2.275 Excess of Births over Deaths, shewing the natural increase of the population 1,871 2,066 BIRTHS. The number of births registered during the year was 4,220; but in addition to these a number of children were born of Bethnal Green mothers who were temporarily residing as inmates of lying-in institutions in other Metropolitan Boroughs. These have been notified to me as follow:- Stepney 91 Poplar 5 Finsbury 5 Hackney 2 City of London 2 Shoreditch 1 Various 15 Total 121 The addition of this number raises the total of Bethnal Green births to 4,341, a figure which exceeds that of 1907, by 189. The births exceeded the deaths by 2,066. DEATHS. The local Registrars give particulars in their weekly returns of 2,251 deaths during the registration year of fifty-three weeks. This number indicates a crude death rate of 16.9. Amongst the deaths registered as occurring in the Borough are included those of 392 non-residents, who were under treatment and died in Bethnal Green public institutions. Seven other persons also non-residents, died sudden or violent deaths, or were found dead within the boundaries of the Borough. They were:- 1. A boy aged three from Regent's Row, Shoreditch, who was run over in Hackney Road, and who died from shock and ruptured lung. 2. The baby, aged five months, of a woman living at Monier Road, Poplar, who was visiting a friend in Warley Street and whilst there the baby died from Enteritis. 3. A painter aged 43, from West Ham was killed by a train at Hemming Street railway bridge. 4. A French Polisher aged 34, of Perry's Place, Shoreditch, committed suicide by shooting himself in Bethnal Green Road. 5. An Engineer aged 54, from Brunswick Street, Shoreditch, died suddenly at Sewardstone Road Saw Mills, from heart disease. 6. A widow aged 67, from Key Street, Stepney, died in Bethnal Green Road, from ruptured heart, the result of fatty degeneration. 7. A Draper's Assistant aged 57, died at the Bethnal Green Police Station from internal hoemorrhage; he was found to have ruptured an Aortic Aneurism; his home was in Whitechapel. The names and previous residences of these 399 persons have been furnished by the local registrars to the Somerset House authorities, and have been by them distributed to the various Metropolitan Boroughs in which the deceased persons ordinarily resided. These deaths are therefore struck out from those actually returned to me. In addition to the deaths registered in Betlinal Green, I receive monthly from Somerset House lists of Bethnal Green residents who have died in various parts of London. These include particulars of 407 institution deaths, and also of sixteen Bethnal Green people who have died sudden or violent deaths in various parts of London, and upon whom Coroner's inquests have been held. Some details of these institutional and violent deaths are given below: — TABLE B. Public Institutions situated outside the Borough into which Bethnal Green residents have been received and where they subsequently died. Banstead Asylum 5 Bermondsey Infirmary 1 Bromley Sick Asylum 1 Brompton Hospital 2 Cancer Hospital, Chelsea 1 Cane Hill Asylum 1 Caterham Asylum 2 Children's Hospital, Gt. Ormond Street 6 Claybury Asylum 12 Colney Hatch Asylum 6 Darenth Asylum 1 Dartford Heath Asylum 4 Eastern Hospital, Homerton 11 East London Hospital, Shadwell 3 Friectenheim Hospital 3 French Hospital, Victoria Park 2 German Hospital 6 Goldsmith Asylum, Hackney 1 Guy's Hospital 1 Hackney Infirmary 3 Hanwell Asylum 8 Horton Asylum 3 Hospital for Women, Soho 1 King's College Hospital 1 Leavesden Asylum 6 London Hospital 204 London Temperance Hospital 1 Long Grove Asylum, Epsom 3 Manor Asylum, Epsom 2 Metropolitan Hospital, Kingsland 5 Middlesex Hospital 1 Mile End Infirmary 2 National Hospital, Queen's Square 1 New Hospital for Women 1 North Eastern Hospital, Tottenham 45 Park Hospital 7 Royal Chest Hospital, City Road 2 Royal Free Hospital 1 St. Ann's House, Stoke Newington 1 St. Bart's Hospital 17 St. Luke's House, Kensington 1 St. Thomas's Hospital 1 South Eastern Hospital 10 Shoreditch Infirmary 4 Tooting Bec Asylum 5 University College Hospital 1 Whitechapel Infirmary 1 407 SUDDEN OR VIOLENT DEATHS In other parts of London, of persons normally resident in Bethnal Green. 1. A retired lamplighter, aged 70, from Wadeson Street, died at the Royal Standard P. H. Victoria Park Road, from Syncope and Asphyxia ; he was choked by a piece of beef. 2. The six months old baby of a Barman from Pereira Street, died at Ironmonger's Row, St. Luke's, as the result of a fall from a chair. 3. A clothes dealer, aged 52, of Darling Row, died at the Montefiore Arms P. H., Houndsditch, from Syncope due to fatty and hypertrophied heart and indigestion. 4. A carman, aged 27, from Durant Street, died in Gray's Inn Road, as the result of injuries received in a collision between his own van and another. 5. A chair manufacturer, aged 69, from Grove Road, died in a nursing home in Wimpole Street, St. Marylebone. The cause of death was stated to be Prostatic disease and calculus of bladder (2 years) operation nine days ; Purulent Thrombosis. 6. A corn merchant, aged 72, from Hackney Road, died in a nursing home at Colosseum Terrace, St. Pancras, from Cancer of Pylorus; exhaustion 7 days after operation. 7. A widow, aged 62 years, from Busby Street, died in the Parish Room of St. Mary's Vicarage, Whitechapel, from Valvular disease of the heart. 8. An orange porter, aged 34, from Hague Street, was run down by a motor car in Bishopsgate Street Without, and killed. 9. The fifteen months old daughter of a domestic servant of Bethnal Green Road, died at Beckerton Road, Islington, from Teething, Marasmus and Exhaustion. 10. A stevedore, aged 40, from Russia Lane, was drowned whilst endeavouring to get on a ladder at the side of S.S. Batavia, in the River Thames, off Tower of London. 11. A widow, aged 73, from Hurley Buildings, died from Rheumatoid Arthritis, Pleuro Pneumonia and heart failure, at St. Barnabas Home, Clerkenwell. 12. A tailor's cutter, aged 46, from Kerbela Street, was found dead in Middlesex Street, Whitechapel. The cause of death is stated to be acute Pneumonia while suffering from Valvular disease of heart. 13. A compositor, aged 57, from Russia Lane, died from Syncope and fatty degeneration of the heart, on Gainsborough Road Bridge, Hackney Wick. 14. A fish porter, aged 48, from Barnsley Houses, was found drowned in the river Lea, near Stannard's Boat House, Hackney. 15. A boot repairer, aged 33, from Kay Street, who had tubercular disease, died at 4, Swiss Terrace, Hampstead, from Asphyxia caused by Hoemorrhage from ruptured blood vessel in left lung. 16. An upholsterer, aged 18, from Chambord Street, hanged himself in Wormwood Scrubbs Prison. These sixteen deaths of persons ordinarily resident in Bethnal Green together with the 407 institution deaths make a total of 423 ; and after adding these to the number actually registered in the Borough and subtracting the 399 non-residents there remains a net total of 2,275. Queen's Hospital for Children, Hackney Road 130 1734 80 232 Mildmay Mission Hospital 585 9 50 17 - 1 Bethnal House Asylum 300 30 Bethnal Green Infirmary 669 3458 575 37 2 Children's Home, Bonner Road - 337 - TABLE D. Deaths in Sub-districts. Deaths. DISTRICT. Population. North-East 1,139 65,830 65,236 South-West 1,114 Previous Residence unknown 22 - Total 2,275 131,066 In the North-East District there were 1,139 deaths and in the South-West 1,114. Twenty-two persons who had no fixed home died in the Workhouse or in the Infirmary. I have included these deaths in calculating the general mortality of the Borough, but I have excluded them when dealing with the subdistricts. DEATH RATE As the registration year 1908 included 53 weeks it is necessary, in order to render statistics for this year comparable with those of previous and future years, to increase the estimated population by a proportionate figure, for purposes of calculation only. Thus corrected we shew a mortality for the year 1908 of 17.10. This is .33 per thousand below the rate for the previous year but is over three points per thousand (3.3) above the general Metropolitan rate. The death rate for the whole of London is 13.8 and is 0.8 below that of the previous year. MORTALITY RATES IN SUB-DISTRICTS. On the basis of the estimated population corrected for a year of ordinary length I calculate a mortality of 17.0 for the North-East Sub-district, and one of 16.8 for the South-West. These rates do not include the deaths of homeless paupers. The next table shews the mortality rates for Bethnal Green and for London compared by months. The rainfall and the mean temperature are also shewn for each period. TABLE E. Month. London Death Rate Bethnal Green Death Rate. Mean Temperature Rainfall (inches) January 18.0 21.3 3 6.6 1.93 February 18.0 1.68 19.9 41.9 March 16.7 19.0 41.4 2.37 2.38 April 17.8 15.5 45.4 May 12.8 58.0 14.3 1.95 June 11.1 12.9 62.6 1.26 July 11.0 13.3 64.1 3.36 August 18.6 61.8 13.5 2.94 September 13.5 16.6 57-7 1.27 October 12.9 15.9 54.9 1.95 November 15.3 16.1 46.9 0.69 December 1 5.0 18.9 40.3 1.89 Total Rainfall 23.67 Average 13.8 17.1 51.0 The following table compares the death rates for Bethnal Green and for London by quarters: — TABLE F. Bethnal Green. Quarter ending. London. March 28th, 1908 17.0 20.3 June 27th, 1908 12.7 1 5 .2 16.0 September 26th, 1908 11.9 16.9 January 2nd, 1909 13.7 Yearly Average 13.8 1 7 .1 BIRTH RATE. The births registered during the year numbered 4,220, but as before mentioned I have received notice of 121 infants born of Bethnal Green mothers in lyingin institutions situated in other parts of London. These births raise the total to 4,341. This number is equal to a rate of 32.6 per thousand population and is slightly above that of the previous year which was 31.74. The general Metropolitan rate has decreased and stands at 25.2. In the registration sub-districts of the Borough the birth rates were as under ; for purposes of comparison the death rate in each district is also shewn:— TABLE G. Death Rate. Sub-Districts. Birth Rate. North-East 17.05 3 1 .4 South-West 33.8 16.83 TABLE H. Marriages. First Quarter 139 Second Quarter 268 Third Quarter 267 Fourth Quarter 253 Total 927 These figures indicate a marriage rate of 14.15 to every thousand persons, as against 15.9 in the County of London. DEATHS OF INFANTS. Of the total number of deaths from all causes, one fourth (25.28 per cent.) are those of infants aged less than twelve months ; as out of 4,341 infants who were born alive only 3,769 attained the age of twelve months; the remainder (572) became victims to various infantile maladies. A mortality calculated upon these figures gives a rate of 131.8 per thousand births. In this direction we shew some slight improvement over the previous year as in 1907 the rate was six per thousand in excess of 1908. The general Metropolitan rate has also fallen and stands at 113 against 116 for the previous year. The heaviest infantile mortality was recorded in the September Quarter, and was in great measure due to excessive prevalence of diarrhoea. In the first quarter of the year the infantile deaths were at the rate of 122 per thousand births; in the summer quarter they were only 115; in the autumn they rose to 161 and fell in the last quarter to 129. Of the total 572 deaths of infants, 124, a proportion of 21.7 per cent, occurred in the first week of existence, and 186 or 32.5 per cent, in the first four weeks after birth. In the second month 9.3, and in the third 7.7 per cent, of the total infantile deaths were recorded. In the appendix is a set of tables prepared in accordance with the instructions of the Local Government Board dealing exclusively with infantile deaths. Referring to these tables and classifying the principal causes of infantile mortality we find them as under: — Premature birth and congenitals defects 131 equals 30.0 per 1,000 births Diarrhoeal Disease 118 27.2 „ „ „ Respiratory Diseases 85 19.5 „ „ „ Wasting Diseases 63 14.5 „ „ „ Common Infectious Diseases Tubercular Diseases 53 12.2 „ „ „ 40 9.2 „ „ „ Suffocation 2 4 5.5 „ „ „ Convulsive Diseases 10 2.3 „ „ „ SPECIAL CAUSES OF INFANTILE DEATHS. As usual, premature birth and congenital defects are responsible for the heaviest mortality, and 23 per cent, of the total infantile deaths are attributable to these ante-natal causes. Diarrhoeal diseases come next with a total of 118, a proportion of 20.6 on the whole number; sixty-eight of these deaths were due to the acute or infective form of the disease, and fifty others wese stated to have been caused by Enteritis, Muco-enteritis, or Gastro-enteritis. The homes of all these infants were visited by Miss Harris, the Sanitary Inspector, and as a result of her enquiries, it was found that of the 68 Diarrhoea cases, nine were entirely breast fed and twelve were partly so, twenty-three had cows' milk and twenty-two condensed milk. Of those dying from other forms of diarrhœal diseases—fifty in number —eight were entirely breast fed and two partly so; ten others were breast fed until admitted to hospital where they died; nine had cows' milk, sixteen had condensed milk, and two patent foods. One mother went to work at a factory and sent her baby to be cared for by friends ; she did not know how it was fed, but at the inquest it was stated to have died from gastro-enteritis and improper feeding. The use of feeding bottles with long rubber tubes appears to be decreasing, as in only nine fatal instances of diarrhœal disease were these found in use. Various forms of Tubercular disease caused forty deaths, a mortality of nine per thousand births. The homes of nearly all these infants were visited by Miss Harris. She reports that nine were entirely breast fed and one other was so fed until its admission to hospital where it died; ten had cows' milk, four condensed milk and two patent foods; in the other cases no information was obtained. In ten out of thirty-three cases there was a history of phthisis on either the mother's or the father's side. In one case where no information as to feeding could be obtained, the mother was in an advanced stage of phthisis, and she herself died at the same time as her baby. Both parents of another infant were suffering from phthisis; they were alternately being admitted as in-patients at hospitals, one being under treatment whilst the other took care of the household; the mother was in hospital at the time of Miss Harris's visit. The deaths from suffocation (overlaying) have decreased and number twenty-four against thirty-two in 1907; possibly the attention which has been recently drawn by the public press to the ordinary causes of this so-called "accident" may have deterred some parents from putting their infants to sleep in the same bed with themselves. REPORT OF THE WORK DONE BY THE Woman Sanitary Inspector, DURING THE YEAR 1908. Public Health Department, Bethnal Green. To the Medical Officer of Health. SIR, I have the honour to present to you a short account of the work done by me in this Borough, during the year 1908. The visits paid numbered 3,414; allocated as follows: — Workshops 305 After Confinement 807 Re-inspections 626 Infant Deaths 439 Infantile (and other) Diseases Special enquiries 1,090 147 3,414 Total The year under consideration was a bad one for the working people. Poverty and distress were both widespread and increasing; work of all kinds was very scarce, and when it was obtained the rate of pay was low. Many people who have previously been found to be fairly comfortably off, are now struggling to “make both ends meet”; those who had lived in the larger houses and more respectable streets, have to do with fewer rooms or remove to poorer neighbourhoods; and women who have not taken in nor gone out to work must now try to obtain it. To mention another evidence of “bad times,” several employers have stated that they intend closing their workplaces, and giving their work to be done by outworkers at home, because they (the employers) would not then be put to the cost of renting, lighting, warming and maintaining expensive premises. The condition of the workrooms is, on the whole, fair. Where nuisances exist they are dealt with as they are discovered, and the employers are generally ready to meet the wishes of the Sanitary Authority. As has before been mentioned, the greatest difficulty is the ventilation of the workrooms. The means exist; but neither the value of fresh air, nor the many dangers of an impure, overheated atmosphere are rightly understood. The number of unventilated gas stoves for heating irons continues to decrease, as, when found, it is required that Hues be provided to the stoves or their use discontinued. Further enquiries made throughout the year confirm the statement which has been previously made, i.e., that the mothers of the young children are not industrially employed in this Borough to any very great extent. It was found that 80 per cent, of them were employed only in their household and family affairs, 8 per cent, were outworkers, and only 7 per cent, go out to work. Seven women were hawkers in the streets, and in the habit of taking the baby with them about their business. Births. Eight hundred and seven visits have been paid to houses where births have occurred. In spite of the fact that their parents are very poor, and that the mothers have to work hard, the majority of Bethnal Green babies, when born, are very fine babies. And it is not found that the mothers are so ignorant as is generally supposed. Indeed, in these days, when every newspaper, novelette and magazine has its page of advice on home and nursery matters, hygiene, cooking, baby-clothing, etc.; with hospitals and dispensaries within the reach of all; with district visitors, health societies, and mothers’ meetings, beside sanitary inspectors and health visitors, there is little excuse for ignorance. Often through poverty, sometimes through carelessness, lack of method, indolence, hopelessness, or through sheer force of habit, (they do much as their mothers before them did), the present day mothers do not give their babies the care an infant requires; but this is not because they do not know. When enquiries are made as to the method of treatment, the things that are told me are often exactly what they should be, even when there is reasonable cause to doubt that this course of action has actually been followed. Nor are the mothers always ready to follow advice when it is given. They first submit the advice to the criticism of their friends and neighbours. If the opinion of these is favourable, the advice given may be acted upon. But it may still be taken for approval, and possibly amendment, to the lady of whom one often hears and sometimes meets —the lady who (approximately) “has had eleven and lost seven.” Should it meet with favour in this quarter, it is thenceforth regarded as an article of faith, though, even then, it may be regarded as too valuable for every-day use, but reserved to be fallen back upon in an emergency. Of the infants visited shortly after birth 94.5 per cent. were found to be breast fed; 2.5 per cent, were partly breast fed; 3.0 per cent, were hand fed. A good reason was given in every case of hand feeding at this early age —usually it was advised by a doctor on either the mother's or the baby's account. Condensed milk was used for most of these hand fed and partly hand fed infants. Re-Inspections. It was intended that every infant whose birth was notified should be re-visited when about six months old, and again at, or just before, one year; but the re-visiting entails much waste of time, as it is usually necessary to make several calls before finding the mother at home; and eventually many are found to have removed. Owing perhaps, to the increase of poverty during the past year, more removals appear to have taken place than in previous years. Some mothers were found at other addresses, but many have entirely escaped. Two hundred and ninety five babies were re-inspected between the ages of 4 and 8 months. Forty five per cent, of these were found to be entirely breast fed, 30 per cent, were partly breast fed, and 25 per cent, entirely hand fed. Cows' milk was the food chiefly in use for these hand fed and partly hand fed infants, but condensed milk (of a good brand), nursery biscuits, oatmeal, and bread, are also largely used. In no case was the use of a cheap brand of condensed milk admitted. Bottles with rubber tubes were used in 30 cases only; three women assured me that they bought these because they were obliged to buy the cheapest they could get. The practice of feeding from a feedingcup seems to be growing in favour. “Comforters” are almost invariably used, though many mothers promise to dispense with them when the dangers are pointed out. The cards of “Advice to Mothers” have been widely distributed ; but I do not find that they are carefully kept. They are sometimes given to friends, but one fears that they are often destroyed. Attention is directed, however, to the most important points at the time that they are given; so no doubt they help to impress these on the mothers’ minds. Infantile Deaths. Three hundred and seventy nine infant deaths were referred to me for investigation involving 439 calls. Of that number 20 were not found, and in 12 cases it was found that the child died in hospital or infirmary while the mother was an in-patient of the same institution, and therefore no information was obtainable. Sixteen of these infants died within a few hours of birth, and had no food at all; and 12 who died in hospital were said to have been entirely breast fed till they went there. Of the rest 128 were said to have been entirely breast fed; 150 „ „ „ „ „ hand fed; 29 „ „ „ „ partly breast fed. Ten of the partly breast fed infants were fed on cows’ milk, condensed