C.I AC4366 BET 16 THE Metropolitan Borough of Bethnal Green REPORT ON THE SANITARY CONDITION AND VITAL STATISTICS DURING THE YEAR 1910, 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 Incorporated 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 Thomas Bean & Son, 67, Golden Lane, E.C. 1911. THE Metropolitan Borough of Bethnal Green. REPORT ON THE SANITARY CONDITION AND VITAL STATISTICS DURING THE YEAR 1910, 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 Incorporated 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 Thomas Bean & Son, 67, Golden Lane, E.C. 1911. 13711 The Public Health Committee. Mr. Councillor J. W. Ward, Chairman. Mr. Alderman R. E. Pearson. Vice-Chairman. His Worship the Mayor, Councillor C. E. FOX, J.P. Mr. Alderman J. J. Fleming. Mr. Councillor J. J. Bartlett. Mr. Councillor W. H. Clark. „ „ G. Bayley. „ „ T. A. Dean. „ „ T. Brooks. „ „ R. Larkins. „ „ P. H. Burton „ „ B. E. Lee. Mr. Councillor A. Lewis. Ex-Officio Members of the Public Health Committee. Mr. Councillor C. Wood. Mr. Councillor A. F. Barnard. Mr. Councillor H. A. Meadway. Mr. Alderman F. J. Read. Meetings—Alternate Wednesdays at 6 p.m., at the TOWN HALL, Cambridge Road, E. STAFF OF PUBLIC HEALTH DEPARTMENT. John Foot, Chief Inspector. E. Ainley, Sanitary inspector. I. R. Jones, Sanitary Inspector. F. T. Bare, do. E. Richards, do. H. F. Bridel, do. W. Rowsell, do. A. S. Henley, do. J. O. G. Weeks, do. Miss A. K. Harris. CLERICAL STAFF. Ernest Q. Bilham, Chief Clerk. George I. Brighting, Assistant Clerk. Joseph H. Hewitt, do. William Billings, Junr. do. Horace A. Saunders, do. H. W. Pendrill, Junior. Disinfectors. One Leading Disinfector. Two Assistant do. One do. do. and General Assistant. Alfred Walter Stokes, F.C.S., F.I.C., Public Analyst. Edgar Taunton, M.B., D.P.H., Barrister-at-Law, Deputy Medical Officer of Health. George Paddock Bate, M.D., Medical Officer of Health. PUBLIC HEALTH OFFICES Town Hall, Patriot Square, Bethnal Green, E. Disinfecting Station. The Council's Depot, Digby Street, Globe Road, E. Shelter. 3, St. James Road, Bethnal Green, N.E. SYNOPSIS of MEDICAL OFFICER'S ANNUAL REPORT, 1910. page General Summary 8 Birth and Death Rates in Metropolitan Boroughs 6 & 7 Population 9 Table "A" Births and Deaths 10 Births 10 Table "B" Public Institutions outside Bethnal Green into which residents have been received and where they have died 16 Table "C" Public Institutions in Bethnal Green 18 Table "D" Deaths in Sub-districts 19 Death Rate 19 Table "E" Monthly Mortality Rates—London and Bethnal Green 20 Table "F" Quarterly Death Rates—London and Bethnal Green 21 Birth Rates 21 Table "G" Birth Rates and Death Rates in Sub-districts 22 Table "H" Marriages 22 Deaths of Infants 22 Special causes of Infantile Deaths 24 Causation of excessive Infantile Mortality 24 Notification of Births Act, 1907 31 Report of Woman Inspector 31 Deaths of Young Children 39 Table "I" Comparative Infantile and Child Mortality 40 Senile Mortality 43 Weekly Mortality 43 Quarterly and Annual Deaths and Mortality Rates 43 Table "J" Quarterly Mortality—Bethnal Green 41 Table ''K" Quarterly Mortality—London 42 The principal Zymotic Diseases 43 Table "L" Deaths at Home and in Hospital 44 Table "M" Zymotic Deaths in 1909 and 1910 45 Table "N" Percentages of Deaths from Zymotic Diseases 45 Notification of Infectious Diseases 46 Table "O" Details of Notifications 47 SYNOPSIS—continued. Table "P" Condition of Premises 48 Scarlet Fever 48 Diphtheria 49 Gratuitous supply of Anti-Toxin 50 Epidemic of Diphtheria at Children's Home 51 Dr. Tunstall's Report 53 Enteric Fever 57 Dr. Collingridge on Contaminated Shell Fish 60 Typhoid Carriers 65 Whooping Cough 66 Diarrhœa 67 Measles 67 Hospital Beds for Measles and Whooping Cough 68 Diseases of Parturition 69 Erysipelas 70 Cerebro-spinal-meningitis 70 Tetanus 70 Anthrax 71 Tuberculosis 71 Cancer 75 Inquests 76 Suicides 76 Housing and Town Planning Act, 1909 76 Customs and Inland Revenue Acts, 1890 to 1903 81 APPENDIX. Local Government Board Order, 15th August, 1910, re Provision, etc., of Diphtheria Anti-Toxin 82 Tables—I.—Vital Statistics of Whole District 85 II.—Vital Statistics of separate Localities in 1910 and previous years 86 III.—Cases of Infectious Disease notified 87 IV.—Causes of, and Ages at Death 88 V, V (a) and V (b).—Infantile Mortality 89-91 VI.—Number of Deaths from the seven principal Zymotic Diseases in the ten years 1900 to 1909 and in the year 1910 92 Street List 95 Administration of Factory and Workshop Act, 1901 93 Home Workers 94 6 London and the Metropolitan Boroughs. Births and Deaths of Persons belonging to London and the Metropolitan Boroughs during the 52 Weeks of 1910. * Boroughs. Population estimated to the middle of 1910 Births. Deaths from Deaths under 1 year of Age. All Causes. Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough.. Typhus. Enteric Fever. Pyrexiat (Origin uncertain) Diarrhœa. Phthisis. COUNTY OF LONDON 4,872,702 114,870 61,756 5559 - 1980 214 434 1363 - 196 4 1368 5555 11809 West. Paddington 153,004 3084 1796 164 - 69 7 9 32 - 4 - 43 128 296 Kensington 184,635 3217 2190 141 53 1 16 32 - 5 - 34 142 340 Hammersmith 127,413 3015 1549 170 70 7 22 26 - 4 — 41 132 302 Fulham 181,282 4303 1907 204 — 65 7 14 60 — 2 — 56 170 462 Chelsea 75,457 1382 950 49 19 - 4 12 2 — 12 87 140 City of Westminster 167,233 2554 1893 78 21 4 10 18 — 6 - 19 186 215 North. St. Marylebone 125,195 2331 1600 116 - 28 7 9 44 - 6 - 22 137 252 Hampstead 95,729 1340 822 44 15 2 5 11 - 3 - 8 56 80 St. Pancras 237,792 5720 3261 330 - 140 17 21 96 - 4 - 52 304 582 Islington 353,356 8289 4529 432 168 11 33 124 17 1 78 397 777 Stoke Newington 54,838 984 600 31 11 1 2 7 2 — 8 50 63 Hackney 239,979 5298 2797 202 66 5 8 61 10 — 52 259 520 Central. Holborn 53,142 1022 792 49 - 14 - 4 16 - 5 - 10 105 105 Finsbury 94,578 2824 1656 182 66 4 21 36 — 4 1 50 160 347 City of London 17,132 227 264 8 — 1 — 2 — 2 — 3 29 15 East. Shoreditch 114,387 3613 1905 217 - 84 4 14 46 - 8 - 61 170 526 BETHNAL GREEN 131,579 4208 2010 192 — 59 9 20 35 18 - 51 188 517 Stepney 314,379 9258 4303 414 103 12 29 114 15 — 111 410 1037 Poplar 172,432 5111 2609 259 — 42 12 21 84 — 13 — 87 234 605 South. Southwark 211,832 5873 3360 427 226 9 35 60 - 7 - 90 368 682 Bermondsey 127,238 4006 2240 310 - 145 14 19 43 - 4 - 85 223 503 Lambeth 327,074 7344 4091 322 122 22 26 54 - 18 - 80 382 691 Battersea 188,222 4483 2120 209 74 7 12 51 7 1 57 194 434 Wandsworth 305,838 6980 3102 185 43 11 13 70 9 — 39 261 545 Camberwell 286,058 6657 3439 308 — 136 10 22 70 9 — 61 309 629 Deptford 119,642 3004 1667 176 59 3 11 48 5 — 50 142 367 Greenwich 112,935 2432 1306 158 48 3 10 57 3 — 37 106 261 Lewisham 164,899 3439 1585 100 12 12 20 29 3 — 24 90 274 Woolwich 135,422 2842 1413 82 - 22 12 4 25 - 1 1 17 136 242 ◦ The Births in this table have been corrected by distributing those which occurred away from home to the boroughs in which the mothers had resided. In 1357 cases the residence was outside the County of London, and these cases have been excluded from this table. With regard to Deaths, all those of persons in or on the way to, Hospitals and other Public Institutions, as well as those of persons under treatment in surgical homes, or dying by accident or otherwise in the streets, have been distributed, as far as practicable, to the boroughs in which the deceased had previously resided. The deaths of 2331 London residents who died outside the County of London in Metropolitan Workhouses, Hospitals, and Lunatic and Imbecile Asylums, have been similarly distributed. Of the deaths registered in London the previous residence was outside the county in 3184 cases, and these have been excluded from the table. † Called Simple Continued Fever previous to 1901. 7 London and the Metropolitan Boroughs. Birth-rates and Death-rates of Persons belonging to London and the Metropolitan Boroughs during the 52 Weeks of 1910. Boroughs. Per 1000 Persons Living. Deaths under one year to 1000 Births. Births. Deaths from All Causes. Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Typhus. Enteric Fever. Pyrexia† Origin uncertain). Diarrhœa. Phthisis. Crude. Corrected* COUNTY OF LONDON 23.6 12.7 13.4 1.14 - 0.41 0.04 0.09 0.28 - 0.04 0.00 0.28 1.14 103 West. Paddington 20.2 11.8 12.6 1.08 - 0.45 0.05 0.06 0.21 - 0.03 — 0.28 0.84 96 Kensington 17.5 11.9 12.8 0.77 - 0.29 0.01 0.09 0.17 — 0.03 — 0.18 0.77 106 Hammersmith 24.0 12.2 12.7 1.33 - 0.55 0.06 0.17 0.20 — 0.03 — 0.32 1.04 99 Fulham 23.8 10.5 11.0 1.13 - 0.36 0.04 0.08 0.33 — 0.01 — 0.31 0.94 107 Chelsea 18.4 12 .0 13.1 0.65 — 0.25 — 0.05 0.16 - 0.03 — 0.16 1.16 101 City of Westminster 15.3 11. 4 12.7 0.47 — 0.13 0.02 0.06 0.11 - 0.04 - 0.11 1.12 84 North. St. Marylebone 18.7 12.8 13.7 0.93 - 0.22 0.06 0.07 0.35 - 0.05 - 0.18 1.10 108 Hampstead 14.0 8.6 9.7 0.46 - 0.16 0.02 0.05 0.12 - 0.03 - 0.08 0.59 60 St. Pancras 24.1 13.8 14.4 1.39 - 0.59 0.07 0.09 0.40 - 0.02 - 0.22 1.28 102 Islington 23.5 12.9 13.4 1.22 - 0.48 0.03 0.09 0.35 — 0.05 0.00 0.22 1.13 94 Stoke Newington 18.0 11.0 11.5 0.58 - 0.20 0.02 0.04 0.13 — 0.04 — 0.15 0.91 64 Hackney 22.1 11.7 12.2 0.84 — 0.28 0.02 0.03 0.25 — 0.04 - 0.22 1.08 98 Central. Holborn 19.3 14.9 16.1 0.91 - 0.26 - 0.07 0.30 — 0.09 — 0.19 1.98 103 Finsbury 29.9 17.6 18.2 1.92 - 0.70 0.04 0.22 0.38 — 0.04 0.01 0.53 1.70 123 City of London 13.3 15.5 17.0 0.48 — - 0.06 - 0.12 - 0.12 — 0.18 1.70 66 East. Shoreditch 31.7 16.7 17.5 1.90 - 0.74 0.04 0.12 0.40 - 0.07 — 0.53 1.49 146 BETHNAL GREEN 32.1 15.3 15.5 1.47 - 0.45 0.07 0.15 0.27 — 0.14 - 0.39 1.43 123 Stepney 29.5 13.7 14.3 1.32 - 0.33 0.04 0.09 0.36 — 0.05 — 0.45 1.31 112 Poplar 29.7 15.2 15.6 1.51 — 0.24 0.07 0.12 0.49 — 0.08 - 0.51 1.36 118 South. Southwark 27.8 15.9 16.6 2.02 - 1.07 0.04 0.17 0.28 - 0.03 - 0.43 1.74 116 Bermondsey 31.6 17.7 18.1 2.44 - 1.14 0.11 0.15 0.34 — 0.03 — 0.67 1.76 126 Lambeth 22.5 12.5 12.9 0.99 - 0.37 0.07 0.08 0.17 — 0.05 — 0.25 1.17 94 Battersea 23.9 11.3 12.1 1.11 - 0.39 0.04 0.06 0.27 — 0.04 0.01 0.30 1.03 97 Wandsworth 22.9 10.2 10.7 0.61 - 0.14 0.04 0.04 0.23 — 0.03 — 0.13 0.86 78 Camberwell 23.3 12.1 12.5 1.09 - 0.48 0.04 0.08 0.25 — 0.03 - 0.21 1.08 94 Deptford 25.2 14.0 14.7 1.47 - 0.49 0.03 0.09 0.40 — 0.04 - 0.42 1.19 122 Greenwich 21.6 11.6 11.8 1.42 - 0.43 0.03 0.09 0.51 — 0.03 - 0.33 0.94 107 Lewisham 20.9 9.6 10 .0 0.61 - 0.07 0.07 0.12 0.18 — 0.02 — 0.15 0.55 80 Woolwich 2.10 10.5 11.2 0.62 - 0.16 0.09 0.03 0.19 - 0.01 0.01 0.13 1.01 85 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. * The Corrected death-rates represent the Crude death-rates multiplied by the respective Factors for Correction for differences of sex and age constitution of population. † Called Simple Continued Fever previous to 1901. 8 SUMMARY, 1909. 1910. Estimated Population of Bethnal Green— 131,316 131,579 Young Children, under 5 years 17,930 17,970 Old People, over 65 years 57,300 57,400 Area—755 acres. Number of Inhabited Houses 14,829 14,819 Rateable Value £548,182 £541,862 Average number of Persons to each House (1901 London Census, 9.2) 8.8 8.9 Average number of Persons to each Acre (1901 London Census, 170.8) 173.9 174.3 Total number of Deaths in the year 2,197 2,003 Total number of Births in the year 4,132 4,208 Total number of Marriages 912 1,008 Marriage Rate—Bethnal Green 13.9 15.3 Marriage Rate—London 14.6 16.0 Death Rate—Bethnal Green 16.73 15.23 Death Rate—London 14.0 12.0 Birth Rate—Bethnal Green 31.7 31.8 Birth Rate—London 24.0 23.0 Infantile Death Rate (on Births), Bethnal Green 129.25 122.62 Infantile Death Rate (on Births), London 108.00 103.00 Young Children's Death Rate (on estimated number of Young Children) 46.3 41.30 Old People's Death Rate (on estimated number of Old People) 88.6 72.10 Zymotic Death Rate (Bethnal Green) 1.93 1.38 Zymotic Death Rate—London 1.31 1.14 Inquest Cases 275 260 Uncertified Deaths (no Inquests held) 2 0 9 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 honour to present my thirty-fifth Annual Report on the vital statistics and sanitary condition of the Borough of Bethnal Green. The period under consideration is the registration year 1910, which commenced on January 2nd of that year, and terminated on Saturday, December 30th last. POPULATION. The Registrar-General's estimate of the population of the Borough in the middle of the year 1910, is 131,579, an increase of 263 over the estimate for the previous year. This figure is arrived at by assuming that the population of the Borough has steadily continued to increase during the past ten years at a rate equal to that of the immediately preceding decennium. 10 In 1901, the actual number found by enumeration was 129,680; and, should the normal increase have been maintained, the Registrar-General's figure would represent our population. But, taking into consideration the large number of houses now unoccupied in Bethnal Green, together with the decreasing numbers of births and deaths, I feel sure the census figure of 1901 more nearly represents our actual numbers than does the official estimate. The results of the census taken on Sunday, April 2nd, last are not yet published*, so that in the absence of the actual enumeration statistics I feel bound to accept the estimate of the Registrar-General. TABLE A. 1909 1910 Estimated population in the middle of the year 131,316 131,579 Total Births 4,132 4,208 Total Deaths 2,197 2,003 Excess of Births over Deaths, shewing the natural increase of the population 1,935 2,205 BIRTHS. The total number of births registered during the year was 4,040, but in addition to these I have received information of 168 infants born of Bethnal Green 11 * Since this report was presented the results of the recent census have been published, and are given below:— Metropolitan Boroughs:— Battersea 168,907 167,793 dec. 0.66 Bermondsey 130,760 125,960 dec. 3.67 Bethnal Green 129,680 128,282 dec. 1.08 Camberwell 259,339 261,357 inc. 0.78 Chelsea 73,842 66,404 dec. 10.07 Deptford 110,398 109,498 dec. 0.82 Finsbury 101,463 87,976 dec. 13.29 Fulham 137,289 153,325 inc. 11.68 Greenwich 95,770 95,977 inc. 0.22 Hackney 219,110 222,587 inc. 1.59 Hammersmith 112,239 121,603 inc. 8.34 Hampstead 81,942 85,510 inc. 4.35 Holborn 59,405 49,336 dec. 16.95 Islington 334,991 327,423 dec. 2.26 Kensington 176,628 172,402 dec. 2.39 Lambeth 301,895 298,126 dec. 1.25 Lewisham 127,495 160,843 inc. 26.16 Paddington 143,976 142,576 dec. 0.97 Poplar 168,822 162,449 dec. 3.77 St. Marylebone 133,301 118,221 dec. 11.31 St. Pancras 235,317 218,453 dec. 7.17 Shoreditch 118,637 111,463 dec. 6.05 Southwark 206,180 191,951 dec. 6.90 Stepney 298,600 280,024 dec. 6.22 Stoke Newington 51,247 50,683 dec. 1.10 Wandsworth 231,922 311,402 inc. 34.27 Westminster, City of 183,011 160,277 dec. 12.42 Woolwich 117,178 121,403 inc. 3.61 City of London 26,923 19,657 dec. 26.99 Administrative County of London 4,536,267 4,522,961 dec. 0.29 Outer Ring 2,045,135 2,730,002 inc. 33.49 Instead of increasing, as was anticipated, the population of Bethnal Green decreased at the rate of 1.08 per cent. Amended statistics, calculated upon this diminished population, are given below:— Death Rate 15.51 Birth Rate 32.81 Marriage Rate 15.71 Zymotic Death Rate 1.42 Phthisical Death Rate 1.37 12 mothers in Lying-in Institutions situated in various parts of London; 25 of these births took place in the City of London Lying-in Hospital and 55 in the East End Mothers' Lying-in Home, Shadwell. Registered births 4,040 Children born of Bethnal Green mothers away from home 168 Total 4,208 The addition of these 168 Institution-births to those registered in the Borough gives a total of 4/208, a number which is 76 in excess of the births of the previous year. This figure is, however, 220 below the decennial average of the births for the ten years 1900 —1909. The births exceeded the deaths by 2,205. DEATHS. The total number of deaths registered in the Borough was 2,034. This total includes 396 non-residents who died in one or other of the Bethnal Green Public institutions, 10 other persons, also non-residents, who died sudden or violent deaths, or were found dead within the boundaries of the Borough. They were:— 1. A carman, aged 39 years, of Retford Street, Shoreditch, died in a cart in Vallance Road, from syncope, due to heart disease. 2. A general dealer, aged 57, of Castle Street, Stoke Newington, died in Brady Street, of apoplexy. He had cerebral hcemorrhage and chronic kidney disease. 13 3. The three-weeks-old baby of a French polisher of Long Street, Shoreditch, suffering from whooping cough and bronchitis; died from convulsions in Virginia Road, 4. A woman, aged 25 years, and her baby boy, aged four years, from Leyton, were suffocated in a burning house in Green Street. 5. The six-months-old baby of a fish curer from Dalston, died in Hackney Road, near the Queen's Hospital. He was suffering from broncho-pneumonia. 6. A charwoman, aged 43 years, from Hanbury Street, Stepney, strangled herself during a fit of insanity in a cell at the Bethnal Green Road Police Station. 7. A commerical traveller, aged 53 years, from Tottenham, died in Bethnal Green Road from syncope. He had suddenly ruptured an aortic aneurism. 8. The six-months-old son of an iron-plate worker, from Poplar, died at Gretton Houses from convulsions, set up by tubercular meningitis. 9. A warehouseman, aged 21 years, from Tottenham, was killed in Cambridge Road. He was crushed by a brewer's motor lorry. The monthly returns from Somerset House contain particulars of 364 deaths of Bethnal Green inhabitants, in Public Institutions in various parts of London; also of eleven persons who died sudden or violent deaths whilst temporarily absent from home. Coroners' inquests were held upon these last, and the causes of death are stated below:— 1. A baby, aged three weeks from Alias Road, died from diarrhoea at Spaniards' Road, Hampstead. 14 2. A corset-steel packer from Paradise Row, died at Brook Street, Ratcliffe, from pleuro-pneumonia and heart failure. 3. A baby, aged four weeks, from Columbia Road, died at Andrew's Road, Hackney, from bronchopneumonia. 4. A stevedore, aged 57 years, from Reuben Street, fell into a ship's hold at the Surrey Commerical Docks; in addition to other injuries, his heart was ruptured and his skull fractured. 5. A stoker, aged 65 years, from Fellbrigg Street, was run over by a motor bus in Mile End Road; in addition to other injuries his skull was fractured. 6. A painter and grainer, aged 53 years, from Guinness' Buildings, cut his throat at Shoreditch Railway Station during a fit of temporary insanity. 7. A stick finisher, aged 54 years, from Abbey Street, died from chronic heart disease in St. John's Road, Shoreditch. 8. A glass beveller, aged 29 years, from Garden Place, was run over and crushed to death by a motor bus in High Street, Shoreditch. 9. The wife of a caretaker, aged 65 years, from Wilmot Street, died at a factory in Sylvester Road, Hackney, from apoplexy due to cerebral hoemorrhage. She had broken a rib in an accidental fall some time previously. 15 10. A chair maker, aged 57 years, from Old Bethnal Road, was found drowned in the River Lea, near Robin Hood Inn, Hackney. 11. The seven-years-old son of a labourer, of Felix Street, was suffocated by drowning in the Regent's Canal near Cambridge Road Bridge. He had been playing on the towing path with some other boys. By the instructions of the Local Government Board the term "Non-resident" has in the past included only such persons as have been brought into the district on account of sickness or infirmity, and have died in Public Institutions therein. Strictly speaking, therefore, only 396 deaths of non-residents should have been excluded, and no account should have been taken of the ten strangers who died suddenly in Bethnal Green Public places; but as eleven of our inhabitants were similarly unfortunate in other parts of London, whilst away from home, these almost exactly balance the stranger deaths, and the total figure remains practically unaltered. It is therefore immaterial for statistical purposes, in this instance, whether they are included or not. New tables have been designed by the Local Government Board, and the two classes of non-resident deaths will in future reports be included under the heading of "transferable deaths," 16 The following table shews the present arrangement:— Residents. Total deaths registered 2,034 Sudden deaths outside the Borough 11 Deaths in Institutions outside Borough 364 2,409 Non-residents. Sudden deaths of strangers in Borough 10 Deaths of strangers in Bethnal Green Public Institutions 396 406 Total 2,003 TABLE B. Public Institutions, situated outside the Borough, into which Bethnal Green residents have been received and where they have subsequently died:— Banstead Asylum 4 Bromley Sick Asylum 2 Cancer Hospital, Chelsea 1 Caterham Asylum 1 Children's Hospital, Carshalton 5 Children's Hospital, Great Ormond Street 4 Claybury Asylum 6 Colney Hatch Asylum 7 Darenth Asylum 2 Dartford Heath Asylum 5 Eastern Hospital, Homerton 20 East London Hospital, Shadwell 11 17 TABLE B—continued. French Hospital, Victoria Park 1 Friedenheim Hospital 2 Guy's Hospital 4 Hackney Infirmary 2 Hanwell Asylum 4 Horton Asylum 1 Infants' Hospital, Vincent Square 1 Leavesden Asylum 8 London Hospital 201 Long Grove Asylum 3 Metropolitan Hospital 4 Middlesex Hospital 1 Mildmay Memorial Hospital 1 National Hospital 1 National Hospital for Diseases of the Heart 1 New Home for Women, St. Pancras 1 North-Eastern Hospital, Tottenham 10 Royal Chest Hospital, City Road 1 Royal London Ophthalmic Hospital 1 Royal Hospital for Incurables 1 St. Bartholomew's Hospital 17 St. George's Hospital 1 St. Joseph's Hospice, Hackney 3 St. Luke's House, Kensington 2 St. Thomas's Hospital 1 South-Eastern Hospital 10 Southwark Infirmary 1 Shoreditch Infirmary 3 Tooting Bee Asylum 5 West End Hospital 1 Whitechapel Infirmary 3 364 18 TABLE C. Public Institutions in Bethnal Green. institution. beds available. in-patients treated. deaths— residents. deaths— non-residents. out-patients treated. City of London Hospital for Diseases of the Chest 170 1,096 8 42 12,379 Queen's Hospital for Children, Hackney Road 134 1,970 101 297 32,975 Mildmay Mission Hospital 50 579 18 15 12,423 Bethnal House Asylum 300 - 4 28 - Bethnal Green Infirmary 669 2,979 575 15 — National Children's Home and Orphanage 349 — 2 — — 19 In the North-East Sub-District 985 deaths occurred amongst the residents and 989 in the South-West. Twenty-nine persons who had no fixed home died in the Workhouse or in the Infirmary. TABLE D. District. Deaths. Population. North-East 985 66,134 South-West 989 65,445 Previous residence unknown 29 — Total 2,003 131,579 DEATH RATE. Upon the population of Bethnal Green, as estimated by the Registrar-General, we shew a mortality for the year 1910 of 15.23 per thousand; but as I am of opinion that our population has been over-estimated for several years past, the actual mortality is probably somewhat higher. This recorded death rate of 15.23 is 1.5 below the calculated death rate of the previous year, which was 16.73; but it is two points and a half above the rate for the whole of London, which is 12.71 per thousand. MORTALITY RATES IN SUB-DISTRICTS. The death rate in the North-East sub-district was 14.9, and that in the South-West was 15.1. These rates take no account of the deaths of homeless persons in the Infirmary, as it is impossible to allocate them to districts. 20 Table E shews the mortality rates for Bethnal Green and for London, compared by months, the rainfall and mean temperature for each month also being shewn. TABLE E. Month. London Death Rate. Bethnal Green Death Rate. Mean Temperature (Degrees). Rainfall (Inches). (Per Thousand) January 14.7 18.2 39.9 1.57 February 16.4 16.8 42.3 2.96 March 13.8 17.0 43.5 0.97 April 13.9 13.8 48.0 2.24 May 12.4 12.6 55.7 2.22 June 10.7 13.0 62.8 2.17 July 10.6 9.3 60.8 2.53 August 10.5 13.6 62.6 1.64 September 12.0 13.7 57.9 0.58 October 12.6 15.0 54.5 2.00 November 17.2 21.9 38.9 3.19 December 15.5 17.8 44.4 3.29 Average 13.4 15.2 50.9 Total Rainfall 25.36 21 The next table compares the death rates for Bethnal Green and for London by Quarters:- TABLE F. Quarter ending. London. Bethnal Green. April 2nd, 1910 14.3 17.3 July 2nd, 1910 11.6 13.2 October 1st, 1910 10.3 12.3 December 31st, 1910 14.7 18.5 Yearly average 12.7 15.3 BIRTH RATE. The births actually registered in Bethnal Green during the year numbered 4,040, but to these must be added the 168 Institution births away from home. This addition raises the total to 4/208, which is equal to a rate of 31.98 per thousand population, and is slightly above that of the previous year, which was 31.47, the highest of all rates for the Metropolitan Boroughs. The general London birth rate continues to decrease, and now stands at 23.6, the lowest on record. The birth rates and death rates in the two registration sub-districts are placed together in the following table for purposes of comparison:— 22 TABLE G. Sub-district. Birth Rate. Death Rate. North-East 30.4 14.9 South-West 33 5 15.1 TABLE H. Marriages. First Quarter 197 Second Quarter 182 Third Quarter 299 Fourth Quarter 330 Total 1,008 These figures indicate a marriage rate of 15.3 per thousand, as against 16.0 in the County of London. DEATHS OF INFANTS. Nearly one-fourth of the total deaths at all ages were those of infants under one year. These numbered 516, giving an infantile death rate of 122.6 per thousand births. We continue to show some improvement in this direction over past years, for our mortality has fallen three points below that of 1909; but, unfortunately, we are still twenty per thousand above the general Metropolitan rate, which has fallen to 103, as against 108 for the previous year. 23 A comparison of the causes of infantile mortality in 1910 with those in the preceding year shews an increase in premature births and respiratory diseases. The mortality from diarrhceal diseases has diminished from 20 per cent, of the total infantile deaths to about 13 per cent. The deaths from respiratory diseases number 102,19.7 per cent, of the whole number. The influence of meteorological conditions is an important factor in the causation of deaths from these two last named diseases, for whilst wet, cool weather, such as was prevalent last summer, checks the distribution of germladen dust—a potent cause of diarrhoea—these conditions do not favour recovery from Bronchitis and Pneumonia. INFANTILE TUBERCULAR DISEASE. Various forms of tuberculosis caused nineteen deaths, a mortality of 4.5 per thousand births. Nine of these deaths were from Tabes Mesenterica, and nine from Tubercular Meningitis. SUFFOCATION. The deaths from suffocation (overlaying) numbered 26, nine fewer than those of the previous year. If a child be prematurely born, injured at birth, or so deformed or undeveloped as to be incapable of prolonged existence, it usually dies within a week of its birth. Seventy-six out of the 87 deaths in this first week were due to the causes I have named; five other infants were suffocated in bed, and two died from convulsions. 