BET 17 THE Metropolitan Borough of Bethnal Green REPORT ON THE SANITARY CONDITION AND VITAL STATISTICS DURING THE YEAR 1911. 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 (post 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.G. 1912. THE Metropolitan Borough of Bethnal Green REPORT ON THE SANITARY CONDITION AND VITAL STATISTICS DURING THE YEAR 1911, 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 Oreen. LONDON: Printed by Thomas Bean & Son, 67. Golden Lane, E.C. 1912. The Public Health Committee. Mr. Alderman R. E. Pearson, Chairman. Mr. Alderman J. Robertson, Vice-Chairman. His Worship the Mayor, Councillor W. H. Clark, J.P. Mr. Alderman J. J. Fleming. Mr. Councillor J. J. Bartlett. Mr. Councillor F. W. Eaton. „ „ G. Bayley. „ „ J. J. Harris. „ „ T. Brooks. „ „ R. Larkins. „ „ T. A. Dean. „ „ B. E. Lee. Mr. Councillor J. W. Ward. Ex-Officio Members of the Public Health Committee. (Chairmen of Standing Committees of the Council). Mr. Alderman Capt. W. H. Hamilton (Finance Committee). Mr. Councillor J. Hall (Electricity Committee). The Chairmen of the Works and Stores, Law and General Purposes, and Baths Committees are ordinary Members of the Public Health Committee. 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 (Resigned upon Marriage, 20th December, 1911). Wm. Billings, Junr., General Assistant. CLERICAL STAFF. Ernest Q. Bilham, Chief Clerk. George I. Brighting, Assistant Clerk. Joseph H. Hewitt, do. F. G. Thomas, do. Horace A. Saunders, do. H. W. Pendrill, Junior. Disinfectors. One Leading Disinfector. Two Assistant do. One do. do. and Messenger. Alfred Waiter 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, 1911. PAGE General Summary 9 Birth and Death Rates in Metropolitan Boroughs 7 Population 10 Table "A" Births and Deaths 12 Births 12 Deaths 13 Table "B" Public Institutions outside Bethnal Green into which residents have been received and where they have died 15 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 Marriages 22 Deaths of Infants 22 Special causes of Infantile Deaths 23 Deaths of Young Children 24 Table "G" Quarterly Mortality—Bethnal Green 25 Table "H" Quarterly Mortality—London 26 Table "I" Deaths from Notifiable Infectious Diseases 27 The seven principal Zymotic Diseases 27 Table "K" Zymotic Deaths in 1910 and 1911 28 Table "L" Percentages of Deaths from Zymotic Diseases 29 Notification of Infectious Disease 29 Table "M" Details of Notifications 31 Table "N" Condition of Premises 32 Scarlet Fever 32 Diphtheria 33 SYNOPSIS—continued. PAGE Enteric Fever 35 Whooping Cough 35 Diarrhoea 36 Measles 37 Variola 43 Chicken Pox 45 Erysipelas 45 Diseases of Parturition 45 Ophthalmia Neonatorum 46 Cerebro-spinal meningitis 47 Acute Polio-myelitis and Encephalitis 47 Tuberculosis 48 Fairlight Sanatorium, Hastings 56 Cancer 60 Inquests 60 Suicides 60 Housing, Town Planning, etc., Act, 1909— Digby Street Area 61 Brady Street Area 63 Customs and Inland Revenue Acts, 1890 to 1903 64 National Insurance Act, 1911 64 The Rag Flock Act, 1911 66 APPENDIX. Report of Woman Inspector 73 Regulations—Rag Flock Act, 1911 84 Table I.—Vital Statistics of Whole District 87 II.—Cases of Infectious Disease notified 88 III.—Causes of, and Ages at Death 89 III. (a)—Deaths in Sub-districts 90 IV, IV (a) and IV (b).-Infantile Mortality 91-93 V.—Number of Deaths from the seven principal Zymotic Diseases in ten years, 1901 to 1910 and in the year 1911 94 Administration of Factory and Workshop Act, 1901 95 Street List 97 London and the Metropolitan Boroughs. Births and Deaths of Persons belonging to London and the Metropolitan Boroughs during the 52 Weeks of 1911.* Boroughs. Population estimated to the middle of 1911. Births. Deaths from Deaths under 1 year of Age. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhœa and Enteritis (under 2 years). Phthisis. COUNTY OF LONDON 4,521,301 111,738 67,826 144 9 2570 172 1038 612 5313 6084 14440 West. Paddington 142,513 3038 1897 5 - 48 3 44 11 134 173 387 Kensington 172,203 3252 2349 4 — 94 2 54 18 146 159 432 Hammersmith 121,766 2927 1891 7 — 36 5 35 28 178 153 428 Fulham 153,705 4121 2203 8 — 64 7 28 27 213 224 517 Chelsea 66,189 1269 1020 - — 30 1 10 5 55 96 138 City of Westminster 159,662 2358 1983 4 — 23 3 26 14 63 193 244 North. St. Marylebone . 117,761 2376 1772 2 — 66 7 28 5 83 172 257 Hampstead 85,589 1276 823 2 — 14 — 3 17 22 52 99 St. Pancras 217,941 5559 3371 7 — 108 12 55 37 201 342 624 Islington 327,203 8108 4853 12 — 130 21 70 51 365 405 1032 Stoke Newington 50,614 1045 658 1 — 28 3 18 3 28 55 107 Hackney 222,623 5226 3185 8 - 148 11 58 20 195 311 621 Central. Holborn 49,092 945 768 3 - 15 3 3 3 34 102 109 Finsbury 87,566 2674 1728 8 — 79 6 24 17 142 163 418 City of London 19,466 226 293 — — 1 1 1 1 10 31 28 East. Shoreditch 111,199 3533 2226 1 - 128 6 32 24 222 204 601 BETHNAL GREEN 128,144 4029 2320 3 — 130 5 49 21 248 208 610 Stepney 279,309 8743 4833 6 7 303 7 49 32 468 493 1261 Poplar 162,274 5015 3054 14 2 225 10 44 44 316 213 787 South. Southwark 191,531 5693 3509 5 - 120 6 64 30 298 326 818 Bermondsey 125,775 3908 2311 5 — 55 6 50 13 212 223 609 Lambeth 297,957 7292 4430 12 — 112 8 67 43 336 419 897 Battersea 167,712 4372 2391 3 — 112 4 36 20 222 223 540 Wandsworth 313,453 6747 3743 9 — 230 10 70 33 293 277 823 Camberwell 261,380 6399 3724 5 — 112 7 45 25 276 350 696 Deptford 109.472 3000 1706 2 — 69 7 37 15 171 139 425 Greenwich 95,973 2376 1409 3 — 41 3 14 16 152 112 305 Lewisham 161,712 3420 1821 5 — 21 5 18 28 128 104 354 Woolwich 121,487 2811 1555 - - 28 3 6 11 102 162 273 *For the purpose of this table the Births registered in London have been corrected by distributing those which occurred in the principal institutions treating maternity cases to the boroughs in which the mothers resided. In 1088 cases the residence was outside the County of London and these cases have been excluded On the other hand 31 births that occurred outside the County have been included. With regard to the Deaths of London residents, all transferable deaths (i.e., those of persons who, having a fixed or usual residence in England and Wales, die in a district other than that in which they resided) occurring in Greater London and in certain Metropolitan Institutions outside Greater London have been distributed to the Metropolitan Borough to which the deceased belonged. Of the deaths registered in London the previous residence was outside the county in 3299 cases, while on the other hand the deaths of 2826 London residents occurred in the Outer Ring or in Metropolitan Institutions outside Greater London. London and the Metropolitan Boroughs. Birth-rates and Death-rates of Persons belonging to London and the Metropolitan Boroughs during the 52 Weeks of 1911. Boroughs. Per 1000 Persons Living. Deaths under one year to 1000 Births. Births. Deaths from All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping-cough. Diphtheria. Diarrhœa and Enteritis (under 2 years). Phthisis. Crude. Corrected* COUNTY OF LONDON 24.8 15.0 15.8 0.03 0.00 0.57 0.04 0.23 0.14 1.18 1.35 129 West. Paddington 21. 4 13.3 14.3 0.04 - 0.34 0.02 0.31 0.08 0.94 1.22 127 Kensington 18.9 13.7 14.7 0.02 — 0.55 0.01 0.31 0.10 0.85 0.93 133 Hammersmith 24.1 15.6 16.2 0.06 — 0.30 0.04 0.29 0.23 1.47 1.26 146 Fulham 26.9 14.4 15.0 0.05 — 0.42 0.05 0.18 0.18 1.39 1.46 125 Chelsea 19.2 15.5 16.0 — — 0.45 0.02 0.15 0.08 0.83 1.45 109 City of Westminster 14.8 12.5 14.0 0.03 — 0.14 0.02 0.16 0.09 0.40 1.21 103 North. St. Marylebone 20.2 15.1 16.1 0.02 - 0.56 0.06 0.24 0.04 0.71 1.46 108 Hampstead 14.9 9.6 10.9 0.02 — 0.16 — 0.04 0.20 0.26 0.61 78 St. Pancras 25.6 15.5 16.2 0.03 — 0.50 0.06 0.25 0.17 0.92 1.57 112 Islington 24.8 14.9 15.5 0.04 — 0.40 0.06 0.21 0.16 1.12 1.24 127 Stoke Newington 20.7 13.0 13.6 0.02 — 0.55 0.06 0.36 0.06 0.55 1.09 102 Hackney 23.5 14.3 15.0 0.04 - 0.67 0.05 0.26 0.09 0.88 1.40 119 Central Holborn 19.3 15.7 16.9 0.06 - 0.31 0.06 0.06 0.06 0.69 2.08 115 Finsbury 30.6 19.8 20.5 0.09 — 0.90 0.07 0.27 0.19 1.63 1.87 156 City of London 11.6 15.1 16.6 — — 0.05 0.05 0.05 0.05 0.52 1.60 124 East. Shoreditch 31.9 20.1 21.1 0.01 - 1.16 0.05 0.29 0.22 2.00 1.84 170 BETHNAL GREEN 31.5 18.2 18.3 0.02 — 1.02 0.04 0.38 0.16 1.94 1.63 151 Stepney 31.4 17. 4 18.1 0.02 0.03 1.09 0.03 0.18 0.11 1.68 1.77 144 Poplar 31.0 18.9 19.5 0.09 0.01 1.39 0.06 0.27 0.27 1.95 1.32 157 South. Southwark 29.8 18.4 19.2 0.03 - 0.63 0.03 0.34 0.16 1.56 1.71 144 Bermondsey 31.2 18.4 18.9 0.04 — 0.44 0.05 0.40 0.10 1.69 1.78 156 Lambeth 24.5 14.9 15.4 0.04 - 0.38 0.03 0.23 0.14 1.13 1.41 123 Battersea. 26.1 14.3 15.3 0.02 - 0.67 0.02 0.22 0.12 1.33 1.33 124 Wandsworth 21.6 12.0 12.6 0.03 - 0.74 0.03 0.22 0.11 0.94 0.89 122 Camberwell 24.5 14.3 14.8 0.02 — 0.43 0.03 0.17 0.10 1.06 1.34 109 Deptford 27.5 15.6 16.4 0.02 — 0.63 0.06 0.34 0.14 1.57 1.27 142 Greenwich 24. 8 14.7 15.0 0.03 - 0.43 0.03 0.15 0.17 1.59 1.17 128 Lewisham 21.2 11.3 11.8 0.03 - 0.13 0.03 0.11 0.17 0.79 0.64 104 Woolwich 23.2 12.8 13.7 - - 0.23 0.02 0.05 0.09 0.84 1.34 97 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 as in 1901. London and the Metropolitan Boroughs. Death-rates per 1000 persons living and Infantile Mortality of persons belonging to London and the Metropolitan Boroughs in the Five years 1906-10, and in 1911. Boroughs. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Dirrhœa and Enteritis (under 2 Years). Phthisis. Deaths under One Year to 1000 Births. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911 19061910. 1911. 19061910. 1911 19061910. 1911. 19961910 1911. 19061910. 1911. County of London 14.9 15.0 0.04 0.03 0.00 0.00 0.42 0.57 0.10 0.04 0.29 0.23 0.14 0.14 The average mortality under this heading cannot be stated. 1.18 1.40 1.35 114 129 Paddington 13.3 13.3 0.04 0.04 - - 0.27 0.34 0.09 0.02 0.20 0.31 0.10 0.08 0.94 1.09 1.22 103 127 Kensington 13.8 13.7 0.03 0.02 — - 0.30 0.55 0.04 0.01 0.21 0.31 0.12 0.10 0.85 1.05 0.93 120 133 Hammersmith 14.5 15.6 0.05 0.06 - - 0.46 0.30 0.09 0.04 0.24 0.29 0.17 0.23 1.47 1.22 1.26 118 146 Fulham 14.3 14.4 0.05 0.05 - - 0.45 0.42 0.09 0.05 0.33 0.18 0.21 0.18 1.39 1.28 1.46 118 125 Chelsea 15.8 15.5 0.03 — — - 0.45 0.45 0.07 0.02 0.24 0.15 0.15 0.08 0.83 1.52 1.45 114 109 City of Westminster 12.9 12.5 0.04 0.03 0.00 — 0.13 0.14 0.06 0.02 0.11 0.16 0.09 0.09 0.40 1.32 1.21 99 103 St. Marylebone 14.8 15.1 0.03 0.02 - - 0.25 0.56 0.10 0.06 0.23 0.24 0.10 0.04 0.71 1.38 1.46 105 108 Hampstead 9.8 9.6 0.04 0.02 — 0.13 0.16 0.05 — 0.11 0.04 0.07 0.20 0.26 0.73 0.61 70 78 St. Pancras 15.8 15.5 0.04 0.03 — - 0.43 0.50 0.10 0.06 0.31 0.25 0.11 0.17 0.92 1.67 1.57 108 112 Islington 14.7 14.9 0.05 0.04 — - 0.47 0.40 0.08 006 0.28 0.21 0.11 0.16 1.12 1.30 1.24 107 127 Stoke Newington 12 .2 13.0 0.04 0.02 - - 0.19 0.55 0.08 0.06 0.25 0.36 0.06 0.06 0.55 1.02 1.09 87 102 Hackney 13.7 14.3 0.05 0.04 — — 0.29 0.67 0.10 0.05 0.24 0.26 0.13 0.09 0.88 1.27 1.40 109 119 Holborn 17.2 15.7 0.05 0.06 - 0.29 0.31 0.06 0.06 0.29 0.06 0.11 0.06 0.69 2.31 2.08 114 115 Finsbury 19.9 19.8 0.08 0.09 — — 0.80 0.90 0.13 0.07 0.48 0.27 0.20 0.19 1.63 2.21 1.87 134 156 City of London 15.5 15.1 0.06 - — — 0.12 0.05 0.08 0.05 0.16 0.05 0.08 0.05 0.52 1.66 1.60 93 124 Shoreditch 18.9 20.1 0.06 0.01 - - 0.81 1.15 0.16 0.05 0.54 0.29 0.15 0.22 2.00 1.90 1.84 149 170 BETHNAL GREEN 17.5 18.2 0.09 0.02 - — 0.58 1.09 0.22 0.04 0.37 0.38 0.16 0.16 1.94 1.78 1.63 135 151 Stepney 17.2 17.4 0.06 0.02 0.00 0.03 0.65 1.09 0.15 0.03 0.36 0.18 0.21l 0.11 1.68 1.70 1.77 123 144 Poplar 17.1 18.9 0.08 0.09 — 0.01 0.59 1.39 0.16 0.06 0.46 0.27 0.18 0.27 1.95 1.43 1.32 129 157 Southwark 18.3 18.4 0.05 0.03 - - 0.65 0.63 0.13 0.03 0.33 0.34 0.17 0.16 1.56 2.04 1.71 130 144 Bermondsey 18.7 18.4 0.04 0.04 - - 0.94 0.44 0.19 0.05 0.35 0.40 0.17 0.10 1.69 1.88 1.78 137 156 Lambeth 14 .9 14.9 0.04 0.04 - 0.34 0.38 0.10 0.03 0.25 0.23 0.15 0.14 1.13 1.49 1.41 112 123 Battersea 13.8 14.3 0.04 0.02 - - 0.38 0.67 0.10 0.02 0.36 0.22 0.13 0.12 1.33 1.31 1.33 109 124 Wandsworth 11.8 12.0 0.03 0.03 - - 0.23 0.74 0.06 0.03 0.26 0.22 0.12 0.11 0.94 0.94 0.89 97 122 Camberwell 14.3 14.3 0.03 0.02 - - 0.40 0.43 0.09 0.03 0.28 0.17 0.14 0.10 1.06 1.28 1.34 109 109 Deptford 15.3 15.6 0.05 0.02 - - 0.51 0.63 0.09 0.06 0.40 0.34 0.15 0.14 1.57 1.33 1.27 119 142 Greenwich 14.2 14.7 0.05 0.03 - - 0.40 0.43 0.09 0.03 0.37 0.15 0.17 0.17 1.59 1.21 1.17 110 128 Lewisham 11.2 11.3 0.02 0.03 - - 0.14 0.13 0.09 0.03 0.21 0.11 0.16 0.17 0.79 0.82 0.64 89 104 Woolwich 13.0 12.8 0.03 — - - 0.31 0.23 0.10 0.02 0.22 0.05 0.15 0.09 0.84 1.31 1.34 96 97 SUMMARY. 1911. Estimated Population of Bethnal Green— 128,247 Young Children, under 5 years 17,690 Old People, over 65 years 4,782 Area—759 acres. Number of Inhabited Houses 14,826 Rateable Value £535,170 Average number of Persons to each House (1911) 8.6 Average number of Persons to each Acre (1911) 168.9 Total number of Deaths in the year 2,316 Total number of Births in the year 4,032 Total number of Marriages 1,005 Marriage Rate—Bethnal Green 15.7 Marriage Rate—London 17.8 Death Rate—Bethnal Green 18.1 Death Rate—London 15.0 Birth Rate—Bethnal Green 31.4 Birth Rate—London 25.0 Infantile Death Rate (on Births), Bethnal Green 122.6 Infantile Death Rate (on Births), London 128.0 Young Children's Death Rate (on estimated number of Young Children) 57.8 Old People's Death Rate (on estimated number of Old People) 92.0 Zymotic Death Rate (Bethnal Green) 3.4 Zymotic Death Rate—London 2.2 Inquest Cases 277 Uncertified Deaths (no Inquests held) 0 Metropolitan Borough of Bethnal Green. REPORT. To the Mayor, Aldermen & Councillors of the Metropolitan Borough of Bethnal Green. Sir and Gentlemen, I have the honour to lay before you my thirtysixth Annual Report on the vital statistics and sanitary condition of the Borough of Bethnal Green, relating to the registration year, 1911, which terminated on Saturday, December 30th, last. POPULATION. The Registrar General's estimate of the population of the Borough in the middle of the year 1911 is 128,247; this figure is based upon the actual census enumeration taken in the early part of that year, when the number of inhabitants in Bethnal Green was found to be 128,282, a number 1,398 below the figure of the previous census in 1901, and being a decrease at the rate of 1.08 per cent. This falling off is common throughout London, for whilst only nine of the Metropolitan Boroughs show any increase of population, twenty others, including Bethnal Green, show a decrease. Such decrease is most marked in the City 12 of London, which is being rapidly depopulated as a residence, for it has lost at the rate of 27 per cent. On the other hand, the outer metropolitan ring has gained no less than 33.5 per cent., a centrifugal flight made possible through the provision of cheap and rapid locomotion by means of rail, tram and bus. Working in London and living in the suburbs is now the order of the day for all employed classes whenever possible. This plan certainly economises both health and pocket, but is a little awkward during a prolonged coal strike, such as we have recently experienced. The Registrar General's report on the census is not yet published, so that details of the distribution of Bethnal Green inhabitants cannot be given here, and must be reserved for a future occasion. TABLE A. 1910 1911 Estimated population in the middle of the year 128,282 128,247 Total Births 4,208 4,032 Total Deaths 2,003 2,316 Excess of Births over Deaths, shewing the natural increase of the population, if it were not checked by emigration 2,205 1,716 BIRTHS. The local Registrars return the total number of births during the year at 3,866, but, in addition to these, I have received information from the Registrar 13 General of 171 infants born of Bethnal Green mothers in Lying-in Institutions outside the Borough; from these must be deducted the births of five infants born in the workhouse of mothers ordinarily resident in other parts of London. Registered births 3,866 Inward transfers 171 Total 4,037 Outward transfers 5 Balance 4,032 The addition of these institution births gives a nett total of 4,032, a number which is 176 below that of the births of the previous year. This figure is also 361 below the decennial average of the births for the ten years 1901—1910, which was 4,393 The births exceeded the deaths by 1,716. DEATHS. The total number of deaths registered in the Borough was 2,345, this total includes 422 nonresidents, who died in some one or other of the Bethnal Green Public Institutions; also five other non-residents, who died violent or sudden deaths or were found dead within the boundaries of the Borough. These last were:— 1. The infant child of a shoe maker of Shoreditch, suffering from Pneumonia; died in Goldsmith's Row on the way to the Queen's Hospital. 14 2. A Spitalfields tailor, aged 30, died in Bethnal Green Road from Phthisis. 3. A Boy, aged six, the son of a Poplar carman, found drowned in the Regent's Canal. 4. The infant child of a domestic servant of Kentish Town, died from Diarrhoea at Hamilton Road. 5. The keeper of the Lock on Regent's Canal, Old Ford Bridge, died at his post from heart disease; he was 61 years of age and had during life resided in Stepney. The monthly returns of transferable deaths, forwarded by the Somerset House authorities, contain particulars of 391 deaths, and, in addition to those occurring in Public Institutions, they include the names of seven inhabitants of Bethnal Green, who died whilst temporarily absent from home. They were:— 1. A cabdriver, of Ravenscroft Buildings, aged 59, found drowned in the River Thames, near Custom House Quay. 2. A French polisher, aged 54, drowned in the River Lea, in Hackney. 3. The infant daughter of a bootmaker, of Quinn's Square, died at Beckerton Road, Islington, from Marasmus. 4. A bricklayer's labourer, of Arline Street, aged 40, slipped from a staging in Goswell Road and fractured his spine 5. A cellarman, aged 33, of Robinson Road, found drowned in the Regent's Canal. 15 6. A chair maker, aged 30, of Ames Street, poisoned himself with oxalic acid, and died in Victoria Park Road. 7. A girl, aged 5 years, of Margaret's Place, knocked down and killed by a motor omnibus in the Strand. TOTALS:— Residents. Total deaths registered 2,345 Sudden deaths outside the Borough 7 Deaths in Institutions outside the Borough 391 2,743 Non-Residents. Sudden deaths of strangers in Bethnal Green 5 Deaths of strangers in Bethnal Green Institutions 422 427 2,316 TABLE B. Public Institutions, situated outside the Borough, into which Bethnal Green residents have been received and where they have subsequently died:— Babies' Home, Shoreditch 3 Banstead Asylum 7 Bromley Sick Asylum 2 Cancer Hospital, Chelsea 2 Caterham Asylum 3 16 TABLE B—continued. Charing Cross Hospital 1 Children's Hospital, Carshalton 1 Children's Hospital, Great Ormond Street 8 City of London Lying in Hospital 2 City of London Asylum 1 Claybury Asylum 11 Colney Hatch Asylum 8 Convent Hospital, Paul Street 1 Creche, The, Whitechapel 1 Dartford Heath Asylum 5 Eastern Hospital, Homerton 42 East London Hospital, Shadwell 10 Evelina Hospital 1 Friedenheim Hospital 1 German Hospital 2 Guy's Hospital 1 Hanwell Asylum 2 Horton Asylum 1 Hostel of God, Wandsworth 2 Infants' Hospital, Vincent Square 1 Leavesden Asylum 6 London Hospital 199 Long Grove Asylum 3 Metropolitan Hospital 3 Middlesex Hospital 2 Mount Vernon Hospital . 1 North Eastern Hospital, Tottenham 11 North Western Hospital 2 Park Hospital 5 Poplar Hospital 1 Queen Mary's Hospital 1 Royal Chest Hospital, City Road 3 Royal Free Hospital 1 Royal London Ophthalmic Hospital 1 St. Bartholomew's Hospital 19 17 TABLE B—continued. St. Joseph's Hospice, Hackney 1 St. Luke's House, Kensington 2 St. Pancras Infirmary 1 St. Thomas's Hospital 1 South Eastern Hospital 2 South Western Hospital 1 Shoreditch Infirmary 3 Whitechapel Infirmary 3 391 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 1,004 10 46 10,094 Queen's Hospital for Children, Hackney Road 134 2,060 115 283 32,992 Mildmay Mission Hospital 50 607 20 28 12,947 Bethnal House Asylum 300 — — 27 — Bethnal Green Infirmary 669 3,118 610 39 ' National Children's Home and Orphanage 304 - — 1 — 19 In the North-East Sub-district 1,140 deaths occurred amongst the residents and 1,134 in the South-West, Forty-two persons who had no fixed home died in the Workhouse or in the Infirmary. TABLE D. District. Deaths. Population. North-East 1,140 63,981 South-West 1,134 64,266 Previous residence unknown 42 — Total 2,316 128,247 DEATH RATE. The mortality rate for the year 1911, calculated upon the population of Bethnal Green as estimated by the Registrar-General, is 18.06 per thousand living; this rate is one per thousand above that of last year as calculated upon the actual enumerated population in April, 1910, and is also over two points above the rate for the whole of London, which is 15.8 per thousand. MORTALITY RATES IN SUB-DISTRICTS. The death rate in the North-East sub-district was 17.8, and that in the South-West 17.6. These rates are exclusive of the homeless paupers who died in the Infirmary, as it is impossible to allocate them to any district. Table E shows the mortality rates for Bethnal Green and for London compared by months, the rainfall and mean temperature for each month also being 20 shewn. It is noticeable that in August, with an average temperature of 708, and only half an inch of rainfall in the whole month, the mortality in Bethnal Green rose to 25 per thousand, due almost entirely to the number of deaths from infantile diarrhoea. TABLE E. Month. London Death Rate. Bethnal Green Death Rate. (Per Thousand) Mean Temperature (Degrees). Rainfall (Inches). January 15.7 18.6 38.5 1.38 February 16.7 20.7 41.0 1.48 March 15.2 22.1 42.8 1.73 April 14.7 18.7 47.9 1.80 May 12.0 14.8 58.6 1.80 June 11.1 11.7 62.0 2.69 July 11.8 13.9 69.3 1.17 August 18.0 24.8 69.4 0.49 September 16.0 20.4 61.5 1.31 October 15.1 16.7 51.0 3.12 November 13.4 16.7 44.6 3.62 December 15.3 14.6 44.4 4.22 Average 14.6 17.8 52.6 Total Rainfall 24.81 21 The next table compares the death rates for Bethnal Green and for London by Quarters:- TABLE F. Quarter ending. London. Bethnal Green. April 1st, 1911 15.8 20.6 July 1st, 1911 13.2 15.3 September 30th, 1911 15.5 20.1 December 30th, 1911 14.3 16.0 Yearly average 14.7 18.0 BIRTH RATE. The births actually registered in Bethnal Green during the year numbered 3,866, but to these must be added the transferable births, particulars of which were furnished to me by the Registrar-General. Ninety-six births of Bethnal Green residents occurred in the London Hospital, 28 in the East End Mothers' Home in Stepney, 25 in the City of London Lying-in Hospital in Finsbury, and 28 elsewhere The addition of these 171 births away from home, minus five foreigners born in the Workhouse, raises the total to 4,032 which gives a birth rate of 31.45 per thousand population; it is below that of the previous year (32.8) when it was the highest of all the Metropolitan Boroughs. The general London birth rate now stands at 25.0, a slight increase over that of the preceding year. 22 Marriages, 1911. First Quarter 136 Second Quarter 257 Third Quarter 271 Fourth Quarter 341 Total 1,005 These figures indicate a marriage rate of 15.7 per thousand, as against 17.8 in the County of London. DEATHS OF INFANTS. More than one-fourth (25.9 per cent.) of the total deaths at all ages were those of infants under one year; these numbered 599, giving an infantile death rate of 148.5 per thousand births, a very considerable increase on the figure for 1910, which was 1226. The general metropolitan rate has also risen to 129, as against 103 for the previous year. A comparison of the causes of infantile mortality in 1911 with those of the previous year, shows an abnormal increase in one particular disease, namely, Diarrhoea, the number of infantile deaths from which nearly trebled those of the preceding year. As is well known, there was during the autumn an epidemic of this disease, due to the combination of heat and drought. I think there can be no doubt that the disease was spread by microbe-laden dust gaining access to the vessels in which infants' food was prepared or stored. 23 INFANTILE TUBERCULAR DISEASE. Various forms of infantile tuberculosis caused 20 deaths, a mortality of five per thousand births. Six of these deaths were from Tabes Mesenterica and nine from Tubercular Meningitis. SUFFOCATION. The deaths from overlaying continue to decrease, and were four fewer than those of the preceding year. I hope this may be taken as evidence of increasing recognition on the part of mothers of the danger incurred by permitting infants to share the parents bed. Our Woman Inspector, I know, does all she can to encourage the provision of simple home-made cradles. In the table below, the principal causes of infantile deaths are tabulated, so as to show the mortality attributed to each as compared with the total number of deaths. SPECIAL CAUSES OF INFANTILE DEATHS. Total. Rate per thousand births. Diarrhœal diseases 180 44.80 Premature birth and congenital defects, including Atelectasis 101 25.15 Respiratory diseases 92 22.90 Wasting diseases 64 16.0 Convulsive diseases 51 12.7 Common infectious diseases 39 9.7 Suffocation 22 5.5 Tubercular diseases 20 5.0 24 DEATHS OF YOUNG CHILDREN. The deaths of young children aged less than five years, including infants, numbered 1024, forming 4.22 per cent. of the deaths at all ages. This is equivalent to a rate of 57.8 per thousand of the estimated population of young children. SENILE MORTALITY. The deaths of persons aged over 65 numbered 440, a proportion of 21 per cent. of the total deaths at all ages, which gives a death rate, calculated upon the estimated population of elderly people, of 92.0. QUARTERLY AND ANNUAL DEATHS AND MORTALITY RATES. Tables G and H, overleaf, show, in addition to actual number of deaths, the quarterly and annual rates of births and deaths, also mortalities from the principal Zymotic diseases and from Pulmonary Tuberculosis. Following these will be found the graphic chart, showing the numbers of deaths week by week in the Borough, corrected for institution deaths. 1911. Deaths from all causes. 25 TABLE G. Quarterly Mortality for the Borough of Bethnal Green 1911. Estimated Population in the middle of 1905. Births. All Causes Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhœa and Enteritis under 2 years). Pulmonary Tuberculosis. Deaths of Infants under one year of age. All Causes. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhœa and Enteritis (under 2 years). Pulmonary Tuberculosis. Deaths under 1 year to 1000 Births Registered. Borough of Bethnal Green. 1 2 3 4 9 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 April 1st 131,855 1,024 676 2 — 72 1 26 7 10 58 134 20.6 0.06 — 2.19 0.03 0.79 0.21 0.30 1.76 131 July 1st 128,247 991 490 — — 39 1 13 6 7 62 97 15.3 — 1.22 0.03 0.41 0.19 0.22 1.94 98 September 30th 128,247 949 642 — — 16 — 8 3 211 41 242 20.1 — — 0.50 — 0.25 0.09 6.60 1.28 255 December 30th 128,247 902 511 1 — 3 2 2 5 20 47 137 16.0 0.03 — 0.09 0.06 0.06 0.16 0.63 1.47 152 129,149 3,866 2,319 3 — 130 4 49 21 248 208 610 18.0 0.02 — 1.00 0.03 0.38 0.16 1.94 1.61 159 26 TABLE H. Quarterly Mortality for the County of London. 1911. Estimated Population in the middle of 1905. Births. All Causes. Enteric Fever. Small-pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Diarrhœa and Enteritis (under 2 years). Pulmonary Tuberculosis. Deaths of Infants under 1 year of age. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria Diarrhœa and Enteri t is (under 2 years). Pulmonary Tuberculosis. Deaths under 1 year to 1000 Births Registered. County of London l 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 April 1st 4,912,054 29,305 19,380 28 8 1581 43 425 170 210 1717 3165 15.8 0.02 0.01 1.29 0.04 0.35 0.14 0.17 1.40 1.08 July 1st 4,522,628 28,430 14,873 16 1 690 43 359 128 211 1436 2524 13.2 0.01 0.00 0.61 0.04 0.32 0.11 0.19 1.27 89 September 30th 4,522,628 28,057 17,431 43 — 159 41 165 129 4310 1358 5693 15.5 0.04 — 014 0.04 0.15 0.11 3.82 1.20 203 December 30th 4,522,628 27,018 16,143 57 — 140 45 89 190 582 1573 3058 14.3 0.05 — 0.12 0.04 0.08 0.17 0.52 1.40 113 4,619,984 112,810 67,827 144 9 2570 172 1038 617 5313 6084 14,440 14.7 0.03 0.00 0.54 0.04 0.22 0.13 1.17 1.32 128 27 NOTIFIABLE INFECTIOUS DISEASES. The deaths from diseases compulsorily notifiable under Sec. 55 of the Public Health (London) Act, 1891, numbered 51, against 62 in 1910, a decrease of 12. Nearly all the fever and diphtheria deaths occurred in hospital, as will be seen from the following table which includes measles, sufferers from which are now admitted to the Metropolitan Asylums Board's Hospitals, although this disease is not at present notifiable:- TABLE I. Disease. Deaths at Home. Deaths in Hospitals. Total. Scarlet Fever — 6 6 Diphtheria 1 23 24 Enteric Fever 1 2 3 Erysipelas 7 — 7 Puerperal Fever — 3 3 Measles 96 32 128 Cerebro-Spinal Meningitis 1 6 7 THE SEVEN PRINCIPAL ZYMOTIC DISEASES. As previously referred to under the heading of infantile deaths, there was, during the Autumn of 1911, an epidemic of diarrhœal diseases. By direction of the Local Government Board, deaths from Enteritis are now to be classed as from Diarrhœa; therefore the 28 number of deaths recorded as from this disease (already much swollen in number by the epidemic) appear disproportionately great when compared with those of the previous year, as set out in Table K. This addition to the Zymotic deaths of a disease, which, although allied to diarrhœa, has hitherto always been classed under a separate heading, nullifies any comparison of Zymotic mortalities for 1911 with those of previous years. The number of deaths from Measles, which was also epidemic during the year, shows a very large increase, and will be again referred to under its proper heading. TABLE K. Disease. 1910. 1911. Measles 58 128 Scarlet Fever 9 6 Diphtheria 20 24 Whooping Cough 34 44 Enteric Fever 18 3 Diarrhœa 43 230 Totals 182 435 The death rate from these Zymotic diseases is 3.4 for 1911 against 1.38 for the previous year. The corresponding rates for the whole of London are 114 and 2.21. 29 Table L shows the percentage of deaths from each disease on the total number of Zymotic deaths. TABLE L. Measles caused 128 deaths, 20.40 per cent. or 1 in 3.4 deaths. Scarlatina ,, 6 ,, 1.38 ,, ,, 72.5 ,, Diphtheria ,, 24 ,, 5.51 „ ,, 18.1 „ Whooping Cough „ 44 ,, 10.12 9.9 „ Enteric Fever ,, 3 „ 0.69 ,, ,, 145.0 „ Diarrhoea ,, 230 „ 52.90 1.9 „ NOTIFICATION OF INFECTIOUS DISEASE. During the year, two additional diseases were, with the consent of the Local Government Board, included in the list made compulsorily notifiable under Section 55 of the Public Health (London) Act, 1891; these were Polio-Myelitis (infantile paralysis) and Ophthalmia Neonatorum (inflamation of the outer membrane of the eye in new-born infants). The order making Chicken-pox notifiable expired on June 21st, and was not renewed. The gross number of certificates forwarded to me by Medical Practitioners under the Act was 1,024; a few of these were sent under a misapprehension as to the boundaries of the Borough, and were, of course, referred to the proper authority; 125 certificates (12.3 per cent) were duplicates, so that the actual number of cases of infectious disease reported and 30 dealt with was 898, a rate of seven per thousand on the estimated population of the Borough. Table II. in the appendix indicates, inter alia, the number of persons suffering from each disease ; it also shows the subdistrict in which such persons resided, and the number (431), of those removed to hospital. In 21 instances information was received from one of the Medical Superintendents of the Metropolitan Asylums Board Hospitals to the effect that the diagnosis, as stated on the notification certificate, was incorrect, a proportion of 2.3 per cent. of the whole. Table M sets out full particulars of all the notifications. 31 TABLE M. 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 4 — 4 — 4 — 1 Diphtheria 205 8 197 5 177 15 6 Membranous Croup 3 — 3 — 3 — — Scarlet Fever 246 4 242 11 231 — 12 Erysipelas 343 96 247 — — — — Enteric Fever 35 4 31 2 16 13 1 Continued Fever 1 — 1 1 — — — Cholera 1 — 1 1 — — 1 Ophthalmia Neonatorum 30 4 26 — — — — Cerebro-Spinal Meningitis 6 — 6 — — — — Puerperal Fever 20 6 14 — — — — Polio-Myelitis 1 — 1 — — — — Chicken Pox 129 4 125 — — — — Totals 1,024 126 898 20 431 28 21 32 TABLE N. Condition of Premises wherein Cases of Infectious Disease have occurred during 1911. Scarlet Fever. Diphtheria. Enteric Fever. Satisfactory 144 122 19 W.C.'s or apparatus defective 17 23 2 Internal drainage defective 2 6 1 External drainage defective 14 9 — Minor Insanitary defects 99 80 15 Single room tenements 11 17 3 Overcrowded 1 2 — SCARLET FEVER. Deaths 6. (Decennial average 26), The type of Scarlet Fever prevalent during the year was of a very simple character, and in most instances without complication. Two hundred and forty-two cases were reported and all except II were removed to hospital, where six of them died. The cases treated at home were of such a mild type as to raise some doubt as to the correctness of the notification certificate, but, as in no case was the characteristic rash visible at the time of my visit, I was unable either to confirm or to deny the diagnosis. The isolation in each case kept at home was fairly satisfactory ; all of Scarlet Aeven. 33 them recovered. The case fatality on the whole number treated in hospital was 2.7 per cent., as against 2.6 amongst all the cases treated in the Metropolitan Asylums Board Eastern Hospital. Twelve of the patients removed to hospital were found not to be suffering from Scarlet Fever, and are, therefore, excluded from this calculation. Three of the fatal cases were amongst young children aged less than five years, and the others were under 14. The Scarlet Fever death rate in this Borough is equal to 0.04 per thousand, which is identical with that of London. One hundred and thirty-two of the cases were reported from the North-East Sub-district and 110 from the South-West. The Inspectors report that the homes of 144 were in a fairly satisfactory condition, but in 17 instances the W.C., or the apparatus connected therewith were found to be defective; the drains were found to be leaky in 14 instances, and minor insanitary defects were noted in 99. Eleven persons were removed from single room tenements, one of which was overcrowded. DIPHTHERIA. Deaths 24. (Decennial Average 31). Diphtheria was notified in 208 cases and Membranous Croup in three others, eight of the certificates being duplicates. One hundred and ninety-seven of the cases certified as Diphtheria and all the Croup cases were removed, 177 of them to the Metropolitan Board Hospitals, and 15, mostly requiring immediate operation, were treated at other hospitals. Five cases remained at home, where one of them died. In six 34 instances a notification was received from one of the hospital Superintendents to the effect that the diagnosis as certified was incorrect. Of the 186 true cases treated in hospital, 23 died, a case mortality of 12.4 per cent., as against 8.1 amongst the whole of the cases treated at the Metropolitan Asylums Board Eastern Hospital. All the Diphtheria deaths except three were among young children aged less than five years. The Diphtheria mortality in Bethnal Green was at the rate of 0.18 per thousand living, as against 0.14 for the whole of London. Eighty-seven of the cases were reported from the North-East Sub-district, and 116 from the South-West. The Inspectors report that the houses of 122 of the patients were in a fairly satisfactory condition, but in 23 instances the W.C., or the apparatus connected therewith, was found to be defective. The drain inside the house was leaky in six instances, that outside the house required amendment in nine, and minor insanitary defects obtained in eighty. Seventeen persons were removed from single room tenements, two of which were overcrowded. During the year, 48,000 units of antitoxin were supplied to various practitioners in the Borough gratuitously. Throat swabs from 47 patients were submitted to the Clinical Research Association at the request of medical practitioner. In seven, the characteristic organism was found, but in 40 the result was negative. 1911 Enteric Fever 1911. Diphtheria 35 ENTERIC FEVER. Deaths 3. (Decennial average 12). Thirty-one persons were certified as suffering from this disease ; all except two were removed to hospital, 16 of these being treated at the Metropolitan Asylums Board hospitals, and 13 at general hospitals. One patient died at home and two others in hospital, a case mortality of 6.9 per cent., as against 10.5 for the whole of the patients treated in the Metropolitan Asylums Board Eastern Hospital. The sanitary condition of the houses from which the Enteric Fever cases had been removed was fairly good in 19 cases; in two, the W.C.'s were defective, and minor insanitary defects were noted in 16. Fifteen of the fever patients had eaten fried fish, four shell-fish, one watercress and one ice-cream. Twenty-three of the cases were notified from the North-Eastern Sub-district and eight from the South-West. The blood of 34 patients was examined at the request of medical practitioners. In nine instances a positive result was obtained, but in the other 25 the re-action was negative. WHOOPING-COUGH. Deaths 44. (Decennial average 49). All these deaths were amongst young children aged less than five years, a mortality on the estimated population of 2.4. 36 DIARRHŒA (including Enteritis). Deaths '230. (Decennial average 100). By order of the Local Government Board, deaths from Enteritis are now to be included under the above heading. Some very interesting particulars as to the incidence of this disease upon infants will be found in Miss Harris's report. MEASLES. Deaths 128. (Decennial average 74). Measles was epidemic during the early part of the year, and caused much anxiety, as we have practically no power to control the spread of the disease. All the deaths, except four, were amongst young children aged less than five years. 1,187 cases of the disease were notified to us by head teachers of elementary schools. All were visited, and instructions given as to isolation and treatment. By arrangement with the Local Government Board, cases of Measles under the care of the District Medical Officers may be admitted to Metropolitan Asylums Board hospitals, and 85 very serious cases were removed. The deaths in hospital numbered 32. It is much to be regretted that this disease is still looked upon by the general public as a trivial complaint, as evinced by the fact that amongst the cases visited by the Inspectors 214 were found to be without medical attendance. Disinfection was offered in all cases, but was accepted in 57 instances only. Enquiry was made throughout London as to the 37 methods adopted in the various Boroughs in dealing with cases of Measles. The following is a summary of the replies received:— MEASLES. 1. Number of Boroughs from which replies have been received -- '29. 2. Notification. No Borough has adopted compulsory notification under Section 56 of the Public Health (London) Act, 1891. 3. (a) Intimations to Medical Officer of Health by Teachers and Attendance Officers. — In 29 boroughs such intimations are given by Teachers, and in some answers testimony is given to their co-operation. (b) Information is stated to be often belated in reaching the Teacher or the Medical Officer of Health from the School Attendance Officers. The question of promptitude of information is not mentioned by four Medical Officers of Health. Information is said to be promptly given to 10 Medical Officers of Health. In the rest of the Metropolitan Boroughs it is stated that "unnecessary" or "serious" delay occurs, or that commonly intimations arrive in weekly batches. In one Borough, out of 771 school cases notified to the Medical Officer of Health, 41% bad been absent more than seven days, 15% more than 14 days, and 7% more than 21 days at the time of notification. 38 4. Visits by Officers of the Borough Council. Of the 29 Sanitary Authorities, in two, all known cases are stated to be visited. In 23, visits are stated to be made without defining whether this applies to all cases. In two, visits are stated to be made only in special cases. In two, no visits are made. 5. Twenty Sanitary Authorities make visits as a rule only once, eight at intervals, one no answer. 6. Instructions.—Verbal instructions are given at visits in 25 Boroughs, not given in four Boroughs. In the 25 Boroughs above, the verbal are accompanied by printed instructions in 20 Boroughs. In two Boroughs printed instructions alone are sent. In one Borough no instructions are given. 7. Disinfection.—This is carried out for all known cases in one Borough; only after deaths from Measles in one Borough; to an undefined extent in 13 Boroughs; when requested and in special cases in nine Boroughs; in 15-16% of known cases in one Borough; in 60% of known cases in another; in a very small proportion in another, and not carried out in two Boroughs. 13th March, 1911. 39 In the month of March, a Conference of Medical Officers was called by Dr. Newsholme; the meeting was held at the Offices of the Local Government Board, and was attended by nearly every Health Officer in London. Mr. John Burns took part in the discussion and was evidently deeply interested. The sense of the meeting was ultimately taken, and the following conclusions were arrived at:— 1. Measles should be made notifiable to the extent of the first case in a family, no second notification being required within 30 days of the first, as the family could be kept under observation. 2. The number of beds available for Measles in the Metropolis should be increased from 1,000 as at present to at least 2,500. 3. All Health Officers are urged to impress upon their Inspectors the importance of circulating knowledge as to the gravity of the disease, and its frequent fatal results, and the necessity of implicit obedience to the instructions of the medical attendant. 4. Children under five years of age should not be allowed to attend school during the present epidemic; moreover the opinion was strongly held that school attendance at this tender age was at all times inadvisable. 5. That Sunday schools and private schools should be treated on the same lines as public elementary schools already are, as to notification. 40 6. Where children are found by the Inspectors to be without medical attendance, pressure should be exerted upon the parent to obtain proper medical aid. As a result of the recommendations of the Conference, the following memorandum was issued by the Local Government Board. Local Government Board, Whitehall, S.W. 10th April, 1911. Sir, MEASLES IN LONDON. I am directed by the Local Government Board to state that they have had under consideration the present outbreak of measles in London, and that on the suggestion of the President their Medical Officer has conferred with the Medical Officers of the London County Council and of the various Borough Councils as to the measures which may be taken for dealing with it. At the conference the view was generally expressed that Sanitary Authorities have been hampered in their efforts to check the spread of the disease by the absence of early information of cases, and the question was considered whether this difficulty would be removed if measles were made a notifiable disease. 41 On this question widely divergent views as to the value of notification were shewn to exist. A very large number of cases are not attended by a doctor, and it was pointed out that in such cases the adoption of the Notification Act would be a dead letter. It may also be observed that the notification of measles has been tried in a large number of towns and then abandoned. Without therefore expressing any view on the question whether the notification of measles would be justified, it is clear that such other means of obtaining information as are available should be fully utilised. The Board find that the School Attendance Department of the London Education Authority have supplied much valuable information as regards measles in the past, and in view of the proceedings at the conference, it appeared to the Board that it might be practicable to arrange that this source of information should be made more readily available. On this question the Board have consulted the Board of Education, and it has now been arranged that so long as the present emergency lasts the School Attendance Officers will give speedy information to the Medical Officers of Health of all cases of illness coming under their notice. It is hoped that, by this means, early information of the majority of cases of measles will reach the Medical Officers of Health. 42 The information thus obtained will necessarily require to be followed up. Probably many cases will be reported which are not measles, and arrangements should be made for obtaining a proper diagnosis, for securing that the cases are properly isolated, and for urging on the parents the need of obtaining medical aid where such aid is required. No doubt the Council's official who visits the home will be able to do much in the way of giving advice as to the care and nursing of the patients. Removal to Hospital. The Board have been in correspondence with the Metropolitan Asylums Board, and it is understood that that Board will agree to receive cases of measles on the recommendation of the Medical Officer of Health. The accommodation of the Metropolitan Asylums Board for this purpose is necessarily limited, and arrangements will be made by which preference will be given to those cases most needing hospital treatment The Board may also remind the Borough Council that they have power to provide temporary hospitals, and if at a subsequent date the amount of accommodation for measles which is available in the hospitals of the Metropolitan Asylums Board should come to be exhausted, this power might have to be utilised. 43 Staff required for dealing with outbreak. For dealing with this outbreak and properly following up the information which will be obtained it is essential that each Medical Officer of Health should be provided with an adequate staff, and the Board trust that the Council will at once appoint any additional temporary assistants (medical and other) that may be required. At the same time I am to enclose a copy of a Memorandum which the Board's Medical Officer has prepared on the subject of measles. I am, Sir, Your obedient Servant, H. C. MONRO, Secretary. To the Town Clerk, Borough of Bethnal Green. VARIOLA. No death (decennial average 7). Four cases of small-pox were notified and removed to hospital where one of them was found to be chicken-pox; this patient was re-vaccinated and sent home. All the sufferers recovered, and indeed there has been no death from small-pox in Bethnal Green since 1904. Considerable anxiety was felt in February owing to an outbreak of small-pox in the wards of a 44 public institution in a neighbouring Borough, where a number of wrongly diagnosed cases were permitted to remain and spread disease. I made up my mind that London was threatened with an epidemic, but fortunately this was averted by the prompt and energetic action taken by Dr. Thomas, the Medical Officer of Health for Stepney. In view of possibilities, the usual precautions were taken in Bethnal Green by the Public Health Department; extra disinfectors were engaged and one of them was put on evening duty; one Sanitary Inspector in turn was directed to remain at the Town Hall until late at night and on Sundays; arrangements were made for the prompt removal of cases immediately upon receipt of notification, and the Public Health Committee authorized payment for copy certificates and messenger fees. Cases reported as chicken-pox were kept under careful observation, and I visited and personally examined every case in which the symptoms were in the slighest degree suspicious. The first true case of small-pox was a man aged twenty-four who arrived at the Infirmary on Sunday morning, February 26th and demanded admission. Dr. Potts telephoned for me; I saw the man and we agreed that he was suffering from small-pox, so he was at once removed to hospital. This man was never admitted to the wards of the Infirmary, but was kept in the receiving room. I anticipated a crop of cases from this one, as we ascertained that the man, having no fixed home, had been wandering about sleeping where he could, sometimes in common lodging houses and occasionally with a relative. On the Sunday morning he was found asleep on some mats in an outhouse at the back of 45 premises in Chilton Street occupied by his brother. As the man was evidently very ill, his sister-in-law brought him to the Infirmary where I saw him. We could trace no connection with any of the Stepney cases, but probably he caught the disease in a common lodging house. Two other cases were reported and removed within a week of the first, one from Waterlow Buildings and another from Northampton Street. Careful enquiry failed to trace any connection with the first case or with the Stepney cases. CHICKEN-POX. The compulsory notification of this disease continued in force until June 21st, up to which date 125 cases were notified; subsequently 232 cases were reported from various schools. All the cases recovered. ERYSIPELAS. The actual number of notifications of this disease received was 243, no fewer than 96 of which were duplicate cases. The disease proved fatal in seven instances. DISEASES OF PARTURITION. Fourteen cases of Puerperal Fever were reported, with three deaths; eleven other women died from some one or other of the diseases and accidents incidental to the puerperal state. They were:— Heart disease 2 Eclampsia 2 Miscarriage 2 46 Post partum hœmorrhage 1 Placenta prævia 1 Cerebral abscess 1 Ruptured uterus 1 Pleuro-pneumonia 1 OPHTHALMIA NEONATORUM. Inflammation of the eyes of new-born babies is very often caused by an infective microbe derived from the mother at birth. In past years this disease has been a frequent cause of blindness, but if taken in time and properly treated a good result may be expected. The disease was made compulsorily notifiable by order of the London County Council, on March 13th, 1911, and on March 17th a meeting of Metropolitan Health Officers, convened by Sir Shirley Murphy, was held at 1, Upper Montagu Street, for the purpose of discussing the steps advisable to be taken in dealing with reported cases. Sir Shirley informed the meeting that up to the present time a general instruction had been given to the Midwives under the control of the London County Council to report all cases of inflammation of the eyes in new-born infants, no matter how slight. We were given to understand that these cases were visited by one of the Inspectors of midwives (medical women) and such instructions given as were necessary. Under the new order all cases of ophthalmia in new born infants whether attended by doctors or midwives would now be compulsorily notified to the Medical Officer of the District. It is well known to Medical men that severe cases of the disease require 47 much constant attention by a skilled nurse that it is almost impossible to treat them at home; this entails removal of both mother and infant to hospital. Dr. Wanklyn had been making enquiries throughout London as to the facilities offered by the various hospitals, but it was found that in very few cases could such help be afforded. Some hospitals have agreed to give up two or three beds, and the London Hospital as many as twelve, in the Marie Celeste Ward. During the year twenty-six cases were reported, the majority of them of a trivial nature. All were kept under observation by Miss Harris, who saw that proper medical attention was secured. One baby died from inter-current disease and another one lost the sight of an eye; the remainder recovered without apparent impairment of vision. CEREBRO-SPINAL MENINGITIS. Seven cases of this disease were reported, all of them fatal in hospital. Continued investigation into the causation of this obscure disease has so far added very little to our knowledge. ACUTE POLIO-MYELITIS AND ENCEPHALITIS The attention of Public Health Authorities has recently been drawn to these diseases, epidemics of which have occurred in various parts of the country. The spinal form of the disease is almost entirely confined to young children. It shows itself as a sudden paralysis of one or both legs or arms following a short 48 febrile stage. The causation of the disease is most obscure; it has been attributed to Cold, to Rheumatism and to Accidental Falls, but it is almost certainly an infectious one. Owing to the sudden onset of the disease its causation has been attributed to the carelessness of children's nurses, who have been unjustly accused of permitting their little charges to sit on cold steps or fall from perambulators or chairs, their asseveration to the contrary being disbelieved. It is now recognized that the disease is in some way contagious, but no specific microbe has at present been discovered. Careful investigations are made into every case and full particulars are forwarded to the Medical Officer of the London County Council. The order making this disease notifiable came into operation on September 1st, 1911. Up to the end of the year only one case was reported. TUBERCULOSIS. During the year 1911, Tuberculosis in its various forms caused 288 deaths, twelve-and-a-half per cent. of the total mortality from all causes in Bethnal Green, a death rate of 2.24 per thousand population. Sixty of the deaths from tubercular disease, other than Phthisis, were amongst young children aged less than five years, a mortality on the estimated population of young children of 3.4 per thousand living. Fourteen infants died from tubercle of the brain and six from tubercle of the bowels. PULMONARY PHTHISIS. The deaths from tubercular disease of the lungs numbered 201, equal to a rate of l.56 against 1.35 for the whole of London. 