milk was used in 15 cases, one had cornflour, two had patent food without milk, and the other (11 months old) had much the same food as the rest of the family. The hand fed babies were mostly fed on cows’ milk, it being used in 70 cases; 61 of them lived on condensed milk, and 13 on patent foods. One baby of 4 months had bread and milk, and bread and gravy; another had “light” food; 3 had the same as the rest of the family; while still another, which was so injured at birth that it could not live long, had both cows’ and condensed milk, and every other kind of food that its parents heard of. There were, in addition to the above, 12 older children, the circumstances of whose deaths were enquired into. In each case, for some time, they had been having the same food as older members of the family had, three of them (13 months, 20 months, and 21 months old respectively) being still also breast fed. There is little to remark upon in the cases of measles and chicken pox notified from the schools. Incorrect addresses are frequently given, and cause much waste of time. Disinfection is offered, but is usually declined; and where nuisances exist, these are dealt with. Waiting Rooms at Stations. Early in the year at your request, I inspected the sanitary conveniences in the ladies’ waiting rooms at the two railway stations in this Borough. Since then these places have been periodically inspected, eleven visits in all having been paid. On every occasion I have found them clean, and the flushing apparatus in good order. They are flushed at intervals by the officials, as the members of the public often seem regardless of their duty in this matter. I am, Sir, Yours faithfully, A. K. HARRIS. BETHNAL GREEN HEALTH SOCIETY. A communication was received from the newly instituted Bethnal Green Health Society to the effect that they were desirous of assisting in the visitation of newly born infants. The matter was referred to the Public Health Committee, and after discussion it was decided to decline the offer under present conditions. As a matter of fact the total number of births reported voluntarily by the midwives during the year is only about 800, and the inspection and re-inspection of these is well within the capabilities of the present staff. I must confess that I am not particularly in love with amateur inspection. The ladies who undertake this work are usually full of zeal but deficient in tact and experience, their knowledge of the causes of infantile mortality, (acquired from books and lectures), is undigested and the advice they give is apt to be contradictory in small details. The importance of these may be slight yet they are liable to be seized upon and used as excuses for failure to obey instructtions. The investigations of Miss Harris, our woman sanitary inspector shew that in many cases poverty and not ignorance is the root of the evil. It occasionally occurs that owing to insufficient nourishment the mother's milk has failed and the cheapest substitute has to be resorted to. What is the use of advising a mother, whose breasts have dried up and whose pockets are empty, to feed her infant on milk and cream diluted in scientific proportions, when she has the greatest difficulty in purchasing even the cheapest brand of condensed milk? Some of the accounts brought in by Miss Harris are positively heartrending, and although members of the staff have responded to appeals for monetary help, it is unfair that they should be called upon, and something ought to be done to remedy this state of affairs. I suggest that the Bethnal Green Health Society should take steps to raise a fund to be used in conjunction with our work. A lady visitor would be welcome and useful if she were able to offer material help in addition to mere advice. NOTIFICATION OF BIRTHS ACT, 1907. So far, the Council of this Borough has not thought fit to put into operation the Notification of Births Act which was passed in 1907. As is well known, this Act is an adoptive one, but the Local Government Board has power, under section 3, to require those authorities which have not adopted the Act, to do so. Eleven London Boroughs, including our own, are in this position, and I learn from the published reports of the County Council that they have asked the Local Government Board to put the Act in force generally throughout the Metropolis; should the Board comply with this request, some action will have to be taken by the Bethnal Green Borough Council in the direction of a redistribution of the duties of the sanitary staff; and if this be not found sufficient, an increase in numbers will be necessary. Section 6 (1) of the London County Council General Powers Act, 1908, enables Borough Councils to appoint suitable persons as health visitors, to deal with the management of young children and the like. The London County Council may repay to Borough Councils appointing such officers, a proportion of their salaries, not exceeding one half. DEATHS OF YOUNG CHILDREN. The deaths of young children aged less than five years numbered 919, and form per cent, of the deaths from all causes. This is equivalent to a rate of 50 - 5 per thousand calculated upon the estimated population of young children. ELDERLY PERSONS DEATH RATE. Of the 2,275 deaths at all ages, 441 were those of persons aged over sixty-five years, a proportion of 19 per cent. This gives a death rate, calculated upon the estimated population of elderly persons of 75.9. WEEKLY MORTALITY. The line on the chart of deaths from all causes indicates the number of deaths in the Borough week by week corrected for institution deaths. QUARTERLY AND ANNUAL DEATHS AND MORTALITY RATES. Tables J and K overleaf, shew in addition to actual numbers of deaths, quarterly and annual rates of mortality for the principal Zymotic diseases and for Phthisis in Bethnal Green and in the whole of London. Particulars of birth and death rates are also given. 1908. Deaths from all causes 34 TABLES 35 Estimated Population in the middle of 1908. Births. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Pyrexia. Phthisis. Deaths of Infants under 1 year of age. All causes. Principal Epidemic diseases. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Deaths. All causes. Diarrhœa. 1908 1 11 12 3 Borough of Bethnal Green:- 2 4 5 6 7 8 9 10 6 13 14 15 16 17 18 19 20 21 22 23 662 - March 28th 131,066 1,132 - 16 12 12 11 4 0.49 - 10 - 496 - 59 141 20.3 1.87 0.37 0.37 0.34 - 0.12 June 27th - 131,066 1,044 20 8 6 19 - 0.61 - - - 70 0.58 522 - 48 122 15.2 1.92 0.24 0.18 - September 26th - 0.52 131,066 1,008 - 12 3 7 3 17 - - 55 174 16.0 342 - 0.37 0.09 0.21 0.09 Jan. 2nd 1909 - 16 595 131,066 1,030 51 8 7 5 6 - - 1.45 - 53 135 16.9 2.64 0.23 0.20 0.l4 0.17 - - 102 131,066 4,220* 104 42 13 - 40 2275 215 572 17.1 2.40 - 0.21 - 28 0.77 0.30 0.32 0.10 County of London:— - 32,151 March 28th 4,795,757 342 2 198 20,334 186 238 400 - 86 31,385 - 1.18 0.20 0.33 0.03 1,870 3,524 17.0 - 0.29 0.16 - June 27th 4,795,757 15,196 473 122 131 333 25 181 - - - 0.40 - - 1.401 2,837 12.7 1.06 0.10 0.11 0.28 0.02 29,874 September 26th 4,795,757 14,208 256 104 130 157 - 49 1,627 - - 1,314 3,847 11.9 1.94 0.21 0.09 0.11 0.13 - 0.04 30,434 Jan. 2nd 1909 4,795,757 17,615 453 136 94 - 225 - 115 - 586 3,735 13.7 1.25 0.35 0.11 0.17 0.07 0.09 1.744 - - 123,844 4,795,757 67,353 724 984 225 2,592 - 548 - 2 1,524 1.36 0.04 13.8 6,419 13,943 0.31 0.11 0.15 0.20 - - * Registered births only (births in outlying Maternity institutions not added). THE PRINCIPAL ZYMOTIC DISEASES. The deaths attributed to the diseases usually included in this group, and upon which the Registrar General calculates his Zymotic mortality, numbered 330 against 251 in 1907, an increase of seventy-nine. Many of these deaths occured in hospital, as will be seen from Table L. TABLE L. Disease. Deaths at Home. Deaths in Hospital. Total. Scarlet Fever 0 39 39 Enteric Fever 3 10 13 Erysipelas 5 2 7 Measles 100 5 105 Diarrhœa 77 25 102 Diphtheria 7 22 29 Notwithstanding this increase of seventy-nine we are still eighteen below the decennial average of the ten years 1898 to 1907. Table VI in the appendix shews this average to be 348. The next table M compares the deaths from each of the Zymotic Diseases in the two years 1907 and 1908. From this it will be seen that the increased mortality is principally due to Measles and Diarrhoea. TABLE M. Disease. 1907. 1908. Measles 71 105 Scarlet Fever 43 39 Diphtheria 18 29 Whooping Cough 53 42 Enteric Fever 7 13 Diarrhœa 59 102 251 330 Totals The death rate from these Zymotic diseases is 2*46 against 1*92 in 1907; whilst the corresponding Metropolitan rates are T.42 and I.35. Table N shews the percentage of deaths from each disease on the total number of zymotic deaths. TABLE N. Measles caused 105 deaths, 31"8 per cent., or 1 in 8-1 deaths Scarlet Fever ,, Diphtheria 39 11.8 8.4 ,, „ „ „ 29 9.0 11.0 „ „ „ „ „ Whooping Cough 42 12.7 7.8 „ „ „ „ „ Enteric Fever 13 3.9 25.3 „ „ „ „ „ Diarrhœa 102 30.9 3.2 „ „ „ „ „ NOTIFICATION OF INFECTIOUS DISEASE. The total number of notification certificates received at the office was 1,740; four of these referred to addresses outside Bethnal Green, and 116 were duplicates; so that the actual number of cases reported and dealt with was 1,620, a rate of 12.2 per thousand on the estimated population. Table 111 in the appendix indicates the number of persons suffering from each disease; it also shews the sub-district in which such persons resided, and the number (1,309) of those removed to hospital. In ninety-seven instances information was received from one of the Medical Superintendents of the Metropolitan Asylums Board Hospitals to the effect that the diagnosis as stated on the notification certificate was incorrect, a proportion of nearly six per cent, on the whole number. Table "O" gives full details of all the notifications. Enteric 83 5 35 43 Continued - - - - - - - Relapsing - - - - - - - Puerperal 6 - 6 2 - 4 - Cholera - - - - - - - Erysipelas 311 64 247 - - - - Cerebro Spinal Meningitis 2 - 2 - - 2 - Totals 1,736 116 1,620 64 1,244 65 97 87 SCARLET FEVER. (Deaths 39. Decennial average 22). As in 1907, scarlet fever of a mild type continued to be prevalent during the whole of the year; 1,005 ca ses were reported, 964 persons suffering with this disease were removed to hospital where 39 of them died, 41 slight cases remained at home and all them recovered. Of those removed 956 went to one of the M.A.B. Hospitals, and eight to other Hospitals or Infirmaries. The case fatality on the whole number treated in Hospital was four per cent. Forty-six of the patients sent to Hospital were found to be not suffering from scarlet fever, and are therefore not taken into consideration in these figures. All the fatal cases except eleven were of young children aged less than five years. The scarlet fever death rate is equal to 0.30 per thousand population at all ages, whilst that of London is 0.11. Five hundred and four cases were reported from the North-East sub-district, and 501 from the South-West. The Inspectors report that the homes of 561 of the patients were in a fairly satisfactpry condition; but in fifty-eight the W.C.'s or the apparatus connected therewith were found to be defective; in five the drain inside the house was leaky; in thirty-six the external drainage was faulty, and other minor insanitary defects were noted in 346 instances. Sixty-eight persons were removed from single room tenements. DIPHTHERIA. Total deaths 29. (Decennial average 43). The number of cases of this disease reported was 270, seven others were notified as Membranous Croup, 1908. Scarlet Febar. 1908. Diphtheria. 2 53 of these person were removed to M.A.B. Hospitals, and eight other urgent cases were treated in general Hospitals, sixteen remained at home. In forty-seven instances a notification was received from the M.A.B. superintendents to the effect that the diagnosis as stated on the certificate was incorrect. Of the 214 true diphtheria patients treated in hospital, twentytow died, a case mortality of ten per cent. Seven of the sixteen patients who were treated in their own homes died, a much heavier mortality. Twenty-two of the deaths from diphtheria were amongst young children aged less than five years. The diphtheria mortality in Bethnal Green was 0.21 per thousand living, against 0.15 for the whole of London. One hundred and twenty-three of the cases were reported from the North East sub-district and 154 from the South West. The Inspectors report that in 140 instances the sanitary condition of the patient's home was satisfactory; in eighteen the W.C.'s were out of order ; in nine the external drains were defective. Twentyseven patients were removed from single room tenements. Throat swabs from thirteen cases of suspected Diphtheritic throats were submitted to the Clinical Research Association. In three instances a positive result was reported, but in ten the characteristic Bacillius was absent. ENTERIC FEVER. Deaths 13. ( Decennial average 16.) Eighty-three persons were reported as suffering from Enteric Fever, seventy-eight of whom were re- moved to Hospital; thirty-five were received at the Metropolitan Asylums Board Hospitals and forty-three at General Hospitals; in four instances the diagnosis as certified was reported to be incorrect. The deaths in Hospital numbered ten. Five persons said to be suffering from Enteric Fever were treated at home and three of them died, they were too ill to be removed when the notification was received. The case mortality on the seventy-nine hospital cases was twelve and a half per cent. The mortality in Bethnal Green, per thousand living, was 0.10 against 0.05 for the whole of London. Forty-nine persons were reported from the North- East sub-district and thirty-four from the South-West. The inspectors note that in twenty-seven instances the homes of the patients were in a satisfactory condition, in three the W.C. apparatus were defective and minor insanitary defects were found in twentyfour instances. Ten patients were removed from single room tenements. The blood in six cases of suspected Typhoid fever was examined; in four instances a positive result was reported by the Clinical Research Association in two others the report was negative. In the Autumn the number of notifications suddenly rose above the normal. Nine cases were reported in the month of September, and enquiry shewed that five of the patients had obtained their milk supply from the same dairy-man. This fact made me suspect the the purity of the milk and I directed that a sample should be obtained and submitted for examination to the Clinical Research Association. Their report was as follows: — " Cultural examination shews the presence in this milk of organisms of the coli-aerogenous group, but the bacillus typhosus has not been found. It is however, almost impossible to detect this organism in milk " Mr. Henley, the Inspector of the district, ascertained that this milk was sent to London from a farm near Uttoxeter in Staffordshire. As the examination shewed the presence of sewage bacilli the Medical Officer of Health for the County was communicated with. He kindly replied by telegraph and informed me that there had been no case of enteric fever in the district for some years. It so happened that the dairyman had just terminated his contract with this particular farmer so no more milk was sent him from this source. On October 8th I deemed it advisable to report the incidence of the outbreak to the Local Government Board and to the London Ccunty Council with full particulars of possible sources of infection. Dr.Hamer came down next day from Spring Gardens and kindly assisted me in the investigation. Regular reports were sent to him as to the names and locality of the cases, many of which he visited in hospital after removal. On the whole, fifty-four cases were reported to me between September 16th and December 24th. From the first Dr.Hamer expressed the opinion that as nearly all the cases reported in September were adults, the probability was that milk could not be the source of infection. Inspector Henley's enquires however shewed that thirty-nine per cent, of the patients had eaten mussels and fourty-four per cent, fried fish. To any one who observes the habits of working people in East London it is obvious that fried fish (purchased ready cooked) is a staple article of diet; but in order to get some definite idea of the ordinary habits of the class of persons amongst whom the large proportion of cases of fever occurred, Mr. Henley, at Dr. Harrier's suggestion undertook an investigation to settle the point. He interviewed some 283 persons who were in ordinary health and who inhabited houses of a similar class to those recently occupied by the fever patients. A summary of Mr. Henley's enquiries will be found in the Appendix at p. 73, and from his report it will be seen that about twentytwo-and-a-half per cent, of the adults interviewed and five-and-a-half per cent, of the children had recently eaten mussels, and that seventy-seven per cent, of the adults, and sixty-three per cent, of the children had recently eaten fried fish. Enquiry was made as to the origin of this fish, and it was found that the mussels were almost invariably bought from street barrows, which could not be traced. Wet fish is bought daily by the fryers at the market in small quantities so as to ensure its freshness. It it not customary to deal with particular salesmen, the fryers seek what they require where it is cheapest and freshest. Rail fish is gutted before being put on rail, but steamer fish is delivered at the market whole. Mr. Henley visited a large number of the fried-fish shops and ascertained that all fish is gutted and well cleaned before it is cooked. This applies to dabs both 1908 Enteric Feber. sole and plaice. Looking at the result of Mr. Henley's investigations, I do not think that fried fish can be blamed as a source of typhoid fever in Bethnal Green; but what I do blame are the dirty, careless habits of many of the people. I was particularly struck with one instance in which five children, whose ages ranged from eight to fifteen, and all members of one family, sickened and were removed to hospital one after another. In the house where these children resided, I repeatedly saw remains of food and unwashed cups and plates left from one meal to the next; and for anything I know the crockery was never properly cleansed. I have no doubt that cultural examination of the hands of the children of this family, or rather of the dirt easily to be scraped from their fingers, would have shewn the presence of the Typhoid bacillus ; the communication of the disease from one to another in this family is no mystery. TYPHUS and SMALL POX No case of either of these diseases was reported during the year. WHOOPING COUGH. Deaths 42. (Decennial average 63). All these deaths were amongst young children, aged less than five years, a mortality on the estimated population of young children of 2.3. DIARRHŒAL DISEASES. Deaths 102. (Decennial average 177). Various forms of diarrhoea caused 102 deaths of which sixty-eight were amongst young children, and thirty-two others amongst persons between the ages of five and fifteen. The death rate on the whole population is 077 against 0.53 for the County of London. MEASLES. Deaths 105. (Decennial average 80). In 105 instances Measles was certified as the primary cause of death. The disease was almost invariably complicated by some form of pulmonary inflammation which was the immediate cause of the fatal result. All the deaths, except five, were amongst young children aged less than five years, a mortality of 5.5 per thousand population under that age. The total mortality on the estimated population at all ages was 0.78 against 0.31 for the County of London. The school authorities reported to us a total of 719 children excluded from school on account of measles. All these were visited by Miss Harris, but in seventy instances the address given in the report was incorrect, and in 139 instances no doctor was in attendance. Disinfection is invariably advised and offered, but it is not enforced as in a large number of instances we have no legal proof that the disease from which the child has recently suffered was really measles. Owing to the prevalence of measles, class-rooms at the following schools were closed and disinfected during 1908. April 15th, class-room D. Peel Grove School. June 2nd, class-room B. Wilmot Street School. July 30th, class-room B. St. Matthias School. Dec. 30th, whole school, Hague Street. CHICKEN POX. One hundred and sixty-six cases of this disease were reported to us from schools, sixteen of the addresses given were incorrect. TUBERCULOSIS. The various forms of disease caused by the tubercle bacillus were responsible for 315 deaths, nearly 14 (13.9) per cent. of our total mortality and equal to a rate of 2.4 per thousand population at all ages. The deaths from the pulmonary form of the disease (Phthisis) numbered 215, and are equal to a rate of 1.62 per thousand population in Bethnal Green as against 1.32 in the whole of London. The lungs of young children are not so vulnerable, and the bacillus seems more prone to find lodgment either in the membranes of the brain or abdomen ; consequently we find that of the 101 deaths from other forms of tuberculous disease, seventy-three of the sufferers were young children, a mortality on the estimated population under that age of 4.0 per thousand living. Of the infants under one year, seventeen had tuberculous meningitis and eight tuberculous peritonitis and fifteen suffered from other tuberculous affections, chiefly of bones and joints. By permission of the Public Health Committee, facilities are now afforded for the gratuitous examina- tion of sputum in suspected cases of phthisis. Nine specimens were submitted to the