24 The deaths in this fatal first week form 16.8 per cent, of the total infantile mortality. Inclusive of these, 29 per cent, died in the first month, 12 per cent, in the second, and 8 per cent, in the third. In the table below the principal causes of infantile deaths are tabulated, so as to shew the mortality attributable to each, as compared with the total number of births:— SPECIAL CAUSES OF INFANTILE DEATHS. Total. Rate per thousand births Premature birth and congenital defects 126 29.9 Respiratory diseases 102 24.2 Diarrhœal diseases 66 15.7 Wasting diseases 59 14.0 Convulsive diseases 40 9.5 Common infectious diseases 37 8.8 Suffocation 26 6.2 Tubercular diseases 19 4.5 THE CAUSATION OF EXCESSIVE INFANTILE MORTALITY The minds of many of our most thoughtful Councillors have been much exercised upon the infantile death rate for Bethnal Green. The fact that this death rate is exceeded in some neighbouring Boroughs is no excuse for inactivity on our part, and it was universally felt that an effort should be made to reduce this heavy death-toll. Many meetings and conferences have been held, with a view to devise some plan of action, but I regret to say that nothing practical has at present been accomplished*. 25 *Report of the Public Health Committee, dated the 29th March, 1911. Infantile Mortality. Further and very careful consideration has been given by the Committee to the important question of the reduction of the rate of infantile mortality in the Borough, especially in view of the reference to the Committee, of the 5th January last, from a Committee of the whole Council which met to consider the subject. Since April, 1908, the subject has from time to time been before the Committee, but, the Council having no power to incur expenditure in dealing with the matter beyond that involved in the appointment of Health Visitors, we have considered as to the prospect of useful assistance and necessary aid being afforded apart from the Council. As it appears that no effectual work is being done, we are strongly of opinion that it is now time that the Council should, as the Sanitary Authority of the Borough, recognise that some steps must be taken to deal with the matter. The London County Council (General Powers) Act, 1908, confers upon the Council the power to appoint suitable women (to be known as "Health Visitors") for the purpose of giving to persons advice as to the proper nurture, care and management of young children, and the promotion of cleanliness, and the discharging of such other duties as may be assigned to them in accordance with the regulations of the Local Government Board. The London County Council may contribute any sum not exceeding one-half of the salary of any person appointed as a Health Visitor. Further than this, the Council has no power. That being so, it is the intention of members of the Committee to take action to establish a Committee to afford aid in the direction of the care of infants, assistance to expectant and nursing mothers, the provision of a school for mothers, the establishment of creches, midwifery kits and like matters. Having regard to the importance of the subject, it is hoped that many members of the Council will join the proposed Committee, and endeavour to secure the active personal services of other persons. We also propose that the Committee to be formed should act upon the official information obtained by the Public Health Committee. In order to secure the objects we have in view, we feel that better and fuller provision should be made for dealing with the notification of births received under the Notification of Births Act, 1907, and that this and other necessary work to be undertaken require the appointment of a Health Visitor. We think that, if two persons were engaged upon this work, the Borough could be divided between the present Female Sanitary Inspector and a Health Visitor, and that useful and necessary work in the public interest might then be accomplished. We, therefore, Recommend— (i.) That the Council authorise the Public Health Committee to take the necessary steps to proceed to the appointment of a suitable person as Health Visitor, at a salary of £100 per annum, rising by annual increments of £5 to a maximum salary of £120 per annum, pursuant to the provisions of section 6 of the London County Council (General Powers) Act, 1908, and the Health Visitors (London) Order, 1909. (ii.) That, in order to assist the project of members of the Public Health Committee in regard to the establishment of a Committee to obtain funds and 26 to supplement the official work of the Public Health Committee, the Council grant the free use of the Town Hall for meetings and other purposes in connection with the establishment of the proposed Committee. Extract from Council's Minutes, 4th May, 1911. (d) Infantile Mortality. At the Council Meeting on the 6th April, 1911, the report of the Public Health Committee, dated the 29th March, 1911, was referred back to the Committee for further consideration and report. We have again given further and very careful consideration to the important question of the reduction of infantile mortality in the Borough. Since April, 1908, the subject has from time to time been before the Committee, bat, the Council having no power to incur expenditure in dealing with the matter, beyond that involved in the appointment of Health Visitors, we have considered as to the prospect of useful assistance and necessary aid being afforded apart from the Council. As it appears that no effectual work is being done, \*e are strongly of opinion that it is now .time that the Council should, as the Sanitary Authority of the Borough, recognise that some steps must be taken to deal with the matter. The London County Council (General Powers) Act, 1908, confers upon the Council the power to appoint suitable women (to be known as "Health Visitors") for the purpose of giving to persons advice as to the proper nurture, care and management of young children, and the promotion of cleanliness, and discharging such other duties as may be assigned to them in accordance with the regulations of the Local Government Board. The London County Council may contribute any sum not exceeding one-half of the salary of any person appointed as a Health Visitor. Further than this, the Council has no power. That being so, it is the intention of members of the Committee to take action to establish a Committee to afford aid in the direction of the care of infants, assistance to expectant and nursing mothers, the provision of a school for mothers, the establishment of creches, midwifery kits and like matters. Having regard to the importance of the subject, it is hoped that many members of the Council will join the proposed Committee and endeavour to secure the active personal services of other persons. We also propose that the Committee to be formed should act upon the official information obtained by the Public Health Committee. In order to secure the objects we have in view, we feel that better and fuller provision should be made for dealing with the notification of births received under the Notification of Births Act, 1907, and in order to give fit and proper attention to all birth cases, we are of opinion that the appointment of an official Health Visitor will eventually become necessary. In the event of the successful establishment of the proposed Committee, it is the intention of this Committee to recommend to the Council the appointment of a suitable person as Health Visitor. We now Recommend—That in order to assist the project of members of the Public Health Committee in regard to the establishment of a Committee to obtain funds and to supplement, the official work of the Public Health Committee, the Council grant the free use of the Town Hall for meetings and other purposes in connection with the establishment of the proposed committee. (Adopted.) J. W. Ward, Chairman. 27 In December, 1909, an order of the Local Government Board put in force in Bethnal Green the Notification of Births Act, 1907. When this came into effect, the Public Health Committee resolved to relieve Miss Harris, our Woman Sanitary Inspector, of all duties in connection with workshops and out-workers, and she was directed to concentrate her efforts upon the visitation of maternity cases reported under the Act. As will be seen from Miss Harris' report (herewith p. 31) a total of 3,859 births has been reported and 2,825 visits have been paid. The time at the Inspector's disposal has permitted her to visit only about half the number reported and to re-visit a much smaller proportion. Assistance in re-visiting was offered by the members of the Bethnal Green Health Society. Unfortunately, these ladies are quite untrained in Sanitary work, and as the funds at the disposal of the Society are only sufficient for their own needs, they are unable to offer help in necessitous cases. The matter was discussed at several meetings of the Public Health Committee, but the opinion formed by the members was that such assistance as could be given by the Health Society was of very limited utility, and the offer was declined. I must confess that I am not particularly in favour of amateur inspection, moreover, I feel sure that what is really required in this connection is not so much visitation and advice as something very much more substantial. Some of the accounts of grinding poverty discovered by Miss Harris are very painful reading, but the funds at our disposal, provided by a few charitable friends, are utterly inadequate for the relief of any but 28 the very worst cases. Should Mr. Lloyd George's praiseworthy effort prove successful, and his Invalidity Bill become law, the proposed 30s. maternity allowance will go far towards the solution of the infantile mortality problem in Bethnal Green. Dr. Arthur Newsholme, the Chief Medical Officer of the Local Government Board, has recently issued a most valuable report upon the subject under consideration. Dr. Newsholme points out that excessive infant mortality implies excessive child mortality, which is continued into adult life, that is to say, numbers of infants maimed by illness survive the first year of life but subsequently succumb and swell the mortality of after years. Dr. Newsholme says in his report "Insanitation, including overcrowding, is a serious cause of disease, and disease in its turn is an important cause of poverty Hence, by a vigorous campaign against the conditions producing disease, such poverty can be prevented; alcoholism and consequent neglect of children can be diminished, and child mortality can be lowered. And this remains true, although it is also true that poverty, alcoholism and moral defects are fertile sources of excessive child mortality. A vicious circle has one excellent virtue: it can be snapped at different points, as opportunity serves, and the sequence of events can thus be inhibited. The greatest hope of success is secured when workers at different parts of the circle co-operate for the common end." The remedies recommended by Dr. Newsholme are A more detailed investigation of all deaths occurring in infancy, with a view to ascertaining the exact cause thereof for future guidance; enquiries into the circumstances of still-births; 29 the adequate training of midwives and their careful supervision; the making of arrangements for giving instruction to wives in mother-craft and infant hygiene; and, above all, efficient domestic and municipal sanitation and housing. I extract the following remarks from a paper, by Dr. Fremantle, on the interaction of death, birth, and marriage rates. Having first demonstrated the fact that, so far as England is concerned, fertility is still highest in rural counties and lowest in London, despite the effect of overcrowding in houses and areas, the speaker continued:— "Let us, then, briefly consider the quality of the decline (in the birth-rate). University College of the University of London issued in 1906 the first of the studies in national deterioration from its department of applied mathematics, in which Heron showed results of superlative interest as to the relation of human fertility to social status during the years 1851 to 1901. They may be summed up as follows : 1. In 1901, in homes where many domestic servants are kept, there the married women have fewest children. This relation is exceedingly close. 2. Prevalence of cancer, especially amongst females, is associated with a low birth-rate. 3. Where labour is of the lowest type, where poverty leads to the pawnbroker and forces the child at an early age into employment, there the married women have most offspring. 30 4. The greater the overcrowding, and the prevalence of phthisis and pauper lunacy, the higher is the birth-rate. 5. Poverty, drunkenness, and absence of thrift are associated with high infant mortality and high birth-rate. 6. About half of this difference in productivity between the poor and the well-to-do is due to difference in age of the wives; the other half to lesser fertility, or to a lessened exercise or deliberate restraint of fertility on the part of the well-to-do. 7. The association of undesirable social conditions and high birth-rate has doubled in intensity during the last fifty years. 8. Fifty years ago districts with the highest birth-rate had the lowest infant mortality. 9. Fifty years ago the difference of birth-rate in districts of different social status was accounted for by the difference in mean age of wives. During these fifty years the relation between low social status and high birth-rate has doubled in intensity, and half the difference between districts of different social status is now due to a reduced nett fertility in the more cultured, more prosperous, healthy and thrifty classes of the community. Karl Pearson has shown that 25 per cent, of the married population produce 50 per cent, of the next generation. It follows, therefore, that in increasing degree our nation is being stocked from its less prosperous classes. As prosperity is in general the result of ability, and as heredity of character and ability is beyond dispute, the nation is degenerating in the quality as well as in the quantity of its birth rate." 31 NOTIFICATION OF BIRTHS ACT, 1907. The total number of births registered in Bethnal Green during 1910 was 4,040. Only 3,859 births were properly reported to me on the post cards supplied to doctors, midwives and hospitals, but as this number includes 116 still births, which are not registerable, some six or seven per cent of the births last year were not notified, and the law was disobeyed to this extent. When the Act first came into operation I requested the Public Health Committee to sanction the supply by the Local Registrars of weekly lists of births, but this was refused on the ground of expense, some £30 per annum. In the absence of the particulars contained in these lists I am unable to identify the defaulters, but the district registrars from time to time examine my records, and have on several occasions supplied me with lists of some of these. By the direction of the Public Health Committee the parent or guardian in each case was written to or visited ; in most instances lapse of memory or ignorance of the law was pleaded as an excuse, but several of the addresses as registered were found to be incorrect. Further particulars as to the working of the Act will be found in Miss Harris' report. 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 1910. 32 The Notification of Births Act has now been in force here for a complete year, and it was obvious that the work in connection with it would be of a very pressing nature. Therefore, my time has been devoted during this year entirely to the visitation of newly-born infants and their mothers. The number of visits paid was as follows:— After notification of births 2,107 Re-visits 468 Visits for special reasons (puerperal fever, poverty, illness of infants, etc.) 201 Enquiries after deaths (diarrhœa and others) 49 Total number of visits 2,825 During the year birth notifications to the number of 3,802 were forwarded to this Department, of which 3,184 were sent by attendant (doctor or midwife). 563 ,, ,, relatives. 55 „ „ person not stated. 3,802 The mothers were attended in their confinements By doctors 1,124 By midwives 1,357 By students from London Hospital 1,237 By whom not stated 84 3,802 33 The infants born were Boys 2,003 Girls 1,791 Sex not stated 65 3,859 It will be seen that the number of births exceeds the number of notifications. The reason is that twins are notified on one card. Two sets of triplets were born during the year, two boys and a girl, all stillborn; and three girls, born alive. Two of these died in a few days, but one lived. There were also 53 pairs of twins, 29 pairs of the same sex, and 24 boy and girl twins. The stillbirths notified numbered 116, but this information is very frequently not given, though asked for on the cards. In addition to the above, 168 births belonging to Bethnal Green have been notified as having occurred in various institutions outside the Borough. About the very large majority of infants visited there is no special remark to make—they are just average nice babies, whose mothers love them and take able care of them that they may grow up into healthy and strong boys and girls. With our high birth rate, and our 70-80 (or even more) birth notifications every week, it is not possible to re-visit many, so that this is not done unless there is some good reason, such as illness, great poverty, or assistance given in food or clothing, or at the request of the mother. Undoubtedly 34 many who start well need keeping up to the mark; and many more are glad of a word of advice or ment from time to time, and would benefit by more visits than are at present possible. The mothers quently ask if there is any arrangement in this Borough for the supply of milk for infants, or for having them weighed. They know that in some places such things are or have been done and they seem to expect body to take an interest in their babies. They are now always invited to bring them to the Town Hall any morning from 9 till 10.30, and quite a number do come. It is hoped that their numbers will increase, for in this way one could keep in touch with them with the least expenditure of time. The visitation of infants continues to disclose a large amount of poverty and distress. It is really marvellous that many of the mothers manage as well as they do on their small and uncertain means. It is wonderful, too, that so many of the babies when born are such fine children; but the result of the mothers' hard lives is to be found in the constantly repeated tale of inability to nurse their children long, and the fact that so many of the babies waste after birth. Many of them are little, if any, bigger when three months old than they were at two and three weeks. There may be another reason for this in the fact that so many women, when they find they are to become mothers again, try to prevent it. This fact also, doubtedly, has something to do with the large number of still-births which occur, and the number of infants who die within a few days of birth. My information on this 35 point is derived from the women themselves, and I am convinced that the practice is a very common one. Sometimes they make themselves so ill that one experience serves as a lesson for a lifetime, but many of them have recourse to it again and again. It is not only themselves that they hurt, but very often the baby is born after all, perhaps crippled, or it may be without vitality, or half poisoned. It is hardly to be wondered at that they should do these things, for they have such small means, and often such large families. Bight, ten, or twelve children are frequent, fifteen or sixteen not uncommon; and I saw one woman who had had twenty. The poor mothers spend all their lives "going without"; for husband and children are fed and clothed before the mother gets a chance, and she is continually under-fed and over-worked. Each new baby is one more to be kept, but when it has arrived they do not want to lose it. Women have informed me during this year that they have taken drugs and other things as follows:— Hikery Pikery Powder. Diachylon (Lead Plaister). Aloes. Aloes and Grin (hot). Beecham's Pills. "Female" Pills. Gin and Nutmeg, which is taken scalding hot. One woman takes hot Mustard baths, and many others purposely fall down stairs or off chairs. The large majority of the newly-born babies are breast-fed; the number in 1910 was 1285, as compared with 76 hand-fed infants and 13 partly so fed. This was, of course, between two and three weeks after the 36 birth. For the hand-feeding at this early age there was in each case some sufficient reason; e.g., doctor's advice, the mother's health, or deformity on the part of the mother or child. The mothers who were partly breast-feeding their infants thought the babies were not satisfied, or they had not sufficient milk. If the ments made by the mothers are to be believed, they would prefer to nurse their infants; but they often lose the milk when getting about again after confinement, though there is usually an ample supply while they main in bed. It has been found that when milk could be obtained for the mothers they have been encouraged and enabled to persevere with breast-feeding, and both mother and baby have improved in health. It will be remembered that in the end of 1909 and the early part of 1910, the Lady Mayoress' (Lady Knill's) Fund for God's Poor, did such a large amount of good in our poor midwifery cases. Since that fund closed we have had most generous help from the Mayor's Fund lished in the Borough; and that good is done in this way is proved by the fact that the babies put on flesh and gain in weight while the help is continued, times, unfortunately, falling away again when it is stopped. It should be mentioned, too. that the Virol Company has allowed a regular supply of their food for ten months to one of our babies, who was found in an almost dying condition. The mother herself was starved and was only able to nurse the baby for a few weeks. Milk was obtained for the child in addition to the Virol, and, though somewhat delicate and not up to standard in weight or size, he is now a plump, solid, baby. 37 The cards of advice to mothers are usually received with an appreciative remark, but they are not kept. The new cards (differing in size and shape from those we had at first) are much better liked than the original ones were, so they may meet with better treatment. They are also certainly much more convenient for carrying on one's round. Diarrhæa Deaths. With regard to the deaths of children under one year from this complaint, 27 visits were paid by me. The feeding was as follows:— Breast-fed 8 Partly breast-fed 5 Hand-fed— Cow's milk 7 Condensed milk 2 Condensed milk with patent food 1 Four diarrhoea deaths were those of children who had been for some time in hospitals or Infirmary, and concerning whose food, therefore, no information was obtained. During September and October 8 babies were brought to me suffering from this illness. As my time was being devoted to infants, I felt justified in giving a good deal of it to these sick babies So I saw that they had medical advice (Dr. Taunton was good enough to see two of them for me, and you will remember that you saw and prescribed for one yourself; the others were taken to a doctor or hospital by the mother), and then 38 that, the mothers understood and properly carried out the instructions given them. They were visited daily while ill and, when necessary, more than once a day; and I am happy to say that seven of them recovered. The one that died had heart disease in addition to the diarrhoea, and would probably not have lived in any case. One which caused a good deal of anxiety was a twin, and very weak and delicate. Eventually he went into hospital for seven weeks, and on his discharge he was very much better. Employed Mothers. Two hundred and sixty five of the mothers called upon were found to have been employed before confinement, and though quite a number were hoping not to have to resume their work, eventually most of them would do so. The reason almost invariably given for the mothers earning money at all is that there is nothing coming in for household expenses, or that the income is inadequate for the purpose. A larger number of the mothers of young children have been interviewed during this year than in any previous one, but there is no reason to depart from the conclusion before arrived at with regard to the number of mothers who are industrially employed, as will be seen from the following table:— Mothers Industrially Employed. Year. Percentage of total number visited. 1906 12 1907 16.9 1908 15 1909 17 1910 12.2 39 The sanitary conveniences provided at the stations in the Borough for the use of ladies have been periodically inspected, and have on each occasion been found in reasonably good condition. I am, Sir, Yours obediently, A. K. HARRIS (Sanitary Inspector). DEATHS OF YOUNG CHILDREN. The deaths of young children aged less than five years, including infants, numbered 743; they form 37.1 per cent. of the deaths at all ages. This is equivalent to a rate of 41.3 per thousand of the estimated population of young children. With a view to ascertaining the effect of an excessive infant mortality upon subsequent child life, the following table has been constructed. It shews the yearly death rates of children aged over one year and under five, calculated upon the estimated population of young children, as compared with infantile mortality rates calculated upon the births in each year. 40 TABLE I. Year. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. Average. 1910. General Death Rate on Population 21.7 20.2 21.1 18.1 19.1 18.6 18.8 17.4 17.1 16.7 18.8 15.3 Child Mortality (over one and under five) calculated on mated population of young children 23.3 23.1 24.8 21.2 20.1 19.3 20.1 17.8 19.4 16.5 20.5 12.6 Infantile Mortality calculated on Births 168 153 155 141 157 151 157 138 131 128 148 123 41 TABLE J. Quarterly Mortality for the Borough of Bethnal Green. 1910. Estimated Population in the middle of 1905. Births. All Causes Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Pyrexia. Diarrhœa. Phthisis. Deaths of Infants under one year of age. All Causes. Principal Epidemic Diseases Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Pyrexia. Diarrhœa. Phthisis. