THE Metropolitan Borough of Bethnal Green REPORT ON THE SANITARY CONDITION AND VITAL STATISTICS DURING THE YEAR 1912. TOGETHER WITH THE Report of the Chief Sanitary Inspector. BY GEORGE PADDOCK BATE, M.D. Fellow of the Royal College of Sun/eons 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.f 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.G. 1913. L.S.N. 11 ??? THE Metropolitan Borough of Bethnal Green REPORT ON THE SANITARY CONDITION AND VITAL STATISTICS DURING THE YEAR 1912. TOGETHER WITH THE Report of the Chief Sanitary Inspector. BY GEORGE PADDOCK BATE, M.D. Fellow of the Royal College of Surgeons and Licentiate of the Royal College •of Physicians of Edinburgh; Fellow of the Royal Society of Medicine; Fellow of the Royal Microscopical Society; Fellow of the Royal Institute of Public Health; Vice-President past President) of the Incorporated Society of Medical Officers of Health; Examiner in Sanitary Science, &c., to His Majesty's Civil Service Commissioners; Honorary Consulting Physician to Queen Adelaide's Dispensary; J.P. for the County of London; and Medical Officer of Health for the Borough of Bethnal Green. LONDON: Printed by Thomas Bean & Son, 67. Golden Lane, E.C. 1913. Metropolitan Borough of Bethnal Green. Public Health Committee, 1912=13. Meetings held at the TOWN HALL, alternate Wednesdays at 6 p.m. Alderman J. Robertson, Chairman. Councillor C. L. Coomber, Vice-Chairman. The Mayor (Councillor W. Rawles, J.P.) Alderman J. J. Fleming. Councillor W. T. Garner. „ R. E. Pearson. „ R. Larkins. Councillor VV. H. Clark. „ T. O'Grady, J.P. „ T. A. Dean. „ J. Sigournay. „ F. W Eaton. „ J. W. Ward. Ex=Officio Members of the Public Health Committee. (Chairmen of Standing Committees of the Council). COMMITTEE. CHAIRMAN. Finance Councillor W. H. Dupree. Works and Stores „ T. Brooks. Law and General Purposes „ C. E. Fox, J.P. Baths „ H. A. Meadway. Electricity „ J. Hall. Valuation ,, A. F. Barnard. STAFF OF PUBLIC HEALTH COMMITTEE. John Foot, Chief Inspector. E. Ainley, Sanitary Inspector. I. R. Jones, Sanitary Inspector. F. T. Bare, do. E. Richards, do. W. Billings, do. W. Rowsell, do. A. S. Henley, do. J. 0. G. Weeks, do. Miss C. Hammond, Health Visitor. H. A. Saunders, General Assistant. CLERICAL STAFF. Ernest Q. Bilham, Chief Clerk. George I. Brighting, Assistant Clerk. Joseph H. Hewitt, do. F. G. Thomas, do. H. W. Pendrill, do. W. H. Heron, Office Youth. Disinfectors. One Leading Disinfector. Two Assistant do. One do. do. and Messenger. Alfred Walter Stokes, F.C.S., F.I.C., Public Analyst. Edgar Taunton, M.B., D.P.H., Barrister-at-Law, Deputy Medical Officer of Health. George Paddock Bate, M.D., Medical Officer of Health. PUBLIC HEALTH OFFICES. Town Hall, Patriot Square, Bethnal Green, E. Disinfecting Station. The Council's Depot, Digby Street, Globe Road, E. Shelter. 3, St. James Road, Bethnal Green, N. E. SYNOPSIS of MEDICAL OFFICER'S ANNUAL REPORT, 1912. PAGE General Summary 10 Births and Deaths in Metropolitan Boroughs 7 Birth and Death Rates in Metropolitan Boroughs 8 Death Rates and Infiantile Mortality in Metropolitan Boroughs 9 Population 11 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 17 Table " D " Deaths in Sub-districts 18 Death Rate 19 Mortality Rate in Sub-districts 19 Table " E " Monthly Mortality Rates 20 Table " F" Quarterly Death Rates—London and Bethnal Green 21 Birth Rate 21 Table " G" Marriages 21 Deaths of Infants 22 Table " H " Special causes of Infantile Deaths 23 Deaths of Young Children 23 Senile Mortality 23 Table " I " Quarterly Mortality—Bethnal Green 25 Table " J " Quarterly Mortality—London 26 Table " K " Deaths from Notifiable Infectious Diseases 27 The seven principal Zymotic Diseases 28 Table " L" Zymotic Deaths in 1911 and 1912 29 Table " M " Percentages of Deaths from Zymotic Diseases... 29 Notification of Infectious Diseases 30 Table " N " Details of Notifications 31 Table " 0 " Condition of Premises 32 S YN OPSIS— continued. PAGE Scarlet Fever 32 Diphtheria 33 Enteric Fever 34 Whooping Cough 34 Measles 35 Chicken Pox 37 Erysipelas 37 Diseases of Parturition 37 Ophthalmia Neonatorum 38 Cerebro-spinal Meningitis 38 Polio-myelitis 38 Tuberculosis 38 Pulmonary Phthisis 39 Public Health (Tuberculosis) Regulations, 1912 39 Pulmonary Tuberculosis—Notifications 42 Pulmonary Tuberculosis—Occupations of persons notified 43 Faiilight Sanatorium 45 National Insurance Act, 1911 51 Cancer 67 Inquests 67 Suicides 68 Customs and Inland Acts, 1890 to 1903 68 By-laws relative to Houses let in lodgings 68 Housing and Town Planning Act, 1909 69 Brady Street Area 72 APPENDIX. Report of Female Health Visitor 85 Table I. Vital Statistics of Whole District 91 II. Cases of Infectious Disease notified 92 III. Causes of, and Ages at Death 93 III. (a) Deaths in Sub-Districts 94 IV., IV (a) and IV (b) Infantile Mortality 95-97 V. Number of Deaths from the seven principal Zymotic Diseases in ten years 1902 to 1911 and in the year 1911 98 Administration of Factory and Workshop Act 99 Street List 100 London and the Metropolitan Boroughs. Births and Deaths of Persons belonging to London and the Metropolitan Boroughs during the 52 Weeks of 1912.* Boroughs. Population estimated to the middle of 1912 Births. Deaths from Deaths under 1 year of Age. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea and Enteritis (under 2 .wars I Phthisis. COUNTY OF LONDON 4,519,754 110,353 61,100 117 1 1799 159 970 452 1371 6069 10056 West. Paddington 142,362 3021 1751 1 31 3 20 6 43 124 296 Kensington 171.746 3326 2226 4 — 27 5 24 6 37 183 303 Hammersmith 122,750 2880 1606 4 — 29 4 17 13 29 165 259 Fulham 155,402 4213 1985 8 — 65 6 45 15 33 209 396 Chklsea 65,397 1229 949 1 — 22 2 14 5 8 85 84 City of Westminster 157,248 2348 1942 4 — 37 4 16 11 38 183 197 North. St. Marylbbonk 116,155 2243 1602 5 40 11 19 8 26 146 209 IIampstead 85,966 1-281 812 1 — 11 1 4 17 1 55 79 St. Pancras 216,115 5367 3118 3 — 95 5 44 25 37 341 472 Islington 326,398 8213 4662 8 — 151 9 57 39 90 441 712 Stoke Nbwington 50,581 1033 611 - -_ 5 3 - 3 44 74 Hackney 222,9*6 5266 2691 3 — 19 8 33 12 60 303 421 Central. Holborn 48,026 902 733 1 - 25 ... 7 7 8 99 72 Finsbury 86,130 2575 1612 1 - 129 5 29 13 44 165 294 City of London 18,695 185 251 — - 2 - 1 1 4 37 15 East. Shoreditch 110,430 3562 1997 4 - 116 5 47 19 94 231 439 BETHNAL GREEN 127.985 3902 1954 3 - 91 2 32 12 48 216 375 Stepney 277,315 8533 4211 9 — 170 13 96 26 153 465 897 Poplar 161,597 5045 2635 7 — 112 3 64 17 68 243 541 South. South wark 190,017 5587 3164 4 - 139 6 49 27 104 354 587 Bermondsby 125,260 3872 2098 5 - 102 8 36 16 67 218 431 Lambeth 297,550 6952 3950 13 — 97 9 55 29 98 406 601 Battersea 167,589 4258 2012 2 - 55 6 40 15 50 195 358 Wandsworth 321,881 6757 3265 8 - 50 11 61 19 73 297 513 Oamberwell 261,591 6422 3362 6 - 81 8 51 21 65 339 535 Deptpord 109.377 2896 1432 2 — 28 6 25 11 29 147 259 Greenwich 95,991 2391 1954 2 — 28 9 30 15 25 135 201 Lewisham 165,249 33f,6 1714 6 - 11 6 24 27 26 115 236 Woolwich 121,932 2738 1411 2 1 31 4 27 20 10 128 200 ° For the purpose of this table the Births registered in London have been corrected by distributing those which occurred in the principal institutions receiving maternity cases to the boroughs in which the mothers resided. In 1252 cases the residence was outside the County of London and these cases have been excluded. On the other hand 44 births that occurred outside the County have been included. With regard to the Deaths of London residents, all transferable deaths (ie., 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 Boroueh to which the deceased belonged. Of the deaths registered in London the previous residence was outside the county in 3092 cate s, while on the other hand the deaths of 2719 London residents occurred in the Outer Ring or in Metropolitan rstitutions 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 1912. Boroughs. Per 1000 Persons Living. Rate per 1000 Births. Births. Deaths from All Causes. Enteric Fever. Small-pox. Measles. St arlet Fever. Whooping-cough. Diphtheria Phthisis. Diarrhcsa and En- teritis (under 2 years). Total Deaths under 1 yeart. Clude. Corrected* COUNTY OF LONDON 245 136 136 003 0.00 0.40 0.04 0-22 0.10 1.35 12.42 91 West. Paddington 21.3 12.3 12.3 0.01 0.22 0.02 0.14 0.04 0.87 14.23 98 Kensington 19.1 13.0 12.9 0.02 — 0.16 0.03 0.14 0.01 1.07 11.12 91 Hammersmith 23.5 13.1 13.0 0.03 — 0.24 0.03 0.14 0.11 1.35 10.07 90 Fulham 27.2 12.8 13.2 0.05 - 0.42 0.04 029 0.10 1.35 7.83 94 Chelsea 18.8 14.6 13.8 0 .02 — 0.34 0.03 0-21 0.08 1.30 6.51 68 City of Westminster 15.0 12.4 13.0 0.03 — 0.24 0.03 0.10 0.07 1.17 16.18 84 North. St. Marylebone 19.4 13.8 14.1 0.01 0.35 0.09 0.16 0.07 1.26 11.59 93 Hampstead 14.9 9.8 10.1 0.01 — 0.13 0.01 0.05 0.20 0.64 0.78 62 St . Pancras 24.9 14.6 14.6 0.01 - 0.44 0.02 0.20 0.12 1.58 6.89 88 Islington 25.2 14.3 14.0 0.02 - 0.46 0.03 0.18 0.12 1.35 10.96 87 Stoku aewington 20.5 12.1 11.5 — - 0.10 - 0.06 - 0.87 2.90 72 Hackney 23.7 12.1 12.2 0.01 — 0.09 0.04 0.15 0.05 1.36 11.39 80 Central. Holborn 18.8 15.3 15.4 0.02 - 0.52 - 0.15 0.15 2.07 8.87 80 Finsbury 30.0 18.8 18.6 0.01 - 1.50 0.06 0.31 0.15 1.92 17.09 114 City of London 9.9 13. 5 14.0 — — 0.11 — 0.05 0.05 1.98 21.62 81 East. Shoreditch 32.3 18.1 18.7 0.01 - 1.05 0.05 0.43 0.17 2.10 26.39 123 B BETHNAL GREEN 30.6 15.3 15.9 0.02 - 0.71 0.02 0.25 0.09 1.69 12.30 96 Stepney 50.9 15.2 15.9 0.03 — 0.61 0.05 0.35 0.09 1.68 l7.93 105 Poplar 31.3 16.4 16'.2 0.04 — 0.69 0.02 0.40 0.11 1.51 13.48 107 South. Southwark 29.5 16.7 16.8 0.02 - 0.73 0.03 0.26 0.11 1.87 18.61 105 Bermondsey 31.0 16.8 16.8 0.04 - 0.82 0.06 0.29 0.13 1.75 17.30 111 Lambeth 23.4 13.3 13.0 0.04 - 0.33 0.03 0.19 0.10 1.37 14.10 86 Battersea 25.5 12.2 12.3 0.01 - 0.33 0.04 0.21 0.09 1.17 11.74 84 Wandsworth 21.0 10.2 10.2 0.02 - 0.16 0.03 0.19 0.06 0.93 10.80 76 Oamberwell 24.6 12.9 12.7 0.02 — 0.31 0.03 0.20 0.08 1.30 10.12 83 Deptford 26.6 13.1 13.0 0.02 - 0.26 0.06 0.23 0.10 1.35 10.01 89 Greenwich 25.0 13.1 12.9 0.02 — 0.29 0.09 0.31 0.16 1..11 10.46 84 Lewisham 20.4 10.4 10.2 0.04 — 0.07 0.04 0.15 0.16 0.70 7.75 70 Woolwich 22.5 11.6 11.9 0.02 0.01 0.25 0. 03 0.22 0.16 1.05 3.65 73 * The Corrected death-rates represent the Crude death-rates multiplied by the respective Factors for Correction for eufferences of sex and age constitution of population in 1911 as compared with that of England and Wales 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 1907—11, and in 1912. Boroughs All Causes. Enteric Fevbr. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Phthisis. Per 1000 Births. Diarrhcea and Enteritis (under 2 Years). Total Deaths under Owe Year. 19071911. 1912 19071911. 1912. 19071911. 1912. 19071911 1912. 19071911. 1912 19071911. 1912. 19071911. 1912. 1907 1911. 1912. 19071911. 1912. 19071911. 1912. County of London . 14.7 13.6 0.04 0.03 0.00 0.00 0.45 0.40 0.09 0.04 0.28 0.22 0.14 0.10 1.37 1.35 The average mortality under this heading cannot be stated. 12.42 114 91 Paddington 13.4 12.3 0.03 0.01 0.32 0.22 0.07 0.02 0.24 0.14 0.09 0.04 1.10 0.87 14.23 107 98 Kensington 13.7 13.0 0.03 0.02 — — 0.31 0.16 0.03 0.03 0.25 0.14 0.12 0.04 0.98 1.07 11.12 120 91 Hammersmith 14.6 13.1 0.01 0.03 — —. 0.13 0.24 0.07 0.03 0.27 0.14 0.17 0.11 1.21 1.35 10.07 120 90 Fulham 11.1 12.8 0.01 0.05 — — 0.46 0.42 0.08 0.01 0.33 0.29 0.20 0.10 1.32 1.35 7.83 116 94 Chrlsea 15.6 14.6 0.03 0.02 — 0.37 0.34 0.05 0.03 0.22 0.21 0.13 0.08 1.47 1.30 6.51 109 68 City of Westminster 12.8 12.1 0.04 0.03 0.00 — 0.13 0.24 0.05 0.03 0.12 0.10 0.09 0.07 1.28 1.17 16.18 97 84 St. Marylebone 14.8 13.8 0.03 0.04 0.28 0.35 0.09 0.09 0.26 0.16 0.09 0.07 1.35 1.26 11.59 103 93 Hampstead 9.7 9.8 0.04 0.01 — — 0.11 0.13 0.01 0.01 0.12 0.05 0.09 0.20 0.71 0.64 0.78 70 62 St. Pancras 15.5 14.6 0.03 0.01 - — 0.44 0.4l 0.09 0.02 0.30 0.20 0.12 0.12 1.61 1.58 6.89 106 88 Islington 14.6 14.3 0.04 0.02 — — 0.43 0.46 0.07 0.03 0.28 0.18 0.13 0.12 1.29 1.35 10.96 108 87 Stoke Newington 12.4 12.1 0.04 — — — 0.26 0.10 0.09 — 0.25 0.06 0.06 - 1.02 0.87 2.90 87 72 Hackney 13.8 12.1 0.05 0.01 — — 0.37 0.09 0.09 0.04 0.26 0.15 0.13 0.05 1.28 1.36 11.39 109 80 Holborn 16.6 15.3 0.06 0.02 0.26 0.52 0.06 - 0.27 0.15 0.10 0.15 2.24 2.07 8.87 113 80 Finsbury 19.6 18.8 0.06 0.01 — — 0.72 1.50 0.11 0.06 0.42 0.31 0.19 0.15 2.14 1.92 17.09 134 114 City of London 15.3 13.5 0.05 — — — 0.10 0.11 0.03 - 0.14 0.05 0.07 0.05 1.66 1.98 21.62 98 81 Shoreditch 19.0 18.1 0.06 0.04 0.91 1.05 0.13 0.05 0.49 0.43 0.17 0.17 1.86 2.10 26.89 149 123 BETHNAL GREEN 17.3 15.3 0.07 0.02 - — 0.69 0.71 0.19 0.02 0.35 0.25 0.16 0.09 1.65 1.69 12.30 134 96 Stepnby 16.9 15.2 0.04 0.03 0.01 — 0.75 0.61 0.13 0.05 0.53 0.35 0.19 0.09 1.69 1.68 17.93 125 105 Poplar 17.2 16.4 0.06 0.01 0.00 — 0.74 0.69 0.15 0.02 0.45 0.40 0.20 0.11 1.38 1.51 13.48 130 107 southwark 18.2 16.7 0.04 0.02 0.68 0.73 0.09 0.03 0.34 0.26 0.17 0.14 1.95 1.87 18.61 130 105 Bbrmondsey 18.1 16.8 0.05 0.04 — 0.88 0.82 0.15 0.06 0.35 0.29 0.13 0.13 1.83 1.75 17.10 137 111 Lambeth 14.8 13.3 0.04 0.04 — — 0.37 0.33 0.09 0.03 0.25 0.19 0.15 0.10 1.48 1.37 14.10 110 86 Battkrsba 13 .8 12.2 0.03 0.01 —- — 0.47 0.33 0.07 0.04 0.31 0.24 0.14 0.09 1.30 1.17 11.74 109 84 Wandsworth 11.6 10.2 0.03 0.02 — — 0.33 0.16 0.06 0.03 0.26 0.19 0.10 0.06 0.92 0.93 10.80 97 76 Camberwbll 11.1 12.9 0.03 0.02 — — 0.40 0.31 0.07 0.03 0.26 0.20 0.13 0.08 1.28 1.30 10.12 104 83 Dbptford 15..1 13.1 0.05 0.02 0.51 0.26 0.08 0.06 0.35 0.23 0.14 0.10 1.32 1.35 10.01 119 89 Greenwich' 14.2 13.1 0.05 0.02 — — 0.12 0.29 0.06 0.09 0.31 0.31 0 14 0.16 1.18 1.11 10.6 111 84 Lbwisham 11.0 10.4 0.02 0.04 — — 0.13 0.07 1.07 0.01 019 (i 15 0.17 0.16 0.78 0.70 7.75 87 70 Woolwich 12.7 11.6 0.02 0.02 — 0.01 0.31 0.25 0.09 0.03 0-19 022 0.13 0.16 1.29 1.05 3.65 94 73 SUMMARY, 1911. 1912. Estimated Population of Bethnal Green— 128,217 127,985 Young Children, under 5 years 10,326 16,300 Old People, over 65 years 4,840 4,833 Area—759 acres. Number of Inhabited Houses 14,826 14,784 Rateable Value £535,170 £535,093 Average number of Persons to each House 8.6 8.6 Average number of Persons to each Acre 108 9 166.0 Total number of Deaths in the year 2,316 1,957 Total number of Births in the year 4,032 3,904 Total number of Marriages 1,005 1,084 Marriage Rate—Bethnal Green 15.7 16.9 Marriage Rate—London 17.8 13.6 Death Rate—Bethnal Green 181 15.3 Death Rate—London 15.0 13.6 Birth Rate—Bethnal Green 3.14 30.5 Birth Rate—London 25.0 24.5 Infantile Death Rate (on Births), Bethnal Green 122.6 96.0 Infantile Death Rate (on Births), London 128.0 90.0 Young Children's Death Rate (on estimated number of Young Children) 57.8 39.2 Old People's Death Rate (on estimated number of Old People) 920 92.7 Zymotic Death Rate (Bethnal Green) 34 1.45 Zymotic Death Rate—London 2.2 1.1 Inquest Cases 277 257 Metropolitan Borough of Betbnal (Breen. REPORT. To the Mayor, Aldermen & Councillors of the Metropolitan Borough of Bethnal Green. Sir and Gentlemen, In this my thirty-seventh Annual Report on the sanitary condition of Bethnal Green, I beg to lay before you the vital and mortal statistics of the inhabitants of the Borough for the year which terminated on the 28th day of December, 1912. POPULATION (Census, 1911). By the courtesy of the Registrar General I am able to present some of the revised figures of the census of Bethnal Green which was taken in April, 1911 ; the population was then found to be 128,183, divided as follows:— Ward. Sub-District. East 42,622 North East 63,966. North 21,344 South 34,479 South West 64,217. West 29,738 Males. Females. Under five years 8,260 8,066 65 years and upwards 2,099 2,741 12 POPULATION, 1912. The Registrar General's estimate of the population of the Borough in the middle of the year under consideration is 127,985 ; this figure is arrived at on the assumption that the rate of decrease obtaining during the ten years 1901 to 1911 has been maintained since April, 1911, and presupposes a continued decrease in our numbers during the year of 198 persons. As a fact the births in the Borough during this period exceeded the deaths by 1,947, so that the question naturally arises as to what has become of these 2,145 persons who must have gone elsewhere instead of remaining to swell our population. Moreover, as the foreign influx continues more or less, the number who have emigrated must largely exceed the figure 1 have set down. Table A shows these details and compares them with those of the previous year:— TABLE A. 1911 1912 Estimated population in the middle of the year 128,247 127,985 Total Births 4,032 3,904 Total Deaths 2,316 1,957 Excess of Births over Deaths, showing the natural increase of the population 1,716 1,947 BIRTHS. The children born actually in the Borough numbered 3,702, but in addition to these I have received information from Somerset House of what are 13 designated "transferable births," that is to say children born of Bethnal Green mothers away from home. These numbered 207, but as five infants were born in the Workhouse of mothers ordinarily residing outside Bethnal Green, they must be deducted, leaving a net total of 3,904. Registered Births 3,702 Inward transfers 207 Total 3,909 Deduct outward transfers 5 Balance 3,904 Details of " transferable births." City of London Lying-in-Hospital 32 British Lying-in-Hospital 1 Queen Caroline's Hospital 2 London Hospital 112 Mothers' Home, Commercial Road 34 Various 26 DEATHS. During the year 1,851 deaths were registered in Bethnal Green, but this total includes 307 non-residents who were under treatment in some one or other of the Public Institutions within our borders ; six other nonresidents died violent or sudden deaths and one was found dead in the waters of the canal. They were:— 1. The illegitimate infant of a domestic servant of St. Albans, Herts. It suffered from Rickets and died from Convulsions in Cambridge Road. 14 2. A van-salesman, aged 38, of Tooting Broadway, who suffered from Pulmonary Phthisis ; he died from Hoemorrhage at Oxford House. 3 The son, aged eleven, of a general dealer from Mile End ; he was run over by a steam waggon in Grove Road, and died from broken ribs and lacerated lung. 4. A woman, aged 38, the wife of a fruiterer from Shoreditch, died in Emma Street from the effects of a corrosive poison (Hydrochloric Acid). 5. The infant son of a carpenter from Walthamstow died in a tramcar in Hackney Road on the way to the Queen's Hospital. 6. A retired box-maker from Edmonton, aged 73, died from valvular disease of the heart in Mount Street 7. A man, occupation unknown, aged 35, of Braintree in Essex, was found drowned in Duckett's Canal near the Skew Bridge. The monthly returns of transferable deaths forwarded by the Somerset House Authorities contain particulars of 414 deaths ; these include, in addition to the deaths in Public Institutions, the names of six inhabitants of Bethnal Green who have died or were found drowned in various parts of London. They were:— 1. A publisher's packer of Warner Place, aged 67, who died on the premises of the Oxford University Press, Amen Corner, E C., from Hoemorrhage due to rupture of an Aneurism of the Aorta. 2. A railway porter of Pollard's Row, aged 31, was run over by a locomotive engine at Broad Street Station ; he died from fracture of the spine. 15 3. A bird-cage maker of Green Street, aged 51, died in Cable Street, Canonbury, of heart disease. 4. A caretaker, aged 51, of Brick Lane, died suddenly in St. Mark's Square, St. Pancras ; bis death was due to malignant disease of nose and pharynx. 5. An ironworker of Shipton Street, aged 38, was found drowned in the River Lea near Shurmur's Wharf, Hackney. 6. A carman, aged 50, of Great Eastern Buildings, was found drowned in the River Thames at Charlton. TABLE B. Public Institutions, situated outside the Borough, into which Bethnal Green residents have been received and where they have subsequently died:— All Saints' Home, Hackney 2 Babies' Home, Shoreditch 1 Banstead Asylum 3 Cancer Hospital, Chelsea 1 Cane Hill Asylum 1 Caterham Asylum 4 Charing Cross Hospital 1 Children's Hospital, Great Ormond Street 6 City of London Lying-in Hospital 1 Claybury Asylum 18 Colney Hatch Asylum 10 Darenth Asylum 1 Dartford Heath Asylum 7 Eastern Hospital, Homerton 32 East London Hospital, Shadwell 3 Fountain Asylum 3 Friedenheim Hospital 2 German Hospital 4 Guy's Hospital 2 16 TABLE B—continued. Hackney Infirmary 1 Hanwell Asylum 3 Home of the Good Shepherd, Shoreditch 3 Horton Asylum 4 Leavesden Asylum 8 London Hospital 194 Long Grove Asylum 2 Metropolitan Hospital 4 Middlesex Hospital 3 Mount Vernon Hospital 1 North Eastern Hospital, Tottenham 12 North Western Hospital, Hampstead 2 Park Hospital 10 Poplar Hospital 1 Queen Mary's Hospital 7 Royal Free Hospital 2 St. Bartholomew's Hospital 22 St. Joseph's Hospice, Hackney 2 St. Luke's House, Kensington 2 St. Pancras Infirmary 1 St. Thomas's Hospital 1 South Eastern Hospital 4 South Western Hospital 1 Shoreditch Infirmary 3 Stepney Workhouse 1 7, The Terrace, St. Pancras 1 Whitecliapel Infirmary 3 Deaths occurring in various institutions outside London, particulars of which were forwarded to me by the Registrar General and subsequently verified 14 414 17 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 175 945 7 47 10,995 Queen's Hospital for Children, Hackney Road 134 1,624 63 201 29,315 Mildmay Mission Hospital 50 559 11 19 11,285 Bethnal House Asylum 300 — — 26 — Bethnal Green Infirmary 669 3,164 586 18 — National Children's Home and Orphanage 300 — — — — 18 SUMMARY. Total deaths registered 1,851 Sudden deaths of residents outside the Borough 6 Deaths of residents in Institutions outside the Borough 414 2,271 From these must be subtracted Sudden deaths of strangers in Bethnal Green 7 Deaths of strangers in Bethnal Green Institutions 307 314 Net Total 1,957 DEATHS IN SUB-DISTRICTS. In the North East Sub-district 956 deaths occurred amongst the residents and 948 in the South West. Fifty-three persons who had no fixed home died in the Workhouse or in the Infirmary. These details are shown in Table D. TABLE D. District. Deaths. Population. North-East 956 63,860 South-West 948 64,125 Previous residence unknown 53 — Total 1,957 127,985 19 DEATH RATE. We show a mortality for the year 1912 of 15.3 per thousand living. This rate is nearly three per thousand below that of the previous year, calculated upon the population as estimated by the Registrar General, but it is nearly two points above the rate for London, which is 13'6 per thousand. MORTALITY RATE IN SUB-DISTRICTS. The death rate in the North-East sub-district was 14.9 and that in the South-West 14.8. These rates do not take into account the deaths of homeless paupers in the Workhouse as it is impossible to allocate them to any sub-district, though we must include them in the general rate for the whole of the Borough. Table E shows the mortality rates for Bethnal Green and for London, compared by months, the rainfall and the mean temperature for each quarter being also shewn. 