Clinical Research Association at the request of medical gentlemen, all of which gave a negative result. In December last the following circular enclosing a copy of the Public Health (Tuberculosis) Regulations, 1908, was received from the Local Government Board : — PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1908. Local Government Board, Whitehall, S.W., 18th December, 1908. Sir, I am directed by the Local Government Board to state that they have had under consideration the desirability of affording facilities for the extension of administrative action for the prevention of tuberculosis, and that with this view they have issued an Order in pursuance of Section 130 of the Public Health Act, 1875, as amended and extended by the Public Health (London) Act, 1891, and the Public Health Act, 1896, to provide for the notification to the Medical Officers of Health of Sanitary Authorities of cases of pulmonary tuberculosis occurring amonst the inmates of Poor Law Institutions, or amongst persons under the care of District Medical Officers, and for the taking of certain measures in such cases. Notifications by Medical Officers of Poor Law Institutions. Article IV. of the Order directs that the Medical Officer of a Poor Law Institution, as defined by Article 1., shall, with 48 hours after his first recognition of the symptoms of pulmonary tuberculosis in the case of a poor person who is an inmate of the institution, post to the Medical Officer of Health for the sanitary district in which the person resided immediately before he became an inmate of the institution a notification of the case. The notification must be made on a printed form as set out in the Schedule to the Order. Notification by District Medical Officers. Article V. directs that a similar notification shall be posted to the Medical Officer of Health by the District Medical Officer in the case of any poor person suffering from pulmonary tuberculosis on whom he is in medical attendance according to his agreement with a Board of Guardians. The notification must be posted within 48 hours after the District Medical Officer has first recognised the symptoms of pulmonary tuberculosis, and must be addressed to the Medical Officer of Health acting for the sanitary district in which the residence of the poor person is situate. Notification by Superintending Officers of Poor Law Institutions. Under Article VI. it will be the duty of the Superintending Officer of a Poor Law Institution to post to the Medical Officer of Health on a printed form as set out in the Schedule to the Order a notification of the actual or intended place of destination and address at that place of any person leaving the institution in respect of whom a notification has been made by the Medical Officer of the institution under Article IV. The notification must be posted within 48 hours after the departure of the person to whom it relates, and must be sent to the Medical Officer of Health of the sanitary district in which the intended destination of the person is situate. Notification of changes of address by Relieving Officers. Article VII. provides that a Relieving Officer shall notify any change of address (other than by admission to a Poor Law Institu- tion) of a person in respect of whom a notification has been made under Article V. by a District Medical Officer. The notification must be made on a printed form as set out in the Schedule to the Order, and must be sent to the Medical Officer of Health for the sanitary district in which the address to which the person moves is situate. The notification must be posted within 48 hours after the Relieving Officer has obtained accurate information respecting the change of residence. Remuneration to be allowed. Provision is made by Article VIII. for the remuneration of the Officers who have to make notifications under the Order. In the case of the Medical Officer of a Poor Law Institution or a District Medical Officer, the remuneration will be at the rate of one shilling for every notification, but where in relation to any one case two or more notifications have been posted by the Medical Officer to the same Medical Officer of Health, his remuneration will be at the rate of sixpence for every such notification after the first. In the case of a Superintending Officer of a Poor Law Institution or a Relieving Officer, the remuneration will be at the rate of threepence for every notification. The remuneration will be payable by the Council of the sanitary district for which the Medical Officer of Health acts, it will be deemed to cover the cost of postage, and it will be payable in the manner and subject to the conditions prescribed by the Article. Supply of Forms. It will be the duty of the Poor Law Authorities referred to in Article 111. to supply to the officers concerned printed copies of the appropriate forms set forth in the Schedule to the Order. Exception and Application of Enactments. Some of the provisions of the Public Health Act, 1875 and of the Public Health (London) Act, 1891, relative to infectious disease are not usually appropriate in cases of pulmonary tuberculosis. The Board have, therefore, provided by Article IX. (i) that nothing in the Regulations shall have effect so as to apply or to authorise any one to put in force with respect to a person in relation to whom a notification has been made any enactment which renders him or any other person liable to a penalty or subjects him to any restriction, prohibition, or disability affecting him or his employment, occupation, means of livelihood, or residence on the ground of his suffering from pulmonary tuberculosis. Special Powers of Councils. Subject to what is stated in the preceding paragraph, it is desirable that Sanitary Authorities acting on the advice of their Medical Officers of Health should utilise their powers for the purpose of preventing the spread of infection from pulmonary tuberculosis. The Order confers some special powers which the Board are advised are suitable for this purpose, and which are set out in Article IX. (2) of the order. The Board propose to issue for the use of Sanitary Authorites and Medical Officers of Health a memorandum by their Medical Officer setting out the appropriate action that can be taken under these powers. Copies of the memorandum will be sent to the Council in due course. Determination of Questions or Differences. Article XI. will enable the Board to determine any question or difference in relation to anything done under the Order on the application of any of the parties affected. Pulmonary Tuberculosis Notifiable under Local Acts. Article XII. deals with those cases in which powers have been obtained with respect to pulmonary tuberculosis by a Local Act. Nothing in the Regulations will have effect in derogation of any power or obligation under any such Act, but subject to this the Regulations will apply to any district in which a Local Act containing provisions with respect to pulmonary tuberculosis is in force. The Board may, however, on the application of the Council of the district direct that so much of the Regulations as relates to a notification by a Medical Officer of a Poor Law Institution or a District Medical Officer shall not have effect in relation to that district. Date on which the Order comes into effect. The Order will take effect on and after January Ist next, and it is desirable that the arrangements which are necessary to facilitate carrying it out should be made without any delay. In fixing January Ist. as the date when the Order shall come into operation the Board have had regard to the convenience, from a statistical point of view, of the Order taking effect at the commencement of a calendar year. If, however, any delay occurs in the printing of the forms, it may be understood that it will not be necessary to carry out the Regulations until these can be obtained. This circular was followed by a memorandum from the pen of Dr. Newsholme the Medical Officer of the Local Government Board of which the following is a precis so far as it affects a Metropolitan Borough:— The tuberculosis regulations deal only with Phthisical paupers who are resident either at home or in poor law Institutions. It is considered that help is more urgently needed in cases of poor relief than in others. In addition, however, the Local Government Board advises Borough Councils to adopt the voluntary notification of Pulmonary Tuberculosis and recommends the payment of reasonable fees to medical men for the same. Dr. Newsholme suggests that such cases as are so reported could be dealt with alongside those compulsorily notified by Poor Law officials. Measures should be taken by Sanitary Authorities (a) to educate and train the sufferer from Phthisis in the method of life suitable to his disease, not only with a view to his own cure, but at the same time to minimise the risk of his infecting others; (b) to secure for the patient separate sleeping accommodation so far as circumstances will permit either at home or in an institution; (c) to disinfect rooms which have become infected and to remove all conditions which favour infection or re-infection. Characteristics of Tuberculosis. Tuberculosis is an infectious disease caused by the tubercle bacillus. Its development is favoured by lowered vitality and insanitary surroundings. The disease is preventable and curable. It is in ordinary circumstances infectious by one channel only, that of the lungs, the infectious material being discharged as expectoration or as cough spray. This mode of infectoin can be controlled by the patient if he be scrupulously careful, moreover short exposure to infection does not suffice to infect healthy persons to an extent that will produce disease ; an exaggerated fear of infection is therefore not justified. Tuberculosis is to a large extent a disease of ignorance. Hygiene should be taught in schools. The pressure of public opinion should be brought to bear against indiscriminate expectoration and against overcrowding and other evils of housing and occupation. Special instruction should be given to those more directly exposed to tuberculous infection, such as the relatives of, and attendants upon consumptive patients and those engaged in occupations in which tuberculosis is most rife e.g. potmen, cutlers, bookbinders, printers, potters, tin, lead, and copper miners, and hair dressers. Distribution of cards of instructions explained by intelligent health visitors is strongly recommended. As tuberculosis is a disease of protracted duration, isolation is impracticable, but if the patient be properly trained and instructed, his powers of infectivity may be rendered inoperative. Temporary abode in a sanatorium is the most effective means to this end. Early Diagnosis. Until the nature of the disease is discovered no steps can be taken to prevent the spread of infection. At present a very large proportion of the cases of Tubercular Phthisis remain unrecognized until the disease has advanced sufficiently far to interfere with the patient's daily occupation. It is most important both for the sake of the patient himself and those brought into contact with him, that precautionary measures should be taken at an early period of the disease. Facilities for securing early diagnosis are therefore of great importance. The gratuitous bacteriological examination of sputum is the most successful means to this end. It is also hoped that the Medical Inspection of school children recently instituted, will secure the detection of previously unrecognised cases amongst children. It is of importance that so soon as a diagnosis has been made, that the patient should be acquainted with the nature of his disease, so as to secure his active co-operation in regard to precautions, as his own welfare depends to a large measure upon his intelligent carrying out of instructions. The majority of cases of Phthisis recover when the disease is recognised in its earliest stages, so that nothing is gained by concealment. Dr. Newsholme advises that when a notification of a case of Phthisis has been received by the M.O.H. an investigation should be made forthwith by a trained health visitor, who would amongst other things advise the patient (if remaining at home) on the lines previously laid down, but care must be taken not to interfere with the instructions already given by the Doctor in attendance upon the patient. " Above all the investigator must not pursue enquiries in such a manner, or give information to others that may prevent a consumptive patient from continuing to earn his livelihood." Revisits should be made by the Officer with a view to encourage the patient in carrying out the necessary treatment and precautions to prevent infection. Action against Infection. The most important measures are: — (a) The prevention of indiscriminate expectoration by the enforcement of Bye-laws and the exhibition of warning notices. (b) The gratuitous supply of pocket spit bottles. (c) The disinfection and cleansing of bedrooms, infected articles and premises. In addition to the measures set forth above, Dr. Newsholme advises where possible:— (id) The institution of tuberculosis dispensaries for the free treatment of sufferers, with staffs of visiting physicians and nurses. (e) The provision of Sanatoria. Under section 131' of the Public Health Act of 1875, (which does not apply to London) the Sanitary Authority has power to provide hospitals or to utilize unoccupied wards of existing hospitals for the treatment of persons suffering from tubercular phthisis. The Metropolitan Asylums Board has somewhat similar powers, but it is doubtful if these could be exercised without fresh legislation. THE INSTITUTIONAL TREATMENT OF CASES of PULMONARY PHTHISIS. This naturally divides itself into two parts: — (a) With respect to persons suffering from the disease in its early stages. Such a person, who is still able to earn his own living, may, with benefit to himself, enter a Sanatorium for a month or six weeks' treatment. He could probably obtain leave from his employer for this purpose so that he would not be compelled to forfeit his position. Whilst in the Sanatorium he would not only be treated for his disease but he would be trained in the best methods of disposal of sputum, and in the general hygienic regulation of his life in a practical manner that would be impossible at home. Moreover, during his absence his friends would be relieved from a source of anxiety, and an opportunity would be given for a thorough cleansing and disinfection of the home, to which the patient would return much improved in health and perhaps on the high road to complete recovery. (b) Advanced Cases.—When a patient suffering from Tubercular Phthisis is in such an advanced stage of the disesase that he is no longer able to work for his living, he usually becomes a source of danger to his family; he gets feeble and bedridden, and his cough violent, with frequent and profuse expectoration. His infectivity is now great and it is almost impossible to prevent (in the homes of the poor) communication of the disease to others. In these circumstances the provision of institutional treatment becomes an absolute necessity. In Bethnal Green, most of these advanced cases gravitate into the Infirmary, but many others remain at home to die. I am strongly of opinion that additional measures are urgently required for the housing and care of such unfortunates without the necessity of inflicting upon them the stigma of pauperism. DISEASES of PARTURITION. Six cases of puerperal fever were reported, but only one death from this disease was recorded ; four of the sufferers were removed to the infirmary and two were treated at home. The registered cause of death in the fatal case was "Puerperal Peritonitis." Twelve women died from one or other of the diseases or accidents incidental to childbirth. Of these, seven died from hœmorrhage, two from septicaemia after miscarriage, and one from exhaustion after the operation of version, necessitated by a hydrocephalic infant; two other women died from intercurrent disease shortly after delivery. ERYSIPELAS AND PUERPERAL FEVER. A communication was received in September from the Battersea Borough Council enclosing a copy of a letter which had been sent by that authority to the Local Government Board urging that the Metropolitan Asylums Board should be called upon to receive cases of Erysipelas and Puerperal Fever on conditions similar to those attaching to other infectious diseases such as small-pox and diphtheria etc. I advised the committee to which this communication was referred, that cases of these diseases would be best treated in general hospitals should they require removal; moreover as the infectivity of both these diseases is low (except under certain well known conditions) no danger to the public would be incurred by such cases being kept at home. The Council, upon the recommendation of the Public Health Committee decided to take no action. CANCER. The various forms of cancerous disease caused 114 deaths, all the sufferers (except two) were amongst persons aged over 25 years. I estimate the number of persons over this age living in Bethnal Green at 57,200. On this number the cancer mortality was 1.97 per thousand; the organs and parts of the body chiefly affected were as under:- Stomach 20 Uterus and Female organs of Generation 19 Intestines 17 Liver and Pancreas 13 Female Breast 12 Œsophagus 8 Jaw, Face and Orbit 5 Tongue 3 Larynx 3 Lung and Mediastinum 3 Brain 2 Testicle 1 Kidney 1 GLANDERS. Under the Notification of Glanders Order, 1907, seventeen cases of this disease amongst horses, have been reported to me by Mr. Shaw the Veterinary Inspector. No action beyond recording the particulars for reference has been taken by this authority. INQUESTS.* The Coroner held 277 inquests at the Court, in Church Row, upon the bodies of 159 males and 118 females; 96 of these were infants aged less than twelve months. Ninety-eight of the inquests were upon persons who had died violent deaths. Twenty-four infants died from suffocation; ten persons died from burns and * 53 weeks. scalds; four were run over in the street, and.one on the Great Eastern Railway; another was crushed to death by an engine. There were three deaths under chloroform administered for the performance of necessary operations. SUICIDES. These numbered sixteen, thirteen males and three females. Two men cut their throats, two men and one woman drowned themselves; two men hanged themselves; one of these was a printer's labourer doing time at Wormwood Scrubs Prison. Eight persons took poison, one man bi-chromate of potash, two others oxalic acid, and another "Rough on Rats," a man and a woman each took spirit of salt, another woman carbolic acid and lastly a man suffocated himself by inhaling coal gas. The man who shot himself in the Bethnal Green Road, and upon whom an inquest was held, was not an inhabitant of the Borough ; he came from Shoreditch. MANSLAUGHTER. In two instances verdicts of Manslaughter were returned. A glass-blower aged 36 died from fracture of the skull inflicted by some person unknown and a labourer died from a similar injury caused by a fall after being struck in the street. UNCERTIFIED DEATHS. No death was registered without a medical certificate or the order of the Coroner. BAKEHOUSES. At the end of 1907 we had ninety-four bakehouses on the register. During last year seven of these were closed by their owners leaving eighty-seven in occupation; twenty-seven of these are below ground. Two-hundred and twenty-nine inspections have been made and twenty, notices requiring cleansing have been served but no legal proceedings have been necessary. CUSTOMS and INLAND REVENUE ACTS, 1890 to 1903. Applications for certificates to secure relief of taxation under these Acts were made in respect of the following premises and with results as noted: — 14, 16, 16a, 18, 18a, 20, 20a, 22, Mace Street. Sixteen tenements—the premises were in a satisfactory condition and the certificate was granted. 12, Bacon Street. Seven tenements—premises not suitable. The certificate was refused. 348, Hackney Road. One tenement and shop below —these are business premises to which the Acts do not apply. The certificate was refused. Reed's Mansions, 7, Gosset Street. Nine tenements —my requirements as to sanitary accommodation and domestic conveniences were not complied with. The application was refused. 1 to 26 Delamere Buildings, Collingwood Street. Twenty-six tenements—the owner of these buildings applied for my certificate but upon inspection such insanitary conditions were discovered that by direction of the Public Health Committee full Statutory notices were served. These were complied with, and nothing more could have been enforced by Police Court proceedings, but I was not satisfied with the condition of the premises and I declined to grant the certificate, much to the disgust of the owner. HOUSING OF THE WORKING CLASSES ACTS, 1890 TO 1903. The Brady Street and the Digby Street insanitary areas remain in statu quo; by repeated inspection and the pressure of statutory notices such repairs as the houses are capable of have been effected, but no steps have been taken under the above Acts. STAFF AND OFFICERS. I regret to say there has been a considerable amount of illness amongst the members of the Paradise Row staff during the year. The occupation of a Sanitary Inspector is not a particularly healthy one at the best of times, but just now we are badly housed as the temporary offices of the Public Health Department are overcrowded and otherwise insanitary. No additional expense to the Council has been incurred on account of illness as the duty of the incapacitated officer has in each instance been willingly and cheerfully discharged by the absent man's colleagues, and though some inconvenience has been caused there has been no neglect and no duty has been left unperformed. I cannot allow this opportunity to pass without according my very best thanks to my colleagues for the manner in which my wishes have been cheerfully acceded to and every assistance afforded to me in the performance of my duty. I have the honour to be, Sir and Gentlemen, Your very obedient servant, GEORGE PADDOCK BATE. TABLE I. Vital Statistics of Whole District during 1908 and Previous Years. Metropolitan Borough of Bethnal Green. Year 1 Births. Total Deaths Registered in the District. Deaths of Residents registered in Public Institutions beyond the District. 