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 April 2nd 131,579 1,059 568 — 13 1 5 15 — 1 — 6 52 138 17.3 1.25 — 0.40 0.03 0.15 0.46 — 0.03 — 0.18 1.59 July 2nd 131,579 1,030 432 - 25 5 3 7 - — — 6 45 103 13.2 1.39 — 0.76 0.15 0.09 0.21 — — - 0.18 1.37 October 1st 131,579 972 402 — 13 3 5 5 - 7 — 22 32 119 12.3 1.67 — 0.40 0.09 0.15 0.15 — 0.21 — 0.67 0.98 December 31st 131,579 979 608 — 8 — 7 8 - 10 - 17 59 157 18.5 1.51 — 0.24 — 0.21 0.24 — 0.30 — 0.52 1.80 131,579 4,040 2,010 — 59 9 20 35 - 18 — 51 188 517 15.3 1.45 — 0.45 0.07 0.15 0.26 — 0.13 — 0.39 1.43 42 TABLE K. Quarterly Mortality for the County of London. 1910. Estimated Population in the middle of 1905. Births. All Causes. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever Pyrexia. Diarrhœa. 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. Pyrexia. Diarrhœa. Phthisis. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 April 2nd 4,872,702 29,719 17,327 — 247 73 126 589 — 35 2 137 1557 3011 14.3 0.98 — 0.20 0.06 0.10 0.48 — 0.03 0.00 0.11 1.28 July 2nd 4,872,702 30,257 14,094 — 542 50 72 446 — 28 1 165 1288 2651 11.6 1.08 — 0.45 0.04 0.06 0.37 — 0.02 0.00 0.14 1.06 October 1st 4,872,702 28,404 12,504 — 348 50 91 196 — 50 1 639 1121 2575 10.3 1.13 - 0.29 0.04 0.07 0.16 — 0.04 0.00 0.53 0.92 December 31st 4,872,702 27,847 17,831 — 843 41 145 131 — 83 — 427 1590 3572 14.7 1.37 — 0.69 0.03 0.12 0.11 — 0.07 — 0.35 1.31 4,872,702 116,227 61,756 — 1980 214 434 1362 — 196 4 1368 5556 11,809 12.7 1.14 — 0.41 0.04 0.09 0.28 — 0.04 0.00 0.28 1.14 43 SENILE MORTALITY. The number of persons aged over 65, who died during the year, numbered 414, a proportion of twenty-one per cent of the total deaths at all ages. This gives a death rate of 72.1, calculated upon the estimated population of elderly persons. WEEKLY MORTALITY. The usual charts shewing the numbers of deaths week by week in the Borough will be found on the next page. The figures are corrected for institution deaths. QUARTERLY AND ANNUAL DEATHS AND MORTALITY RATES. Tables J and K overleaf shew, in addition to actual numbers of deaths, the quarterly and annual rates of births and deaths, also mortalities from the principal Zymotic diseases and from Phthisis. THE PRINCIPAL ZYMOTIC DISEASES. The deaths recorded as from diseases included in this group, and upon which the zymotic mortality is calculated, numbered 182 against 254 in 1909, a decrease of 72. Nearly all the fever and diphtheria deaths occurred in hospitals, as will be seen from the following table:— 44 TABLE L. Disease. Deaths at Home. Deaths in Hospitals. Total. Small-Pox - - - Scarlet Fever - 9 9 Diphtheria 2 18 20 Enteric Fever 6 12 18 Erysipelas 2 2 4 Puerperal Fever 1 7 8 Measles 54 4 58 Cerebro-Spinal Meningitis 2 1 3 This decrease of seventy-two in the total number of Zymotic deaths for the year 1910 is also 133 below the decennial average of the ten years 1900—1909. Table VI in the appendix shews this average to be 315. The next table M compares the deaths from each of the zymotic diseases in the two years 1909 and 1910; it shews that there was a marked decrease in three out of the six diseases, whilst the only one shewing increase was Enteric Fever. This disease was epidemic in East London during the autumn, when it caused 18 deaths in Bethnal Green as against only four in the whole of 1909. 1910. Deaths From all causes. 45 TABLE M. Disease. 1909. 1910. Measles 78 58 Scarlet Fever 25 9 Diphtheria 20 20 Whooping Cough 37 34 Enteric Fever 4 18 Diarrhœa 90 43 Totals 254 182 The death rate from these zymotic diseases is 1.38 for 1910 against 1.93 for the previous year. The corresponding Metropolitan rates are 1.36 and 1.14. Table N shews the percentage of deaths from each disease on the total number of zymotic deaths. TABLE N. Measles caused 58 deaths, 31.8 per cent. or 1 in 3.1 deaths. Scarlatina „ 9 „ 4.9 „ „ 20.2 „ Diphtheria „ 20 „ 10.9 „ „ 9.1 „ Whooping Cough „ 34 „ 18.7 „ „ 5.3 „ Typhus Fever „ - „ - „ „ - „ Enteric Fever „ 18 „ 9.8 „ „ 10.1 „ Simple Fever „ — „ - „ „ — „ Diarrhœa „ 43 „ 23.6 „ „ 4.2 „ 46 NOTIFICATION OF INFECTIOUS DISEASES. The total number of certificates forwarded to me by Medical Practitioners in accordance with Sec. 55 of the Public Health (London) Act, 1891, was 814. Two of these referred to addresses outside Bethnal Green, and were of course referred to the proper authority; in another instance a practitioner notified a case in error and withdrew his certificate; and one certificate was cancelled at the request of the notifying practitioner, as the case had been previously reported by a colleague at the same Institution. 93 certificates (11.4%) were duplicates, so that the actual number of cases of infectious disease reported and dealt with was 721, a rate of 5.5 per thousand on the estimated population. Table III 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 of those removed to the hospital (516). During the year the London County Council made an Order extending the notification of Cerebro-spinal Meningitis for a further period of twelve months as from and including the 13th of March, 1910. In 55 instances information was received from one of the Medical Superintendents of the Metropolitan Board Hospitals to the effect that the diagnosis, as stated on the notification certificate, was incorrect, a proportion of 7.6 per cent on the whole. Table O gives full details of all the notifications. 47 TABLE O. Nature of Disease. No. of Certificates received. Duplicate Certificates received. Actual number of cases reported. Treated at Home. Removed to M. A. B. Hospitals. Treated at other Hospitals and Infirmary. Diagnosis incorrect. Small Pox — — — — — - - Diphtheria 179 6 173 5 153 15 32 Membranous Croup 8 — 8 — 6 2 — Scarlet Fever 244 8 236 14 218 4 20 Typhus Fever — — — - — — - Enteric Fever 115 7 108 9 63 36 2 Continued Fever 1 — 1 - 1 — 1 Relapsing Fever — — — - - - — Puerperal Fever 19 6 13 1 — 12 - Erysipelas 240 66 174 — — - — Cerebro-Spinal Meningitis 7 — 7 2 1 4 — Anthrax 1 — 1 — — 1 - Totals 814 93 721 31 442 74 55 48 TABLE P. Condition of Premises wherein Cases of Infectious Disease have occurred during 1910. Scarlet Fever. Diphtheria. Enteric Fever. Satisfactory 133 91 49 W.C.'s or apparatus defective 10 8 5 Internal drainage defective 5 1 2 External drainage defective 3 13 5 Minor Insanitary defects 66 59 28 Single room tenements 16 19 10 Overcrowded 2 2 1 SCARLET FEVER. Deaths 9. (Decennial average 26). A very mild type of Scarlet Fever prevailed during the year, and only 236 cases were reported, not half so many as in the previous year. All the patients except fourteen were removed to hospital, where nine died. I visited the cases remaining at home and satisfied myself that they were sufficiently isolated. All of these recovered. The case fatality on the whole number treated in hospital was 4.5 per cent. Twenty of the patients removed to hospital were found not to be suffering from scarlet fever and are therefore excluded from this calculation. 1910. Scarlet Fever. 1910. Diphtheria. 49 Five of the fatal cases were amongst young children aged less than five years and the other four were under fourteen. Our scarlet fever death rate is equal to 0.07 per thousand population, whilst that of London is 0.04, 134 of the cases were reported from the North-East subdistrict and 102 from the South-West. The Inspectors report that the homes of 133 of the patients were in a fairly satisfactory condition, but in ten instances the W.C., or the apparatus connected therewith, was found to be defective. The drainage was leaky in eight instances, and minor insanitary defects were noted in sixty-six. Sixteen persons were removed from single room tenements, two of which were overcrowded. DIPHTHERIA. Deaths 20. (Decennial average 35). Diphtheria was notified in 179 cases, and eight children were certified to be suffering from Membranous Croup, a total of 187; of these 158 were removed to Metropolitan Asylums Board Hospitals, and fifteen others, most of them requiring immediate operation, were treated in other hospitals. Five cases remained at home, where two of them died. So far as I can ascertain, these two did not receive the benefit of anti-toxin injection; the other three were very mild cases, and call for no special remark. In thirty-two instances a notification was received from the Metropolitan Board Hospital Superintendents to the effect that the diagnosis, as stated on the certificate, was incorrect. Of the 166 true cases of 50 diphtheria treated in hospital, 18 died, a case mortality of 10.8 per cent. as against 9.4 amongst the whole of the cases treated at the Asylums Board Hospitals during the year. All the diphtheria deaths, except six, were amongst young children aged less than five years. The diphtheria mortality in Bethnal Green was 0.15 per thousand living, as against 0.09 for the whole of London. Eighty-seven of the cases were reported from the North-East sub-district, and ninety four from the South-West. During the year the Local Government Board placed the gratuitous supply of anti-toxin on a satisfactory basis by issuing an order (vide Appendix) authorising the provision of this serum both for curative and prophylactic purposes. By direction of the Public Health Committee, a supply of anti-toxin was obtained and placed at the disposal of practitioners in the district, and the following circular was issued:— Metropolitan Borough or Bethnal Green. Public Health Department, Cambridge Road, N.E. Dear Sir, A supply of Diphtheria anti-toxin is now kept at this Office and is available for (gratuitous) use by medical gentlemen practising in the Borough, for the poorer inhabitants thereof. You are probably fully aware of the great reduction in the mortality of diphtheria due to the use of anti-toxin, but this great benefit is most marked when the remedy is used at the 51 possible moment. The prompt administration of anti-toxin before the patient is removed to hospital may, especially if delay in removal is inevitable, go far towards preventing the attack of diphtheria from being fatal. The injection should be made directly the clinical symptoms of diphtheria are apparent, and without waiting for the result of a Bacteriological examination of swabs from the throat. In the event of your requiring to administer anti-toxin, application for a supply should be made at this Office by messenger between the hours of 9 a.m. and 5 p.m. All applications must state the name and address of the patient and the number of units required, (the stock being held in tubes of 2,000 units each), and be signed by a registered medical practitioner. Yours faithfully, GEORGE PADDOCK BATE, M.D. Medical Officer of Health. The serum proved most useful in an epidemic of diphtheria at the Children's Home, Bonner Road. The Medical Officer to the Institution remarks in his report; "I have no hesitation in stating that the antitoxin injection proved of great value in treating the disease in the patients attacked; in fact, no case m which I used the anti-toxin has been fatal." 52 There are about 320 children in the various buildings comprising this Institution. The first two cases occurred on the 12th of November last, but were not diagnosed as diphtheria until the following day (Sunday); the cases were removed to hospital at once, but both died, one on the day of removal and the other nine days afterwards. Anti-toxin was not injected before removal as Dr. Tunstall, the Medical Officer to the Institution, was unaware that the serum could be obtained from the Public Health Office on Sunday, and he had none of his own. In all ten cases were reported and removed to hospital, where all except the first two recovered. I inspected the whole buildings of the Home with Dr. Tunstall; the drains were tested and flushed, the milk supplied to the Institution was subjected to repeated chemical and bacteriological Examination with a negative result, and every effort was made to trace the source of the epidemic, but without success. Possibly the germs of the disease were introduced by some "carrier" child, suffering from "Bacteriological Diphtheria" without symptoms, who visited the Institution on the rainy 3rd of November, referred to in Dr. Tunstall's report, a copy of which is printed below:— 53 To E. C. MORGAN, Esq., Governor of the London Branch of National Children's Home and Orphanage, Bonner Road, London, N.E. From A. C. TUNSTALL, M.D., F.R.C.S., Ed., L.R.C.R, etc., Medical Officer of London Branch. Sir, 24th January, 1911. In answer to the letter from the Local Government Board, reference (5486 A, 19th January, 1911). I have the honour to report as under:— The London Branch of the National Children's Home and Orphanage, with which we are concerned, is in the Borough of Bethnal Green, and is composed of three groups of Houses, etc., quite separate from each other, viz:— First or Main Group—Contains Chapel, School-rooms, Offices, Workshops, Swimming-bath and 17 Houses, opening on to five Playgrounds, etc. Second Group—Two Houses used entirely for Hospital purposes. Third Group—One House used as a Receiving House. All these are situated at Bonner Road, and at Bishop's Road, at the back of Bonner Road. There are about 320 children in this Branch. 54 The first two cases of Diphtheria in "The Home" occurred on the 13th November last, I saw them first on Saturday, the 12th November, they had ulcerated throats, but nothing characteristic. On Sunday, the 13th November, the Diphtheritic Symptoms had developed very rapidly and the cases were sent to the Fever Hospital with as little delay as possible, so that they might have the benefit of the Anti-toxin injection at once, as I had none by me and could not get it on Sunday at a short notice. Both these two died, one on the 13th November, and the other on the 22nd November. They were from two of the Houses in the First Group. The third case was on the 19th November, also from a House in the First Group. The fourth, fifth and sixth cases were on 20th November, two from First Group, and one from Third Group, i.e., the Receiving House. The seventh, eighth, ninth and tenth cases occurred respectively on the 21st, 23rd and 29th November, and 18th December, all from the last mentioned (Receiving) House. In every suspicious case that occurred (except the first two) a swab was immediately taken, and an Anti-toxin Injection given; and Patient and House completely isolated. In some bad cases the swab was repeated three or four times, and the Injection twice. When the result of a swab was positive the Patient was removed to the Fever Hospital within 55 an hour. All Houses were fumigated with Sulphur; all the clothes and bedding were disinfected several times at the Borough Disinfecting Station. All the children had carbolic baths, and gargle of permanganate of potash, or lozenges of Formamint, Carbolic or Chlorate of Potash. All children were sent for a walk, when fine, into Victoria Park (close by) every day. The Chapel, Sunday and Day Schools were closed and fumigated. There was complete isolation of every suspicious case in its room, and of every house in itself. There were no admissions to or discharges from "The Home" during this period. All the drains and lavatories were thoroughly looked after and are in good condition. The milk has been tested and found quite clear from any diphtheritic germs, and has been ordered to be boiled before use. As regards the cause, I cannot find that there has been any Diphtheria in the neigbourhood, nor in the district round the Farm where we get our milk, nor in the other places supplied by the same farm, so I have come to the conclusion that the Epidemic can only be traced to Visiting Day which occurred on the 3rd of November, ten days before the first cases of Diphtheria developed. We enquired, as usual, if there were any cases of infectious disease in the district, and as none were known, Visiting Day was allowed; but of course there are friends of the children who come to "The Home "from long distances round London. 56 About these we cannot get information. The 3rd November (Visiting Day) happened to be a very wet day, and the visitors and the children they came to see had all to be crowded into the School-rooms instead of being distributed about the Playgrounds as usual; hence the probable concentrated cause of infection. I should like to take this opportunity of stating how much we are indebted to Dr. G. P. Bate, the Medical Officer of Health for Bethnal Green, and to his Staff, for all the help they have given us during this very trying time. I have no hesitation in stating that the Anti-toxin Injection proved of great value in arresting the disease in the Patients attacked; in fact no case in which I used the Anti-toxin has been fatal. We have had no further cases since the 18th December, 1910, I have the honour to be, Sir, Your obedient Servant, A. C. TUNSTALL, M.D. With reference to the condition of premises from which diphtheria patients were removed, the Inspectors report that in ninety-one instances everything was fairly satisfactory, in eight the W.C, or the fittings thereof were out of order, and minor insanitary conditions necessitating notice were found in seventy-three. Nineteen patients were removed from single-room tenemenos. Throat swabs from eighty-seven patients 1910. Entric Fever. 57 were submitted to the Clinical Research Association at the request of medical practitioners; in twenty-five instances the characteristic organism was found, but in sixty-two the result was negative. ENTERIC FEVER. Deaths 18. (Decennial average 12). Enteric Fever was prevalent in East London during the Autumn, and the visitation was specially severe in Bethnal Green. A total of 108 persons were notified as suffering from this disease. Sixty-three of the patients were removed to Asylums Board Hospitals, thirty-six were treated in general hospitals, and nine remained at home, where six of them died. Twelve of the hospital patients also died, a case mortality on the admissions of 15.5 per cent. as against 11.9 amongst the whole of the patients under treatment in the Asylums Board Hospitals in 1909-1910. The Enteric Fever mortality in Bethnal Green, calculated upon the estimated population, was 0.14 as against 0.04 for the County of London. The sanitary condition of the houses from which the Enteric Fever patients were removed was fairly good; in five the W.C. or the apparatus connected therewith, was found to be defective; in seven others the drains were leaky, and minor insanitary defects were found in twenty-eight. Ten patients were removed from single room tenements, one of which was overcrowded. 58 The blood of twenty-eight patients was examined at the request of medical practitioners; in ten instances a positive result was obtained, but in the other eighteen the reaction was negative. Careful enquiry was made as to articles of food partaken of by the patients before they were attacked with illness. Forty-six had eaten fried fish, twenty-two watercress, thirty-seven shell-fish (usually mussels), and fourteen ice cream. During the first week in August increased numbers of notifications of Enteric were received, and though augmentation in this direction is usual in the Autumn, it was apparent that we had here something abnormal to deal with in the South-West District, from which quarter nearly the whole of the cases were reported. Efforts were made to trace the source of the epidemic; the dairies from which the sufferers had obtained their milk were visited, and possible sources of contamination sought for; wholesale dealers from whom the dairymen had purchased milk were sampled, and enquiry was made as to local incidence of disease in the neighbourhood of the Farms, but without incriminating any of them. At first I was inclined to attribute the epidemic to mussel eating, as the proportion of mussel eaters in Bethnal Green is known to be high and this handbill was circulated:— 59 Metropolitan Borough of Bethnal Green. Public Health Department. Enteric or Typhoid Fever. A number of cases of Enteric Fever have occurred in Bethnal Green during the past few weeks. Enteric Fever is usually contracted by eating some uncooked article of food containing the germ of the disease, such as shell fish (especially mussels) milk or watercress. Inhabitants of Bethnal Green are strongly advised against eating raw mussels or oysters; these should be thoroughly cooked, and milk should be boiled, and watercress should not be eaten. By Order of the Public Health Committee, GEORGE PADDOCK BATE, M.D., Medical Officer of Health. As a result of enquiries made in 1908 in the case of 283 persons taken at random, it was found that about one fourth of them had been in the habit of eating mussels two or three times a week. With respect to the Fever patients who had eaten mussels, and who in several instances attributed their illness to this cause, it was ascertained that other members of the family had joined in the feast without ill effects; moreover at least half of the sufferers from fever had never eaten mussels at all. It thus became 60 fairly obvious that mussels alone were not the cause of the trouble. One peculiar circumstance was noted: the only sufferer from Typhoid Fever, who was of Jewish persuasion, confessed that, contrary to the Mosaic law, he had eaten mussels! In the circumstances I felt it my duty to communicate with Dr. Collingridge, the Medical Officer of Health for the City of London, with reference to the condition of the shell-fish sold in Billingsgate Market, and I received the following reply to my letter:— Corporation of London. Public Health Department, Guildhall, E.C, l9th September, 1910. To the Medical Officer of Health, Cambridge Road, N.E. Dear Dr. Bate, ENTERIC FEVER AND MUSSELS. In reply to your letter of the 15th instant, the last time I had occasion to have a bacteriological examination of mussels made was early in March of this year, when a sample of Dutch mussels was found to be polluted. Acting on my advice, the salesmen in Billingsgate Market have for some time past insisted that consignments of mussels from Holland shall be accompanied by an official certificate that they are gathered from an unpolluted source. 61 In the case in question the facts were reported to the representative of the Netherlands Government in this country and also to the Fishmongers' Company. I enclose a copy of my annual report for 1908, which deals, on page 112, with the question of mussel pollution, while my views on the pollution of shell fish generally are set out on page 93 of my annual report for last year, a copy of which is also sent herewith. Yours truly, W. Collingridge. Extract from Dr. Collingridge's Report for 1908. "I had occasion, in 1903, to direct attention to the danger incurred in the consumption of mussels derived from polluted sources. In the course of that year, out of 11 samples taken in Billingsgate Market and neighbourhood, no less than 10 were found to be sewage-contaminated. Seven of the polluted samples having been imported from Holland, the Fishmongers' Company co-operated with the Netherlands Government with a view to a thorough investigation being made of the conditions under which they were cultivated and exported to this country. At the present time it is the custom of the wholesale dealers in the City, who purchase shell fish from Holland, to see that each consignment is accompanied by an official certificate, issued by the Netherlands Authorities, to the effect that the produce is derived from unpolluted sources." 62 " Cases of mussel-poisoning are common during the mussel season, the symptoms of the disease being disturbance of the gastro-intestinal and peripheral nervous systems. There is also very strong evidence that they may be an active agent in the spread of Enteric Fever." CONTAMINATED SHELL FISH. In 1908 the attention of Dr. Collingridge was again directed to the risk incurred by the eating of possibly contaminated shell fish, especially oysters and mussels. Upon enquiry it was ascertained that each of the firms dealing with such mussels was able to produce a certificate from the Netherlands Government that their consignments came from unpolluted sources. Samples were, however, taken and submitted to Dr. Klein for analysis, who reported thereon that, although he was unable to identify the actual bacillus of Enteric Fever, the mussels were polluted with organisms of a fæcal character. A further examination was subsequently made of mussels from South Devonshire with a similar result. Extract from Dr. Collingridge's Report, 1908. " As regards the general question of shell fish pollution, it is greatly to be regretted that, in spite of the opinion expressed by the Commissioners in their Fourth Report on sewage treatment and disposal, issued in December, 1903, that there is a growing demand for legislation dealing with the matter and that "the evil is sufficiently grave to 63 demand a remedy,'' no action has been taken by the government for giving effect to the recommendations of the Commissioners. The following remedial measures were advocated in the Report referred to :— 1. Purification of sewage before its discharge in tidal waters. 