49 Pulmonary Phthisis or Tuberculosis of the lungs, popularly known as "consumption" or "decline" is an infectious disease usually of a chronic nature. Its infectivity is dependent upon the presence of a microbe called the Bacillus Tuberculosis, which multiplies in the lungs and may be conveyed from person to person, either (a) by means of the mucous expectorated or coughed up as spray or (b) by the expectorated matter reduced to the form of dust and inhaled. The disease itself is not hereditary, but the peculiarly delicate constitution and formation of body which is most receptive of the bacillus certainly is so. Phthisis in its early stages is only slightly, if at all, infectious, but in advanced cases of the disease the consolidated masses of tubercle in the lungs break down and form cavities. The patient in this advanced condition of the disease is constantly coughing and spitting, he becomes a focus of infection, and should be isolated accordingly. Pulmonary Tuberculosis was first made compulsorily notifiable by order of the Local Government Board in January, 1909, this order confined notification to patients under the care of Poor Law Medical Officers. In May, 1911, the requirement was extended to the Medical Officers of Public Hospitals and Dispensaries, and recently this has been followed by a third order, which came into force in January, 1912, by which every Medical Practitioner attending or called into visit any person who, in his opinion is suffering from Pulmonary Phthisis, must notify the case to the Medical Officer of Health. 50 The system of notification commenced in 1909 is now complete, and every case of Tubercular Phthisis should be known to, and kept under observation by, a Public Health Authority. The fees payable to medical men for the notification certificates are identical with those set out in Sec. 55 of the Public Health (London) Act, 1891, that is to say 2s. 6d. to a private medical practioner, and 1s. to Hospital and Poor Law Medical Officers. No provision, however, is made to re-imburse the Borough Councils for the expense so incurred, which will fall wholly upon the local rates. The object in requiring these notifications, is for the purpose of preventing the spread of Tuberculosis. Every case reported must be visited, a note taken of the conditions under which the sick person lives, and such instructions and advice given as is necessary or desirable for preventing the spread of the disease, and for removing conditions favourable to infection. Apart from isolation of advanced cases, the methods available for preventing the spread of Tuberculosis are:— (1) Advice and instructions to the patient and his friends as to the usual hygienic precautions which are well known, and are unnecessary to be detailed here. (2) Such measures as tend to improve the general sanitary condition of a district. The close association between bad housing and the prevalence of tuberculosis is common 51 ledge; hence the importance of checking overcrowding in houses and on area, of improving lighting and ventilation, and removing dampness of walls and floors. Improved housing implies larger rooms and more of them, so as to permit separate sleeping accommodation for adults and children, and for separating the sick from the healthy. It is a common thing to find a phthisical patient occupying the same room and even the same bed with his wife and children, than which no more certain method of spreading infection could be found. (3) The posting of warning notices against spitting on pavements and tramcars, etc. The pernicious habit of promiscuous expectoration has of late been somewhat checked by the publication of notices, but is still much too common, such filthy habits undoubtedly help to spread disease. (4) Early recognition of disease. A very large proportion of those persons who contract pulmonary tuberculosis in its slighter forms forms recover with no permanent ill-effects, and that this is so, is demonstrated by the fact that the scars of old healed tubercular lesions are found in a very large number of post-mortem examinations made upon patients who have died from diseases other than tuberculosis. Every means for the early recognition of tubercular invasion should be 52 adopted. It stands to reason that a man suffering from consumption in its later stages and treated at home under conditions commonly found amongst the poor, almost certainly infects his wife and children, and it is in this connection that the institution of a special dispensary or clinic, equipped with a staff of doctors and nurses, can do so much good by thoroughly investigating the health conditions of all who are associated with the sufferer. Tuberculosis in its early stages can thus be detected and effectually treated in the Sanatoria about to be established under the provisions of the Insurance Act, which has recently become law. Tuberculosis Dispensaries can be established in three ways:— 1. By an extension of the Out-patients department of the existing hospitals. 2. By voluntary efforts. 3. Supported wholly or partially by the rates. The obligations imposed by these new regulations were carefully considered by the Public Health Committee. It was strongly urged by Mr. Foot and myself that the staff, as at present constituted, was unable to cope with the requirements of the new order. It was obvious that a considerable proportion of the cases notified as Pulmonary Tuberculosis would be women, and it was thought that these cases should be left in the hands of a Woman 53 Inspector or Health Visitor.* Now it was well known that the duties imposed by the Notification of Births Act, 1908, fully occupied the time and energies of Miss Harris, so that no fresh duties could be thrown upon her. Just about this time Miss Harris (Mrs. H. F. Bridel), sent in her resignation on the occasion of her marriage, and the appointment of her successor was referred by the Council to the Public Health Committee. It was thought by many members of the Committee that this was a favourable opportunity to recommend the appointment of two Health Visitors in place of one woman Sanitary Inspector, as the Borough could then be divided, and a Health Visitor appointed to each Sub-district. This plan was strongly urged by Mr. Foot and myself. It was felt by the Committee that our advice was good, but, unfortunately, considerations of economy prevailed, and it was decided to recommend the appointment of one Health Visitor in place of Miss Harris on her retirement, which course was ultimately sanctioned by the Council and carried out. * Home Management of Consumptives. The employment of trained women in the work of visiting and instructing consumptives has proved so advantageous in administration that the Conference recommends it should receive encouragement. As much of the work of investigation will be in the region of the home life of the consumptive, it is conceivable that in this connection the trained woman has an important aud useful sphere of action. The employment of trained women to investigate the home conditions of patients, and to advise as to means of personal and domestic hygiene, has proved so increasingly successful in some of the States that the Conference commends it for universal consideration. The systematic home visiting of consumptives by a competent and sympathetic woman visitor or nurse should go far to secure, on the part of the patient, continuous adoption of the necessary precautions when wisely, firmly, and persistently directed. (Report of Australian Conference on Tuberculosis). 54 Public Health (Tuberculosis) Regulations, 1908. Total notified during 1911 200 From Bethnal Green Infirmary and Workhouse 166 From their homes 23 From other Institutions 11 Up to the end of the year I had received information that out of this total of 200 cases 75 had proved fatal. The notified cases belonged to the following trades:— Baker 1 Labourers 13 Bookbinder 1 Motor worker 1 Boot and shoe workers 7 Packer 1 Box maker 1 Painter 1 Brush worker 1 Paperhanger 1 Butcher 1 Porters 2 Cabinet makers 16 Potmen 4 Cardboard cutter 1 Printers 5 Carmen 6 Rag sorters 3 Charwomen 5 Scavenger 1 Chimney sweeps 2 Seamen 2 Cigarette maker 1 Stoker 1 Clerk 1 Tailors 8 Costermongers 3 Tie maker 1 Domestic servant 1 Tobacco moulder 1 Dress and mantle makers 2 Tooth-brush maker 1 Fancy leather worker 1 Traveller 1 Feather curler 1 Trunk finisher 1 Fish frier 1 Upholsterers 4 French polishers 3 Warehousemen 3 Glass beveller 1 Window cleaner 1 Hawkers 8 Infant 1 Housebreaker 1 School children 11 House wives 20 No information 46 200 55 Public Health (Tuberculosis in Hospitals) Regulations, 1911. List of Trades in which persons notified under these Regulations were engaged. Almanac Mounter 1 Labourer (printer) 1 Assistant Rabbi 1 Leather workers 2 Barber 1 Limelight operators 1 Barmaid 1 Machinists 5 Barmen 2 Messenger 1 Belt Cutter 1 Milliners 3 Blouse makers 2 Newspaper seller 1 Boot makers and trimmers 16 Nurse 1 Book binders 2 Packers 5 'Bus conductors 2 Paper bag maker 1 Box makers 4 Piano maker 1 Cabinet makers 10 Pill wrapper 1 Canvasser (tailor) 1 Plasterer 1 Cap maker 1 Plate glass cutter 1 Cap packer 1 Polishers 5 Carmen 8 Porters (fish market) 1 Carriage cleaner 1 Do. (meat market) 2 Carpet sewer 1 Do. (fruit market) 1 Carvers 4 Do. furniture 1 Case maker 1 Potman 1 Chair caner 1 Printers 6 Chair makers 4 Salesmen (linens) 1 Charwomen 2 Do. (furriers) 1 Cigarette makers 4 Saw mill worker 1 Cigar maker 1 School children 16 Chemist's assistant 1 School keeper 1 Clerks 5 Scrubber 1 Cracker maker 1 Seaman 1 Coach builder 1 Sewing machine repairer 1 Compositor 1 Shop assistants 5 Dealers 4 Shunter 1 Deputy at lodging house 1 Silver refiner 1 56 Draper's assistant 1 Tailors 9 Dressmaker 1 Tailoresses 5 Electrician 1 Teacher 1 Errand Boys 2 Tea packer 1 Fish Frier 1 Timekeeper 1 Flesher (tannery) 1 Tie maker 1 Flower seller 1 Tooth-brush makers 2 Furniture fitter 1 Toy maker 1 Gas fitter 1 Traveller 1 Glass blower 1 Trimming makers 2 Greehgrocer 1 Type founders 2 Hat blocker 1 Typist 1 Hat maker 1 Umbrella makers 2 Hawkers 4 Underclothing presser 1 Hairdresser 1 Upholsterers 4 Housewives 45 Warehousemen 3 Labourers (builder) 1 Washerwoman 1 Do. (dock) 3 Occupation not ascertained or cases of no occupation 28 Do. (general) 3 296 In addition to the total of 296 oases notified under the Tuberculosis Regulations, 1911, particulars of 1,222 cases were notified to us by Medical Officers of Institutions in Bethnal Green, of patients ordinarily residing outside the Borough. These particulars were forwarded to the Medical Officer of Health for the district concerned. Twenty-seven samples of sputum were sent to the Clinical Research Association for examination. Tubercle Bacilli were found in six. FAIRLIGHT SANATORIUM, HASTINGS. The six beds retained by this Authority were kept constantly occupied during the year. Eighteen persons 57 in the early stages of consumption were sent to Hastings. These were selected from a very much larger number examined by me. Most of the selected patients were interviewed by the Committee, and careful enquiry was made into the circumstances of each. A number of the young men I examined were in the very early stage of the disease, but I regret to say that, in several instances, the urgency of home conditions forbade a man eminently suitable for sanatorium treatment to accept the offer of Fairlight. These men were in more or less constant employment, and the sole support of their families. It was originally intended by the Chancellor of the Exchequer that the family of the consumptive workman who is sent to a sanatorium should receive 10s. per week while he is being cured, but I am afraid funds will not be available for this purpose, so far as deposit contributors are concerned, at any rate, for some years to come. As a matter of fact, no approved society would knowingly accept a consumptive as a member; he must, therefore, be a Post Office contributor, in which case it would take him eight years to provide the sum of 10s. per week for 26 weeks. 58 FAIRLIGHT SANATORIUM. Daring the year under review, 18 persons in the early stages of Consumption have been sent by this Authority to the Fairlight Sanatorium, Hastings; brief particulars of these cases are appended:— Initials. Address. Age. Trade. Date of Admission and Discharge. Remarks of Medical Superintendent on Patient's Discharge. R. J. Elwin Street 30 Glass beveller 13th Feb. to 9th June Disease arrested. J. L. Horatio Street 36 Butcher 13th Feb. to 8th May No improvement; lost weight; heart muscles very weak. A. R. Viaduct Street 19 Patient in Bethnal Green Infirmary. 13th Feb. to 19th June Disease arrested. T. H. Old Ford Road 45 Gasfitter 6th Mar. to 24th April No improvement. Has since died. G. K. Old Ford Road 24 Upholsterer 6th Mar. to 16th Nov Disease arrested. W. D. Guinness Bldgs. 27 Cabinet maker 6th Mar. to 14th Aug Disease arrested. G.J. Baxendale Street 23 Packer 1st May to 26th Aug Disease apparently arrested. G. S. Bonwell Street 44 Dock Labourer 15th May to 8th July Discharged himself; much improved. 59 FAIRLIGHT SANATORIUM-continued. Initials. Address. Age. Trade. Date of Admission and Discharge. Remarks of Medical Superintendent on Patient's Discharge. B.C. Baxendale Street 28 Block mould maker 19th June to 3rd Aug. Discharged himself; much improved. A. C. Medway Road 17 Messenger 19th June to 30th Mar., 1912. Disease arrested. W. P. Royston Street 31 Carman 1st Sept. to 9th Sept. Discharged himself; homesick. A. S. Cyprus Street 25 Belt flnisher 14th Aug. to 25th Nov. Disease arrested. C. A. Elwin Street 37 Potman 11th Sept to 30th Dec. Disease arrested. J. W. Collingwood Street 57 Railway checker 14th Sept. to 26th Oct. Much improved; discharged himself. J. T. Casket Street 19 Chair maker 20th September Died at Sanatorium, 14th January, 1912, from Pleuro Pericarditis and Dropsy. C. B. Coventry Street 17 Tea packer 10th November Still at Sanatorium; has been operated upon for Fistula. G.W. Thorold Street 22 Furniture Porter 17th Nov. to 28th Dec. Discharged himself to attend his mother's funeral. J. L. Prospect Terrace 39 Boot laster 11th Dec. to 13th April, 1912. Disease arrested. 60 CANCER. The various forms of malignant disease caused 120 deaths; all the sufferers except four were over 25 years of age, the estimated number of adults over this age living in Bethnal Green being 51,806. On this number, the cancer mortality is at the rate of 2.2 per thousand. The following list shows the organs and parts of the body chiefly affected by cancerous disease:— Stomach, Liver and Pancreas 46 Female organs of generation 12 Intestines 12 Rectum 9 Tongue and Mouth 7 Larynx and Œsophagus 7 Lung and Mediastinum 7 Female Breast 4 Prostrate and Male Bladder 2 INQUESTS. The Inquests held numbered 277. Ninety-nine persons died violent deaths, of whom 13 committed suicide. In two instances, verdicts of manslaughter were returned. SUICIDES. These numbered 13:—The wife of a stationer's porter, aged 61, tried to poison herself with turpentine, and then hanged herself. A cabdriver, aged 40, also hanged himself. A tailor's machinist, aged 20, 61 drowned herself in the River Thames, as did also a cabinet maker, aged 30. A police constable, aged 31, and a naval pensioner, aged 42, each cut their throats. A wood turner, aged 42, threw himself from a roof, another man, aged 45, threw himself out of a window, and a third man went to Southend and threw himself under a tram-car. The following persons took poison:—Oxalic Acid—a chair maker, aged 30, and the wife of a fish curer, aged 41 Spirits of Salt—a dairyman, aged 39, and the wife of a general dealer, aged 47. Caustic Soda—a bottle washer, aged 15, took this very unpleasant substance. HOUSING, TOWN PLANNING, Etc., ACT, 1909. Digby Street Area. This was represented as an unhealthy area in the year 1902. As the size of this area was, in the opinion of the London County Council, insufficient for a satisfactory re-housing scheme under Part I. of the Act of 1890, it was not proceeded with* but an offer was made on the part of the Council, that if the Borough Council undertook to clear the site under Part II. of the Act, a portion of the expense would be contributed out of Public funds, but no action in this direction has been takeu beyond the preparation of plans and estimates by the Borough Surveyor. The coming into operation of the new Town Planning Act of 1909 seemed to offer a favourable *The area was said to be so limited that a 40-ft. street, driven through the middle of it, would leave no space upon which to erect dwellings for the displaced inhabitants. 62 opportunity for a reconsideration of the matter, accordingly during the early part of 1911 every house on the area was visited and carefully examined by Inspector Henley and a note taken as to its condition, these notes I subsequently verified by personal inspection. A fresh set of mortality statistics for every street and place on the area was prepared, of which the following is a summary:— There are altogether 135 houses on the area inhabited by 761 persons, of whom 334 are children under five years of age. The average death rate for the three years 1908-1910 was 29.4 per thousand persons living, against 16.8 in the whole of Bethnal Green for a similar period. The 761 inhabitants constitute 173 separate families, 44 of which live in single room tenements. I found that since I last made a systematic house-to-house inspection of this district, a large amount of repair work, including in many instances actual re-building, had been carried out, the chief defective portions remaining being the large block of back-to-back houses in Digby Street and Digby Walk, and the aged and worn out condition of a number of other houses. On consideration I was not very hopeful that a new representation would be more successful than the previous one, but as a rehousing scheme for this district would give an opportunity for carrying out a much needed public improvement, namely, the widening of Green Street, I requested the Public Health Committee to view the area with me. The Committee agreed upon inspection, that it was 63 extremely unlikely that the London County Council would go beyond their previous offer, so it was decided to serve full notices under the Housing, Town Planning, &c., Act of 1909, where necessary, and to exert pressure upon the owners of property to carry out extensive repairs. By direction of the Committee some 90 notices under Sec. 15 were served, with the result that a large amount of work has been carried out; most of the defective houses have been thoroughly stripped, walls and woodwork repaired, and afterwards papered and painted throughout. Nine old houses at the corner of Baker Street and Green Street have been pulled down. Brady Street Area. In my last Annual Report I somewhat rashly committed myself to the statement that "No portion of the Borough taken as an area could now be successfully scheduled as unhealthy." A recent re-inspection of what is known "the Brady Street area" has considerably modified that opinion, and I feel bound to withdraw the statement for, notwithstanding the strenuous efforts of the officers of my department, the district referred to has steadily deteriorated since I last made a house-to-house inspection in 1901, prior to a representation of the area under the old Housing Act. Before this report is printed, a new representation under the Housing, Town Planning &c., Act, 1909, will be in the hands of the London County Council. It is my earnest hope that it will meet with a better fate than its predecessor. 64 Full particulars of other action taken under this Act will be found in Mr. Foot's Report on page 70. Customs and Inland Revenue Acts, 1890 to 1903. Application for exemption was received in respect of the following premises:— 27a, 27b and 27c, Winchester Street. 4a, 4b, 4c, 4d, 4e and 4f, Winchester Place. 20a, 20b, 20c, Cheshire Street. 22a, 22b, 22c, do. 24a, 24b, 24c, do. 26a, 26b, 26c, 26d, 26e, Cheshire Street. 28a, 2bb, 28c, Cheshire Street. Application was refused; only one W.C. and one copper and washhouse were provided on each block of these premises. NATIONAL INSURANCE ACT. 1911. One of the most important measures ever considered by Parliament was passed during 1911, though it does not come into operation in any way until July, 1912, and its full benefit will not be experienced until the commencement of 1913. The Act is one "to provide for insurance against loss of health, and for the prevention and cure of sickness, and for insurance against unemployment, and for purposes incidental thereto." Some of the provisions of this Act may have a far-reaching effect upon Sanitary administration in three principal directions. (a) Sanatorium Benefit. The provision of means for the sanatorium treatment of tuberculosis should prove of enormous advantage, 65 and a large sum of money is made available for the purpose. Insured persons suffering from tuberculosis in any of its forms may claim to be admitted to sanatoria. Local Authorities, as defined by this Act, may arrange to provide medical treatment for such persons otherwise than in a sanatorium, and such treatment, either in a sanatorium or outside, may be extended to the dependents of insured persons. Approved Societies or Insurance Committees are to be empowered to subscribe to Hospitals, etc., and appoint and pay nurses to visit and attend upon insured persons who require nursing. (b) Excessive Sickness due to Insanitary Conditions. The most drastic clause in the whole Act is Sec. 62, which provides that, upon complaint by the Insurance Commissioners or Local Insurance Committee, or by any approved Society, that excessive sickness is caused in a district through faultv Public Health administration or bad housing or bad water, or other insanitary conditions, an inquiry may be held by a competent person to be appointed by the Secretary of State or the Local Government Board. If, upon such inquiry being held, it is proved to the satisfaction of the person holding the inquiry, that:— (1) The amount of such sickness has been excessive during a period of not less than three years before the date of the inquiry, or (2) If there has been an outbreak of any epidemic, endemic or infectious disease during any less period in excess of the average expectation of 66 sickness by more than 10 per cent., and that such excess was in whole or in part due to any such cause as aforesaid. The amount of any extra expenditure found by the person holding the inquiry to have been incurred under this part of this Act by any societies or committees, where the allegation is made by the Insurance Commissioners, or if the allegation is made by a society or committtee, by the society or committee in question, by reason of such cause, shall be ordered by him to be made good in accordance with certain provisions. How any of these allegations are to be proved I do not know, but if any one of them is proved to the satisfaction of the person holding the inquiry, the authority at fault, be it County Council, Borough Council, Water Board, employers of labour, or what not, will have to pay, for there is no appeal from the decision of the person holding the inquiry. (c) Maternity Benefit. The Act provides a maternity allowance of 30s. to the wives of insured persons, or to the insured persons themselves if they are women workers. So far as I can judge, this timely help should diminish the infantile mortality, which is so great during the fatal first month. Last year 26 per cent. of the whole of the deaths of infants under one year occurred during the first four weeks of life, and many of these were due to poverty. THE RAG FLOCK ACT, 1911. This Act renders it illegal for any person (1) to sell or have in his possession for sale flock manufactured 67 from rags, or (2) to use for the purpose of making any article of upholstery, cushions, or bedding, flock manufactured from rags, or (3) to have in his possession flock manufactured from rags intended to be used for any such purpose, unless the flock conforms to such standard of cleanliness as may be prescribed by regulations to be made by the Local Government Board. Any person who sells, uses, or has in his possession flock in contravention of the Act becomes liable on summary conviction to a fine not exceeding, in the case of a first offence, ten pounds, or in the case of a second or subsequent offence, fifty pounds. All fines imposed in any proceedings under the Act are to be paid to the credit of the Funds of the Council. It is the duty of the Council, as the Sanitary Authority for Bethnal Green, to enforce the provisions of the Act within the Borough. We had formerly in the Borough a Flock Mill where filthy rags of all kinds were devilled into flocks and afterwards sold to the manufacturers of cheap bedding and upholstery. This mill was for many years a horrible nuisance to the surrounding district, but, I am happy to say, it is now a thing of the past and the site of the mill is occupied as a timber yard. A careful investigation was made by the Sanitary Committee of the old Vestry in the year 1888 into the manufacture of flocks on these premises and at almost every other flock mill throughout London. Your Medical Officer and present Chief Inspector accompanied the Committee, and therefore know that a great danger to health will be abolished if the Act is properly worked. Regulations 68 fixing the standard of cleanliness are under consideration and will shortly be issued by the Local Government Board.