11 Nett Deaths at All Ages Belonging to the District. Deaths of Nonresidents registered in Public Institutions in the District. 10 Total Deaths In Public Institutions In THE DISTRICT. 9 Under 1 Year of Age. Number. 3 Rate. 4 At all Ages. Population estimated to Middle of each Year, 2 Number. 5 Rate per 1,000 Births registered. 6 Number. 7 Number, 12 Rate.* 8 Bate,* 13 1898 2,633 119 129,200 4,779 37.0 839 185 20.4 620 358 2,872 22.2 1899 129,200 4,753 36.8 827 174 2,669 20.7 727 431 | 2,936 22.7 164 1900 129,600 4,588 35.4 771 168 2,535 19.5 873 150 22.7 431 | 2,816 49,339 1930 355 1,861 814 954 827 1899 1,168 34,194 227 45,667 1,462 245 129,200 4,753 2,936 1900 51,500 1,935 1,142 314 33,450 1,218 776 211 177 44,650 1,435 898 246 129,600 4,588 2,816 771 1901 51,514 1,864 1,112 308 33,472 1,239 721 44,714 1,505 795 223 129,700 4,608 2.628 708 1902 51,600 1056 307 34,000 1,237 730 186 44,289 1,414 961 217 129,890 4.589 2,747 710 1,938 947 33,000 1,171 202 625 1903 51,600 1,945 269 616 181 45,428 1,511 800 130,028 4.627 2.363 1904 51,000 1,892 1,001 351 33,179 1,194 665 154 145,428 1,440 802 206 130.207 4,526 2,468 711 1905 51,617 1,808 979 263 33,266 1,088 629 191 45,518 1,425 810 197 130,207 4,321 2,418 651 65,600 1,178 ... 65,009 65,115 ... 1,224 ... ... *1906 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1907 ... ... 357 217 ... ... ... ... ... ... ... ... ... ... ... 65,716 1,929 1,068 2,168 1,178 ... ... ... ... Averages of Years 1898 to 1905. 51,014 726 199 ... 1,139 1,066 317 33,594 865 4,624 739 ... ... ... 1,225 1,464 129,754 ... ... ... ... 1,910 45,170 222 2,656 572 ... ... ... ... ... ... 131,066 2,275 2,103 2,228 1,114 1908. ... ... ... ... 4,341 284 165,236 288 ... ... 65,830 * In 1906 the Borough was divided Into two sub-districts instead of three m heretofore. TABLE 111. Cases of Infectious Disease notified during the Year 1908. Notifiable Diseases, Cases Notified in Whole District. Total cases notified in each Locality. No of crises removed to Hospital from each Locality. At all Ages. All Ages.. Years. 1 North East. 2 South West. 2 South West. 1 North East. 3 Total crises removed to Hospital. Under 1, 1 to 5. 5 to 15. 15 to 25 25 to 65 65 and Upwards. ... Small Pox ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... TABLE IV. Causes of, and Ages at, Death during Year, 1908. Causes of Death. 1 Deaths at the subjoined ages of "Residents' whether occuring in or beyond the District. Deaths at all ages of "Residents" belonging to Localities, whether occurring in or beyond the District. All Ages 2 Under 1 year. 3 1 and under 5. 4 5 and under 15. 5 15 and under 25 6 25 and under 65. 7 65 and upwards 8 TOTAL. 9 N.K. S.W. 11 No Home 12 Small-pox ... ... ... ... ... ... ... ... ... ... ... Measles 105 28 77 5 ... ... ... 105 51 54 ... 2 2 ... Scarlet fever 39 1 27 7 39 20 19 ... Whooping-cough 42 24 18 ... ... ... ... 42 23 19 ... Diphtheria (including Membranous croup) 29 5 7 ... ... ... 29 13 1G ... Croup ... ... ... ... ... ... ... ... ... ... ... 17 Typhus ... ... ... ... ... ... ... ... ... ... Enteric 13 ... 2 1 1 9 ... 13 6 7 ... Other continued ... ... ... ... ... ... ... ... ... ... ... Epidemic influenza 39 ... ... 1 1 21 9 32 11 21 ... ... ... ... ... ... ... ... ... ... Diarrhœa 102 68 82 ... ... 1 102 42 ... ... 1 60 46 4 ... ... ••• 23 ... Enteritis 52 2 52 29 Puerperal fever 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... 7 2 3 2 7 3 3 1 Erysipelas Phthisis, Pulmonary Tuberculosis 6 215 ... 5 31 215 103 110 2 161 12 Other tuberculous disease 101 101 44 29 9 4 10 5 53 47 1 Cancer, malignant disease 114 ... 21 69 1 1 43 114 59 53 2 76 Bronchitis 211 ... 41 1 3 69 211 116 94 1 Pneumonia 45 59 5 7 53 8 22 191 86 103 2 191 5 Pleurisy 20 1 5 ... 1 20 8 12 ... 2 ... ... Other diseases of Respiratory organs 7 ... 14 2 3 14 5 9 19 ... 21 1 ... 1 21 11 10 ... Alcoholism Cirrhosis of liver ... ... ... ... 1 ... Venereal diseases 6 5 6 2 4 ... Premature birth 86 86 ... ... ... ... ... 86 51 35 ... Diseases and accidents of parturition ... 12 ... ... 12 ... ... 12 4 8 ... Heart diseases 221 2 25 102 103 11l 7 10 11 71 221 21 Accidents 89 29 ... 16 14 2 7 89 35 54 16 ... Suicides 1 14 1 16 7 9 ... ... Kidney disease 83 1 ... 2 8 49 25 83 31 49 5 1 3 Rickets 9 ... ... ... ... 9 6 1 3 ... Cerebrospinal Meningitis 2 ... ... ... ... ... 5 3 5 3 2 2 ... Homicide ... ... ... 2 ... 2 2 ... ... Old age 89 ... 4 85 180 26 3 ••• ... ... 89 All other causes 348 17 6 102 76 135 12 348 180 168 ... 728 347 441 22 All causes 2275 572 83 104 2275 1139 1114 ... Cholera TABLE V. Infantile Mortality during the Year, 1908. Deaths from stated Causes in Weeks and Months under one Year of Age Population, (estimated to middle of 1901), 131,000. Births in the year, 4,341, Deaths in the year, 572 Infants Deaths from all Causes at all Ages, 2,422. 24 34 21 33 40 33 45 1 2 ... ... 1 1 7 ... 1 3 ... 1 ... ... ... 2 1 ... ... 2 ... 2 ... 1 1 1 2 ... ... ... ... ... ... ... ... ... ... 3 5 3 3 ... ... 3 ... 7 2 1 ... 2 ... ... ... 4 1 1 ... 1 ... 1 ... ... ... ... 1 1 1 ... 2 2 ... 2 ... 1 ... ... ... 1 ... 2 2 ... 3 ... ... ... 1 ... ... ... ... 2 4 ... 1 ... 1 ... ... 3 11 3 ... 1 3 ... 2 1 2 ... 4 ... ... ... ... 1 4 ... 2 1 ... ... ... 1 1 ... 5 7 4 1 ... 4 ... ... ... ... 3 ... 3 ... ... ... ... ... 3 2 1 4 ... ... ... ... 1 3 7 5 1 ... ... ... ... 1 3 4 ... 7 ... ... ... ... ... 1 1 1 6 ... ... ... 2 ... 6 11 2 ... ... ... ... ... 3 2 2 ... 3 2 ... ... ... ... 2 1 ... 11 ... ... 1 1 1 10 5 ... ... ... ... ... ... 44 53 186 21 5 3 7 7 ... 2 ... 5 ... 1 ... ... 8 ... ... ... 21 9 4 ... 5 ... 1 ... ... 1 ... ... 1 22 ... 9 31 77 5 2 3 4 1 ... ... ... ... ... ... 3 1 1 ... ... ... ... ... 27 14 124 ... ... ... ... 4 2 2 ... 3 ... 1 ... ... ... ... ... 1 2 ... ... 2 2 ... ... 1 1 ... ... ... ... 6 3 ... ... 2 ... ... ... ... 1 ... ... ... 5 ... ... 4 4 ... 2 ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... 3 ... ... 4 3 ... ... ... ... ... ... ... ... ... 9 4 ... ... ... ... ... ... ... ... ... ... ... 12 ... 9 21 68 ... 1 ... ... ... ... Other Causes Suffocation, overlying Pneumonia Laryngitis Bronchitis Convulsions Meningitis (not Tuberculous) Rickets Syphilis v. Other Causes Erysipelas Other Tuberculous Diseases Tuberculous Peritonitis, TabesMesenterica iv. Tuberculous Diseases Tuberculous Meningitis Atrophy, Debility, Marasmus Want of Breast-milk, Starvation Injury at Birth Congenital Defects iii. Wasting Diseases Premature Birth Gastritis, Gastrointestinal Catarrh Enteritis, Mucoenteritis, Gastroenteritis ii. Diarrhœal Diseases Diarrhœa, all forms Whooping Cough Diphtheria (including Membranous Croup) Scarlet Fever Measles ... Chickon-pox i. Common Infectious Diseases Small-pox 24 34 21 33 40 33 45 44 53 186 21 27 14 124 All Causes. Certified Uncertified 9-10 Months. 8-9 Months. 7-8 Months. 6-7 Months. 5-6 Months. 4-5 Months. 3-4 Months. 2-3 Months. 1-2 Months. Total under 1 Month. 3-4 Weeks. 2-3 Weeks. 1-2 Weeks. Under 1 Week. CAUSE OF DEATH. TABLE V(a). District—North East Bethnal Green. Infantile Mortality during the Year, 1908. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH Under 1 Week. 1-2 Weeks. 2-3 Weeks 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. All Causes. Certified ... 64 6 13 G6 89 20 23 15 ... 23 14 13 20 13 14 25 ... I ... ... ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... i. Common Infectious Diseases ... ... ... ... Small-pox ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... 2 ... 1 ... 1 ... ... 1 ... 3 ... 9 ... ... ... ... ... ... 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Diptheria (including Membranous Croup) ... ... ... ... ... ... 1 ... ... 2 ... 1 Whooping Cough ... ... ... ... 1 2 3 ... ... ... 2 ... 1 ... ii. Diarrhcea.l Diseases Diarrhoea, all forms ... ... ... 5 ... 7 2 4 3 4 3 3 3 ... ... ... 4 ... Enteritis, Mucoenteritis, Gastroenteritis 1 1 1 8 9 1 1 ... ... ... ... ... ... ... ... 1 ... 2 4 1 Gastritis, Gastrointestinal Catarrh 1 ... ... ... ... ... ... iii. Wasting Diseases Premature Birth ... 1 40 3 ... 2 ... ... 38 ... ... ... 1 Congenital Defects 9 1 2 ... ... ... 1 13 ... ... ... ... ... ... ... 1 ... ... 1 ... Injury at Birth 4 ... ... 4 ... ... ... ... Want of Breast-milk, Starvation ... ... ... ... ... ... 4 ... ... Atrophy, Debility, Marasmus 1 ... ... 4 10 3 2 1 ... ... 5 ... ... 1 11 ... ... ... ... 1 iv. Tuberculous Diseases Tuberculous Meningitis Tuberculous Peritonitis: ... 1 ... ... ... ... ... 2 1 ... ... ... 1 ... ... 1 1 . .. Tabes Mesentcrica ... ... ... 1 1 1 ... ... Other Tuberculous Diseases 2 1 2 2 ... ... 8 ... 1 ... ... ... 1 ... ... ... 1 ... ... ... 1 ... Syphilis ... ... ... ... ... ... ... 1 ... ... Rickets ... ... ... ... ... ... ... 1 ... 1 M ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... •2 ... ... ... 4 Convulsions ... 1 ... ... ... 3 3 3 2 1 Bronchitis 1 ... 4 1 ... ... ... ... ... 3 ... ... ... ... ... 3 ... ... ... ... 1 1 ... ... ... Laryngitis ... ... ... 8 2 ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... 1 ... 1 ... 4 ... 2 2 1 1 ... 3 ... ... ... ... ... ... 3 Suffocation, overlying ... ... ... ... ... ... 3 ... 1 1 1 1 1 ... Other Causes 2 9 ... ... 2 1 ... ... 5 ... 2 1 2 ... 1 14 13 23 25 20 15 23 14 13 20 13 89 64 6 6 Births in the year, 2103. Deaths in the year of infants, 284. Population, (estimated to middle of 1908), 65,830. Deaths from all Causes at all ages, 1,139 ... ... ... ... Meningitis {not Tuberculous) ... ... • TABLE V(b). District—South West Bethnal Green. Infantile Mortality during the Year, 1908. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 week. 1-2 Weeks 2-3 Weeks. 3-4 Weeks. Total under one month. 1-2 Months. 2-3 Months 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months 9-10 Months. 10-11 Months. 17 6 14 11 u 20 23 All causes Certified 8 15 33 14 97 21 18 60 ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... i. Common Infectious Diseases Small-pox ... ... ... ... ... ... ... ... ... Chicken pox .... ... ... ... 1 1 ... 2 2 ... 1 ... •• ... ... ... ... ... ... 1 ... ... ... ... Scarlet Fever ... ... ... ... ... ... Diphtheria (including Membranous Croup) ... ... ... 1 ... 1 1 ... 1 ... ... 2 1 ... 1 ... ... ... 3 1 3 ... Whooping Cough ... ... ... ... ... ... 4 ... 2 ii. Diarrhceal Diseases Diarrhoea, all forms ... ... 1 1 1 3 1 ... 2 7 4 3 3 5 Enteritis, Mucoontcritis, Gastroenteritis 2 2 1 ... 1 1 9 2 2 ... 1 1 ... ... ... ... ... ... ... ... Gastritis, Gastrointestinal Catarrh ... ... ... ... ... 1 1 1 37 1 ... ... ... ... ... iii. Wasting Diseases Premature Birth 2 ... ... 3 2 1 30 2 1 18 2 1 1 ... ... ... ... 1 Congenital Defects 12 3 2 ... ... ... ... ... ... ... ... ... ... 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk, Starvation ... ... ... 1 Atrophy, Debility, Marasmus 7 1 2 12 3 ... 4 ... 2 2 2 1 1 2 ... ... 1 1 1 ... 3 iv. Tuberculous Diseases Tuberculous Meningitis 1 ... ... 1 ... 2 ... 1 ... ... ... ... ... ... Tuberculous Peritonitis, Tabes Mesenterica ... ... ... ... ... ... ... ... 2 Other Tuberculous Diseases ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 ... ... ... ... ... 2 4 14 Syphilis ... ... ... 4 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... Rickets ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... 1 4 2 4 ... Bronchitis Laryngitis 1 ... ... ... ... ... ... ... 1 4 ... 2 ... ... 1 2 5 1 3 2 1 1 5 3 1 1 ... 1 1 ... ... 2 ... Suffocation, overlying 1 2 1 ... 1 ... 2 1 1 ... 4 12 4 1 ... Other Causes 4 ... 17 20 6 11 15 97 33 18 14 60 21 23 14 8 Births in the year, 2,238. Deaths in the year of infants, 288. Population (estimated to middle of 1908,) 66,236. Deaths from all causes at all ages 1,114. ... Pueumonia Convulsions ... ... ... ... ... Measles ... ... TABLE VI. Shewing the number of Deaths from the Seven principal Zymotic Diseases, inclusive of Hospital Deaths in the 10 years,' 1898 to 1907, and in the year 1908. FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors. Number of Premises Inspections. Written Notices Prosecutions, ... 200 19 Factories (Including Factory Laundries) Workshops ... 4703 841 (Including workshop Laundries) Workplaces 1017 47 ... Total 5920 907 ... 2.—OTHER DEFECTS. Number of Defects. Number of Prosecutions Particulars. Referred to H.M. Inspector. Found Remedied. Nuisances under the Public Health Act: - * Want of cleanliness ... 355 24 355 ... 24 | ... ... Want of Ventilation Overcrowding ... ... ... ... Want of Drainage of Floors ... ... ... Other Nuisances 264 264 ... ... insufficient 8 8 ... ... Sanitary Accommodation 210 ... ... unsuitable or defective 210 6 ... ... not separate for sexes 6 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Bieach of special sanitary requirements for bakehouses (ss. 97 to 100) ... ... ... ... Other offences ... 2 ... ... Total 876 768 2 ... * Including those specified In sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. Paper bags and boxes 22 Brush making 903 | ... ... 50 533 ... ... 590 ... ... ... ... ... ... 14 ... 190 3,055 8 92 3,055 1,684 ... ... 5,900 ... Total ... ... ... ... 4.—REGISTERED WORKSHOPS. 5.—OTHER MATTERS. Workshops on the Register (s. 131) at the end of the year. Number Class. Number. Matters notified to H.M. Inspector op Factories— Workshops, including Laundries 1,831 Failure to affix Abstract of the Factory and Workshops Act (s 133) 46 Notified by H.M. Inspector 225 42 Workplaces Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act, (s. 5) Reports (of action taken) sent to H.M. Inspectors Bakehouses 42 87 2,143 Underground Bakehouses (s. 101) — Total numbers of workshops on Register Certificates granted during the year - 27 In use at the end of year | 542 ... 482 ... ... ... ... ... ... 1,358 ... TABLE VIII. Fried fish and Mussels as articles of Diet. No. of houses whence information has been obtained 36 „ families do. do. 67 „ Adults who are said to have eaten mussels 35 „ do. do. not to have do. 120 „ Children do. to have do. 7 „ do. do. not to have do. 121 Total number of persons 283 Percentage of adults who have eaten mussels 22½ per cent. do. Children do. do. 5½ do. do. Adults and children do. 14¾ do. No. of adults who are said to have eaten fried fish 120 „ do. do. not to have do. 35 „ Children do. to have do. 59 „ do. do. not to have do. 62 Total number of persons 283 Percentage of adults who have eaten fish 77 per cent. do. Children do. 46 do. do. Adults and Children 63 do. NOTE .— Adults include young persons who go to work. METROPOLITAN BOROUGH OF BETHNAL GREEN. STREET LIST. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Abbey street ... ... 1 Blythe street ... 5 3 4 2 ... 7 Abingdon street ... ... 3 3 Bonner road ... ... ... 7 7 ... Abingdon buildings ... ... Ada place ... ... ... 2 3 Bouner street 1 ... 3 5 1 1 3 3 Bonwell street 1 ... 1 2 2 2 Ainsley street ... ... ... 1 1 Boundary street ... ... ... 2 1 ... ... ... Albert buildings ... ... ... ... ... Bradys buildings 1 Albert grove ... ... ... ... 1 ... 2 4 7 ... Brady street 1 ... 1 3 Albion place ... ... ... ... ... Braemar street 1 1 1 Alfred place 1 ... 5 ... 1 Bratley street ... ... ... 11 Allas road 3 1 5 2 Brick lane 3 1 6 9 19 Alma road ... 1 1 3 5 Brierley street ... ... ... ... 3 3 1 2 1 3 8 Bucks court 1 1 Ames street 2 1 1 1 1 2 4 8 Angela gardens ... ... 2 Buckhurst street 1 ... ... ... ... Anglcsea street ... 1 3 5 Bullards place ... Anns place ... ... 1 ... 1 Bunsen street ... ... ... ... ... 1 2 4 Burgoyne road 1 ... 2 1 4 Approach road ... 1 1 ... 1 Arbery road 1 1 3 5 Burnham square ... 4 Burnside street ... 3 9 Except Nos. 74 & 76) 4 2 2 ... ... ... ... Busby street 1 4 7 Busby square ... ... ... Archer street ... ... ... ... 2 ... 3 1 2 3 Arline street ... 1 Butlers buildings ... ... 3 ... 1 1 2 4 Artillery street 2 1 6 Butler street Buxton street 1 2 3 1 ... 1 1 3 Ash well road ... ... 2 2 6 (Odd Nos. i lo 33 Even Nos. 2 to 10) Auckland road 1 1 2 4 Austin street 1 ... 7 2 Bacon street 1 Cadell street Calvert avenue ... ... 2 1 ... 2 7 12 1 4 Bakers court 1 1 2 ... ... ... ... 1 ... 2 ... 3 5 Bakers rents ... ... 1 Cambridge circus ... 4 4 7 15 Baker street ... ... ... 1 1 Cambridge road ... Bandon road 2 2 1 1 6 (All odd nos. and even nos. from 160) 2 1 2 2 1 5 10 2 ... Barnet grove ... 3 4 Cambridge buildings Cambridge street 5 Barnsley street ... 1 Barnsley houses ... 1 1 ... ... ... ... ... ... 5 1 Baroness road ... 3 ... ... 6 Camden street 2 1 9 10 1 1 Canrobert street 1 3 4 18 Bath grove ... ... ... Carlisle street ... ... ... 1 1 Bath street ... ... ... ... ... Baxendale street 2 2 2 5 11 Carter street ... ... ... ... ... Bedford row ... ... ... ... ... Casket street ... ... ... ... ... 1 4 5 Caslon place 2 ... ... 2 Bellhaven street ... ... ... 1 1 2 2 2 Bessy street ... ... Catherine street ... ... ... 1 3 1 1 3 Bethnal Green road Birbeck street ... ... 1 4 5 11 21 Centre street 1 2 6 12 1 1 2 Chambord street 1 ... ... ... 1 Bishops road 1 2 2 7 12 Chance street 75 STREET LIST— continued. Respiratory Diseases. Tubercular Diseases. Zymotic Diseases. General Diseases. Name of Street. Total. Cudworth street Chapel place 1 1 1 1 ... ... ... ... ... ... Chapel street 1 3 4 Culhani buildings 2 2 ... ... ... ... ... Charles terrace 1 1 Cygnet street ... ... ... ... ... ... 2 1 1 3 ... ... 4 Charlotte street 7 Cymon street 2 1 1 ... 21 Chertsey buildings Cyprus street 2 1 6 12 ... ... ... ... 8 ... Cheshire street 1 2 11 ... Chester street 1 1 1 3 ... 3 1 2 6 1 3 Chilton street ... Dagnall place 1 1 2 3 1 3 ... 3 Chisenhale road 9 Daniel street 1 1 1 1 3 ... Church street 2 Darling row 1 3 4 ... ... ... ... (Except Even Nos. from 2 to 26.) ... Davis place 2 2 ... ... ... Davis buildings ... ... ... ... ... 1 Church row ... Delamere dwellings 1 ... ... ... ... ... ... ... 2 Clare street 4 3 2 3 12 Delta street 1 1 ... Claremont street 3 3 Derbyshire street 4 4 5 4 17 ... ... ... Clarence street 2 1 2 5 10 Devonshire place ... ... 1 5 6 Digby street ... 2 ... ... 7 Clarkson street 2 1 2 ... ... Clifton buildings 1 1 Digby walk 1 4 5 ... ... ... ... ... Club row 1 1 Dinmont street 1 3 4 ... 1 ... ... ... ... Coate street 2 1 4 1 1 ... Diss street ... ... ... Code street 1 1 4 1 3 11 ... ... Dixie street 3 ... 1 5 Collingwood place Driffield road 1 3 ... ... ... ... ... Collingwood street 3 3 5 8 19 (Odd numbers) Collyer's court Ducal street 1 1 3 5 ... ... ... ... ... 1 1 1 3 6 Collins place ... ... ... ... Durant street ... Columbia market ... ... ... ... 1 ... Columbia road 2 1 7 11 7 Columbia square 3 1 11 Eastman street 2 1 1 4 ... ... Conyer street 1 2 3 Ebor street ... ... ... ... ... ... ... 1 2 Cookham buildings ... 1 ... Co-operative b'ld'gs (Except Nos. II to 19 Odd) ... ... ... ... ... 6 Coopers gardens 4 2 Eckersley street 1 1 ... ... ... ... ... Cordova road 1 1 2 Edgar place ... ... ... ... ... 1 3 ... 2 6 7 18 Corfield street Edward place ... ... 1 1 ... Cornwall road Ellesmere road 1 3 1 1 6 ... ... ... ... ... (North side Nos. 163 175) Elwin street 4 4 ... ... Emma street 2 3 ... 1 ... Ernest place ... ... ... ... ... Evesham houses 1 1 2 ... ... Cottage place Ezra street 1 1 2 ... ... ... . ... ... ... Coventry place ... ... ... ... ... Coventry street 2 2 6 9 19 Coxs buildings 1 1 2 Cranbrook street ... 5 ... 3 13 5 Falcon buildings ... 2 2 ... 2 ... ... Cranbrook road 2 Felix street 5 1 1 3 ... ... ... 10 Craven buildings 1 2 3 6 Fellbrigg street 1 ... 3 ... 8 12 Crescent cottages 1 3 1 1 Finnis street 2 2 3 2 9 ... 2 Crescent place 2 4 Fleet street hill Cross street ... ... ... ... ... ... ... Flint court 1 1 ... ... ... ... ... ... ... ... Crossland square 1 1 2 Florida street 2 9 ... ... ... ... 7 1 Florida terrace ... ... ... 1 76 STREET LIST— continued. Tubercular Diseases. Respiratory Diseases. General Diseases. Zymotic Diseases. Name of Street Total. 1 Hackney road 2 3 4 14 13 Fossett's buildings 1 ... ... ... 1 1 (All even nos and odd nos. from 323) Foster street ... ... ... 1 1 Fountain street ... ... ... Fox street 1 1 Hague buildings ... ... ... ... ... ... ... ... Hague place 1 1 Fox's buildings ... ... ... ... ... ... ... ... 7 4 14 Hague street 1 1 5 7 Fuller street 2 1 ... Hammonds gardens 1 1 ... ... ... 1 1 6 10 Hamilton road 2 1 Hare court 1 2 ... ... Hare marsh ... ... ... ... ... Hare row ... ... ... ... 12 1 ... 3 2 10 16 Gales gardens 2 1 4 5 Hare street 2 3 6 Garden place Harold street 1 ... ... ... ... ... ... Hartley street 3 3 5 11 Violet street ... Hassard place Garden place ... ... ... ... ... ... ... ... ... ... Hassard street 2 1 3 6 James street ... 1 Gardners road 1 6 7 Havelock place ... 1 ... ... ... 2 ... 1 3 Helens place 1 ... 1 2 Garner street ... 2 ... ... 1 5 Hedsor buildings 1 1 1 3 Gascoigne place 2 ... ... Hemming street 2 2 2 1 7 Gawber street 1 2 3 ... ... 2 3 5 Georgina gardens 1 1 2 Henley buildings ... ... ... ... 1 1 2 Henrietta street 1 1 ... 2 4 Gernon road ... ... 1 3 Hereford buildings 1 ... 1 Gibraltar buildings 1 1 ... ... ... 1 3 Hereford street 2 1 2 5 Gibraltar gardens 1 1 ... ... 2 2 3 2 9 Gibraltar place ... Hersee place ... ... ... 1 Gibraltar walk 6 ... 4 5 15 Holly mansions ... ... 1 ... 1 ... 2 3 Hollybush gardens 1 2 5 8 Gilman street ... ... ... Hollybush place 1 1 Glass street ... ... ... ... ... ... ... ... Holmes Avenue 1 1 Globe road 2 2 7 11 ... ... ... 