2. The seizure and destruction of unwholesome shell fish exposed for sale. 3. The setting up of a competent authority to deal with all tidal waters, with power to control foreshores, to close dangerous beds, pits, ponds and layings, and in certain circumstances to require treatment of sewage. In my opinion, No. 3 is of the greatest importance; and until such competent authority, armed with ample powers to give effect to its views, is established, the present unsatisfactory state of affairs will continue." In Dr. Collingridge's Report for 1909 he again refers to this subject, and in connection with reports on cases of Enteric Fever attributed to the consumption of contaminated oysters, he writes :— " It will be seen from the foregoing that in spite of the efforts of your officers and those of the Fishmongers' Company, to prevent the distribution and sale of polluted shell fish, it is clear that, until 64 the public are better protected than they are at present from the danger incurred in the consumption of such questionable food, the evil will continue. There is little doubt that the traders in shell fish would welcome any remedial legislation that would restore public confidence in the wholesomeness of their wares. The whole question has been thoroughly investigated by the Commissions engaged in the enquiry relating to sewage treatment and disposal, and in their fourth report—issued as far back as December, 1903—they strongly advocated the remedial measures referred to in the Annual Report for 1908. Although this Commission went so far as to express the opinion that " the evil was sufficiently grave to demand a remedy" no steps appear to have been taken by the Government to give effect to their recommendations." I reported the outbreak to the Local Government Board and to the London County Council, and, by direction of Sir Shirley Murphy, Dr. Hamer, the assistant Medical Officer to the Council, made a careful investigation into the whole circumstances of the epidemic in Bethnal Green, Poplar and Stepney. An exhaustive report was published in November last, which contains full details of Dr. Hamer's investigations and his conclusions. He considers that the outbreak was due to the consumption of fried fish which had been imperfectly cleansed prior to being cooked. Dr. Hamer records 65 his high appreciation of the valuable assistance of Mr. Rowsell, our Food Inspector, whose intimate knowledge of local conditions was most helpful. Twentyseven fried fish shops were visited, the extent of the business done enquired into, and the number of the customers at each, who had suffered from Enteric, was determined. It was found as a fact that forty-nine out of fifty sufferers had obtained fried fish from one or other of three shops, at each of which "late steamer fish" was cooked. Full details will be found in Dr. Hamer's report. TYPHOID CARRIERS. Occasionally a person who has suffered from Typhoid Fever, and who is apparently quite well, continues to excrete the specific germ of the disease either in the urine or in the faeces, and this condition may persist for an indefinite period It appears that about two per cent, of the convalescents from Typhoid may be in this condition. It is, of course, impossible to keep these people in Hospital for years, though they may be capable of spreading infection. Since this condition has been recognized, it has been the custom to examine the dejecta of all typhoid patients at the Asylums Board Hospitals prior to discharge; and should the specific germ persist, a notification to this effect is sent to the Medical Officer of Health of the district to which such person is proceeding. Two such cases were reported to me last year:—E. W. was removed to Hospital on September 6th 1910, suffering from Enteric Fever, she was discharged on November 16th. S. A. was removed on September 29th, 1910, and discharged December 7th, 66 1910. Both patients were reported to be passing the germs of Enteric Fever in urine and faeces. At the request of Dr. Theodore Thompson, these persons were kept under observation, and samples of urine and feces were periodically obtained and forwarded for examination. Mr. Henley kindly undertook this somewhat disagreeable duty, with the consent of the Committee. It was afterwards proposed that all convalescents from Typhoid should be kept under similar observation, but this the Committee declined to sanction, and observations were confined to specially reported cases. With reference to these two the germs have now quite disappeared from the dejecta of S. A., but E. W. continues to shew a positive result so far as the fæces are concerned, though the urine is negative. It is somewhat unfortunate that Mrs. E. W, serves in a fried fish shop, and of course handles food intended for human consumption. All Mr. Henley can do is to keep in touch with her and to impress upon her strongly the absolute necessity of special care in the disinfection of dejecta and the careful washing of the hands after having attended to the calls of nature; and this advice he continues to inculcate. It may be as well to mention here that careful investigation failed to trace infection of any Typhoid case to this shop. WHOOPING COUGH. Deaths 34 (decennial average 55). All these deaths were amongst young children aged less than five years, a mortality on the estimated population of young children of 1.9. 67 DIARRHŒA. Deaths 43 (decennial average 106). No grown person died from simple diarrhoea during the year, but eleven young children, aged between one and five, succumbed. The remainder of the deaths, thirty-two in number, were amongst infants, but as these have been noticed under the heading of infantile mortality, they call for no remark here. The death rate on the whole population is 0.33 against 0.28 for the County of London. MEASLES. Deaths 58 (decennial average 74). This is not a compulsorily notifiable disease, and our only sources of information as to its prevalence are the school authorities and the weekly death returns. Altogether 519 cases of measles were reported from schools, but sixty-three of the addresses given were found to be incorrect. In 123 cases no doctor was in attendance. Disinfection was always offered but was allowed in thirty-five instances only. Practically all children are susceptible to measles, and develop the disease after exposure to infection. The period of incubation is about a fortnight, and as the early symptoms are those of a sneezing catarrh or common cold (during the existence of which the disease, if it be measles, is most contagious), it is practically impossible to prevent the spread of infection in schools. Moreover, it is amongst children of tender age that the heaviest mortality obtains. Last year the whole number of 68 deaths from measles in Bethnal Green, with a single exception, were amongst children aged less than five years. I have no doubt that the bringing together of children (so-called " infants ") in school rooms is the sole cause of the excessive mortality from measles. Very few children die from it after they have attained six or seven years of age ; and even if we accept the supposition that every one must have measles at some period during life, undoubtedly the later the attack the better the chance of recovery. I am strongly of opinion that these "infant" schools are hot-beds of infection and should be abolished. No children should be admitted to schools under six years of age. A recent regulation of the London County Council as to compulsory school attendance of children from houses in which measles exists is certainly a retrograde step. Children who have already suffered from measles are now required to continue school attendance, although they come from homes where their little brothers and sisters are down with the disease, and doubtless they carry the germs of measles in their clothing and communicate the complaint to others. The death rate from measles on the whole population of Bethnal Green is 0.45 against 0.41 for London. Hospital Beds for Measles. The Local Government Board has issued an order enabling the Metropolitan Asylums Board to utilize spare accommodation in the Hospitals of the 69 Asylums Board for the reception and treatment of additional classes of poor persons. Under the authority thus conferred upon them, the Asylums Board will be enabled to receive from any of the Poor Law Authorities of the Metropolis children suffering from Measles or Whooping-Cough into any of their Hospitals, or parts of their Hospitals, where there is vacant accommodation. It is understood that some 1,000 beds will be available for these cases. CHICKEN POX. The School Authorities reported a total of 193 children as suffering from Chicken Pox. The disease was very mild and calls for no special remark. DISEASES OF PARTURITION. Thirteen cases of Puerperal Fever (including Pyaemia and Septicaemia) were reported; all the sufferers, except one were removed either to the Infirmary or the London Hospital, and eight of these died. Septic poisoning in the Puerperal state is a preventable disease and is almost invariably due to ignorance or want of care on the part of someone in attendance upon the patient. All the cases were visited and carefully investigated by Miss Harris. Four women died from diseases or accidents due to Parturition. They were :— Placenta Præevia and Hæmorrhage, patient aged 28 Post-partum Hæmorrhage " 45 Heart Disease " 41 Kidney Disease " 44 70 The wife of a warehouseman, aged forcy-four, died from septicæmia, consequent on an injury to the uterus by a catheter introduced by herself to produce abortion. Verdict of Coroner's Jury :—Misadventure. ERYSIPELAS. The actual number of certificates received was 240, but sixty-six were duplicates. The disease proved fatal in four instances. CEREBRO-SPINAL MENINGITIS. Seven cases of this disease were notified, with four deaths—all in hospital. The causation of this disease is extremely obscure. Minute investigations are made in every case, and the details are forwarded to the Medical Officer of the London County Council. The disease is usually associated with a peculiar microorganism called the meningococcus, though how this is conveyed from patient to patient is quite unknown. It is on account of the obscurity of the causation of this disease that the County Council continues to require its notification. TETANUS. There were two deaths from tetanus or lock-jaw:— A clerk, aged 63, residing at Huntingdon Buildings, injured his hand whilst cycling; he developed tetanus and died in Guy's Hospital. A warehouseman, aged 50, was shifting some preserved meat tins, and pinched his finger; he developed 71 septic broncho-pneumonia and tetanus, and died in the London Hospital. In both instances the specific microorganism of tetanus was found. ANTHRAX. H. P., a checking clerk employed at some riverside premises, developed a boil on his neck after inspecting some foreign hides. On May 19th he consulted a local medical man who advised him to go to the London Hospital where he was at once taken in. A cultivation from the boil was made, the specific bacillus of anthrax was found and the usual operation of excision was performed. The patient recovered. TUBERCULOSIS. During 1910 tuberculosis in its various forms caused 242 deaths, over twelve per cent. of the total mortality from all causes in the Borough, and equal to a rate of l-84 per thousand population. The deaths from pulmonary phthisis alone numbered 176, equal to a rate of 1.34 against 1.14 for the whole of London. Fifty-one of the 66 deaths from forms of tuberculosis, other than phthisis, were amongst young children aged less than five years, a mortality on the estimated population of young children of 2.8 per thousand living. Nine infants died from Tuberculous Meningitis, and an equal number from Tabes Mesenterica. Sixteen samples of suspected sputum were examined at the request of medical practitioners, but in three instances only was a positive result reported. 72 The question as to the provision of Sanatorium treatment of early cases of phthisis was discussed on several occasions by the Public Health Committee. It was strongly felt that whatever is done in this direction should be provided for the metropolis as a whole by some central body such as the Asylums Board, and the Council was urged to bring pressure on the Board to take the matter up, with the assistance of an adequate grant from the Exchequer. Pending such action, the Committee presented the following report:— Sanatorium Treatment of Consumptives. We report that, agreeably with the resolution of the Council dated the 7th July last, we have caused enquiries to be made respecting the provision of sanatorium treatment for poor persons in the Borough in the initial stages of consumption, and the cost of maintenance of beds in approved sanatoria. In a memorandum by the Medical Officer of the Local Government Board, attention is called to many advantages of sanatorium treatment. Patients able to work are received for treatment for a short period, which would not usually involve dismissal from their place of business; the improvement experienced during even a short stay in a sanatorium is often most remarkable. Further, when the patient enters a sanatorium, his dwelling is disinfected, and his relatives are temporarily relieved from a source of anxiety; and the patient, whilst in the sanatorium, is trained in the methods 73 of disposal of sputum, and in the general hygienic regulation of his life in a practical manner hardly possible at home. The memorandum continues :— " From the standpoint of the sanitary authority a " much larger number of patients can in this way " be treated and prevented from becoming a source " of infection than if permanent cure of the indivi" dual patient were made the only consideration." Enquiries were made with regard to the Maitland Sanatorium, Peppard Common, Oxon; Fairlight Sanatorium, Hastings, and the National Sanatorium, Benenden, Kent. The cost of maintenance at these Institutions is quoted as follows :— 1. Maitland Sanatorium £78 per bed per annum 2. Fairlight do. £50 do. do. 3. National do. £78 do. do. From further information obtained as to Fairlight Sanatorium, the treatment there, in the opinion of the Medical Officer of Health, appears to be established on a very satisfactory basis, and this Institution would appear to be well suited to the needs of patients from this Borough. Sanatorium treatment would, of course, be confined to persons whose symptoms indicated that they would derive benefit from the treatment, that is to say, those in the early stages of the disease. 74 Patients would, in the first instance, except under some exceptional circumstances, be sent to . the Sanatorium for one month, an extension being granted in the case of those who showed great progress towards recovery. We Recommend— That a contract be entered into by the Council with the authorities of the Fairlight Sanatorium, Hastings, for the maintenance of six beds in that Institution for a period of twelve months, for the reception of poor persons in the early stages of consumption, resident in the Borough, at a charge of £50 per bed per annum. T. Brooks, Chairman. The recommendation was accepted by the Council, and ultimately a contract was entered into with the managing Committee of the Fairlight Sanatorium, and six beds were placed at the disposal of the Public Health Committee; the occupation of these, however, did not commence until 1911. Public Health (Tuberculosis) Regulations, 1908. Total notified during 1910 210 From Bethnal Green Infirmary and Workhouse 182 From their homes 18 From other Institutions 10 Up to the end of the year I had received information that out of this total of '210 cases 74 had proved fatal. 75 The notified cases belonged to the following trades:— Artificial flower maker 1 House wives 18 Barber 1 Insurance agents 2 Belt maker 1 Interpreter 1 Boot and shoe workers 13 Labourers 17 Bottle stopper maker 1 Musician 1 Box makers 3 Needleworker 1 Brush workers 3 Packers 2 Bus conductor 1 Packing case makers 2 Butcher 1 Paper sorter I Cabinet makers 14 Porters 5 Carmen 3 Potman 1 Charwoman 1 Printers 3 Cigarette makers 3 Saddlery 1 Clerk 1 Shoe black 1 Coachmen 3 Soldier 1 Cork cutters 2 Steward 1 Costermongers 2 Tailors 11 Decorators 2 Travellers 2 Domestic servant 1 Trimming makers 2 Enamellers 2 Umbrella and walking Errand boy 1 stick makers 3 Farrier 1 Upholsterers 2 Fish curer 1 Weaver 1 French polishers 2 Wood carvers and turners 10 General dealer 1 School children 16 Glass fitter 1 Infants 4 Hawkers 9 No information 25 Housebreaker 1 210 CANCER. The various forms of malignant disease caused 131 deaths ; all the sufferers except eight were over 25 years of age. The estimated number of adults over this age 76 living in Bethnal Green is 57,500; on this number the cancer mortality is at the rate of 2.2 per thousand. The following list shews the organs and parts of the body chiefly affected by cancerous disease :— Stomach. Liver asd Pancreas 43 Female Organs of Generation 16 Tongue and Mouth 10 Brain 10 Rectum 10 Intestines 10 Larynx and (Esophagus 8 Lung and Mediastinum 7 Female Breast 6 Prostate and Male Bladder 3 INQUESTS. The inquests held numbered 260. Seventy-nine persons died violent deaths, of whom fifteen committed suicide. SUICIDES. A woman, aged 43, hanged herself in a cell at Bethnal Green Road Police Station; the wife of a shoemaker, aged 74, a hair pad maker, aged 64, and a boot laster, aged 41, also hanged themselves; a coal merchant, aged 54, strangled himself; the wife of a wood carver, aged 63, starved herself to death; a painter, aged 53, cut his throat; a chairmaker, aged 57, drowned himself in the river Lea ; and three men and two women took poison. HOUSING AND TOWN PLANNING ACT, 1909. In my report for the year 1909 there appeared notes on the Housing and Town Planning Act, 1909, by 77 Dr. Edgar Taunton, Barrister at Law, Deputy Medical Officer of Health for the Borough, These notes touched upon the more important sections of the Act so far as they apply to Metropolitan Borough Councils. Since then the Local Government Board has issued orders, made under the Act, together with explanatory circulars and memoranda for the guidance of local authorities. The provisions for dealing with the acquisition of land have been much simplified without being weakened. The failure of this authority to induce the London County Council to take action under the old housing Acts in respect of two eminently suitable areas within the Borough, will be within the recollection of most Councillors. Since 1905 the provisions of the Public Health Act (although unavailing to modify the existing evils of badly planned narrow streets and courts, and decayed and out-of-date structures) have been enforced to such an extent that no portion of the Borough, taken as an area, could now be successfully scheduled under the housing Acts as "unhealthy." Valuable work has been carried out under Sec. 15 of the new Act. This section gives power to a local authority to deal with landlords who fail to keep houses of a gross rental not exceeding £40 per annum, in such a state as to be reasonably fit for human habitation. The powers previously enjoyed in this respect were incomplete, for it was necessary to prove, either the existence of a statutory nuisance, or else to show to the satisfaction of a Court of Summary Jurisdiction that a house was in a state so dangerous or injurious to health 78 as to be unfit for human habitation. The rental limit has been doubled by the new Act, and this largely extends the class of house to which the powers of the local authority are now applicable. Fifteen notices under Sec. 15 of the Housing and Town Planning Act, 1909, were served during last year ; they were upon the following houses:— 177, Bethnal Green Road. 49, Kay Street. 8, Coate Street. Markham's Yard, Green 129, Columbia Road. Street. 24, Felix Street. 24, Matilda Street. 12, Fox Street. 135, Old Bethnal Green Road. 13, Fox Street. 85, St. Peter Street. 374, Hackney Road. 52, Surat Street. 46, Hassard Street. 126, Teesdale Street. On December 31st last, the requirements of 12 of these notices had been complied with, and in 3 the necessary works were in hand. Section 16 amends in a most important direction codes of by-laws, framed in accordance with the model by-laws of the Local Government Board, relating to houses let in lodgings. The by-laws so framed have in the past required a landlord to do certain works which, as he did not invariably retain possession and control of the premises, he could not execute in certain instances without committing a trepass. (Arlidge v. Islington Borough Council, 1909, 2 K. B. 127 ; 78 L. J. K. B. 553 ; 7 L. G. R. .649; 100 L. T. 903; 73 J. P. 301). The new section overcomes the effect of the decision quoted, at any rate so far as regards new by-laws; but whether it can have the effect of validating by-laws made before 79 the passing of the Act, such as those in force in this Borough, is a matter upon which advice should he sought without delay. The very valuable powers vested in the local authority by Section 17 were under consideration by the Public Health Committee during the year, and are of such importance that they may with advantage be summarised here:— 1. Every local authority shall cause inspections of its district to be made with a view to ascertaining whether any dveiling house therein is in a state so dangerous or injurious to health as to be unfit for human habitation. Such inspections are to be made, and the records kept, in accordance with regulations prescribed by the Local Government Board. 2. The power to make closing orders is transferred from a Court of Summary Jurisdiction to the Local Authority. 3. The power to decide appeals against the action of the Local Authority is transferred from Courts of Summary Jurisdiction to the Local Government Board. 4. The Local Authority is given power to make regulations, to be approved by the Local Government Board, with regard to rooms habitually used for sleeping purposes, the floors of which are more than three feet below the surface of the adjacent ground; and the Local Government Board can act in default of the Local Authority. 80 Under this section the Local Government Board has issued detailed regulations as to the inspection of districts and the keeping of records. Officers must be specifically designated to carry out the duties under the Act. The necessary officers were duly designated; certain premises have been inspected, and their condition was under consideration; but no definite action had been taken with respect thereto up to December 31st last. Two matters are at present under consideration by the Committee:— The present by-laws of the Council relating to houses let in lodgings, as affected by Section 16 of the new Act. The making of regulations relating to underground rooms. LODGING HOUSES FOR THE WORKING CLASSES. Housing and Town Planning Act, 1909, Section 35. Four applications for my certificate as to the satisfactory condition of lodging houses were made; certain defects were found upon examination, but as these were remedied after informal notice I granted the certificate in each case. They were situated at:— 402, Hackney Road Common Lodging House. 5, Victoria Park Square „ „ 2-6, Ames Street „ „ 119-121, Green Street Salvation Army Shelter. 81 CUSTOMS AND INLAND REVENUE ACTS, 1890 TO 1903. Only two applications were received; both were refused. They were in respect of:— 105 and 107, Sclater Street. Six tenements; separate W.C. and water supply are not provided to each. 1 to 8, Merceron Street. Twenty-one tenements; the lower portions of six of the houses are occupied as shops and not as dwellings. Tenements are not self-contained, that is to say, each is unprovided with separate W.C., water tap, sink and copper. During the year a very large amount of good work has been carried out in a thoroughly satisfactory manner by the staff under Mr. Foot's control, details of which will be found in his report appended hereto. The change from the old offices in Paradise Row to the palatial building in Cambridge Road was managed with a minimum of inconvenience to the public; and now that we are settled in our new quarters, in which I am specially favoured, I find the great advantage of all the departments being housed under one roof. To you, Sir, and to the Members of the Council, my best thanks are due for much consideration and kindness. I have the honour to be, Sir, and Gentlemen, Your very obedient servant, GEORGE PADDOCK BATE. 82 APPENDIX. (15th August, 1910.) Provision, &c., of Diphtheria Anti-toxin. LONDON. To the Sanitary Authorities for the execution of the Public Health (London) Act, 1891;— To the Medical Officers of Health of the Authorities aforesaid;— And to all others whom it may concern. WHEREAS under Section 77 of the Public Health 'London) Act, 1891, any Sanitary Authority for the execution of that Act may, with the sanction of the Local Government Board, themselves provide or contract with any person to provide a temporary supply of medicine and medical assistance for the poorer inhabitants of their District; And whereas it is expedient that, subject as herein-after stated, the sanction of the Local Government Board should be given under the above-cited enactment to the provision by any such Sanitary Authority of a temporary supply of the medicine known and herein-after referred to as "diphtheria anti-toxin," and of medical assistance in connection with the temporary supply of diphtheria anti-toxin; And whereas, in pursuance of the enactments in that behalf, the Local Government Board by the Sanitary Officers (London) Order, 1891, 83 scribed in relation to Medical Officers of Health appointed by the Sanitary Authorities for the execution of the said Act Regulations with respect to the duties and salaries of the said Medical Officers of Health; And whereas, with respect to the said Medical Officers of Health, it is expedient that further provision should be made with regard to the following matters; that is to say,— (a) the duties of the said Medical Officers of Health in connexion with the use of diphtheria anti-toxin in cases of disease, as well for the prevention of disease as for the prevention of its extension; and (b) the compensation of the said Medical Officers of Health for the discharge of the said duties: NOW THEREFORE, We, the Local Government Board in the exercise of Our powers in that behalf, do hereby Order as follows— Article I —We sanction the provision by every Sanitary Authority as aforesaid, or their contracting with any person for the provision, in pursuance of Section 77 of the Public Health (London) Act, 1891, of a temporary supply of diphtheria anti-toxin, and of medical assistance in connexion with the temporary supply of diphtheria anti-toxin, for the poorer inhabitants of their District, subject to the following condition, that is to say,— The arrangements with respect to the keeping, distribution, and use of the diphtheria anti-toxin shall be made in accordance with the advice of the Medical Officer of Health. 84 Article II.—The duties assigned to the Medical Officer of Health by the Sanitary Officers (London) Order, 1891, or other the Regulations for the time being issued by Us and superseding the Regulations prescribed by that Order, shall be deemed to extend to and to include all action by the Medical Officer of Health in the execution of this Order. Article III.—The Sanitary Officers (London) Order, 1891, or other the Regulations for the time being issued by Us and superseding the Regulations prescribed by that Order, shall apply and have effect as if the Regulations thereby prescribed included a provision authorising the Sanitary Authority, or requiring them at Our direction, to pay from time to time to the Medical Officer of Health, in addition to the salary or other compensation payable under the said Regulations, a reasonable compensation for all action by the Medical Officer of Health in the execution of this Order. Article IV.—This Order may be cited as "The Diphtheria Anti-toxin (London) Order, 1910." Given under the Seal of Office of the Local Government Board, this Fifteenth day of August, in the year One thousand nine hundred and ten. JOHN BURNS, President. H. C. MONRO, Secretary. 