20 TABLE E. Month. London Death Rate. Bethnal Green Death Rate. Mean Temperature (Degrees). Rainfall (Inches). January 15.5 17.3 } }42.3 } 9.73 February 17.0 18.6 March 13.5 13.2 April 13 5 15.2 } ) 53.3 } 6.65 May 12.7 13.1 June 11.1 10.7 July 11.2 12.6 } } 57.0 } 11.31 August 11.5 13.4 September 11.9 12.2 October 14.8 19.1 } }45.6 } 9.67 November 14.7 170 December 15.6 19.7 Average 13.6 15.2 49.2 Total Rainfall 37.36 Table F compares the death rates for London and for Bethnal Green by quarters:— 21 TABLE F. Quarter ending. London. Bethnal Green March 30th, 1912 15•3 16•6 June 29th, 1912 12•4 13•3 September 28th, 1912 11•5 12•6 December 28th, 1912 15•0 18•7 Yearly average 13•5 15•3 BIRTH RATE. The births actually registered in Bethnal Green during the year numbered 3,702, but to these must be added the balance of the transferable births (202) notified by the Registrar General, thus raising the total to 3,904, This gives a birth rate of 3055 per thousand population, nearly one per thousand below that of last year. The general London rate now stands at 24.5, a figure identical with that of the preceding year. Marriages, 1912. First Quarter 136 Second Quarter 262 Third Quarter 329 Fourth Quarter 357 Total 1,084 These figures indicate a marriage rate of 16.9 to every thousand persons, as against 18'6 in the County of London. 22 DEATHS OF INFANTS. About one-fifth (19.2 per cent.) of the total deaths at all ages were those of infants in the first year of life ; these numbered 375 and give an infantile death rate of 96 per thousand births. This is a very considerable decrease on the figure for 1911, which was 148. The general Metropolitan rate has also fallen to 90 as against 128 for the previous year. An inspection of the accompanying table of special causes of infantile deaths will demonstrate the fact that, though there has been an inprovernent all round the great diminution of mortality was due to the small number of deaths from infantile diarrhoea, a disease which was epidemic in the autumn of 1911 and almost absent in 1912; convulsions and marasmus, frequent results of severe diarrhoea, also show a marked decrease; and although the cold wet summer might have been expected to cause many deaths from respiratory diseases, the table shows a decrease of nineteen. The only cause, in fact, from which an increase is shown is suffocation, and this notwithstanding the urgent injunctions given to mothers by our woman Inspector. Miss Hammond tells me she always withholds such small benefits as are at her disposal in those cases where the infant is permitted to occupy the parents' bed, until this pernicious practice is discontinued. Seven infants died from Tubercular Meningitis, four from Tabes Mesenterica and eight from other forms of tuberculosis, a total of nineteen, which gives a mortality of 4.9, a figure identical with that of the previous year. 23 TABLE H. Special Causes of Infantile Deaths. Totals. Rate per thousand births. 1911 1912 1911 1912 Diarrhœal diseases 180 36 44•8 9•2 Premature birth, injury at birth and congenital defects, including Atelectasis 161 90 25•2 23•4 Respiratory diseases 92 73 22•9 18•7 Wasting diseases 64 41 16•0 10•5 Convulsive diseases 51 30 12•7 7•7 Common infectious diseases 39 30 9•7 7•7 Suffocation 22 26 5•5 6•6 Tubercular disease 20 19 5•0 4•9 24 QUARTERLY AND ANNUAL DEATHS AND MORTALITY RATES. Tables I and J are compiled from the quarterly returns of the Registrar General and are subject to correction on publication of the Annual Return. They show, in addition to the actual number of deaths, the quarterly and annual rate 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 number of deaths week by week in the Borough, corrected for institution deaths. 1912. Deaths from all causes 25 TABLE I. Quarterly Mortality for the Borough of Bethnal Green. 1912. Estimated Population in the middle of 1912. Births. All Causes Enteric Fever. Small Pox. Measles. Soarlet Fever. Whooping Cough. Diphtheria. Diarrhoea and En teritis 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 Diarrhoea and Enteritis (under 2 years). Pulmonary Tuberculosis. Deaths under 1 year to 1000 Births Regis tered. Borough of Bethnal Green. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 March 30th 127,985 978 530 2 — 2 1 6 4 4 60 84 16•6 0•06 — 00•6 00•3 0•19 0•13 0•13 1•88 86 Jane 29th 127,985 943 425 1 — 6 - 11 2 7 48 77 13•3 0•03 — 0•19 — 0•34 0•06 7•42 1•50 82 September 28th 127,985 854 401 — — 18 - 7 2 23 52 79 12•6 — — 0•56 — 0•22 0•06 26•93 1•63 93 December 28th 127,985 886 598 — — 65 1 8 4 14 56 135 18•7 — — 2•04 0•03 0•25 0•13 15•80 1•75 152 127,985 3,661 1,954 3 — 91 2 32 12 48 216 375 15•3 0•02 — 0•71 0•01 0•25 0•09 12•57 1•69 103 26 TABLE J. Quarterly Mortality for the County of London. 1912. Estimated Population in the middle of 1912. Births. All Causes. Enteric Fever Small-pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea and Enteritis (under 2 years ) Pulmonary Tuberculosis. jDeaths of Infants under 1 year of age. All Causes Enteric Fever. Small-pox Measles. Scarlet Fever. Whooping Cough Diphtheria Diarrhoea and Enteritis(under 2 years) Pulmonary Tuberculosis. Deaths under 1 year to 1000 Births Registered. County of London 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 March 30th 4,519,754 29,020 17,215 31 1 202 23 282 133 217 1711 2746 15•3 0•03 0•00 0•18 0•02 0•25 0•12 0•19 1•52 95 June 29th 4,519,754 27,854 14,015 27 - 433 42 354 99 207 1369 2293 12•4 0•02 - 0•38 0•04 0•31 0•09 7•43 1•21 82 September 28th 4,519,754 27,700 12,972 29 — 376 44 182 107 629 1333 2230 11•5 0•03 — 0•33 0•04 0•16 0•09 22•71 1•18 81 December 28th 4,519,754 26,938 16,899 30 — 788 50 152 113 318 1656 2787 15•0 0•03 — 0•70 0•04 0•13 0•10 11•80 1•47 103 4,519,754 111,512 61,101 117 1 1799 159 970 452 1371 6069 10056 13•5 0•03 0•00 4•00 0•03 0•21 0•10 10•53 1•34 90 27 DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES. Under Section 55 of the Public Health (London) Act, 1891, sixteen diseases are now compulsorily notifiable, the list having been increased by the inclusion of an obscure disease of the nervous system known (according as it affects either the brain or the spinal cord) as Polio-Myelitis or Polio-Encephalitis. The total zymotic deaths numbered 49 against 51 in 1911, a decrease of two. As these diseases are all of a very serious nature the majority of the sufferers require hospital treatment, so that most of those who fail to recover die away from home. The following table includes Measles and Whooping Cough, cases of which are now admitted to the Metropolitan Asylums Board's hospitals under certain conditions, although the diseases are not notifiable. Table K shows the deaths at home and in hospital from the diseases named in the margin. No death was recorded from Small-pox, Cholera, Typhus Fever, Relapsing Fever, Ophthalmia Neonatorum, Plague, Glanders, Anthrax, Hydrophobia. TABLE K. Disease. Deaths at Home. Deaths in Hospitals. Total. Scarlet Fever — 2 2 Diphtheria 1 14 15 Enteric Fever 1 2 3 Erysipelas 8 2 10 Puerperal Fever 2 7 9 *Measles 65 25 90 Cerebro-Spinal Meningitis 2 4 6 Polio-Myelitis 1 3 4 *Whooping Cough 20 8 28 * Not Notifiable diseases. 28 The large proportion of our Fever and Diphtheria patients are treated at the Eastern Hospital, Homerton; and, by the courtesy of Dr. Goodall, the Medical Superintendent, I am able to give the following statistics which refer to the whole number of persons treated during the past year in the hospital. They are as follow :— Scarlet Fever mortality 1.3 per cent. Diphtheria ,, 7.4 „ Enteric Fever ,, 23.0 ,, Dr. Goodall says in his letter to me: " There were only ten cases of Enteric Fever admitted during the year. The Scarlet Fever and Diphtheria mortalities are the lowest that have ever been recorded at the hospital. In fact, making allowance for some three or four cases amongst the Scarlet Fever deaths, in which the fatal issue was due to some previously existing disease and not Scarlet Fever, the mortality was only 08 per cent. There were 892 Scarlet Fever admissions and 376 Diphtheria admissions." THE SEVEN PRINCIPAL ZYMOTIC DISEASES. (Decennial average, 303). The total number of deaths usually included under this heading was 186, a decrease of 249, due chiefly to the diminished mortality from Measles and Diarrhoea, as will be seen from the following comparative table of mortalities in 1911 and 1912. 29 TABLE L. Disease. 1911. 1912. Measles 128 90 Scarlet Fever 6 2 Diphtheria 24 15 Whooping Cough 44 28 Enteric Fever 3 3 Diarrhœa 230 48 Totals 435 186 The death rate from these Zymotic diseases is 1.45 for 1912 against 3.4 for the previous year; the corresponding rates for the whole of London being 2.21 and 1.1. The deaths from Zymotic diseases form 9.5 per cent. of the total mortality from all causes. Table M shows the percentage of deaths from each of these diseases calculated on the total number of Zymotic deaths. TABLE M. Small Pox caused 0 deaths, 0 per cent. Measles „ 90 „ 48•40 „ or 1 in 2•06 deaths Scarlatina „ 2 „ 1•08 „ „ 93•00 „ Diphtheria „ 15 „ 8•06 „ „ 12•40 „ Whooping Cough „ 28 „ 15•05 „ „ 6•64 „ Enteric Fever „ 3 „ 1•61 „ „ 62•00 „ Diarrhœa „ 48 „ 25•80 „ „ 3•87 „ 30 NOTIFICATION OF INFECTIOUS DISEASES. Public Health (London) Act, 1891, s. 55. In accordance with the above Act, Medical Practitioners have forwarded to me a gross total of 867 notification certificates ; three of these were cancelled owing to inaccurate addresses and 88 (ten per cent.) were duplicates, so that the actual number of cases of infectious disease notified and dealt with was 779, a rate of six 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 sub-district in which such persons resided, and the number (485) of those removed to hospital. In fourteen instances information was received from one of the Medical Superintendents of the Metropolitan Asylums Board Hospitals to the effect that the diagnosis as stated upon the notification certificate was incorrect, a proportion of 1.8 per cent. on the whole. Table N sets out full particulars of all the notifications. 31 TABLE N. 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. Diphtheria 221 10 211 9 194 8 9 Membranous Croup 9 — 9 — 9 — — Scarlet Fever 294 12 282 12 268 2 5 Erysipelas 243 53 190 — — — — Enteric Fever 31 1 30 — 14 15 1 Ophthalmia Neonatorum 36 8 28 — — — — Cerebro-Spinal Meningitis 6 — 6 — — — — Puerperal Fever 19 3 16 2 — 14 — Polio-Myelitis 8 1 7 — — — — Totals 867 88 779 23 485 39 15 32 TABLE O. Condition of Premises where Cases of Infectious Disease have occurred during 1912. Scarlet Fever. Diphtheria. Enteric Fever. Satisfactory 141 125 8 W.C.'s or apparatus defective 12 16 2 Internal drainage defective 4 2 - External drainage defective 21 19 1 Minor Insanitary defects 120 99 16 Single room tenements 13 14 3 Overcrowded 1 1 — SCARLET FEVER. Deaths 2 (Decennial average 22). The type of this disease throughout the Metropolis continued to be of the mildest; 282 cases were reported in Bethnal Green, all of which, with the exception of twelve, were removed to Hospital; live of the cases so removed were found to be not suffering from Scarlet Fever. The case mortality on the remaining 268 was 075 per cent. as against 1.3 amongst all those treated at the M.A.B. Eastern Hospital. 124 of our cases were reported from the North East sub-district and 158 from the South West. The Inspectors report that the houses of 141 of the patients were in fair condition, but that in twelve instances the W.C., or apparatus connected with it, was in an unsatisfactory state; the drainage was defective in 25 instances and minor 1912. Scarlet Fever. 1912. Diphtheria. 33 insanitary defects obtained in 120. Thirteen persons were removed from single room tenements, one of which was overcrowded. I found the isolation in all the home cases fairly satisfactory. DIPHTHERIA. Deaths 15 (Decennial average 25). Diphtheria was notified in 221 cases and Membranous Croup in nine others. Ten of the certificates were duplicates. Nine persons, most of them suffering from a very mild form of the disease, were treated at home where one of them died; of the others 203 were removed to M.A.B. Hospitals and eight urgent cases were treated in local hospitals (London or Queen's). In nine instances information was received to the effect that the diagnosis as certified was incorrect. Of the 202 true cases treated in hospital fourteen died, a case mortality of 6.9 per cent. as against 7.4 amongst the whole of the Eastern Hospital cases. All the Diphtheria deaths were amongst young children aged less than five years, a mortality of 0.9 per thousand on the estimated population of young children. 103 of the cases were reported from the North-East sub-district and 117 from the South-West. The Inspectors report that 125 of the homes of the patients were satisfactory; in 16 others the W.C., or the apparatus connected therewith, was defective. Drainage defects were found in 18 and minor insanitary conditions in 99. Fourteen persons were removed from single room tenements, one of which was overcrowded. 36,000 units of antitoxin were supplied free during 34 the year, and 133 throat swabs were submitted to the Clinical Research Association for examination, 38 of which gave positive results and 95 negative ENTERIC FEVER. Deaths 3 (Decennial average 10). Thirty persons were certified as suffering from this insidious disease ; all except one, who was too ill to be removed, were treated in hospital. Fourteen of these were admitted to the M.A.B. Hospitals and 15 to General Hospitals. The case mortality was 6.6 per cent. The Inspectors report that 8 of the patients' homes were in fair condition, the W C.'s were defective in two, the drainage in one, and minor insanitary defects were found in 16, three persons being removed from single room tenements. Twenty-one of the patients were removed from the North-East sub-district and 9 from the South West Twelve of the sufferers had eaten fried fish, two shell fish, five ice-cream and five water-cress Twenty-four samples of blood in suspicious cases were examined at the request of medical practitioners; in six cases the reaction characteristic of Typhoid Fever was obtained, the remainder being negative. WHOOPING COUGH. Deaths 28 (Decennial average 50). All the deaths from Whooping-cough were amongst young children, a mortality on the population under five years of age of 1.7. Cases of this disease are now 1912. Enteric Fever. 35 accepted by the Asylums Board under exceptional circumstances, and 55 were removed to Hospital on the certificate of the District Medical Officers. DIARRHCEA (including deaths under two years of age from Enteritis). Deaths 48 (Decennial average 111). Thirty-six of the deaths from Diarrhceal disease were amongst infants under one year of age, a mortality at the rate of 9.2 per thousand births. Two-thirds of these deaths were certified as from Enteritis, and I have no doubt that most of them were due to improper feeding. All these cases were visited and reported upon by Miss Hammond. MEASLES. Deaths 90. (Decennial average 78). Though still above the average, the mortality from Measles has much diminished. All the deaths except five were amongst young children aged less than five years, a mortality of 5.2 per thousand children under that age. 849 cases of Measles were notified to us by Head Teachers of Elementary Schools; all were visited. 193 were found without medical attendance and 161 serious cases were removed to hospital where 25 died. The fatality of Measles is almost invariably due to lung complication, and is undoubtedly aggravated by faulty sanitation. Were every case of this disease treated under proper conditions, the mortality would be very slight. Warmth, good ventilation, proper bedding and good nursing would ensure the recovery of nearly 36 every sufferer; but a bed made up on two chairs in a stuffy living room certainly does not fulfil these requirements. The Authorities at the Local Government Board recognise these facts, but it is impossible to provide hospital accommodation for any but the worst housed cases. Acting on these lines, the Metropolitan Asylums Board now accept for removal cases of Measles certified by the Poor Law Medical Officers, and also such other cases as are certified by Medical Officers of Health to require removal on account of faulty home conditions. 61 such cases were removed during the year. As would naturally be expected, the death rate amongst these was high (41 per cent.), as many of them were not removed until after lung complications had set in. Still, there is no doubt that many of the survivors would have died had they remained at home under such unfavourable conditions as were found to exist. Measles is a disease which is almost invariably transmitted by direct personal infection, and as affecting school attendance is mostly confined to the Infant Department. Based upon this fact, the rule in force in the London County Council Schools is to exclude from attendance in the case of measles-infected houses, only the infants and the boys and girls who have not had the disease. With regard to disinfection, our rule is to offer it in all cases, but only in twenty-one instances was it accepted. I am not so much concerned at this refusal as the infection of measles is short-lived, and domestic cleansing, if thoroughly carried out, suffices for disinfection. 37 CHICKEN POX. (No death). The school authorities reported a total of 349 children with Chicken Pox; all were visited by the Inspectors and doubtful cases referred to me. In some of these the rash was so extensive as to give rise to a suspicion of Small-pox, but no case of this disease was discovered. ERYSIPELAS. The actual number of notifications of this disease was 243, no fewer than 53 of which were duplicates. The disease proved fatal in ten instances out of 190. It is not our custom to disinfect after Erysipelas; removal (except to the Infirmary) is almost impossible, as the General Hospitals will not accept cases of Erysipelas owing to the danger of conveying the disease to other patients with open wounds. In these circumstances I fail to see any good purpose served by the compulsory notification of this disease. DISEASES OF PARTURITION. Sixteen cases of Puerperal Fever were reported, with nine deaths. Six other women died from one or other of the diseases and accidents incidental to the puerperal state, these being :— Ante-partum haemorrhage 3 Post-partum haemorrhage 1 Endocarditis 1 Eclampsia 1 38 OPHTHALMIA NEONATORUM. During the year 36 notifications of this disease were received, but as eight were duplicates the number of cases was only 28. Full particulars of these will be found in Miss Hammond's Report. CEREBRO-SPINAL MENINGITIS. Six cases of this disease were reported, all of them proving fatal in hospital. I endeavoured to obtain on the County Council form full particulars of all the cases from the Hospital House-Physicians, but failed to do so in two instances. I presume that these gentlemen (who are unpaid officers) look upon the gratuitous filling up of these elaborate forms as a somewhat onerous duty. I think a small fee should be payable by the County Council in each case. POLIO-MYELITIS. Seven cases were notified, with four deaths, all of them of children under five years of age. An adult male, aged 31, is still under treatment. Full particulars were obtained in five cases and forwarded to Spring Gardens, but I received no reply to my request for particulars in two instances. TUBERCULOSIS. During the year 1912, Tuberculosis in its various forms caused 239 deaths, 15.3 per cent of the total mortality from all causes in Bethnal Green, a death rate of 2.3 per thousand population. Sixty-four of the deaths from tubercular disease were amongst young children, only three of these being from the pulmonary 39 form of the disease, a mortality of three per thousand children living. Seven infants died from tubercle of brain and four from tubercular disease of the bowels. PULMONARY PHTHISIS, The deaths from tubercular disease of the lungs numbered 205, equal to a rate of 1.62 against 1.35 for the whole of London. So far as Poor-Law Officers are concerned, this disease has been compulsorily notifiable since January, 1909; in May, 1911, the requirement was extended to the Medical Officers of Public Hospitals and Dispensaries, and in January, 1912, a third Order of the Local Government Board imposed a similar obligation upon private medical practitioners. Finally the three orders were revoked, and the Public Health (Tuberculosis) Regulations 1912, were issued. The new regulations provide for the notification of all hinds of Tuberculosis, and make considerable changes in the method of notification. By direction of the Public Health Committee the following circular letter was forwarded to all medical Practitioners in the Borough. December, 1912. PUBLIC HEATH (TUBERCULOSIS) REGULATIONS, 1912. Dear Sir, I beg to inform you that the above-mentioned Regulations will come into force on the first day of February next; the previous Regulations and Orders made thereunder, relating to the notification of Pulmonary Tuberculosis, are revoked from that date. The method of notification has undergone considerable modification. 40 A residential institution approved by the Local Government Board under the National Insurance Act, 1911, is termed a "Sanatorium." The new Regulations provide for the notification of all kinds of Tuberculosis, and forms for use thereunder (a supply of which will be forwarded to you immediately they are ready), provide for this and for the particulars which are already required; they must also state occupation of the patient. All Institutional Medical Officers are required to notify cases of persons suffering from Tuberculosis, with the exception of those who have already been reported, on the form designated A, within 48 hours to the Medical Officer of Health for the district within which the usual place of residence of the patient is situate. In cases which have been previously notified, Poor Law Medical Officers and Medical Officers of Sanatoria are required to send to the Medical Officer of Health weekly, on form C, a list of all such cases admitted during the week, which terminates at Saturday midnight. Cases discharged from Poor Law Institutions and Sanatoria, excepting those transferred to other Poor Law Institutions and Sanatoria, are to be notified weekly on form D. The two weekly lists are to be sent respectively to the Medical Officer of Health of the district of residence, and to the Medical Officer of Health of the district of destination. 