1 3 6 (even numbers from is 6, odd from 131) ... Horatio street ... 2 Horts place. ... ... ... ... ... Hunslett street 2 4 1 7 Gloucester gardens ... ... ... ... ... ... Hutingdon buildings 1 1 Goldsmith's row 1 1 2 4 ... ... ... ... Hurley buildings ... ... ... ... ... (Children's Hospital & Nos. 8 to 62 even) 5 11 Gossett street 2 ... 4 Iffley buildings 1 1 Granby place ... ... ... ... ... ... ... ... 3 6 9 Granby street 1 3 4 Ion square ... ... ... ... 1 2 3 3 Ivimey street ... Great Eastern bldgs 1 2 ... ... ... 15 33 Green street 7 8 3 4 Gretton houses 1 2 7 ... Grove road 2 2 2 11 17 James court ... ... ... ... ... (Odd nos. from 59 Even nos. fron 110) James place ... ... ... ... 1 3 James street 2 ... ... (Odd nos. from 39, even from no. 4) Grove row ... ... ... ... ... Guinness' buildings 4 3 2 3 12 1 4 7 12 Jersey street ... 2 2 3 2 9 Kay street (Nos. 3 to 53 odd) 77 STREET LIST— continued. Tubercular Diseases. Respiratory Diseases Zymotic Diseases. General Diseases. Name of Street. Total. 1 1 2 Menotti street 1 2 8 11 Kelsey street ... ... ... 1 1 4 6 2 1 3 Kenilworth road ... Merceron street 3 2 2 10 17 ... 2 ... 1 Kerbela street Merceron houses 3 ... ... Kings place 1 2 3 Middleton street 1 1 2 7 11 ... ... 1 1 2 4 Minerva street 1 6 7 Kirkwall Place ... ... ... 1 2 1 4 Minto place 1 1 Kite place ... ... ... ... 1 1 2 4 1 1 2 Knottisford street Mocatta house ... ... ... Molesey buildings ... ... ... ... ... Laleham buildings 1 1 Montfort house 1 1 2 ... ... ... ... ... 2 1 1 4 Moravian street Lansdell place ... ... ... ... ... ... 2 1 3 2 4 6 Lark row ... Morpeth street ... ... ... Lawfranc road 1 1 ... 2 4 Moss street 7 3 5 8 23 Leopold buildings 2 1 2 5 Mount street 1 3 4 ... ... ... Mowlem street Letchfoid buildings ... ... ... ... ... ... ... ... ... 1 3 3 7 1 1 Lessada street ... Museum buildings ... ... ... Lily House, Brick Lane ... ... ... ... ... 1 1 3 5 Nant street 1 1 Linden buildings ... ... ... ... 4 1 2 7 Neath place 1 2 1 4 8 Lisbon buildings ... 1 1 1 1 Lisbon street ... Nelson place 2 4 ... ... ... Little York street Nelson street 1 3 4 2 10 ... ... ... ... ... London street ... 2 1 2 5 New Church street 1 1 2 ... ... 2 2 Newling street 2 3 5 Lucas street ... ... ... ... 1 1 ... 1 3 3 Lyal road ... ... ... New Tyssen street ... 7 1 (Nos. 57a, and 58 to 88 Consecutive Nos ) Norah street 1 3 3 8 Northampton street 3 2 5 ... ... 2 2 Norton street 1 1 3 5 Lyte street ... ... ... ... Mace street 5 1 3 9 ... Manchester b'ld'gs 1 1 Octagon street 1 1 ... ... ... ... ... ... Old Bethnal Green road Manchester place ... ... ... ... 3 8 11 3 4 3 Mansford street ... 5 15 1 ... 13 Mansford buildings 1 5 6 Old Ford road 3 4 4 17 28 Mape street 2 2 5 4 13 (Odd Nos. to 205 even Nos. to 368) Margaret place ... ... ... ... ... 2 2 Marion place ... ... ... Old Nichol street ... ... 1 1 ... ... ... Marion street ... Olga street 1 1 2 ... ... ... ... Marion square 1 1 2 Orange street 2 2 1 5 ... ... ... 2 3 5 3 1 4 Marlow buildings ... ... Oval ... ... 1 1 Martha court ... ... ... ... ... Oxford street ... ... 2 4 6 ... Matilda street ... ... Meadows dwellings 1 1 5 7 ... Medhurst road 1 1 8 10 Palm street 1 1 5 7 ... ... Medway buildings ... ... ... ... ... Palmers road ... ... ... ... ... 2 1 5 8 1 1 Med way road ... Paradise row ... ... ... (Odd Nos. 3 to 49 even Nos. 2 to 62.) Park place ... ... ... ... ... Parliament place ... ... ... ... ... Memorial Hall bids. 1 1 Parliament street 1 1 ... ... ... ... ... ... 4 4 1 2 3 Mendip houses ... ... ... Parmiter houses ... ... 78 STREET LlST—continued. Tabercular Diaoaaoa. Reapiratoiy Diseases. General Deseases. Zymotic Diseases Name of Street. Total. 1 3 2 6 Parmiter street ... Rooks place ... ... ... ... ... Patriot square 1 3 5 9 Ropley street ... ... ... ... ... ... Peacock place 1 1 Ross buildings ... ... ... ... ... ... ... ... Peacock street 3 3 ... ... ... (Moss street) Pearl yard ... ... ... Royal Victor place ... ... ... ... ... 2 ... ... 3 3 7 4 17 Pedley street 1 4 7 Royston street ... Peel grove 1 1 1 3 Russia lane 3 5 8 ... ... ... Peel grove mews ... ... ... ... ... 1 3 1 5 Pelter street ... Sabbage yard ... ... ... ... ... 1 1 4 1 6 5 16 Pereira street Sale street ... ... ... Peter street 1 1 1 3 Sandford buildings ... ... ... ... ... ... Pollard place Satchwell rents 3 1 1 5 ... ... ... ... _ ... 1 6 7 2 6 1 9 Pollard row ... ... Satchwell street ... 1 6 7 Pollard street ... School place ... ... ... ... ... 2 ... 2 2 8 Portman place 1 3 6 Sclater street 3 1 ... Pott street 3 1 2 6 Scott street 2 4 4 6 16 ... Poyser street 1 1 1 3 6 1 2 11 20 ... Seabright street 1 1 1 2 5 1 2 3 Preston street Selby street ... ... 1 Primrose street 1 (even numbers) ... ... ... Princes court 2 1 3 3 9 Sewardstone road 4 3 1 7 15 1 3 2 6 12 Shacklewell street Pritchards road ... ... ... ... ... (.Except Nos. 57 to 117). 1 1 2 Sheldon place ... ... 1 1 Shepton houses ... ... ... Prospect terrace 1 1 3 5 Shetland street 1 1 2 4 ... ... Providence place 1 1 1 1 4 Shiplake buildings 1 1 ... ... ... 1 1 1 2 2 4 9 Providence yard ... ... ... Shipton street 3 1 2 5 11 Punderson gardens Skinners court ... ... ... ... ... 2 5 6 15 Sidney street 2 Queen's buildings Smart street 2 2 ... ... ... ... ... ... ... ... (Princes placet Smiths place ... ... ... ... ... 1 3 4 1 5 4 10 Queen's buildings ... ... Somerford street ... 1 2 3 (Gossett street) Somerford buildings 1 ... 2 Queen's buildings 1 1 Sunning buildings 1 1 ... ... - ... ... (Chambord street) S'hampton cottages 1 1 ... ... ... 2 1 3 Qu'n Caroline place ... ... Southampton place ... ... ... ... ... 1 1 4 11 17 1 1 Quilter street Southampton street ... ... ... 1 2 3 Quinns square 2 3 7 12 Southampton terrace ... ... ... Spencer passage ... ... ... ... ... Railway arches ... ... ... ... ... Spicer buildings ... ... ... ... ... 1 1 4 2 8 Ramsey street Spital street ... ... ... ... ... Rapley place (Nos. 11 to 27) ... ... ... ... ... Ravenscroft build'gs 5 1 7 13 Squirries street 1 4 5 ... ... ... Ravenscroft street 1 4 5 1 1 ... ... St. Andrews street ... ... ... 1 1 2 3 3 Reuben street ... ... St. James road ... ... 1 1 1 2 Riders buildings ... ... 1 St. John street ... ... ... 2 2 Roan horse yard St. Jude street ... ... ... 2 ... ... ... ... ... Robert street 3 5 ... ... St. Mark's buildings ... ... ... ... ... 1 3 4 Robinson road ... ... (Tagg street) 4 1 2 6 13 Roman road St. Marys place ... ... ... ... ... (Odd Nos. to 127, even Nos. to 142). St. Matthias place ... ... ... ... ... St. Peter square 3 3 ... ... ... 79 STREET LIST— continued. Respiratory Diseases. Tubercular Diseases. Zymotic Diseases. General Diseases. Name of Street. Total. St. Peter street 4 1 2 7 14 Victoria park 1 1 ... ... Stainsbury street 1 3 Victoria place ... ... ... ... ... Stanfield road Victoria place ... ... ... ... ... ... ... ... ... 1 1 ("Stoneleigh" House and gateway adjoining) ... ... ... James street Victoria park square 1 1 2 ... ... Violet row 1 1 ... Steels buildings Violet street ... ... ... ... ... ... ... 1 1 Strahan road 1 4 5 Virginia road ... ... ... ... ... 1 1 5 7 14 (odd numbers) Vivian road 2 5 7 2 2 1 2 7 ... ... Streatley buildings Voss street 1 1 ... ... Stroud place Vyner street ... ... ... ... ... ... 1 2 2 4 9 Sugar loaf walk 1 1 2 ... ... Suubury buildings 2 2 4 ... ... 6 1 1 2 10 Surat street Wadeson street 1 1 3 1 5 Sweet apple square ... ... ... 1 Walter street ... 1 2 3 5 Walton buildings ... 2 1 2 5 ... Wargrave buildings 1 1 ... ... ... Warley street 4 1 4 9 Tagg street 2 2 4 ... 8 Warner place 2 1 8 16 ... 5 Taplow buildings 1 1 2 Waterloo place ... ... Tapp street 1 1 ... ... ... ... ... ... ... ... Waterloo road Tavistock street 1 2 3 ... ... ... ... ... ... ... Waterloo terrace 1 1 2 Teale street 1 1 ... ... ... ... ... Waterlow buildings 1 9 ... Tecsdale street 2 3 15 Weaver street ... ... ... ... 1 1 Temple dwellings 1 1 1 3 ... ... ... ... (Odd numbers) Temple street 1 4 3 6 14 Weldon street Tent street 1 3 4 8 ... ... ... ... ... ... Wellington row 2 2 3 7 14 1 2 Thorold street 3 Wennington road 2 1 ... ... 3 Thoydon road 1 1 2 West street ... ... ... ... Three Colt corner ... ... ... ... ... ... ... ... ... ... (Nos. 177 to 191) Three Colt lane 2 7 9 ... ... Wharf road 1 1 2 1 2 ... Thurlow place ... ... 3 Wharncliffe street ... 1 2 1 ... ... Totty street 1 5 8 Whites court ... ... Toyes buildings 1 1 ... ... ... ... ... ... ... ... Whitechapel road. (Old Bethnal G'n rd) J I I Toyes buildings (Mansford street) ... ... ... ... ... (Odd nos from 319) 2 1 1 4 ... Whitmore buildings 1 ... 1 ... ... Wilmot house 1 1 Treadway street 5 5 3 7 20 ... ... ... Wilmot street 1 5 4 14 24 Turin street 1 1 2 4 ... Winbolt street 1 2 1 4 Turville street 1 1 ... ... ... ... Winchester b'ld'gs Tuscan street 1 2 2 ... ... ... 5 Winchester crescent ... 2 ... 2 ... 2 Type street 2 1 3 8 ... ... ... Winchester place 1 1 2 Tyrrell street 2 2 4 ... ... ... ... Winchester street ... ... ... ... ... Wolverley passage 2 1 1 2 6 Usk street 1 2 2 7 12 Wolverley street ... ... ... Wood close ... ... Vallance road 3 6 7 5 21 ... ... ... ... ... Wood street Venice street 1 3 4 ... ... ... ... ... ... ... Workhouse Viaduct place ... ... ... ... ... ... ... ... ... York place Viaduct street 5 1 8 ... ... ... ... ... 5 19 Infirmary ... ... ... ... ... ... No home 1 3 4 14 22 80 INQUEST CASES.* Inquest Cases according to age periods— Numher under one year 96 Ditto over one year and under five years 42 Ditto over five ditto twenty years 12 Ditto over twenty ditto forty years 24 Ditto over forty ditto sixty years 51 Ditto over sixty ditto eighty years 39 Ditto over eighty 10 Total 274 Cause of death in Inquest cases— Acute Bronchitis 6 Acute Congestion of the Lungs 1 Acute Indigestion 1 Apoplexy 15 Broncho-Pneumonia i Cancer of Stomach 5 Cardiac Valvular Disease 10 Chronic Alcoholism 1 Chronic Kidney Disease 3 Chronic Liver Disease 2 Convulsions 16 Diphtheria 6 Destitution and Poverty 6 Dropsy 1 Exhaustion from Diarrhœa 4 Erysipelas 1 Gastro-Enteritis 6 Fatty Degeneration of Heart 15 Hemorrhage 1 * 52 weeks. 81 Causes of death in Inquest Cases — continued. Inanition 13 Improper Feeding 1 Marasmus 2 2 Measles 5 Meningitis 3 Natural Debility 2 Pericarditis 1 Peritonitis 2 2 Phthisis 9 Pleurisy 3 Pneumonia 4 Premature Births 6 Rupture of Aorta 7 Self Neglect 1 Senile Decay 2 Still-Born 2 Want of attention at birth 10 Accidental Deaths— Falls 27 Drowning 1 Crushed by Engine 1 Run over on Great Eastern Railway 1 1 Run over in street 4 Suffocation in Bed 20 Burns 10 Found Drowned 1 Misadventure—Deaths while under Chloroform 3 Blood Poisoning 4 82 Ptomaine Poisoning 1 1 Scalds 6 Shock due to Explosion 1 Tetanus 2 Suicide— Cut Throat 2 Drowning 2 Hanging 2 Gas Poisoning 1 Poisoning 6 Revolver Shot 1 1- 14 Manslaughter 2 274 The Inquest cases according to sex, were:— Males 158 Females 116 Total 274 Metropolitan Borough of Bethnal Green. THE CHIEF INSPECTOR'S THIRTEENTH ANNUAL REPORT ON THE WORK OF THE Public Health Department, FOR THE YEAR ENDING 31ST. DECEMBER, 1908, Ordered by the Public Health Committee to be printed and circulated, 27th January, 1909. W. H. CLARK, Chairman of Public Health Committee Printed by G. F. Furby & Co. Hampton Road, Forest Gate. The Public Health Committee. Councillor W. H. Clark, Chairman. Alderman J. J. Fleming, Vice-Chairman. Aldermen , J. J. Fleming and J. Merison. Councillors G. Bayley, T. Brooks, W. H Clark, T. A. Dean, J. Durell, J. W. How, R, Larkins, J. Phipps, E. A. Slade, J. W. Ward, His Worship the Mayor, Councillor A. F. Barnard, J. P. EX-OFFICIO MEMBERS. The Chairman of Standing Committees of the Council: Councillor C. E. Fox, (Finance). Councillor G. Bayley, (Works and Stores). Councillor F. J. Read (Law and General Purposes). Councillor J. Pullen (Baths). Meetings—Alternate Wednesdays at 6 p.m., at the PUBLIC HEALTH OFFICES, 2, Paradise Row, Cambridge Road, N.E. TO THE PUBLIC HEALTH COMMITTEE. Mr. Chairman and Gentlemen, In accordance with vour standing instructions I herewith beg to submit the usual Annual Report on the work of the Health Department of the Council for the year ending December 31st, 1908. Thirteenth Annual Report At the end of a very full and varied year's work there is some little difficulty in deciding what particular items to select for especial consideration, and what to include as mere details in the mass of totals and figures that go to record and represent the operations of the staff for another year. All are important in some respect or another, but neither time nor space permit of all being dealt with at length. items tor special mention In view of the uninformed strictures and very feeble attempts at criticising last year's report by two or three persons totally unacquainted with either the duties or the responsibilities of a Sanitary Authority, and which want of knowledge did not prevent and most probably induced their rushing into correspondence over matters evidently beyond their scope, it Reply to uninformed Critics. 4 Council and Committee Justified. would perhaps be advisable for the information of the Council, as well as the public, to touch upon a few of the more important items which, if they stood alone, instead of being parts of a larger whole would, I submit, go very far indeed to justify the active policy of + he Council and its Committee, and also the efforts of the Sanitary Staff in giving effect to such policy. There is no necessity for any apologetic attitude to be taken in respect of the forward policy of this Authority, either by Members of the Committee or its Staff. Justification can easily be shown by the results obtained, and which results do not permit any wrong conclusion, and that apart from statutory duties a complete and active Sanitary Department is a good investment for the Borough. Taking only a few of the most important items we find: — 1. The Staff has dealt with 1,480 cases of infectious disease, and has had removed to Hospital no less than 1,308 patients, a large number of whom were children, and which children could not possibly have obtained the necessary nursing and attention in the average homes of the Borough. 2. The supervision of the food-stuffs deposited and exposed for sale in the shops and markets is in every way satisfactory, as is shown by the fact that the average number of adulterated samples of food has been reduced over a period of years from 31% to 8%. In a specially given time the figures worked out even better and were in fact reduced from 31% to 6½%. Further it should be mentioned that under the old regime about 100 samples of food were taken annually ; last year no less than 617 such samples were taken and analysed, and legal proceedings taken where necessary, i.e. in 52 cases. As regards unsound food, meat, fish, fruit and the like, over 4 cwts. were officially seized and taken before the Magistrates for condemnation. In addition to this about 2½ tons were surrendered by the various tradesmen who, in their own interest, are now taking advantage of this procedure to an extent never practised prior to existing arrangements. Quite recently the rate of surrender by various tradesmen was over 6 tons per annum. 3. The provisions of the Factory and Workshop Act and the Orders of the Home Secretary made thereunder have been dealt with by this Authority in a manner that probably constitutes a record in sanitary supervision. The numbers of outworkers to be dealt with mainly in the sweated industries have progressed as regards inspections made from 286 in 1902 to 4173 in 1908. Every workplace and outworker's home has been visited twice per year, and the number of entries in the workshop register amounted in 1908 to about 7,775. 4. As regards sanitary supervision generally, about 18,204 primary inspections of all kinds were made. This would refer to house to house inspections, complaints, tenement houses, trade premises, dairies and cowsheds, and places where food is prepared for sale, and enquiry into every complaint made. Apart from the constant supervision involved in the above inspections, it may be stated that these have resulted in sanitary improvements being carried out, the supervision of works necessary entailing upwards of 17,000 re-inspections. Amongst these improvements maybe stated the fact that something over one half of the premises in the Borough have had the drainage and sanitary arrangements renewed or amended and left in a satisfactory working condition. 5. As to cleansing and purifying, we can point to the fact that upwards of 1,578 rooms have been disinfected, many of which were found by your Officers to be in a verminous condition and, in addition, about 27,851 articles of beds, bedding, wearing apparel and the like, have been removed from the homes and treated by the disinfectors at the station. 6 Moreover, we have a shelter and baths for the accommodation of poor persons during the time their rooms and things are being disinfected, and a modern disinfecting station, with up-todate machinery and appliances, all free from debt. 6. With regard to the clerical staff which has been referred to, it should be mentioned that each and every additional duty thrown upon a Health Authority necessitates increased book-keeping, statistical and other returns, and I again submit that it would be the most false economy to keep Inspectors in their offices for the purpose of keeping these statutory registers and returns instead of being on their districts. In other words, it may safely be claimed that with the addition of an efficient clerical staff the Inspectors have been free to devote their entire time and attention to the improvement of the districts. 7. With respect to any attempt at comparing the staff of 25 years back with that of to-day, one has only to mention the different Acts of Parliament, the additional duties and statutory requirements under each of same, to show that it is absolutely useless to attempt any such comparison between the present day needs and those of the former period. The following list of comparatively recent Acts of Parliament, &C, will illustrate to some extent, and perhaps give some idea of the different standard of duties required now : — Factory and Workshop Act, 1901. L. C. C. (General Powers) Act, 1902. Housing of the Working Classes Act, 1903. L. C. C. (General Powers) Act, 1904. L. C. C. Plan Bye-Laws, 1904. L. C. C. (General Powers) Act, 1907. Factory and Workshop Act, 1907. Notification of Births Act, 1907, when and if adopted. P. H. (Regulations as to Food) Act, 1907. Glanders or Farcy Order, 1907. Butter and Margarine Act, 1907. L. C. C. (General Powers) Act, 1908. Pure Food Regulations, 1908. 8. With regard to the financial considerations, I have purposely avoided going into this as the details are so admirably set forth in the Annual Report of Mr. Ashmole, the Borough Treasurer, but it may be stated that, in consequence of the steady decrease in the combined drainage works and the improved disinfecting machinery provided in the new station, at the end of the Financial Year it will be found that a saving of close upon will be effected, as compared with the year when the expenditure for this department reached its highest point. So far as mere money is concerned, I should however like to add that an efficient Public Health service is a good investment and can be shown to justify itself, not only on the figures above-mentioned, but upon the last and final fact of the difference in the death rate of the Borough which, from Dr. Bate's statistics, we find has been gradually pulled down in the last ten years from 22.7 to 17.43. 9. Taken fairly and as a whole I therefore venture respectfully to submit that the policy of this Committee and the efforts of its officials are completely and amply justified by results of which the above represent a few items taken from here and there in the proceedings of the year, and when the fact is remembered that the above results are obtained at a cost of about 2d. in every pound of rateable value, or at about Bd. per head of population, there is not, I venture to think, much to complain of on the score of extravagance, so far as the working is concerned. So much for the would be "criticisms" of half-adozen small property owners and a few shopkeepers, whose objection to Sanitary effort is quite understandable to any disinterested person. Having briefly emphasised these important items of the work, and the results shown to arise therefrom, I now proceed to direct your consideration to other matters that have engaged the efforts of your staff. Matters for consideration. Purity of Food Supply. First in importance stands the question of the soundness and purity of the Food Supply, as is shown by the attention that has again been devoted to the matter by the legislature and the different Government departments concerned. Official Samples. Sale of Food &c Drugs Acts. Under the provisions of the Sale of Food and Drugs Acts 617 samples of various kinds of food were taken and submitted for analysis by the Public Analyst, Mr. Stokes. Of these samples 52 proved to be adulterated. Details of the legal proceedings taken in respect of these are set out in the Appendix marked P. The proceedings are all of the usual character, and resulted satisfactorily, so far as is possible, with such an intricate and uncertain machine as these statutes. None of the cases call for special comment, except that I desire to record my appreciation of the manner in which all the Officers engaged in this work have done their duty, often under very great difficulties. Samples for information and on delivery. Beyond the samples officially taken many others were purchased and analysed for the purposes of information. It is only by such means that the Authority can be kept aware of the quality of the Food on sale in the Borough. 