85 TABLE I. Vital Statistics of Whole District during 1910 and Previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Death of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District Number. Rate. Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Births. registered. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1900 129,600 4,588 35.4 771 168 2,535 19.5 873 150 431 2,816 22.7 1901 129,700 4,608 35.5 678 147 2,423 18.7 834 220 425 2,628 20.3 1902 129,889 4,589 35.3 710 155 2,522 18.5 864 245 470 2,744 21.1 1903 130,028 4,627 35.6 630 136 2.253 17.3 915 272 380 2,361 18.1 1904 130,207 4,526 34.7 711 157 2,393 18.4 918 300 399 2,489 19.1 1905 130,401 4,321 33.2 652 151 2,351 18.0 975 295 356 2,412 18.5 1906 130,609 4,430 33.9 696 157 2,398 18.4 934 326 391 2,463 18.9 1907 130,831 4,152 31.8 574 138 2,200 16.8 985 298 379 2,281 17.4 1908 131,006 4,341 32.6 572 132 2,251 16.9 961 392 407 2,266 17.0 1909 131,316 4,132 31.22 534 130 2,243 17.0 1,182 435 385 2,193 16.7 Averages for Years 1900-1909 130,359 4,428 33.9 653 147 2,357 17.9 944 293 402 2,465 18.9 1910 131,579 4,208 31.98 516 122.6 2,034 15.4 1,103 396 364 2,002 15.23 86 TABLE II. Vital Statistics of Separate Localities in 1910 and Previous Years. Names of Localities 1. North. 2. South. 3. East. 4. Totals 5. North East. 6. South West. Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births. Deaths at all Ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 1900 51,500 1,935 1,142 314 33,450 1,218 776 211 44,650 1,435 898 246 129,600 4,588 2,816 771 1901 51,514 1,864 1,112 308 33,472 1,239 721 177 44,714 1,505 795 223 129,700 4,608 2,628 708 1902 51,600 1,938 1,056 307 34,000 1,237 730 186 44,289 1,414 961 217 129,890 4,589 2,747 710 1903 51,600 1,945 947 269 33,000 1,171 616 181 45,428 1,511 800 202 130,028 4,627 2,363 652 1904 51,600 1,892 1,001 351 33,179 1,194 665 154 45,428 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 1906 65,600 ... 1,178 ... 65,009 ... 1,224 ... 1907 66,716 1,929 1,068 357 65,115 2,168 1,178 217 1908 65,830 2,103 1,139 284 65,236 2,228 1,114 288 1909 66,003 1,972 1,081 246 65,313 2,027 1,083 288 Averages of Years 1900 to 1905 51,572 1,897 1,039 302 33,394 1,191 689 183 45,004 1,455 844 215 129,938 4,543 2,573 700 ... ... ... ... ... ... ... ... 1910 66,134 2,014 985 236 65,445 2,194 989 280 87 TABLE III. Cases of Infectious Disease notified during the Year 1910. Notifiable Disease. Cases Notified in whole District. Total Cases Notified in each Locality. Number of Cases removed to Hospital from each Locality. At all Ages. At Ages—Years. 1 2 1 2 3 Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. North Last. South West. North East. South West. Total cases removed to Hospital. Small-pox - - - - - - - - - - - - Cholera — — — - - - - - - - - - Diphtheria (including Membranous Croup) 181 8 98 65 8 2 — 87 94 85 91 176 Erysipelas 174 9 5 14 24 103 19 80 94 - - - Scarlet Fever 236 5 92 128 8 3 — 134 102 127 95 222 Typhus Fever - - - - - - - - - - - - Enteric Fever 108 - 7 29 28 44 - 47 61 44 55 99 Relapsing Fever - - - - - - - - - - - - Continued Fever 1 - - 1 - - - - 1 - 1 1 Puerperal Fever 13 - - - 4 9 - 4 9 3 9 12 Plague - - - - - - - - - - - - Epidemic Cerebro 7 3 1 1 1 1 - 4 3 2 3 5 Meningitis Anthrax 1 - - - - 1 — 1 — 1 — 1 Totals 721 25 203 238 73 163 19 357 364 262 254 516 88 TABLE IV. Causes of, and Ages at, Death during Year, 1910. Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Deaths at all ages of "Residents" belonging to Localities, whether occurring in or beyond the District. Total Deaths whether of Residents or Nonresidents in Public Institutions in the District. All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and Upwards. Total N.E. S.W. No Home. 1 2 3 4 5 6 7 8 9 10 11 12 13 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 58 16 41 1 ... ... ... 58 20 37 1 22 Scarlet fever 9 1 4 4 ... ... ... 9 8 1 ... ... Whooping-cough 34 19 15 ... ... ... ... 34 14 20 ... 12 Diphtheria (including Membranous croup) 20 1 13 6 ... ... ... 20 14 6 ... 8 Croup ... ... ... ... ... ... ... ... ... ... ... ... Fever Typhus 18 ... 1 4 1 12 ... 18 9 9 ... 6 Enteric Other continued Epidemic influenza 8 ... ... ... 1 5 2 8 6 2 ... 1 Cholera ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... Diarrhæa 43 32 11 ... ... ... ... 43 19 24 ... 49 Enteritis 45 35 6 ... ... 1 3 45 12 33 ... 13 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 8 ... ... ... 2 6 ... 8 2 6 ... 1 Erysipelas 4 l ... ... ... 2 1 4 3 1 ... 3 Phthisis, (Pulmonary Tuberculosis) 176 ... 3 5 21 143 4 176 85 90 1 114 Other tuberculous diseases 66 19 32 6 1 7 1 66 31 35 ... 73 Cancer, malignant disease 131 ... 3 2 3 87 36 131 69 58 4 81 Bronchitis 198 39 12 ... 2 57 88 198 106 89 3 75 Pneumonia 213 68 51 3 7 63 21 213 95 116 2 136 Pleurisy 30 2 6 1 2 14 5 30 10 19 1 14 Other diseases of Respiratory organs 11 ... ... 1 1 5 4 11 4 6 1 8 Alcoholism Cirrhosis of liver 32 1 ... ... ... 26 5 32 17 14 1 14 Venereal diseases 5 4 1 ... ... ... ... 5 4 1 ... 2 Premature birth 92 92 ... ... ... ... ... 92 48 44 ... 9 Diseases and accidents of parturition 4 ... ... ... ... 4 ... 4 4 ... ... 1 Heart diseases 191 8 2 9 12 95 65 191 106 83 2 115 Accidents 95 33 12 4 5 21 20 95 33 62 ... 25 Suicides 15 ... ... ... 2 11 2 15 6 8 1 2 Rickets 3 1 2 ... ... ... ... 3 1 2 ... 3 Old age 68 ... ... ... ... 2 66 68 41 24 3 27 Meningitis 22 14 3 1 1 3 22 11 11 ... 14 Kidney disease 77 ... 1 3 1 48 24 77 34 39 4 52 All other causes 327 130 8 8 11 103 67 327 173 149 5 220 All causes 2003 516 227 58 73 715 414 2003 985 989 29 1100 89 TABLE V. Whole District—Infantile Mortality During the Year 1910. 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. 11-12 Months. Total Deaths under One Year. i. Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 ... ... ... 1 ... ... ... ... 1 1 1 2 2 2 6 16 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Diphtheria (including Membranous Croup) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Whooping Cough ... ... 1 ... 1 2 ... 1 1 1 ... 2 3 1 6 1 19 ii. Diarrhæal Diseases. Diarrhæa, all forms ... 1 ... ... 1 1 3 4 5 3 2 4 1 2 3 3 32 Enteritis, Muco-enteritis, Gastro-enteritis ... 1 1 ... 2 5 3 4 ... 3 5 1 1 1 1 ... 26 Gastritis, Gastrointestinal Catarrh ... ... ... 1 1 1 ... 1 1 1 ... ... 2 ... 1 ... 8 iii. Wasting Diseases. Premature Birth 57 14 7 2 80 5 3 ... ... ... ... ... ... ... ... ... 88 Congenital Defects 15 4 3 1 23 1 4 1 ... 1 1 1 1 ... ... ... 33 Injury at Birth 4 ... ... ... 4 1 ... ... ... ... ... ... ... ... ... ... 5 Want of Breast-milk, Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus 2 4 ... 3 9 17 6 3 9 3 4 3 1 ... 3 1 59 iv. Tuberculous Diseases. Tuberculous Meningitis, ... ... ... ... ... 1 ... 1 3 ... 1 1 ... ... 1 1 9 Tuberculous Peritonitis, Tabes Mesenterica ... ... ... ... ... ... ... 1 1 ... 2 3 ... 1 1 ... 9 Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 v. Other Causes. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Syphilis 1 ... ... ... 1 1 ... 1 1 ... ... ... ... ... ... ... 4 Rickets ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 2 Meningitis (not Tuberculous) ... ... ... ... ... 1 1 2 1 1 2 2 ... 2 1 1 14 Convulsions 2 1 1 2 6 6 5 1 2 2 1 1 1 ... ... 1 26 Bronchitis ... 1 1 ... 2 7 4 3 5 1 3 3 3 2 2 3 38 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... 1 1 1 3 6 6 3 3 6 2 4 3 13 10 5 64 Suffocation, overlaying 5 3 ... 2 10 5 4 3 3 1 ... ... ... ... ... ... 26 Other causes ... 1 1 3 5 3 2 2 6 4 1 1 1 3 1 5 34 87 31 16 15 149 63 41 32 42 28 25 27 20 29 33 27 516 Population (estimated to middle of 1910) 131,579. Births in the year, 4,208. Deaths in the year, of Infants, 516. Deaths from all causes at all ages, 2,003. 90 TABLE V (a), North-East Bethnal Green. Infantile Mortality During the Year 1910. 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. 11-12 Months. Total Deaths under One Year. i. Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 3 7 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Diphtheria (including Membranous Croup) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Whooping Cough ... ... ... ... ... 2 ... ... ... ... ... 1 1 ... 3 ... 7 ii. Diarrhæal Diseases. Diarrhæa, all forms ... ... ... ... ... ... ... 2 1 2 2 3 1 ... ... 2 13 Enteritis, Muco-enteritis, Gastro-enteritis ... ... ... ... ... 1 1 2 ... ... 2 ... ... ... 1 ... 7 Gastritis, Gastro-intestinal Catarrh ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 2 iii. Wasting Diseases. Premature Birth 28 7 3 1 39 4 2 ... ... ... ... ... ... ... ... ... 45 Congenital Defects 5 1 2 ... 8 1 2 ... ... 1 ... ... 1 ... ... ... 13 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk, Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus 1 1 ... 2 4 10 3 1 6 ... 2 2 1 ... 3 ... 32 iv. Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... 1 ... 1 2 ... ... ... ... ... ... ... 4 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... 1 ... ... 1 3 ... ... 1 ... 6 Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 v. Other Causes. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 1 ... ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... 3 Rickets ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 2 Meningitis (not Tuberculous) ... ... ... ... ... 1 1 ... ... 1 1 1 ... 1 ... ... 6 Convulsions ... 1 ... 2 3 5 1 ... ... 1 1 ... ... ... ... ... 11 Bronchitis ... 1 ... ... 1 4 2 1 4 1 2 2 2 ... 1 3 23 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... 1 1 3 2 2 2 3 ... 2 2 6 5 1 29 Suffocation, overlaying 2 ... ... 2 4 1 2 ... 1 ... ... ... ... ... ... ... 8 Other causes ... l 1 1 3 2 ... 1 3 2 ... 1 ... 1 ... 2 15 37 12 6 9 64 36 16 13 21 11 12 16 9 10 17 11 236 Population (estimated to middle of 1910), 66,134. Births in the year, 2,014. Deaths in the year, of Infants, 236. Deaths from all causes at all ages, 985. 91 TABLE V. (b) South-West Bethnal Green. Infantile Mortality During the Year 1910. 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. 11-12 Months. Total Deaths under One Year. i. Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 ... ... ... 1 ... ... ... ... 1 ... ... 2 1 1 3 9 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... 1 ... 1 ... ... 1 1 1 ... 1 2 1 3 1 12 ii. Diarrhœal Diseases. Diarrhœa, all forms ... 1 ... ... 1 1 3 2 4 l ... 1 ... 2 3 1 19 Enteritis, Muco-enteritis, Gastro-enteritis ... 1 1 ... 2 4 2 2 ... 3 3 1 1 1 ... ... 19 Gastritis, Gastrointestinal Catarrh ... ... ... 1 1 1 ... ... 1 1 ... ... 2 ... ... ... 6 iii. Wasting Diseases. Premature Birth 29 7 4 1 41 1 1 ... ... ... ... ... ... ... ... ... 43 Congenital defects 10 3 1 1 15 ... 2 1 ... ... 1 1 ... ... ... ... 20 Injury at Birth 4 ... ... ... 4 1 ... ... ... ... ... ... ... ... ... ... 5 Want of Breast-milk, Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus 1 3 ... 1 5 7 3 2 3 3 2 1 ... ... ... 1 27 iv. Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... 1 1 5 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... 3 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... v Other Causes Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Syphilis ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... 2 1 ... 1 1 ... 1 1 1 8 Convulsions 2 ... 1 ... 3 1 4 1 2 1 1 1 1 ... ... 1 16 Bronchitis ... ... l ... 1 3 2 2 1 ... ... 1 1 2 1 ... 14 Laryngitis ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... 3 Pneumonia ... 1 1 ... 2 3 4 1 1 ... 2 2 1 7 5 4 32 Suffocation, overlaying 3 3 ... ... 6 4 2 3 2 1 ... ... ... ... ... ... 18 Other causes ... ... ... 2 2 1 2 1 3 2 1 ... 1 2 1 3 19 50 19 10 6 85 27 25 19 21 17 13 11 11 19 16 16 280 Population (estimated to middle of 3910) 65,445. Births in the year, 2,194. Deaths in the year, of Infants, 280. Deaths from all causes at all ages, 989. 92 TABLE VI. Showing the number of Deaths from the seven principal Zymotic Diseases, inclusive of Hospital Deaths in the 10 years 1900 to 1909 and in the year 1910. Disease. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. Annual Average of 10 years, 1900-1909 1910. Small Pox - 2 64 - 8 - - - - - 7 - Measles 63 84 59 85 89 48 60 71 105 78 74 58 Scarlet Fever 12 44 19 13 18 27 22 43 39 25 26 9 Diphtheria 60 63 33 26 48 31 20 18 29 20 35 20 Whooping Cough 93 38 89 41 44 50 63 53 42 37 55 34 Fever 18 20 15 12 7 9 14 7 13 4 12 18 Diarrhœa 103 119 60 112 147 119 152 59 102 90 106 43 Totals 349 370 339 289 361 284 331 251 330 254 315 182 93 Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES & HOMEWORK. I. Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 363 22 Nil Workshops (Including Workshop Laundries) 4,904 806 1 Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 760 24 Nil Total 6,027 852 1 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:-* Want of cleanliness 428 428 — — Want of ventilation 16 16 — — Overcrowding 3 3 — — Want of drainage of floors - — - - Other nuisances 690 690 - - Sanitary accommodation insufficient 15 15 - - unsuitable or defective 102 102 - 1 not separate for sexes 4 4 - - Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) — — — — Other offences - - - - (Excluding offences relating to outwork which are included in Part 3 of this Report) Total 1258 1258 — 1 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 94 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Number of Inspections and Re-inspections of Outworkers' Premises. outwork in unwholesome premises, section 108. outwork in infected premises sections 109, 110. Lists received from Employers Names and Addresses of Outworkers received from other Councils. Names and Addresses of Outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (Section 110). Prosecutions (Sections 109, 110) Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers Lists. Outworkers Wearing Apparel— (1) Making, &c. ... ... ... ... ... ... ... ... 3816 ... ... ... ... ... ... (2) Cleaning and washing 142 1906 6 11 2446 1032 ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... 1 1 ... ... 2 ... ... ... ... ... ... Artificial flowers ... ... ... ... 14 2 ... ... 37 ... ... ... ... ... ... Tents ... ... ... ... 2 ... ... ... 4 ... ... ... ... ... ... Furniture and upholstery 12 172 ... ... 14 106 ... ... 92 ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... 42 3 ... ... 94 ... ... ... ... ... ... Carding, &c., of buttons, &c. 2 18 ... ... ... ... ... ... 39 ... ... ... ... ... ... Paper bags and boxes 22 595 4 17 597 136 ... ... 1582 ... ... ... ... ... ... Brush making 10 703 ... ... 145 361 ... ... 552 ... ... ... ... ... ... Total 188 3394 10 28 3261 1640 ... ... 6218 ... ... ... ... ... ... 4. Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. Workshops, including Laundries 1,873 Workplaces 230 Bakehouses 90 Total numbers of workshops on Register 2,193 5-—Other Matters. Glass. Number. Masters notified to H.M Insprctor of Factories- Failure to affix Abstract of the Factory and Workshop Act(s. 133) 25 Action taken in matters referred byH.M. Inspector as remediable under the Public Health Acts, but not under the Factory & Workshop Act (s. 5) Notified byH.M. Inspector 39 Reports (of action taken) sent to H.M. Inspector 39 Other Underground Bakehouses (s. 101)— In use at the end of year 27 95 METROPOLITAN BOROUGH OF BETHNAL GREEN. STREET LIST. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases Respiratory Disease-. General Diseases. Total. Abbey street 1 ... 2 6 9 Bonner road 3 1 2 9 15 Abingdon buildings ... ... ... 2 2 Bonner street 1 2 1 2 6 Abingdon street 1 1 1 4 7 Bonwell street ... ... ... 2 2 Ada place 2 ... ... ... 2 Boreham street 1 ... ... ... 1 Ainsley street ... ... 1 2 3 Boundary street ... ... 1 1 2 Albert buildings ... ... ... ... ... Bradys buildings 1 1 ... ... 2 Albion place ... ... ... ... ... Brady street 2 ... ... 8 10 Alfred place ... 1 ... 1 2 Braemar street ... ... ... 1 1 Alias road 3 2 2 5 12 Bratley street ... ... ... ... ... Alma road ... 1 2 5 8 Brick lane 1 ... 1 12 14 Ames street ... 1 2 3 6 Brierley street ... ... 2 7 9 Angela gardens 1 ... ... 1 2 Bucks court ... ... ... ... ... Anglesea street ... ... 2 1 3 Buckhurst street 2 2 ... 5 9 Anns place ... ... ... ... ... Bullards place 1 ... 3 2 6 Approach road ... ... 2 ... 2 Bunsen street ... ... ... ... ... Arbery road {Except Nos. 74 and 76) ... ... ... 3 3 Burgoyne road ... ... 1 ... 1 Burnham square ... ... ... ... ... Burnside street ... 2 2 3 7 Archer street ... ... ... ... ... Busby square ... ... 1 ... 1 Arline street 1 ... 3 ... 4 Busby street 1 ... 2 2 5 Artillery street 2 ... ... ... 2 Butler's buildings ... ... 1 1 2 Ashwell road ... 2 ... 4 6 Butler street ... ... ... 2 2 Auckland road ... ... 2 4 6 Buxton street (Odd Nos. 1 to 33 Eren Nos. 2 to 10) ... ... ... 1 1 Austin street 1 ... ... 1 2 Bacon street 1 1 2 3 7 Baker's court ... ... ... 2 2 Cadell street ... ... ... 1 1 Baker's rents ... ... 2 ... 2 Calvert avenue ... ... ... ... ... Baker street ... ... 1 1 2 Cambridge buildings ... 1 1 ... 2 Bandon road ... 1 1 5 7 Cambridge circus ... ... 1 5 6 Barnet grove 1 ... ... 3 4 Cambridge road (All Odd Nos. and Even No8. from 160) 1 1 ... 11 13 Barnsley houses ... ... 2 1 3 Barnsley street 1 ... 2 6 9 Baroness road 1 1 ... 4 6 Cambridge street ... ... ... ... ... Bath grove ... ... 1 1 2 Camden street ... ... 2 3 5 Bath street ... ... ... ... ... Camlet street ... ... ... ... ... Baxendale street ... ... 1 6 7 Canrobert street 1 2 6 15 24 Bellhaven street ... ... 1 3 4 Carlisle street ... 1 1 ... 2 Benson buildings ... 1 1 ... 2 Carmel house ... ... ... ... ... Bessy street ... ... ... ... ... Carter street ... ... ... ... ... Bethnal Green road ... 2 4 15 21 Casket street ... ... ... ... ... Birkl eck street l 2 3 Caslon place ... ... ... ... ... Bishop's road ... ... 2 10 12 Catherine street ... ... 1 ... 1 Blythe street 1 l 2 3 7 Centre street ... ... ... ... ... 96 STREET LIST—continued. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Chambord street ... 2 4 2 8 Cymon Street ... ... 1 4 5 Chance street ... 1 1 ... 2 Cyprus street 1 2 3 7 13 Chapel street ... ... 2 ... 2 Charles terrace ... ... ... ... ... Charlotte street ... 2 2 2 6 Dagnall place * 1 ... 1 ... 2 Chertsey buildings ... ... ... ... ... Daniel street ... ... ... ... ... Cheshire street ... 2 8 5 15 Darling row ... ... ... ... ... Chester street ... ... 1 3 4 Davis place ... ... ... ... ... Chilton street 1 ... 1 6 8 Davis buildings ... ... ... ... ... Chisenhale road 1 2 1 6 10 Delamere dwellings ... 1 ... ... 1 Church row 1 ... ... ... 1 Delta street ... ... 1 ... 1 Church street (Except Even Nos. from 2 to 26) 1 ... 1 7 9 Derbyshire street 1 1 1 4 7 Devonshire place ... ... ... ... ... Digby street ... 2 ... 2 4 Clare street 1 ... 2 5 8 Digby walk 1 ... 1 2 4 Claremont street. ... ... ... ... ... Dinmont street 1 ... 1 ... 2 Clarence street ... ... 1 2 3 Diss street 1 2 1 3 7 Clarkson street ... ... 4 1 5 Dixie street 2 ... 3 2 7 Clifton buildings ... 1 ... 3 4 Driffield road (Odd numbers) 1 ... 2 5 8 Club row 1 ... ... ... 1 Coate street ... ... ... 1 1 Ducal street ... ... ... ... ... Code street ... 2 ... 2 4 Durant Street ... ... ... 2 2 Colling place ... ... ... ... ... Colling street 4 ... 2 1 7 Collingwood street 1 1 5 4 11 Eastman street 1 ... 1 1 3 Collyer's court 2 ... ... ... 2 Ebor street (Except Nos. 11 to 19 Odd) ... ... ... ... ... Columbia market ... ... ... 1 1 Columbia road 1 1 4 7 13 Columbia square 2 l 2 7 12 Eckersley street ... 1 ... 3 4 Conyer street ... ... ... 1 2 Edgar place ... ... 1 ... 1 Cookham buildings ... ... ... 1 1 Edward place ... 1 1 ... 2 Co-operative b'ld'gs ... ... ... ... ... Ellesmere road 2 2 1 9 14 Cooper's gardens ... ... 1 2 3 Elwin street ... ... 1 5 6 Cordova road ... ... 3 3 6 Emma street 3 1 1 3 8 Corfield street ... 3 1 6 10 Ernest place ... 1 ... 1 2 Cottage place ... ... ... ... ... Evesham houses ... ... ... 1 1 Coventry place ... ... ... ... ... Ezra street ... ... ... ... ... Coventry street 3 1 5 7 16 Cox's buildings ... ... ... ... ... Cranbrook road ... ... ... ... ... Falcon buildings ... ... 1 ... 1 Cranbrook street ... 2 ... 2 6 Felix street ... 1 2 4 7 Craven buildings ... 1 ... 2 3 Fellbrigg street 1 1 8 9 19 Crescent cottages ... ... ... 1 1 Finnis street 2 1 2 4 9 Crescent place 1 1 1 3 6 Fleet street hill ... ... ... ... ... Cross street ... ... ... ... ... Flint court ... ... ... ... ... Grassland square ... ... 1 1 2 Florida street 2 ... 2 5 9 Cudworth street ... 1 1 4 6 Florida terrace ... ... ... ... ... Culham buildings ... 1 ... 1 2 Fossett's buildings 1 ... ... ... 1 Cygnet street ... ... ... ... ... Foster street ... ... ... ... ... 97 STREET LIST—continued. Name of Street. Zymotic Diseases. Tubercular Diseases Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Fountain street ... ... ... ... ... Hammonds gardens ... ... ... ... ... Fox street ... 1 3 2 6 Hamilton road 1 ... ... 2 3 Fox's buildings ... ... ... ... ... Hare court ... ... ... ... ... Fuller street ... ... 1 7 8 Hare marsh ... ... ... ... ... Hare row ... ... ... ... ... Hare street 1 1 3 14 19 Gales gardens 2 ... 2 8 12 Harold street 2 ... 2 1 5 Garden place Violet street ... ... ... ... ... Hartley street ... ... ... 1 1 Hassard place ... ... ... ... ... Garden place James street ... ... ... ... ... Hassard street ... 2 2 5 9 Havelock place 1 ... 1 ... 2 Gardners road ... ... ... 2 2 Heroming street ... 1 1 4 6 Garner street 1 ... 3 5 9 Hedsor buildings ... ... ... ... ... Gascoigne place ... ... ... ... ... Helens place ... 1 1 ... 2 Gawber street ... ... ... ... ... Henley buildings ... 1 1 1 3 George place ... ... ... ... ... Henrietta street 2 1 1 2 6 Georgina gardens ... ... ... 1 1 Hereford buildings ... ... ... 1 1 Gernon road ... ... ... ... ... Hereford street ... 3 2 7 12 Gibraltar buildings ... ... 1 ... 1 Hersee place ... ... 3 3 6 Gibraltar gardens ... ... ... 3 3 Hocker street ... ... ... ... ... Gibraltar walk ... 1 ... ... 1 Holly mansions ... ... ... ... ... Gilman street ... ... ... 3 3 Hollybush gardens 1 2 ... 3 6 Glass street ... ... ... 1 1 Hollybush place ... ... ... 1 1 Globe road (Even Nos. from 156 Odd from 131 2 2 6 9 19 Holmes avenue ... 2 1 1 4 Horatio street ... ... 1 1 2 Horts place ... ... ... ... ... Gloucester passage ... ... ... ... ... Hunslett street ... ... ... 1 1 Goldsmith's row (Children's Hospital & Nos. 8 to 62 Even) ... ... 1 ... 1 Huntingdon b'ldings ... ... ... 3 3 Hurley buildings ... ... ... 1 1 Gossett street ... ... 5 4 9 Granby place ... ... ... ... ... Iffley buildings ... ... ... ... ... Granby street ... ... ... ... ... Ion square ... 2 3 4 9 Great Eastern bldgs. 3 ... 1 3 7 Ivimey street ... ... ... 1 1 Green street 1 2 4 15 22 Gretton houses 3 I 1 4 9 Grimsby street 1 ... ... 2 3 James court ... ... ... ... ... Grove road (Odd Nos. from 59 Even Nos. from 110) 1 2 6 7 16 James place ... ... ... ... ... James street (Odd Nos. f rom, 39, Even from No. 4) 1 1 1 3 6 Guinness' buildings 3 1 1 11 16 Jersey street 2 ... 2 1 5 Hackney road (All Even Nos. and Odd Nos. from 323) ... 3 10 13 26 Kay street (Nos. 3 to 53 Odd) 2 1 3 3 9 Hague buildings ... 2 ... ... 2 Kelsey street ... ... ... ... ... Hague place ... ... ... ... ... Kenilworth road ... 1 1 3 5 Hague street 1 1 1 2 5 Kerbela street 1 3 1 4 9 98 STREET LIST—continued. Name of Street. Zymotic Diseases. Tubercular Diseases Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Kirkwall place 1 1 1 ... 3 Merceron houses ... ... ... 1 1 Kite place ... 1 ... ... 1 Merceron street 1 ... ... 3 4 Knottisford street 1 ... 1 1 3 Middleton street ... 2 3 5 10 Minerva street ... 1 ... 4 5 Minto place ... ... ... ... ... Laleham buildings ... ... 1 2 3 Mocatta house ... ... ... ... ... Lansdell place ... 1 3 2 6 Molesey buildings ... 2 ... 1 3 Lark row 2 ... ... 2 4 Montclare street ... ... ... ... ... Lawfranc road ... ... ... 2 2 Montfort house ... 1 ... ... 1 Leopold buildings ... 1 ... 2 3 Moravian street ... ... 1 1 2 Leslie bouse 1 2 ... 1 4 Morpeth street 1 1 5 3 10 Letchford buildings ... ... ... ... ... Moss street 1 3 6 7 17 Lessada street ... ... 2 5 7 Mount street ... 1 ... 2 3 Ligonier street ... ... ... ... ... Mowlem street ... ... 1 4 5 Lily house 1 ... ... ... 1 Museum buildings ... ... ... 1 1 Linden buildings ... ... 1 ... 1 Lisbon buildings 2 ... 1 ... 6 Lisbon street ... ... 2 ... 2 Nant street ... ... ... ... ... Little York street ... ... ... ... ... Navarre street ... ... ... ... ... London street 2 1 ... 1 4 Neath place ... 2 ... 3 5 Lucas street ... 2 2 ... 4 Nelson place ... ... ... 2 2 Lyal road (Nos. 57a and 58, to 88, Consecutive Nos.) ... ... ... 2 2 Nelson street ... 2 1 2 5 New Church street ... ... 1 1 2 Newling street 2 ... 1 1 4 Lyte street ... ... 1 1 2 New Tyssen street. 1 1 3 2 7 Norah street ... 1 1 5 7 Northampton street ... ... 3 2 5 Mace street 3 1 3 3 10 Norton street 1 ... 1 2 4 Manchester buildings ... ... ... 1 1 Manchester place ... ... ... ... ... Mansford buildings 3 1 1 ... 5 Octagon street ... ... ... 1 1 Mansford street 1 1 4 3 9 Old Bethnal Green road 2 2 ... 6 10 Mape street ... 2 6 6 14 Margaret place ... 1 ... 2 3 Old Ford road (Odd Nos. to 205, even Nos. to 368) ... 4 4 25 33 Marion place ... ... ... ... ... Marion square ... ... ... 1 1 Marion street ... 1 ... 1 2 Old Nicol street ... 2 ... ... 2 Marlow buildings ... ... ... 1 1 Olga street ... ... 1 1 2 Martha court ... 2 ... 2 5 Orange street ... ... 4 ... 4 Matilda street ... 1 1 2 4 Oval ... ... 2 7 9 Meadows dwellings 2 ... 1 6 9 Medhurst road 2 1 1 5 9 Medway buildings 2 1 2 8 13 Palissy street ... ... ... ... ... Med way road (Odd Nos. 3 to 49, even Nos. 2 to 62) ... ... ... ... ... Palm street 2 ... ... 4 6 Palmer's road ... ... ... ... ... Paradise row ... ... 1 1 9 Memorial Hall bldgs. ... ... ... ... ... Parliament place ... ... ... 1 1 Mendip houses ... ... ... ... ... Parliament street ... ... ... 1 1 Menotti street 1 1 ... 8 10 Parmiter houses ... ... ... 1 1 99 STREET LIST—continued. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseaes. Total. Parmiter street ... 1 2 4 7 Reuben street ... 1 1 1 3 Patriot square ... ... ... 5 5 Riders buildings ... 1 ... ... 1 Peabody buildings ... ... ... ... 1 Roan horse yard ... ... ... ... ... Peacock place ... ... ... 1 1 Robert street ... ... 2 ... 2 Peacock street ... ... ... ... ... Robinson road ... ... ... ... ... Pearl yard ... ... ... ... ... Rochelle street ... ... ... ... ...16 Peary place ... ... 1 ... 1 Roman road ... 2 5 3 Pedley street ... ... ... 5 6 (Odd Nos to 127, even Nos. to 142) ... ... ... ... ... Peel grove ... ... ... 3 3 Perl grove mews ... ... ... ... ... Pelter street 1 1 ... 2 4 Pereira street ... 1 2 3 6 Rooks place ... ... ... ... ... Peter street ... l 3 ... 