41 It is expressly provided that diagnosis of tuberculosis shall not depend solely upon tuberculin reaction. Further, no medical practitioner shall notify a case if he has reasonable grounds for believing that it has been already notified under these or the previous Regulations. Notifications are to be forwarded in a sealed envelope addressed to the Medical Officer of Health of the district in which the patient's usual residence is situate. Poor Law Medical Officers will not be required in future to submit any account of fees claimed by them. It is the duty of the Local Authority to pay the amount of the fees due, as soon as may be practicable after the end of each quarter. Will Poor Law Medical Officers, therefore, at the end of the current month kindly let me have their accounts for notifications under the previous Regulations made during the month, and thereafter we will proceed as prescribed by the new Regulations. The scale of fees payable is set forth on the accompanying slip. Under the previous Regulations, Hospital Medical Officers sent all notifications to the Medical Officer of Health of the district within which their Institution was situate; under the new Regulations they will notify direct to the 42 Medical Officer of Health of the district of residence of patient at time of notification. For this purpose the lists of Medical Officers of Health in the Medical Directory (1913) will be found most useful:— (1) London MM.O.H page 441 (2) Provincial MM.O.H. ,, 1,199 In cases of great doubt provincial notifications might be sent to the respective County Medical Officers of Health, who would doubtless forward to the correct destination. I am, Dear Sir, Yours faithfully, GEORGE P. BATE, M.D., Medical Officer of Health. PULMONARY TUBERCULOSIS. Notifications during 1912. MALES. FEMALES. Insured. Not Insured. Insured. Not Insured. 160 127 46 172 No Information. 52 25 Total Notifications. 339 240 579 43 PULMONARY TUBERCULOSIS. Occupations of persons notified during 1912. Occupation. Males. Females. Total. Artificial Flower Makers — 3 3 Bag Makers 1 1 2 Bamboo Workers 2 — 2 Basket Maker 1 — 1 Bookbinding Trade 3 4 7 Boot and Shoe Makers 21 2 23 Box Makers 8 7 15 Brush Makers — 4 4 Butcher 1 — 1 Cab, 'Bus and Tram Workers 1 — 1 Cabinet Makers 25 — 25 Carmen 15 — 15 Carpenter 1 — 1 Carvers and Turners 4 — 4 Charwomen — 4 4 Chemists' Assistants 2 — 2 Clerks 8 — 8 Domestic Servants 1 2 3 Doorkeeper 1 — 1 Dress Makers, etc — 7 7 Electrical Worker 1 — 1 Engineers 2 — 2 Feather and Fur Workers 1 5 6 Fish Frier 1 - 1 French Polishers 1 2 3 Glass Workers 4 — 4 Gold and Silver Workers 2 1 3 Hairdresser 1 — 1 Hat and Cap Makers 4 4 8 Hawkers 10 4 14 Hebrew Teacher 1 — 1 Housewives — 105 105 Infants 5 2 7 Insurance Agents 2 — 2 Labourers—Corporation 3 — 3 Dock 6 — 6 Housebreaker 1 — 1 Moulder 1 — 1 General 9 — 9 Lamplighter 1 — 1 Carried forward 151 157 308 44 PULMONARY TUBERCULOSIS- continued. Occupation. Males. Females Total. Brought forward 151 157 308 Laundresses — 5 5 Leather Workers 2 2 4 Lodging House Keeper 1 — 1 Machine Boy 1 — 1 Mason 1 — 1 Messengers 2 — 2 Milk Dealer 1 — 1 Missionary (Jewish) 1 — 1 Motor Worker — 1 1 Packers—Furniture 4 — 4 Printer 1 — 1 General 1 — 1 Packing Case Maker 2 — 2 Painter 1 — 1 Picture Framers 2 1 3 Porters and Warehousemen 8 - 8 Post Mistress — 1 1 Printers, Compositors, etc. 8 — 8 Public House Employees 12 1 13 Rag Sorter 1 — 1 Railway Workers 6 — 6 Saw Mill Workers 6 — 6 School and Office Cleaners — 3 3 School Children 25 19 44 Sewer Man 1 — 1 Shop Assistants 1 1 2 Shop Keepers 3 — 3 Sieve Makers 2 — 2 Silk Workers — 2 2 Stick Makers 2 — 2 Tailors 16 11 27 Tobacco Workers 5 1 6 Umbrella Repairer — 1 1 Upholsterers 2 3 5 Waiters and Valets 3 — 3 Watchmaker 1 — 1 Window Cleaner 1 — 1 No occupation 13 9 22 No information obtainable or person removed 52 22 74 339 240 579 45 In addition to the total of 579 local cases of Phthisis notified under the existing tuberculosis regulations, 1,196 certificates referring to persons ordinarily residing outside Bethnal Green were received About 90 per cent. of these were sent by the Medical Officers of the City of London Hospital for Diseases of the Chest, and the remainder from the Queen's and Mildmay Hospitals. These certificates were (as required by the regulations then in force) forwarded to the M.O H. of the district in which the patient ordinarily resided, and the Medical Officer who signed the certificate was notified that this had been done. This complicated method of notification is now abolished by the new regulations, and the simpler practice of Sec. 5 of the Public Health (London) Act, 1891, is followed, but dual notification is not required. 148 specimens of sputum were submitted to the Clinical Research Association for examination. The tubercle bacillus was detected in 25, the examination being negative in 123. FAIRLIGHT SANATORIUM. Report of the Medical Officer of Health on the Borough Council's Scheme for the treatment of persons suffering from Pulmonary Tuberculosis at Fairlight Sanatorium. 10th December, 1912. The arrangements for the retention of six beds at Fairlight Sanatorium for the treatment of residents of this Borough suffering from Pulmonary Tuberculosis came into force on the 1st February, 1911. 46 Since that date there have been 82 candidates for Sanatorium treatment. Of this number 22 withdrew for various reasons before they were medically examined. The majority of these last were at work, and feared that during their absence at the Sanatorium their families would be in need, and further that they would not be reinstated at their place of employment upon return. A smaller number were admitted to the Infirmary, and the remainder removed from the Borough or died. The remaining 60 patients were all examined by me, and were disposed of as follows:— Approved for treatment 42 Rejected 18 The 42 patients approved were again divided as follows:— Treated at Fairlight (to 11th December, 1912) 33 Awaiting interview with the Committee 1 Refused to go to Fairlight, mainly owing to necessary dental treatment required, and for domestic and business reasons 8 To the end of November, 1912, the total cost of the scheme from its inception in February, 1911, was £579 10s. 3d., representing an outlay of £17 l1s. 2d. per head admitted to Fairlight Sanatorium. 47 Our experience of the treatment of patients under the agreement is now fairly extensive, and is somewhat disappointing. To avoid misapprehension I must say that the actual treatment at Fairlight Sanatorium appears to be all that can be desired. The patients return immensely improved in health with the disease arrested, and with glowing accounts of treatment received; but other causes outside the control of the Council or of the Sanatorium Authorities operate adversely. In the first place, we have been unable to secure the most suitable patients, as these, in the majority of cases, are the family breadwinners and whilst they can work prefer not to go away, especially as in the majority of cases ultimate loss of employment is feared. For these reasons application for treatment is delayed until a time when they are less able to work, and when the disease has reached a less tractable stage. Others refuse to undergo the slight dental treatment necessary to secure to them the full benefit of the treatment at Fairlight. As mentioned above, the majority of patients treated return immensely improved in health generally, and with the disease arrested, but many of these, owing probably to the lack of proper surroundings and suitable employment on return, soon again become ill It will also be observed that a very small number of patients can be treated under the existing agreement. 48 To sum up, the greatest difficulties in the way of the successful application of the present system are those of inducing patients to enter the Sanatorium whilst the disease is yet in a stage amenable to Sanatorium treatment, and that of the provision of proper surroundings and employment upon their return. The latter difficulty is one which the Committee are entirely unable to remove. The former is to some extent met by the adoption of constant inspection and the advising of patients as to precautions relating to their methods of life, both being measures already carried out by the Sanitary Inspectors, as well as by the gratuitous supply of spittoons and flasks for indoor and outdoor use, and the distribution of printed leaflets of advice to consumptives. All these methods are in force throughout the Borough, but I am strongly of opinion, with regard to the institutional side of the treatment, that this should be provided within the Borough, a course which would minimise, if not entirely abolish. some of our present difficulties. GEORGE P. BATE, M.D., Medical Officer of Health. 49 Cases of Phthisis treated at FAIRLIGHT SANATORIUM during 1912. Initials. Address. Age. Trade. Dates of Admission and Discharge. Remarks of Medical Superintendent on Patient's Discharge. C. L. Winchester Place 24 Labourer 2nd Jan. to 29th Jan. Discharged himself. H. H. Crescent Place 34 Cabinet fitter 10th Jan. to 9th April Discharged for intemperance; improved in health. C. G. Totty Street 39 Furniture packer 8th Feb. to 1st June Disease arrested. P. N. Tagg Street 48 Bricklayer's Labourer 12th Feb. to 2nd Sept. Much improved. W. B. Ellesmere Road 18 Railway Van Guard 1st April to 28th Sept. Disease arrested. C. H. Green Street 24 Yard man 11th April to 6th Aug. Disease arrested. H. T. Prospect Terrace 35 Dust carrier 15th April to 25th May Left for family reasons. T. W. Coventry Street 36 Labourer 29th May to 12th Oct. Much improved. S. B. Lessada Street 29 Sawyer 5th June to 28th Sept. Disease arrested. J. C. Virginia Road 22 Cabinet maker 10th June Still at Fairlight. 50 FAIRLIGHT SANATORIUM—continued. Initials. Address. Age. Trade. Dates of Admission and Discharge. Remarks of Medical Superintendent on Patient's Discharge. F. O. Cookham Buildings 16 Clerk 12th Aug. to 18th Jan. Disease arrested. J. V. Chilton Street 34 Telephone wireman 28th Aug. to 16th Nov. Much improved. C. B. Auckland Road 25 Cigar maker 30th Sept. to 31st Jan. Disease arrested. R. C. Robinson Road 35 Carpenter 30th Sept. to 21st Dec. Disease arrested. H. J. Busby Street 27 Wood Carver 28th October Still at Fairlight. F. C. — — Sewer man 16th Doc. to 18th Jan. Seems in good health; left for family reasons. W.H. Emma Street 39 Warehouseman 28th Dec. to 31st Jan. Needed longer treatment. 51 THE NATIONAL INSURANCE ACT, 1911, AND TUBERCULOSIS DISPENSARIES. This Act came into force in the middle of the year 1912. Inter alra, it revolutionizes medical practice amongst persons earning less than £160 per annum, as it abolishes the Club Doctor and substitutes an enormously extended form of contract medical practice. The effect of this change must of necessity be farreaching, for although almost every thoughtful artisan is a member of some benefit society, and many of these societies formerly included the services of the club surgeon amongst the benefits given for the quarterly subscription, yet the large majority of the lower ranks of working men, and nearly all the women workers, have been ill-provided with medical care. It is a fact that many of the workers are of necessity improvident, the wages they earn only suffice for a hand to mouth existence, and moreover, they are liable to spells of unemployment. For these reasons they are barely able to meet the home expenses of even a short illness and are quite unable to pay the doctor in addition. In these circumstances they have in the past been compelled to fall back upon charity for medical attendance as is evidenced by the crowded condition of the outpatient rooms of Public Hospitals. The Insurance Act changes all this; all employed persons are now entitled as a right to free medical attendance and a weekly money payment during illness. The Hospital authorities are naturally afraid that the new Act will interfere with their receipts from the charitable public, and the special Chest Hospitals, such 52 as Victoria Park and Brompton, are still more concerned as the proposed tuberculosis dispensaries will to a certain extent compete with their out-patient departments. On this point there appears to be a good deal of misconception on the part of the Chest Hospital authorities. In my opinion there is plenty of room for both institutions. The Chest Hospital is mainly concerned with the restoration to health of such phthisical persons as apply to them for treatment, whereas the staff of a Tuberculosis Dispensary deals more directly with methods of prevention; its officers look for the seeds of disease amongst persons who have been in contact with known cases of Phthisis, many of whom are quite unaware that they have anything wrong with them until this is revealed by the examination of the Tuberculosis Officer. It will also be the duty of this officer to deal with and rectify faulty habits and home conditions, of which the Hospital Medical Officer can have no cognizance. Moreover, the true functions of the Hospitals will in no way be interfered with, as cases requiring treatment in the wards must still be referred to them. The National Insurance Act includes in its provisions a gigantic scheme having for its object the treatment and ultimate abolition of tuberculosis, and one of the inducements held out by the Chancellor of the Exchequer to get medical men to work under the Act was the promise that they would be entirely relieved of the treatment of all forms of tuberculosis. His idea evidently was that cases of this disease require treatment by specially trained physicians. The intense 53 disfavour with which the Act was received by the medical profession caused Mr. Lloyd George to modify his original scheme, and payment for the domiciliary treatment of tuberculosis has been promised to the Doctors on the Insurance Panel as a make-weight. This change will certainly modify the financial position of Tuberculosis Dispensaries, inasmuch as the amount available for Sanatorium treatment will be diminished by the sum paid to the Doctors on the Insurance Panel for the domiciliary treatment of tuberculosis. Early in June a circular letter from the Local Government Board, addressed to County and Borough Councils, drew attention to the desirability of organizing one or more Tuberculosis Dispensaries in each Metropolitan Borough. The letter was referred to the Public Health Committee, and I was directed to prepare a report on the exact liability of the Council as to the medical treatment of tuberculosis under the Public Health (London) Act, 1891, the National Insurance Act, 1911, and the various Orders of the Local Government Board then in force. The report, dated July 9th, was as follows :— Pulmonary Tuberculosis. Since Tuberculosis has been made a compulsorily notifiable disease, regulations have been issued by the Local Government Board imposing upon Sanitary Authorities, and their officers, certain definite duties and obligations for the administrative control of the disease. These are:— (1) The Borough Council must provide and supply printed copies of the scheduled notification form, must pay certain fees to medical men for notification 54 certificates, and must repay any expenses incurred by the Medical Officer of Health in carrying out these requirements. (2) The Medical Officer of Health must keep a register containing full particulars of every notification relating to a patient residing in his own District. (3) The Medical Officer of Health for the District must forward, weekly, to the County Medical Officer of Health, a complete statement of every notification received, containing full particulars of each case. (4) Under Article viii. of the Order of the Local Government Board (dated 15th November, 1911), upon receipt of a notification, the Medical Officer of Health or some officer acting under his instructions must visit the address of the patient, make certain enquiries, and take such steps as may appear to him to be necessary or desirable for preventing the spread of infection, and for removing conditions favourable to infection. All these directions are compulsory and must be obeyed. Also, under Article ix. of the previously-mentioned General Order of the Local Governmeut Board, the Borough Council may supply such medical assistance, nurses, etc., as are necessary for treating cases of Pulmonary Tuberculosis in their own homes, or in dispensaries or other institutions, or may subscribe to a sanatorium or dispensary. " Sanatorium treatment," in addition to medical treatment, may include broadly anything which may tend to increase the patient's resistance to disease, such as healthy surroundings, pure air, good light and sufficient food. Section 75 of the Public Health (London) Act, 1891, emp nvers a Borough Council to build a hospital, contract for the use of a hospital, or enter into an agreement with 55 the managers of any hospital, for the reception of the sick inhabitants of the District. Under Section 77, the Council may, (with the sanction of the Local Government Board) themselves provide, or contract with any person to provide, a temporary supply of medicines and medical assistance for the poorer inhabitants of their District. Further powers are conferred by Section 82, but these are only operative when certain regulations known as the " Epidemic Regulations " are issued by the Local Government Board. None of these powers except the last is compulsory upon Borough Councils, and no penalty can be inflicted for failing to put them in force. The Public Health (London) Act has been in operation for twenty-one years, and I know of no instance where Sections 75 and 77 have been put in operation beyond the contracting with Sanatoria and Hospitals, such as we have already done with Fairlight. The Sections were, I believe, included in the Act with a view of meeting any sudden epidemic, such as Plague or Cholera, which could not be adequately dealt with by existing Hospitals. It is highly improbable that it was ever intended that Metropolitan Borough Councils (the old Vestries) should enter into competition with existing Hospital Authorities for the treatment of general disease; and twenty years ago Pulmonary Tuberculosis was not recognised as communicable. Notwithstanding this, the clauses undoubtedly confer upon Borough Councils the powers to erect Sanatoria should they think fit to do so. Article IX. of the Local Government Board's Regulations previously referred to, is on quite a different footing. It is not confined to London, but applies to the whole of England and Wales. It was drawn expressly to authorise Borough Councils to undertake the treatment of disease in addition to preventive measures, and though an Anti-Tuberculosis 56 Dispensary is not actually mentioned, an Institution of this kind is clearly indicated, and, in my opinion, the Borough Council of Bethnal Green is under a moral obligation to take steps to provide one. The National Insurance Act, 1911, creates an Insurance Committee for every County and County Borough, but it entirely ignores the Metropolitan Borough Councils and makes the County of London the unit. The London Insurance Committee will be required by the Act to deal with the treatment of Tuberculosis so far as it affects insured persons and perhaps their dependents. This Committee may contract with the managers of existing institutions (other than Poor Law), but cannot themselves erect or control Sanatoria; they must arrange with the London County Council for the erection of buildings, and this authority will be entitled to a share of the money set aside by the Finance Act of 1911, which is earmarked for the erection and maintenance of Sanatoria. The Insurance Committee will have no power to control these Sanatoria, when erected, but they must administer the " benefit" which is only to be granted on their special recommendation, and would, I suppose, be confined to insured persons and possibly their dependents. As only a small proportion of the present sufferers from Phthisis in Bethnal Green are employed contributors under the Act, the greater number would be outside the Insurance scheme, and this is exactly where the obligations of the Borough Council come in. We have in the Borough at the present time about 637 reported cases of Pulmonary Tuberculosis. Most of them are under treatment at hospitals, dispensaries or Poor Law infirmaries, but the large proportion are remaining at home and quite unable to provide proper healthy surroundings. 57 In the interim report of the Departmental Committee on Tuberculosis, it is urged that any scheme that is to form the basis of an attempt to deal with the problem of Tuberculosis should provide:— (1) That it should be available for the whole community. (2) That a definite organization should exist for the detection of disease at the earliest possible moment. (3) That the best methods of treatment should be available for all those suffering from the disease. (4) That concurrently with these methods of detection and treatment provision should ,be made for increasing existing medical knowledge of the disease, and of the methods for its prevention and cure, by research. The Tuberculosis Committee point out that the first unit should consist of the tuberculosis dispensary. This I referred to and described in a previous memorandum. The Departmental Committee are of opinion that one tuberculosis dispensary will be required in the immediate future for every 150,000 of the population in Metropolitan Districts. So far as I can ascertain, the cost of such dispensaries as have been established in London have averaged from £750 to £1,000 per annum. George Paddock Bate, M.D., Medical Officer of Health. 