26 Samples of Milk and a few other articles were taken on delivery from wholesale firms. These were as follows: — At Cambridge Heath Railway Station 13 Bethnal Green Infirmary 8 At Shops 4 City of London Hospital for Diseases of the Chest 1 Of these all save five were reported to be genuine. The five were among those taken at Cambridge Heath Railway Station, and were taken from milk consigned from a farmer at Waltham Abbey to a retailer in the Borough. Two of the five were so near the limit as not to warrant prosecutions, but in respect to the remainirg three the farmer, after having set up a somewhat unusual defence, in which a leaky Milkcooler was put forward as the delinquent, was fined in all £9. Under Section 12 of the Sale of Food and Drugs Act, 1875, any purchaser of a Food, or Drug, may for a sum not exceeding 10/6 have such article analysed, and is entitled to receive from the analyst a certificate of such analysis. One person only during the year availed himself of this power, the article examined being gravy dripping, reported genuine. Portion of Private Purchaser. Inspector Rowsell lias continued the daily inspection of the markets and the food deposited for sale on the stalls and in the shops with most excellent results. Detection of Unsound Food. Public Health (London) Act, 1891. In view of the exceptional weather and the number of stalls on Sundays, I have found it necessary to have additional supervision and Mr. Ainley has again rendered the most valuable assistance in this direction on Sundays and at other times. 10 The particulars relating to the seizure and surrender of unsound food in the borough during the year 1908 are as follows : — FOODSTUFF SEIZED. Fruit 3 cwts. 0 qr. Ist. 121 lbs. Meat 2 qr. 1 St. 81 lbs. Fish 2 st. 0 2 st. 0 lbs. Total 4 cwts. 0 qr. 1 st. 6 lbs. Four fowls were also seized in an almost putrid condition. They were offered for sale by a woman who had been warned and cautioned officially only a fortnight prior to this offence. The learned Magistrate, after hearing her own story, said he regarded her as simply a public danger and that on her own showing this was a shocking case and he sentenced her to five weeks in the second division. FOODSTUFF SURRENDERED. Fish 2 1 ton. 7 cwt. 2 qr. 1 St. 3 lbs. Fruit IB cwt. 1 qr. Ist. 3 lbs. Meat 5 cwt. 2 qr. 0 st. 5 lbs. Vegetables 1 cwt. 0 qr. 0 st, 8 lbs. Rabbits 1 qr. 1 st. 4 lbs. Total 2 ton. 8 cwt. 0 qrs. 0 st. 9 lbs. Cases of Special Interest. The following are perhaps the only cases that need be commented upon. 1. Seizure of about 12 lbs. of beef and pork on the Ist May, at Brick Lane. Defendant said he thought the decomposing meat would be rendered lit for consumption if well washed in water. 11 This from an experienced sausage maker seemed somewhat quaint and on legal proceedings being taken he was fined £5. 2. A tuberculous fore quarter of beef was found by Mr. Rowsell in a shop in Cambridge Road. Pleura stripped and sternal gland removed; other glands except dorsal gland tuberculous. Apparently cowbeef. Owner had reputation for selling old cow beef. Soon after surrender of this fore quarter the shop was closed. 3. A tuberculous fore quarter of beef which had been passed elsewhere previous to examination by this Authority was found by Inspector Rowsell at Pollard Street in December. There were certain technical difficulties about both the above beef cases consequently the retail men were allowed to surrender and were cautioned. 4. On the 27th February, a fowl said to have been bought the previous night from a man standing in Bethnal Green Road was brought to the office by a purchaser, a woman. The fowl looked very plump and seemed a heavy bird but was found subsequently to be stuffed with sand and sacking. Apart from this stuffing the fowl was in a most emaciated condition. A condemnation order was granted by the Magistrate as a necessary precedent to taking legal proceedings but the vendor could not be traced. Chicken and Sand. A post mortem was conducted by Dr. John Bate on the body of the fowl which was found to be roupy and emaciated and had probably died a natural death, or at best had been slain to prevent its dying. 12 Imported Food Regulations. Foreign Box Beef and Scraps. The Regulations anticipated by the above Act were duly drawn up and came into force on the ist October, 1908. The Regulations are issued in two series and apply throughout to imported foodstuffs. The first series deal with imported foodstuffs generally, and the second series with foreign boneless meat imported in the form of scraps, trimmings, or other pieces not sufficiently identifiable with definite parts of a carcass, and which has not before importation been made ready for human consumption in the form of a sausage, or other prepared or manufactured articles of food; with imported tripe, tongues, or kidneys to which certain chemical preservatives have been applied ; and with severed parts of a pig not prepared before importation as bacon or ham, and not contained in a package with an "official certificate" The Regulations also deal with the prevention of importation of carcasses of pigs from which the lymphatic glands are absent thus preventing the detection of signs of tuberculosis, and with severed parts of pigs with the above mentioned "official certificate". The 'official certificate' is a certificate given by a competent authority in the place of origin to the effect that the animals were free from disease at the time of slaughter, and the meat had been dressed, packed and prepared with all needful precautions for the prevention of danger arising to public health. Authorities affected. The Regulations are made to apply and to be enforced by Port Sanitary Authorities, Riparian Authorities, and the Customs. Other Authorities such as Bethnal Green, are concerned only when required by the Local Government Board to co-operate with 13 one of the Authorities above mentioned. Thus the additional powers which it was hoped would be conferred upon Sanitary Authorities generally for dealing with foodstuffs heavily dosed with chemical preservatives in order to mask their possibly more than doubtful condition are still not forthcoming. On the 5th December 1907, the Local Government Board issued an Order under the Margarine Act 1887, Sec. 9., as extended by the sale of Food and Drugs Act 1899, Sec. 7., and applied by the Butter and Margarine Act 1907, Sec. 1., to butter factories and to any premises in which milk blended butter is manufactured or a wholesale trade in this article is carried on, prescribing the method of registration of such premises and a form of certificate as to such registration. Up to the present one firm only is subject to registration under the Butter and Margarine Act, in this Borough, this has been duly effected and the necessary certificate issued. Order as to Margarine. Amongst the now usual output of new legislation affecting theoretically the powers of the Sanitary Authorities whilst practically leaving things much as they were, may be mentioned the L.C.C. General Powers Act 1908; Part II of which relates to sanitary provisions. Sections 5 to 14 purport to give various powers to the Metropolitan Sanitary Authorities to regulate a variety of matters but as most of the Sections contain a proviso that the said Section shall not apply directly to any existing house or thing one feels somewhat diffident in offering any decided New legislation affecting Milk and other Food. 14 opinion as to what it does really mean. Other Sections are so confused and contradictory that all that one can apparently say is that the high-water mark of doubt and difficulty seems to have been reached in these Sections. I submit a short synopsis of the provisions with more then the usual amount of doubt as to its accuracy. Section 5 (1) purports to enable the sanitary authority to register and remove from the register of cow keepers and dairymen who carry on their business on premises which in the opinion of the authority are unsuitable for the sale of milk therein. Then follows a proviso which to me is quite unintelligible and upon the meaning of which it is not safe to attempt to express any opinion. Various experts, committees etc. are holding consultations and making enquiries and in time it is I believe hoped that someone may be found to attempt an explanation. And further under Sub-Section (2) —any person who thinks himself aggrieved by any decision of the authority may, within twenty-one days, appeal from from such decision to a Court of summary jurisdiction, consequently the only thing clear about this confusing section is that the authority is not now the final power for registering, refusing to register, or removing persons from such register. Power to appoint Health Visitors. Section 6 (i) enables sanitary authorities on and after the 1st January, 1909, to appoint suitable persons as Health Visitors to deal with the management of young children and the like. 15 Sub-Section (2) of the same Section empowers the Local Government Board to make regulations as to appointment, qualifications, salary and the like, and Sub-Section (3) gives power for the reimbursement of the local authorities of one-half of the salaries of such Health Visitors. Section 7 deals with the accommodation for cooking food in tenement houses and appears to provide a number of provisions for this purpose but, under the proviso, it is stated this section shall not apply to any tenement house used or occupied as such prior to the passing of this Act, consequently this section is absolutely valueless so far as any existing tenement house is concerned. Cooking food in Tenement Houses Section 8 provides a number of regulations relating to premises used for the sale of food for human consumption, clauses A to F, and which regulations may be described as of an ordinary character, apparently insisting on nothing more than such an ordinary standard of cleanliness and upkeep as is already in force in this borough. Preparation of Food for Sale. Sub-Section (2) provides a penalty for letting or occupying a building contrary to this section. Section 9, Sub-Sections (1) and (2), provide a number of requirements and the application of Bye-Laws to business premises in which are carried on the vending of fried fish, fish curing, and the trade of a rag and Bye-Laws as to Fried Fish Shops and other trades. bone dealer, but under Sub-Section (6) is enacted that nothing in this section or in any of the Bye-Laws made or applied thereunder shall be construed as imposing upon any person any obligation to alter any premises which at the passing of the Act were used for the business aforesaid, consequently this elaborate section appears to be of no use for all existing trades and premises and would only apply in the event of their being rebuilt or renewed. Section 10 makes it a statutory duty of the Sanitary Authority to carry out and enforce this part of the Act and the Bye-Laws made thereunder. Section 12 gives the usual right of entry to officers or persons duly authorised to enter premises for the purpose of enforcing the Act or Bye-Laws made thereunder, but does not appear to clear up any of the difficulties or technicalities as to what the power of entry really means. Section 13 enables any owner to enter premises for the purpose of carrying out alterations and requirements under the Act notwithstanding the provisions of any lease, under-lease, or agreement, relating to such premises. Section 14 applies the general provisions as to power of entry and penalties for obstruction already in existence in Sections 115 and 116 of the Public Health (London) Act, 1891, to the purposes of this Act. 17 The remaining Sections apply to the Corporation of London, and do not appear to affect the Metropoitan Sanitary Authorities at all. When the Bill which ultimately became the above Act, was issued, it was noted with much satisfaction by this Authority, that provision was made for Local Authorites to deal with offensive offal fish refuse and the like, which are at present dealt with by Contractors, being removed in tank vans which if not most carefully used are a source of great nuisance, many complaints having been received from ratepayers. The Bill proposed to vest the ownership of such refuse in the Local Authority who would arrange for the removal and disposal of the same, at the same time safeguarding the financial interests of the shopkeepers in respect of the value of this refuse, which is very largely used in the making of fish guano. Powers for effectually controlling removal of Offensive Offal Omitted. For some reason or other it was found impracticable to allow those provisions to remain, and when this Act was finally issued it was found that no provision had been made for dealing with offensive refuse of this character. Mention was made in the monthly Reports for the months of January and May as to the very necessary provision contained in the London County Council (General Powers) Act, 1907, for enforcing a supply of water to the upper floors of tenement houses. Water Supply to Upper Floors of Tenement Houses. 18 In the working of this clause there is found, as usual, many difficulties, although the short time which has elapsed is obviously too short a period in which to form a conclusive opinion as to the real practical value of the clause. Having regard to the internal structural arrangements of many premises in the Borough, the applications of the provisions of the clause are impracticable in a number of cases. In some instances there is very good reason to anticipate that the sink, which must be fixed under the water taps in the upper floors, will be largely used as slop sinks for disposing of liquid filth. From a sanitary point of view this would be most objectionable and calculated to cause serious nuisance. In many cases when; a supply of water to the upper storeys is of great consequence, it is found the height of the premises exceeds that to which the Metropolitan Water Board is required to furnish a supply. It seems that the clause as drafted will not work out in quite such a beneficial manner as was the intention of the promoters of the Act. Up to the present we have succeeded in getting this additional water supply to about 36 houses. In some advantage has acrued, but the structural arrangements of many of the existing houses prevent the full benefit. 19 That very vexed and much debated subject—"The advantages and disadvantages of the Intercepting System" has fortunately, after much controversy, been advanced to the position of inquiry by a Departmental Committee appointed by the President of the Local Government Board. The Ventilation and Trapping of House Drains and Sewers. This question, involving as it does the effective ventilation of the entire system of house drains and sewers, is not by any means free from difficulty. Everyone desirous of arriving at some sound conclusion must rejoice that the question has at last been removed from the clamant theorist stage to a more calm atmosphere, where all the pros and cons can be fully considered in the light of experience. Herewith I submit a copy of the evidence I prepared agreeably with your request, on the receipt of the Circular Letter in November last, inviting evidence on behalf of the Commission. DEPARTMENTAL INQUIRY With regard to the use of Intercepting Traps in House Drains, etc. Proof of evidence submitted by JOHN FOOT, in pursuance of a Resolution passed by the Public Health Committee of the Metropolitan Borough of Bethnal Green at their Meeting held on the 4th November, 1908, who says: — I am the Chief Sanitary Inspector of the Borough of Bethnal Green, a Member of the Royal Institute of Public Health, and I hold the Certificate of Competency in Sanitary Knowledge of the Sanitary Institute of Great Britain. 20 I have had upwards of twenty years practical exerience in the laying of Drains and supervising the fitting up of Sanitary Appliances for some hundreds of houses and premises of all kinds. I have supervised or inspected the construction of a large number of Inspection Chambers, and the fixing of Interceptor Traps to same. My experience of this work includes the provision of entirely new systems, as well as the amendment and modernising of older systems of drainage and works incidental thereto. I believe I am acquainted with all the various makes and designs of Interceptor Traps in the market, and have considered the claims advanced by the inventors or manufacturers of most of them. In addition to practical acquaintance with Sanitary and Drainage Works, tunning into many miles of drains, and including systems laid both with and without any Interceptor, I have for about fifteen years past given much consideration to the many points and theories advanced by one school and another in connection with this matter. I have attended numerous Conferences, Lectures, and discussions, and I believe I have heard the most of the Papers, and have read nearly all the Reports and proceedings that have been published on the question of Interceptor Traps, their advantages and disadvantages. The question is not a new one, and had in fact reached the stage of debate some years prior to the abolition of the old Metropolitan Vestries. In one's early days as Sanitary Student and Inspector the Intercepting proposals had to be accepted as they stood. Text book writers had taken the idea from Mr. Buchan, and from this it apparently got included in the draft provisions of the Model Bye-Laws. Practical Sanitary Science was in its earliest infancy, there was no opinion to the contrary and, truth compels the admission, very little confirmatory ; consequently, the system of Intercepting Drains appears to have been accepted in theory at least as the proper thing and this position was not, indeed could not be, challenged. Practical knowledge of actual working however very soon caused thinking sanitarians much concern, and the question was asked whether in practice the appliance did fulfil all or any of the many claims advanced 21 on its behalf. Results began to be compared and opinions exchanged, and then it became apparent that the idea of the advantages of the Interceptor Trap had been taken up without any real inquiry. So far as I have been able to discover, Mr. Buchan's theories seem to have been accepted without question as to whether they were based on any scientific principle or whether the then new idea was possible in practice. It is certain the proposal was adopted and incorporated into the requirements of the Bye-Laws on what now appears to be very meagre grounds indeed. Although this point is, I submit, important it has not, so far as I know, had any influence in the formation of opinion now largely held to the effect that actual experience has not justified at any rate all the theoretic advantages claimed. Whatever the value of the supposed advantages may be, it cannot be disputed that they are very considerably discounted by the fact that some very positive disadvantages have developed themselves which, in point of fact, have caused very serious nuisance as well as proving of very doubtful value in other respects. On this point I submit with deference that, apart from the purely health phase of the matter, some consideration must be given to the question as to how far in the face of present knowledge we can in equity continue to insist by the mandatory powers of the Bye-Law on the provision of an appliance or system that has lead to serious trouble in many instances. With a view to arriving at some safe conclusion I have made inquiries and examined large numbers of Intercepting Traps actually in use on many drainage systems serving premises of various kinds. As a result of this examination I found: — Large numbers of these Traps choked, the Inspection Chambers containing varying quantities of sewage and filth, some nearly full, and all forming most perfect but very filthy and disgusting specimens of modern cesspools. 22 In a large number of cases the Traps were choked full bore, the the channels, benching and lower parts of the chambers, covered with decomposing sewage matter, and the drainage system only escaping complete blockage by the fact that some genius had removed the clearing arm caps through the aperture of which the drainage was passing as best it could over the decomposing offensive deposit in the choked Traps and channels. In several cases the cap of the clearing arm had been removed entirely, and the imagined security of disconnection compeletly negatived by actual and direct opening from the sewer. In many other cases like results and conditions were found in consequence of these caps not being properly fixed, or which did not fit the grooves or collars on the clearing arms. In scores of cases, in fact as one walks along the street it can be seen that the mica flap valves of the fresh air inlet pipes are either completely missing or are so defective that they do not close properly and, in either case, the intended procedure has been quite reversed, and the imaginary inlet pipe becomes an outlet for foul air. Many of these pipes are fixed in close proximity to doors and windows of dwellings where they may be seen daily doing their best and worst, all being silent, but most emphatic witnesses to the wisdom or otherwise of conventional sanitary requirements. Defects, such as badly constructed manholes, defective covers, absence of effective benching and channelling, leading to the retention of faecal matter, which were found in numerous cases to be present, and causing nuisances, may be passed over as more capable of abatement than the serious defects above which seem inherent in the system. I am aware the advocates of the Trapping system are now asserting that these detects which can no longer be denied or ignored are caused by the use of a Trap, defective in design or make, that has been badly fitted. As a matter of fact, choked Traps and the nuisance arising from them, have been found in work of a high character and to which no objection could be taken. 