4 Ropley street ... ... ... ... ... Pollard place ... ... ... ... ... Ross buildings ... ... ... 3 3 Pollard row 1 1 3 5 10 Moss street ... ... ... ... ... Pollard street l ... ... 2 3 Royal Victor place ... ... ... ... ... Portman place ... ... 1 3 4 Royston street ... 1 4 6 11 Pott street 2 l ... 1 4 Russia lane ... ... 3 10 13 Poyser street 1 ... 1 1 3 Sabbage yard ... ... ... ... ... Preston street 1 ... 2 1 4 Primrose street ... ... 2 2 Princes court 1 1 ... 3 6 Sale street ... ... 4 5 9 Pritchard's road ... 2 1 7 10 Sandford buildings ... ... ... ... l (Except Nos. 57 Satchwell rents ... ... 1 to 117) Satchwell street ... ... 2 3 Prospect terrace ... ... ... 2 2 Sclater street ... 1 1 1 3 Providence place ... 1 1 1 3 Scott street 4 2 4 4 14 Providence yard ... ... ... ... ... Seabright street 1 ... 4 8 13 Punderson gardens 1 ... 6 9 16 Selby street. 1 ... ... 2 3 (even numbers) Sewardstone road 2 1 4 4 11 Queen's buildings ... ... ... ... ... Shacklewell street 1 ... ... ... 1 Princes place Queen's buildings ... ... ... 1 1 Sheldon place ... ... ... ... ... Shepton houses ... 1 2 1 4 Oo88ett street ... ... ... ... ... Shetland street ... ... ... 3 3 Queen's buildings ... ... ... ... ... Shiplake buildings . ... ... ... ... ... Chambord street ... ... 1 1 2 Shipton street 2 1 3 2 8 Qu'n Caroline place Quilter street Skinners court ... ... ... ... ... 2 5 1 2 10 Sidney street ... ... 1 1 9 Quinns square 8 5 7 6 26 Smart street ... ... 1 1 9 Smiths place Somerford houses 1 2 2 3 1 5 4 Railway arches ... ... ... ... ... Somerford street ... 1 2 5 8 Ramsey street ... 2 ... 1 4 Sonning buildings ... 1 ... 2 3 Rapley place ... ... ... ... ... S'hampton cottages ... ... 1 ... 1 Ravenscioft build'gs 1 1 2 2 6 Southampton place ... ... ... ... ... Ravenscroft street 4 ... 1 2 7 Southampton street ... ... ... 1 1 Reid's mansions ... ... ... ... ... Southampton terrace ... ... ... Gossett street Spencer passage ... ... ... ... ... 100 STREET LIST—continued. Name of Street. Zymotic Ureases. Tubercular Diseases. Respiiatory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Dieases Respiratory Diseases. General Diseases. Total. Spicer buildings ... ... ... ... ... Treadway street 1 2 3 6 12 Spital street ... ... ... 1 1 Turin street ... 2 1 6 9 (Nos. 11 to 27) ... ... ... ... ... Turville street ... ... ... ... ... Squirries street ... 1 1 3 5 Tuscan street ... 1 ... 1 2 St. Andrews street ... ... ... 4 4 Type street ... ... 4 5 9 St. James road ... 1 ... ... 1 Tyrrell Street ... ... ... 1 1 St. Jude street 1 ... ... 2 3 St. Mark's buildings ... ... ... ... ... Tagg street St. Mary's place ... ... ... ... ... Usk street 2 1 ... 5 8 St. Matthias place ... St Peter square ... ... ... ... ... Vallance road 1 1 4 8 14 St. Peter street 2 1 1 6 10 Venice street ... ... ... ... ... Stainsbury street ... 2 2 2 6 Viaduct place ... ... ... 9 ... Stamp place ... ... ... ... ... Viaduct street ... ... 4 14 Stanfield road ... ... ... ... ... Victoria park ... ... ... ... ... ("Sloneleigh" House & Gateway adjoining) Steels buildings ... ... ... ... ... Victoria place ... ... ... 1 1 Victoria place ... 1 1 James street Victoria Park sq're ... 1 1 2 4 Strahan road ... 1 ... ... 1 (odd numbers) Violet row ... ... ... ... ... Streatley buildings ... 2 1 1 4 Violet street ... ... 1 ... 9 Stroud place ... ... ... ... ... Virginia road ... 1 6 Sugar Loaf walk ... 1 ... ... 1 Vivian road ... ... ... 4 4 Sunbury buildings ... ... ... 3 3 Voss street ... ... ... 2 2 Surat street ... 1 2 2 5 v yner street ... 1 1 3 5 Sutton buildings 1 ... 1 9 11 Sweetapple square ... ... 2 ... 2 Wadeson street 1 ... 2 6 9 Tagg street ... l 3 2 6 Walter street 1 1 ... 8 10 Taplow buildings 1 ... 1 2 4 Walton buildings ... 1 1 3 5 Tapp street ... ... ... ... ... Wargrave build'gs 1 1 2 3 7 Tavistock street ... ... ... 3 3 Warloy street l ... 5 4 10 Teale street ... ... ... 1 1 Warner place 1 ... 2 6 9 Teesdale street 2 3 2 5 12 Waterloo place ... ... ... ... ... Temple dwellings ... ... 3 ... 3 Waterloo road ... ... ... ... ... Temple street ... 1 3 7 11 Waterl oo ter race ... ... ... 1 1 Tent street ... 1 1 5 7 Wear street ... ... ... ... ... Thorold street ... 1 3 2 6 Weaver street (Odd numbers) ... ... ... l 1 Theydon road ... 3 ... ... 3 Three Colt corner ... ... ... ... ... Weldon street ... ... ... ... ... Three Colt lane 1 2 ... 1 ... Wellington place ... ... ... ... 17 Thurlow place ... ... ... ... ... Wellington row 1 5 5 6 Totty street ... 1 4 8 13 Wennington road 1 2 ... 1 4 Toyes dwellings ... ... ... ... ... Wharf road ... ... ... ... ... Old B'thnal G'n rd ... ... ... ... ... Wharncliffe street ... ... 1 4 5 Toyes buildings ... ... 1 2 3 Wheeler street ... ... ... ... ... Mans ford street Whites court 1 ... 1 ... 2 101 STREET LIST—continued. Name of Street. Zymotic Diseases Tubercular Diseases Respiratory Diseases General Diseaes Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total.[/##] Whitechapel road ... ... ... ... ... Winchester street 1 ... 2 ... 3 (Odd No8. from 319 Whitmore build'gs ... ... ... ... Wolverley passage ... ... ... ... ... Wolverley street ... ... ... 4 4 Wilmot house 1 2 2 12 17 Wood close ... ... ... ... ... Wilmot street ... ... ... ... ... Wood street ... ... ... ... ... Wimbolt street ... ... ... 4 4 Wingham street ... ... ... ... ... Winchester bu'd'gs ... ... ... ... ... No Home 1 1 7 19 28 Winchester cr'sc'nt Winchester place .. 1 1 2 Metropolitan Borough of Bethnal Green. THE CHIEF INSPECTOR'S FIFTEENTH ANNUAL REPORT on the work of the Public Health Department, for the YEAR ENDING 31ST DECEMBER, 1910. Ordered by the Public Health Committee to be printed and circulated, J. W. WARD, Chairman of the Public Health Committee. Metropolitan Borough of Bethnal Green. Public Health Department, Town Hall, Patriot Square, Bethnal Green, E. to the PUBLIC HEALTH COMMITTEE. Mr. Chairman and Gentlemen, I have the honour to present, in accordance Report. with your standing orders, the Annual Report on the work carried out by the staff of the Public Health Department for the year ending 31st December, 1910. As the period covered by this Report synchronises more or less closely with the termination of certain other periods, it will perhaps be permissible to take this as a convenient opportunity for directing attention to a few interesting figures which may prove, not only of some general interest to the members of the Council, but might I venture to suggest, be taken as evidence that the policy and procedure of the Health Committee and its Department for some years past stands out more fully justified by results as year after year elapses. 4 Two decades The periods referred to are the two decades of death rates. covered by the twenty years elapsing from 1891 to 1910, both inclusive; and the figures relating to the death rates of each of these two decades supply, I submit, ample evidence that a policy of sanitary activity can be, and is, fully justified by the tale of human lives saved or prolonged. Reduced death rates fortwenty years. If we take for comparison the general death-rate for the first of the twenty years under consideration, i.e., 1891, we find this to be somewhere about 25 per thousand. At the end of the first decade, i.e., 1900, we find that this rate had been gradually pulled down from 25 to 21 per thousand, whilst by the end of the two decades, i.e., 1910, this has been further reduced to the more satisfactory figure of about 16 per thousand. Death rate of If we take the Children's death-rate, i.e., under children reduced. five years of age, we arrive at, if possible, a more remarkable rate of progress. In 1891, on the estimated number of children, we find that this death rate was about 75 per thousand. By the end of last year it had been gradually reduced by regular steady rates each year for the twenty years under review to 45. Result of In other words we find as one of the many activity. undeniable results of twenty years of keen enforcement of Sanitary Measures, that the general death rate of the district has been reduced by about 9 per thousand or upwards of one-third of the former rate, whilst the children's, or under five, death rate shows a decrease of 30 per thousand, or three-fifths of its former bad total. 5 In order that the significance of these figures might be fully understood, I should point out that a drop of one point per thousand in the general death rate means on our average population that 129 lives have been saved. In twenty years it means, roughly, that 1,032 less people have died during the period of sanitary activity than during a similar period prior to such activity, when there was no sanitary staff, no health department, and not even much Committee to speak of. These figures and results speak for themselves, Department justified and I would only venture to add that a department that can show, by its annual tally of human lives prolonged, has no need to apologise for its existence, and has, I submit, every reason for continued confidence and support in carrying forward its various and ever increasing duties. Passing on from the consideration of the reduction infantile in death rates, we come to the question of what is Infantile mortallty. usually referred to as "Infantile Mortality," a matter of the greatest importance to the community, and containing factors calculated to lead to a further reduction of our children's death rate, if properly and effectively dealt with. As the Members of your Committee are well Abortive Conferences. aware, this question has been under consideration in some shape or other for a very considerable period, some three or four years at least; and one might say, if conferences could provide creches, or discussion evolve a school for mothers, and differences of opinion 6 upon procedure of feeding babies, we should be the best equipped authority in the world for dealing with this vast and difficult problem. Unfortunately, nothing remains of all our conferences and consultations except a memory of the painful poverty of ideas exhibited by both sections, plus the fact that no one really seems to be sufficiently interested to take up this matter and deal with it in right down dead earnest. For purposes of record and report, I herewith reproduce copies of three memoranda prepared in connection with this matte Health security. The first was circulated by the Medical Officer of Health on the 20th of April, 1910, to the members of the Bethnal Green Health Society, as well as the members of your Committee who attended the conference on that date, and as that memorandum was thought not to be sufficiently full, I prepared the second memorandum and circulated same on April 26th. Unfortunately, nothing came of either the conferences or the memoranda, and the matter lapsed Considered until November last, when His Worship the Mayor council. again brought the matter before the Council, with the result that after an adjourned discussion at two Council Meetings—where the third memorandum dated 25th November was discussed—the whole question was then referred back to your Committee, the place from whence it originally started many weary months ago. 7 All that has happened to it since is that some Mayor's 1 Committee faint-hearted suggestion was made that the subject for Necessitous should be referred in its entirety to the Mayor s Comchildren, mittee for dealing with Necessitous Children. It was thought that the scope and objects of that fund could be enlarged so as to provide and include this matter of Infantile Mortality. What will ultimately come out of the proposal cannot even be guessed at as yet. The only thing certain is that the present constitution of the Mayor's Fund Committee for Necessitous Children can only be varied with the consent and approval of the existing members, and this suggestion of tacking on to that Committee the dealing with this Infantile Mortality problem has been so far received with a frigidity creditable to a high-class refrigerator. These three memoranda contain all the important Special Memoranda, data bearing on the question and are as follows:— INFANTILE MORTALITY. Memorandum by the Medical Officer of Health re the Conference with the Bethnal Green Health Society on the 20th April, 1910. We have carefully considered the proposals of the Health Society, and are of opinion that the arrangements suggested are not feasible. It is absolutely essential that the whole district should be covered, and that the voluntary workers should be under the direct control of this Authority. The original visit after a birth must, of course, be made by the Official Health Visitor, Miss Harris, but much benefit would result if this visit could be followed up by some one who would get into friendly relations with the mothers, and see that the instructions given are faithfully carried out. 8 We suggest that some eight or ten voluntary visitors should be selected by the Health Society and placed at our disposal; each of these women should be held responsible for a district and each should be provided by this Authority with copies of the report cards on such cases as are thought suitable for reinspection in the district allotted. The visitor would be expected to call on each case at intervals of about a month during the first year of the child's life, and to note on the card anything she considered worthy of note. These cards should be periodically handed to Miss Harris, and by her submitted to the Medical Officer of Health, so that such action might be taken as would seem desirable or possible. In addition to this a committee of ladies should be formed to establish a fund to provide for the immediate assistance of deserving cases, which could be supported by voluntary contributions from churches, chapels, and private sources. (Signed) GEORGE P. BATE, Medical Officer of Health. JOHN FOOT, Chief Inspector. INFANTILE MORTALITY. Memorandum re Conference with Bethnal Green Health Society on the 20th April, 1910. At the request of several members, the following brief Memorandum has been prepared with a view to assisting members of both the Public Health Committee and the Bethnal Green Health Society, in their consideration of what is admittedly a subject of the greatest interest, and of far reaching importance. Like other great and important subjects, this question of apparent excessive infant mortality has attracted a considerable amount of attention for some few years past, and has also been the subject matter of an enormous output of oratory of a more or less inconclusive and impractical character. 9 Societies for what is euphemiously termed "pulling down the death rate" have become quite numerous, and in some respects fashionable, but, apart from certain exceptions, the practical results, if carefully inquired into, do not appear to quite tally with all the pretentious claims made in so many directions. The excessive death rate of young children is the product of many factors—social, economic, industrial and personal—and the one thing certain is that until the factors producing the result are carefully inquired into and removed or remedied, there is going to be no real or permanent improvement. About the most useless thing to rely upon in a question of this nature is that of sentimental expressions of platitudes and pious opinions ; the facts must be faced. The root cause of the matter lays deep down, and the application of real remedies as distinguished from mere surface palliatives must be equally deep, broad and far reaching. Each according to his peculiar idiosyncrasy has his own pet proposition as to the cause of the trouble as well as a remedy for the same. The extreme teetotaller has the advantage of brevity in a one word definition of both cause and effect, but at the Conference on the 20th, " ignorance of the mother " appeared to be the bed rock of local opinion. The sociologist will know that highly important as are the questions of " drink " and " ignorance " in connection with this subject, they are of comparatively minor importance in relation to the whole. Of the many points that will all have to be considered in their proper perspective before we can even begin to talk about " pulling down the death rate," are those of density of population, poverty, occupation, heredity and individual habits. 10 Omitting any expression as to what has led up to the formation of congested areas, it will be sufficient to point out here, that so long as human beings are permitted to be packed on space to the extent of upwards of 160 persons to every acre, it is really useless to try to deceive ourselves by using a series of platitudes about lifting up the people or pulling down the death rate. Fifty persons per acre would be an ideal healthy state; upwards of 160 persons per acre is simply fatal to such healthy state, and means not overcrowding in the legal sense, but such a state of actual overcrowding and density, that both individual and community alike are stifled and congested, and, in the natural sequence of events, the young children, being most weak, suffer, and fortunately die out the quickest. What applies to density of population applies with equal force to poverty and a low standard of life. Where we have the two in close combination, acting and re-acting the one on the other, the results are of course intensified to a far greater degree. Some of our friends who pride themselves on their local knowledge tell us there is no poverty; I wish it were so. I am dealing with the Bethnal Green I have known and worked in for upwards of twenty years, not with any imaginary place, and again I say that until your poverty problem has been eliminated, or at least reduced, it is simply fallacious to hope that your death rate is going to improve to any appreciable extent. Next to "density" and "poverty" I should place" occupation " and results arising out of industrial conditions. Apart from circumstances connected with the general conditions of a not high standard of employment—either as to regularity of work or remuneration—we have specially to consider the question of woman labour in factories and workshops and its results in relation to the mothering and rearing of children. 11 Whilst authorities may differ as to the actual extent of the harm done generally by the displacement of male labour by women in factories and workplaces, there can be no difference of opinion amongst sociologists that the factory or workshop is no place for a pregnant woman, nor for a mother suckling, or who should be suckling, her young child. The State, in the most mean and despicable manner possible, has recognised this principle by forbidding a woman to return to her work in a less period than one month from the time of her confinement. The principle is good and should be applied for a much longer period both before and after the confinement, but not at the expense of the mother who, poor wretch, is often the sole support of the family. and who has to starve or do as best she can during the period her work is stopped in the interest of the State, without compensation by the State. So far as the question of improving the race of babies is concerned, it should be recognised once and for all that, neither during pregnancy nor the nursing period should a mother be permitted to do work in factories or workshops or in any industrial capacity. There remains the question of heredity and environment, both of which factors have an enormous bearing on the question. On the first point it will be sufficient to refer to a fact recently mentioned to me by Mr. Ex-Mayor Barnard in connection with a special school for the mentally deficient. Here we see a school provided at the cost of the fit for those that are unfit, where, after years of education, certain of these unfits are allowed to marry and, in the natural course of events, to produce a further brood of unfits more burdensome to the community than were the original begetters of all these unfits. 12 This incident condenses and illustrates, as it were, the whole question of keeping alive and breeding from unfits. A slum produced population can only produce a generation of weedy stunts, and is important in this question for the reason that infantile mortality will never be reduced to a proper level so long as the most weedy and unfit are permitted to increase and multiply in a far greater ratio than do the more fit and useful members of the community. The question of drink, ignorance, vice and personal habits, are those where an improvement might reasonably be expected to take place as a result of a real sustained educational effort, and would form the very ideal ground for the efforts of an advisory voluntary Society formed for the purpose of carrying into individual homes and lives the benefits of a higher standard of personal and domestic hygiene. I have dealt later on with what this Society may be and do. Official inspection as at present understood and legally applied in this country stops short of being educational and demonstrative inside the homes and in the daily lives of the people. At its best it can, under such a wretched pretence as the Notification of Births Act, be only advisory and, as you all know, " advice " is the one thing that has no value and cannot be disposed of to anyone with advantage. In connection with this especial question, the advice is of far less value than usual for the reason that hundreds of those who need it most simply do not understand it or are not in a position to apply what they do understand. The admirable maxims set forth in the card bearing the legend " Advice to Mothers" means to an intelligent person conversant with actual conditions nothing but an exercise in an exquisite, if somewhat bitter, irony. It would be equally practicable to advise the daily use of gold watches and precious jewels, ad lib. 13 At its best, then, official action can only offer "advice" when medical comforts and liberal nursing diet is required. The one seems a poor substitute for the other, but the law says you may give the one and be surcharged if you attempt the other. At its worst, official action and inspection during a lying-in period may be such a meddlesome officiousness at a time when perfect rest and quiet is so essential, as to amount to an outrageous interference with the privacy and comfort of poor people. It will never be perpetrated on the rich and well to do. It is obvious, then, so far as we have gone with this retrogade and mischievous measure of notification of births, that neither at its best nor worst does it permit of anything more than " inspection " and " advice." It is certain that these two things alone will never begin to touch the remotest fringe of the question of "How to correct a heavy infantile death rate?" Having so far tried to make the situation a little more clear by pointing out briefly and not, of course, exhaustively the vastness and complexity of the problem under consideration, and incidentally illustrating how a serious matter is so lightly talked about and neglected by those who should be better informed, I now come to the consideration of what might peihaps be done under existing conditions to mitigate this evil by local voluntary effort. I would therefore submit, especially in view of this Conference with the Health Society, whether it is not possible to make some attempt to put into practical shape what many of the speakers appeared earnestly to desire, but did not seem to realise even theoretically how to set to work upon. Whilst carefully guarding myself from assenting to fallacious statements about pulling down the death rate in a few weeks, or entering into it as a kind of relaxation from other duties, I am firmly of opinion that a voluntary association 14 formed on right lines with workers willing to learn and who understand the nature of the problem and the vastness of the work to be done, could do most excellent work in this Borough. Such an association or society as I have in my mind should be formed of women workers, ready and willing to visit the cases and render assistance in the homes and to follow them up day by day during the critical periods and less frequently later on. The visitors should be women of experience, good tact and sound common sense, capable of teaching and advising in a non-official conversational kind of manner the mothers and others with whom they come in contact. They should be willing and able to attend instruction classes, capable of carrying out instructions and giving directions in the practice of a simple system of personal and domestic hygiene in the homes visited and, where necessary to do so, to see that proper temporary assistance is provided. Above all, such visitors should never play "policeman" in any direction, but should deal tactfully and discreetly with whatever information they may acquire in the course of their visits. Such an association could be well directed by a small committee of ladies with, as a suggestion, the Mayoress for the time being at its head, and the whole should be under the direction and at the disposal of the Public Health Authority acting by its chief adviser, the Medical Officer of Health. Such a society, officered by its Committee, should direct its early efforts to enlisting a sufficient band of workers to cover the entire district in such a manner that any and every case sent them by the Medical Officer of Health or official Woman Sanitary Inspector should have proper care and attention so long as may be necessary, and a shoit report of results and particulars supplied to the Medical Officer of Health, 15 Amongst other branches of this society's work it would probably be found necessary to provide some funds for rendering assistance to poor cases by means of necessary articles of clothing, midwifery kits, food, etc., for temporary help, pending communication with the Poor Law and other Authorities. There are many other details such as a school for mothers, etc., that would more properly be developed later on the formation of such a Committee rather than in this necessarily short and incomplete memorandum. I content myself here with merely submitting there is good work to be done and suggesting only the merest outline of how the same might be attempted with the hearty co-operation of all parties earnestly interested. With regard to the existing "Health Society," it is not for me to express any opinion as to how far as at present constituted it does possess or can be made to possess the organisation ready to take up this work and carry it on to a wider and more successful issue. In any case, I feel very strongly that before any voluntary society is given as it were a quasi official countenance and authority, there should be at least a very clear understanding as to the scope of the activities and a clearer knowledge of the proposed line of action in all its details. JOHN FOOT, 26th April, 1910. Chief Inspector. MEMORANDUM, NOVEMBER 25th, 1910. With respect to the question of Infantile Mortality in connection with the operations of and proposed further references to the Bethnal Green Health Society. With reference to the proposal to hold an informal meeting or conference of the members of the Council to consider whether any, and if so, what measures can be taken to deal 16 effectively with the questions of Infantile. Mortality, Necessitous Children, and similar matters, the following points may prove of service as a basis for discussion:— 1. As to the necessity for any action. The figures given below, setting out the death rates at different ages, seem to suggest, that although the rates prevailing in Bethnal Green are not abnormally high when compared with boroughs and districts of a similar character, the deaths of young children are higher than they need be, and with a proper system of advisory and educational effort, could be very considerably decreased. 