58 It is quite possible, having regard to the provision of Section 75 of the Public Health (London) Act, empowering Local Sanitary Authorities to provide sanatoria and hospital treatment, that strong pressure may be brought to bear upon Borough Councils, with a view to inducing them to exercise such power and to make provision for all cases not included in the National Insurance Scheme. Where there is so much that is confusing it is scarcely possible to hazard an opinion, but in view of the fact that there are numbers of cases of tubercular disease apparently unprovided for, and which cases will be quite unable to join any approved society, it seems reasonable to suppose that every attempt will be made to throw the cost of and responsibility for these cases upon the local authorities. It will doubtless be suggested that, under the powers of the above-mentioned section, to make provision for these cases is simply an ordinary duty devolving upon the local authority under the requirements of the Public Health (London) Act. The temptation to relieve the national scheme of such a large share of cost and responsibility is too apparent to be overlooked. In any case it seems desirable that this point of view may not be lost sight of, because there does appear to be at least a possibility that, in addition to a large increase of detail, and responsibility, your Council may find itself involved in the cost of providing dispensaries, plus the staff and all requisites necessary, and the supply of medical treatment for such cases as cannot come in the general scheme of approved society and deposit contributors. John Foot, Chief Sanitary Inspector. The following extract.is taken from a Memorandum issued by the National Health Insurance Commission, dated 6th July, 1912. 59 The Dispensary Unit. 15. The term "dispensary" is used in this connection in a special sense as a local centre of expert diagnosis and treatment. As is pointed out in the Report of the Departmental Committee, the essential element is not the building but the expert medical officer to be designated the 'tuberculosis officer.' He should be a person of such experience, attainments, and professional status as are likely to command the confidence of the medical practitioners of the district, on whose effective co-operation the success of the whole scheme must largely depend. To carry out his duties efficiently he must usually give his whole time to the work of the dispensary. 16. Where necessary the tuberculosis officer will be assisted at the dispensary by a medical staff, which may include private practitioners giving part of their time to this work, and one or more junior whole-time officers. Arrangements for nursing will also usually be necessary. 17. When the scheme is in full operation, persons, whether insured or not, who are suspected to be suffering from tuberculosis should be examined by the tuberculosis officer or officers of the dispensary, who should recommend the kind of treatment most suitable for each. The tuberculosis officer and his assistants could thus act as the medical advisers of the Insurance Committee in carrying out its duty of deciding which insured persons should receive sanatorium benefit and what kind of treatment should be provided for each. In those cases which can best be treated at the dispensary itself the medical staff will give the necessary treatment. Where the case is treated at home under the care of a private practitioner, the tuberculosis officer will act as a consultant, and, with the dispensary staff, will assist the practitioner in such way as may be necessary. 60 When patients return home after a period of treatment in a residential institution, prolonged care and medical supervision may frequently be required, and it will be the duty of the dispensary stall: to co-operate with the private practitioners in carrying this out. The dispensary staff will also act under the direction of the Medical Officer of Health in carrying out any duties that are necessary for his assistance in administrative and preventive work for the protection of Public Health such as the examination of 'contacts,' i.e., persons who have been associated with tuberculous persons, and may therefore be themselves infected. In October I received a letter from the Medical Officer to the Local Government Board, desiring me to again draw the attention of the Borough Council to the advisability of proceeding with the organization of a Tuberculosis Dispensary in Bethnal Green. Accordingly, the following memorandum was prepared and submitted to the Public Health Committee:— Memorandum by the Medical Officer of Health re The Esiablishment of a Tuberculosis Dispensary. 22nd October, 1912. I have on two previous occasions reported upon the advantages of a Tuberculosis Dispensary, and as the period is rapidly approaching when the Council's contract with the Governors of Fairlight Sanatorium will expire, I think the time has arrived when it should be seriously taken into consideration whether their contract should be renewed or whether the £300 per annum now paid to Fairlight should be devoted towards the establishment and maintenance of a Tuberculosis Dispensary. The preliminary report of the Astor Committee urges the establishment of at least one Tuberculosis Institution in each Metropolitan Borough, and all the adjoining Boroughs are moving in this direction. 61 The Chancellor of the Exchequer recently received a deputation from the County Councils' Association on the question of a grant from public funds towards the necessary expenses of these dispensaries. He said that, so far as insured persons are concerned, it may be assumed that the Authority running the scheme of institutional treatment would receive the actual expenditure on the insured. Then there are the non-insured two-thirds of the population; the Government is willing to pay half the cost if the local authorities will pay the other half; therefore for a full scheme two-thirds will be paid otherwise than from the rates—part from the County Insurance Committee and part from the Grant. The maintenance of a Tuberculosis Dispensary should not exceed £1,000 per annum, so that the cost to the Borough Council would be very little more than what is now paid to Fairlight. As regards the initial expenditure, I understand from Mr. Willis, the Assistant Secretary to the Local Government Board, that the Government is willing to provide four-fifths of the cost of establishing a Dispensary. My idea of a scheme for the establishment of a Tuberculosis Dispensary is somewhat as follows:— (a) An arrangement might be made with the Governors of Queen Adelaide's Dispensary for the use of their building on a certain number of afternoons and evenings per week, or even every afternoon if found necessary. (b) A whole-time Tuberculosis Officer should be appointed at a salary of £400 or £500 per annum. This would secure a man of experience, in fact an expert. His duty would be to treat all patients able to attend at the Dispensary, to visit their homes, examine contacts, advise as to the removal of unfavourable home conditions, and report insanitary conditions to the Medical Officer of Health. 62 (c) The appointment of a Dispenser, who would also act as Secretary. (d) The appointment of one or two nurses or Health Visitors, who should keep the home conditions of the patients under observation and see that the medical instructions are faithfully carried out. (e) Finally, when patients are too ill to attend at the Dispensary, arrangements should be made with the private practitioners in the district to attend them at their own homes, as I am of opinion that domiciliary treatment, as such, should be no part of the duty of the Tuberculosis Officer (unless called into consultation by the attending doctor), as he would have plenty of visiting to do for the purpose of advising upon home conditions and of examining contacts. In submitting these remarks, which are of course somewhat sketchy, I need scarcely remind the Committee that although there is no legal obligation on this Council to provide a Tuberculosis Dispensary, yet the Government evidently expects that it will be done, and I strongly urge that the matter should receive early consideration. GEORGE P. BATE, M.D., Medical Officer of Health. Extract from the Interim Report of the Departmental Committee on Tuberculosis. 27. The chief tuberculosis officer of the dispensary should be independent of control by any other medical man so far as his clinical duties are concerned, and should, subject to his relationship to other officers as defined by the local authorities' regulations, be responsible for the management of these institutions. He should be in intimate relationship not only with Medical Officers of Health, but 63 also with the general practitioners in the locality, and the medical officers of the several institutions (sanatoria, hospitals, &c.), which constitute elements in the co-ordinated scheme. He should decide as to the suitability of patients for the sanatorium, the hospital for advanced cases, &c., in co-operation, so far as is possible, with the general practitioners and with the medical officers of these institutions. He should also be in close touch with other authorities (including those responsible for Poor Law institutions), charity organization societies, and all agencies, voluntary or otherwise, which have an interest in tuberculous persons. The Committee desire to lay emphasis upon the necessity of having suitably qualified and experienced medical men for the senior appointments in connection with the dispensaries and sanatoria. Indeed, the effectiveness and economy of the administration of the scheme suggested by the Committee will be dependent, in a large degree, upon the judicious selection of these officers. With a view to securing desirable officers the Committee recommend that, in giving or withholding approval, the Local Government Board should take into consideration the whole management and staffing of these institutions (including the tenure and other conditions of appointment of the staff), not only from the point of view of the advantage to the patients concerned, but in order to command the confidence and co-operation of the medical practitioners within the area. Whilst not desiring to lay down any hard-and-fast conditions, the Committee are of opinion that preference should be given to registered medical practitioners of suitable qualifications and experience and not less than twenty-five years of age, who have held house appointments for at least six months in a general hospital, in addition to a similar period of attendance at a special institution for the treatment of tuberculosis They should also be competent to supervise such laboratory work as may be necessary. 64 On December 19th, the Public Health Committee presented the following report to the Council (a) Local Dispensary for the Treatment of Tuberculosis. We report that we have carefully considered the question of the provision by the Council of a dispensary for the diagnosis and treatment of persons suffering from tuberculosis, and who are resident within the Borough. We have received a report from the Medical Officer of Health relating to the establishment of a tuberculosis dispensary, with a return as to the action being taken by other metropolitan borough councils in this matter generally, and in particular cases. At a recent conference between representatives of the Local Government Board, the National Health Insurance Commission, and the Medical Officers of Health of several Metropolitan Boroughs, it was stated on behalf of the Local Government Board that the Board looked to the Borough Councils, in the first instance, to provide dispensaries, or to satisfy themselves that there is a dispensary which serves the needs of patients in relation to dispensary treatment. We have also received a letter from the Insurance Committee of the County of London, expressing the opinion of the Bethnal Green local sub-committee that there should be in the Borough a fully equipped dispensary for the treatment of tuberculosis. In the circumstances we are of opinion that the question of the establishment in this Borough of a dispensary for the treatment of persons suffering from tuberculosis should be carefully considered by the Council, and in order that the matter may be fully investigated, we suggest that we be empowered to prepare a scheme to meet 65 the requirements of the Borough, and to report as to buildings and necessary staff, also the estimated costs and expenses which would be incurred. We therefore Recommend—That the Public Health Committee be empowered to prepare and submit to the Council a scheme for the provision by the Council of a dispensary for the treatment of persons suffering from tuberculosis. (Adopted). (b) Fairlight Sanatorium. We have had under consideration the agreement between the Council and the Governors of Margaret Street Hospital for the maintenance of six beds for the treatment of persons suffering from pulmonary tuberculosis resident in the borough, at Fairlight Sanatorium, Ore, Hastings, which expires on the 31st January, 1913. The Medical Officer of Health has reported to us as to the patients treated under the terms of the agreement. It has been our practice to interview patients both before and after treatment at the Sanatorium. From the report of the Medical Officer of Health, a copy of which accompanies this report, it is clear that there are persons suitable for and desiring treatment, but who are precluded from proceeding to Fairlight, as to do so would involve absence of the family breadwinners and their probable ultimate loss of employment. It is also apparent that the satisfactory results hoped for have not been attained owing probably to the lack of proper surroundings and suitable employment on return; further, the present arrangements permit of the treatment of a very small number of patients. We are of opinion that it would be more satisfactory for the Council to take action in relation to the treatment of persons suffering from tuberculosis by means of institutional treatment within the Borough, which would 66 afford proper assistance to many persons susceptible to treatment by that means, and that the expenses at present incurred should be available for the purpose of some other scheme upon which the Committee desire to report at a later date. We therefore Recommend —That the Town Clerk be requested to inform the Governors of Margaret Street Hospital that, inasmuch as the Council is about to consider a scheme with a view to the treatment of patients suffering from tuberculosis in the Borough by means of the Dispensary system, it is not the desire of the Council to make further provision for the maintenance of beds at Fairlight Sanatorium. (Adopted). J. ROBERTSON, Chairman. By direction of the Public Health Committee the Authorities of Queen Adelaide's Dispensary were first approached, but after consideration the Board decided that " a Tuberculosis Dispensary in their building would probably militate against the prosperity of the Institution; and, moreover, that as persons in an infectious condition would occupy the waiting rooms, a certain danger of communicating the disease to others would be incurred " ; they therefore declined to entertain the proposal. The matter was further discussed at a full meeting of the Public Health Committee, and a strong opinion was expressed, " That it is in the best interests of the Borough that Bethnal Green should have an Institution of its own entirely independent of existing hospitals, and run on municipal lines." Subsequently the Public Health Committee visited the Tuberculosis Dispensary at Deptford, which is in full working order, installed in an ordinary dwelling 67 house rendered suitable for the purpose. On their return they re-affirmed the principle of the establishment of a fully staffed tuberculosis dispensary under municipal control. The Borough Surveyor was requested to get out plans and estimates for rebuilding 18, Patriot Square, the Council's freehold property adjoining the Town Hall; these are being prepared and the whole subject is still under consideration. Since July I have acted as Tuberculosis Officer and at the request of the Insurance Committee have kept and supplied forms of application for Sanatorium benefit. Much time has been occupied in attendance at Committees, Conferences and correspondence with the London County Council and the Local Government Board also with medical practitioners and the Officers of the City of London Hospital for Diseases of the Chest, with reference to Sanatorium benefit including the domiciliary treatment of Phthisical persons and payment for the same. The work of the Department has also been materially increased by visits to the homes of insured consumptives for the purpose of giving advice, etc. CANCER. The various forms of malignant disease caused 121 deaths ; all the sufferers except one were over five years of age, and 103 were over 45. Cancer is a disease of degeneration and usually attacks people of middle or advanced age. The following list shows the organs and parts of 68 the body chiefly affected by malignant disease in order of fatality : — Stomach, Liver and Pancreas 30 Intestines 20 Larynx and (Esophagus 13 Female Organs of Generation 12 Female Breast 10 Rectum 8 Prostate and Male Bladder 7 Lung and Mediastinum 6 Tongue and Mouth 4 INQUESTS. The Inquests held numbered 257; 104 persons died violent deaths, of whom 13 committed suicide. SUICIDES. Four men and one woman drowned themselves ; two men and two women hanged themselves; one woman poisoned herself with opium, another with spirit of salt and a third with carbolic acid ; a man threw himself from a roof, and one man and one woman cut their throats. CUSTOMS AND INLAND REVENUE ACTS. 1890 to 1903. Application for exemption was received in respect of the following premises :— 374, 376 and 378, Hackney Road. Application was refused, as the premises do not comply with the requirements ; moreover, they are used for shops, and various sets of rooms are not selfcontained. BY-LAWS RELATIVE TO HOUSES LET IN LODGINGS OR OCCUPIED BY MEMBERS OF MORE THAN ONE FAMILY. The By-laws of the Council relating to houses let 69 in lodgings or occupied by more than one family were recast during the year. The original By-laws were made by the late Vestry in 1894, and were in conformity with the model By-laws of the Local Government Board. We, in common with other Borough Councils, had experienced great difficulty in the administration of the original By-laws, as was apparent in proceedings taken from time to time in the High Court. The Housing, Town Planning, etc., Act, 1909, sec. 16, provided against some of the difficulties which had arisen, and it was referred to the Town Clerk, the Chief Inspector and myself to prepare new draft Bylaws. This was done, and the draft was informally submitted to the Local Government Board, who approved same with little alteration. The By-laws were formally made and adopted by the Council on the 20th June, and were sanctioned by the Local Government Board on the 14th August. The principal amendments introduced consist of provisions for the exemption from the operation of the By-laws of certain classes of lodgings exceeding stated rental values, for regulating the removal of cases of infectious disease to hospital, and for the service of notice in the case of any breach of the By-laws. The maximum penalty upon conviction for offences has been increased from two to five pounds, and in case of repeated offences from ten to forty shillings daily. The original By-law prohibiting the occupation of a room by more than two persons above the age of twelve years and of opposite sexes was omitted, the Local Government Board being of opinion that such provision might operate oppressively. 70 HOUSING, TOWN PLANNING, ETC., ACT, 1909. Closing of Premises. During the year, 74 houses were closed ; 16 of these have been repaired and reoccupied, 18 have been demolished and 40 others still remain empty. Repairs under Section 15. 362 notices were served under the provisions of this section ; most of them were complied with and the remainder are in progress, though somewhat slowly. Section 15 of the Act provides that, in default of the owner carrying out the required works, the Borough Council may themselves enter the premises, execute the works specified in the notice served, and recover the cost from the owner. Unfortunately the Act contains no provision for making the expense so incurred a first charge upon the property, and there is great difficulty in ascertaining who is the responsible owner within the meaning of the Act. A circular letter was sent to all the London Borough Councils enquiring as to their views upon this section and the replies were unanimous as to the difficulties experienced or feared. Many of the Councils' advisers expressed themselves strongly to the effect that they were not prepared to recommend their Authority to enter premises and carry out work in view of the assumed difficulty in recovering the cost. As a matter of fact, no single Authority had at that time attempted to effect repairs under the section owing to this feeling of uncertainty. Notices were served in respect of 17 houses in Princes Court; these have not yet been complied with on account of other notices about to be served upon the owners (the lessees) by the freeholder in respect of dilapidations generally. It was felt that the two 71 matters might be more conveniently dealt with at one and the same time, consequently our notices were allowed to remain in abeyance for the present. Rebuilding Scheme. A letter was sent to the owner of 13 houses in Chambord Street and Gosset Street, calling attention to the worn out condition of the property and suggesting that, as the leases were falling in very shortly, the present time would be opportune for the consideration of a rebuilding scheme. After much correspondence and many interviews between the owners and the Public Health Committee it was arranged that clearance of the site, with a view to rebuilding the houses, should be taken in hand very shortly. Difficulties in Administration. Experience in working the Act proves that Local Authorities have to face unforeseen difficulties in enforcing closing orders under section 17. A certain Metropolitan Borough Council made a closing order on some houses, but on appeal to the Law Courts it was decided that the closing order so made was bad in law owing to the fact that the order as made contained no notice to the owner that he had a right of appeal to the Local Government Board. It seems somewhat peculiar that the Authority making the order should be required to indicate the method by which that order may be defeated. About two years ago another Metropolitan Authority made a closing order in respect of a certain house, which order, although made so long ago, is still a matter of unsettled litigation between the owner and the Local Authority. The house has continued to be occupied during the whole period. 