* In the year 1888 I presented a report to the Vestry on the flock factory referred to above. On the consideration of this report it was resolved that before moving further in the matter it would be advisable to take the opinion of an expert; accordingly Dr. Thos. Stevenson, the Home Office Adviser, was asked to inspect the factory, and his report will give some idea of what " coloured flocks " are. DR. THOS. STEVENSON'S REPORT. Sir, Flock Factory Nuisance. On the 19th inst. I visited, without notice, the Flock Factory of Mr. Sanderson, in company with one of the Sanitary Inspectors of Bethnal Green. The machinery appeared to be in full working when I visited. I have read the report embodying the opinion of your Medical Officer of Health, Dr. Bate, furnished me by you, and also one by Dr. Septimus Gibbons, sent to me by Mr. Sanderson. *Regulations issued by the Local Government Board will be found in the Appendix. 69 The situation of the factory—at the junction of Satchwell's Rents, and Satchwell Street—and the limited area of the premises (for there is no yard) render the site a most undesirable one; and I have no hesitation in stating that, in my opinion, the factory is unfitted for the purpose, causes nuisance, and entails danger to the public health. It is evident that endeavours have recently been made to obviate nuisance, but with only a measure of success. The report which you sent to me sufficiently explains the process of manufacture. Briefly, filthy woollen rags are received in bags from the marine store dealers, and without any cleansing or disinfecting process are fed by hand, to the extent of 15 cwt. a day, into a machine technically known as a "devil," and by this are torn into shreds. Much fluff and dust are driven out during this rending process, and a cloud of fine dust rises through the crevices in the machine and is desseminated through the atmosphere, and thence through the open door and windows into the outside air, and must be carried into the houses situated in close proximity, in Satchwell's Rents, Orange Street and Satchwell Street. This dust, I find, is of a highly complex character, containing fine broken fragments of woollen and cotton, starch, animal cells, mineral matter, and spores of vegetable organisms. The dirty fluffy roof of the entry testifies to the escape of this dust. From the devil the torn rags pass into a second machine, which by means of a fan extracts the fluff, dust and lighter particles which form a 70 siderable percentage of the torn up material. The flocks fall out of the side of this machine and are placed in bags for removal. The lighter portionfluff and dust—is driven by the blast from the fan along a tube into successive chambers of the aggregate capacity of nearly 1,200 cubic feet, divided into compartments. Means are taken to divide and slacken the current of air entering these chambers, so as to allow the heavier particles of fluff and dust to settle out of the air. From the winnowed flocks the finer suspended dust is conveyed by a pipe which opens immediately below the furnace bars of the boiler furnace. The organic and noxious dust passing this tube is thereby destroyed by combustion. Another pipe or tube from the settling chambers passes into the chimney shaft beyond the furnace fire, and the dust is of necessity carried up the chimney shaft and discharged into the open air. This is objectionable; the whole of the residual air from the settling chambers ought to pass through the furnace fire, so as to ensure destruction of its combustible ingredients. The fluffy dust deposited in the settling chambers is periodically removed to the extent of several hundred weight a day, packed in bags and used as manure. It is an indescribable mass of debris—woollen fibres, cotton fibres, other vegetable fibres, sand and earth, spores, ova of insects, and animal cells. Fleas abound on the premises. The processes carried on are defective in consequence of the inadequate size of the settling 71 chambers. These ought to be much more capacious so as to secure more efficient subsidence of the dust and fluff; but the limited space available on the premises would appear to preclude the provision of chambers of adequate size. Screens of sacking should be employed to detain fine dust. Besides the injurious nuisance arising from the escape of filthy dust, which is likely to contain from time to time the germs of contagious diseases, and so disseminate disease in the neighbourhood, there is an additional danger to public health in the dissemination of disease by means of flocks sent to furniture dealers. The use of flock beds made from filthy, and perhaps specifically infected, rags is an undoubted source of danger to the public. To summarise:— 1. The factory in question is so situated as to expose the neighbourhood to nuisance and danger to health by the dissemination of filthy dust through the air. 2. The space is too limited to admit of the construction of settling chambers of adequate size. 3. The whole of the dust is not passed through the fire, so as to ensure destruction of its deleterious components. 4. No disinfecting process is applied to the rags and flocks; but this is a customary defect in the manufacture of low class flocks. 72 5. The best available means of obviating nuisance are not used, and the limited space at command prevents the adoption of means which would be easily available were the factory more favourably situated, and of adequate size and area. I am, Sir, Your obedient servant, THOS. STEVENSON, M.D. Lond., L.R.C.P. Lond., Lecturer on Chemistry and Medical Jurisprudence at Guy's Hospital, Examiner in Public Health to the Royal Colleges of Physicians and Surgeons, Vice-President of the Society of Medical Officers of Health. In conclusion I have very much pleasure in referring to the cordial relations existing between the Public Health Committee and its Officers. Speaking for my colleagues in the Office, we feel that we have the hearty support of the whole Council in our efforts to ameliorate the health conditions of the Borough. Moreover, as we are naturally jealous of any attempt to belittle our work, we much appreciate the manner in which the Council as a whole indignantly refuted a recent attempt in this direction. I beg to tender my sincere thanks to the Public Health Committee for their kind and courteous consideration, and to my colleagues of all departments for their willing help and information. I have the honor to be, Sir and Gentlemen, Your very obedient servant, GEORGE PADDOCK BATE. 73 APPENDIX. Report of Woman Sanitary Inspector. Public Health Department, Bethnal Green. To the Medical Officer of Health, Sir, I have the honour to submit to you a short account of the work done by me in this Borough during the past year. The work has been almost entirely that involved in the working of the Notification of Births Act, and has included the visiting of newly born infants and their mothers, inspection in cases of Ophthalmia Neonatorium, and Puerperal Fever, and investigation of the circumstances attending fatal cases of Summer Diarrhœa. Owing to the fact that from various causes (excessive heat, strikes, unusual poverty) there was during this year a very large amount of illness among infants and young children, an increased number of re-inspections proved to be not only desirable, but imperatively called for. The number of visits paid was as follows:— After notification of births 1,964 For sp cial reasons (such as illness, poverty, etc.) 149 Re-visits 298 Enquiries after infantile deaths 150 Total number of visits paid 2,561 74 The births notified to this Department during the year numbered 3,785 of which 3,226 were sent in by attendant (doctor or midwife). 547 „ „ relatives. 12 ,, ,, person not stated. The mothers were attended in confinement By qualified medical practitioners 1,246 By midwives 1,294 Assistants from the London Hospital 1,182 By whom not stated 60 3,782 Three were attended at the time of the birth by relations or friends, no doctor or midwife being called in. The infants born were Boys 1,966 Girls 1,848 Sex not stated 18 3,832 The number of births exceeds the number of notifications, as twins and triplets are notified on the same form. There were 47 pairs of twins, eight pairs of boys, 17 pairs of girls, and 22 boy and girl twins. There was one set of triplets, two boys and a girl, who, although they lived for several months, eventually died. Information as to whether the infants were living or stillborn is usually not given, though asked for on the 75 notification forms. It was given this year in the cases only of 11 stillborn boys, and 17 stillborn girls, of whom five were one of twins. The visitation of infants continues to disclose a large and increasing amount of poverty and distress in the district. This fact is mentioned annually in my report; but it should always be borne in mind when our birth rate, infantile mortality rate, or sickness rate is under consideration, because it would appear that the dire and sordid poverty in which many of the people spend the greater part, if not all, of their lives, is the very root from which spring many of the difficulties we have to cope with. Many mothers are found to be really suffering from want of sufficient and proper food, and naturally the babies suffer too. Cases have been found where their condition could only be described as one of starvation. Such steps as were possible have been taken in every case, to leave these poor ones better off for our visits. In five somewhat exceptional cases the baby has been allowed sufficient milk for its food during at least its first nine months, and each baby has justified the effort made on its behalf. Generous help has been afforded for some cases (19 in number) from the fund established in the Borough for necessitous children; others have been referred to the Guardians for assistance, and yet others have been helped from private sources. I am of opinion that if the mothers could only be properly fed, both before and after the birth of their infants, the coming generation would be much better for it. Something of the kind required is already being done in Paris, and ladies of means in 76 London who wish to find some outlet for their energies, and at the same time to benefit others, might well follow the example set there. "In a small street in the Montmartre quarter is a modest looking window, with 'Cantine Maternelle' written across it. Push open the door and see the rows of benches and tables laid with plates, knives and forks, and glasses. And note that there are only women here; women with babies in their arms, who have entered quite unceremoniously and taken their places at the tables, waiting to be served. But this is no restaurant. It is a glorious institution for feeding the mothers of young children, mothers nursing their infants, who require good and regular food. There are numbers of charitable organisations in Paris, but none are conducted on such noble lines. A woman has only to be poor, and a mother, to find a welcome. No recommendation is required. She is not asked who she is, whence she comes, her religion, nor her country; neither are questions put to her relating to her marriage. Her baby is her introduction. She comes timidly the first day, scarcely believing what she has heard. Can it be possible that no questions are asked? This seems to surprise her more than all the food they may give her. But she soon grows accustomed to the gentle, tactful way in which this charity is conducted, and she arrives once or twice a day, smilingly nodding to those near her. And she comes sometimes for six months, day after day, as long as she nurses her baby. The ladies at the head of the 'Cantine Maternelle' keep in the background. They go into the kitchen to see how the food s prepared, but they never show themselves in the 77 dining-room. Everything is done on simple, unostentatious lines. Only two women are seen by the mothers, the woman who cooks and the woman who serves. In the course of the month, especially during the winter, they distribute nearly 3,000 meals, and, according to their last report, each meal on an average costs them 3d. This institution helps to lower infant mortality and make the new generation healthy and strong." And, unquestionably, the effect would be the same here; but to induce the mothers to accept such assistance it would have to be managed in much the same way. However poor they may be, the mothers resent impertinent questions about what they consider their private affairs; though if they feel that they meet with sympathy and interest they are ready and eager to talk over their difficulties. The necessary feeding of mothers being too big a thing for us to manage, we have done what seemed possible towards feeding the babies, especially the delicate, wasting and ricketty ones; and with most satisfactory results. For these, Virol has been used; and the improvements noticed has in many cases been astonishing. When taking this food, the babies are inspected and weighed periodically; and, after the first two or three days, many of them almost visibly put on flesh and gam strength. It is quite usual for them to gain from £-lb. to 1 lb. in weight for a time, i.e., till they are approaching or have reached the normal weight for age, and after this point is reached they go steadily on. But for the fact that they can be helped 78 in this way, it would be sad and discouraging to contemplate the manner in which the babies waste after birth—many of them are even smaller and lighter in weight at three months old than at three weeks; later on, these become ricketty, while the weight is somewhere about 1 lb. per month of age, i.e., a child 12 months old weighs about 12 lbs. Some are worse, as, for example, the following:— Child A 12 months old, weighed 9 lbs. in clothes. „ B 15½ ,, „ 10 lbs. 6 ozs. „ „ C 15 „ „ 14 lbs. ,, „ D 17 „ „ 12 lbs. 14 ozs. „ „ E 18 „ „ 11 lbs. 12 ozs. „ These are actual cases, all of whom improved. The weight of a normally healthy child should be about 18½ lbs. at 12 months, so that these, when put under treatment, were far below the standard. Some of these infants were visited after their birth, but were then lost sight of; and many were found when the mother was visited after the birth of another baby. This fact goes to show the importance of re-inspection and of keeping in touch with the mothers when their acquaintance has once been made. The mothers may be described as roughly of three classes:— (a) The good mothers, who, usually, are already, when visited, doing the best they can for their children according to their knowledge and their means. 79 (b) The average mothers, whose children get on fairly. (c) The indifferent mothers, who require constant "keeping up to the mark." The first two classes are the large majority, and are generally glad to avail themselves of any help or advice offered, while the last very often will not trouble; and it has not been possible to give them the amount of attention which is necessary. All are invited to bring their children for weighing or advice to the Town Hall any morning, and a large number have made a practice of attending regularly for this purpose. In this way they can be kept in touch with, with the least expenditure of time. These poor wasting babies are almost always bottle-fed. Practically all the Bethnal Green mothers who cease to nurse their infants, do so because they cannot, not because they will not continue. Women who are underfed and worried, and who have to work so hard, cannot secrete milk good either in quantity or quality. Some mothers too are women who are quite unfit for such a vocation. Women obviously diseased or delicate have stated that they married because they knew themselves to be unable to depend upon their own efforts for a living, and such women have no chance of bearing strong and healthy children. Enquiries concerning the industrial employment of women, continue to shew that a very small percentage of the mothers of young children in this district are so employed, though most of the women are ready and 80 willing to accept casual work when it offers, or even to engage regularly in such work as street hawking, officecleaning, etc. And it would appear that what harm might be done by factory work is more than compensated for by the better and more regular food the mother is thus enabled to obtain. Housework seems to be at least as bad for the expectant mother. The women themselves often attribute difficulty and danger at confinement to their having had to do heavy washing, or to carry weights (e.g. water) up and down stairs to and from their rooms. One woman who was greatly distressed about her stillborn baby, said that it was killed while she was moving the bed in preparing her room for her confinement. During the hot summer months much attention was given to infants and young children suffering from Diarrhoea. Every case that came to our knowledge was visited, most cases repeatedly. It was found necessary in some cases to see that the feeding bottles, milk jugs, etc., were properly washed, that the bedding was clean, and the child changed as required; that the Doctor's instructions were carried out, and even that the mother understood and knew how to do what she had been told. It is believed at present that insanitary home conditions, and the contamination of food there and elsewhere are responsible for Summer Diarrhœa. But undoubtedly other factors should be taken into consideration, for I have remarked repeatedly that in Bethnal Green many of the children who died from this complaint lived in clean homes. Possibly they 81 would die in any case, but are kept alive by care and comfort until some influence in their surroundings proves too much for them. Of course, illness is often invited by careless and dirty habits, but much might perhaps be prevented if the streets and roads (especially side streets and courts) could be swept while wet. Last summer the experiment was to have been tried in a portion of the Borough, but owing to various exceptional circumstances it fell through. Dry sweeping raises clouds of germ-laden dust, which enters the houses, settles on food, and is swallowed by the people. Proper food storage is non-existent in many of the smaller houses, and food that is unconsumed is left about on tables and open shelves, while cooking and feeding utensils are often uncleansed and exposed to dust and flies, and are used again and again without washing. Then, too, although it is only very occasionally that there is reason to believe that the existent poverty and distress are due to indulgence in drink (at least, on the part of the mother) indubitably the amount many mothers do take is sufficient to affect their infants unfavourably. It is quite usual for nursing mothers to take stout under the impression that it increases the milk supply, and even most temperate women will at that time take from one to two pints per day, if they can afford it. One other point urgently requires notice. During last summer three illegitimate babies left in the care of the mothers' relatives were, I am absolutely certain, not only allowed, but assisted to catch summer 82 diarrhoea, and they all died. Now the London County Council supervise women who take in children to nurse; though it is to the woman's own interest in such cases to take good care of the child. But these poor mites are not wanted, and though the mothers themselves might be disposed to love and care for their children, they are generally both young and ignorant, and moreover have to work to earn their living. So the babies are left with relatives who sometimes neglect and even actively illtreat them. We occasionally refer cases to the N.S.P.C.C., and sometimes we can do more unaided; but undoubtedly many lives are thus sacrificed without any authority being a bit the wiser. And it is a matter which requires immediate attention. The deaths of children under one year old from diarrhoea number 180 during the year. It was not possible to investigate the circumstances attending all of them, as the press of work during the hot weather made it appear more desirable and useful to devote extra attention to those who were living and might be saved rather than to spend much valuable time in making enquiries after death. In some cases it was found that the whole family had been attacked by this disease, and doubtless the baby was thus infected. In three instances the mother bad been made ill by eating fish; in three, weaning was in progress; in one case only did the mother of an infant admit giving it the same food as the rest of the family were having. The people here were very poor, and buying sufficient milk for the baby was beyond their means. 83 Only five mothers admitted having used a feeding bottle with a rubber tube. There is now no need for anyone in Bethnal Green to use these abominations, as by the kindness of the Ex-Mayor, Mr. Councillor Fox, properly shaped feeding bottles can be obtained through the Public Health Department even more cheaply than bad ones can be got at a shop. Fifty-four of the infants who died were breast-fed as against 67 hand-fed. This was a much larger proportion of naturally-fed babies than usual. Thirty-four babies were fed on condensed milk (all of a good brand), twenty-five on ordinary cow's milk, three on sterilized milk, one on malted milk and four on patent foods. Though the women frequently deny the practice, cornflour, oatmeal, &c., is often added to the milk given to young babies—even those of a few days or hours old. The mothers think that the feeding value of the milk is increased thereby. Many of the babies were said to have been ill a very short time—a few days or hours only. No information was obtained concerning 59 infants. Some were never visited; in a few cases the families had moved, and could not be traced; one had never lived at the address registered, and no baby had died there; one was known at the address given under a different name, and had left; one family lived at their address only four days, during which the baby was admitted to the Infirmary; and three others went into the workhouse. One family had been turned into the street for arrears of rent, and were found later at another address, 84 in the greatest poverty. The mother stated that she and her husband had spent several nights in the streets, while her children were taken in by various neighbours. And so they come and go. The lives of the poor are always hard; the babies suffer so, that often when they die, in spite of the death rate, one can only think it a mercy they were taken. The fathers' lives are hard, whether they are in work or out of work. But the lives of the mothers are the hardest of all. After six years' work in the Borough, and other experience elsewhere, I have only a great pity and sympathy for them. They are so cheerful and brave about it all, and so many of them work so hard, that for many things one cannot but admire them. My work among them is now finished; but the work I found such great pleasure in beginning will be carried on, and I hope that at least I have left some few a little better off than I found them. I am, Sir, Your obedient servant, A. K. HARRIS (Sanitary Inspector). RAG FLOCK ACT, 1911. REGULATIONS OF THE LOCAL GOVERNMENT BOARD. Section 1 (1) of the Rag Flock Act, 1911. To the Mayor, Aldermen, and Commons of the City of London in Common Council assembled:— 85 To the Councils of the several Metropolitan Boroughs;— To the Councils of the several Municipal Boroughs and other Urban Districts in England and Wales;— To the Councils of the several Rural Districts in England and Wales;— To the several Port Sanitary Authorities;— And to all others whom it may concern. Whereas by subsection (1) of Section 1 of the Rag Flock Act, 1911 (hereinafter referred to as "the Act"), it is enacted as follows:— "(1) It shall not he lawful for any person to sell or have in "his possession for sale flock manufactured from rags "or to use for the purpose of making any article of "upholstery, cushions, or bedding flock manufactured "from rags or to have in his possession flock manu"factured from rags intended to he used for any such "purpose, unless the flock conforms to such standard "of cleanliness as may be prescribed by regulations "to be made by the Local Government Board, and, if "any person sells or uses or has in his possession flock "in contravention of this Act, he shall be liable on "summary conviction to a fine not exceeding, in the "case of a first offence, ten pounds, or in the case of a "second or subsequent offence fifty pounds." And whereas it is expedient that the Regulations herein-after set forth be made in relation to flock manufactured from rags: 86 Now therefore, We, the Local Government Board, by this Our Order, and in the exercise of the powers conferred upon Us by the Act, and of every other power enabling Us in that behalf, do make the following Regulations, that is to say:— Article I.—Flock shall be deemed to conform to the standard of cleanliness for the purposes of sub-section (1) of Section 1 of the Act when the amount of soluble chlorine, in the form of chlorides, removed by thorough washing with distilled water at a temperature not exceeding 25 degrees Centrigade from not less than 40 grammes of a well-mixed sample of flock, does not exceed 30 parts of chlorine in 100,000 parts of the flock. Article II.—These Regulations may be cited as "The Rag Flock Regulations, 1912," and shall come into operation on the First day of July, One thousand nine hundred and twelve. Given under the Seal of Office of the Local Government Board, this Eighth day of June, in the year One thousand nine hundred and twelve. JOHN BURNS, President. H. C. MONRO, Secretary. 87 TABLE I. Vital Statistics of Whole District during 1911 and Previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Under 1 Year of Age. At all Ages. Uncorrected Number. " Nett." N umber. Rate. Of Nonresidents registered in the District. Of Residents not registered in the District. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 130,609 4,430 4,430 33.90 2,398 18.4 337 397 696 157.0 2,463 18.9 1907 130,831 4,152 4,152 31.74 2,200 16.8 310 391 574 135.2 2,281 17.4 1908 131,006 4,220 4,341 33.13 2,251 16.9 399 423 572 131.8 2,266 170 1909 131,316 3,999 4,132 31.46 2,243 17.0 443 397 534 129.2 2,193 16.7 1910 131,579 4,040 4,208 31.98 2,034 15.4 406 375 516 122.6 2,002 15.2 1911 128,247 3,866 4,032 31.45 2,345 18.3 427 391 599 148.5 2,316 18.0 Note.—This Table is arranged to show the gross births and deaths in the district, and the births and deaths properly belonging to it with the corresponding rates. For years before 1911 some of the corrected rates are not available. The rates are calculated per 1,000 of the estimated gross population. 88 TABLE II. Cases of Infectious Disease notified during the Year 1911. Notifiable Disease. Cases Notified in whole District. Total Cases Notified in each Ward. Total cases removed to Hospital. At all Ages At Ages—Years. 1 2 1 2 Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. North East. South West. North East. South West. Small-pox 4 — — — 3 1 — — — 4 — 4 Cholera 1 — — — — 1 — — — 1 — — Diphtheria (including Membranous Croup) 200 14 112 60 11 3 — — 87 113 84 111 Erysipelas 247 13 12 28 25 69 70 30 131 116 — — Scarlet Fever 242 4 87 139 11 1 — — 132 110 128 102 Typhus Fever — — — —_ — — — — — — Enteric Fever 31 — 1 10 7 12 1 — 23 8 23 6 Relapsing Fever — — — — — — — — — — — — Continued Fever 1 — — — 1 — — — — 1 — — Puerperal Fever 14 — — — 8 6 — —_ 3 11 3 10 Plague — — — — — — — — — — — — Phthisis Under Tubercuculosis Regulations, 1908 200 — 4 11 27 113 40 5 116 84 — — Ditto 1911 398 1 2 18 94 237 46 — 188 210 — — Ophthalmia Neonatorum 26 26 — — — — — — 14 12 2 3 Epidemic Cerebrospinal 6 3 1 — 1 1 — — 3 3 3 2 Chicken Pox 125 17 64 42 2 — — — 54 71 — — Polio Myelitis 1 — 1 — — — — — 1 — 1 — Totals 1496 78 284 308 190 444 157 35 752 744 244 238 89 TABLE III. Causes of, and Ages at, Death during Year, 1911. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total Deaths whether of Residents or Nonresidents in Public Institutions in the District. All Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 Enteric Fever 3 ... ... ... 1 1 1 ... ... 2 Small Pox ... ... ... ... ... ... ... ... ... ... Measles 128 20 54 50 4 ... ... ... ... 14 Scarlet Fever 6 ... 2 1 3 ... ... ... ... ... Whooping Cough 44 15 19 10 ... ... ... ... ... ... Diphtheria and Croup 24 4 9 8 3 ... ... ... ... 5 Influenza 11 1 1 1 ... 1 3 3 1 ... Erysipelas 7 ... ... ... ... 2 1 1 3 6 Cerebro-Spinal Fever 7 3 1 1 ... 1 1 ... ... 10 Other Septic Diseases 39 7 4 3 7 4 7 4 3 39 Phthisis, (Pulmonary Tuberculosis) 201 ... 3 4 5 23 106 53 7 125 Tuberculosis Meningitis 41 14 13 9 4 ... 1 ... ... 39 Other Tuberculous Diseases 46 7 9 8 6 3 11 2 ... 27 Rheumatic Fever 4 ... ... ... ... 2 2 ... ... 2 Cancer, malignant disease 120 ... ... ... 3 1 18 55 43 74 Bronchitis 219 39 14 5 ... 1 13 58 89 73 Broncho-Pneumonia 119 32 36 16 l 3 5 11 15 70 Pneumonia (all other forms) 148 25 20 13 6 6 25 30 23 83 Other diseases of Respiratory organs 20 4 2 2 ... ... ... 7 5 20 Diarrhœa and Enteritis 253 180 50 12 1 1 ... 4 5 133 Appendicitis and Typhlitis 5 ... ... ... 4 ... ... ... 1 6 Alcoholism 5 ... ... ... ... ... 1 2 2 ... Cirrhosis of Liver 11 ... ... ... ... ... 2 7 2 4 Nephritis & Bright's Disease 79 1 ... 1 4 3 12 31 27 63 Puerperal Fever 3 ... ... ... ... 2 1 ... ... ... Other accidents and diseases of Pregnancy and Parturition 11 ... ... ... ... ... 11 ... ... ... Congenital Debility and Malformation, including Premature Birth 150 150 ... ... ... ... ... ... ... 22 Violent Deaths, excluding Suicide 84 23 2 4 14 5 8 7 21 30 Suicides 13 ... ... ... ... 3 6 4 ... 1 Heart Disease 215 1 2 4 12 11 39 70 76 123 Murder 2 ... ... ... ... ... 2 ... ... ... Other Defined Diseases 250 73 9 9 6 4 19 60 70 171 Diseases ill-defined or un-known 48 ... ... ... ... ... ... 1 47 24 Totals 2316 599 250 161 84 77 295 410 440 1175 90 TABLE IIIa. Deaths in Sub-Districts. Causes of Death. North-East. South-West No Home. Totals. Enteric Fever 2 1 — 3 Small Pox — — — — Measles 71 57 — 128 Scarlet Fever 4 2 — 6 Whooping Cough 27 17 — 44 Diphtheria and Croup 8 16 — 24 Influenza 9 2 — 11 Erysipelas 3 4 — 7 Cerebro-Spinal Fever 3 4 — 7 Other Septic Diseases 16 22 1 39 Phthisis (Pulmonary Tuberculosis) 102 92 7 201 Tuberculous Meningitis 16 25 — 41 Other Tuberculous Diseases 20 24 2 46 Rheumatic Fever 3 1 — 4 Cancer, malignant disease 57 60 3 120 Bronchitis 112 103 4 219 Broncho-Pneumonia 50 62 7 119 Pneumonia (all other forms) Other diseases of Respiratory 78 67 3 148 organs 5 14 1 20 Diarrhœa and Enteritis 116 137 — 253 Appendicitis and Typhlitis 4 1 — 5 Alcoholism 2 1 2 5 Cirrhosis of Liver 8 3 — 11 Nephritis and Bright's Disease 37 39 3 79 Puerperal Fever — 3 — 3 Other accidents and diseases of Pregnancy and Parturition 8 3 — 11 Congenital Debility and Malformation, including Premature Birth 73 77 — 150 Violent Deaths, excluding Suicide 45 37 2 84 Suicides 8 5 — 13 Heart Disease 103 107 5 215 Murder 1 1 — 2 Other Defined Diseases 116 126 8 250 Diseases ill-defined or unknown 28 18 2 48 Total 1,135 1,131 50 2,316 91 TABLE IV. Whole District—Infantile Mortality During the Year 1911. Deaths from stated Causes at various Ages under One Year of Age. Cause of Death Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months 9-12 Months. Total Deaths under One Year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 2 5 13 20 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... 1 ... 3 4 Whooping Cough ... ... ... 1 1 2 1 5 6 15 Diarrhœa 1 ... ... 4 5 20 51 27 18 121 Enteritis ... 2 ... 2 4 7 22 12 14 59 Tuberculous Meningitis ... ... ... ... ... 2 ... 2 5 9 Abdominal Tuberculosis ... ... ... ... ... 3 1 2 ... 6 Other Tuberculous Diseases ... ... ... ... ... ... ... 2 3 5 Congenital Malformations 2 2 2 ... 6 2 2 3 1 14 Premature Birth 44 8 7 3 62 7 3 ... ... 72 Atrophy, Debility and Marasmus 7 7 ... 3 17 20 21 4 2 64 Atelectasis 8 ... 1 1 10 ... ... ... ... 10 Injury at Birth 5 ... ... ... 5 ... ... ... ... 5 Erysipelas ... ... ... ... ... ... ... ... ... ... Syphilis ... ... 1 ... 1 3 1 ... 1 6 Rickets ... ... ... ... ... ... ... ... 2 2 Meningitis (not Tuberculous) ... ... ... ... ... 1 3 5 4 13 Convulsions 7 3 6 5 21 10 5 ... 2 38 Gastritis ... ... ... 1 1 1 2 ... ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 1 2 4 8 9 4 10 35 Pneumonia (all forms) ... 1 5 3 9 8 13 14 13 57 Suffocation, overlying 5 ... 1 2 8 8 4 1 1 22 Other causes 1 1 ... ... 2 7 ... 4 5 18 80 25 24 27 156 109 141 90 103 599 Nett Births in the year, 4,032. Nett Deaths in the year, 599. 92 TABLE IV (a). North-East Bethnal Green. Infntile Mortality During the Year 1911. Nett Deaths from stated causes at various Ages under One Year of Age. Cause of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 2 4 6 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... 3 4 8 Diarrhœa ... ... ... 1 1 10 26 10 12 59 Enteritis ... 1 ... 1 2 5 9 6 3 25 Tuberculous Meningitis ... ... ... ... ... 1 ... 1 2 4 Abdominal Tuberculosis ... ... ... ... ... 2 1 ... ... 3 Other Tuberculous Diseases ... ... ... ... ... ... ... ... 2 2 Congenital Malformations 1 1 1 ... 3 2 ... ... ... 5 Premature Birth 23 2 5 3 33 2 1 ... ... 36 Atrophy, Debility and Marasmus 2 2 ... 3 7 9 8 2 2 28 Atelectasis 3 ... ... 1 4 ... ... ... ... 4 Injury at Birth 3 ... ... ... 3 ... ... ... ... 3 Erysipelas ... ... ... ... ... ... ... ... ... ... Syphilis ... ... 1 ... 1 1 ... ... 1 3 Rickets ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... 3 1 1 5 Convulsions 3 1 3 2 9 8 3 ... 1 21 Gastritis ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 1 1 3 3 6 2 9 23 Pneumonia (all forms) ... 1 2 1 4 4 6 8 4 26 Suffocation, overlying 3 ... 1 1 5 3 ... 1 1 10 Other causes ... 1 ... ... 1 3 ... 2 2 8 38 10 14 14 76 54 63 38 48 279 93 TABLE IV. (b) South-West Bethnal Green. Infantile Mortality During the Year 1911. Deaths from stated Causes at various Ages under One Year of Age. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 2 3 9 14 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... 1 ... 3 4 Whooping Cough ... ... ... 1 1 1 1 2 2 7 Diarrhœa 1 ... ... 3 4 10 25 17 6 62 Enteritis ... 1 ... 1 2 2 13 6 11 34 Tuberculous Meningitis ... ... ... ... ... 1 ... 1 3 5 Abdominal Tuberculosis ... ... ... ... ... 1 ... 2 ... 3 Other Tuberculous Diseases ... ... ... ... ... ... ... 2 1 3 Congenital Malformations 1 1 1 ... 3 ... 2 3 1 9 Premature Birth 21 6 2 ... 29 5 2 ... ... 36 Atrophy, Debility and Marasmus 5 5 ... ... 10 11 13 2 ... 36 Atelectasis 5 ... 1 ... 6 ... ... ... ... 6 Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 Erysipelas ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 2 1 ... ... 3 Rickets ... ... ... ... ... ... ... ... 2 2 Meningitis (not Tuberculous) ... ... ... ... ... 1 ... 4 3 8 Convulsions 4 2 3 3 12 2 2 ... 1 17 Gastritis ... ... ... 1 1 1 2 ... ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 5 3 2 1 12 Pneumonia (all forms) ... ... 3 2 5 4 7 6 9 31 Suffocation, overlying 2 ... ... 1 3 5 4 ... ... 12 Other causes 1 ... ... ... 1 4 ... 2 3 10 42 15 10 13 80 55 78 52 55 320 94 TABLE V. Showing the number of Deaths from the seven principal Zymotic Diseases, inclusive of Hospital Deaths in the 10 years 1901 to 1910 and in the year 1911. Disease. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. Annual Average of 10 years, 1901-1910. 1911. Small Pox 2 64 — 8 — — — — — — 7 0 Measles 84 59 85 89 48 60 71 105 78 58 74 128 Scarlet Fever 44 19 13 18 27 22 43 39 25 9 26 6 Diphtheria 63 33 26 48 31 20 18 29 20 20 31 5 Whooping Cough 38 89 41 44 50 63 53 42 37 34 49 44 Fever 20 15 12 7 9 14 7 13 4 18 12 3 Diarrhœa 119 60 112 147 119 152 59 102 90 43 100 230* Totals 370 339 289 361 284 331 251 330 254 182 299 416 * Including deaths from Enteritis amongst children under two years of age. 95 Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES & HOMEWORK. 1. Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 261 13 — Workshops (Including Workshop Laundries) 3,568 709 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 881 56 - Total 4,710 778 — 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied Referred to H.M. luspector Nuisances under the Public Health Acts :—* Want of cleanliness 415 415 - — Want of ventilation 37 37 - — Overcrowding 2 2 — — Want of drainage of floors 4 4 — Other nuisances 426 426 4 — Sanitary accommodation insufficient 7 7 — — unsuitable or defective 203 203 - — not separate for sexes — — - — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) 1 1 1 - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 18 18 — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) 5 5 - - Total 1118 1118 5 - * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 96 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., Embroidery, Waterproofs, Weaving 128 1972 7 93 ... ... ... ... ... ... ... ... ... ... ... (2) Gleaning and washing 2 30 ... ... ... ... ... ... ... ... ... ... ... ... ... Household linen 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets 2 44 ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery 8 47 2 50 ... ... ... ... ... ... ... ... ... ... ... Paper bags and boxes 24 548 1 2 ... ... ... ... ... ... ... ... ... ... ... Cigar boxes 2 3 1 2 ... ... ... ... ... ... ... ... ... ... ... Brush making 8 654 1 8 ... ... ... ... ... ... ... ... ... ... ... Carding, Ac., of buttons, Ac. 2 16 ... ... ... ... ... ... ... ... ... ... ... ... ... Total 178 3318 12 155 ... ... ... ... ... ... ... ... ... ... ... 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. Workshops, including Laundries 1,910 Workplaces 211 Bakehouses 92 Total numbers of workshops on Register 2,213 5.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 20 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory & Workshop Act (s. 5) Notified by H.M. Inspector 50 Reports (of action taken) sent to H.M. Inspector 53 Other 4 Underground Bakehouses (s. 101)— In use at the end of year 26 97 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 1 4 Bonner road ... 3 ... 3 6 Abingdon buildings ... ... ... 1 1 Bonner street ... 1 2 5 8 Abingdon street ... ... 1 3 4 Bonwell street 1 1 4 2 8 Ada place 1 ... ... 2 3 Boreham street ... 1 ... 1 2 Ainsley street ... ... 1 2 3 Boundary street ... ... 2 1 3 Albert buildings ... ... ... ... ... Bradys buildings ... ... ... 1 1 Albion place ... ... ... ... ... Brady street 1 ... 1 6 8 Alfred place ... 1 ... ... 1 Braemar street 1 ... ... 2 3 Allas road 1 2 3 1 7 Bratley street ... ... ... ... ... Alma road ... 1 1 5 7 Brick lane 7 3 2 4 16 Ames street 1 3 3 4 11 Brierley street 2 1 1 4 8 Angela gardens ... ... 1 ... 1 Bucks court ... ... ... ... ... Anglesea street ... 1 ... 5 6 Buckhurst street 1 1 4 8 14 Anns place ... ... ... ... ... Bullards place ... ... 1 1 2 Approach road ... 1 1 5 7 Bunsen street ... ... ... ... ... Arbery road (Except Nos. 74 and 76) ... 1 ... 3 4 Burgoyne road ... 1 ... ... 1 Burnham square ... ... ... 1 1 Burnside street ... ... 3 1 4 Archer street l ... ... 1 2 Busby square ... ... ... ... ... Arline street 1 ... ... 4 5 Busby street 1 ... 2 1 4 Artillery street 1 ... 1 3 5 Butler's buildings ... ... 1 ... 1 Ashwell road 1 ... ... 2 3 Butler street ... ... ... ... ... Auckland road 4 2 1 3 10 Buxton street (Odd Nos. 1 to 33 Even Nos. 2 to 10) 1 ... 1 1 3 Austin street ... 2 1 2 5 Bacon street 3 2 3 3 11 Baker's court ... 1 ... ... 1 Cadell street 1 1 1 2 5 Baker's rents ... ... ... ... ... Calvert avenue ... ... ... ... ... Baker street ... 1 2 ... 3 Cambridge buildings 1 ... 1 1 3 Bandon road 2 ... 1 4 7 Cambridge circus 1 1 2 3 7 Barnet grove 3 2 4 6 15 Cambridge road (All Odd Nos. and Even Nos. from 160) 6 ... 6 12 24 Barnsley houses 2 2 4 Barnsley street 1 3 3 7 Baroness road 2 ... 1 8 11 Cambridge street ... ... ... ... ... Bath grove 1 ... 1 1 3 Camden street 2 ... 3 6 11 Bath street ... ... ... ... ... Camlet street ... ... ... ... ... Baxendale street 2 3 1 6 12 Canrobert street 5 1 2 6 14 Bellhaven street ... ... ... 3 3 Carlisle street ... 1 1 ... 2 Benson buildings ... ... ... 1 1 Carmel house ... ... ... 1 1 Bessy street 1 ... 1 ... 2 Carter street ... ... ... ... ... Bethnal Green road 2 1 7 9 19 Casket street ... ... ... ... ... Birkbeck street 1 ... ... ... 1 Caslon place ... ... ... 1 1 Bishops road ... 1 1 7 9 Catherine street 2 ... ... ... 2 Blyth street 2 ... 1 4 7 Centre street ... 1 ... 2 3 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. Chambord street 4 1 1 6 12 Cymon Street 2 ... 1 2 5 Chance street ... ... ... 1 1 Cyprus street 2 1 8 13 24 Chapel street ... 1 ... 1 2 Charles terrace ... 2 ... 2 4 Charlotte street 1 ... ... ... 1 Dagnall place ... 3 ... 2 5 Chertsey buildings ... ... ... ... ... Daniel street ... ... ... 1 1 Cheshire street 2 1 3 4 10 Darling row ... ... ... ... ... Chester street ... ... ... 1 1 Davis place ... 1 1 ... 2 Chilton street 3 1 ... 5 9 Davis buildings ... ... ... ... ... Chisenhale road 3 2 3 1 9 Delamere dwellings ... ... ... 1 1 Church row 1 2 ... 4 7 Delta street 1 1 1 ... 3 Church street (Except Nos. 1-13 and 2 to 26) 2 1 ... 3 6 Derbyshire street 1 2 2 3 8 Devonshire place ... ... ... ... ... Digby street 3 ... 2 ... 5 Clare street 1 1 2 3 7 Digby walk 1 1 ... 1 3 Claremont street ... ... ... 1 1 Dinmont street 1 ... 1 3 5 Clarence street 1 1 1 2 5 Diss street 1 1 ... ... 2 Clarkson street l 1 1 4 7 Dixie street 1 1 1 3 6 Clifton buildings ... 1 1 3 5 Driffield road (Odd numbers) 3 2 ... 3 8 Club row ... ... ... 1 1 Coate street 1 ... 3 1 5 Ducal street 3 ... ... ... 3 Code street ... 2 ... ... 2 Durant Street 1 1 1 1 4 Colling place ... ... ... 2 2 Colling street 1 1 ... ... 2 Collingwood street 5 1 4 6 16 Collyer's court ... ... ... ... ... Eastman street 2 1 1 6 10 Columbia market ... ... ... ... ... Ebor street (Even Nos. only) ... ... ... ... ... Columbia road 2 1 ... 12 15 Columbia square 3 3 3 4 13 Eckersley street ... ... ... ... ... Conyer street ... ... 1 1 2 Edgar place 1 ... ... ... 1 Cookham buildings ... 1 ... 2 3 Edward place 1 ... ... 1 2 Co-operative b'ld'gs ... ... ... ... ... Ellesmere road ... 3 1 5 9 Cooper's gardens ... ... 1 3 4 Elwin street 2 1 ... 2 5 Cordova road 2 ... 3 2 7 Emma street ... 2 2 2 6 Corfield street 1 6 6 5 18 Ernest place 1 ... 2 ... 3 Cottage place ... ... ... ... ... Evesham houses ... ... ... ... ... Coventry place ... ... ... ... ... Ezra street 1 ... 1 ... 2 Coventry street 5 2 2 14 23 Cox's buildings ... ... ... ... ... Cranbrook road ... ... ... 1 1 Falcon buildings 1 ... ... ... 1 Cranbrook street 3 1 4 7 15 Felix street ... ... 4 8 12 Craven buildings ... ... 1 2 3 Fellbrigg street 1 1 2 6 10 Crescent cottages ... 1 ... ... 1 Finnis street 4 1 4 4 13 Crescent place 1 1 1 2 5 Fleet street hill 1 ... ... 2 3 Cross street ... ... ... ... ... Flint court ... ... 2 ... 2 Crossland square 2 1 ... ... 3 Florida street 1 ... 5 7 13 Cudworth street ... ... ... 1 1 Florida terrace ... ... ... ... ... Culham buildings ... ... ... ... ... Fossett's buildings ... ... ... ... ... Cygnet street ... ... ... ... ... Foster street 1 1 ... ... 2 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 Diseases. Total. Fountain street ... ... ... ... ... Hammonds gardens ... ... ... ... ... Fox street 1 ... ... 3 4 Hamilton road 3 1 4 6 14 Fox's buildings ... ... ... ... ... Hare court ... ... ... ... ... Fuller street 3 1 4 4 12 Hare marsh ... ... ... ... ... Hare row ... ... ... ... ... Hare street 5 3 2 7 17 Gales gardens 2 ... 5 3 10 Harold street 2 1 3 4 10 Garden place Violet street ... ... ... ... ... Hartley street 1 2 2 2 7 Hansard place ... 2 ... ... 2 Garden place James street ... ... ... ... ... Hassard street 4 1 2 1 8 Havelock place ... ... ... 1 1 Gardeners road 3 ... ... 1 4 Hemming street 6 1 2 3 12 Garner street 1 1 2 3 7 Hedsor buildings ... ... 2 ... 2 Gascoigne place ... 1 1 1 3 Helens place ... ... ... 1 1 Gawber street 3 ... 2 1 6 Henley buildings 1 1 ... 4 6 George place ... ... ... ... ... Henrietta street 1 1 2 2 6 Georgina gardens ... ... 1 ... 1 Hereford buildings ... 1 ... ... 1 Gernon road ... ... ... 2 2 Hereford street 1 ... 1 4 6 Gibraltar buildings ... ... ... ... ... Hersee place 3 ... 2 5 10 Gibraltar gardens 1 ... 1 1 3 Hocker street ... ... ... ... ... Gibraltar walk 1 1 2 7 11 Holly mansions ... ... ... ... ... Gilman street 1 1 ... 3 5 Hollybush gardens 2 ... 3 3 8 Glass street ... ... ... ... ... Holly bush place ... ... ... 1 1 Globe road (Even Nos. from 156 Odd from 131 ... ... 2 7 9 Holmes avenue 1 ... ... ... 1 Horatio street ... 1 ... 1 3 Horts place ... ... ... ... ... Gloucester passage ... ... ... ... ... Hunslett street 1 ... ... 1 2 Goldsmith's row (Children's Hospital & Nos. 8 to 62 Even) ... ... ... 1 1 Huntingdon b'ldings ... ... ... 1 2 Hurley buildings ... ... ... ... ... Gossett street 2 1 4 3 10 Granby place 1 ... ... ... 1 Iffley buildings ... ... ... 2 2 Granby street 2 ... ... 4 6 Ion square 1 ... 3 6 10 Great Eastern bldgs ... ... 1 2 3 Ivimey street 1 ... ... 4 5 Green street 3 4 9 5 21 Gretton houses 3 ... 2 3 8 Grimsby street ... 1 ... ... 1 James yard ... ... ... 3 3 Grove road (Odd Nos. from 59 Even Nos. from 110) 3 2 1 10 16 James place ... ... ... ... ... James street (Odd Nos. from 39, Even from No. 4) 2 ... ... 3 5 Guinness' buildings 2 ... 3 11 16 Jersey street 3 1 1 2 7 Hackney road (All Even Nos. and Odd Nos. from 321) 3 4 11 11 29 Kav street (Nos. 1-53, 2-46) ... 2 2 4 8 Hague buildings ... ... ... ... ... Kelsey street ... ... ... ... ... Hague place ... ... ... 2 2 Kenilworth road ... ... 4 4 8 Hague street 2 3 2 2 9 Kerbela street 1 1 5 5 12 100 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 ... 2 2 5 Merceron houses ... ... 2 3 5 Kite place ... ... ... 2 2 Merceron street ... ... ... 1 1 Knottisford street 2 ... ... ... 2 Middleton street 2 ... 2 3 7 Minerva street 2 ... 2 1 5 Minto place ... 1 ... ... 1 Laleham buildings 2 1 ... 2 5 Mocatta house 1 l 1 ... 3 Lansdell place 3 ... 1 7 11 Molesey buildings 1 1 ... ... 2 Lark row 1 ... ... 4 5 Montclare street ... ... ... ... ... Lawfranc road ... ... ... 2 2 Montfort house ... ... ... ... ... Leopold buildings ... 1 2 2 5 Moravian street 1 ... ... ... 1 Leslie house ... ... ... ... ... Morpeth street l 1 4 5 11 Letch ford buildings ... ... ... ... ... Moss street 6 3 1 6 16 Lessada street 2 1 1 6 10 Mount street ... 1 1 3 5 Ligonier street ... ... ... ... ... Mowlem street ... ... ... 1 1 Lily house ... ... ... ... ... Museum buildings ... ... ... 2 2 Linden buildings ... ... 1 1 2 Lisbon buildings 1 ... ... ... 1 Lisbon street ... ... ... 2 2 Nant street ... ... 1 1 2 Little York street ... ... ... ... ... Navarre street ... ... ... ... ... London street ... ... ... 3 3 Neath place 1 1 3 2 7 Lucas street ... ... ... ... ... Nelson place ... ... 2 ... 2 Lyal road (Nos. 57a to 86, Consecutive Nos.) ... ... 1 ... 1 Nelson street 3 ... 3 4 10 New Church street 1 2 2 2 7 Newling street 3 1 1 1 6 Lyte street ... ... ... 1 1 New Tyssen street 1 1 4 4 10 Norah street 1 ... ... 3 4 Northampton street ... ... 1 4 5 Mace street l 2 2 6 11 Norton street 1 ... ... 4 5 Manchester buildings ... 1 ... 3 4 Manchester place ... ... ... ... ... Mansford buildings ... 2 1 2 5 Octagon street ... ... 2 ... 2 Mansford street 3 2 4 4 13 Old Bethnal Green road 3 2 3 8 16 Mape street 1 ... 2 7 10 Margaret place ... 3 ... 2 5 Old Ford road (Odd Nos. to 211, even Nos. to 368a) 1 2 9 14 26 Marion place ... 1 ... ... 1 Marion square ... ... ... 1 1 Marion street ... ... 2 1 3 Old Nicol street ... ... ... ... ... Marlow buildings ... ... ... ... ... Olga street 3 ... 1 ... 4 Martha court 1 ... ... ... 1 Orange street 1 ... 1 2 4 Matilda street 4 ... ... 4 8 Oval 1 1 4 6 12 Meadows dwellings ... ... 2 5 7 Med hurst road 3 ... 3 3 9 Medway buildings ... ... ... ... ... Palissy street ... ... ... ... ... Medway road (Odd Nos. 1 to 49, even Nos. 2 to 62) ... ... ... 7 7 Palm street 2 ... 1 4 7 Palmer's road ... ... ... ... ... Paradise row ... ... ... ... ... Memorial Hall bldgs. ... ... ... 1 1 Parliament place ... ... ... ... ... Mendip houses ... ... 1 1 2 Parliament street ... ... ... 1 1 Menotti strreet ... 2 4 9 15 Parmiter houses ... ... ... 1 1 101 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. Parmiter street ... ... 3 3 6 Reuben street ... 1 ... 1 2 Patriot square ... 1 2 4 7 Riders buildings 1 ... ... 1 2 Peabody buildings 4 1 1 1 7 Roan horse yard ... ... ... ... ... Peacock place ... ... ... ... ... Robert street 2 2 ... 2 6 Peacock street ... ... 1 1 2 Robinson road ... 2 ... 3 5 Pearl yard ... ... ... ... ... Rochelle street ... ... ... ... ... Peary place ... ... ... 1 1 Roman road (Odd Nos to 127, even Nos. to 142) 4 ... 3 3 10 Pedley street ... ... 1 ... 1 Peel grove ... ... 2 3 5 Perl grove mews ... ... ... ... ... Pelter street 1 1 2 ... 4 Pereira street 3 ... 2 ... 5 Rooks place ... ... ... ... ... Peter street ... ... 1 ... 1 Roplev street ... ... 1 ... 1 Pollard place ... ... ... ... ... Ross buildings Moss street ... 1 ... ... 1 Pollard row 5 1 ... 5 11 Pollard street 3 ... 1 3 7 Royal Victor place ... ... ... ... ... Portman place ... ... 1 1 2 Royston street 4 2 3 5 14 Pott street 2 ... 1 2 5 Russia lane 1 4 1 4 10 Poyser street ... 3 3 1 7 Preston street 1 ... 1 2 4 Primrose street ... ... 1 1 2 Sabbage yard ... ... ... ... ... Princes court 3 1 1 3 8 Sale street 2 2 1 3 8 Pritchard's road (Except Nos. 47 to ) 17) 1 1 ... 7 9 Sandford buildings ... ... ... 1 1 Satchwell rents ... ... ... 1 1 Satchwell street 3 1 1 5 10 Prospect terrace 6 ... 2 3 11 Sclater street 4 1 1 3 9 Providence place ... ... 1 1 2 Scott street 5 ... 2 2 9 Providence yard ... ... ... ... ... Seabright street 5 3 6 5 19 Punderson gardens 3 1 2 10 16 Selby Street (even numbers) 1 ... ... ... 1 Sewardstone road 1 1 1 10 13 Queen's buildings Princes place ... ... ... ... ... Shacklewell street ... ... ... ... ... Sheldon place ... 1 ... ... 1 Queen's buildings Gossett street 1 ... 1 1 3 Shepton houses 3 ... ... ... 3 Shetland street 3 ... 1 ... 4 Queen's buildings Chambord street ... ... ... ... ... Shiplake buildings ... 1 ... ... 1 Shipton street ... 1 1 1 3 Qu'n Caroline place ... ... 1 ... 1 Skinners court ... ... ... ... ... Quilter street 1 2 8 8 19 Sidney street 1 ... 2 3 6 Quinns square 1 2 4 11 18 Smart street ... ... ... ... ... Smiths buildings 1 ... 3 3 7 Somerford houses 1 3 ... 1 5 Railway arches ... ... ... ... ... Somerford street 3 2 2 7 14 Ramsey street ... 2 2 5 9 Sonning buildings ... ... 1 1 2 Rapley place ... ... ... ... ... Shampton cottages ... ... ... ... ... Ravenscroft build'gs 1 ... 1 3 5 Southampton g'dens 1 ... ... ... 1 Ravenscroft street 1 4 2 3 10 Southampton street ... ... ... ... ... Reid s mansions Gossett street ... ... ... ... ... Southampton terrace ... ... ... 1 1 Spencer passage ... ... ... ... ... 102 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. Spicer buildings ... ... ... ... ... Treadway street 2 2 3 14 21 Spital street (Nos. 11 to 27) ... ... ... 1 1 Turin street ... ... 4 3 7 Turville street 1 ... ... ... 1 Squirries street 5 ... 5 2 12 Tuscan street 1 ... ... ... 1 St. Andrews street ... ... ... 2 2 Type street 1 1 2 2 6 St. James road ... ... 1 ... 1 Tyrrell street ... 1 ... 2 3 St Jude street 1 ... 2 1 4 St. Mark's buildings Tagg street ... 1 ... ... 1 Usk street 3 1 2 6 12 St. Mary's place ... ... ... ... ... St. Matthias place ... ... ... ... ... St. Peter square ... ... ... 1 1 Vallance road 2 2 2 9 15 St. Peter street 2 1 2 8 13 Venice street ... ... ... 5 5 Stainsbury street 2 ... 2 1 5 Viaduct place ... ... ... ... ... Stamp place ... ... ... ... ... Viaduct street 3 ... 7 7 17 Stanfield road ("Stoneleigh" House & Gateway adjoining) ... ... ... ... ... Victoria park ... ... ... ... ... Victoria place ... ... ... ... ... Victoria place James street ... ... ... 1 1 Steels buildings ... ... ... ... ... Strahan road (odd numbers) 1 1 1 3 6 Victoria Park sq're ... ... ... 1 1 Violet row ... 1 1 ... 2 Streatley buildings ... ... ... 2 2 Violet street ... ... ... 1 1 Strout's place ... ... ... ... ... Virginia road 2 ... 3 4 9 Sugar Loaf walk ... ... ... ... ... Vivian road 1 4 1 3 9 Sunbury buildings ... ... ... 4 4 Voss street ... ... ... ... ... Surat street ... ... 3 5 8 Vyner street ... 2 1 1 4 Sutton buildings 4 2 2 3 11 Sweet Apple square ... 1 ... ... 1 Wadeson street ... ... 1 2 3 Tagg street 2 ... 1 1 4 Walter street ... ... 2 5 7 Taplow buildings 1 2 ... ... 3 Walton buildings 2 ... ... 1 3 Tapp street ... 1 ... ... 1 Wargrave build'gs 2 ... ... ... 2 Tavistock street ... ... ... 2 2 Warley street 3 ... 5 8 16 Teale street ... ... ... 1 1 Warner place ... ... 