23 Other reasons connected with flushing arrangements have probably more relation to this point than the question of the shape, etc., of the Trap. Further, it is very little satisfaction to the householder and the public to learn about these badly designed appliances after a costly system, forced on them by law, has proved a failure, and aggravated original conditions by stopping up their drains and flooding their forecourts and areas with sewage. I submit we are morally under some obligation, if this practice is to continue, to be at least able to guarantee that the thing we are insisting upon by pains and penalties shall do reasonably what is claimed for it, and shall not in any circumstances be capable of causing a most offensive and foul nuisance to recur at short or long intervals. In other words, I submit that the advocates of the Intercepting theory should be asked to produce something which in practice will be free from the gross defects of present systems. Owners of property cannot be continually requested to be removing nuisances caused by these repeated stoppages. As the executive officer of a local Authority I can say we have experienced difficulty in this connection. Owners of property and their Surveyors have resisted proceedings taken to enforce the provision of Intercepting Traps and Chambers which they allege are costly to provide, ineffective as to alleged safeguards, and, in many cases, are the direct cause of serious nuisance. Another point I submit is the absurdity of insisting upon the same rigid requirements for say the drain of a small two-roomed cottage (with simply a single sanitary convenience and gully both situated external to the dwelling) as applies to a large hotel or institution drained by an elaborate system serving a series of sanitary conveniences, baths, sinks, etc., and together forming an intricate combination bearing no comparison to a cottage. Some consideration, I suggest, should be given to varying circumstances and to conditions of size, situation, formation and use. At present the same rigid requirements apply all round, whether it be Hotel Cecil or a two-roomed hut. 24 With regard to the object originally intended to be secured by the introduction of the Intercepting idea or system, as I understand it, the theory advanced was that, in the absence of these Traps, there would be some danger of such an infectious disease as Typhoid Fever being communicated through the house drains from the common sewer in the event of the dejecta of a patient being discharged into any part of the drainage system of a town or city. A secondary idea was, I believe, that, unless house drains were intercepted, sewer gas would on the same principle pass into the interior of the dwellings and so cause a low state of health, if not specific disease. Briefly, those two ideas combined seem fairly to represent what one perhaps might term the case for the Interceptor Trap system. So far as I have been able to discover there is not a scrap of evidence to justify these theories prior to their introduction, and inquiry and research only go to show that neither before nor since have any such conditions been found to exist. If we take all the official Reports relating to the outbreaks of Enteric Fever for several years past we cannot find in any single instance that any one has yet been found to make the suggestion that the absence of an Interceptor Trap or Traps had any influence whatever in the causation or spreading of Enteric or any other infectious or non-infectious disease. It is remarkable that after all these years, during which many Official Inquiries have been held in respect to large and small outbreaks of Typhoid, in addition to the numerous cases met with in every day practice, that there cannot be found in all these proceedings any single suggestion that goes to support this theory ; consequently, in face of a series of Reports covering a number of years, as these do, one cannot feel quite sure that the earlier ideas and theories were so well founded. It can in fact be shown that Typhoid occurs quite impartially in those districts and houses where the drains are on the Intercepted principle, as well as in the non-Intercepted, and I am quite unable to find that these Traps exert the slightest influence in this respect. 25 The most exceptionally and well known healthy condition of men who pass from four to six hours daily in the sewers, though not conclusive evidence against, goes some way to discount the idea of the harmfulness and deadly poisonous character of sewer gas. Moreover, a series of highly interesting experiments recently made, go far to correct some of the ideas prevalent in this question. Resume: — I beg to submit, therefore, as a result of much inquiry and experience, that: — 1. The advantages claimed for the Intercepting system have not generally been made good in practice, and are not apparent. 2. At best the disconnection is theoretic, not actual or effective, and in certain respects fallacious. 3. In many instances serious nuisances have been directly caused by this system. 4. The present standard of flushing is totally inadequate to clear house drains on the Interceptor system. 5. "Trapping" provides no remedy for foul smells in either "drain" or "sewer." It removes nothing, and at best can "bottle up stink" to a certain point only. 6. The system is inconsistent with the effectual ventilation of the drainage system as a whole. 7. The idea of affecting to consider the house "drain" and "sewer" as separate and distinct is as erroneous in principle as it is contrary to fact. The house drains of any district cannot in reality be in a healthier condition than the sewerage system to which they are connected, Trap or no Trap. 26 8. The use of Interceptors has had no effect on the health of the community either as regards general health or specific disease, as is shown by the fact that— (a) Those districts where Interceptors are not in use are as healthy as those on the contrary, and (b) In cases where the Trap has been removed no ill results have followed its removal any more than did improvement follow its incroduction. 9. In shallow fiat lying districts the system is decidedly disadvantaeous. 10. It should be an offence to fix— (a) Traps inside buildings, or under the Hoors of dwellings, or (b) A Trap in any situation without providing ample access by means of a Chamber or Manhole. Traps with alleged "raking arms" should be suppressed. 11. Whilst the system of Intercepting may be useful for large institutions, hotels, etc., with large and complicated drainage systems, some elasticity should be allowed to meet the requirements of small cottages and premises with no internal drainage. JOHN FOOT. 17th November, 1908. 27 Since submitting the above in November we have First results of the Inquiry. had the great advantage of perusing numerous reports and proofs of evidence, from almost every school of thought in Sanitary Science. So much interest is decidedly advantageous and the sobering effect of official inquiry on the extreme faddist section is all to the good. If no other good result is obtained we shall at least have put a period to the vagaries of the text book expert who in his lack of practical experience and with desire to trap any and everything he could lay hands on was fast reducing sanitary procedure to ridicule and bringing discredit on the whole thing. First results of the Inquiry. The progress of the past few months is surprising. The pro-Intercepting School are going so fast that quite unconsciously they are completely giving away whatever merits the system possessed. One authority goes so far as to say that without the intercepting system the Sanitary Inspector could not properly test the drains after a case of fever had occurred. If this be the whole case one can only say that both the Inspector and the Interceptor System too must be in a very bad way indeed. Another whose conventional ideas are not even suspect has expressed the opinion that the Interceptor Trap is of comparatively small value. Others are appealing to the manufacturers to press on with an improved Trap to meet the objections raised in so many quarters and on the whole those who ventured to suggest there was at least a case for inquiry have during the past three months got greater justification then they could have hoped for or anticipated this side the next ten vears or more. No Justification for those who asked for an Inquiry. 28 one of course wants to abolish Traps where same are necessary. What is required is some protection from the persecution of the faddist with his cast iron ByeLaws for all and sundry irrespective of the circumstances of each case. Re-drainage of the Workhouse and Guardians' Offices. The works in connection with the re-drainage of the Guardian's Offices and Workhouse are now approaching the last stages, and by the time this report is in the hands of the members, will, I trust be practically completed. In view of the details contained in former reports, I do not know that there is much that can with advantage be added but I should like here to be allowed to record my grateful appreciation of the ready assistance that has been rendered by all the Officers of the Guardians. To .Mr. 1). Thomas, the Clerk, and Mr. R. Bushell, the Master, my thanks are especially due; also to Mr. Martin who has acted throughout as the practical representative of the Guardians, and who has given us his ready and best assistance in making a very difficult undertaking the success it undoubtedly has been. 1 would also beg to be allowed to commend to your consideration the very careful and able services rendered by Messrs. I. R. Jones and T. Ward your Superintendent of drainage and leading drainlayer respectively. In their several capacities both have done excellently well. As regards the work I am content to let that speak for itself, feeling quite confident that in the public interests your Committee did the right thing when 29 you decided to accede to the request of the Guardian's that this work should be carried out by the Staff and under the supervision of the Public Health Department, without the intervention of a contractor. As to the cost I am unable as yet to give the final figures and I will therefore only say here for the information of the Council, as well as the Guardians, that the works have been inspected by representatives of the Local Government Board, prior to the issue of the necessary Authority to expend the money on each section as the work proceeded. I have every reason to believe those Gentlemen went away on each occasion fully satisfied with all they had seen. To this I would just add that I feel pretty safe in predicting that the total cost of all this work is not likely to reach one half of the highest figure so freely mentioned about a year ago by those experts who in their igorance could predict the actual "cost of this terrible undertaking". For the comfort of these friends and others I may mention the fact that I have good hopes of getting out at about the lowest of all the various sums mentioned at that time. So much the better for the Guardians in particular and the ratepayers in general, who have good value for money expended on a matter that required most earnest attention and which probably had been too long delayed. In any case the conditions found existing have more than justified the expenditure. As to cost of the Works. 30 Dangerous Premises, Premises Fire) During the year various premises were reported to the London County Council as being most dangerous, on account of their structure, should fire occur at any of them. The following were the grounds on which the representation was made: — Staircases in centre; double off-rooms to each house all let out to separate tenants; beyond staircase, over the head of which there was a trap-door, the opening of which would form of the staircase one great flue, and windows, there would be no means of escape in case of fire. Wooden partition between two houses at top of staircase. Probably at one time both premises were in one occupation. A reply was subsequently received from the London County Council expressing inability to take action in either case under the existing law. Detailed Returns of Inspections and various matters I annex hereto the usual detailed reports of the various items dealt with under each particular head in the several appendices to which I beg to direct your attention. In Appendix A will be round the details of the Inspections made by each and all of the Inspectors throughout the year and in B will be found a list of the nuisances and general insanitary conditions found existing. In Appendix C is the detailed list of sanitary inprovements resulting from the above Inspections, and 1) contains particulars of legal proceedings taken under the Public Health (London) Act, 1891. 31 Appendix E, contains the legal proceedings taken under the Sale of Food and Drugs Acts. Appendix F, details of premises under observation in connection with Smoke Nuisances. In Appendix G, will be found the usual Mortuary Returns. In Appendix 11, are particulars of the inspection of places subject to Special Bye-Laws &c. and I, contains particulars of the Bakehouses and inspection of same. In Appendix J, are particulars of Inspection of those premises where food is prepared for sale ; and K, contains the like particulars in respect of those premises where Ice-Cream is manufactured or sold. Appendix L, contains particulars of complaints received from outside sources other than occupiers and ratepayers. It will be noted that no complaint relating to Smoke Nuisance lias been made by anyone resident or interested in the Borough except the Coal Officer of the L.C.C. I would especially beg leave to ask your attention to the details of Clerical Work in the Appendix marked M, as this is the only manner in which the clerical labour of the department can be adequately brought to your notice. The same remarks apply to the work of the disinfectors detailed for each month in Appendix N. 32 Particulars respecting Houses Let in Lodgings, or Tenement Houses as they are usually termed, are set out in Appendix O, and in Oα particulars of water supplied to upper floors. Appendices P (i), P (2), P (3) contain full details of the articles purchased, and resultant proceedings under the Food and Drugs Ads. P (2) shows year by year the decrease of adulterated food stuffs from 24.6 in 1998 to 8.4 in 1908. The lowest on record being 6"6 in 1907 a most exceptional year. P (3) gives particulars of articles bought in various shops, etc. for private information. Appendix Q contains particulars of ever increasing duties, both for Clerks' and Inspectors', in connection with outworkers' homes. Appendix R contains the details of House to House inspection, overcrowding and defects detected. Appendix S contains the details of work carried out by the combined drainage men under Mr. Jones' supervision. I also annex as per your instructions, details of the sanitary labour and wages account, together with the monthly details of the petty cash account, and expenditure in connection with police court proceedings, food and drugs, etc. Conclusion. In concluding this necessarily short and imperfect survey of the year's work, I would beg to thank the 33 members of your committee, for their continued confidence and support, expressed on more than one occasion. Without such support and confidence, the difficult work of this department could not be carried on effectively. Respectfully commending the efforts of all the staff to your most favourable consideration. I have the honour to be, Mr. Chairman and Gentlemen, Your obedient Servant, JOHN FOOT, Chief Sanitary Inspector. Member of the Royal Institute of Public Health, etc. 34 APPEN Total Number of Inspections and Particulars of Cases in Hand Trades' Inspections. factory and Workshop Inspections. Outworkers' Homes Inspections. Infectious Cases. House to House Inspections. Tenement House Inspec tions. Ioe Cream Shop Inspections. Re-inspections. New Buildings Inspections, Complaints. Milkshop Inspections. District. * A 279 403 70 3175 107 279 1021 240 1 13 ... B 188 1850 156 835 189 197 24 93 19 20 ... C 269 377 518 36 2943 330 451 594 258 62 ... D 2658 146 476 210 243 5 2 192 297 7 ... ... E 2548 172 778 798 307 250 72 ... 359 2 19 F 16 227 193 93 3074 247 1055 733 51 ... ... Drainage and New Buildings 826 2 ... ... ... ... ... ... ... ... .. Markets 16 935 ... 1 ... ... ... ... ... ... ... Totals 1480 1670 829 971 17074 1096 3195 4173 1394 24 137 * Numbers of cast's of Infection ami Complaints Investigated, arc apparently excessive, to Inspector Bridel's illness in earlier part of year, ami Inspeoctor Richards performing his duties in connection with these matters 35 Combined Drainage Inspections. Smoke Nuisances— Premises under Observation. Other Inspections or work of Special Character Nuisances Abated. Number of Calls. Samples of Food and Drugs taken. Number of Cases in Hand. Unsound Food Seizures. Total Visits for the Week. Police Court Attendances. Inspector. 56 67 96 95 14 866 45 5807 E. Richards. ... ... 106 3781 H. F. Bridel. 57 47 2 540 35 ... ... ... 198 116 1 2 905 40 6036 F. T. Bare. ... ... ... ... 60 84 26 644 J. G. Weeks. 79 30 441 1 ... ... ... 140 55 1 90 7 907 42 5500 A. S. Henley. ... ... 138 28 5906 E. AINLEY. 79 4 100 722 72 ... ... 1336 I. R. Jones. 70 2234 ... ... ... ... ... ... ... 650 8 164 36 1603 W. ROWSELL. ... 1 3 ... ... 1449 650 669 467 13 6 49 125 4587 264 35278 ... DIX A. for the Year ended 31 st December, 1908. APPENDIX B. List of Nuisances and Insanitary Conditions generally, discovered during the year 1908. Dirty Premises. Defective Drains. Defective and Dirty W.C's. Defective Water Supply, Smoke Nuisances. Other Matters. Period. Total. 5 weeks ending Ist February 247 16 47 3 426 852 113 312 4 ,, ,, 29th ,, 248 8 91 41 2 702 4 „ „ 28th March 226 11 91 21 - 3 11 660 5 „ „ 2nd May 308 69 36 338 768 10 7 4 ,, ,, 30th ,, 321 14 91 54 1 256 737 4 ,, ,, 2 7 th J une 273 20 56 39 4 245 637 5 ,, ,, 1st August 273 22 97 42 1 3 6 3 798 4 ,, ,, 29th ,, 8 176 3 68 129 29 25 1 4 „ „ 26th September 2 57 6 84 2 305 688 34 5 „ „ 31st October 423 5 105 36 1 436 1006 4 „ „ 28th November 36 381 252 21 152 3 845 5 ,, ,, 2nd Jan., 1909 278 83 13 47 - 326 747 Total 1061 458 3875 8808 3 2 35 154 25 37 APPENDIX C. List of Sanitary Improvements effected during the Year. Cleansing— Premises, &c , cleansed, repaired, or whitewashed 3,757 Workshops ditto ditto ditto 776 House Drains — Drains relaid 298 Drains amended 131 Drains cleared 316 Drains trapped and ventitated 7 Rain water pipes and waste pipes disconnected 10 Sink and bath waste pipes trapped 48 Water Closets— W.C.'s repaired, cleansed, &c. 1,424 W.C.'s fitted with new pans and traps 175 W.C.'s supplied with water, and water supply apparatus 393 W.C.'s ventilated 8 W.C.'s rebuilt 4 New W.C.'s provided 52 Partitions provided round W.C.'s to separate same from workshops 2 Water Supply— Houses provided with water supply 239 House supply disconnected from W.C. cistern Cisterns supplied, repaired and cleaned 49 Miscellaneous— Paving of yards 146 Washhouses paved 36 Forecourt and Areas paved and drained 10 Stables paved and drained 6 Removal of accumulation of Dung and other refuge 136 Removal of Animals improperly kept 26 New Dung-pits provided and covers for same 7 Premises closed previous to executing the necessary repairs 17 Gutters, Rainwater Pipes and Waste Pipes repaired 536 Illegal occupation of Basements discontinued Overcrowding abated 151 Urinal accommodation provided 18 Grids provided to Gullies 22 Urinals supplied with proper Water Supply 21 Urinals cleansed 16 Dust Shots repaired and Receptacles provided 521 Vacant lands cleansed Yards cleansed 120 Indecent occupation discontinued 12 Verminous Rooms remedied 295 Damp Rooms remedied 169 Lighting and Ventilation improved 71 Total 10,364 APPENDIX D. Police Court Proceedings, 1908.—Public Health (London) Act, 1891. Date of hearing, Defendant. Result Offence. L. " " " .. „ ~ Inspector. Magistrate. 1908. Feb. 25 I. G. Non compliance with notice ... E. Richards Mr. Cluer Works done, costs 3s. Improperly keeping Cats Drainage works carried out without giving notice J. G. Weeks Do. Abatement order, 48 hours. „ 25 E. W. Mar. 17 S. G. j. G. Weeks Do. Fined £3, costs £-2 2s. Fined £5, costs £2 2s. May 12 j. C. Non-compliance with notice re dirty sanitary convenience A. S. Henley Do. „ 26 J. D. Non-compliance with notice re dirty premises Exposing unsound half calves' heads for purpose of sale E. Ainley Do. Work done, costs 3s: „ 26 J. G. W. Rowsell Do. Fined £4. „ 26 Do. Depositing do. do. E. Ainley Do. Withdrawn. Conviction on other summons re same parcel, Fined £h. „ 26 A. W. Depositing unsound meat for purpose of preparation for sale W. Rowsell Do. „ 26 L. Non-compliance with notice re water supply A. S. Henley Do. Fined £5. Police Court Proceedings, 1908. —Public Health (London) Act, 1891.