72 In recent proceedings, following a closing order made by a neighbouring Authority, ten houses in a certain Court were included. The owners appealed to the Local Government Board with reference to five of them and the Board confirmed the closing order as to four of the houses but allowed the appeal as to the fifth. I took the opportunity of inspecting these houses, as an object lesson, and the opinion I formed was that there could be absolutely no doubt as to the four, and as to the fifth that the standard of the Local Government Board Inspector was a somewhat low one; moreover, the allowing of this fifth house to stand holds up any effectual rebuilding scheme. Contract with tenant under Section 14 It was hoped that a much higher standard of repair would have resulted from what was generally understood to be an implied contract between the owner and his tenant as to the repair and upkeep of premises under the provisions of this section. Recent litigation goes to show that this contract is strictly limited to the actual tenant and does not apply to other persons occupying the premises; hence the improvement to be looked for would appear to be very limited. Brady Street Unhealthy Area. As foreshadowed in my Annual Report for the year 1911, I made a formal representation to the London County Council in April, under Part I of the Housing, Town Planning, etc., Act, 1909. The formal document was accompanied by a coloured plan, tables of statistics, and the following explanatory letter:— 73 The Clerk to the London County Council, Spring Gardens, S.W. 4th April, 1912. Brady Street Area. Sir, Herewith a formal representation under Part I of the Housing of the Working Classes Act, 1890, as amended by the Housing and Town Planning Act, 1909. It refers to a small area in South-West Bethnal Green comprising the following streets and courts :— Brady Street West side 53 to 81 odd numbers), Dixie Street, Scott Street, Southampton Terrace, Tent Street, Somerford Street (South side, excluding Somerford Houses and Mission Hall), Collingwood Street (West side, excluding Delamere Dwellings), Cambridge Buildings (Darling Row;, Lisbon Street Buildings, Foster Street, Merceron Street, Brady Street (East side Nos. 82 to 140), James Yard, Holmes Avenue, Dagnall Place, Reuben Street, Tapp Street (Nos. 10, 12 and 14), Neath Place, Pereira Street, Colling Place, and Colling Street. The area contains 528 houses, inhabited by 3,058 persons. The average mortality from all causes in the area during the past three years has been at the rate of twentyfive per 1,000 living, as against seventeen in the whole of Bethnal Green for the like period. The death rate from zymotic diseases has been 4.4 against 1.7 for the whole Borough ; the tubercular rate 3.9 against 2.0, and the rate for diseases of the respiratory organs 6.3 as against 3.8. Roughly speaking, the mortality from each of these classes of disease in the Brady Street area has doubled that for the whole Borough. In the year 1904 a representation of an area somewhat smaller than the one under consideration was laid before the Council; the present representation includes that area and takes in the following additional streets :— 74 Tent Street, Scott Street, Southampton Terrace, Dixie Street, Brady Street (Nos. 53 to 81 odd), Foster Street (East side), Cambridge Buildings (Darling Row), and Lisbon Street Buildings. Sixty per cent, of the houses in this area are in such condition, either from position, original faulty construction, or decay, as to be absolutely unfit for human habitation; another thirty-three per cent. are more or less bad, but could be repaired and made habitable at the cost of considerable expenditure of money. During the seven years which have elapsed since the original representation was presented the houses in the area have steadily deteriorated. Many hundreds of sanitary notices have been served, Closing Orders on individual houses have been obtained, and an enormous amount of work has been carried out. Indeed, the supervision of this area absorbs almost the whole time of one sanitary inspector. Notwithstanding these efforts, the result is most unsatisfactory by reason of the original faulty construction of the houses, many of which are two roomed huts, built in the cheapest manner, of inferior and often second-hand material; these are so decayed that substantial repairs are impossible, and all that can be done is surface work and patching up. I have no doubt that this system of unsatisfactory repair has been going on for over half a century, for recently Mr. Foot, our Chief Inspector, having occasion to make a search at Spring Gardens for some drainage plans, came across a bundle of correspondence dated 1854, respecting the removal of some cess-pools and the re-drainage of certain premises in this very area. The then Surveyor of the Metropolitan Board of Works recommended 75 " That, having regard to the small and fourth-class character of the property, and its aged and worn out condition generally, it would only he necessary to make arrangements for its temporary drainage, as the premises would soon come down." This is nearly sixty years ago, and probably all the persons concerned in the transaction are dead, yet the houses are still standing and inhabited. The " temporary drainage " has been remodelled and brought up to date as occasion arose under the supervision of the officers of our Public Health Department, but had this been neglected or improperly carried out, the present excessive mortality would undoubtedly have been enormously increased. As probably you remember, the London County Council, in 1905, declined to act upon my representation as they had information that at no distant date the whole area would be re-developed by a private firm without expenses to the County. It was known as a matter of fact that a firm of brewers had purchased the southern portion of the area in 1903, with the intention of erecting a beer-bottling factory upon the site, but the intention was abandoned without any probability of revival. The erection of Model dwellings on the site by private firms is also most unlikely. Empty houses in Bethnal Green are common, and to my certain knowledge schemes for the erection of flats in the neighbourhood have been abandoned or curtailed. Under date March 18th, 1905, in reply to my appeal for a reconsideration of the Council's determination not to act, you advised Bethnal Green to exercise its powers under the Public Health and other Acts for remedying the evils connected with this area. This has been done, and much misery has been caused thereby; houses have been stripped and repaired after a fashion with tenants still in them, and, as 1 said before, with unsatisfactory results as to permanent improvement. 76 I am convinced that dealing with individual houses is worse than useless, for nothing short of an improvement scheme for entire reconstruction will widen any of the narrow streets or abolish the blind alley slums in this area. I have the honour to be, Sir, Your obedient servant, GEORGE PADDOCK BATE, Medical Officer of Health. To the London County Council, Spring Gardens, S.W. Housing of the Working Classes Act, 1890, as Amended by the Housing and Town Planning Act, 1909. 1 have the honour to report that I have investigated the sanitary condition of a small area in the South West Registration District of the Borough of Bethnal Green in the County of London. The area referred to is delineated and coloured red on the plan herewith annexed, and signed by me, and I hereby make an official representation within the meaning of the above Acts, to the effect following, that is to say : — 1. Most of the houses within the said area are unfit for human habitation. 2. The narrowness, closeness and bad arrangement of some of the Streets and Houses within such area, and the want of light, air and ventilation are dangerous and injurious to the health of the inhabitants of the buildings in the said area and of the neighbouring buildings. 3. That the evils connected with such houses and the sanitary defects in such area cannot be effectually remedied otherwise than by an improvement scheme for the re-arrangement and re-construction of the Streets and Houses within ths area. 1 have the honour to be, Sir, Your obedient servant, GEORGE PADDOCK BATE, Medical Officer of Health for Bethnal Green. 77 VITAL STATISTICS, BRADY STREET AREA. Name of Street. Population. Year. Deaths from Total Deaths from all Causes Death rate per 1,000 population. Zymotic Diseases Tuber cular Diseases. Respiratory Diseases. General Diseases. Brady Street (West Side, Odd Nos. 53 to 81.) 100 1909 i 1 2 1910 2 1 3 1911 — — -- 3 3 3 Years Total 2 — 1 5 8 26.6 Dixie Street. 173 1909 1 1 4 2 8 1910 2 3 2 7 1911 1 1 1 3 6 3 Years Total 4 2 8 7 21 40-4 Scott Street. 286 1000 1 2 2 10 1910 4 2 4 4 14 1911 1 2 2 5 3 Years Total 6 4 8 11 29 33-8 Southampton Terrace. 62 1909 1 1 1910 — — 1 1 1911 1 — — — _ 1 3 Years Total 2 — — 1 3 161 Tent Street. 233 1909 g 5 1910 1 1 6 7 1911 3 1 J 4 9 3 Years Total 8 2 2 14 21 300 Somerford Street, South Side,excluding Mission Hall and Somerford Houses. 173 1909 1 4 1 6 1910 1 1 1911 3 1 2 3 9 3 Years Total 3 Q 7 4 16 308 Collingwood Street,West Side, excluding Delamere Dwellings. 272 1909 - 1 2 2 5 1910 - - 3 2 5 1911 1 1 2 4 8 3 Years Total 1 2 7 8 18 22.1 Cambridge Buildings, Darling Row. 1909 1 - 1 1 3 196 1910 - 1 I - 2 1911 1 — 1 1 3 3 Years Total 2 1 3 2 8 13.6 78 Vital Statistics, Brady Street Area-continued. Name of Street Population. Year. Deaths from Total Deaths from all Causes. Death rate per 1,000 population. Zymotic Diseases Tubercular Diseases. Respir atory Diseases General Diseases Lisbon Street Buildings 227 1909 - 3 - - 3 1910 2 3 3 8 1911 1 — — 2 3 3 Years Total 3 3 3 5 14 20.5 Foster Street. 72 1909 — 1910 — — — — 1911 1 1 — — 2 3 Years Total 1 1 — — 2 9.2 Merceron Street. 99 1909 1 - 1 1910 1 3 4 1911 - — 1 1 3 Years Total 1 1 — 4 6 20.2 Brady Street, East Side (Nos. 82 to 140). 200 1909 1 2 3 6 1910 — 5 5 1911 1 — — 2 3 3 Years Total 1 1 2 10 14 23.3 James' Yard. 7 1909 — — — 1910 — — 1911 — — — 1 1 3 Years Total — — — 1 1 47.6 Holmes Avenue. 151 1909 — 2 1 3 1910 — 2 1 1 4 1911 1 — — — 1 3 Years Total 1 4 2 1 8 17.6 Dagnall Place. 90 1909 — 1 i — 2 1010 1 — 1 — 2 1911 — 3 — 2 5 3 Years Total 1 4 2 2 9 31.2 Reuben Street. 108 1909 — 1 — 1 1910 — 1 1 1 3 1911 — 1 — 1 2 3 Years Total — 3 1 2 6 18.5 79 Vital Statistics, Brady Street Area—continued. Deaths from Total Deaths from all Causes Death rate per 1,000 population. Name of Street. Population. Year Zymotic Diseases. Tubercular Diseas s. Respiratory Diseases. General Diseases. Tapp Street, Nos. 10, 12, 14. 6 1909 — — — 1 1 1910 — — — — 1911 — — — — — 3 Years Total — — — 1 1 55.5 Neath Place. 195 1909 — 1 2 — 3 1910 — 2 — 3 5 1911 1 1 3 2 7 3 Years Total 1 4 5 5 15 25.6 Pereira Street. 303 1909 — — 1 4 5 1910 1 2 3 6 1911 3 — 2 — 5 3 Years Total 3 1 5 7 16 17.6 Colling Place. 27 1909 1910 — — — — 1911 — — — 2 2 3 Years Total — — — 2 2 24.7 Colling Street. 72 1909 — — — — — 1910 4 2 1 7 1911 1 1 — — 2 3 Years Total 5 1 2 1 9 41.7 80 SUMMARY. Average Death Rates, per 1,000 population, for years 1909, 1910 and 1911. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. Area. Borough. Area. Borough. Area. Borough. 4-4 1-7 3'9 20 6-3 3 8 Population of Area 3,058 Deaths for 3 years 227 Death Rate for Area 24.74 Death Rate for whole Borough 16.71 Summary of Condition of Premises. Premises so badly situated, so damp or in such a condition of decay and dilapidation, as to be utterly incapable of conversion into healthy dwellings 59.28 per cent. Premises structurally defective, but capable of being altered and repaired so as to be made fit for human habitation 32.58 per cent. Premises in sound structural condition, some cleansing and minor repairs necessary 8.14 per cent. It may be useful here to recapitulate the general conditions and history of this locality. 81 The area of the Brady Street site is seven acres and one third, the density of the population is 417 persons per acre, the average mortality for the three years 1909 to 1911 was twenty-five per thousand living against seventeen for the whole Borough, whilst the rate for the whole of London was only fourteen. These facts show conclusively that the area is congested and unhealthy beyond any reasonable standard. There are no fewer than seven streets or passages that are actual blind-alleys or no-thoroughfares. There are five streets the width of which is less than fourteen feet; some of these are mere passages varying in width from three to seven feet (as is Neath Place) to 13 feet 8 inches (as is Colling Street). Many of the rooms in the houses are so small as to be incapable of occupation by more than one person without causing illegal overcrowding, and numbers of these rooms are so low that a tall man cannot stand upright in them. Back yards are very small and in many instances absent. The history of the district is instructive. The sewering of the area was under consideration in 1854, and the then Surveyor reported " That having regard to the small and fourth-class character of the property, and its aged and worn-out condition generally, it would only be necessary to make arrangements for its temporary drainage, as the premises would soon come down." Prior to the passing of any of the existing Housing Acts, I certified (in conjunction with Mr. Barratt, the then Surveyor) a number of these houses for dealing with under Torrens' Act, and many of them were closed and repaired. 82 Shortly after the Housing of the Working Classes Act, 1890, came into force, all the London Vestries and District Boards were called upon to make a special house to house inspection of their districts for the purpose of locating unhealthy areas. I then took steps to make representations as to two unhealthy areas, of which Brady Street was one and Boundary Street the other; both were submitted to the Medical Officer of the London County Council (Mr. now Sir Shirley Murphy). In the result it was agreed between us that, although the area now under consideration was almost as ripe for treatment as Boundary Street, yet it was not likely that the Council would undertake both, and ultimately I decided to make a formal representation of the Boundary Street area with the well known result. Although Boundary Street was taken and Brady Street was left, the Local Authority has continued to do what was possible by means of constant steady inspection. Since 1890 many hundreds of sanitary notices have been served, many individual houses have been closed and repaired and afterwards reoccupied for a few years, but owing to faulty construction and old age they have again had to be closed and the worst of them demolished. Drains have been reconstructed, yards paved, modern sanitary conveniences provided, and such cleansing and repairs as were possible carried out; but nothing in our power can abolish the defects inherent in original faulty construction or in those resulting from natural decay. In 1904 I made a formal representation under the 1890 Housing Act. On receipt of this the London County Council caused the usual enquiries and surveys to be made ; and, although they discovered nothing to 83 controvert the statements contained in that representation, they declined to undertake a clearance scheme on the ground that it would be unnecessary for the London County Council to act as the estates would shortly be developed by private enterprise. All this happened nine years ago, the private enterprise suggested has proved a myth, and the area remains just as it was, with the exception that it is nine years older and proportionately more decayed. The Local Authority and their Officers feel that all ordinary efforts have been exhausted and that anything short of an absolute and entire clearing away of this congested area is worse than useless. Since my last representation was made there has been the usual enquiry with many interviews and much correspondence. My statistics have been carefully checked, the area has been inspected on many occasions, not only by the responsible Officers of the Council, but by various Committees and individual members. Up to the present no decision has been arrived at : but, though no formal objection has been taken, 1 gather that considerable opposition has been raised to a clearance scheme. A suggestion was made at one of the conferences between the Borough Council and the Housing Committee of the London County Council that it would be possible to deal with the area on lines similar to those said to have been successfully carried out in Manchester and other places on what is known as Mr. Nettlefold's plan. Shortly, this is for the Borough Council to obtain powers under Section 38 of the Housing of the Working Classes Act, 1890, to purchase, as obstructive buildings, the houses on one side of each of the narrow streets, demolish these, and throw the cleared site into the roadway. That the effect of this 84 would be to improve the lighting and ventilation of the remaining houses cannot be denied, but the expense would be great and the result disproportionate. The people who would reap the greatest benefit would be the landlords ; those whose houses were purchased would get this in cash and the others in " betterment," for the remaining property would certainly increase both in letting and selling value Moreover, if the owners elected to demolish, there is nothing in the London Building Acts to prevent their rebuilding on the old foundations and thus perpetuating the present evil and unhealthy conditions. With all due deference to the authors of this scheme I can only characterise the proposal as childish. It is not very likely that a Borough Council, composed of business men, could be induced to spend a large sum of money upon what is, at the best, a maimed and incomplete scheme, in order to relieve the proper Housing Authority of the cost of doing its duty. The selection of Inspector Richards as the Officer specially designated to carry out the provisions of this Act has been a distinct success, and he has fully justified the confidence placed in him. He most carefully collected all the facts upon which the statistics for my formal representation were calculated. In conclusion, I beg to tender to the Members of the Public Health Committee my grateful thanks for their continued support, and to my colleagues for their assistance in the performance of my duties. I have the honour to be, Sir and Gentlemen, Your very obedient servant, GEORGE PADDOCK BATE. 85 REPORT OF HEALTH VISITOR. Public Health Department, Town Hall, Bethnal Green. To the Medical Officer of Health. Sir, I have the honour to submit to you a short account of my work during the past nine months. It has been almost entirely that entailed by the working of the " Notification of Births Act." A larger percentage of births were notified this year than previously, only a few having escaped. The births notified numbered 3,675. Notifications were sent in by Doctors 829 Midwives 1,073 London Hospital Maternity Assistants and Midwives 1,284 Infirmary 64 Relatives 320 By whom not stated 86 3,656 The mothers were attended at their Confinements by Doctors 1,054 Midwives 1,212 London Hospital Midwives or Maternity Assistants 1,248 Whom not stated 106 3,620 86 The Infants born were Boys 1,869 Girls 1,768 Sex not stated 38 3,675 The number of births exceeds the number of notifications, as twins and triplets are usually notified on the same form. This year there were 55 twin births : 25 pairs of boys, 10 pairs of girls, and 20 pairs of boy and girl twins. Information as to whether the infants born are living or stillborn is not always stated on the notification card. This year it was given in 122 cases: 59 boys and 63 girls. Four of the cases (3 male and 1 female) were twins. During the nine months since my appointment the visits paid were After notification of births 1,225 Special visits (illness, poverty, etc.) 313 Re-visits 201 Total visits 1,739 Twenty-six infants were overlain during the year and in almost every case the mother had been previously visited not only by me but by my predecessor, Mrs. Bridel, and urged to get a separate cot for the baby. In some cases the mother could not be brought to see the necessity of this precaution; one woman said to me 87 "oh yes lady, I knows as it's a fad of you ladies, but I've had six children and I knows what's good for 'em" Some of the others promised to get cots and failed to do so. Thanks to being able to supply Virol to the delicate babies at cost price (through the kindness of the Virol Company), we do not have nearly so many babies die of Marasmus The mothers come from all parts of the Borough to ask for it for their babies if they do not get on. It certainly has saved the lives of many and very much benefited others. The babies begin to improve almost at once, many of them gaining in weight rapidly. The majority of our Bethnal Green babies are breast fed and when they are hand fed it is almost always because the mother cannot feed the baby and not because she will not. I have, in my visits, only found three cases where the mother declined to suckle her infant. Of the cases visited about 90 per cent. are breast fed for the first month, about 80 per cent. for the first three months and about 75 per cent. for the full nine months. In cases where the mother has to go out to work she has to supplement nursing by one or two bottle feeds during the day and however bad this may be for the baby it is the lesser of two evils and the baby is compensated by the better food the mother is able to obtain. Some of the people are so desperately poor that only the mother's work provides money for the extra food so badly needed. 88 Drink is undoubtedly responsible for much of the poverty and dirt. It is not so much that the women actually get drunk except in a few cases. (One woman was so drank when her baby was born that when sober two days later she would not believe it was hers), but they do spend on drink money that should be spent on food for themselves and the children. When the mother spends the whole of the morning gossiping outside the public house (as many of them do), there is not much work going forward towards the comfort or cleanliness of the home, and children suffer accordingly. 