2 6 8 Teesdale street 2 1 4 9 16 Waterloo place ... ... ... ... ... Temple dwellings 1 ... ... ... 1 Waterloo road 1 ... ... ... 1 Temple Street 1 1 3 7 12 Waterloo terrace ... ... 1 1 2 Tent street 3 1 1 4 9 Wear street ... ... ... ... ... Thorold street ... ... 1 7 8 Weaver street (Odd numbers) 1 ... 2 1 4 Thoydon road ... 1 ... 3 4 Three Colt corner ... ... ... ... ... Weldon street ... ... ... ... ... Three Colt lane ... 2 2 3 7 Wellington place ... ... ... ... ... Thurlow place ... ... ... ... ... Wellington row 6 1 2 7 16 Totty street 5 ... 1 3 9 Wennington road 3 1 1 3 8 Toyes buildings Old B'thnal G'n rd. ... ... ... 1 1 Wharf road ... 1 2 ... 3 Wharncliffe street ... ... 1 ... 1 Toyes buildings Mansford street ... 1 ... 3 4 Wheeler street ... ... ... ... ... Whites court 2 ... ... ... 2 103 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. Whitechapel road (Odd Nos. from 319) ... ... ... ... ... Winchester street ... 2 ... 1 3 Wolverley passage ... ... ... ... ... Whitmore build'gs ... ... ... ... ... Wolverley street 2 2 2 5 11 Wilmot house ... 1 ... 1 2 Wood close ... ... ... ... ... Wilmot street 1 3 4 14 22 Wood street 1 ... ... ... 1 Wimbolt street ... ... 4 ... 4 Wingham street ... 1 ... ... 1 Winchester bu'd'gs ... ... ... ... ... No Home ... 4 12 23 39 Winchester cr'sc'nt 1 ... ... ... 1 Winchester place ... ... ... ... ... Metropolitan Borough of Bethnal Green THE CHIEF INSPECTOR'S SIXTEENTH ANNUAL REPORT on the work of the Public Health Department, for the YEAR ENDING 31st DECEMBER, 1911. Ordered by the Public Health Committee to be printed and circulated, 20th March, 1912. R. E. PEARSON, Chairman of the Public Health Committee. The Public Health Committee. Mr. Alderman R. E. Pearson, Chairman. Mr. Alderman J. Robertson, Vice-Chairman. His Worship the Mayor, Councillor W. H. Clark, J.P. Mr. Alderman J. J. Fleming. Mr. Councillor J. J. Bartlett. Mr. Councillor F. W. Eaton. „ „ G. Bayley. „ J. J. Harris. „ „ T. Brooks. „ „ R. Larkins. „ „ T. A. Dean. „ „ B. E. Lee. Mr. Councillor J. W. Ward. Ex-Officio Members of the Public Health Committee. Mr. Alderman Capt. W. H. Hamilton. Mr. Councillor J. Hall. Meetings:—Alternate Wednesdays at 6 p.m., at the TOWN HALL, Cambridge Road, E. Metropolitan Borough of Bethnal Green. Public Health Department, Town Hall, Patriot Square, Bethnal Green, E. TO THE PUBLIC HEALTH COMMITTEE. Mr. Chairman & Gentlemen, Agreeably with your standing instructions, I respectfully beg leave to submit for your consideration the following particulars of the work of the Public Health Department for the year ending December 31st, 1911. In submitting this, the 16th Annual Report since my appointment as Chief Inspector, I would, with submission, venture to hope that, in spite of some disappointments and difficulties met with here and there, the Report as a whole will be found to contain evidence of much good work and sustained effort on the part of the staff of the department throughout, all of which is respectfully commended to your most favourable consideration. 4 In view of the constant variation of the duties of a Health Department made by various orders, regulations and requisitions of the Local Government Board and other authorities now taking an active interest, if not in public health, at least in looking after Public Health Departments, it would, perhaps, be as well to set out and record some particulars of the measures taken for covering this Borough from the public health work point of view. First, on the Housing and Town Planning Act coming into force, your Committee decided that one special officer should be designated to take entire charge of this work, to carry on house-to-house inspection and generally to see to the preparation of notices, schedules of requirements, and other matters necessary for the due enforcement of this Act. After due consideration, your Committee decided that the better plan would be to take Mr. Richards (who on many occasions has acted as my representative and carried out the duties of Chief Inspector in my absence), from off District E and specially designate him as the officer for carrying into force this Housing Act, and otherwise to generally assist in the work of the Department. Amongst other advantages calculated to arise from this arrangement was that of uniformity, and I need not point out how desirable it is, both as to the methods of inspection and the preparation of the lists of the repairs, and supervision of the same, that, so far as possible, uniformity should be insisted upon throughout the District. Inspectors— Duties and Districts. 5 From the coming into force of this Act and up to the time of writing, which does not quite coincide with the end of the year, 17 streets have been visited houseto-house, by Mr. Richards and the other Inspectors, 353 notices have been served and 177 premises have been repaired. So far as we have gone, the requirements of the authority have been met in a fairly reasonable manner, there being some delay in certain cases; but with the exception of the present constantly low standard of repair, at times carried out by various owners, I do not know that we have experienced many difficulties so far. It is satisfactory to know that although a considerable amount of repair is required, as it always will be in an old district of this character, practically no houses have been met with that require formal closing orders. These facts, I venture to submit, speak volumes for what the ordinary work of the staff has been during the past few years. In addition to ordinary house to house work, Mr. Richards and Mr. Weeks have been engaged in special house to house visitation in what is known as the Brady Street area, an area representing I believe the smallest and most worn out properties in this Borough; an area in which there is a large number of cul-de-sacs and narrow passages, and which area has been officially reported upon on more than one occasion, the last of which was in 1904, when the Medical Officer of Health officially certified (under Part 1 of the Housing of the 6 Working Classes Act, 1890) to the London County Council, that the area was suitable for dealing with as an improvement scheme. After considerable correspondence, the London County Council, in their wisdom, decided not to deal with the area as represented to them, putting forward as the reason for this action, or rather want of action, that the said area was likely to be dealt with in the near future, by means of private enterprise. As your Committee are aware, no evidence of this suggested private enterprise could then be discovered by us, and as a simple matter of fact, from that time to this, such private enterprise has not been heard of, and the district remains, in all prime essentials, in the condition it then was, save only that your officers have paid considerable attention to inspecting and the service of notices for what may be called mere ordinary sanitary upkeep. Your Committee have felt that action of this kind has become exhausted, and has long since been futile, simply because the mere service of notices and the making of a few closing orders only results in the patching up of a house here and there, which house is re-opened and then again let for a dwelling. This has happened in certain of the instances on two, three, and more occasions. Moreover, your Committee felt that no amount of repair would make houses of this kind completely satisfactory for any length of time, and that in addition to 7 these premises having constantly to be repaired, it would not open up any of the dark and narrow passages or various cul-de-sacs or lead to the necessary re-arrangement of streets, courts, and passages, recognised by all to he so essential to the proper development and improvement of this particular area. Your Committee have recently viewed the district, and have confirmed a representation made to them by the Medical Officer of Health, who is now engaged in preparing a farther official report to the London County Council, as the authority responsible under Part 1 of the Act for housing orders and improvement schemes. In addition to this special feature of house to house work, which I beg to submit is so far satisfactory, the Borough is particularly well covered for ordinary sanitary work, and is divided into six districts with a Sanitary Inspector devoting his whole time to each. Mr. Jones, formerly Superintendent of Drainage Works, having been appointed to the district vacated by Mr. Richards, this completed the six districts I have already referred to and makes two Sanitary Inspectors east of Cambridge Road, two south of Bethnal Green Road, and two north of Bethnal Green Road. It will thus be seen that none of the districts are exceptionally large, that not only is the ground well covered, but that all sanitary work can be, and is, promptly dealt with. 8 The areas of the districts and the names of the officers of the same are as follows:— District A—Mr. Ainley.—The portion of the Borough east of Cambridge Road, from St. John's Church northwards to the boundary at Cambridge Heath Bridge; proceeding eastwards from St. John's Church along Green Street to Twig Folly Bridge; thence in a line northwards to Old Ford Road, with all the intervening streets between these lines to the Borough boundary. District B—Mr. Henley.—The portion of the Borough east of Cambridge Road and southwards from St. John's Church, along Green Street to the western boundary of the Borough at Stepney, with all the streets intervening between these lines, from St. John's Church and the boundary at Driffield Road. District C—Mr. Weeks.—The portion of the Borough south of the "Salmon and Ball," along Cambridge Road and westwards from the "Salmon and Ball" along Bethnal Green Road to Mape Street; and from thence southwards to the boundary at Whitechapel, with all the intervening streets between the points mentioned. District D—Mr. Bare.—The portion of the Borough south of Bethnal Green Road and west of Mape Street to the boundary line, with all the streets intervening. District E—Mr. Jones.—The portion of the Borough west of Cambridge Road from Bethnal Green Road to Old Bethal Green Road, and thence westward along Wellington Row and Columbia Road to the boundary of the, Borough in Hackney Road. District F—Mr. Bridel.—The portion of the Borough north of Old Bethnal Green Road and west of Cambridge Road to the Borough boundary in each case. 9 It will thus be seen that, having regard to the area of the Borough, the district is well provided for everyday purposes of sanitary work, and, as a result of the efforts of these officers, we have a constant output of above 150 notices served in each and every week. In addition to this, what I may term the ordinary every-day work, your Committee appointed Mr. W. Billings to succeed Mr. Jones in assisting with the special duties in connection with combined drainage works, the drainage of new premises, and the enforcement of bye-laws in connection therewith, and I have every reason to hope that the specially high level of this Department taken for some years past in connection with all drainage matters will be continued. The other special officer, Mr. Rowsell, is as your Committee are well aware engaged in the highly important work of food inspection, the inspection of the markets, procuring of samples under the Sale of Food and Drugs Acts and otherwise generally making the food of the people of the Borough his special important work. I cannot speak too highly of the work done in this direction. This officer has been most valuably assisted by other officers at different times of the year, viz.:— Mr. Ainley and others. They are constantly on the look-out for complaints as to unsatisfactory foodstuffs which has resulted as a matter of fact in the past year in 22 rabbits, 8½ cwt. of meat, 6½ cwt. of fish, 10¾ cwt. of fruit, 2½ cwt. of tomatoes, ½ cwt. of onions, 70 quarts of ice cream and 630 eggs having been surrendered or seized. Clerks. 10 In addition to the officers referred to, Miss Harris, Female Sanitary Inspector, is specially concerned in those duties relating to the improvement of the health conditions of women and children in the Borough. This officer is more particularly under the direction of Dr. Bate and I am only including her here, so as to make the staff complete, and perhaps might be permitted to add that I much appreciate the good work done by Miss Harris since she has been in the Borough, and as she is leaving, desire to record the fact that all her relations with the other members of the staff have been remarkably happy, and I can only trust that her successor will endeavour to work on the same harmonious lines as has been evinced by Miss Harris (now Mrs. Bridel) since her appointment nearly 6 years ago. As to our clerical and indoor work, that is amply provided for, leaving the Inspectors quite free to devote their whole time to the inspection and improvement of their different districts; the names and responsibilities of the clerical staff are as follows:— GRADING AND DUTIES OF CLERICAL STAFF. Chief Clerk.—Mr. E. Q. Bilham. This Officer is a qualified Sanitary Inspector' having passed the examinations of the Sanitary Inspectors' Examination Board. He performs the following duties:— (a) Attends all meetings of the Public Health Committee and keeps the Minutes of the Committee. 11 (b) Prepares statistics and other information for the Annual and Monthly Reports of the Medical Officer of Health and Chief Sanitary Inspector. (c) Drafts all summonses, orders, etc., in connection with cases under the Public Health (London) Act, 1891 and Sale of Food and Drugs Acts, &c. (d) Prepares monthly statements of accounts, salary lists and pay sheets for Staff. (e) Checks all notices and other documents prior to service. (f) Keeps various accounts, books, and records appertaining to a Public Health Office. (g) Supervises the work performed by the assistant clerks. 1st Assistant Clerk.—Mr. G. I. Brighting. This Officer is responsible for the posting up of the following Registers:— (a) Nuisance Register. (b) Milkshop Register (Loose Leaf System). (c) Cowhouse Register. (d) Slaughterhouse Register, (e) Bakehouse Register. (f) Offensive Trades Register. (g) Prepares lists for systematic inspection of premises. This Clerk takes charge of the Indoor Staff during the absence of the Chief Clerk and assists Chief Clerk when required. 12 2nd Assistant Cleric.—Mr. J. H. Hewitt- This Officer acts as clerk to the Medical Officer of Health. His duties are as follows:— (а) Keeps all registers relating to infectious diseases. A separate register is kept for each Notifiable Disease. (b) Prepares report papers for Sanitary Inspectors in cases of infectious disease. (c) Prepares Medical Fees Account and cheques for payments thereon. (d) Assists in the preparation of the Medical Officer's Annual Report. (e) Keeps records in connection with cases of verminous children notified by the London County Council. (f) Types M.O.H.'s correspondence, reports, &c. (g) Keeps street case-index. 3rd Assistant Clerk.—Mr. F. G. Thomas. This Officer acts as Correspondence Clerk to the Chief Inspector. He performs the following duties:— (a) Typewriting from his shorthand notes all correspondence. (b) Preparation of briefs to the Council's Solicitor. (c) Preparation of report cards under the Tuberculosis Regulations and filing same (Card Index System). 13 (d) Clerical work in connection with outworkers (Card Index System). (e) Posting up Workshop Register (Loose Leaf System). 4th Assistant Clerk.— Mr. H. A. Saunders. The duties of this Officer are as follows:— (a) Preparation of Intimation and Statutory Notices from Inspectors report papers. (b) Preparation of notices under the Housing and Town Planning Act, 1909, from specifications prepared by Sanitary Inspectors. (c) Serving Statutory Notices within the Borough. (d) Posting up the Tenement House Register. Junior Clerk.—Mr. H. W. Pendrill Performs the usual duties of an office youth. In addition to the staff of inspectors and clerks above described, we have a regular staff of four disinfectors constantly engaged in the disinfection and purification of rooms, bedding and wearing apparel, and articles of all descriptions. Our staff of "combined drainage" men, which of necessity varies with the amount of work in hand, has steadily decreased to the comparatively small number of four, a relief satisfactory from the financial aspect, as well as showing the large amount of work done and completed towards the re-drainage of the Borough. With the addition of a Mortuary Keeper, the above completes the staff of the Department as at present organised. Weekly Staff. 14 SANITARY WORK OF THE YEAR. As a result of the combined efforts of this staff, the output of sanitary activity for the year under review is, I venture to suggest, quite up to the high level that has been attained in previous years, and it is with very full confidence, that I beg to invite the attention of your Committee to the enormous amount of detail work carried out, in all branches of the department. Apart from the detailed tabular and statistical information set out in the various appendices in the latter part of this report I venture to briefly direct your attention to some of the more important items. Arising out of the various inspections upwards of 150 notices per week of various kinds are served, with the result that for the past twelve months the authority had amongst many others the following matters attended to:— Details of Sanitary Work. 5,082 rooms or houses, and 852 workshops were cleansed, whitewashed and otherwise repaired. Defective drains at 640 premises were renewed or made good, or cleared. Defective sanitary conveniences, water supply to closets and the like, to the extent of 2,709 were attended to, and at 177 different premises, an improved water supply was provided or leaky taps and other defective fittings remedied. 30 premises were constantly under observation in connection with smoke nuisances throughout the year. 15 In 4,093 cases, smaller matters, repairs to premises, defective ventilation, and other detail work, were attended to. These figures total to the comparatively large amount of 13,553, and prove, first, what a large amount of detail work is carried out in the six districts and moreover shows conclusively how necessary it is that constant and repeated inspection should take place in a Borough of this description. Under the provisions of the Sale of Food and Drugs Acts, 646 samples of food were officially taken. Of these 62 were sold contrary to the law or under some mis-description and about 9 per cent. were found to be adulterated. The particulars relating to adulterated food are interesting from the fact that some years since, prior to what may be termed sanitary activity, the percentage of adulterated food was 33 per cent. The steady persistent workingof these Acts, technical and unsatisfactory though they be, has gradually reduced adulterated foods offered for sale in the different markets, in, say, about 15 years from 33 per cent. to 9 per cent. In addition to samples taken officially under the Act, we have for the purpose of information, a system of having purchases made at various shops of all kinds of articles, and these are analysed with a view to ascertaining the quality and nature of the goods sold at the different establishments. During the past 12 months, 94 such samples were purchased and submitted 16 to the Public Analyst, 79 of which were genuine and of good quality, and 15 of which were adulterated to a greater or less extent, or contained some objectionable preservative such as boric acid or boron preservatives. Proceedings were taken against the vendors of adulterated goods, and 72 summonses were issued during the year. Of this comparatively large number of prosecutions about 98 per cent. resulted satisfactorily, the authority securing convictions. Among other important items calling for special mention are:— 1560 complaints enquired into and necessary action taken; 858 house to house inspections made; 1,060 visits were made to various trades premises; factories, workshops and workplaces were inspected to the number of 2,883. 3,487 visits and inspections were made to outworkers homes; tenement houses were visited to a total of 1,146, an average of about three visits per year. 1,339 inspections were made in connection with cases of Infectious Disease notified, and 582 patients were removed to hospital; 809 inspections were made of the Dairies and Milkshops and 209 to the various places where Ice-Cream is manufactured or sold to the public; 6 seizures of unsound food were made under the Public Health (London) Act, and your officers attended at the Police Court on 117 days during the year. The special work done 17 under the provisions of the Housing and Town Planning Act is of such importance that I venture to direct your particular attention to a return set out in the last appendix T to this report. A total of 382 houses specially inspected and dealt with under Section 15, within a few months of the new Act coming into force, does not afford much comfort to those persons desirous of suggesting that the local authorities are slow in taking advantage of the powers given to them. The figures and details of the present and past years work are sufficient, so far as this authority is concerned, to negative such a suggestion, and to prove that both the authority and its officers are active and aggressive in enforcing the various Acts of Parliament entrusted to them. WOLVERLEY STREET AREA. But for the fact that silence may have led to equivocal suggestions, either now or on some future occasion, I, for my part, should have been quite content to deal with this matter in the manner it, in my judgment, merits. Apart from my view of the proceedings—in so far as they purport to cast a stigma upon the Public Health Department of this Boroughthere is a duty to be performed. Certain of your officers have been responsible for the proper carrying out of routine duties in this district, and it appears to me to be a matter of mere elementary justice to those officers that it should be recorded once for all they have done their duty 18 efficiently and well in spite of much difficulty and many disappointments. Mr. Henley, who had the district for a long period, and Mr. Richards, who, some time since on the change of districts succeeded him, have both done good service and sound solid work, entitling them to your fullest confidence and support. On behalf of the Department, it is only necessary to add here that so soon and whenever the authors of these reports—reports damaging to the good name and credit of the Borough, and particularly calculated and doubtless intended to injure and discredit the Borough Council and its Public Health Department—are prepared to present such reports as public official documents, that can be dealt with as such, and free from the safety provided by being marked "Private and Confidential," so soon are your officers prepared to prove to demonstration that the animadversions contained in these reports, in which it was sought to convict this authority of Some grave and serious dereliction of duty, are not based upon fact. For the purposes of record and information, I attach your Committee's Report to the Council, dated June 21st, 1911, together with the correspondence that passed between Mr. Percy Harris, L.C.C., and the Town Clerk; also your Committee's further Report to the Council, dated July 19th, 1911. REPORT OF THE PUBLIC HEALTH COMMITTEE, DATED 21st JUNE, 1911. wolverley street school area—overcrowding. Your Committee beg to report that they have made very careful enquiry into the subject-matter of the letter 19 from Mr. Percy A. Harris, L.C.C., referred to them by the Council at its meeting on 15th June, 1911, which letter alleged serious overcrowding in the families whose children attend Wolverley Street L.C.C. School, and suggesting that the condition of these children was attributable to such overcrowding. Your Committee have, in the ordinary course of their duty, ordered notices to be served in those cases where there was justification for such action. Your Committee find that no complaints of overcrowding or other insanitary conditions have at any time been made by the authorities at this school until Saturday, 10th June, 1911, when a letter was received from the Headmaster alleging overcrowding at one house in Mape Street, which coplaint affected one family. On Tuesday, 13th June, 1911, a further letter was received from the Headmaster, complaining of overcrowding at two houses in Wolverley Street, affecting eight families. In each case the premises were visited immediately upon receipt of complaints, and the following particulars obtained. The usual features of squalid poverty and the low standard of life inseparable from nearly all these overcrowding cases were strongly in evidence. Every family was poor or very poor, and, except in one case, were all in arrears with their rent, whilst the incomes were of a most precarious and uncertain nature, and as a whole totally inadequate to furnish the barest common necessities of healthy life. Family A.—Man, wife, and nine children under twelve years of age; are dragging out an existence on an income of about 20s. per week. The woman works 20 with the man, and both have difficulty in providing food for the nine children. Home very poor. Clothes, boots, etc., bad. Family B.—Man, wife, and two children under the age of twelve years. Man, no regular work, earns about 10s. per week. Very poor, and in arrears with rent. Pays 3s. per week rent. Family C.—Man, wife, and four children. Man, a painter: present wages 24s. per week, but this is not regular. Rent 6s. 6d., two rooms; all sleep in one room. Home fairly clean, arrears of rent, not yet paid up. Family D.—Man, wife, and live children, three of adult age. Occupy upper room and earn a precarious living by selling papers in the streets. Rent 5s. fid. Very poor and dirty, and in arrears with rent. Family E.—Man, wife, and two children under twelve years of age. Occupy one room at 4s. per week. Earns about 16s. per week by selling twine in the street. Very poor. Family F.—Man, wife, and four children under twelve years of age. Occupy one room at 4s. Very poor; in arrears with rent. Carman, in casual employment only About 20s. per week when at work. Family G.