—continued. Date ill hearing, Defendant, Offence. Inspector. Magistrate. Result. June 16 L. Non-compliance with notice F. Bare Mr. Cluer Fined £1, costs £ 3 3s. ,, 16 W. Commencing drainage works without notice Do. Do. Work remedied, costs 6s. July 7 H. Absence of water supply to dwelling F. Bare Do. Costs £3 3s. „ 14 S. R. & Co. Ditto workshop A. S. Henley Do. Fined £5, costs 2s. ,, 16 B. C. Unsound Kippers exposed for sale W. Rowsell Mr, Biron Fined £5, costs £1 lls. 6d. Sept. 22 M. S. Exposure for sale of unsound pears A. S. Henley Do. Fined £2, costs 2s. „ 22 E. H. Do. do. E. Ainley Do. Fined £1, costs 2s. „ 22 S.S. Do. do. Do. Do. Fined £2 ,costs 2s. J.D. 2 Summonses Non-compliance with notice A. S. Henley Do. Works completed, costs 6s. Oct. 6 „ 6 W.W. Exposing for sale unsound Pears E. Ainley Do. Fined £1, costs £1 1s. Police Court Proceedings, 1908. —Public Health (London) Act, 1891. —continued. Date of hearing. Defendent. Offence. Inspector. Magistrate. Result. ,,20 J. C. D. Making drainage amendments without giving notice J. G. Weeks Mr. Biron Costs 2s. „ 20 J.D. Do. do. Do Do. Costs £2 25., by agreement. Five weeks imprisonment in Second Division. Works done, costs 3s. „ 20 E. L. Exposing for sale unsound Fowls W. Rowsell Do. E. Kichards Mr. Cluer Nov. 10 W. J, B Non-compliance with notice „ 10 K. Do. do. F. Bare Do. Fined £2, costs £2 2. ,, 17 J. R. Do. do. H. F. Bridel Do. | Order made, costs £5 ss. Do. „ 17 Do. 2 Summonses Do. do. J. G. Weeks „ 17 J.F. Exposing for sale unsound Bloaters W. Roswell Do. Fined £15, costs £5 5s. Dec. 8 L. Non-compliance with notice F. Bare Do. Costs £2 2s. „ 8 W. S. Exposing for sale unsound Bloaters W. Rowsell Do. Fined £4, or one month. Went to Prison. APPENDIX E Police Court Proceedings, 1908.—Sale of Food and Drugs Acts, 1875-1907. Date of Hearing. Defendant. Offence, Inspector. Magistrate. Result. 1908. Jan. 7 J. S. Batter, containing excess moisture W. Rowsell Mr.Cluer Fined £2. „ 14 J. T. J. Do. do. E. Richards Do. Fined l3. „ 21 A. F. Milk, containing added water Margarine, sold in plain wrapper Do. Do. Costs 12s. 6d. Magistrate satisfied articles sold as received by vendor. Do. Do. Do. Costs 12s. 6d. „ 21 „ 28 I. N. Milk, containing added water W. Rowsell Do. Dismissed on warranty proved. „ 28 S. G. Do. do. Do. Do. Fined £2. F. T. Pined £4. „ 29 Raspberry Jam. containing apple pulp Do. Do. Feb. 4 S. G. Adulterated Butter E. Ainley Do. Pined £4, including costs. „ 4 Do. Margarine in plain wrapper Do. Do. Conviction on other summons, re same sample. „ 4 J. J. Adulterated Milk Do. Do. Fined £5, including costs. „ 4 E. B. B. Do. do. W. Rowsell Do. Fined £20. ,, 11 H. K. Adulterated Margarine Do. Do. Withdrawn on payment of costs by defendant. W. H. P. Do. do. Do. Do. Do. do. „ 11 „ 11 C. H. Adulterated Butter E. Richards Do. Fined £10. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. 1208. Feb. 11 C. H. Margarine in plain wrapper E. Richards Mr. Cluer Conviction on other summons, re same sample. „ 25 I. K. Milk, deficient in fat J. G. Weeks Do. Fined £2. „ 25 N.E.D. Co. Adulterated Milk Do. Do. Dismissed on warranty defence. Mar. 10 B. C. Milk, deficient in butter fat E. Ainley Do. Fined £3. ,, 24 F. C. Milk, containing added water E. Richards Do. Fined £10. „ 24 Milk, containing added water (3 summonses)... F. Bare Do. Fined £9. J. L. „ 24 Kidneys, containing boric acid J. G. Weeks Do. Fined £2., costs £4 4s. C. W. A. B. Margarine in plain wrapper Do. „ 24 Do. Pined £ 8. „ 31 C. H. Milk, containing added water Do. Fined 62. Do. ,, 31 J. J. Milk, deficient in butter fat Do. Do. Fined 612. „ 31 J. J. Milk, containing added water Do. Do. Withdrawn. Conviction on other summons re game sample. April 7 Do. Milk, deficient in butter Eat E. Ainley I. K. Fined £5. 7 I. K. Camphorated Oil, deficient in Camphor W. Rowsell C.H.F. Fined £ 2. Date of Hearing. Defendant. Offence. Inspector. Magistrate, Result. 1908. S. B. Camphorated Oil, being a mixture of paraffin oil and camphor W. Rowsell Mr. Cluer Fined £10. April 7 „ 14 K. W. Milk, containing added water A. S. Henley Do. Dismissed on warranty defence. E.& A. M. Milk, deficient in butter fat J. G. Weeks... May 12 Do. Fined £4. ,, 12 Do. Milk, containing added water Do. Do. Withdrawn. Conviction on other summons re same sample. „ 12 A. P. Butter, containing foreign fat Adulterated Milk E. Richards Do. Pined £4. June 2 A. P. F. Bare Do. Fined £3. „ 16 M. F. Do. do. E. Ainley Do. Dismissed on warranty defence. „ 16 J.J. Adulterated Butter A. S. Henley Do. Fined £8. „ 16 Do. Margarine sold in plain wrapper Do. Do. Conviction on other summons re same sample. L. G. Deficiency of Butter Pat in Milk' Do. Do. Fined £3. July 14 Sept. 22 B. S. Milk, containing added water Do. do. E. Ainley Mr. Biron Fined £1, costs 23s. „ 22 T. J. H. Do. Do. Fined £1, costs 235. Fined £2 costs £1 1s. Oct. 6 G. B. Butter, containing 87½ per cent, of foreign fat Do. Do. „ 6 Do. Selling Margarine in plain wrapper Do. Do. Withdrawn. Conviction on other summons re same sample. Police Court Proceedings, 1908. —Bale of Food and Drugs Acts, 1875-1907. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. 1908. Oct. 13 c. M. Milk containing 15 per cent, added water E. Ainley Mr. Biron Fined 10s., costs 12s. 6d. 27 A. J. P. Butter containing 46 per cent, foreign fat J. G. Weeks Do. Fined £10, costs 2s. Withdrawn. Conviction on other summons re same sample. „ 27 Do. Selling Margarine in plain wrapper Do. Do. 27 A. D. Do. Do. Fined £1, costs 2s. Milk,containing 14 percent. added water „ 27 Do. Coffee, containing 30 percent, chicory Do. Do. Fined £1, costs 2s. Nov. 17 C. P. Milk, containing 13 per cent. added water E. Ainley Mr. Ciller Fined £2. Dec. 1 J. R. Milk,containing 12 percent, added water J. G. Weeks Do. Withdrawn. Fresh summons issued against another person re same sample. „ 1 M. R. Do. do. Do. Do. Withdrawn. „ 1 J.M. Delivery in pursuance of a contract, containg 10 per cent. added water W. Rowsell Do. Fined £10, or prison 2 months. Went to prison. 8 S. G. Milk. 26 per cent, deficient in Butter Fat E. Ainley Do. Pined £8. „ 22 F. S. Milk, containing 7 per cent. added water E.Richards Do. Costs 12s. 6d. 45 APPENDIX F. Report us Smoke Observation during the year 1908. Number of Shafts kept under observation—about 100 Number of hours spent in observation 356 Number of intimation notices served 22 Number of statutory notices served 7 APPENDIX G. Mortuary Returns for 1908. Bodies removed to Mortuary — On Coroner's Order 257 By Police 20 By Firemen 1 From London Hospital 18 On Sanitary Inspector's Orders 2 On request of relatives 46 Total 344 Total infectious bodies removed to Mortuary under the provisions of Public Health (London) Act, 1891 14 Number of Inquests held 274 Number of Post Mortem Examinations made 111 Particulars of bodies on which Inquests were held — Bodies removed by Police from Great Eastern Railway 1 Ditto ditto Canal 3 Ditto ditto Street, &c 14 Ditto ditto Found in parcels 2 Ditto ditto Firemen 1 Bodies received from Bethnal Green Infirmary 35 Ditto Queen's Hospital 26 Ditto Mildmay Hospital 8 Ditto Private houses, &c 184 Total 274 APPENDIX H. Inspection of Places subject to Special Bye-Laws and Regulations. No. of Places. No. of Inspections. No of Notices. No. of Prosecutions. Premises. On Register at end of 1907 Added in 1908. Removed in 1908. On Register at end of 1908 46 Milk-shops 346 3 7 342 1163 62 ... Cowhouses 16 16 63 ... ... ... ... Slaughterhouses 6 6 30 ... ... ... ... Other offensive Trade Premises 1 1 4 ... ... ... ... 47 APPENDIX I. Inspection, etc. of Bakehouses. Number on register nt end of 1907 94 Do. do. 1908 87 Number above ground 60 Number under ground 27 Number of Inspections 229 Number of Notices 20 Number of Prosecutions — APPENDIX J. Premises where Food is prepared for Sale. Number of premises on register at end of 1908 225 Number of premises removed from register during 1908 12 Number of premises added to register during 1908 3 Number of visits 1,017 Number of notices served 47 Number of Prosecutions APPENDIX K. Particulars respecting Premises where "Ice Cream" is Manufactured or Sold. Number of premises on register at end of 1908 78 Do. do. do. 1907 71 Number of premises removed from register during 1908 10 Number of premises added to register during 1908 17 Number of visits paid to premises by Inspectors and particulars entered in register 180 Number of notices written and served for the abatement of nuisances and insanitary conditions 35 Number of prosecutions 48 APPENDIX L. The complaints received during the year from public and semi public bodies were as follows: — Mansion House Council (Local Sanitary Aid Committee) 53 H.M. Factory Inspector 48 London County Council (mainly copies of anonymous complaints sent to L.C.C.) 33 London County Council Smoke complaints per Coal Officers 4 Jewish Hoard of Guardians 3 N.S.P.C.C. Inspector 2 Metropolitan Water Board (Notifications of the cessation of supply of water) 63 APPENDIX M. Clerical Work. Intimation notices written and served 4,473 Statutory do. do. 2,128 Entries in Nuisance register 5,222 Entries in Tenement House register 2,693 Entries in Food and Drugs register 648 Entries in Workshop register 7,775 Notices respecting combined drainage 133 Smoke nuisance notices written and served (Intimation) 22 Do. do. do. (Statutory) 7 Number of callers at Office and particulars of cases recorded 1,998 Final notices prepared and served 617 Letters written 2,594 Briefs and instructions to Solicitor prepared 70 Summonses made out (four copies of each) 86 School notifications prepared and despatched 2,302 Notices to District Surveyor 40 Circular letters and circulars prepared and despatched 830 APPENDIX N. Particulars respecting Work of Disinfectors and Shelter. No of Articles of Bedding disinfected at Station. No. of Cases in which Shelter was used. No. of Persons accommodated at Shelter. No of Rooms Disinfected. No. of Rooms by request. No of Schools Disinfected. No. of Articles destroyed. No. of Cabs. Month January 113 4 7 2535 ... ... ... ... 1913 February 139 14 4 ... ... ... ... March 119 8 3 2878 .. ... ... ... April 95 1 1 4 2577 2 15 ... May 129 7 14 3650 ... ... ... ... June 123 14 1 2 1617 ... ... ... July 116 12 1 12 1307 ... ... ... August 158 6 2 2765 2 7 ... ... Sept. 170 12 7 2325 ... ... ... .. 2811 1 1 3 October 145 5 4 ... November 136 12 1 1822 ... ... ... ... December 135 4 1 1651 1 2 ... ... Totals 1587 99 4 60 27851 1 6 27 * Including 42 rooms at Hague Street School. 50 Total number of articles disinfected with Formalin lamp in Formalin Chamber during 1908, was 597. Fifty-three casks of Sanitas Powder each weighing one hundredweight, and making up 3,710 packets, have been distributed from the Offices. Three hundred and twenty-eight 1-pint bottles of Sanitas Fluid and 216: —1-pint tins of Izal Fluid have also been distributed from the Offices—68 gallons in all. Seventeen hundred-weight of Sulphur Candles has been used in the disinfection of rooms throughout the year. One gallon of 40 per cent. Formaldehyde Solution has been used in spraying the walls of rooms, and 6 lbs. of Formalin Tablets have been used for fumigating in certain cases in place of Sulphur Candles. 1½ gallons of Carbolic Acid have been used for disinfection in conection with cases of Enteric Fever. APPENDIX 0 (1). Particulars respecting Houses let in Lodgings. Number of Houses Registered 517 Number of Houses Registered during year 1908 20 Number of Houses Removed from Register during 1908 12 Visits paid to Registered Houses by Inspectors and particulars recorded in Register 2693 Registration Forms written and served 26 Cases of Overcrowding abated 24 Cases of Indecent Occupation abated 7 Number of Notices served for Insanitary Conditions 728 Number of Prosecutions Nil APPENDIX 0 (2). Tenement Houses supplied with Water to Upper Floors. Under Notice. Voluntarily. District A. ... 10 ... - B. ... 2 ...8 C. ... - ... - „ D. ... 3 ... 2 „ E. ... 1 ... - „ F. ... 10 ... - 26 10 Total 36. 51 APPENDIX P (1). Sale of Food and Drugs Acts, 1875—1907. Samples taken Officially and submitted for Analysis during the Year. Total No. of Samples taken. Article. Genuine, Adulterated. Arrowroot 2 2 ... Butter 125 114 11 „ Milk-blended 1 1 ... Salt 1 1 ... Camphorated Oil 4 2 2 Cheese 3 3 ... Cocoa 6 5 1 Coffee 25 24 1 „ and Chicory 1 1 ... Cornflour 1 1 ... Jam, Blackcurrant 1 1 ... „ Raspberry 6 6 ... Lard 1 1 ... Margarine 5 5 ... Milk 409 373 36 „ Separated 3 3 ... Mustard 13 13 ... Olive Oil 2 2 ... Pepper 3 3 ... Pigs' Kidney 1 1 ... Tea Dust 3 3 ... Vinegar, Malt 1 1 ... Totals 617 565 52 52 The following is a summary of legal proceedings, &c., taken in connection with the above cases.:- Other offences under Sale of Food and Drugs Acts. No. of Samples Adulterated. No. of Summonses Issued. No. of Convictions Obtained. No. of cases Dismissed. No. of Summonses Withdrawn. 52 11 52 35 5 12 The offences against the Sale of Food and Drug Acts, other than adulteration, consisted in all eases of margarine being sold to the purchaser in an unstamped wrapper. In two cases summonses were withdrawn before the hearing, owing to a technical error in the designation of the defendants. In thirteen cases no summonses were issued, the committee exercising the discretionary powers vested in them and cautioning the vendors in each case. The cases were as follows: — In three casts the sample was obtained from a very small quantity of milk left in counter-pan after being constantly dipped from for some hours, there being a deficiency in butter-fat. In two cases margarine was served for butter in plain paper but from a slab marked "margarine." In the case of two milks and one butter the percentage adulteration was two small to warrant proceedings. In another case chocolate powder was served for cocoa, but from a well-labelled tin. In one case of adulterated milk a notice displayed in the shop protected the vendor. In the remaining case margarine was sold for butter, but the paper wrapper was clearly marked "magarine." All five dismissals of summonses were owing 0 successful " warranty" defences being set up in the case of adulterated or skimmed milk. The twelve summonses were withdrawn for the following reasons: — In eight cases convictions were obtained upon other summonses in respect of the same sample. In one case it was known that a "warranty" defence would be set up, after the issue of the summons. Two cases are mentioned above. 53 In one case owing to the business changing hands from husband to wife, and the wife having omitted to register herself, the wrong person was summoned. This was soon rectified and the right person duly convicted. APPENDIX P (2). FOODS AND DRUGS. Table showing Percentage Adulteration for Decennial Period 1898—1907 Compared with 1908. No. of Samples Taken. No Adulterated. Per centage. Year. 1898 146 36 25.0 1899 201 42 20.4 1900 186 35 15.8 1901 326 62 16.0 1902 396 57 14.4 1903 485 64 11.7 1904 609 79 12.9 656 1905 75 11.4 1906 671 87 12.9 1907 682 45 6.6 Decennial average percentage adulteration 14.7 1908 617 52 8.4 APPENDIX P (3) Sale of Food and Drugs Acts 1875 to 1907. Samples taken for General Information. No. of Samples Purchased. No. Reported Genuine. No. Reported Adulterated. Articles. Butter 1 1 ... Bread and Butter 1 1 ... Camphorated Oil 1 1 ... Cheese 1 1 ... Cocoa, Flaked 1 1 ... 2 2 Dripping, Beef ... Gingerbread 4 4 ... „ Biscuits 1 1 ... Lemonade 4 4 ... 4 3 1 Milk Pepper 1 1 ... Pigs Kidneys 1 1 ... Sausages, Beef 1 1 ... 2 1 1 „ Pork 1 1 Sugar ... 26 23 3 These samples are purchased quite privately and submitted to analysis by the Public Analyst and in the case of any proving unsatisfactory, the vendor is of course kept under observation. This course has been approved and, indeed, suggested by the Board of Agriculture and has been found a very useful means of obtaining information. Other samples have been for special reasons submitted for examination to the Clinical Research Association, as follows:- Beef pieces (box beef) 1, Ice Cream 1, Lemonade 4; these were all satisfactorily reported upon. 54 55 APPENDIX Q (1). Outworkers, 1908. No. of Outworkers comprised therein. No. of lists received from employers. Reported from other Boroughs. Reported to other Boroughs. Year. 1907 189 3,455 2,613 1,707 1908 198 3,286 3,055 1,684 Number of Outworkers dealt with in 1908 6,341 „ „ „ „ 1907 6,068 Increase over 1907 273 56 APPENDIX Q (2) Outworkers' List of Trades. The following is a list of the trades in which the Outworkers' notified during 1908 were engaged:— Artificial Flower Making 10 Bamboo Workers 1 Bathing Costume Maker 1 Belt Makers 37 Bibs and Pinafores 9 Blouse Work 30 Bodice Steels 3 Bonnet Making 1 Boot and Shoe Making 582 Box Making, &c. 582 Brace Making 2 Brush Making, &c. 220 Button Covering 1 Cabinet Making 5 Cap Making 8 Chair Making 4 Collar Making 7 Curtain Nets 4 Dressmaking 20 Embroidery 9 Fan Making 2 Feather Curling 2 French Polishing 4 Fur-slip Stitching & Trimming 4 Glove Making 1 Mantle Making 12 Millinery 13 Paper Bag Making 9 Paste Fitting 4 Pom Pom Making 4 Pyjama Making 5 Shirt Making 11 Silk Winding and Weaving 68 Skin Dressing 1 Skirt Making 28 Smock Making 1 Stay Making 5 Tailoring 475 Ties and Bow work 35 Toy Maker 1 Trouser Making, &c. 133 Trimmings, (fancy) 42 Upholsterers Trimmings 25 Underclothing 65 Umbrella Making 20 do. Band Making 5 do. Machinists 3 do. Covering 2 do. Tassels 8 Total 2524 Of the above number of Outworkers' 447 were incorrectly notified or have discontinued work. 57 APPENDIX R. Overcrowding. Number of Dwelling Rooms Overcrowded in 1908 163 do. do. do. Remedied in 1908 154 Number of Prosecutions Nil APPENDIX S. House to House Inspections. Number of House to House Inspections in 1908 829 Number of Defects discovered 1253 Number of Notices Served 552 APPENDIX T. Works carried out and in progress by Combined Drainage Staff during the Year. Relaying Combined Drains. 148 to 152, Bethnal Green Road. 62 and 64, Florida Street. 78 to 86, Bishop's Road. 81 to 89, Green Street. 1 and 3, Bonner Road. 46 and 48, Hassard Street. 6 and 8, Birkbeck Street. 24 and 25, Henrietta Street. 68 to 72, Bonner Road. 2 to 6, Hereford Street. 8 to 14, Bonner Street. 1 to 9, (consec.) Tent Street. 19 to 37, (odd) Scott Street. 1 5 to 8, (consec.) Bullard's Place. 46 to 52, (even) Usk Street. 10 to 19, (consec.) Tent Street. 1 to 17, (odd) Scott Street. 5 and 6, Chapel Street. 1a to 4, Durant Street. 1 to 7, Southampton Terrace. 58 Other Works. Workhouse: —Drainage system re-construction. Public Health Offices: —lnternal Cleansing and Re-papering. Disinfecting Station: —Building Formalin Chamber. Shelter-3, St. James Road: —External Painting, etc. Unstopping Combined Drains:— 19, Chilton Street. 13, Marian Street. 56, Collingwood Street. 320, Old Ford Road. 247, Green Street. 7, Queen Caroline Gardens. 214, Hackney Road. 18, Venice Street. Holmes Avenue. Cutting off old Connections: — 1 to 4, New Church Street. 35, Northampton Street. Flushing and Sweeping Drains and renewing and sealing Manhole covers: — 2 and 4, Bacon Street. 50 to 54, Fellbrig Street. 5 to 19, Code Street. 1 to 15, Fox Street. 2 to 10, Collingwood Street. 1 to 25, Gales Gardens. 38, do. 2 to 10, do. 58 to 70, do. 12 to 22, do. 67 to 87, do. 27 to 41, do. 64. do. 43 to 45, do. 70 to 90 do. 27, Gardeners Road. 107 to 119, do. 7 to 11, Lucas Street. 1 to 9, Coventry Street. 12, do. 15 to 25, do. 2 to 16, Margaret's Place. 34 to 54, do. 1 to 5, New Church Street. 68 to 70, do. 11, Neath Place. 73 to 81, do. 25 to 36, Neath Place. 100 to 104, do. 45 to 63, do. 112 to 176, do. 5, 7, 9, Northampton Street, 59 147 to 157, Coventry Street 8 to 20, Northampton Street. 161 to 163, do. 13 to 23, do. 1 to 9, Eckersley Street. 25 to 33, do. 15, Pedley Street. 22 to 40, do. 8 to 14, Fleet Street Hill. 35 to 39, do. 1 to 7, do. 9 to 13, Octagon Street. 2 to 7, Bratley Street. 1 to 4, Pedley Street. 29 to 33, Weaver Street. 18 to 30, do. 22 to 24, Fellbrig Street. 1 to 23, Weaver Street. 29 to 33, do. Whites Court. 34 to 86, do. Butlers Buildings. 43 to 53, do. APPENDIX V (1) Wages and Sick Pay Account. Workhouse Drainage. No. of Weeks. Ending. Combined Drainage. Sanitary Labour. Sick Pay. 1908 £ s. d. £ s. d. £ s. d. £ s. d. 1st February 47 5 4 41 19 3 119 18 3 5 ... 4 29th February 78 3 0 32 11 6 3 0 0 85 2 2 4 28th March 89 11 1 32 11 6 104 11 10 ... 7 2 6 123 5 7 5 2nd May 49 4 11 39 8 0 4 30th May 54 15 4 32 8 0 2 1 3 101 19 4 4 27th June 42 1 8 33 4 1 105 1 4 ... 5 1st August 44 15 7 43 0 0 128 7 0 ... 4 29th August 17 12 1 41 0 0 102 8 11 ... 26th September 68 19 0 33 18 11 109 1 11 4 ... 5 31st October 36 9 1 41 1 11 1 6 3 142 6 7 4 28th November 19 11 7 33 17 7 114 5 3 ... 5 2nd January, 1909 16 14 4 42 1 6 131 2 2 ... Totals 560 3 0 447 2 3 13 10 0 1368 0 4 Shelter-External Painting. -In April it was decided to put in hand the paintwork, etc. required to the exterior of the Shelter, 3, St. James Road. The sum of £20 was provided for this work, the actual figure at which the work was carried out by our own men being £20 10 7. APPENDIX V (2) STATEMENT OF PETTY CASH ACCOUNT. Amount received each month from Finance Committee. Public Health (London) Act 1891. - Cost of Prosecutions, Seizure of Unsound Food. &c. Sale of Food and Drugs Acts. - Cost of obtaining Samples for Analysis, Prosecutions, &c. Combined Drainage and General Small Accounts for Tools, Materials, &c., not kept in Stock. Drain Plug Hire. - Returned Deposit s. General - Sundry Small Payments, Bus Fares, Office and Other Expenses. Mortuary - Washing, Sundry Requirements, &c. Fines, Costs, &c., recovered and paid into Council's Account. 1908. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. January 9 16 2 2 0 11 3 3 11 1 12 2 4 10 0 0 7 2 18 3 0 ... February 15 14 10 1 7 4 3 1 10 1 8 2 0 15 0 0 15 4 16 10 0 ... March 11 14 2 1 19 4 4 4 3 0 13 5 3 0 0 0 6 4 0 16 10 65 0 6 7 7 8 April 2 7 1 1 6 4 1 4 10 4 0 0 0 3 3 48 1 0 ... 11 0 2 2 5 3 1 16 7 5 11 0 May 2 1 6 1 10 0 0 7 4 ... June 9 1 6 1 2 8 1 10 4 1 9 5 1 0 0 0 10 11 0 10 8 43 1 0 61 July .. 8 0 8 1 7 6 0 18 6 2 4 2 0 10 0 0 15 9 21 6 6 ... August 6 4 0 0 17 5 0 2 4 1 8 1 0 14 0 0 3 1 0 17 6 ... Sept. 5 15 11 1 8 0 1 2 3 2 18 8 0 5 0 0 16 8 8 18 6 ... October 3 4 11 1 4 11 3 4 11 1 3 10 1 15 0 0 11 6 0 15 7 8 7 6 0 3 7 Nov. 6 10 7 2 3 0 1 14 7 1 9 11 2 18 0 0 11 2 50 2 0 8 15 9 Dec. 1 11 10 2 2 5 2 4 11 1 14 0 0 8 8 10 17 0 ... Total for Year. 103 6 4 19 15 3 24 13 2 19 14 2 22 11 0 5 17 2 2 6 8 296 15 6 Total amount received from Finance Committee £ 103 6 4 Balance from 1907 9 8 11 £112 15 3 Less Expenditure 1908 94 17 5 Balance £17 17 10