2,050 mothers have during the past nine months brought their babies to the Town Hall for weighing and advice. This branch of our work has grown tremendously, it is still growing and is doing much good as well as lessening the work of registration and so enabling me to visit many more new cases than would otherwise be possible. And how the mothers appreciate it! well, the numbers speak for themselves. So many of the mothers are hopelessly wanting in even the most elementary knowledge, and often so eager to learn. There is great need for more accommodation, it is so difficult under present conditions to teach the mothers enough. If only I had a larger room and could have them all in and talk to them for a few minutes each week before weighing the babies I could do so much more in 89 the way of teaching them how to care for the baby and prepare its food properly and how to clothe it sensibly. In addition they need much instruction in keeping cooking utensils, etc., clean, how to store food properly and so many other things. It is teaching they want. The more I work amongst them the more convinced I am of this Unhealthy surroundings and poverty may cause some of the infant mortality, but the deplorable ignorance of the mothers is responsible for far, far more of it. I do not for a moment deny the influence of poverty, the people are poor, but often I find it is the poorest who in their ig orance will buy such things as cornflour, to add to the babies milk because the baby is not growing and the mother thinks she must feed it up. A mother I visited was feeding a baby only a fortnight old with boiled sago; she complained that " he choked a little over the bits in it." Another who was unable to nurse her baby and had been told by the doctor to feed it on milk and barley water threw away the water in which the barley was boiled and added the pearl barley to the milk ; she complained " he didn't like it and she had to feed him with a spoon as he couldn't get the seeds out of the bottle." I could tell of others who do similar things, not knowing how much harm and how little good they are doing. Many of the mothers do try their best and are so ready to learn. Life is very hard for most of them, some are careless and do not try, but cau one wholly blame them, should 90 one not rather pity them? Their lives are so dull and sordid. There is no encouragement to be clean and tidy themselves or to keep the home so. Environment means a great deal. It is surprising how bravely most of them bear their burdens, and how seldom they complain. One longs to be able to help them more, but if a few lives are made easier, happier and better, the work done is not done in vain. I am, Sir, Your obedient Servant, CHARLOTTE HAMMOND. 91 TABLE I. Vital Statistics of Whole District during 1912 and Previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to tub District. Under 1 Year of Age. At all Ages. Uncorrected Number. Nett. Number. 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[/### 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 17.0 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 1912 127,985 3,702 3,904 305 1,851 13.4 314 420 375 96.1 1,957 15.3 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. 92 TABLE II. Cases of Infectious Disease notified during the Year 1912. Notifiable Disease. Oases 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 6.5 and upwards. North East. South West. North East. South West. Small-pox - - - - - - - - - - - - Cholera - - - - - - - - — — — — Diphtheria (including Membranous Croup) 220 12 114 74 9 9 2 - 103 117 96 114 Frysipelas 190 6 17 10 15 51 67 24 100 90 — — Scarlet Fever 282 5 111 146 15 5 - - 124 158 117 152 Typhus Fever - - - - - - - — - - - — Enteric Fever - - 3 13 3 9 1 1 21 9 21 9 Relapsing Fever - - - - - — — — — — — Continued Fever — - — — — — - - — — — — Puerperal Fever 16 - - — 4 12 — — 4 12 3 11 Cerebro-Spinal Meningitis 6 - 4 1 1 - - - 1 5 3 Polio Myelitis 7 - 7 — — — — — 1 6 1 5 Pulmonary Tuberculosis 579 - 4 23 130 268 145 9 280 299 — — Ophthalmia Neonatorum 28 28 — - — — — - 18 10 — — Totals 1358 51 260 267 177 354 215 34 652 706 238 294 93 TABLE III. Causes of, and Ages at, Death during Year, 1912. 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 ... ... 1 Small Pox ... ... ... ... ... ... ... ... ... ... Measles 90 21 38 26 4 1 ... ... ... 11 Scarlet Fever 2 1 ... 1 ... ... ... ... ... ... Whooping Cough 28 6 13 9 ... ... ... ... ... 11 Diphtheria and Croup 15 3 5 7 ... ... ... ... ... 2 Influenza 5 ... ... ... ... 1 1 2 1 1 Erysipelas 10 2 ... ... ... 1 1 2 4 9 Other Septic Diseases 30 6 1 3 3 4 2 6 5 34 Phthisis, (Pulmonary Tuberculosis) 205 ... 1 2 7 33 91 64 7 136 Tuberculous Meningitis 31 7 10 7 5 1 ... 1 ... 26 Other Tuberculous Diseases 63 12 11 14 11 3 2 7 3 37 Cancer, malignant disease 121 ... ... 1 ... 3 14 67 36 65 Rheumatic Fever 18 ... ... ... 6 6 4 1 1 8 Meningitis 6 2 3 ... ... ... ... 1 ... 4 Organic Heart Disease 207 ... ... 2 11 6 40 67 81 119 Bronchitis 202 26 5 4 ... 2 13 49 103 86 Pneumonia (all forms) 214 48 34 24 6 6 17 49 30 108 Other diseases of Respiratory organs 18 3 ... 3 ... 1 3 7 1 14 Diarrhœa and Enteritis 48 32 6 3 ... ... 2 5 ... 33 Appendicitis and Typhlitis 8 ... ... ... 3 4 1 ... ... 6 Cirrhosis of Liver 14 ... ... ... ... ... 1 9 4 8 Alcoholism 2 ... ... ... ... ... ... 2 ... 1 Nephritis & Bright's Disease 85 1 ... 1 ... 3 10 40 30 58 Diabetes 8 ... ... ... ... ... 2 3 3 1 Puerperal Fever 9 ... ... ... ... 2 7 ... ... 2 Other accidents and diseases of Pregnancy and Parturition 6 ... ... ... ... ... 5 1 ... 1 Congenital Debility and Malformation, including Premature Birth 140 138 1 1 ... ... ... ... ... 55 Violent Deaths, excluding Suicide 91 29 5 7 10 2 12 12 14 20 Suicide 13 ... ... 6 7 2 Other Defined Diseases 164 21 5 6 8 5 23 45 51 83 Diseases ill-defined or un-known 101 17 5 ... ... 5 74 41 Totals 1957 375 143 121 75 85 258 452 448 983 Subentries included in above figures. Cerebro-spinal Meningitis 6 2 3 ... ... ... ... 1 ... 4 Polio-myelitis 4 ... 1 3 ... ... ... ... ... ... 94 TABLE IIIa. Deaths in Sub-Districts. Causes of Death. North-East. South-West No Home. Totals. Enteric Fever 2 1 — 3 Small Pox — — — — Measles 45 45 — 90 Scarlet Fever 1 1 — 2 Whooping Cough 16 12 — 28 Diphtheria and Croup 8 7 — 15 Influenza 3 2 — 5 Erysipelas 4 5 1 10 Phthisis (Pulmonary Tuberculosis) 106 94 5 205 Tuberculous Meningitis 14 17 31 Other Tuberculous Diseases 33 28 2 63 Cancer, malignant disease 55 59 7 121 Rheumatic Fever 9 8 1 18 Meningitis 3 3 — 6 Organic Heart Disease 115 80 12 207 Bronchitis 99 100 3 202 Pneumonia (all other forms) 103 110 1 214 Other diseases of Respiratory organs 9 8 1 18 Diarrhoea and Enteritis 20 27 1 48 Appendicitis and Typhlitis 5 3 — 8 Cirrhosis of Liver 5 9 — 14 Alcoholism 1 — 1 2 Nephritis and Bright's Disease 44 41 — 85 Puerperal Fever 4 5 — 9 Other accidents and diseases of Pregnancy and Parturition 2 4 — 6 Congenital Debility and Malformation, including Premature Birth 68 72 — 140 Violent Deaths, excluding Suicide 43 47 1 91 Suicides 10 3 — 13 Other Defined Diseases 74 81 5 160 Diseases ill-defined or unknown 43 48 10 101 Diabetes 2 6 8 Other Septic Diseases 10 18 2 30 Polio Myelitis — 4 — 4 Total 956 948 53 1,957 Sub-entry, included Cerebro-spinal in above Meningitis figures 3 3 — 6 95 TABLE IV. Infantile Mortality During the Year 1912. 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 ... ... ... ... ... ... ... 9 10 19 Scarlet Fever ... ... ... ... ... ... ... 1 ... 1 Whooping Cough ... ... ... ... ... 1 1 1 3 6 Diphtheria and Croup ... ... ... 1 1 ... ... ... 1 2 Erysipelas ... ... 1 ... 1 ... 1 ... ... 2 Tuberculous Meningitis ... ... ... ... ... 1 1 1 4 7 Abdominal Tuberculosis ... ... ... ... ... 1 2 ... 1 4 Other Tuberculous Diseases ... ... ... ... ... ... 2 2 4 8 Meningitis (not Tuberculous) ... ... ... ... ... ... 1 2 ... 3 Convulsions 4 1 1 2 8 7 7 1 2 25 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 1 2 10 6 7 3 28 Pneumonia (all forms) ... 1 ... 3 4 8 11 8 14 45 Diarrhœa ... ... 1 ... 2 2 5 2 1 12 Enteritis ... ... 1 ... 1 7 7 7 2 24 Gastritis 2 1 ... ... 3 4 3 ... ... 10 Syphilis ... ... 2 ... 2 3 ... ... ... 5 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 4 1 ... 1 6 8 10 1 1 26 Injury at Birth 6 ... 2 ... 8 ... ... ... ... 8 Atelectasis 4 ... ... ... 4 ... ... ... ... 4 Congenital Malformations 5 4 1 ... 10 ... 1 ... ... 11 Premature Birth 44 6 4 4 58 7 2 ... ... 67 Atrophy, Debility and Marasmus 4 2 3 2 11 15 7 5 3 41 Other causes ... 2 2 1 5 1 3 1 5 15 Tetanus ... 2 ... ... 2 ... ... ... ... 2 73 21 19 15 128 75 70 48 54 375 Nett Births in the year, 3,904. Nett Deaths in the year, 375. 96 TABLE IV (a). North-East Bethnal Green. Infantile Mortality During the Year 1912. 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 trader 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 5 5 10 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 ... 1 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... 1 ... 1 ... 1 ... ... 2 Tuberculous Meningitis ... ... ... ... ... ... ... ... 2 2 Abdominal Tuberculosis ... ... ... ... ... 1 ... ... 1 2 Other Tuberculous Diseases ... ... ... ... ... ... ... 2 ... 2 Meningitis (not Tuberculous) ... ... ... ... ... ... 1 1 ... 2 Convulsions 2 1 ... 1 4 2 3 ... ... 9 Laryngritis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 4 3 4 1 12 Pneumonia (all forms) ... 1 ... 1 2 2 5 1 7 17 Diarrhœa ... 1 ... ... 1 2 4 1 ... 8 Enteritis ... ... 1 ... 1 3 ... 3 ... 7 Gastritis 1 1 ... ... 2 3 1 ... ... 6 Syphilis ... ... 1 ... 1 2 ... ... ... 3 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... 1 ... ... 1 5 5 1 ... 12 Injury at Birth 4 ... 1 ... 5 ... ... ... ... 5 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations 2 2 1 ... 5 ... ... ... ... 5 Premature Birth 22 2 1 2 27 4 2 ... ... 33 Atrophy, Debility and Marasmus ... 1 2 ... 3 7 5 2 1 18 Other causes ... 1 ... 1 2 1 3 ... 1 7 Tetanus ... 1 ... ... 1 ... ... ... ... 1 32 12 8 5 57 36 34 20 19 166 97 TABLE IV. (b) South-West Bethnal Green. Infantile Mortality During the Year 1912. 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 ... ... ... ... ... ... ... 4 5 9 Scarlet Fever ... ... ... ... ... ... ... 1 ... 1 Whooping Cough ... ... ... ... ... 1 ... 1 2 4 Diphtheria and Croup ... ... ... 1 1 ... ... ... 1 2 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... 1 1 1 1 4 Abdominal Tuberculosis ... ... ... ... ... ... 2 ... ... 2 Other Tuberculous Diseases ... ... ... ... ... ... 2 ... 2 4 Meningitis (not Tuberculous) ... ... ... ... ... ... ... 1 ... 1 Convulsions 2 ... 1 1 4 5 4 1 2 16 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 1 2 6 3 3 2 16 Pneumonia (all forms) ... ... ... 2 2 6 6 7 7 28 Diarrhœa ... ... 1 ... 1 ... 1 1 1 4 Enteritis ... ... ... ... ... 4 7 4 2 17 Gastritis 1 ... ... ... 1 1 2 ... ... 4 Syphilis ... ... 1 ... 1 1 ... ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 4 ... ... 1 5 3 5 ... 1 14 Injury at Birth 2 ... 1 ... 3 ... ... ... ... 3 Atelectasis 3 ... ... ... 3 ... ... ... ... 3 Congenital Malformations 3 2 ... ... 5 ... 1 ... ... 6 Premature Birth 22 4 3 2 31 3 ... ... ... 34 Atrophy, Debility and Marasmus 4 1 1 2 8 8 2 3 2 23 Other causes ... 1 2 ... 3 ... ... 1 1 5 Tetanus ... 1 ... ... 1 ... ... ... ... 1 41 9 11 10 71 39 36 28 29 203 98 TABLE V. Showing the number of Deaths from the seven principal Zymotic Diseases, inclusive of Hospital Deaths in the 10 years 1902 to 1911 and in the year 1912. Disease. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. Annual Average of 10 years, 1902 1911. 1912. Small Pox 64 — 8 — — — — — — — 7 — Measles 59 85 89 48 60 71 105 78 58 128 78 90 Scarlet Fever 19 13 18 27 22 43 39 25 9 6 22 2 Diphtheria 33 26 48 31 20 18 29 20 20 5 25 15 Whooping Cough 89 41 44 50 63 53 42 37 34 44 50 28 Fever 15 12 7 9 14 7 13 4 18 3 10 3 Diarrhoea (and Enteritis under 2 years after 1910) 60 112 147 119 152 59 102 90 43 230 111 48 Totals 339 289 361 284 331 251 330 254 182 416 303 186 99 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) 167 22 — Workshops (Including Workshop Laundries) 3,573 899 — Workplaces . (Otlher than Outworkers' premises included in Part 3 of this Report ) 1.004 61 — Total 4,744 982 — 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prose— cutions. Found. Remedied. Referred to h.M. Inspector. Nuisances under the Public Health Acts:—* Want of cleanliness 650 650 — — Want of ventilation 31 31 — — Overcrowding 5 5 — — Want of drainage of floors 8 8 — — Other nuisances 638 633 — — (insufficient Samitary unsuitable or defective accommodation not separate tor sexes 14 14 — — 315 315 — — 3 8 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bake— house (s. 101) ... — — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) — — — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this — — — — Total 1669 1669 — — • Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts 3.-H0ME WORK. NATURE OF WORK. outworkers' lists, sbotion 107. Number of Inspections and Re-inspections of Outworkers' Premises. outwork in unwholbbomb premises, section 108. outwork in inpbctbd prbmisbs sbotions 109, 110. List* received from Employers 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. Out— workers Wearing Apparel— 130 1625 8 79 ... ... ... 330 330 ... ... ... ... (2) Gleaning and washing ... ... ... ... ... ... ... ... ... Furniture and upholstery 4 26 2 43 ... ... ... 9 9 ... ... ... ... Surgical Instruments ... ... ... ... ... ... ... 1 1 ... ... ... ... Umbrellas. &c. ... ... ... ... ... ... ... 11 11 ... ... ... ... Artificial Flowers ... ... ... ... ... 3 3 ... ... ... ... Paper bags and boxes 28 500 ... ... ... ... 94 94 ... ... ... ... Brush making 6 635 1 3 ... ... ... 41 41 ... ... ... ... Carding, &c., of buttons, Ac. 2 17 ... ... ... ... ... 1 1 ... ... ... ... Total 170 2803 11 125 ... ... ... 490 490 ... ... ... ... 4. Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. Workshops, including Laundries 2 068 Food Premises 212 Bakehouses 89 Total numbers of workshops on Register 2,369 5—Other Matters. Glass. Number. Matters notified to H..M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 21 Action taken in matters referred by H.M. Notified by H.M. Inspector 71 Public Health Acts, but not under Reports (of action taken) the Factory & Workshop Act (s. 5) sent to H.M. Inspector 72 Other — Underground Bakbhousbs (c. 101)— In use at the end of year 26 100 101 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 1 ... 3 5 Bonner road ... 1 3 5 9 Abingdon buildings ... ... ... 1 1 Bonner street ... 2 ... ... 2 Abingdon street 1 ... 1 ... 2 Bon well street ... ... 2 ... 2 Ada place ... ... 2 2 4 Boreham street ... ... 1 2 3 Ainsley street ... ... 2 2 4 Boundary street ... 2 ... 2 Albert buildings ... ... ... ... ... ... Bradys buildings ... 1 1 1 3 Albion place ... ... ... ... ... Brady street 1 1 1 5 8 Alfred place ... ... ... 1 1 Braemar street ... ... ... 3 3 Alias road ... ... 2 2 4 Bratley street ... ... 1 ... 1 Alma road ... 2 ... 3 1 6 Brick lane 1 ... 3 10 14 Ames street ... 1 2 ... 3 Brierley street ... 1 1 1 3 Angela gardens ... ... 1 1 Bucks court ... ... ... Anglesea street ... ... 1 2 3 Buckhurst street 1 ... 1 3 5 Anns place... ... ... ... ... ... Bullards place ... ... 1 ... 1 Approach road ... 3 2 1 6 Bunsen street ... ... ... ... ... Arbery road (Except Nos 74 and 76) 2 1 1 1 5 Burgoyne road 1 ... ... 1 2 Burnham square ... 1 1 2 Burnside street ... 3 1 3 7 Archer street ... ... ... ... ... Busby square ... ... ... 1 1 Arline street 1 2 2 "2 7 Busby street ... 1 3 6 10 Artillery street ... ... ... 1 1 Butler's buildings ... ... ... ... Ashwell road 1 ... 2 1 4 Butler street ... ... ... 1 1 Auckland road ... 1 1 1 3 Buxton street (Odd Nos. 1 to 33 Even Nos. 2 to 10) ... ... ... ... ... Austin street ... 1 ... 3 4 Bacon street 1 3 1 5 10 Cadell street ... . ..... 2 3 5 Baker's court ... ... 1 1 2 Baker's rents ... ... ... ... ... Calvert avenue ... . ..... ... ... ... Baker street ... 2 2 3 7 Cambridge buildings ... . ..... 1 ... 1 Bandon road ... 1 1 7 9 Cambridge circus ... 1 ... 1 2 Barnet grove ... 1 1 5 7 Cambridge road (All Odd Nos.and Even Nos. from 160) 1 2 8 16 27 Barnsley houses 1 ... 3 1 5 Barnsley street ... ... 2 5 7 Baroness road 1 ... 2 4 7 Cambridge street ... ... 1 ... 1 Bath grove ... ... ... ... ... ... Camden street 1 1 1 2 5 Bath street ... ... ... ... ... ... Camlet street ... ... ... Baxendale street ... ... ... 3 1 4 Canrobert street . 1 5 4 16 26 Bellhaven street ... 1 ... 3 4 Carlisle street ... ... ... ... Benson buildings ... ... 1 ... 6 7 Carmel house ... ... ... ... ... Bessy street ... ... ... 1 1 Carter street ... ... ... ... ... Bethnal Green road ... 1 2 14 17 Casket street ... 2 1 ... 3 Birkbeck street 1 ... 2 1 4 Caslon place ... ... ... ... ... Bishops road ... ... ... 3 5 8 Catherine street ... ... ... ... ... Blyth street 1 2 2 2 7 Centre street ... ... ... 1 1 102 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. Chambord street ... 1 3 ... 4 Cymon Street 1 ... ... 4 5 Chance street ... ... ... 1 1 Cyprus street 1 4 4 15 24 Chapel street ... ... 1 2 3 Pagnall place ... ... ... 2 2 Charles terrace ... ... ... 1 1 Charlotte Btreet 1 4 1 2 8 Chertsey buildings ... ... ... ... ... Daniel stieet ... ... ... ... ... Cheshire street 2 2 2 8 14 Darling row ... ... ... 2 2 Chester street ... ... 1 2 3 Davis place Davis buildings ... ... ... ... ... Chilton street 1 ... ... 3 4 ... ... ... ... ... Chisenhale road 1 2 4 4 11 Delamere dwellings ... ... ... 1 1 Church row ... ... ... 7 7 Delta street ... ... 1 1 2 Church street (Except even Nos. from 2 to 26) 1 1 ... 3 5 Derbyshire street ... ... 2 1 6 9 Devonshire place ... ... ... ... ... Digby street ... ... 1 3 4 Clare street 1 1 2 2 6 Digby walk ... 1 4 4 10 Clareniont street ... ... ... 3 3 Dinmont street ... ... 1 ... 2 3 Clarence street ... 1 ... 2 3 Diss street ... ... 2 2 Clarkson street ... 1 1 1 3 Dixie street 3 1 2 1 7 Clifton buildings ... ... ... 2 2 Driffield road (Odd numbers) 1 1 2 3 7 Club row ... ... ... ... ... Coate street 1 ... ... 1 2 Ducal street ... ... 2 ... 2 Code street ... ... ... 2 2 Durant Street ... ... 4 1 5 Coiling place ... ... 1 ... 1 Colling street ... ... ... ... ... Eastman street 2 2 2 1 7 Collingwood street. 1 1 6 5 13 Collyer's court ... ... ... ... ... Ebor street (Except Nos. 11 to 19 odd) ... 1 ... 1 2 Columbia market ... ... ... ... ... Columbia road 1 1 1 4 7 Columbia square ... 1 3 1 5 10 Eckersley street ... ... ... ... ... Conyer street ... ... ... 1 1 Edgar place 1 ... ... ... 1 Cookham buildings 1 ... 1 1 3 Edward place ... ... ... 1 1 Co-operative b'ld'gs ... ... ... ... ... Ellesmere road 1 ... 8 9 18 Cooper's gardens 2 1 1 1 5 Elwin street 1 ... ... 1 2 Cordova road 1 1 1 ... 3 Emma street 3 ... 1 1 5 Corfield street 1 ... 3 13 17 Ernest place ... ... ... ... ... Cottage place ... ... ... ... ... Evesham houses ... ... 1 ... 1 Coventry place ... ... ... ... ... Ezra street ... ... ... ... ... Coventry street 5 1 2 14 22 Falcon buildings ... 1 ... ... ... 1 Cox's buildings ... ... ... ... ... Cranbrook road ... ... 1 ... 1 Cranbrook street 2 2 2 3 9 Felix street ... 1 2 9 12 Craven buildings ... ... 1 2 3 Fellbrigg street ... ... 2 5 7 Crescent cottages ... 1 1 2 Finnis street 1 2 2 5 10 Crescent place ... 1 3 3 7 Fleet street hill 1 ... ... .. . 1 Cross street ... ... ... ... ... Flint court ... ... ... 3 3 f!rossland square ... 1 ... 1 2 Florida street ... ... 1 7 8 ... Cudworth street 1 1 1 1 4 Florida terrace ... ... ... ... Culham buildings ... ... ... 1 1 Fossett's buildings ... ... ... ... ... Cygnet street ... ... ... ... ... Foster street 3 1 ... ... 4 103 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. Fountain street ... ... ... ... ... Hammonds gardens ... ... ... ... ... Fox street ... 1 ... 1 2 Hamilton road 2 2 1 4 9 Fox's buildings ... ... ... ... ... ... Hare court ... ... 1 ... 1 Fuller street ... ... 4 5 9 Hare marsh ... ... ... ... ... Gales gardens ... l 1 5 7 Hare row ... ... ... ... ... Hare street ... ... 1 5 4 10 Harold street 1 2 ... 2 5 r Garden place ... ... ... ... ... Hartley street 1 ... 1 3 5 Violet street Hassard place ... 1 ... ... 1 Garden place ... ... ... ... ... Hassard street ... 1 2 3 6 James street Havel0ck place ... ... 1 1 2 Gardeners road 1 ... 1 1 3 Hemming street 2 ... 2 4 8 Garner street 1 ... 2 2 5 Hedsor buildings ... 2 1 2 ... 5 Gascoigne place ... ... 1 2 3 Helens place ... 1 ... 1 2 Gawber street ... ... 1 ... 1 Henley buildings ... 1 1 ... ... 2 George place ... ... ... ... ... Henrietta street ... ... ... ... ... Georeina gardens . ... ... 1 1 2 Hereford buildings ... ... ... ... ... o o Gernon road 1 1 1 ... 3 Hereford street 1 ... 3 4 Gibraltar buildings ... ... ... ... ... Hersee place 1 ... 1 1 3 Gibraltar gardens .. ... ... 1 ... 1 Hocker street ... ... ... ... ... Gibraltar walk ... ... 2 8 12 Holly mansions ... ... ... ... ... Gilman street ... 2 1 2 5 Hollybush gardens... 1 3 1 6 11 Glass street ... ... ... 1 1 Holly bush place ... ... ... ... ... Globe road . (Even Nos. from. 156 Odd from 131 2 1 5 10 18 Holmes avenue ... ... ... 2 2 Horatio street ... ... ... 2 2 Horts place... ... ... ... ... ... Gloucester passage ... ... ... ... ... Hunslett street ... ... 3 I 4 Goldsmith's row ... ... ... ... ... ... Huntingdon b'ldingB ... ... 1 ... 1 (Children's Hospital & Nos. 8 to 62 Even) Gossett street 3 ... 1 7 11 Hurley buildings .. ... ... ... 1 1 ISley buildings ... ... ... ... ... Granby place ... ... ... ... ... Granby street ... 1 ... 2 3 Ion square ... 1 1 1 4 7 Great Eastern bldgs. ... 1 ... 2 3 Ivimey street ... ... ... ... ... Green street 4 2 2 15 23 Gretton houses 3 3 3 3 12 Grimsby street ... ... ... 1 1 James court ... ... ... ... ... Grove road... ... 1 2 6 9 James place ... ... ... ... ... (Odd Nos. from 59 Even Nos. from 110) Guinness' buildings ... 4 3 6 13 James sti eet (Odd Nos. from 39, Even from No. 4) ... l 1 2 4 Hackney road (All Even Nos. and Odd Nos. from 323) 2 3 4 15 24 Jersey street ... 2 3 3 8 Kay street (Nos. 3 to 53 odd) ... 4 2 3 9 Hague buildings ... ... ... 1 1 Kelsey street ... ... ... ... ... Hague place ... ... ... ... ... Kenilworth road 2 ... 1 2 5 Hague street ... 1 1 2 4 Kerbela street 1 2 ... 3 6 104 STREET LIST -continued. Name of Street. Zymotic Diseases. Tubercular Diseases Respiratory I useases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Kirkwall place ... ... ... 3 3 Merceron houses ... ... ... 2 2 Kite place ... ... ... 1 2 3 Merceron street ... ... ... 1 1 Knottisford street ... ... ... 2 2 Middleton street ... 1 3 ... 4 Laleham buildings ... 1 ... ... 1 Minerva street ... 1 ... 5 6 Minto place ... 1 1 1 3 Mocatta house ... ... ... ... ... Lansdell place ... ... ... ... ... Molesey buildings . ... ... ... 1 1 Lark row ... 1 2 3 6 Montclare street ... ... ... ... ... Lawfranc road ... 1 1 ... 2 Montfort house ... ... ... ... ... Leopold buildings ... 1 I 3 3 8 Moravian street ... ... ... ... ... Leslie house ... ... ... 1 1 Morpeth street 2 1 1 3 7 Letchford buildings ... ... ... ... ... Moss street 1 I 2 8 12 Lessada street ... ... 2 7 9 Mount street 1 1 ... 3 5 Ligonier street ... ... ... ... ... Mowlem street ... ... ... 4 4 Lily house ... ... 1 ... 1 Museum buildings ... ... 1 1 2 Linden buildings ... ... 2 2 4 Nant street. ... ... ... ... ... Lisbon buildings ... 