—Man, wife, and five children, one over twelve. Occupy two back rooms at 5s. 6d. per week. Man, a labourer in cabinet maker's workshop. Casual work only; earns 4d. per hour when at work. Very poor, and in arrears with rent. Family H.—Man, wife, and two children under twelve years of age. Occupy one room at 4s. per week. Man, a carman; no regular work, out of work four weeks. Very poor, and in arrears with rent. 21 Family I.—Man, wife, and five children, one over twelve years of age. Occupy upper room, rent 5s. per week. Man, a casual labourer. The mother paralysed. No stated earnings. Very poor, and in arrears with rent. Of the nine cases dealt with, there was found in four to be no legal overcrowding at all. In one, the overcrowding arises solely from the fact of the children sleeping in the same room as their parents, and would not justify action. In two cases overcrowding existed to the extent of two children; in one case to the extent of one and a-half children; in one case to the extent of one child. From these cases, which so far are the only ones your Committee have had officially before them, it seems that a large amount of sensational talk current in the neighbourhood arises from the fact that the authorities at Wolverley Street School appear to consider overcrowding, and the results arising therefrom, from some sort of basis which bears no relation to the legal standard usually observed in dealing with such cases. Moreover, they do not appear to appreciate the fact that your Public Health Committee cannot intervene, however desirable from many points of view such intervention may be, beyond the legal limits, nor can they deal with matters outside their jurisdiction. On paper, the existing conditions appear to be deplorable. They are, in fact, bad enough, and ought not to be tolerated, but here, again, neither the number of single room lettings in this locality nor the number of persons occupying the same can be dealt with by your Committee otherwise than in accordance with the law as it now stands. Unfortunately, several of the cases presenting some of the worst features from many points of view cannot be 22 dealt with by your Committee acting as the Sanitary Authority. For instance, many of the rooms in question are the large rooms originally specially constructed for and formerly occupied by weavers. As is well known to members of the Council, these rooms are well lighted and ventilated, and have a cubic capacity of about 2,500 feet, so that legally a man, his wife, and eight children under say ten years of age, can legally live and sleep in such a room. For sleeping purposes only, the number of children may be increased by two under the age of ten years, whilst six adult persons of either sex may legally occupy such a room for the purpose of a dwelling so far as cubic space and legal overcrowding are concerned. Your Committee do not express any opinion as to whether such single room dwellings are desirable in any circumstances. They simply report the facts of the situation as it stands, and as it is generally understood in daily practice. Overcrowding, as is very well known by all students of social conditions, is a poverty problem, one of the resultant products of irregular or total loss of employment. In all its prime essentials it is simply a social and economic question, requiring far deeper and broader treatment than the service of a few sanitary notices, no matter how often the service of such notices may be repeated. That overcrowding, with all its deplorable aspects, exists in this and in every other poor class quarter, is, unfortunately, only too well known, and your sanitary officers are constantly serving notices and causing the worst cases to remove from room to room and from street to street until they disappear into some other locality of a like nature, to be replaced in this by a like migratory population of similar habits and conditions of life to those displaced. Consequently, it is a fact that the bulk of overcrowding is 23 never diminished to any appreciable extent. It is only moved about from time to time, and it seems certain that until the conditions of life producing it are entirely remodelled no permanent improvement can in the main be hoped for. The only question of interest to practical men appears to be, what is proposed to be done in connection with this matter? As already stated above, your Committee are constantly serving notices and dealing with the worst of these cases, but no one can honestly pretend that the continued hunting and chasing of a few score of the poorest and most miserable of these poor people from pillar to post is of any real use to the people themselves or the community at large. It has been suggested amongst many other things that the class of population amongst which these cases so constantly recur should be removed in bulk to the workhouses or other institutions to be dealt with by the Poor Law authorities. Whilst your Committee express no opinion on the practicability of this suggestion, they report they have not the legal power, nor the desire, to carry out this suggestion without further consideration. Generally:— 1. The men require regular work and wages. 2. The women require tuition in all that pertains to mother-craft and the personal and domestic hygiene of healthy and decent home life. 3. The children require feeding, cleansing and clothing on lines they have never yet experienced. (Received.) J. W. Ward, Chairman. Consideration of this paragraph of the report of the Public Health Committee, dated the 21st June, 1911, was deferred by the Council at its meeting held on the 6th 24 July, 1911, in order that the correspondence between Mr. Percy A. Harris, L.C.C., and the Town Clerk, might be circulated amongst the members of the Council. Additional information relating to Family A referred to in the report—Occupy three rooms; total cubic capacity sufficient. Copy of Correspondence referred to:— Percy Lodge, Campden Hill, W. 14th June, 1911 Dear Sir, I should feel obliged if you will kindly bring the attention of your Council to the number of cases of overcrowding that are alleged to exist in the neighbourhood of Wolverley Street School. As many as eight people are said to be sleeping in one room in Wolverley Street, while in a certain house in Mape Street, there are said to be eleven in one room. The permission of this overcrowding brings high rents into the pockets of the owners of these houses, and keeps those rents high and is in every way objectionable. I know it is held that the allowing of a family to live in one room sometimes enables a man to tide over a period of unemployment, but such overcrowding permanently undermines the mental and bodily health of the children, unfits them for education, and sows the seeds of disease that prevents them growing into healthy citizens. I do pray your Council to take such action as their powers under the Public Health and Housing Acts allows, while if my Council is approached in the matter I will endeavour to get its co-operation. Please lay this letter before your Council. Yours faithfully, Percy A. Harris, L.C.C. Representative S.W. Bethnal Green. The Deputy Town Clerk, Borough of Bethnal Green. 25 Town Clerk's Office, Town Hall, Bethnal Green, E. 16th June, 1911. Dear Sir, Your letter of the 14th instant, relating to the number of cases of overcrowding that are alleged to exist in the neighbourhood of Wolverley Street School, has been submitted to the Council and carefully considered by the Public Health Committee. The Public Health Committee are fully sensible of the importance of dealing effectually with cases of overcrowding and in order to do so they are continually serving notices in respect of the worst cases and moving the families concerned., Unfortunately this action does not result in much permanent improvement. It is an ascertained fact that irregular employment and want of employment are the direct causes of an almost chronic state of poverty which lead to certain overcrowding. With regard to the alleged overcrowding in the vicinity of the Wolverley Street School, I understand there is no evidence that there are cases in which the Council could have taken action and have not done sc. The Council, as you know, are restricted in their powers and cannot take effective action in a matter beyond their jurisdiction, in the particular area of Wolverley Street School the size of many of the single rooms separately let is of greater cubic capacity than the total area of two smaller rooms in other areas. There may be a difference of opinion on the subject of high rents, and the relation of such rents to wilful and deliberate overcrowding of rooms of houses in the district. 26 I understand that the result of the examinations of the children at Wolverley Street School goes to show that, generally, the condition of the children is the result of insufficient food, and, in other cases, of malnutrition. The Headmaster of Wolverley Street School has recently communicated to the Public Health Committee particulars of certain cases, many of which it was found had already been under the notice of the Public Health Committee, and in regard to other cases, and where such overcrowding as would justify the Council in taking action, it is being done. I desire to make it quite clear that there is no permissible overcrowding on the part of this authority. The evils of overcrowding are so well-known, and the difficulties of the cases recognised, that you may be assured that within their powers the Council take such action as they properly can in all cases which come to their notice. Faithfully yours, C. G. E. Fletcher, Deputy Town Clerk. Percy A. Harris, Esq., L.C.C. Percy Lodge, Campden Hill, W. Percy Lodge, Campden Hill, W. 27th June, 1911. Dear Mr. Fletcher, I am obliged for yours of the 16th instant. I quite feel confident that your Health Committee is doing its utmost to discharge most difficult duties. What I am most anxious to get at are the facts, and though I am the first to admit there are many other 27 contributory causes—and, not least, malnutrition—to account for the physical condition of many children revealed by the Medical Inspection, yet overcrowding is an important contributory cause, of which the Education Committee of my Council has no control. My point is that, even our efforts to feed the children and medically treat them will not be of much avail if they are permitted to continue in overcrowded rooms. That your Chief Sanitary Inspector very rightly testifies in his excellent Annual Report for 1910. On page 10 he writes:— "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 "or congested, and in the natural sequence of "events the young children, being most weak, "suffer, and, fortunately, die out the quickest." It may be the remedy is a slum clearance; it may be the remedy is the use of the powers under the Housing and and Town Planning Act and the closing of some of this property as insanitary, or, on the other hand, the remedy may be found in a remodelling of some of the worst houses, as done in Camberwell. But the fact I want to get at is: Are people overcrowded in certain parts of your Borough, and, if so, what is the remedy? I know poverty is the root cause, and to deal with that some of the reforms suggested in the Royal Commission on the Poor Law are badly needed. 28 But, in the meantime, let all be done that our present powers allow. Yours very truly, Percy A. Harris. Town Clerk's Office, Town Hall, Bethnal Green, E. 29th June, 1911. Dear Mr. Harris, Thank you for your letter of the 27th instant. I am sending, by direction of the Public Health Committee, a copy of the report presented to that Committee by the Chief Sanitary Inspector, and adopted by them at their last meeting. This report is being presented to the Council. Yours very truly, C. G. E. Fletcher, Town Clerk. Percy A. Harris, Esq., L.C.C., Percy Lodge, Campden Hill, W. Percy Lodge, Campden Hill, W. 3rd July, 1911. Dear Mr. Fletcher, Your letter to hand enclosing report. I am obliged to your Committee for their prompt enquiry into the condition in which some of the children at Wolverley Street live. The headmaster aimed at finding root cause for the physical condition of certain children under his care, and his enquiry having revealed the number that were in the room in which they slept, it was his obvious duty to call the attention of your Council to it. 29 Obviously it was not within his province to know whether your Council's powers made it possible to remedy that condition, or whether the cubic space per person made it technical illegal overcrowding. And the facts revealed by your enquiry are pathetic enough; it is sad comment, on our civilisation that, within the law, no remedy is apparent. Certainly it points to the need of a drastic alteration of a Poor Law that fails to help the children out of the quagmire into which their parents have sunk. Meanwhile, a report on the housing conditions of your Borough would be of value; it would show if there was a need for any alteration in the law. Believe me, Yours faithfully, Percy A. Harris. P.S.—Perhaps, as my name is mentioned in the report, my three letters will be submitted with it. (Report Received). REPORT OF THE PUBLIC HEALTH COMMITTEE, DATED 19th JULY, 1911. Sanitary Condition of the Borough. We have considered the following letter received from the London County Council:— London County Council, County Hall, Spring Gardens, S.W. 17th July, 1911. Sir, I am directed to inform you that the Public Health Committee of the Council, at their meeting on the 6th instant, passed a resolution as follows:— 30 "That it be referred to the Medical Officer of "Health to enquire and report as to the Sanitary "condition of the Metropolitan Borough of "Bethnal Green with particular reference to over"crowding." I am to ask that the Bethnal Green Metropolitan Borough Council will be so good as to afford facilities to Sir Shirley Murphy, the Council's Medical Officer of Health, to enable him to make the enquiry referred to in the resolution. Dr. Hamer, Medical Officer (General Purposes), proposes to call upon Dr. Bate, the Borough Council's Medical Officer, with a view to arrangements being made, and I shall be glad if you will inform me of an early date for this interview which will suit the convenience of Dr. Bate. I am, Sir, Your obedient Servant, (Signed) Laurence Gomme, Clerk to the Council. The Town Clerk to the Metropolitan Borough of Bethnal Green. We are somewhat surprised that the London County Council should see fit to address a communication in these terms to this Council. Although the resolution of the Public Health Committee of the County Council refers to enquiry as to the sanitary condition of the Borough, it will be observed that it is stated to be with particular reference to overcrowding. We can, therefore, only conjecture that the suggested enquiry has some relation to certain reports which we are informed have been submitted to a Committee of the County Council as to the alleged overcrowding in the Wolverley Street area. We understand that these reports contain misleading statements and reflect unfavourably upon the performance of the sanitary work of this Authority. 31 We have, however, received no communication from the London County Council on the subject. We think, therefore, some explanation is due to the Council as to the circumstances which led to the passing of the above resolution, especially as we question the jurisdiction of the London County Council to undertake the proposed enquiry. While we have no knowledge of any cause which would justify an enquiry into the sanitary condition of this Borough, we think it proper to ask for some evidence as to the reason which is alleged to exist for the proposed enquiry. No formal resolution of the London County Council, or of any of its Committees, is needed for the purpose of obtaining any information on Public Health matters in the possession of the Council's Medical Officer of Health, as the knowledge and experience of Dr. Bate is now, as it always has been, freely and entirely at the service of the Medical Officer of the County Council and his assistants. We therefore, Recommend — (i.) That the Town Clerk inform the London County Council that this Council is willing to afford the County Council's Medical Officer of Health every opportunity of obtaining information from Dr. Bate as to the sanitary condition of the Borough. (Amended, see below.) (ii.) That the County Council be asked for information as to the reason which is alleged to exist to justify the suggested enquiry of the London County Coucil. (iii.) That in the event of the London County Council pressing for an enquiry into the sanitary condition of the Borough, the Town Clerk make application to the Local Government Board to investigate the cause of the proposal 32 of the London County Council, and for the Local Government Board to make any enquiry winch it may consider necessary into the sanitary condition of the Borough. (Adopted.) J. W. War d, Chairman Amendment:-That the report be received, and that the Town Clerk inform the London County Council that the County Council's Medical Officer of Health can obtain from Dr. Bate any information he requires as to the sanitary condition of the Borough. (Adopted.) In the latter portion of this Report I append the usual detailed statements of the various duties carried out during the year. The Appendices A to T contain particulars of every section of the departmental work, which, taken as a whole, is, I venture to submit, fairly conclusive evidence that the Public Heath work of the Borough has been attended to promptly and carefully, and I respectfully venture to solicit your favourable consideration to the efforts of the Staff, who have rendered good and loyal service in a somewhat trying and difficult period, and for which I desire to express my best thanks to them. I should also wish to record my grateful appreciation of the most effective service rendered to this Department on many occasions by the Town Clerk, particularly when he so ably intervened in the matter of the attacks made by the Education Authority on the work of this authority. 33 In conclusion, I desire to thank all the members of your Committee for much kind and sympathetic support. So long as the Staff can feel they have the confidence of the Committee to support them in their trying and difficult duties, so long will the Department continue to exert its best efforts in the improvement of the Borough. I am Mr. Chairman and Gentlemen, Your most obedient servant, JOHN FOOT. Certificate Sanitary Institute, 1888. Member Royal Institute Public Health, 1895. Chief Sanitary Inspector, 1895. 34 APPEN Total Number of Inspections and Particulars of Cases in Hand District. Infectious Cases. Complaints. House to House Inspections. Trades' Inspections. Re inspections. Milk-sbop Inspections. Factory and Workshop Inspections. Outworkers' Homes inspections. Tenement House Inspections. New Buildings Inspections. Ice Cream Shop Inspections. A 279 229 42 - 3080 106 467 928 167 - 18 B 117 191 269 — 2068 115 282 511 92 — 45 C 191 315 55 12 2695 117 193 401 160 — 26 D 161 101 87 46 3670 203 805 200 533 — 65 E 101 116 — - 1561 61 37 367 22 434 — F 275 272 13 2 2568 135 788 783 43 2 43 215 321 392 1 3049 72 311 297 129 1 12 - 15 — 999 — — - — — — — Totals 1339 1560 858 1060 18691 809 2883 3487 1146 437 209 35 DIX A. for the Year ended 31st December, 1911. Combined Drainage Inspections. Smoke NuisancesPremises under Observation. Other Inspections or work of Pliflrftoipr. 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. — — 375 196 3 103 11 758 58 5887 E. Ainley. — — 404 165 — 81 4 627 36 4259 A. S. Henley. — - 504 191 — 108 35 773 30 4860 J. G. Weeks. — - 431 4 - 117 19 861 45 6306 F. Bare. 1118 — 123 153 — — 5 303 43 4093 I. R. Jones. — — 459 108 - 92 8 695 40 5491 H. F. Bridel. 5 - 569 134 — 52 3 667 179 5508 E. Richards. — 555 - 6 3 164 32 - — 1575 W. Rowsell. 1123 555| 2805 957 6 717 117 4684 431 37979 36 APPENDIX B. List of Nuisanees and Insanitary Conditions generally, discovered during the year 1911. Period. Dirty Premises. Defective Drains. Defective and Dirty W.C.'s. Defective Water Supply. Smoke Nuisances. Other matters. Total. 1911. 4 weeks ending 28th January 248 7 69 16 3 325 668 4 „ 25th February 191 5 50 16 3 276 541 5 „ 1st April 316 23 187 29 2 443 1000 4 „ 29th 383 7 91 39 3 402 925 5 „ 3rd June 495 26 118 41 9 522 1211 4 „ 1st July 342 17 76 53 1 393 882 4 „ 29th July 365 11 82 63 1 431 953 5 „ 2nd September 265 14 36 27 - 338 680 4 „ 30th „ 356 37 263 78 3 709 1446 4 „ 28th October 375 16 142 63 2 691 1289 5 ,, 2nd December 532 14 121 43 2 860 1572 4 „ 30th „ 323 9 108 61 1 402 904 Totals 4191 186 1343 529 30 5792 12071 37 APPENDIX C. List of Sanitary Improvements effected diring the Year. Cleansing— Premises, Ac., cleaned, repaired or whitewashed 5,082 Workshops ditto ditto ditto 852 House Drains— Drains relaid 135 Drains amended 151 Drains cleared 305 Drains trapped and ventilated 49 Rain water pipes and waste pipes disconnected 9 Sink and bath waste pipes trapped 82 Water Closets— W.C.'s repaired, cleaned, &c. 1.695 W.C.'s fitted with new pans and traps 241 W.C.'s supplied with water, and water supply apparatus 611 W.C.'s ventilated 22 W.C.'s rebuilt 7 New W.C.'s provided 36 Partitions provided round W.C.'s to separate same from workshops 6 Water Supply— Houses provided with water supply 154 House supply disconnected from W.C. cistern 1 Cisterns supplied, repaired and cleaned 22 Miscellaneous— Paving of yards 685 Wash-houses paved 55 Forecourts and Areas paved and drained 28 Stables paved and drained 14 Removal of accumulation of Dung and other refuse 162 Removal of Animals improperly kept 52 New Dung-pits provided and covers for same 23 Premises closed previous to executing the necessary repairs 81 Gutters, Rainwater Pipes, and Waste pipes repaired 834 Illegal occupation of Basement discontinued 3 Overcrowding abated 231 Urinal accommodation provided 3 Grids provided to Gullies 29 Urinals supplied with proper water supply 9 Urinals cleaned 17 Dust Shoots repaired and Receptacles provided 514 Vacant lands cleansed - Yards cleansed 182 Indecent occupation discontinued 28 Verminous Rooms remedied 552 Damp Rooms remedied 279 Lighting and Ventilation improved 312 Total 13,553 38 APPENDIX D. (1). Police Court Proceedings, 1911.—Public Health (London) Act, 1891. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. 1911 Jan. 24 J.W. Exposing for sale unsound meat W. Rowsell Mr. Cluer Fined £5. Mar. 7 J.S. Exposing for sale unsound bacon „ Mr. Biron Fined £5. „ 21 M.S.A. Suffering occupation of new premises without certificate of Sanitary Authority I.R. Jones „ Police unable to effect service of summons. Apr. 25 M.S.A. Occupying premises without certificate of Sanitary Authority „ Mr. Cluer Withdrawn. Work carried out. June 27 M.H.C. Smoke Nuisance W. Rowsell ,, Fined £1. Costs 2s. 39 Police Court Proceedings, 1911.—Public Health (London) Act, 1891—continued. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. 1911 June 27 M.H.C. Smoke Nuisance W. Rowsell Mr. Cluer Fined £1. Costs 2s. July 4 A.C. & Co. Do. „ Mr. Biron Fined £2, costs 20s. „ 18 J.B. Do. „ „ Fined £1. Costs 23s. Sept. 26 S.R. Exposing for sale unsound pears E. Ainley „ Fined £2. Costs 2s. „ 26 A.C. Do. do. „ „ Fined 10s. Costs 2s. „ 26 J.S. Do. do. „ „ Fined £5. Costs 23s. Oct. 3 M.G. Exposing for sale unsound eggs W. Rowsell „ Absconded. „ 17 A.B. Exposing for sale unsound bacon E. Ainley „ Fined £5. Costs 23s. 40 Police Court Proceedings, 1911.—Public Health (London) Act, 1891—continued. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. 1911 Dec. 5 A.H. Exposing for sale unsound bacon W. Rowsell Mr. Biron Fined £10. Costs 23s. APPENDIX D. (2). Police Court Proceedings—Dairies, Cowsheds & Milkshops Orders, 1885-1886. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. 1911 June 27 D.S. Selling milk whilst not registered W. Rowsell Mr. Cluer Fined £4. Costs 23s. 41 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 482 430 52 2 Butter 117 110 7 6 Flour 10 10 — — Coffee 8 6 2 — Cocoa 4 4 — — Margarine 3 3 — — Raspberry Jam 2 2 — — Bread, Standard 2 2 — — Rice 2 2 — — Pepper 2 2 — — Gregory Powder 2 2 — — Sulphur 2 2 — — Epsom Salts 2 2 — — Butter, Milk-blended 1 1 — — Lard 1 1 — — Gooseberry Jam 1 1 — — Sugar, Demerara 1 1 — — Camphorated Oil 1 — 1 — Phosphate of Soda 1 1 — — Glycerine 1 1 — — Mustard 1 1 — — Total 646 584 62 8 A sample of a preservative named "Keypsit" was examined and was found to be a chemical, which, in the opinion of an Inspector of Foods of the Local Government Board, shonld be included in any schedule of prohibited preservatives. In the absence, however, of any legislation on the subject, and of any instance 42 in which the preservative had been used in such quantity as to be injurious to health, no action could be taken to prevent its use. In the cases of four samples of Milk, all slightly adulterated, the vendors were cautioned, the offence being too slight to warrant a prosecution. In consequence of "legal" notice be given at the time of sale, no proceedings were possible in the following cases:—two milks 12 per cent. and 36 per cent. deficient in fat respectively, one margarine, which was sold as butter, but in a paper stamped "margarine," one "butter" containing 90 per cent. of foreign fat, and one coffee containing 60 per cent. of chicory. 43 APPENDIX E (2). Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1911. Jan. 3 L.T. Obstructing Inspector F. Bare Mr. Cluer Fined £4. Feb. 7 J.R. Selling milk 10 per cent. deficient in fat „ ,, Fined £1. Costs 12s. 6d. „ 21 J.W.S. Delivering to consignee milk 28 per cent. deficient in fat „ Mr. Biron Magistrate satisfied milk sold and delivered as given by cow „ 21 J.W.S. Delivering to consignee milk 21 per cent. deficient in fat „ „ „ 21 A.N. Selling milk 29 per cent. deficient in fat „ „ Withdrawn following decision in above case. *„ 21 W. Smith, 30, Aahwell Road Selling milk 18 per cent. deficient in fat A.S. Henley „ Fined £1. Costs 12s. 6d. „ 21 A.E. Selling milk 9 per cent. deficient in fat H.F. Bridel „ Summons dismissed. Warranty defence. „ 21 G.H. Selling milk 17 per cent. deficiet in fat W. Rowsell „ Fined £1. Costs 12s. 6d. * Second or subsequent conviction, reported by order of the Public Health Committee. 