2. The figures published by Dr. Bate, Medical Officer of Health, show that during the past ten years the average death rate per 1,000 of births was 148 under one year of age, and 20-5 per 1,000 children living between one year and five. The detailed figures for the ten years areas follows:— 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 Under 1 year 168 153 155 141 157 151 157 188 131 128 Between 1 & 5 23-3 28-1 24-8 21-2 20-1 19-3 20-1 17-8 19-4 16-5 3. The first point that arises on these figures appears to be that the death rate is unduly high and is capable of being reduced. 4. The next points appear to be, what measures, if any, can and should be taken ? 5. By whom should such measures be carried out? In many Boroughs various voluntary Committees, Health Societies, After-care Associations, etc., have been formed whose province it is to supplement official action in many directions. The activities of these societies have in several instances resulted in most excellent work. So far as Bethnal Green is concerned, some attempt was made by Mr. Edmonds during his Mayoralty to form some such Society for this Borough. 17 As a result of Mr. Edmond's efforts a small Association known as "The Bethnal Green Health Society" was inaugurated, and has been in existence for some time past. Without entering into any unnecessary details, it is sufficient to say here that there is considerable difference of opinion as to whether the present Health Society possesses a sufficiently large organisation to deal effectively with the subject as a whole; and there is a further difference of opinion as to whether the execution of such work ought to be delegated to a Society quite outside and independent of the Council or its responsible officers. There is undoubtly a strong feeling that as a sort of official sanction is to be given to a number of persons to enter the different houses with a view to carrying out certain directions, the Council either by its Public Health Committee or by its Medical Officer of Health, should retain the right to supervise and direct, and to intervene as may be found necessary. Moreover it is felt by many members of the Council that apart from the mere question of supervision the time is now opportune for considering as to the advisability of amalgamating under the auspices of the Council certain other matters in connection with:— (1). The Mayor's Fund for Necessitous Children. (2). Duties in connection with Midwifery Cases, and Infant Mortality. (3). After-care of Mothers and Infants. (4). Duties in connection with Phthisis, and secondary cases of Tubercular Disease, and (5). Generally how best to deal with the entire question of Infant Mortality and kindred matters relating to the health of the Borough. 18 It should be explained that there is no desire to abolish the existing Health Society but rather to incorporate it into a larger organisation to cover the entire district. It is hoped that the members of the Council and their friends will assist to form a much larger and more representative Society or Association whose objects and duties will be to cover the entire district, and who acting in conjunction with the Council and its officers will take all necessary measures to carry out the work of an auxiliary Health Society. The immediate questions for the consideration of the Conference appear to be:— (a) Shall such work be done under the auspices of the Council, or if done at all, (b) Left to a Society acting on its own initiative outside and independent of the Council. Assuming the Council decides to support the Mayor in his effort to deal with the above matters, it seems that the next step will be to consider as to forming some Society or Association whose duties and objects should be to carry into effect the above suggestion on lines similar to the existing Health Societies or Associations existing in many other Boroughs and districts. JOHN FOOT. 25th November, 1910. Food That very important matter of the supervision of inspection. food-stuffs exposed for sale in various parts of the Borough has continued to receive the close attention of the department. Mr. Rowsell has continued the daily inspection of the market places and stalls with most satisfactory results. In this connection Mr. Ainley has on many occasions as heretofore rendered most valuable and ready assistance. 19 Reference to the detailed Appendices I and J set out in a later part of this report shows that upwards of tons of unsound food have been seized by, or surrendered to, your Inspectors by the various tradesmen. These comprised meat, fish, poultry, fruit, etc. It is very gratifying to be once more able to report that all the proceedings taken in respect of sei/Aires of unsound food terminated satisfactorily. The following particulars of the location and Cen sus of . Traders in nature of trades taken on a given Saturday night may Food-stuffs, prove of some interest as showing the position and nature of the articles dealt in at various points. . No. of Butchers' Shops, Butchers' Stalls, Fish Shops, Fish Stalls, Provision Shops, Rabbit Stalls. Brick Lane. Butchers' Shops. Butchers' S talls. Fish Stalls. Provision Shops IO 4 II I Mile End Gate. Butchers' Fish Provision Fish Rabbit Shops. Shops. Shops. Stalls. Stalls. 5 1 1 7 I Green Street. Butchers' Butchers' Fish Fish Provision Rabbit Shops. Stalls. Stalls . Shops. Shops. Stalls. 12 12 7 3 4 2 Bethnal Green Road. Butchers' Butchers' Fish Fish Provision Rabbit Shops. Stalls. Stalls. Shops. Shops. Stalls. 22 17 13 2 2 6 Situated in other parts of the Borough. Butchers' Shops. Fish Shops and Stalls. Rabbit Stalls. 26 3 1 20 Food and Drugs Acts not effective. Public not protected. Evasion of all responsibility made quite easy. The steady regular enforcement of the Sale of Food and Drugs Acts, ineffectual and most unsatisfactory as they are known to be, has been continued with more or less satisfactory results. In view, however, of the many technicalities and conflicting decisions that have been given from time to time, the successful administration of these Acts is becoming increasingly difficult, and moreover a large amount of the protection originally intended for the public benefit has been destroyed. The effect of these technicalities can be seen on reference to the Appendix containing the list of legal proceedings, where it will be found a large number of summonses are dismissed on what are termed "warranty-defences." The procedure is quite simple. The wholesale dealer procures a warranty from the farmer or other contractor; the retail vendor proves a warranty from the said wholesaler. Both prove respectively that they never tampered with the milk whilst it was in their possession and the law is complied with. A good legal defence has been set up, and in the result the standard fixed for milk by the Board of Agriculture is daily rendered meaningless, the protection afforded the public as to the genuineness of the milk is illusory, and the administration of the Food and Drugs Act becomes an endless farce except in the expenditure of public funds which are largely wasted in this will-o'-the-wisp business. Action taken by Committee This question of Milk Warranty defences has been under your consideration on many occasions, in common with that of the other Sanitary Authorities of the Metropolis, and recently the Town Clerk was 21 requested to bring the matter to the notice of the Local Government Board, the Board of Agriculture, and the two Members of Parliament for the Borough. The Memorandum following was submitted to the Town Clerk for the purposes of information on which to base his communications to the above. Special Memorandum. SALE OF FOOD AND DRUGS ACTS, 1875—1907. Milk Warranty Defence. The question of "milk warranty defence" has again been under the consideration of the Public Health Committee of this Council, and at their meeting on the 22nd instant, on the report of certain Police Court proceedings the Town Clerk was requested to write to: — (a) The President of the Board of Agriculture and eries, and (b) The President of the Local Government Board, and to request their earnest attention to the matter. With- a view to securing some early amendment of the law as it now stands, the Public Health Committee desire to point out that in common with other Sanitary Authorities who have already directed attention to this matter, it is becoming increasingly difficult to take any proceedings likely to have a successful issue, especially in respect to milk samples found upon analysis to be deficient in butter fat or cream. In practice it is now quite common on any milk retailer being prosecuted for any offence relating to the sale of milk, for such retailer to give notice to the prosecution that he intends to rely upon a warranty granted by the wholesale contractors. At the hearing of the information such warranty is duly proved and the complaint dismissed. If proceedings be taken against the wholesale contractor, precisely similar procedure is repeated by this contractor, giving notice of a warranty from some other person. 22 In cases where the wholesale dealer happens to be a farmer originally producing the milk from his own cows, such proceedings are then varied to the extent, that instead of relying upon a warranty, the defence to be set up is that the milk in question has been sold and delivered in all respects as the cow gave it, and on the authority of Smithies v. Bridge, (1902), 2 K.B., 13, and later, Wolfenden v. McCullock, 92, L.T., 857, the information and complaint is in due course dismissed. The precedure has become quite stereotyped and general, even in cases where the deficiency in butter fat has amounted to 28% less than the proper amount, the only variation to its complete success appears to be mainly in the case of small retail shop-keepers, innocent alike of any tampering with the milk or the informed subtlety necessary to escape a conviction where detected. Recently this Authority has prosecuted shop-keeper, contractor and farmer, with the usual unsatisfactory results, each and every one of them put up the well-known defences successfully. In the result it is found apart from the inducements to manufacture the requisite warranties and other evidence that:— (a) In the present state of the law, the protection intended to ensure to the public, a milk supply up to the standard fixed is in the main, non-existent. (J) That the standard of milk as fixed by the order of the Board of Agriculture no longer obtains, and that such order has been rendered meaningless. (c) That in the present circumstances, the taking of samples for analysis, and the institution of legal proceedings calculated to terminate unsuccessfully can lead to no effective results, and (d) That having regard to the importance of this matter the Government should, in the public interest give it their earnest and immediate attention and legislate accordingly. 23 Boric and Chemical Preservatives in Food. During the year it was found that certain samples of ham and bacon purchased at different shops contained boric or chemical preservatives, and on this being reported to your Committee, the following circular letter was ordered to be sent to all the bacon dealers in the Borough. This letter seems in itself sufficiently to convey the idea that the Sanitary Authority merely desired (as it were) to put the several tradesmen on their guard, as well, of course, as to protect the public. Unfortunately some few of our local tradesmen do not appear to possess the saving grace of humour, and in one or two instances, the desire to accept advice, even when kindly meant, was not fully apparent. In any case, I was informed that if this interference was continued, the Trade Association would take the matter up, and very soon settle it; the Association would never allow the sacred cause of surreptitiously drugging the people, and the selling of drugs and chemicals disguised as bacon and ham to be lightly suppressed. It is only fair to add that the very large majority of the traders with great good sense did much appreciate the cautionary advice given. The letter referred to is as follows :— BORIC ACID IN BACON, etc. Circular letter re Boric Acid in Bacon and Ham. I am instructed by the Public Health Committee to inform you and all other persons dealing in bacon in this Borough, that certain purchases of bacon made at various shops in the district prove that bacon which has been preserved with boric acid is being sold to the public. 24 As you are doubtless aware, legal proceedings have been taken in certain cases where various articles of food have been found to contain preservatives of this character. The Public Health Committee have no desire to initiate proceedings without first giving the various traders full warning of further similar action on their part. In accordance with the Committee's directions I have therefore to request, in bringing this matter to your notice, that you and all other traders in the Borough will in their own interest take all necessary steps to ensure that bacon and all other foodstuffs sold to the public are free from any injurious preservatives whatever. Your obedient servant, JOHN FOOT. REGISTERED MILKSHOPS. Milkshops unsuitable. In a previous report allusion was made to the new powers granted to local authorities in connection with the registration of Milkshops and Dairies, such authorities being now empowered to refuse to register such premises if of opinion that the same are unsuitable for the sale of milk. These powers came into force 011 the 1st January, 1909, and in that month a circular letter was sent to each milk vendor in the Borough calling attention to the same, and requesting that all necessary measures to avoid action by this Authority would be taken. Some amount of improvement did take place, but amongst a certain class of traders no notice appeared to be taken of the warning. 25 Removed from register. By order of the Committee a list of milkshops where unsuitable conditions existed was prepared, and a notice was served upon each to the number of 174 giving warning of action by the Authority. Thirtyeight of these traders immediately put their premises in order, but it was found necessary after further notice to remove the remaining 136 from the Milk shops Register. Legal proceedings were commenced against the Authority to show cause why these milk vendors should not be reinstated, but were not carried through, a working compromise being arranged whereby the more objectionable features at the shops in question were removed by the proprietors, and upon completion of satisfactory alterations they were re-instated. In all, thirty milk vendors were so re-instated. The remaining 106 remain struck off the register. Some few of these attempted to continue the sale of milk after being removed from the register, but with the exception of three did not persist after notice. These three were summoned and duly fined by the Magistrate at Old Street. Bread sold under unsuitable conditions. Following upon this action with regard to registered milkshops, attention was widely directed through the press and other agencies to the danger of contamination of bread, owing to, in numerous cases, the unsuitable conditions attending the sale of same in general chandlers' shops where so often bread is sold in company with paraffin oil, strong pickles, coal, coal blocks, etc. The Authority in June were in receipt of a letter from the County Council, transmitting a letter from the Bermondsey and 26 Rotherhithe Master Bakers' Association on this question, asking that action should be taken to secure the regulation of places where bread is sold. The County Council were of opinion that the provisions of the General Powers Act of 1908, relating to the sanitary regulation of premises used for the sale of food would meet all requirements. The remedy proposed by this Authority The Public Health Committee however were of opinion that some definite and efficient action should be taken, and upon their recommendation the Council urged the London County Council to obtain powers enabling sanitary Authorities by annual licencing, registration, or other means to exercise adequate control over all premises used for the sale of any and every description of foodstuffs. CLEANSING OF VERMINOUS PERSONS. Further enquiries were received during the year from the London County Council and its officers, as to the possibility of coming to some arrangement with this Authority for the cleansing of verminous school children and persons coming from common lodging houses, both within and without the Borough. The County Council was informed, after due consideration, that this Authority were still strongly of opinion as previously indicated to the Council, viz.:—that the County Council should itself provide cleansing stations properly appointed and conveniently situated for the purpose required, but that a disinfecting station where large quantities of infected clothing are dealt with was not a suitable place for 27 numbers of children to be brought to for cleansing or any other purpose. Your Committee further suggested that bathing centres available for groups of schools, or bathing accommodation in connection with individual schools was a much more suitable suggestion than the proposal to utilise disinfecting stations for the purpose of bathing and cleansing these children. Borough of Bethnal Green Necessitous Children's Fund, and Lady Mayoress' God's Poor Fund. Upon application from the Committee of the above Funds, the Public Health Committee consented to assistance being rendered by the staff of the Department to both Funds during the year 1909-1910. Many hundreds of investigations were carried out and reported to the Committees concerned, and in the result over 750 pairs of boots, and other assistance, were distributed under the former Fund, and over 680 families were relieved with grants of meat, coal, bread, milk, etc., from the Lady Mayoress' Fund. The only staff changes throughout the year were staff, as follows:—Inspector Jones who had been in charge of combined drainage works and sanitary requirements of new buildings since his appointment in 28 1902, and whose salary in consequence of his duties being mainly outside the Sanitary Officers (London) Order, 1891, had been entirely borne by the Council, was appointed a regular Sanitary Inspector in consequence of the large diminution of combined drainage work, the supervision of which was otherwise provided for, Inspector Jones' duties being re-arranged accordingly. The result of this arrangement, which has received the sanction of the Local Government Board, is that one half of this officer's salary is borne by the County Council. The Clerical Staff of the department lost a most efficient member and an excellent officer, when, in September Mr. L. Bull, 3rd Assistant Clerk, obtained another appointment. In order to fill the vacancy, Messrs. W. Billings and H. A. Saunders, 4th and 5th Assistant Clerks respectively were promoted, and a Junior Clerk, H. W. Pendrill, appointed. Details ill Appendices on later pages Tabulated and detailed statements of the various duties performed and different matters dealt with, together with the legal proceedings taken throughout .lie year are fully set out in the several appendices which follow. I trust and believe these detailed particulars furnish evidence that the work of your department has received all proper care and attention it the hands of the staff on whose behalf I venture to solicit your best consideration, and whose efforts I respectfully commend to your kind attention. 29 Again thanking the Committee for their continued confidence and support. I have the honour to be, Mr. Chairman and Gentlemen, Your very obedient servant, JOHN FOOT, Chief Inspector, 1895. Member Royal Institute of Public Health, 1895. Certificate Sanitary Institute, 1888. 30 APPEN Total Number of Inspections and Particulars of Cases in Hand District. Infectious Cases. Complaints. House to House Inspections. Trades' Inspections. Re-inspections. Milkshop Inspections. Factory and Workshop Inspections. Outworkers' Homes Inspections. Tenement House Inspections. New Buildings Inspections. Ice Cream Shop Inspections. A 113 146 122 l 2359 132 416 818 150 ... 35 B 97 219 496 95 2544 152 202 1201 162 1 65 C 146 389 125 10 3028 154 214 506 154 ... 26 D 110 192 419 51 3162 330 901 302 635 ... 56 E 196 423 15 8 3179 287 850 678 151 4 25 F 169 233 ... 6 2216 222 1030 915 42 2 51 56 31 11 ... 1347 ... 28 267 ... 731 ... ... 22 ... 902 ... ... ... ... ... ... ... Totals 887 1705 1188 1068 17835 1277 3641 4687 1294 738 258 31 DIX A. for the Year ended 31st December, 1910. Combined Drainage Inspections. Smoke Nuisances— Premises under Observation. Other Inspections or work of Special Character Number of Calls. Unsound Food Seizures. Samples of Food and Drugs taken. Police Court Attendances. Nuisances Abated. Number of Cases in Hand. Total Visits for the Year. Inspector. ... ... 130 92 2 78 16 662 52 4514 E. Ainley ... ... 215 36 ... 101 8 845 52 5485 A. S. Henley ... ... 402 116 1 107 23 870 60 5270 J. G. Weeks ... ... 227 4 ... 130 27 1010 40 6387 F. Bare ... ... 294 180 1 103 15 1113 73 6285 E. Richards ... ... 445 152 ... 99 7 698 42 5533 H. F. Bridel 1169 ... 11 66 ... 3 ... 54 ... 3717 I. R. Jones ... 617 ... ... 4 107 19 ... ... 1541 W. Rowsell 1169 617 1724 646 8 728 115 5252 319 38734 ... 32 APPENDIX B. List of Nuisances and Insanitary Conditions generally, discovered during the year 1910. Period. Dirty Premises. Defective Drains. Defective and Dirty W.C's. Defective Water Supply Smoke Nuisances. Other Matters. Total. 1910 4 weeks ending 29th January 416 7 109 48 ... 491 1071 4 „ „ 26th February 253 7 76 47 ... 372 755 5 „ 2nd April 447 20 36 37 ... 511 1051 4 „ „ 30th April 308 3 39 27 ... 352 729 4 „ „ 28th May 317 8 49 38 ... 341 753 5 „ „ 2nd July 439 9 57 16 1 463 985 4 „ „ 30th „ 193 19 115 21 6 335 689 5 ,, „ 3rd September 213 4 46 27 3 279 572 4 „ „ 1st October 374 16 194 45 4 531 1164 4 „ „ 29th „ 285 4 67 29 3 381 769 5 „ „ 3rd December 363 27 224 85 3 568 1270 4 „ „ 31st „ 302 19 213 54 ... 611 1199 Total 3910 143 1225 474 20 5235 11007 33 APPENDIX C. List of Sanitary Improvements effected during the Year. Cleansing— Premises, &c„ cleaned, repaired or whitewashed 4,833 Workshops ditto ditto ditto 861 House Drains— Drains relaid 113 Drains amended 132 Drains cleared 291 Drains trapped and ventilated 32 Rain water pipes and waste pipes disconnected 13 Sink and bath waste pipes trapped 49 Water Closets— W.C.'s repaired, cleaned, &c. 1,861 W.C.'s fitted with new pans and traps 349 W.C.'s supplied with water, and water supply apparatus 656 W.C.'s ventilated 16 W.C.'s rebuilt 6 New W.C.'s provided 43 Partitions provided round W.C.'s to separate same from workshops 5 Water Supply— Houses provided with water supply 178 House supply disconnected from W.C. cistern ... Cisterns supplied, repaired and cleaned 22 Miscellaneous— Paving of yards 681 Washhouses paved 64 Forecourts and Areas paved and drained 15 Stables paved and drained 13 Removal of accumulation of Dung and other refuse 87 Removal of Animals improperly kept 41 New Dung-pits provided and covers for same 15 Premises closed previous to executing the necessary repairs 103 Gutters, Rainwater Pipes, and Waste pipes repaired 859 Illegal occupation of Basement discontinued 1 Overcrowding abated 182 Urinal accommodation provided 8 Grids provided to Gullies 33 Urinals supplied with proper water supply 16 Urinals cleaned 28 Dust Shoots repaired and Receptacles provided 641 Vacant lands cleansed 1 Yards cleansed 118 Indecent occupation discontinued 17 Verminous Rooms remedied 397 Damp Rooms remedied 304 Lighting and Ventilation improved 287 Total 13,321 34 APPENDIX D. Police Court Proceedings, 1910.–Public Health (London) Act, 1891. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. 1910 Feb. 1 H. Fixing untrapped sink waste pipe, 4, W. road H. F. Bridel Mr.Cluer Works done. Costs 3s. „ H. do. 6, W. road „ „ Works done. Costs 3s. Mar. 1 W.A. Exposing for sale unsound oranges E. Ainley „ Defendant absconded. Warrant issued. „ 15 H.S. Exposing for sale unsound bloaters W. Rowsell „ Fined £2, or prison 14 days. Went to prison. June 9 E. Non-compliance with notice A. S. Henley „ Works done. Costs 3s. „ 14 M.F. Depositing unsound cherries for sale E. Ainley „ Fined £1 10s. Costs 2s. August 4 J.S. Exposing for sale unsound codlings W. Rowsell „ Fined £1. Costs 2s. Went to prision for seven days. 35 Police Court Proceedings, 1910.—Public Health (London) Act, 1891—continued. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. „ 4 S.H. Exposing for sale unsound onions „ Mr. Cluer Fined £2. Costs 2s. „ 4 R.B. Failing to deposit plans in repect of drainage works E. Richards „ Fined 10s. Costs 2s. „ 4 R.B. Failing to give notice of drainage works „ „ Fined 10s. Costs 2s. „ 4 R.B. Improperly constructing W.C. „ „ Fined £2. Costs £3 3s. „ 4 A.G. 2 summons Exposing and depositing for sale unsound Dutch herrings „ „ Dismissed. Magistrate of opinion fish not exposed or deposited for sale. Dec. 20 I.B. Exposing for sale unsound pears E. Ainley „ Fined 15s. Costs 2s. 36 APPENDIX E. (1). Sale of Food and Drugs Acts, 1875—1907. Samples taken officially and submitted for analysis during the year. Article. Total No. of Samples taken. Genuine. Adulterated. Offences other than adulteration. Milk 375 348 27 ... Butter 140 128 12 6 Mustard 4 4 ... ... Pepper 20 20 ... ... Gooseberry Jam 2 1 1 ... Coffee 33 26 7 ... Cocoa 12 12 ... ... Blaud's Iron Pills 1 1 ... ... Lard 7 5 2 ... Cheese 2 2 ... ... Raspberry Jam 14 12 2 ... Apricot Jam 1 1 ... ... Marmalade 1 1 ... ... Bloater Paste 1 1 ... ... Crab and Lobster Paste 1 1 ... ... Cream of Tartar 2 1 1 ... Glycerine 9 9 ... ... Rice 6 6 ... ... Eucalyptus Oil 1 1 ... ... Margarine 1 1 ... ... Castor Oil 2 2 ... ... Tea Dust 2 2 ... ... Milk, Condensed Skimmed 1 1 ... ... Butter, Salt 2 2 ... ... German Sausage 1 1 ... ... Bacon 1 ... 