1 ... 3 2 6 Lisbon street 2 1 ... ... 3 London street ... ... ... 1 1 Navarre street ... ... ... ... ... Lucas street ... ... 1 ... 1 Neath place 1 1 1 2 5 Lyal road ... ... 2 ... 2 4 Nelson place ... ... ... ... ... (Nos. 57 a, and 58 to Nelson street ... 1 1 2 4 88 Consecutive Nos.) New Church street ... ... ... 1 1 Lyte street ... ... 2 3 5 \ewling street ... ... 1 1 3 Mace street. 1 2 2 ... 5 New Tyssen street. . ... ... ... 5 5 Norah street 2 2 3 3 10 Northampton street 1 ... ... 3 4 Norton street 1 ... ... 2 3 Manchester buildings ... ... ... 1 1 Octagon street ... ... ... 2 2 Manchester place . ... ... ... ... ... Mansford buildings 1 1 1 ... 3 Mansford street 2 2 3 4 11 Old Bethnal Green road 1 6 ... 6 13 Mape street ... ... 4 7 11 Margaret place ... ... ... 3 3 Old Ford road (Odd No*. to 205, even Nng.to 368) 2 7 5 16 30 Marian place ... ... ... ... ... Marian square ... 1 ... 2 3 Marian street ... 1 1 3 5 Old Nicol street ... ... ... ... ... Marlow buildings . ... ... ... ... ... Olga street ... ... ... 2 2 Martha court ... ... ... 1 1 Orange street ... 1 1 2 4 Matilda street 1 1 ... 1 3 Oval ... 3 2 4 9 Meadows dwellings ... 3 ... 4 7 Palissy street ... ... ... ... ... Med hurst road 3 1 1 1 6 Med way buildings .. ... ... ... ... ... Med way road (Odd Nos. 3 to 49, even Nos. 2 to 62) ... ... ... 1 1 Palm street... ... ... 2 2 4 Palmer's road ... ... ... ... ... Paradise row ... ... 2 ... 2 Memorial Hall bldgs. ... 1 ... ... 1 Parliament place ... ... ... ... ... Mendip houses ... ... ... 1 1 Parliament street .. ... ... 1 ... 1 Menotti street ... 2 ... 1 3 Parmiter houses .. ... ... ... ... ... 105 STREET LIST—continued. Name of Street. Zymotic Diseases. Tuberc .lar Diseases. Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic 1)iseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total Parmiter street ... ... 2 6 8 Reuben street 2 ... ... ... 2 Patriot square ... ... ... 2 2 Riders buildings ... 1 ... 1 2 Peabody buildings 2 1 1 1 5 Roan horse yard . ... ... ... ... ... Peacock place ... ... ... ... ... Robert street ... 2 1 1 4 Peacock street ... ... ... 2 2 Robinson road ... ... 1 2 3 Pearl yard ... ... ... ... ... Rochelle street ... ... ... ... ... Pedley street ... ... 1 3 4 Ronian road (Odd Nos to 127, even Nos. to 142) ... 3 4 3 10 Peel grove . ... ... 3 ... 3 Pepl grove mews ... ... ... ... ... Pelter street ... ... 1 ... l Pereira street 1 ... 2 3 6 Peter street ... ... ... ... ... Rooks place ... ... ... ... ... Pollard place ... ... ... ... ... Ropley street ... ... ... ... ... Pollard row ... ...3 8 11 22 Ross house ... ... ... ... ... Pollard street ... 1 1 1 3 Moss street Royal Victor place . ... ... ... ... ... Portman place ... ... 2 1 3 Pott street l 1 3 1 6 Hoyston street 2 1 3 2 8 Poyser street ... ... 1 6 7 Ru>sia lane ... 4 4 3 11 Preston street 1 1 3 2 7 Primrose street l ... ... 2 3 Princes court l 2 1 5 9 Sabbage yard ... ... ... ... ... Pritchard's road (Except Nos. 57 to 1 17) ... 2 4 5 11 Sale street ... 1 2 4 5 12 Sandford buildings ... ... ... ... ... Satchwell rents ... 2 ... 1 3 Prospect terrace ... 1 3 5 9 Satchwell street 1 ... 4 2 7 Providence place ... ... ... 2 2 Sclater street ... ... ... 3 3 Providence yard ... ... ... ... ... Scott street. 1 ... 5 3 9 Pundersoil gardens 1 1 3 4 9 Seabright street 1 2 6 12 21 Selby street (even numbers) ... 2 ... 3 5 Queen's buildings Prince8 place ... ... 1 2 3 Sewardstone road 1 2 3 8 14 Shacklewell street.. ... ... ... ... ... Sheldon place ... ... ... 1 1 Queen's buildings Go88ett street I ... ... 3 4 Shepton houses 1 1 ... 1 3 Shetland street ... ... 2 1 3 Queen's buildings Chambord street ... ... ... ... ... Shiplake buildings. ... ... ... ... ... Shipton street ... ... ... 1 1 Qu'n Caroline place ... ... 3 3 7 Skinners court ... ... ... ... ... Quilter street 3 3 1 6 13 Sidney street 1 1 3 5 Quinns square 3 3 1 6 13 Smart street ... 2 1 ... 3 Smiths place 1 1 1 ... 3 Somerford houses 1 1 ... ... 2 Railway arches ... ... ... ... ... Somerford street 1 1 4 4 10 Ramsey street 1 3 ... 2 6 Sonning buildings 2 ... 1 1 4 Rapley place ... ... ... 1 1 S'hampton cottages ... ... ... 1 1 Ravenscroft build'gs ... 2 ... 3 5 Southampton place ... ... ... ... ... Ravenscroft street... ... 2 2 4 8 Southampton street ... ... ... ... ... Reid's mansions Gosaett street ... ... ... ... ... Southampton terrace ... ... ... ... ... Spencer passage ... ... ... ... ... 106 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. Bpicer buildings ... ... ... ... ... Treadway street 1 2 4 5 12 Spital street ... 1 ... ... 1 Turin street 1 2 5 2 10 (Noa. 11 to 27) Turville street ... ... ... ... ... Squirries street ... ... 1 4 5 Tuscan street 2 ... ... 1 3 3t. Andrews street... ... ... ... 3 3 Type street... 1 2 2 2 7 3t. James road ... ... 1 2 3 Tyrrell street ... ... 3 ... 3 St. Jude street ... 1 ... 4 5 St. Mark's buildings Tagg street 2 ... ... ... 3 Usk street ... 2 1 6 4 13 3t. .Mary's place ... ... ... ... ... •St. Matthias place ... ... ... ... ... ... 5t. Peter square ... ... ... 1 1 Vail ance road ... 2 1 4 7 St. Peter street ... 1 ... 10 12 Venice street ... 1 ... 2 3 Stainsbury street 1 1 ... 2 7 Viaduct place ... ... 1 ... 1 Stamp place ... ... ... 2 2 Viaduct street ... 1 2 3 6 Stanfield road [" Stoneleigh " House & Gateway adjoining) ... ... ... ... ... Victoria park ... ... ... ... ... Victoria place ... ... ... 1 1 Victoria place ... ... ... ... ... Steels buildings ... ... ... ... ... James street Victoria Park sq're ... ... 1 2 3 Strahan road (odd numbers) ... ... ... 2 2 Violet row .. ... ... 1 1 2 Streatley buildings . 2 1 1 2 6 Violet street ... 1 ... ... 1 Strout s place ... ... ... ... ... Virginia road ... 2 3 2 7 Sugar Loaf walk ... ... 1 ... ... l Vivian road ... 1 2 2 5 Sunbury buildings... ... 1 ... ... 2 Voss street ... ... ... 2 ... 2 Surat street .. 3 ... 3 3 9 Yyner street ... 1 2 3 6 Sutton buildings 1 2 ... 6 9 Wadeson street ... ... 1 1 2 Sweet Apple square ... ... ... 1 1 Tagg street. 1 1 5 2 9 Walter street ... 3 2 3 8 Taplow buildings ... ... 1 ... ... 1 Walton buildings ... ... ... ... ... Tapp street . ... ... 1 ... 1 Wargrave build'gs.. ... ... 1 2 3 Tavistock street ... ... 1 1 2 Warley street 1 ... 2 4 7 Teale street ... ... ... ... ... Warner place ... 2 2 7 11 Teesdale street 3 4 4 5 16 W.iterloo place ... ... ... ... ... Temple dwellings .. 1 ... ... 3 4 Waterloo road ... ... ... 1 1 Temple street ... 2 1 6 9 Waterloo terrace ... ... ... 1 1 2 Tent street ... ... ... 2 1 3 Wear street ... ... ... ... ... Thorold street ... 2 2 2 6 Weaver street ... ... 1 ... 1 Thoydon road ... ... ... 1 1 (Odd numbers) Three Colt corner ... ... ... ... ... Weldon street ... ... ... 1 1 Three Colt lane 2 ... 3 3 8 Well ington place ... ... ... ... ... ... Thurlow place ... 1 1 ... 2 Wellington row ... 1 4 11 16 Totty street ... 3 1 l 5 Wennington road ... ... 1 2 3 6 Toyes buildings ... 1 ... ... 1 Wharf road ... ... ... ... ... Old Bethnal G'n rd Toyes buil d ings ... ... ... 3 3 Wharncliffe street 1 ... ... 3 4 Wheeler street ... ... ... ... ... Mansford street Whites court ... ... ... ... ... 107 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 ... ... ... 2 2 Winchester street ... ... ... ... ... (Odd Nos. from 319) Whitmore build'gs ... ... ... ... ... Wolverley passage. ... ... ... ... ... Wolverley street . 1 2 1 1 5 Wilmot house ... 1 ... ... 1 Wood close ... ... ... ... ... Wilmot street 1 4 ... 14 19 Wood street ... ... ... 2 2 Wimbolt street ... ... ... ... ... Wingham street 1 ... 1 2 4 Winchester bu'd'gs ... ... ... ... ... No Home 1 6 7 39 53 Winchester cr'sc'nt ... ... ... 1 1 Winchester place ... ... 1 ... 1 Metropolitan Borough of Bethnal Green. CHIEF SANITARY INSPECTOR'S SEVENTEENTH ANNUAL REPORT ON THE WORK OF THE Public Health Department FOR THE Year ended 31st December, 1912. LONDON: Thomas Bean & Son, Printers, 67, Golden Lane, E.O. INDEX TO Chief Sanitary Inspector's Report for 1912. PAGE. Adulteration 6, 7, 19, 31 Do. Decennial Period 6 Bakehouses 36 Clerical Work 46 Complaints 6. 10 Cost of Working 9 Cow Houses 6,45 Dairies 6 Death Rate Disinfectants 0 Drains—Defective 7 Factories 6, 10 Food Inspection 7,35 Food Premises Inspections 35 General Summary of Inspections 10,11 House to House Inspections 6, 10, 38 Houses Let in Lodgings 6,37 Housing, Town Planning, etc., Act, 1909 47 Ice Cream Premises 6,36 Improvements Effected 7, 11,13 Infantile Mortality 8 Inspections—Combined Drainage 11 Complaints 6, 10 Cowhouses 6 Dairies and Milkshops 6 Factories and Workshops 6,10 Food Premises 35 House to House 6, 10, 38 Ice Cream Premises 6,36 Infectious Disease 6, 10 Milk Shops 10 New Buildings 10 Out-workers 6, 10, 36 Primary 5 Slaughter-houses 6 Tenement Houses (Houses let in Lodgings) 6 Trade Premises 6 IN D EX—continued. PAGE. Milk Shops 6, 10, 45 Miscellaneous 45 Mortuary Returns 41 New Duties 8 New Buildings Inspections 10 Nuisances Abated 7, 11, 13 Do. Discovered 12 Offensive Trades 45 Out-workers 6, 10, 36 Do. Trades 37 Police Court Proceedings 14-18,21-30 Premises Repaired and Cleansed 7 Primary Inspections 5 Sale of Food and Drugs Acts 6, 19 Samples—Informal 33,34 Do. Official 6, 19 Do. Taken on Delivery 32 Sanitary Conveniences Repaired, etc 7,13 Sanitary Improvements Effected 7,11,13 Sanitary Supervision 5 Saving on Original Duties . 9 Slaughter-houses 6, 45 Smoke Nuisances 11, 40 Staff 8 Summary of Inspections . 10-11 Do. Disinfection and Shelter 39 Tenement Houses (Houses let in Lodgings) 6,37 Trade Premises 6 Unsound Food 7, 11, 35 Verminous School Children 38 Water Supply 13 Workshops 6, 10 Metropolitan Borough of Bethnal Green. Public Health Department, Town Hall, Patriot Square, Bethnal Green, E. TO THE PUBLIC HEALTH COMMITTEE. Annual Report. Mr. Chairman & Gentlemen, Herewith I beg to submit for your consideration the Annual Report on the work of the Public Health Department for the year ended December 31st, 1912. Details in Appendices. Full details of the various duties performed by the staff are tabulated under the different headings in the following Appendices lettered A to R, which renders it unnecessary to recapitulate them here. A brief mention of the more important items may perhaps prove of some interest to the members generally. Sanitary Supervision. As regards the sanitary supervision of the Borough the total number of all primary inspections amounts to 4,236 and goes to show that the former high level of administrative effort has been maintained. 6 Primary Inspections. The total just referred to is made up of 1,415 House-to-house Inspections, 1,533 Investigations of Complaints, and 1,288 Inspections in respect of Infectious Diseases. Inspection of Workplaces. As regards the supervision of places where work is performed, no less than 4,961 inspections were made. These were :—To factories and workshops, 2,'218, to Outworkers and in connection with various home industries, 2,843. It is probably safe to add that the supervision now being exercised in connection with the workplaces in this Borough is much above the average. Inspection of Trade Premises. In connection with the inspection of Trade Premises, viz.:—Slaughter-houses, Cow-houses and the Offensive Trades, a total of 1,111 visits were made, whilst 561 inspections were made to the several Dairies and Milkshops. Ice-cream Shops. The places where Ice-cream is manufactured or sold were kept under observation, and 172 visits, mainly during the summer months, were made at different times. Tenement Houses. The tenement houses now on the register, num— bering 528, varied during the year, but to these a total of 1,033 visits were made. Food and Drugs Samples. Under the provisions of the Sale of Food and Drugs Acts, 665 samples of food and drugs were taken and submitted to the Public Analyst for examination and report. It is so far satisfactory to be able to add that the average of adulterated samples is again' low, being 9 per cent, for the year, as against ll-66 per cent, for the decennial period 1902-1911. 7 Particulars of Adulteration. The outstanding feature of the adulteration practised in this Borough lies in the fact that, with the exception of one sample of camphorated oil, every sample adulterated, or sold to the prejudice of the purchaser, consisted of some article of dairy produce. 45 samples of milk and 11 samples of butter or in other words 98 per cent, of the adulterated foods were milk and butter, or margarine sold as butter. Food Inspection. Daily observation has been kept on the food deposited for sale on the stalls and in the markets, with excellent results. During the year there was sur— rendered about 3¼ cwts. of fish, 3 cwts. of meat, 6 cwts. of fruit, 197 rabbits, 5 cwts. of potatoes, 194 tins of vegetables, 73 tins of jam, besides smaller quantities of other articles. Nuisances al>ated and improvements effected. As regards the constructional or positive results, it may be added that 5,010 nuisances were abated, 3,772 dirty and defective premises were repaired and cleansed. 319 defective drains were amended or renewed, 2,410 foul and defective sanitary conveniences were cleansed, repaired and made good. Defective and insufficient water supplies were improved in 665 cases. 24 com— plaints of smoke nuisances were attended to, and with 8,078 matters of a miscellaneous character, makes up a total of 15,258 sanitary improvements effected. Without venturing upon further details, I would submit that the above items afford evidence that the work of detection and sanitary supervision generally has been well maintained in every section. 8 Staff changes. The changes of staff and working arrangements are as follows:—Mr. Richards was appointed to carry out duties under the provisions of the Housing and Town Planning Act. Mr. Jones was appointed to the District vacated by Mr. Richards. Mr. Bridel, who had held the appointment of Inspector for 16 years, resigned in October, having obtained a post in connection with the National Insurance Act. Mr. W. Billings, who had previously qualified himself for the post, was appointed an Inspector to fill the vacancy created by Mr. Bridel's resignation. New duties. The important matter of new and additional duties has been considered from time to time, but up to the present no decision has been arrived at. In the absence of serious epidemic infectious diseases, the daily detail work of a Health Department, important though it be, is not a matter of general interest, which is not helpful to administrative officers charged with the responsibility of carrying all this detail work into prompt execution Results. As regards the final conclusion, I am content that the following results shall speak for the activity and efficiency of the Department as a whole:— Reduction of Death Rates 1. The high death rate of about '26 per thousand, which seemed such a fixed and constant feature some years back, has been steadily and slowly reduced to the proportion of 15.3 per thousand. Infantile Mortality. '2. The heavy mortality of your infantile population has likewise been reduced from 155 per thousand to 103 per thousand births. 9 Figures like these should arrest some attention. When it is possible to reduce your general death rate by upwards of one-third and your infantile death rate in a greater degree, and to show by such a tally in human lives as these figures represent in a population of 130,000, one can rest fairly content that both the Committee and its staff stand justified. In connection with the question of what is some- Financial cost of working times termed economy, I would with your permission venture to direct attention to one fact, that hitherto seems to have been lost sight of. In spite of the numerous additional duties already referred to, duties in connection with the Notification of Births Act, the notification of Tuberculosis, the notification of Measles, the treatment of Verminous Children, and a host of kindred matters, all providing additional work for the Sanitary Office, it is a fact that we are carrying out all this extra work without making any additional demands upon the Council's Exchequer. Thanks to the lowering of the original notifiable Saving on original duties providing for new, Infectious Diseases, the saving effected in connection with Combined Drainage, to the absence of costly unsuccessful legal proceedings; the total cost of working the Department as a whole is substantially less now than it was some ten years ago. I have the honour to be, Mr. Chairman and Gentlemen Your most obedient servant, JOHN FOOT, Certificate Sanitary Institute, 1888. Member Royal Institute Public Health, 1895. Chief Sanitary Inspector, 1895. 10 APPEN Total Number of Inspections and Particulars of Cases in Hand District. Infectious Cases. Complaints. House to House Inspections. Trades' Inspections. Re inspections. Milk-shop Inspections. Factory and Work shop Inspections. Outworkers' Homes J nspections. Tenement House Inspections. New Buildings Inspections. Ice Cream Shop Inspections. A 240 197 63 — 3378 73 253 705 147 — 18 B 145 159 242 — 2405 78 137 887 130 1 42 C 163 259 197 1 2067 49 202 260 150 — 26 D 147 63 77 60 3701 230 896 196 571 — 62 E 287 356 11 — 2787 64 154 257 5 26 8 235 348 102 — 2089 16 267 354 29 — 16 F 42 72 — 20 796 51 309 84 1 — — 29 69 723 — 3226 — — — — — — — 10 — 1030 — — — — — — — Total 1288 1533 1415 1111 20449 561 2218 2743 1033 27 172 11 D1X A. for the Year ended 28th December, 1912. ned Drainage Inspections. Smoke NuisancesPremises under Observation. Other Inspections or work of Special Character. Number of Calls. Unsoun Food Seizures. Samples of Food and Drugs taken. Police Court Attendances. Nuisat ces Abated. Number of Cases in Hand. Total Visits for the Year. Inspector. — — 289 289 — 81 5 Flock 9 714 75 5652 E. Ainley. — — 273 71 — 92 4 706 54 4570 A. S. Henley. — — 565 134 — 95 5 Flock 36 667 49 4073 J. G. Weeks. — — 389 74 — 107 3 Flock 14 881 40 6466 F. Bare. — — 683 644 — 92 6 916 53 5282 1. R. Jones. — — 139 157 — 57 6 520 — 3752 H. F. Bridel. — — 87 18 — — 1 231 64 1480 W. Billings, Jr. — — 31 168 — 5 Flock 4 375 201 4246 E. Richards. — 541 — — 3 141 29 — — 1581 W. Rowsell. — 541 2456 1555 3 665 18 Flock 109 5010 536 37102 APPENDIX B. List of Nuisances and general Insanitary Conditions discovered during the year 1912. Period. Dirty Premises. Defective Drains. Defective and Dirty W C.'s. Defective Water Supply. Smoke Nuisances. Other matters. Total. 1912. 5 weeks ended 3rd February 269 63 126 32 4 548 1042 4 ,, 2nd March. ... 197 13 169 88 1 583 1051 4 „ 30th „ 334 22 211 50 4 643 1264 4 „ 27th April 284 21 151 28 2 509 995 5 ,, 1st June 421 27 219 38 — 651 1356 4 „ 29th , 332 29 213 45 3 511 1133 5 „ 3rd August 377 23 251 66 2 813 1532 4 „ 31st „ 161 13 101 26 1 412 714 4 „ 28th September 324 27 236 63 — 779 1429 5 „ 2nd November 446 32 309 87 3 1214 2091 4 „ 30th „ 341 32 237 79 3 757 1449 4 ,, 28th December 286 17 187 53 1 658 1202 Totals 3772 319 2410 655 24 8078 15258 12 13 APPENDIX C. List ok Sanitary Improvements effected during the Year. Cleansing— Premises, &c., cleaned, repaired or whitewashed 4,455 Workhops ditto ditto ditto 967 House Drains— Drains relaid 139 Drains amended 137 Drains cleared 308 Drains trapped and ventilated 47 Rain water pipes and waste pipes disconnected 7 Sink and bath waste pipes trapped 69 Water Closets— W.C.'s repaired, cleaned, &c. 1,819 W.C.'s fitted with new pans and traps 107 W.C.'s supplied with water, and water supply apparatus 652 W.C.'s ventilated 12 W.C.'s rebuilt 5 New W.C.'s provided 46 Partitions provided round W.C.'s to separate same from workshops 1 Water Supply— Houses provided with water supply 129 House supply disconnected from W.C. cistern — Cisterns supplied, repaired and cleaned 20 miscellaneous— Paving of yards 753 Wash-houses paved 69 Forecourts and Areas paved and drained 61 Stables paved and drained 12 Removal of accumulation of Dung and other refuse 150 Removal of Animals improperly kept 38 New Dung-pits provided and covers for same 12 Premises closed previous to executing the necessary repairs 98 Gutters, Rainwater Pipes, and Waste Pipes repaired 1,031 Illegal occupation of Basement discontinued 6 Overcrowding abated 242 Urinal accommodation provided 2 Grids provided to Gullies 26 Urinals supplied with proper water supply 16 Urinals cleaned and repaired 31 Dust Shoots repaired and Receptacles provided 507 Vacant lands cleansed — Yards cleansed 206 Indecent occupation discontinued 17 Verminous Rooms remedied 409 Damp Rooms remedied 373 Lighting and Ventilation improved 419 Total 13,398 APPENDIX D. (1). Police Court Proceedings, 1912—Public Health (London) Act, 1891. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1912 Feb 20 H. B. A. (two summonses') Non - com notice pliance with J. G. Weeks Mr. Biron Works done. Costs 3s. * ., 20 Joseph Donn, 25, Princelet Street, E. Do. do E. Ainley ,, ... Works done. Costs 3s. Mar. 19 M. S. A. (two summonses) Do. do. F. Bare ,, ... Works carried out. May 16 H. B A. Do. do. J. G. Weeks ,, ... Works carried out. Costs £1 4s. June 13 H. J. B. Do. do. A. S. Henley ,, ... Works done. Costs 3s. 14 Police Court Proceedings, 1912—Public Health (London) Act, 1891—continued. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result 1912 June 13 H. J. B. Non - compliance with notice A. S. Henley Mr Biron Works done. Costs 3s. „ 27 H. B. do Do F. Bare ,, ... Works done. Costs 3s. July 11 Reuben Button, 7, Gibraltar Walk Making drain, &c., without notice to Authority, at 3, Gibraltar Wk. I. R. Jones and E. Richards ,, ... Fined £2. Costs £1 3s. „ 11 Do. Do. 5, Gibraltar Walk Do. ,, ... Adjourmed, sine die. „ 11 Do. Executing drainage works without submitting plans, 3, Gibraltar Wk. Do. ,, ... Adjourned, sine die. 15 * Second or subsequent offence, reported in accordance with instructions of Public Health Committee. Police Court Proceedings, 1912—Public Health (London) Act, 1891—continued. Date of Hearing. Defendant. Offence Inspector. Magistrate. Result. 1912 Recheck427 * July 11 Reuben Button, 7, Gibraltar Walk Executing drainage works without submitting plans, 5, Gibraltar Wk. I. R. Jones and E. Richards Mr Biron Adjourned, sine die. Aug. 13 L. Overcrowding A. S. Henley Mr. Chester Jones Overcrowding abated. Costs 2s. „ 20 C. H. Exposing for sale unsound mutton W. Rowsell ,, Fined £15. Costs £2 2s. Sept. 24 D. N. Exposing for sale unsound tinned vegetables W. Rowsell & E. Ainley Mr. Biron Fined 10s. Costs 2s. Committed to prison for ten days in lieu of payment „ 24 ,, ... Depositing do. Do. ,, ... Withdrawn. Conviction on other summons re same article. 