44 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1911. Feb. 21 A.C. Selling milk 8 per cent. deficient in fat H.F. Bridel Mr. Biron Summons dismissed Warranty defence. „ 21 E.J. Selling milk 95 per cent. deficient in fat F. Bare „ Dismissed, with 10s. costs, it being proved that defendant was not the owner of the milk. Seller having given false name, and since absconded. „ 21 E.J. Selling milk 293/4 per cent. deficient in fat „ „ *Mar. 7 M. Griffiths, 6, Warley Street Selling milk 6 per cent. deficient in fat A.S. Henley „ Withdrawn, on proof that milk was sold as given by cow. „ 14 M.L. Selling milk 14 per cent. deficient in fat J.G. Weeks „ Fined £1. Costs £1. Apr. 4 D.J. Selling milk 11 per cent. deficient in fat F. Bare ,, Fined 10s. Costs 12s. 6d. ,, 11 W.G. Selling milk 9 per cent. deficient in fat W.Rowsell ,, Fined 20s. Costs 12s. 6d. *„ 25 J. Morgan, 184, Hackney Road Selling butter containing 81 per cent. foreign fat H.F. Bridel Mr. Cluer Fined £6. „ 25 „ Selling margarine in plain wrapper „ „ Withdrawn. Conviction on other summons re same sample. *Second or subsequent conviction, reported by order of the Public Health Committee. 45 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1911. Apr. 25 I.P. Selling milk containing 11 per cent of added water E. Richards Mr. Cluer Fined £5. „ 25 J.H. Selling milk containing 25 per cent. of added water J.G. Weeks „ Fined £3. May 30 J.L. Selling milk 5 per cent. deficient in fat „ Mr. Biron Costs £2 2s. *„ 30 L. Marcus, 21, Leslie Street, E. Selling milk containing 14 per cent. of added water „ „ Fined £5. Costs £1 13s. 6d. „ 30 „ Selling milk 10 per cent. deficient in fat „ „ Withdrawn. Conviction on other summons re same sample. *„ 30 H. Polonsky 367 Bethnal Green Rd. Selling milk 13 per cent. deficient in fat E. Richards „ Fined £10. Costs 12s. 6d. June 1 H.J.L. Selling milk 45 per cent. deficient in fat J.G. Weeks „ Fined £5. *Second or subsequent conviction, reported by order of the Public Health Committee. 46 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1191 June 13 A.C. Selling milk containing 10 per cent. added water F. Bare Mr. Biron Absconded. *„ 20 H. Liddiard, 17, Arbery rd. Selling milk 6 per cent. deficient in fat A.S. Henley „ Fined £2. Costs 33s. 6d. „ 20 H.S. Selling milk 38 per cent. deficient in fat „ „ Fined £5. Costs 12s. 6d., 7 days to pay. „ 20 C.B. Selling milk 12 per cent. deficient in fat H.F. Bridel „ Fined £1. Costs 12. 6d. July 11 J.G. Selling milk 32 per cent. deficient in fat J.G. Weeks „ Fined £2. Costs 12s. 6d. „ 11 H.W. Selling milk 13 per cent. deficient in fat W. RowBell „ Fined £2. Costs 12s. 6d. „ 11 N.C. Selling milk 21 per cent. deficient in fat „ „ Fined £2. Costs 12s. 6d. „ 11 J.C. Selling milk 15 per cent. deficient in fat F. Bare „ Fined £2 Coats 12s. 6d. Aug. 4 J.B. Selling milk 83 per cent. deficient in fat J.G. Weeks Mr. Chester Jones Absconded. Arrested Sept. 22nd. Went to prison for one month. * Second or subsequent conviction, reported by order of the Public Health Committee. 47 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing. Defendant. offence. Inspector. Magistrate. Result. 1911. Aug. 15 E.R. Selling milk containing 10 per cent. added water E. Ainley Mr. ChesterJones Fined £1. Costs £1 3s. „ 15 J.P. Selling milk containing 8 per cent. added water „ „ Fined £3. Costs £1 3s. „ 22 E.J.K. Selling milk containing 12 per cent. added water „ „ Costs £1 3s. Sept. 1 I.S. Selling milk 12 per cent. deficient in fat H.F. Bridel Mr. Biron Fined £1. Costs £1 11s. 6d. „ 5 J.R. Selling milk 60 per cent. deficient in fat E. Ainley „ Fined £2. Costs £1 3s. „ 5 A.B. Selling milk containing 18 per cent. added water „ „ Fined £1. Costs £1 3s. „ 5 C.G. Selling milk containing 10 per cent. added water „ „ Fined 10s. Costs £1 3s. 48 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1911 Sept. 12 W.E.A. Selling camphorated oil 15 per cent. deficient in camphor W. Rowsell Mr. Biron Fined £1. Costs £1 3s. *Oct. 3 H. Liddiard 17, Arbery Road Selling milk 69 per cent. deficient in fat J.G. Weeks „ Fined £20. Costs £1 3s. in default went to prison for two months. 3 T.P. Selling milk containing 7 per cent. added water E. Ainley „ Dismissed. Warranty defence. „ 10 M. & S. Selling milk containing 18 per cent. added water F. Bare „ Fined £3. Costa £1 1s. Nov. 28 D.E. Selling butter containing 88 per cent. foreign fat J.G. Weeks „ Fined £2. Costs £1 11s. 6d. „ 28 „ Selling margarine in plain paper wrapper „ „ Withdrawn. Conviction on other summons re same sample. *Second or subsequent conviction, reported by order of the Public Health Committee. 49 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1911 Nov. 28 S.H. Selling coffee containing 50 per cent. added water J.G. Weeks Mr. Biron Fined £1. Costs 10s. „ 28 E.J.K. Selling butter containing 461/2 per cent. foreign fat W. Rowsell „ Fined £3. Costs £1 11s. 6d. „ 28 „ Selling margarine containing more than 10 per cent. butter fat „ „ Withdrawn. Conviction on other summons re same sample. „ 28 A.M. Selling milk containing 16 per cent. added water F. Bare „ Fined £1 Costs £1 11s. 6d. * „ 28 H. Liddiard 17, Arbery Road Selling milk 36 per cent. deficient in fat A.S. Henley „ Adjourned 6 months in view of recent imprisonment for similar offence. * Second or subsequent conviction, reported by order of the Public Health Committee. 50 APPENDIX E (3). FOODS AND DRUGS. Table showing percentage adulteration for Decennial Period 1901—1910, compared with 1911:— Year. No. of Samples Taken. No. of Samples Adulterated. Percentage of Adulterated Samples. 1901 186 35 18.8 1902 326 62 19.0 1903 396 57 14.4 1904 485 64 13.2 1905 609 79 12.9 1906 656 75 11.4 1907 671 87 12.9 1908 682 45 6.6 1909 617 52 8.4 1910 642 53 8.2 Decennial average percentage adulteration 12.58 1911 646 62 9.6 51 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 Act. No. of Summonses Issued. No. of Convictions Obtained. No. of Cases Dismissed. No. of Summonses Withdrawn, &c. 62 8 60 42 6 12 The difference, viz., ten, between the total offences against the Acts, and the number of summonses issued, is accounted for as follows:—In the case of three milks the deficiency in fat was so slight that the Committee in the exercise of their discretion administered warnings to the vendors ; in two instances of milks deficient to the extent of 36 per cent. and 12 per cent. of fat respectively, a notice was exhibited in each shop stating that though the milk was sold in an unaltered state as received from the contractors, it was not guaranteed to meet the requirements of the Sale of Food and Drugs Acts ; this afforded ample protection to the vendor, although the position of the consumer would hardly be considered as satisfactory. Comment upon a law allowing such a state of things would be superfluous. In two cases butter was asked for and nothing was said by the vendor to lead the purchaser to suppose that any other article was being sold, but in each case margarine was supplied, the vendor being duly protected in one instance by a paper wrapper not too plainly marked "Margarine," and in the other by a notice similar to the milk notice mentioned above ; two other minor offences were involved in the cases of these two "butters" but did not 52 warrant prosecution. In the ease of one sample purchased as coffee it was found to be a mixture containing 60 per cent. of chicory. With regard to the cases dismissed, in four of these cases " appeal to the cow " was made by the wholesale man, and as the herd from which the milk was said to be drawn were notoriously poor " milkers," the appeal was successful, only, however, on the farmer promising to take prompt measures to ensure that the milk sold in future from his farms should be up to the required standard. In one case the vendor, a milk hawker, gave the Inspector a wrong name and address ; the case was of course dismissed, with 10s. costs against the Council; similar circumstances were connected with a second sample, but no costs were granted on either side. In three cases summonses were withdrawn upon proof of warranties, and in another the defendant absconded ; one summons was withdrawn upon a conviction being sustained in respect of another summons respecting the same sample, one summons could not be served by the Police, and the remaining summons was adjourned for six months, owing to the defendant having just come out of prison after a series of convictions for offences against the Acts. APPENDIX E (4). Sale of Food and Drugs Acts. Samples taken on delivery. The following samples were taken on delivery from wholesale firms delivering goods to various retail tradesmen, etc., in the Borough. Article. Total Samples Taken. Genuine. Adulterated. Milk 56 49 7 53 APPENDIX E (5). Samples of Foods and Drugs taken informally for information:— Article. Total Samples Taken. Genuine. See below (*) Adulterated. See below (†) Milk 23 16 7 Margarine 12 12 — German Sausage 10 10 — Butter 8 3 5 Sausages 8 8 — Brawn 6 6 — Bacon 5 5 — Lard 4 4 — Vinegar 3 2 1 Dripping 3 3 — Salmon and Shrimp Paste 2 2 — Tinned Peas 1 1 — Ginger Beer 1 1 — Camphorated Oil 1 — 1 Raspberry Jam 1 1 — Cheese 1 1 — Egg Powder 1 1 — Mustard 1 1 — Sultanas 1 1 — Cocoa Essence 1 1 — Coffee 1 — 1 Totals 94 79 15 * Or preservatised to very slight extent. †Or preservatised to such an extent as under ordinary circumstances would warrant prosecution. The amounts of preservatives discovered ranged from 2 grains to 8½ grains per pound of boric acid in bacon, sausages, and brawn; in one case traces of benzoic acid were discovered. 54 Comparing this table with that showing samples taken officially (Appendix E (1)) it will be observed that the adulteration, etc., in the case of samples taken informally is 18.9 percent., whilst in the case of samples taken officially it is 9.6 per cent. only. APPENDIX F. Unsound Food—Surrendered. Cwts. qrs. st. lbs. Fish 6 2 0 8 Fruit 10 1 0 0 Meat 8 0 0 5 Tomatoes 2 2 0 0 Onions - 2 0 4 Total 27 3 1 3 22 Rabbits were also surrendered. 70 quarts of Ice Cream do. Unsound Food—Seized. Cwts. qrs. st. lbs. Fruit — 2 1 8 Meat — 2 0 4 Total 1 0 1 12 630 Eggs were also seized. 55 APPENDIX G. Premises where Food is prepared for Sale. No. of premises on Register at end of 1911 14 Factories. 211 Workplaces. Do. removed from do. 6 „ Do. added to do. 12 ,, No. of Inspections 96 Factories. 881 Workplaces. No. of Notices served 66 No. of Prosecutions — APPENDIX H. Inspection of Bakehouses. No. of Bakehouses on Register at end of 1910 90 „ „ „ „ 1911 92 „ above ground 66 ,, under ground 26 No. of Inspections 251 No. of Notices served 23 No. of Prosecutions — APPENDIX I. (1). Outworkers. Year. No. of lists received from employers. No. of Outworkers comprised therein. Reported from other Boroughs. Reported to other Boroughs. 1910 198 3,394 3,261 1,640 1911 190 3,473 3,351 1,822 No. of Outworkers dealt with in 1910 6,655 „ „ „ 1911 6,824 56 APPENDIX I. (2) Outworkers' List of Trades. The following is a list of the trades in which the Outworkers' notified during 1911 were engaged:— Artificial Flower Making 17 Belt Makers 32 Bibs and Pinafores 7 Blouse Work 23 Boot and Shoe Making 522 Box Making 472 Brace Making 3 Brush Making 190 Button Making 2 Cabinet Making 8 Caps, etc 13 Chair Making 3 Cigar Box Making 1 Collar Making 12 Dressmaking 38 Embroidery and Fancy Trimmings 59 Feather Work 2 Fur Stiching, etc. 8 Glove Work 1 Lace and Netting 1 Mantle Making 25 Match Box Making 45 Millinery 18 Paper Bag Making 7 Pyjama Making 2 Sack Making 1 Shirt Making 20 Sieve Making 3 Silk Weaving 51 Tailoring 607 Ties and Bow Work 31 Upholsterers Trimmings 30 Underclothing 13 Umbrellas 46 Incorrect addresses and those having discontinued work 434 Total 2,747 APPENDIX J. Tenement Houses. No. of Tenement Houses on Register at end of 1911 536 No. of Tenement Houses cancelled during 1911 11 „ „ registered „ 30 57 Inspections made 2,006 Rooms overcrowded 24 Cellars illegally occupied 0 Water provided to upper floors 5 Cases of indecent occupation 2 Notices served 590 Registration forms written and served 33 APPENDIX K. House to House Inspections and Overcrowding. No. of House to House inspections during 1911 858 Dwelling rooms found overcrowded during 1911 246 Cases of overcrowding remedied during 1911 231 No. of other defects discovered 1,123 No. of notices served 547 No. of prosecutions - APPENDIX L. Complaints received from L.C.C. respecting "Verminous School Children. No. of complaints received during 1911 329 Inspections made 358 Premises found to be verminous 16 Defects discovered 317 No. of notices served 152 No. of prosecutions 58 APPENDIX M (1). Particulars respecting work of Disinfectors and Shelter. Month. No. of Rooms Disinfected. P.T. and Phthisis Cases. Verminous Rooms. Articles of Bedding Destroyed. 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 60 18 — 7 1237 Books, Roots, Dresses, Fancy Material, &c. 1,050 — — — February 94 31 4 23 1405 1 2 7 March 71 17 — 18 1351 — — — April 49 7 3 15 1656 — — — May 64 22 3 2 4388 — — — June 98 19 26 1 915 — — — July 88 16 31 — 1405 — — — August 91 21 20 176 3423 — — — September 113 25 6 1 1678 — — — October 96 25 2 1 1652 — — — November 75 20 5 1 1023 — — — December 68 17 4 9 1975 — — — Totals 967 238 104 254 22,108 1,050 1 2 7 Fourteen Men from various Common Lodging Houses in the Borough were battled and had their clothes disinfected at Station. 59 APPENDIX M (2). Fifty casks of Sanitas Powder, making up into 3,500 packets, have been distributed from the Public Health Department. Six hundred and forty-one pint bottles of Sanitas Fluid, and three hundred and sixty-one pint 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. One and a-half gallons of Formaldehyde. 40 per cent. solution, has been used in spraying the walls of rooms, and five pounds of Formalin Tablets have been used for fumigating rooms, in certain cases, instead of sulphur candles. Fifteen gallons of Creocide were used for disinfection in connection with cases of Enteric Fever. APPENDIX N. Smoke Observation. Shafts under observation 100 No. of hours occupied in observation 360 No. of intimation notices served 34 No. of statutory notices served 9 No. of prosecutions 4 60 APPENDIX O. Mortuary Returns, 1911. Bodies removed to Mortuary— On Coroner's Order 267 By Police 10 By Firemen — From London Hospital 15 On Sanitary Inspector's Order 2 On Request of Relatives 68 Total 362 Number of Inquests held 277 Number of Post Mortem Examinations 99 Particulars of bodies on which Inquests were held— Bodies removed by Police from Canal 4 Do. do. Street, etc. 5 Do. do. found in Parcels (Baby) 1 Bodies received from Bethnal Green Infirmary 55 Do. do. Bethnal House Asylum 1 Do. do. Queen's Hospital 14 Do. do. Mildmay Mission Hospital 10 Do. do. Private Houses, etc. 187 Total 277 Inquest cases according to age period— Number under one year 80 Number over one year and under five years 31 Do. five do. ten do. 14 Do. ten do. twenty years 8 Do. twenty do. thirty do. 12 Do. thirty do. forty do. 17 Do. forty do. fifty do. 24 Do. fifty do. sixty do. 24 Do. sixty do. seventy do. 32 Do. seventy do. eighty do. 21 Do. eighty years 14 Total 277 61 Causes of death in Inquest cases— Acute Gastritis 2 Apoplexy 15 Atelectasis 1 Atrophy of the Heart 1 Bronchitis 17 Bronco-Pneumonia 4 Cardiac Rupture 2 „ Thrombosis 1 „ Valvular Disease 8 Cerebro-Spinal Meningitis 1 Chronic Nephritis 3 Congestion of Lungs 1 Convulsions 16 Diabetes 1 Diphtheria 3 Endocarditis 1 Enlarged Thymus Gland 2 Epidemic Diarrhœa 6 Epileptic Fit 1 Fatty Degeneration of the Heart 4 General Dropsy 1 „ Tuberculosis 4 Heat Stroke 1 Inanition 3 Improper Feeding 1 Laryngitis 1 Marasmus 2 Measles 1 Meningitis 1 Peritonitis 2 Pericarditis 5 Phthisis 8 Premature Birth 10 Pneumonia 22 Rickets 2 Rupture of an Aneurism of Aorta 3 62 Causes of death in Inquest cases—continued— Senile Decay 6 Still Born 6 Spasm of Glottis 2 Tumour of the Brain 2 Ulcer of the Stomach 2 Want of Attention at Birth 4 Accidental Deaths— Crushed by Machinery 2 Burns 4 Drowned 4 Death while under Chloroform 2 Exhaustion from Operation 1 Falls 37 Ptomaine Poisoning 2 Run over in the Street 4 Scalds 3 Septiœemia 1 Suffocation in Bed 21 „ while in a Fit 2 Accelerated by Exposure 1 Chronic Alcoholism 6 Death due to Forcible Feeding 1 Manslaughter 1 Suicides— Fall from Window 1 Poisoning 2 Hanging 2 Cut Throat 2 7 Total ... 277 Bodies recovered under Public Health (London) Act— Diphtheria 3 Measles 1 Total 4 63 APPENDIX P. Inspection of certain places subject to special Bye-Laws and Regulations. Premises. No. of Premises No. of Inspections. No. of Notices. No. of Prosecutions. On Register at end of 1910. Added in 1911. Removed in 1911. On Register at end of 1911. Milkshops 243 20 7 256 806 33 1 Cow-houses 15 — 1 14 63 1 — Slaughter-houses 5 — 1 4 34 1 — Other Offensive Trade Premises 1 — — 1 4 — — 64 APPENDIX Q. Clerical Work. Intimation notices written and served 5,051 Statutory do. do. 2,297 Notices under provisions of Housing and Town Planning Act, 1909 283 Entries in Nuisance Register 6,157 do. Tenement House Register 2,796 do. Food and Drugs do. 739 do. Workshops do. 5,558 Notices respecting Combined Drainage 46 Final notices prepared and served 727 Letters written 3,996 Briefs and Instructions to Solicitor prepared 70 Summons prepared (4 copies each) 78 School notifications prepared and dispatched 2,179 Notices to District Surveyor 106 65 APPENDIX R. Works carried out and in progress by Combined Drainage Staff during 1911. Relaying Combined Drains ("Sewers"). 1—3, Anglesea Street. 28—32, Anglesea Street. 31—35, Approach Road. 8—18, Ashwell Road. 440—444, Bethnal Green Road. 110—124, Brady Street, and 11—20, Reuben Street. 92--96, Coventry Street. 11—15, Ellesmere Road. 54—58, Florida Street. 202 - 204, Grove Road. 133—167, Vallance Road. 21—25, Warley Street. 85—91, Barnet Grove and 36—38, Elwin Street. Other Works. 199—205, Cambridge Road and 66—68, Three Colt Lane:— Tracing Drains. 232, Cambridge Road:— Laying drain to vent shaft. 77, Church Street:—Amending manhole. 201, Old Ford Road:—Tracing and relaying drain. 1, Squirries Street:—Sealing off old drain. Infirmary, Cambridge Road:—Flushing and cleansing drainage system and repairing defective drains. Removing cause of settlement at entrance gates (private charge). Mortuary:—Internal and external renovations. Shelter:—Removing old shed and fixing copper. "Bee Hive," Somerford Street:—Unstopping drain. Town Hall:—Sweeping drains, clearing manhole, etc. 333, Bethnal Green Road, 7, Chilton Street, 3, Northampton Street and 331, Waterlow Buildings:—Washing down and stripping, etc, after smallpox. 66 Combined Drains flushed, covers re-fixed and sealed. 2 to 20, Alma Road, and 7 to 25, Cranbrook Street. 29 to 39, Alma Road. 36 to 44, Alma Road, and 39 to 61, Cranbrook Street. 27 to 29, Ames Street. 1 to 3, Arbery Road. 1 to 4, Arline Street. 16 to 22, do. 27 to 30, do. 10 to 28, Ashwell Road. 14 to 18, Bacon Street. 24 to 32, do. 18 to 32, Bellhaven Street. 34 to 48, do. 120, Bethnal Green Road, and 23, Granby Street. 148 to 152, Bethnal Green Road. 15 to 19, Bonner Street. 110 to 124, Brady Street, and 11 to 20, Reuben Street. 162 to 176, Brick Lane. 1 to 3, Buxton Street, and "Two Brewers," Brick Lane. 31 to 37, Cadell Street. 9 to 11, do. 227 to 233, Cambridge Road. 9 to 17, Chapel Street. 5 to 9, Cheshire Street. 57 to 69, Cheshire Street. 14 to 24, Chilton Street, 12 to 14, Granby Street, 5 to 10, Granby Row, and 1, Busby Street. 8a, Chilton Street. 5 to 15, Chilton Street, and Workshops at rear. 17 to 31, Chilton Street. 7 to 15, Chisenhale Road. 75 to 83, Church Street. I to 7, Code Street, and 1 to 4, Pedley Street, and 4 to 6, Collver's Court. 17 to 23, Columbia Road. 90 to 100, do. 216, do. 136 to 138, do. 17 to 25, Cooper's Gardens. 22 to 26, Cordova Road. 19 to 21, do. 27 & 28, do. 9 to 12, do. 11 to 15, Cranbrook Road. 10 & 12, Cranbrook Street. 1 to 5, Cygnet Street, and 1 to 3, Bacon Street. 7 to 11, Cygnet Street, and 2 to 4, Bacon Street. 1 to 9, Diss Street. 8 to 16, do. 11 to 15, do. 67 Combined Drains flushed, covers re-fixed and sealed—continued. 1 to 9, Eckersley Street, and 6 to 13, New Church Street, and 15 & 16 Pedley Street. 72 to 74, Ellesmere Road. 73 & 75, Ellesmere Road, and 19 to 25, Chisenhale Rd. 11 to 15, Ellesmere Road. 1 & 2, Fleet Street Hill, and 2, Bratley Street. 4 to 6, Flint Terrace, and 7 to 17, Mace Street. 44 to 52, Fuller Street. 47 to 51, do. 21 to 31, Gardener's Road. 26 to 32, do. 6 to 18, do. 1 to 3, Gibraltar Buildings (Private charge). 2 to 8, Grauby Street, 2 to 8, Busby Street, and 1 to 7, Busby Square. 233 to 235, Green Street. 10 to 12, Grimsby Street. 173 to 175, Grove Road. 183 to 191, do. 40 to 50, Hague Street. 1 to 6, Hague Place. 8 to 12, Hamilton Road. 27 to 43, do. 51 to 65, do. 7 to 9, Hare Street, and 1 & 2, Hare Court. 30, Hare Street, and 13 to 17, Grimsby Street. 12 to 14, Harold Street. 17 to 19, Hartley Street. 65 to 75, Hassard Street. 49 to 63, do. 38 to 50, do. 28 to 34, do. 1 to 7, Havelock Place. 9 to 17, Havelock Place, anc 100 to 104, Cranbrool Street. 2 to 12, Hemming Street. 14 to 24, do. 39 to 51, do. 12 to 20, Hereford Street. 1 to 19, do. 21 to 39, do. 2 to 8, do. 1 to 18, Holmes Avenue. 15 to 19, Horatio Street. 21 to 31, do. 1 to 19, Kerbela Street. 1 to 6, King's Place. 41 to 45, Lark Row. 2 to 9, Lawfrance Road. 17 & 18, Lessada Street. 47 & 48, do. 2 to 16, London Street. 73 to 80, Lyal Road. 64 to 70, do. 71 & 72, do. 81 to 86, do. 57 to 63, do. 32 to 34, Mace Street, and 178, Old Ford Road. 2 to 20, Margaret's Place. 68 Combined Drains flushed, covcrs re-fixed and sealed—continued. 46 to 52, Medhurst Road. 35 to 45, Menotti Street. 35 to 55, do. 36 to 44, do. 1 to 5, do. 29 to 33, Norton Street. 23 to 30, Pedley Street, and 8 to 14, Fleet Street Hill, and 11 to 23, Weaver Street. 19 to 22, Pedley Street, 1 to 5, New Church Street, and 1 to 9, Weaver Street. Queen's Hospital, Hackney Road (Private charge). 25 to 27, Ravenscroft Street. 2 to 8, Roman Road. 9 to 21, do. 98 to 100a, do. 83 to 89, Sclater Street. 2 to 12, Seahright Street. 14 to 24, do. 64 to 88, do. 71 to 93, do. 16 to 20, Shipton Street. 15 to 19, Shipton Street. 19 to 23, Smith's Buildings. 3 & 4, Tagg Street, and 22, Bonner Street. 16 to 25, Tagg Street. 11 & 12, Theydon Road. 24 & 26, do. 6, Type Street, and 1, Harold Street. 36 to 42, Type Street. 133 to 167, Vallance Road. 170 to 176, do. 178 to 184, do. 240 to 246, do. 194 to 232, do. 8 to 22, Virginia Road. 3 to 5, Vivian Road. 54 to 64, Wadeson Street. 21 to 23, Warley Street. 27 to 33, Weaver Street, 4 & 7, Bratley Street, and 5 to 7, Fleet Street Hill. 1 to 8, Whites Court, 1 to 14, Butler's Buildings, and 9 to 19, Code Street. 69 APPENDIX S. STATEMENT OF WAGES ACCOUNT. No. of Weeks. Ending. Sanitary Labour. Combined Drainage Infirmary Drainage. Shelter, removing old shed and fixing copper. Mortuary Renovations. Stripping, &c., after Small Pox. Messenger &c. Holiday Pay. Sick Pay. 1911 £ s. d. £ s. d. £ s. d. £ 8. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. 4 26th January 31 11 8 27 11 6 — — — — 3 0 0 — 0 15 0 4 23rd February 30 2 0 32 17 0 — — — — 3 0 0 — — 5 30th March 44 10 2 25 13 6 7 4 6 — — 6 18 1 3 15 0 — — 4 27th April 31 11 3 5 3 8 23 19 11 — — 1 14 8 3 2 6 — 4 25th May 29 3 0 42 13 9 9 6 9 — — — 3 0 0 - — 5 29th June 39 0 7 138 6 3 — - — - 3 17 6 7 15 10 — 4 27th July 31 4 2 161 8 3 — — — — 3 0 0 3 0 0 1 2 6 5 31st August 37 13 5 42 7 6 — — — 3 15 0 15 15 8 4 28th September 30 19 10 10 4 1 — 7 1 5 13 15 5 — 2 5 7 — 2 5 0 4 26th October 30 15 2 6 7 3 3 7 0 — 27 0 0 — 2 17 6 — 0 3 9 5 30th November 37 18 4 33 7 4 1 15 0 - 18 5 11 - 3 15 0 - 1 17 6 4 28th December 31 5 2 25 2 11 — — 2 9 7 — 3 0 0 — 0 7 2 Totals £ 405 14 9 551 3 0 45 13 2 7 1 5 61 10 11 8 12 9 38 8 1 26 11 6 5 16 3 70 71 APPENDIX T. Housing and Town Planning Act. Summary of Results of House to House Inspections. Canrobert Street. Shetland Street. Jersey Street. Cambridge Street. Wolverley Street. Punderson Gardens. Camden Street. Anglesea Street Hague Place. Hare Court. Selly Street. Virginia Road. Gillman Street. Chester Street. Hersee Place. Helens Place. Sundry Streets. TOTAL Number of Houses Inspected 40 14 46 7 34 64 51 8 2 4 15 8 39 3 6 2 39 382 Number of Houses where admission was not obtained . . 2 . . . . . 2 . . . . 4 Number of Empty Houses - 1 2 4 2 1 - - - 1 - 1 . . . 1 13 Number of Houses where defects were found and where notices were required 38 14 44 7 33 52 47 8 2 4 15 8 39 3 6 2 31 353 Number of Houses where no defects were found 2 . 2 . 1 12 4 - - . - . - . . - 8 29 Number of Houses where overcrowding was found 3 1 2 1 1 2 6 - . - - . 4 . . . . 20 Number of Houses so unfit for habitation as to be suitable for Closing Order under Section 17, H. & T. P. Act - - - - - - - - - - - - - - - - - - Number of Houses so defective as to be suitable for dealing under Sec. 15, H. & T. P. Act 32 11 17 6 25 5 23 8 2 4 15 . 38 . 1 2 7 196 Number of Houses where ordinary notices under Public Health Act met the case 6 3 27 1 8 47 24 . - . . 8 1 3 5 . 24 157 Number of Houses to which it was necessary to draw the attention of District Surveyor 1 2 . - - - - - - - - - 5 - - - - 12 72 APPENDIX U. STATEMENT OF PETTY CASH ACCOUNT. 1911 Amounts received from Finance Committee. PETTY DISBURSEMENTS. Fines, Costs, Ac., recovered and paid into Council's Account. Public Health (London) Act, 1891. General Expenses. Sale of Food and Drugs Acts. Expenses re sampling, prosecutions, &c Sundry small Accounts for Tools, Materials. &c., not kept in Stock. Drain Plug Hire. Returned Deposits. Mortuary. Washing, Sundry Small Requirements. &c. Fairlight Sanatorium. Patients' Fares, Ac. Office. Petty Expenses, Fares, &c. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. January 11 7 6 19 1 3 3 11 0 8 0 1 15 0 0 15 7 1 10 3 7 19 0 February 6 10 4 4 16 8 3 18 5 — 0 15 0 — — 3 2 11 7 17 0 March 9 11 10 3 8 11 2 8 0 0 3 6 1 5 0 0 11 8 — 0 19 2 12 7 6 April 12 13 0 2 19 2 2 8 10 0 1 8 1 0 0 — — 0 17 6 7 7 6 May 7 7 2 3 1 3 2 8 9 — 1 0 0 — 0 10 0 0 12 11 15 15 6 June 8 16 3 2 4 5 3 18 5 — 0 10 0 1 2 6 29 16 0 July 15 8 3 0 17 2 2 6 9 1 6 10 1 5 0 0 11 10 — 0 12 1 2 4 0 August — 1 3 1 1 11 10 1 1 8 — — — 0 8 10 46 18 5 Sept. — 6 14 4 2 10 11 0 3 6 — 1 1 0 1 0 0 0 6 5 October 11 5 1 4 1 10 2 5 5 — 0 18 2 0 2 11 0 8 2 9 6 6 Nov. 11 16 2 1 12 11 3 17 5 0 3 11 0 7 2 0 10 0 0 10 4 6 3 0 Dec. 7 16 6 2 15 9 4 4 6 0 2 8 — 0 4 6 0 5 0 0 11 10 19 7 0 Total for Year. 102 12 1 35 14 7 35 3 2 3 11 9 7 0 0 4 9 11 2 17 11 11 2 11 165 1 5 Total amount received from Finance Committee Balance from 1910 Lees Expenditure Balance £119 14 3 100 0 3 £19 14 0 £102 12 1 17 2 2