1 ... Total 642 589 53 6 In one case, the inspector was obstructed while acting in the course of his duties. 37 One sample of butter was served in a paper stamped "Margarine." In the cases of one sample of butter, one of bacon, and two of milk, all slightly adulterated, the offence was too slight to warrant a prosecution, the vendors being cautioned. One sample purporting to consist of cream of tartar was found to be entirely saltpetre. An obvious mistake had been made and a caution was administered. Owing to "legal" notice exhibited at the time of purchase, no proceedings were possible in the following cases:—one lard consisting entirely of cocoanut fat, two milks 90 per cent. and 11 per cent. deficient in fat respectively, and two coffees containing 45 per cent. and 47 per cent. of chicory respectively. 38 APPENDIX E (2). FOODS AND DRUGS. Table showing Percentage Adulteration for Decennial Period 1899—1908 Compared with 1909. Year. No. of Samples Taken. No. Adulterated. Per centage Adulterated. 1899 201 42 20.9 1900 186 35 18.8 1901 326 62 19.0 1902 896 57 14.4 1903 485 64 13.2 1904 609 79 12.9 1905 656 75 11.4 1906 671 87 12.9 1907 682 45 6.6 1908 617 52 8.4 Decennial average percentage adulteration 13.85. 1909 642 53 8.2 39 The following is a summary of legal proceedings, etc., in connection with the above cases:— No. of Adulterations Other offences under Sale of Food and Drugs Acts No. of Summonses Issued. No. of Convictions obtained. No. of Cases Dismissed. No. of Summonses Withdrawn. 53 7 49 34 6 9 The offences other than sophistication of samples consisted in six cases of margarine served in a plain wrapper, and in one case of obstruction as above noted. The cases dismissed consisted of one in which the magistrate held that the milk was sold as it came from the cow, and in another case as it was received from the farmer, and in one case that legal notice had been given before purchase; in three cases warranties were proved resulting in dismissal. Six summonses were withdrawn upon convictions being obtained on other summonses in respect of the same samples, one against a retailer was withdrawn upon his wholesale man being convicted for delivering milk deficient in fat, and in one case a summons against a large firm was withdrawn upon the firm obtaining a conviction against their roundsman for tampering with the milk. In connection with these tables, no proceedings were taken in the cases of three samples of margarine served in plain wrappers owing to the bulk from which the inspectors were served being properly labelled, 40 but the circumstances raise doubts whether an unsuspecting purchaser, asking for butter, might not have been served from the same—as a matter of fact a sample of "butter" purchased subsequently from one of these vendors proved to consist entirely of margarine. In two cases genuine milk was purchased from shops in which were hung notices to the effect that the milk sold there was not guaranteed. APPENDIX E (3). Sale of Food Drugs Acts, 1875 to 1907. Samples taken for General Information. Articles. Examined by Public Analyst. Examined by Clinical Research Association. Genuine. Adulterated, etc. Genuine. Adulterated, etc. Bacon 7 3 ... ... Brawn 1 ... ... ... Butter 4 4 ... ... Cocoa 2 ... ... ... Coffee 1 ... ... ... Cheese 2 ... ... ... Cream of Tartar 1 ... ... ... German Sausage ... ... 4 ... Ham 3 ... ... ... Lard 16 ... ... ... Margarine 16 ... ... ... Mussels ... ... 4 1 Peas 2 ... ... ... Powder from Peas 3 ... ... ... Sauce 1 ... ... ... Tea, China 3 1 ... ... Totals 62 8 8 1 41 These samples are purchased privately, and submitted for examination, and in the case of any proving unsatisfactory the vendor is kept under observation. The samples of mussels mentioned were purchased in connection with the outbreak of enteric fever, an account of which appears in the report of the Medical Officer of Health; the one adversely reported upon showed evidence of sewage contamination. The authorities in the City of London were thereupon communicated with for the purpose of dealing with the wholesale dealer in Bishopsgate Market. The samples of Margarine and Lard were purchased in consequence of a circular letter from the Board of Agriculture on the subject of alleged complaints which had been received by the Board to an extensive trade in lard substitutes and the fraudulent sale of margarine. Four samples of Tea sold as China were kindly examined free of charge by Messrs. C. Hope & Sons, Tea Experts, of Eastcheap, E.C., who reported them to be all as sold with the exception of one, a blend of Indian and Ceylon. APPENDIX E (4). Samples taken on Delivery. The following samples were taken on delivery from wholesale firms delivering goods to various retail tradesmen in the Borough:— Total taken. Genuine. Adulterated. Milk 27 22 5 Butter 3 — 3 42 APPENDIX F (1). Police Court Proceedings,–Sale of Food Drugs Acts, 1875-1907. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. 1910 Jan. 18 M.J. Selling milk containing 7 per cent. added water W. Rowsell Mr. Cluer Fined £10. „ 18 I.F. Selling milk 16 per cent. deficient in fat „ „ Fined £6. Feb. 1 E.P. Selling coffee containing 11 per cent. chicory. A. S. Henley , Costs 12s. 6d. „ 8 W.P. Selling coffee containing 65 per cent. chicory. E. Ainley , Fined £1. „ 15 B.J.B. Selling butter containing 30 per cent. foreign fat. „ „ Fined £4. „ 15 „ Selling margarine in plain wrapper „ „ Withdrawn. Conviction on other summons re same sample. „ 22 L.S. Selling milk 26 per cent. deficient in fat E. Richards Mr. Biron Fined £2. Costs 12s. 6d. „ 22 H.P. Selling milk 13 per cent. deficient in fat „ „ Fined £5. Costs 12s. 6d. „ 32 M.K. Selling coffee containing 87 per cent. chicory „ „ Fined £1. Costs 12s. 6d. Mar. 1 T.B. Selling milk containing 8 per cent. added water W. Rowsell Mr. Cluer Fined £2. 43 Police Court Proceedings.—Sale of Food and Drugs Acts, 1875-1907-continued. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. „ 8 G.F. Selling coffee containing 40 per cent. chicory E. Ainley Mr. Cluer Fined £2. „ 8 „ Selling butter containing 89 per cent. foreign fat „ „ Fined £2. „ 8 „ Selling margarine in plain wrapper „ Withdrawn. Conviction on other summons re same sample. „ 22 J.S. Selling milk containing 8 per cent. added water A. S. Henley „ Withdrawn. Conviction against wholesale dealer. „ 22 G.C. Delivering under contract milk containing 4 per cent. added water „ „ Fined £4. April 5 J.P. Selling milk containing 12 per cent. added water J. G. Weeks „ Magistrate held that notice of adulteration had been given. „ 5 W.C. Delivering milk under contract 11 per cent. deficient in fat „ „ Fined £10. „ 5 D.C. Selling milk containing 5 per cent. added water F. T. Bare „ Fined £2. 44 Police Court Proceedings.—Sale of Food and Drugs Acts, 1875-1907—continued. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. „ 6 R.G. Selling butter containing .28 per cent. boric acid above limit of .5 per cent. A. S. Henley Mr. Cluer Costs 12s. 6d. „ 6 A.L. (two summones) Delivering butter on contract containing .2 per cent. boric acid above limit of 5 per cent. „ „ Fined £10. „ 6 J.L. Selling butter containing .17 per cent. boric acid above limit of .5 per cent. E. Richards „ Costs 12s. 6d. „ 6 H. & Co. Delivering butter on contract containing .22 per cent. boric acid above limit of .5 per cent. „ „ Fined £5. „ 12 H.H. Delivering milk under contract 9 per cent. deficient in fat E. Ainley „ Dismissed. Warranty defence. 45 Police Court Proceedings.—Sale of Food and Drugs Acts, 1875-1907—continued. Date of Hearing. Defendant. Offence. Inspector. Magistrate Result. May 3 W.T.G. Selling milk 9 per cent. deficient in fat. F. T. Bare Mr. Cluer Fined £2. „ 3 D.J. Selling milk containing 5 per cent. added water „ „ Dismissed. Warranty defence. „ 3 J.J. Selling butter containing 47 per cent. foreign fat „ Fined £15. „ 3 „ Selling margarine in plain wrapper „ „ Withdrawn. Conviction on other summons re same sample. „ 3 C.A. Selling milk 11 per cent. deficient in fat A. S. Henley Mr. Cluer Dismissed. Warranty defence. „ 24 J.S. Selling milk 9 per cent. deficient in milk J. G. Weeks „ Costs 12s. 6d. „ 24 S.R. Selling milk containing 6 per cent. added water W. Rowsell „ Fined £1. „ 24 S.F. Selling milk 11 per cent. deficient in fat „ „ Costs 12s. 6d. „ 31 J.T.J. Selling butter containing 77¾ per cent. foreign fat W. Rowsell Mr. Cluer Fined £2. „ 31 „ Selling margarine in plain wrapper „ „ Withdrawn. Conviction on other summons re same sample. 46 Police Court Proceedings.—Sale of Food and Drugs Acts, 1875-1907—continued. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. July 5 D.C. Selling milk 10 per cent. deficient in fat F.T. Bare Mr. Cluer Dismissed. Magistrate satisfied milk was sold as received. „ 5 E.G. Selling raspberry jam containing 15 per cent. apple pulp E. Ainley „ Costs 12s. 6d. „ 5 H.C. Selling milk 7 per cent. deficient in fat F. T. Bare „ Fined £1. Costs 12s. 6d. „ 19 S.L. Selling raspberry jam containing 20 per cent. gooseberry fruit, 20 per cent. apple pulp J. G. Weeks Mr. Cluer Dismissed. Magistrate of opinion that notice was given at time of purchase. „ 19 S.L. Selling gooseberry jam containing 15 per cent. apple pulp „ „ Fined £2. „ 26 W.J. Selling lard containing 90 per cent. cotton seed stearin W. Rowsell „ Fined £10. August 4 M.A.G. Delivering under contract milk 6 per cent. deficient in fat E. Ainley „ Fined £5. 47 Police Court Proceeding.—Sale of Food and Drugs Acts, 1875-1907—continued. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. „ 4 J.B. Selling milk 9 per cent. deficient in fat „ „ Costs 12s. 6d. „ 4 C.S. Selling coffee containing 37 per cent. chicory „ „ Fined £2. Sept. 27 E.P. Selling butter containing 74 per cent. foreign fat J. G. Weeks Mr. Cluer Fined £2. „ 27 E.P. Selling margarine in plain wrapper „ „ Withdrawn. Conviction on other summons re same sample. Nov. 8 A.P. Selling milk 8 per cent. deficient in fat W. Rowsell Mr. Biron Magistrate satisfied milk sold as given by cow. „ 22 W.& S Selling milk containing 7½ per cent. water H. Bridel „ Withdrawn upon conviction of roundsman for watering milk on round. „ 29 J.J.L. Selling butter containing 84 per cent. foreign fat E. Richards „ Fined £10. Costs 23s. „ 29 „ Selling margarine in plain wrapper „ „ Withdrawn upon coviction on other aummons re same sample. „ 29 F.J.S. Selling milk containing 28 per cent. added water „ „ Fined £2. Costs 23s. 48 APPENDIX F (2). Police Court Proceedings.—Dairies, Cowsheds & Milkshops Orders, 1885-1886. Date of Hearing. Defendant. Offence. Inspector Magistrate. Result. Oct. 25 B.S. Selling milk whilst not registered E. Richards Mr. Biron Fined £2 and 23s. cost. „ 25 L.S. Do. „ „ Fined £2 and 25s. cost. Nov. 29 M.G. Do. A. S. Henley Mr. Biron Fined £2 and 23s. cost. APPENDIX F (3). Police Court Proceedings.—London County Council (General Powers) Act, 1902. Oct. 25 N.F. Neglecting to take all measures to prevent contamination of ice cream F. T. Bare Mr. Biron Fined £2. Costs 23s. 49 APPENDIX G. Premises where Food is prepared for Sale. Number of premises on register at end of 1910 219 Number of premises removed from register during 1910 12 Number of premises added to register during 1910 15 Number of visits 793 Number of notices served 20 Number of Prosecutions Nil. APPENDIX H. Inspection, etc., of Bakehouses. Number on Register at end of 1909 89 „ „ „ 1910 90 Number above ground 63 Number under ground 27 Number of inspections 216 Number of notices 11 Number of Prosecutions Nil. APPENDIX I. Unsound Food—Surrenders. Tons cwts. qrs. st. lbs. Fish 2 2 1 1 7 Fruit 3 5 Meat 2 0 1 5 Total 2 5 1 1 3 95 Turkeys were also surrendered 50 APPENDIX J. Unsound Food—Seizures. Cwts. qrs. st. lbs. Fish 2 1 1 9 Fruit 1 2 1 8 Meat 0 0 1 4 Total 4 1 0 7 57 lbs. of Onions were also seized. APPENDIX K (1). Outworkers, 1910. Year. No. of iists received from employers. No. of Outworkers comprised therein. Reported from other Boroughs. Reported to other Boroughs. 1909 194 3,085 3,599 1,463 1910 198 3,394 3,261 1,640 Number of Outworkers dealt with in 1909 6,684 „ „ „ 1910 6,655 51 APPENDIX K (2). Outworkers' List of Trades. The following is a list of the trades in which the Outworkers' notified during 1910 were engaged:— Artificial Flower Making 8 Fur-slip Stitching and Trimming 9 Belt Makers 20 Mantle Making 29 Bibs and Pinafores 11 Millinery 9 Blouse Work 36 Pyjama Making 1 Boot and Shoe Making 832 Shirt Making 42 Box and Paper Bag Making 631 Silk Winding and Weaving 64 Brace Making 1 Tailoring 960 Brush Making, &c. 442 Tent Making 2 Button Making 9 Ties and Bow work 85 Cabinet Making 5 Upholsterers and Fancy Trimmings 125 Cap Making 9 Underclothing 33 Chair Making 3 Umbrella Making 16 Collar Making 3 Waterproof Manufacturers 4 Dressmaking 25 Total 3,435 Embroidery 12 Feather Curling 2 Of the above number of Outworkers' 545 were incorrectly notified or have discontinued work. 52 APPENDIX L. Tenement Houses. No. on Register 517 Inspections made 2,334 Notices served 640 Rooms overcrowded 12 Cellars Illegally occupied o Number Cancelled 21 Water provided to upper floors 6 Cases of Indecent occupation 3 No. of Houses registered during 1910 21 Registration Forms writted and served 28 APPENDIX M. Overcrowding and House to House Inspections. Number of dwelling rooms overcrowded in 1910 182 Number of dwelling rooms remedied in 1910 167 Number of Prosecutions — Number of House to House Inspections in 1910 1,188 Number of defects discovered 1,372 Number of notices served 781 APPENDIX N. Complaints received from L.C.C. respecting Verminous School Children. Number of complaints received in 1910 252 Number of Inspections made in 1910 289 Number of premises found to be verminous 46 Number of defects discovered 334 Number of Notices served 206 Number of Prosecutions — 53 APPENDIX 0 (1). Work of the Disinfectors during 1910. Month No. of Rooms disinfected Disinfections following Phthisis No. of Rooms disinfected by request No. of Articles destroyed at Station. No. of Articles of Bedding disinfected at Station No. of Articles disinfected in Formalin Chamber No. of Cases in which Shelter was used No. of Persons accommodated at Shelter No. of hours for which Shelter was occupied January 71 24 6 16 1587 ... ... ... February 82 25 1 1 1459 Books, 2 3 12 March 66 21 4 1685 Boots, ... ... ... April 76 20 6 1970 ... ... ... May 60 12 12 85 1577 Dresses, ... ... ... June 80 12 9 2 1576 Fancy 1 3 10 July 77 11 9 3931 ... ... ... August 67 18 5 2481 Material, ... ... ... September 134 21 12 5 2174 &c. ... ... ... October 104 18 2 1549 1 2 12 November 72 20 3 6532 2,400 ... ... ... December 63 23 3 5 3390 ... ... ... Totals 952 220 72 114 29,861 2,400 4 8 34 Number of Verminous people who were bathed and had their clothes disinfected at station during 1910. Fifteen men, all from the Homeless Poor Asylum, Warner Place. 54 APPENDIX 0 (2). Forty-two casks of Sanitas Powder, making up into 2,940 packets, have been distributed from the offices. Three hundred and twenty one-pint bottles of Sanitas Fluid and one hundred and forty four onepint tins of Izal Fluid have also been distributed from the offices. Half-a-ton of Sulphur in the form of Sulphur Candles has been used in the disinfection of rooms throughout the year. Half-a-gallon of Formaldehyde. 40 per cent, solution, has been used in spraying the walls of rooms, five pounds of formalin tablets have been used for fumigating rooms in certain cases instead of Sulphur Candles. Three-and-a-half gallons of Carbolic Acid and five gallons of Creocide were used for disinfection in connection with cases of Enteric Fever. APPENDIX P. Smoke Observation. Shafts under observation 100 Number of hours spent in observation 400 „ Intimation Notices served 22 „ Statutory „ „ — 55 APPENDIX Q. Mortuary Returns, 1910. Bodies removed to Mortuary— On Coroner's Order 249 By Police 14 By Firemen 3 From London Hospital 15 On Sanitary Inspectors' Order 5 On Request of Relatives 39 Total 325 Number of Inquests held 266 Number of Post Mortem Examinations 91 Particulars of bodies on which Inquests were held— Bodies removed by Police from Railway 2 Ditto ditto Canal 1 Ditto ditto Street 7 Ditto ditto Police Station 1 Ditto ditto Found in Parcels 4 Ditto Firemen (74, Green Street) 3 Bodies received from Bethnal Green Infirmary 54 Ditto Bethnal Green Asylum 1 Ditto Queen's Hospital 18 Ditto Mildmay Mission Hospital 8 Ditto Private Houses, etc 167 Total 266 Inquest cases according to age period— Number under one year 79 Number over one year and under five years 24 Do. five do. ten do 8 Do. ten do. twenty years 5 Do. twenty do. thirty do. 5 Do. thirty do. forty do. 19 Do. forty do. fifty do. 29 Number over fifty years and under sixty years 23 Do. sixty do. seventy do. 29 Do. seventy do. eighty do. 38 Do. eighty years 7 Total 266 56 Causes of death in Inquest cases— Abscess 1 Apoplexy 14 Atelectasis 1 Bronchitis 10 Broncho-Pneumonia 3 Cancer 4 Cardiac Valvular Disease 10 Cerebro-Spinal Meningitis 2 Cerebral Thrombosis 1 Chronic Kidney Disease 4 „ Liver Disease 1 „ Nephritis 1 Congestion of Lungs 2 Convulsions 12 Diarrhoea 3 Diphtheria 1 Dropsy 1 Enteric Fever 1 Erysipelas 1 Epileptic Fits 1 Exhauston Melancholy 2 Fatty Degeneration of Heart 6 Gastritis 1 General Tuberculosis 3 Inanition 3 Marasmus 4 Measles 2 Meningitis 3 Pericarditis 2 Peritonitis 1 Phthisis 8 Pleurisy 5 Pneumonia 13 Premature Birth 9 Rupture of Aneurism 3 Rickets 1 Senile Decay 11 Spasm of Windpipe 1 Status Symphaticus 3 57 Causes of death in inquest cases—continued— Still Born 5 Strangulated Hernia 1 Tumour on the Brain 1 Ulcer of the Stomach 2 Weak Heart 1 Whooping Cough 1 Destitution and Want 2 Chronic Alcoholism 10 Neglect 1 Want of Attention at Birth 2 Accidental Deaths— Death while under Chloroform 1 Falls 21 Suffocation in Bed 25 Do. at Birth 1 Do. while Drunk 1 Drowned 1 Burns 11 Ptomaine Poisoning 1 Misadventure 2 Scalds 2 Run over on the Great Eastern Railway 2 Run over in Street 5 Septic Poisoning 3 Suicide— Hanging 3 Poisoning 3 Self Starvation 1 Strangulation 2-9 Total 266 Bodies received under Public Health (London) Act— Diphtheria 2 Enteric 1 Erysipelas 1 Measles 2 Total 6 58 APPENDIX R. Inspection of places subject to Special Bye-Laws and Regulations. Premises. No. of Places. No. of Inspections. No. of Notices. No. of Prosecutions On Register at end of 1909 Added in 1910 Removed in 1910. On Register at end of 1910 Milkshops 327 48 132 243 1413 226 3 Cowhouses 15 .... .... 15 56 5 .... Slaughterhouses 5 .... 5 24 .... .... Other offensive trade premises 1 .... .... 1 3 .... .... 59 APPENDIX S. Clerical Work. Intimation notices written and served 5,430 Statutory do. do. 1,975 Entries in Nuisance Register 6,349 do. Tenement House Register 3,166 do. Food and Drugs do 728 do. Workshops do 7,022 Notices respecting Combined Drainage 63 Final notices prepared and served 608 Letters written 3,795 Briefs and Instructions to Solicitor prepared 59 Summonses prepared (4 copies each) 67 School notifications prepared and dispatched 1,992 Notices to District Surveyor 53 60 APPENDIX T. Works carried out and in progress by Combined Drainage Staff during the year. Relaying Combined Drains. 424 to 428, Bethnal Green Road. 43 to 49, Medway Road. 110 to 116, Bonner Road. 45 to 51, Old Ford Road. 110 to 124, Brady Street. " City of Paris," Old Ford Road, la, Durant Street. 11 to 20, Reuben Street. 172, Hackney Road and 26 to 28, Scott Street. adjoining premises. 53 to 57 Sewardstone Road. 7 to 11, Kite Place. 82 to 116, Warner Place. 32 to 34, Mace Street. 3 to 6, Waterloo Terrace. Other Works. 15, Abingdon Street:—Exposing drain for examintion. 28, Bacon Street:—Relaying branch drain (private charge). Disinfecting Station :—Fitting new tallboy. Infirmary :—Repairing sunken drain. Repairing imperfect branch drains. Relaying branch drains and building manhole. Clearing drains. Drain repairs. Mortuary :—Clearing drains. 61, Neath Place :—Unstopping drains (private charge). Peabody Buildings:—Testing drains. Clearing drains (private charge). Public Health Offices :—Repairing stove. 24, Seabright Street:—Cutting off old connection. 26 to 28, Scott Street:—Sealing off drain {private charge). Workhouse :—W.C. branch drain and manhole. Alteration of W.C. branch drain. 61 Flushing combined drains, refixing Manhole covers, &c. 43 to 47, Alias Road. Butlers Buildings. 18 to 20, do. 3 to 7, Code Street. 29 to 61. Alma Road. 9 to 19, do. 36 to 44, do. and 4 to 6, Collyers Court 27 to 29, Approach Road. and 1 to 4, Pedley Street 19 to 23, do. 17 to 22, Colling Street. 25 to 29, do. 1 to 9, Collingwood Street. 49 to 57, do. 2 to 10, do. 99 to 105, do. 36 to 46, do. 23 to 25, Arbery Road. 45 to 47, do. 1 to 3, Austin Street. 48 to 56, do. Bakers Court. 58 to 70, do. 1 to 23, Baxendale Street. 67 to 87, do. 1 to 25, Bellhaven Street. 72 to 90, do. 2, Bratley Street and 17 to 23, Columbia Road. 1 & 2, Fleet Street Hill. 90 to 100, do. 12 to 30, Bishops Road. 1 to 9, Coventry Street. 36 to 48, do. 31 to 59, do. 52 to 72, do. 34 to 54, do. 76 to 88, do. 68 to 70, do. 90 to 96, do. 73 to 81, do. 77a to 79, do. 100 to 104, do. 81 to 91, do. 112 to 176, do. 97 to 103, do. 147 to 157, do. 124 to 132, do. 161 to 163, do. 144 to 154, do. 11 to 15, Cranbrook Road. 33, do. 10 to 12, Cranbrook Street. 112, do. 39 to 61, do. 261 to 265, Brick Lane. 100 to 104, do. 269 to 277, do. 1 to 13, Digby Street. 1 to 3, Brierley Street. 1 to 9, Eckersley Street. 2 to 6, do. 22 to 34, Fellbrigg Street. 38 to 40, do. 29 to 33, do. 32 to 34, do. 33 to 39, do. 62 to 68, Buckhurst Street. 34 to 39, do. 34 to 60, do. 43 to 53, do. 9a to 11a, do, 50 to 54, do. 62 Flushing combined drains, refixing Manhole covers, &c.—continued. 67 to 69, Felbrigg Street. 5 to 9, Northampton Street. 14, Fleet Street Hill 8 to 20, do. and 15 to 23, Weaver St. 13 to 23, do. and 23 to 26, Pedley St. 22 to 40, do. 44 to 52, Fuller Street. 25 to 33, do. 47 to 51, do. 31 to 33, Norton Street. 4 to 8, Gauber Street. 1 to 8, Octagon Street. 1 to 12, Georgina Gardens. 9 to 18, do. 164 to 170, Globe Road. 14 to 16, do. 181 to 187, do. 34 to 42, Old Ford Road. 191 to 195, do. 48 to 72, do. 197 to 209, do. 101 to 105, do. 871, Hackney Road. 107 to 109, do. 1, Harold Street. 122 to 124, do. 12 to 14, do. 155 to 161, do. 2 to 6, Hartley Street. 197 to 209, do. 11 to 15, do. 1 to 4, The Oval. 17 to 19, do. 15 to 29, Parmiter Street. 25 to 27, do. 31 to 33, do. 26 to 34, do. 35 to 41, do. 37 to 55, do. 19 & 20, Pedley Street, 1 to 17, Havelock Place. and 1 to 5, New Church St. Holmes Avenue. and 1 to 9, Weaver St. 1 to 16, London Street. 23 to 26, Pedley Street. 7 to 17, Mace Street. 57 to 71, Pereira Street. 1 to 25, Mowlem Street. 68 to 88, do. 9 to 81, Neath Place. 58 & 60, Pollard Row. 26 to 36, do. 5 to 8, Providence Place. 45 to 47, do. 1 to 3, Queen Caroline Gdns. 49 to 51, do. 1 to 9, Robinson Road. 58 to 55, do. 2 to 8, Roman Road. 57 to 59, do. 9 to 21, do. 61 to 63, do. 96 to 110, do. 14 to 46, Nelson Street. 2 to 8, Royston Street. 48 to 65, do. 3 to 5, do. 6 to 13, New Church Street, 23 to 25, do. and 15 to 16, Pedley St. 35 to 37, do. 63 Flushing combined drains, refixing Manhole covers, &c.—continued. 39 to 43, Royston Street. 1 to 5," Southampton Bulidings 60 to 84, do. 1 to 7, Southampton Terrace. 12 to 19, St. James' Road 3 to 4, Tagg Street. 68 to 60, St. Peter Street. 16 to 25, do. 74 to 76, do. 1 lo 19, Tent Street. 78 & 80, do. 3 to 4, Thurlow Place. 85 & 87, do. 5 to 6, do. 90 to 98, do. 34 to 42, Type Street. 11 to 15, Sewardstone Road. 1 to 11, Venice Street. 23 to 29, do. 8 to 22, Virginia Road. 24 to 26, do. 3 to 5, Vivian Road. 69 to 73, do. 11 to 15, Vyner Street. 76 to 82, do. 57 to 61, do. 132 to 138, do. 11, Wadeson Street. 144 to 150, do. 26 to 30, do. 160 to 166, do. 27 to 33, Weaver Street, 7 to 11, Smiths Buildings. and 5 to 7, Fleet St. Hill 13 to 17, do. and 4 to 7, Bratley Street. 1 to 5, Somerford Street, Whites Court & Butlers and 142 to 166 Brady St. Buildings. 10 to 28, Somerford Street. 59 to 61, do. 64 APPENDIX U. STATEMENT OF WAGES ACCOUNT. No. of Weeks. Ending. Sanitary Labour. Combined Drainage. Disinfecting Station. Infirmary Drainage. Workhouse Drainage. General Assistant. Sick Pay. 1910 £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. 4 27th January 30 3 6 30 15 0 ... 4 11 0 ... 3 0 0 ... 4 24th February 29 18 0 27 9 0 ... ... ... 3 0 0 ... 5 31st March 38 2 0 44 5 4 ... ... ... 3 15 0 ... 4 28th April 29 11 11 41 1 5 ... 10 12 6 ... 3 0 0 ... 4 26th May 31 0 1 43 18 3 ... ... 6 14 6 3 0 0 ... 5 30th June 37 10 0 30 1 0 ... 22 14 11 ... 3 15 0 ... 4 28th July 33 12 4 17 2 10 ... 14 0 0 4 0 9 3 2 6 ... 5 1st September 44 17 3 21 16 4 13 1 4 ... 4 0 0 4 10 0 2 ... 3 4 29th September 31 5 4 24 0 7 8 12 10 ... ... 3 5 1 ... 4 27th October 30 13 9 51 13 7 ... ... ... 3 0 0 ... 5 1st December 37 9 10 43 12 1 ... ... ... 3 15 0 ... 4 29th December 30 3 2 36 1 5 ... ... ... 3 0 0 ... Total for year 404 7 2 411 16 10 21 14 2 51 18 5 14 15 3 40 2 6 2 1 3 65 APPENDIX V. STATEMENT OF PETTY CASH ACCOUNT. 1920 Amounts received from Finance Committee. PETTY DISBURSEM ENT'S. Fines, Costs, &c. recovered and paid into Council's Account. Public Health (London) Act 1S91. Cost of Prosecutions, Enquiries, & c. Sale of Food and Drugs Acts. Cost of obtaining Samples for Analysis, Prosecutions &c. Sundry Small Accounts for Tools, Materials, Ac., not kept in Stock. Drain Plug; Hire. Returned Deposits. Mortuary Washing, Sundry Requirements, Are. Office Petty Expenses, Bus Fares, &c. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. January 5 0 6 1 4 4 1 18 3 ... 1 17 6 1 6 3 1 7 8 29 5 0 Feb. ... 6 11 1 1 17 6 3 17 8 12 4 2 5 0 ... 16 10 15 1 0 March... 7 14 0 1 12 1 3 9 3 ... 1 5 0 ... 1 1 0 11 5 0 April ... 9 9 4 13 2 3 8 2 ... 15 0 11 3 1 16 6 12 0 May ... 7 7 4 16 11 2 15 3 ... 1 0 0 ... 15 5 22 10 0 June .. 7 4 2 1 7 4 3 5 9 11 6 4 0 0 ... 10 1 91 3 6 July ... 15 2 3 2 19 11 1 19 7 11 1 2 10 0 16 11 19 5 7 14 6 August ... 13 7 9 0 ... 1 0 0 ... 1 0 1 19 1 6 Sept. .. ... 2 9 4 2 9 6 14 3 10 0 ... 15 5 10 10 0 October 12 19 7 2 14 3 1 13 0 ... 2 5 0 10 1 1 0 0 13 7 0 Nov. ... 6 18 6 2 4 7 2 19 11 8 3 3 15 0 2 1 1 17 8 ... Dec. ... 8 2 4 3 1 5 1 18 0 ... 5 0 ... 1 5 11 38 12 6 Total for Year. 86 9 1 21 14 5 30 3 4 2 17 5 21 7 6 3 6 7 13 6 1 195 2 0 Total amount received from Finance Committee £80 9 1 Balance from 1909 23 8 5 Less Expenditure £109 17 6 92 15 4 Balance £17 2 2