16 Police Court Proceedings, 1912—Public Health (London) Act, 1891—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1912 Sept. 24 J. c. Exposing for sale unsound tinned vegetables W. Rowsell & E. Ainley Mr. Biron Fined 10. Costs 2s. „ 24 ,, ... Depositing do. Do. ,, • • • Withdrawn. Conviction on other summons re same articles. Oct. 17 J. J. E. Depositing for preparation for sale unsound fat and jam W. Rowsell & E. Richards Mr. ChesterJones Fined £15. Costs £2 2s. Nov. 14 H. J. B. Non - compliance with notice A. S. Henley ,, Works done. Costs 3s. „ 14 B. P Exposing for sale unsound fish W. Rowsell ,, Fined £10. Costs £2 2s. Committed to prison for one month in lieu of payment. 17 * Second or subsequent offence, reported in accordance with instructions of Public Health Committee. APPENDIX D. (2). Police Court Proceedings, 1912—Dairies, Cowsheds & Milkshops Orders, 1885-1886. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1912 Jan. 9 A. P Selling milk registered seller whilst not as milk- W. Rowsell Mr. Biron Fined 10s. Costs 2s. *June 20 L. Sternberg, Turville House, Turville Street (7 summonses) Selling milk registered whilst not ,, ... Mr. ChesterJones Fined £5. Costs £2 2s. *Dec. 12 I. Solomon, 16, Club Row Do. do. ,, ... Mr. Biron Fined £2. Costs £2 2s. 18 * Second or subsequent offence, reported in accordance with instructions of Public Health Committee. 19 APPENDIX E (1). Sale of Food and Drugs Act, 1875-1907. Samples taken officially and submitted for analysis during the year. Article. Total No. of Samples taken. Genuine. Adulterated. offences other than Adulteration. Ammoniated Tincture of Quinine l l — — Arrowroot 5 5 — — Baking Powder 2 2 — — Butter 152 141 11 9 Camphorated Oil 8 7 1 — Cheese 1 1 — — Cheese, Sour 1 1 — — Cocoa 4 4 — — Coffee 9 9 — — Cream of Tartar 1 1 — — Crystal Jelly Powder 1 1 — — Flcur 1 1 — — Jam, Plum 1 1 — — Jam, Raspberry 2 2 — — Jelly, Table 3 3 — — Jelly, Raspberry 1 1 — — Lard 3 3 — — Margarine 4 4 — 1 Milk 410 366 44 1 Milk and Water 2 2 — — Milk, separated 4 3 1 — Mustard 7 7 — — Oil of Almonds 1 1 — — Olive Oil 1 1 — — Pepper 7 7 — — Total 632 575 57 11 The simples of " milk and water," probably sold as such owing to suspicion on the part of the vendor, were found to contain 24 and 22 per cent, of added water respectively. 20 In the case of two samples of milk containing 2 and 2⅓ per cent, of cane sugar respectively, investigations proved that these milks, supplied to school children at a meals centre, were sweetened by the contractor by arrangement with the purchaser to render the milk more palatable to the children. Four samples of milk were deficient in fat to so slight an extent as not to warrant legal proceedings ; the vendors were cautioned In the undermentioned cases " legal" notice was given at the time of sale and no proceedings therefore were possible Two margarines, sold as butter, but in stamped wrappers, and a margarine sold as butter in respect of which a protective notice was exhibited in the shop. APPENDIX E (2). Police Court Proceedings, 1912—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1912 *Jan. 9 Abraham Millman, 30, Smith Street, E. Selling milk containing 6 per cent, added water W. Rowsell Mr. Biron Fined £2. Costs £1 3s. ,, 9 M. J. Margarine sold in plain wrapper ,, ... ,, ... Fined £2. Costs £1 3s. ,, 9 A. P. Selling milk containing 4 per cent, added water ,, ... ,, .... Costs 10s. 6d. * ,, 9 David Edwards, 211 Bethnal Green Rd. Selling butter containing 42 per cent, foreign fat F. Bare ,, ... Fined £10. Costs £1 3s. ,, 9 ,, Margarine sold in plain wrapper ,, ... ,, .... Withdrawn. Conviction on other summons re same sample. ,, 9 I. M. Selling milk 19 per cent, deficient in fat J. G. Weeks ,, ... Fined £5. Costs £1 3s. ,, 9 J. C. Selling milk 17 per cent, deficient in fat F. Bare ,, ... Fined £1. Costs £1 3s. 21 *Second or subsequent offence, reported in accordance with instructions of Public Health Committee. Police Court Proceedings, 1912—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1912 Jan. 16 C. F. Delivering milk 39 per cent, deficient in fat W. Rowsell Mr. Bagallay Fined £5. Costs £1 3s. Feb. 6 A. W. L. Selling butter containing 86½ per cent, foreign fat J. G. Weeks Mr. Riron Fined £2. Costs £i 3s. ,, 6 ,, ... Selling margarine in plain wrapper ,, ... ,, ... Withdrawn. Conviction on other summons re same sample. ,, 13 M. o. Selling milk 19 per cent, deficient in fat A. S. Henley ,, ... Fined £1. Costs £1 3s. ,, 13 J. S. Selling milk containing 7½ per cent, added water ,, ... ,, ... Fined £1. Costs 12s. 6d. ,, 20 A. D. Selling butter containing 78 per cent, foreign fat E. Ainley „ ... Fined £1. Costs 2s. ,, 20 ,, ... Selling margarine in plain wrapper ,, ... ,, ... Withdrawn. Conviction on other summons re same sample. *Mar. 5 David Edwards, 21 1 Betlinal Green Rd. Selling butter containing 46 per cent, foreign fat W. Rowsell ,, ... Fined £50. Costs £2 2s. 22 * Second or subsequent offence, reported in accordance with instructions of Public Health Committee. Police Court Proceedings, 1912—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing Defendant. Offence. Inspector. Magistrate. Result. 1912 *Mar. 5 David Edwards, 211 Bethnal Green Rd. Selling margarine containing more than 10 per cent, butter fat W. Rowsell Mr. Biron Withdrawn. Conviction on other summons re same sample. ,, 5 J. D. Selling milk containing 17 per cent, added water F. Rare ,, ... Fined £1. Costs £1 3s. ,, 19 J. A. Selling milk containing 9 per cent, added water ,, • • • ,, ... Fined £1. Costs £1 13s. 6d. ,, 26 D. M. E. Selling milk containing 6 per cent, added water W. Rowsell ,, ... Dismissed upon warranty defence. "Apr. 11 Lewis Marcus, 2, Leslie Street, E. Refusal to serve Inspector J. G. Weeks Mr. Cheater Jones Fined £10. Costs £2 7s. ,, 16 J. L. ... Selling milk containing 17 per cent, added water W. Rowsell Mr. Biron Fined £2. Costs £1 13s. 6d. ,, 16 A. L Selling milk 7 per cent, deficient in fat J. G. Weeks ,, ... Fined £1. Costs £1 13s. 6d. 23 * Second or subsequent offence, reported in accordance with instructions of Public Health Committee- Police Court Proceedings, 1912—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1912 April 23 W.H Selling milk containing 5 per cent, added water H. F. Bridel Mr. Biron Fined £1 Costs £1 12s. 6d. May 2 R. D. M. S. Selling milk containing 7 per cent, added water J. G. Weeks Mr. Chester Jones Dismissed on warranty defence. *,, 2 J. Latsky, 13, Spital Street Selling milk containing 3½ per cent, added water F. Bare ,, ... Fined £1. Costs £1 3s. * ,, 16 J. Parry, 68, Green Street Selling milk 7 per cent, deficient in fat E. Ainley Mr. Biron ,, 16 ,, Selling milk 8 per cent, deficient in fat ,, ... ,, Fined £5. Costs £3 3s. ,, 16 ,, Selling milk 11 per cent, deficient in fat ,, ... ,, ,, 23 A G. P. Selling milk containing 6½ per cent, added water H. F. Bridel Mr. Chester Jones Fined £1. Costs £1 3s. ,, 23 J. F. Selling milk 22 per cent, deficient in fat ,, ... ,, ... Fined 10s. Costs 12s. 6d. 24 * Second or subsequent offence, reported in accordance with instructions of Public Health Committee. Police Court Proceedings, 1912—Sale of Food and Drugs Acts, 1875-1907—continued. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. 1912 June 6 A. W. Selling milk containing 11 per cent, added water J. G. Weeks Mr. Chester Jones Withdrawn upon conviction of wholesale dealer. * ,, 6 J. Rokenzohn, 43 Brady Street Selling milk 12 per cent, deficient in fat „ ... ,, ... Fined £3. Costs £1 1s. ,, 6 B. W. Selling milk 12 per cent, deficient in fat ,, ... ,, ... Fined 10s. Costs 12s. 6d. * ,, 6 E. & A. Motts, 38, Three Colt Lane Delivering milk 18 per cent, added water ,, ... ,, ... Fined £20. Costs £5 5s. ,, 18 J. A. Selling milk 12 per cent, deficient, in fat A. S. Henley Mr. Biron Fined £2. Costs 12s. 6d. *„ 20 B. Johen, 62, Old Bethnal Green Rd. Selling milk 22 per cent, deficient in fat I. R. Jones Mr. Chester Jones Fined £5. Costs £1 3s. 25 * Second or subsequent offence, reported in accordance with instructions of Public Health Committee. Police Court Proceedings, 1912—Sale of Food and Drugs Acts, 1875-1907—continued. Date of Hearing. Defendant. Offence. Inspector. Magistrate. Result. 1912 June 27 E A. Selling margarine purporting to be butter E. Ainley Mr. Chester Jones Fined £1. Costs 12s. 6d ,, 27 ,, ... Selling; margarine in plain wrapper ,, • • • ,, ... Withdrawn. Conviction on other summons re same sample. *July 4 Meredith Jenkins, 104, Gibraltar Walk Selling milk 10 per cent, deficient in fat F. Bare Mr. Leycester Fined £15. Costs £2 2s. *„ 5 Joseph Latsky, 13, Spital Street Selling milk 11 per cent, deficient in fat ,, ••• Mr. Biron Fined 1s Costs £1 lis. 6d. Wholesale man convicted re subsequent sample. ,, 5 A. L. Selling milk 12 per cent, deficient in fat ,, ... ,, ... Fined £5. Costs £2 2s. ,, 5 ,, ... Selling milk containing 5 per cent, added water ,, ... ,, ... Withdrawn Conviction on other summons re, same sample. 26 * Second or subsequent offence, reported in accordance with instructions of Public Health Committee. Police Court Proceedings, 1912—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1912 July 5 M. G. Selling milk 8 per cent, deficient in fat F. Bare Mr. Biron Fined Is. Costs £1 lis. 6d. Wholesale man convicted re same sample. ,, 11 T. C. T. Selling milk containing 10 per cent, added water J. G. Weeks ,, ... Withdrawn. Defendant exercised right to send sample to Government Analyst, whose certificate differed from that of the Public Analyst. No power to proceed further. ,, 11 J. C. Selling milk containing 25 per cent, added water ,, ... ,, ... Withdrawn. This case depended upon case of T. C. T. above, who was the wholesale man. ,, 11 M. T. Selling milk containing 10 per cent, added water ,, ... ,, ... Withdrawn. Same sample concerned as in case of T. C. T. In view of disputed ownership, summons issued against wife. 27 Police Court Proceedings, 1912—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1912 July 23 E. M. Selling butter containing 85 per cent, foreign fat H. F. Bridel Mr. Biron Fined £2. Costs £1 lis. 6d. ,, 23 ,, ... Selling margarine in plain wrapper ,, ... ,, ... Withdrawn. Conviction on other summons re same sample. *,, 23 Lewis Marcus, 2, Leslie Street, E. Selling milk containing 10 per cent, added water W. Rowsell ,, ... Fined £20. Costs £1 lis. 6d. ,, 23 A. L. Selling milk 10 per cent, deficient in fat I. R. Jones ,, ... Fined £1. Costs £1 lis. fid. Aug. 20 E. J.K. Selling milk containing 14 per cent, added water W. Rowsell Mr. Chester Jones Notice of warranty given. Costs only, £1 lis. fid. J. E. Selling milk containing 18 per cent, added water ,, ... ,, ... Defendant absconded. *Sept. 24 James Regan, 334, Old Ford Road Selling milk 16 per cent, deficient in fat E. Ainley Mr. Biron Fined £1. Costs £1 lis. 6d. 28 * Second or subsequent offence, reported in accordance with instructions of Public Health Committee. Police Court Proceedings, 1912— Sale of Food and Drugs Acts, 1875-1907—confirmed. Date of hearing. Defendant. Offence. Inspector. Magistrate. j Result. 1912 *Nov. 14 Evan Roberts, 379, Cambridge Rd. Selling milk containing 9 per cent, added water J. G. Weeks Mr. Chester Jones Fined £3. Costa £ 1 3s. ,, 14 R. B. Selling milk containing 6 per cent, added water W. Rowsell ,, ... Fined £1. Costs £1 3s. ,, 14 J. P. Selling milk containing 8 per cent, added water E. Ainley ,, ... Fined £1. Costs £1 3s. ,, 21 V. c. Selling milk 6 per cent, deficient in butter fat A. S. Henley ,, ... Costs 12s 6d. ,, 21 F. F. Selling milk 13 per cent, deficient in butter fat ,, ... ,, ... Fined £1. Costs £1 3a. *Dec. 5 Soloman Nisonson, 8, Hare Street Selling milk containing 10 per cent, added water F. Bare ,, ... Fined £1. Costs £1 3s. 29 * Second or subsequent offence, reported in accordance with instructions of Public Health Committee. Police Court Proceedings, 1912—Sale of Food and Drugs Acts, 1875-1907—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1912 *Dec. 19 Benj. Levy, 88. Brady Street Selling butter containing 85 per cent, foreign fat J. G. Weeks Mr. Chester Jones Fined £10. Costs £2 ?a. ,, ... Selling margarine in plain wrapper ,, ... ,, ... Fined 10s. Costs 2s. ,, ... Selling margarine in plain wrapper ,, ... ,, ... Withdrawn. Conviction on other summons re same sample. 30 * Second or subsequent offence, reported in accordance with instructions of Public Health Committee. 31 APPENDIX E. (3). FOODS AND DRUGS. Table showing percentage adulteration for Decennial Period !902—1911, compared with 1912 :— Year. No. of Samples Taken. No of Samples Adulterated. Percentage of Adulterated tramples. 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 1911 646 62 9.6 Decennial average percentage adulteration 11.66 1912 632 57 9.0 32 The following is a summary of legal proceedings, etc., in connection with samples taken for analysis :— No of Adultera tions Other Offences under Acts. No. of Summonses Issued. No. of Convictions Obtained. No. of Cases Dismissed No. of Summons# s W thdrawn. No. of casps pending at 31 t Dec 1912. 57 11 60 39 2 13 6 In eight cases, viz. : Butter 4, milk 4, no proceedings could be instituted owing to "legal " notice having been given at the time of sata or to the offences being too slight to warrant the issue of summonses. * The summonses dismissed were in respect of two milks, a warranty being successfully pleaded in each case. • Seven cases were withdrawn owing to the conviction of offenders in respect of other charges concerning the same samples. APPENDIX E (4). Sale of Food and Drugs Acts. Samples taken on Delivery. The undermentioned samples were taken on delivery from wholesale firms delivering goods to various retail tradesmen, etc., in the Borough. Total Samples Articles. Taken. Genuine. Adulterated. Milk 24 19 5 33 APPENDIX E. (5). Samples of Foods and Drugs taken informally for information :— Article. Total Samples Taken. Genuine. See below (*) Adulterated. See below (†) Milk 23 19 4 Lard 14 14 — Margarine 6 6 — Flour 3 3 — Butter 3 1 2 Cotton-seed Oil 1 1 — Oatmeal 1 1 — Extract of Meat 1 — 1 " Romo " (Margarine) 1 1 — " Pearksown " (Milk-blended Butter) 1 1 — Nut Lard 1 1 — Nut Margarine 1 1 — Totals 56 49 7 * Or preservatised to very slight extent or answering trade description. † Or preservatised, or differing from trade description, to such an extent that if purchased officially would warrant prosecution. The sample of extract of meat was taken from a quantity of tins which were being hawked ; it was certified to consist mainly of boiled wheaten flour mixed with a little meat extract and much salt; it had lost all its flavour except that of salt and was useless as a food; it could not be termed injurious to health ; the vendor was cautioned and the sale of this stuff ceased. The fourteen samples of lard were purchased following a letter from the Board of Agriculture giving 34 warning of the extensive sale of lard substitutes as lard ; full enquiries were instituted but nothing of the kind was discovered in the Borough. Comparing this table with that showing samples taken officially (Appendix E (1) ) it will be seen that adulteration in the case of samples taken informally is 12.5 per cent, as against 18.9 per cent, for 1911, and as against 9.6 per cent, of the samples taken officially during 1911. Particular of Samples examined in Laboratory at Town Hall. Article. Total Samples Taken. Genuine. Adulterated, etc. Poor Quality. Butler 9 2 7 — Lard 8 8 — — Milk 31 12 13 6 Self-raising Flour 5 5 — — Vinegar 1 — 1 — Totals 54 27 21 6 In the cases of samples found to be adulterated the vendors were followed up and official samples purchased, which likewise proved to be adulterated; upon proceedings being taken substantial penalties followed in every case upon conviction. The tines and costs in these cases amounted to £'35 17s. 6d. 35 APPENDIX F. Particulars relating to Unsound Food for 1912. Surrendered. Cwts. qrs. st. lbs. Fish 3 3 — 7 Meat 3 — — 4 Fruit 6 1 — 6 197 Rabbits. 5 cases of Tomatoes. 560 lbs. Potatoes. 4 boxes of do. 5 kits of Crabs. Seized. Cwts. qrs. St. lbs. Fish — 1 — — Meat — — — 6 19 J tins of Vegetables (various kinds). 73 tins of Jam. 18 lbs. of Fat. APPENDIX G (1). Premises where Food is prepared for Sale. No. of premises on Register at end of 1912 12 Factories. 212 Workplaces. Do. removed from Register 2 Factories. 6 Workplaces. Do. added to do. 7 ,, No. of Inspections 79 Factories. 1004 Workplaces. No. of Notices served 1 Factory. 1 61 Workplaces. No. of Prosecutions — 36 APPENDIX G (2). Particulars relating to Ice Cream Shops. No. on Register 104 No. of Inspections made 236 No. of Notices served 33 No. removed from Register 5 No. added to Register 7 APPENDIX H. Inspection of Bakehouses. No. of Bakehouses on Register at end of 1911 92 Do. do. 1912 89 Do. above ground 63 Do. under ground 26 No. of Inspections 187 No. of Notices 13 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. 1911 190 3,473 3,351 1,822 1912 181 2,928 3,103 1,561 Number of Outworkers dealt with in 1911 6,824 ,, ,, ,, 1912 6,031 APPENDIX I. (2). Outworkers' List of Trades. The following is a list of the trades in which the Outworkers notified in 1912 were engaged :— 37 Artificial Flower Making 18 Belt Making 23 Bibs, etc 5 Blouse Making 29 Boot and Shoe Making 436 Box Making 422 Brace Making 5 Brush Making 170 Button Making 2 Cabinet Making 3 Cap Making 14 Chair Making 2 Collar Making 9 Corset Making 7 Dress Making 26 Embroiderers 32 Feather Work 4 Furriers 12 Glove Making 1 Hair Sieve Making 2 Lace Making 1 Mantle Making 41 Match Box Making 44 Milliners 17 Paper Bag Making 4 Pyjama Making 2 Sack Making 1 Shirt Making 21 Silk Weaving 47 Surgical Instruments 1 Tailoring 527 Tie Making 26 Upholsterers' Trimmings 36 Underclothing 13 Umbrellas 36 Waterproof Makers 2 Incorrect addresses and those having discontinued work 441 2482 APPENDIX J. Tenement Houses. No. of Tenement Houses on Register at end of 1912 528 No. of Tenement Houses cancelled during 1912 12 „ „ registered „ 4 38 Inspections made 1,724 Rooms overcrowded 7 Cellars illegally occupied 0 Water provided to upper floors 4 Cases of indecent occupation 1 Notices served 502 Registration forms written and served 6 APPENDIX K. House to House Inspections and Overcrowding. No. of House to House inspections during 1912 1,415 Dwelling rooms found overcrowded during 1912 242 Cases of overcrowding remedied during 1912 218 No. of other defects discovered 2,864 No. of Prosecutions — APPENDIX L. Complaints received from L.C.C. respecting Verminous School Children. No. of complaints received during 1912 974 Inspections made 991 Premises found to be verminous 82 Defects discovered 1,114 No of notices served 211 No. of prosecutions — 39 APPENDIX M (1). Particulars respecting work of Disinfectors and Shelter. NUMBER. OF ROOMS DISINFECTED. Month. Notifiable Infectious Diseases (Public Health Act). Phthisis. Chicken Pox. Cancer. Erysipelas. Measles. Scabies. Verminous Rooms. By Request. Total Articles Disinfected at Station. January 44 20 2 1 - - - 4 - 71 1,584 February 32 18 - 1 3 - - 3 - 57 1,310 March 33 20 — - - - - 9 - 62 1,238 April 31 22 - - - - - 13 - 66 1,148 May 34 14 - - - 2 - 25 2 77 1,808 June 40 11 1 - - - - 47 - 99 1,105 July 45 16 - - 3 3 - 30 5 104 607 August 41 14 - - - 3 9 8 2 77 1,352 September 54 12 — - - 4 10 11 - 91 2,507 October 64 13 - - - 2 16 10 2 107 1,456 November 52 14 — — — 4 20 3 1 94 2,070 December 55 19 - - - - 8 1 - 73 1,451 525 183 3 2 6 18 65 164 12 978 17,636 The number of articles of Bedding and Clothing destroyed at the Disinfecting Station during the year was 44. The number of articles disinfected in Formalin Chamber (Books, Boots, Boot Uppers, and Fancy Goods) was 1820. Twenty-five Men and two Children were bathed and their clothes were disinfected at the Disinfecting Station. 40 APPENDIX M. (2). Fifty casks of Sanitas Powder, making up into 3,500 packets, have been distributed from the Public Health Department. Seven hundred and twenty-one pint bottles of Sanitas Fluid, and two hundred and eighty-eight onepint tins of Izal Fluid have also been distributed. Half-a-ton of Sulphur Candles have been used in the disinfection of rooms throughout the year. One gallon of Formaldehyde Solution (40 percent) bas been used in spraying the walls of rooms and five pounds of Formalin Tablets have been used for fumigating rooms and articles in the Formalin Chamber. Ten gallons of Creocide also have been used for disinfecting purposes. APPENDIX N. Smoke Nuisance Observation. No of Shafts under observation 100 No. of hours occupied in observation 305 No. of intimation notices served 26 No. of statutory notices served 3 No. of prosecutions nil. 41 APPENDIX O. Mortuary Returns, 1912. Bodies removed to Mortuary— On Coroner's Orders 245 By Police 10 From London Hospital 14 On Sanitary Inspector's Order 5 On Request of Relatives 63 Total 337 Number of Inquests held 257 Number of Post Mortem Examinations made 105 Particulars of Bodies on which Inquests were held— Bodies removed by Police from Canal 4 Do. do. Street 5 Do. do. found in Parcel 1 Bodies received from Bethnal Green Infirmary 51 Do. do. Queen's Hospital 14 Do. do. Mild may Mission Hospital 8 Do. do. Private Houses, etc. 174 Total 257 Inquest cases according to age period— Number under one year 69 Number over one year and under five years 19 Do. five do. ten do. 14 Do. ten do. twenty years 10 Do. twenty do. thirty do. 4 Do. thirty do. forty do. 18 Do. forty do. fifty do. 28 Do. fifty do. sixty do. 28 Do. sixty do. seventy do. 38 Do. seventy do. eighty do. 21 Do. eighty years 8 Total 257 42 Causes of death in Inquest cases- Acute Pneumonia 17 „ Indigestion 1 Angina Pectoris 1 Aortic Incompetence 4 Apoplexy 10 Atelectasis 2 Atrophy of the Heart 2 Bronchitis 4 Bronco-Pneumonia 5 Cancer of Liver 1 „ Larynx 1 Cardiac Rupture 1 „ Valvular Disease 16 Cerebral Tumour I Cerebro-Spinal Meningitis 1 Collapse and Hoemorrhage 1 Convulsions 7 Cystic Kidney Disease 1 Diabetes 1 Diarrhoea and Enteritis 3 Emphysema Erysipelas 4 Fatty Degeneration of Heart 10 Gastric Ulcer 1 Gastro-Enteritis General Tuberculosis 8 Improper Feeding 1 Inanition 2 Intussusception of Bowels 3 Liver and Kidney Disease 1 Malnutrition 1 Meningitis 1 Measles 1 Mitral Incompetence I Peritonitis 3 Pertussis 4 43 Cause of death in Inquest cases -continued— Phthisis 4 Pleuro-Pneumonia 3 Pleurisy 5 Premature Birth 7 Rickets 1 Rupture of an Aneurism of the Aorta 3 Senile Decay 5 Still Born 4 Status Lymphaticus 1 Ulcer of the Colon 1 Venous Thrombosis 1 Volvulus of Intestines 3 Want of Attention at Birth 2 Accidental Deaths, etc.— Choking 3 Falls 24 Suffocation at Birth 2 „ whilst in Bed 24 „ whilst in a Fit 1 Drowning 3 Coal Gas Poisoning 1 Burns 4 Fracture of Spine 1 Obstruction of Bowels 1 Misadventure, death while under Chloroform 2 „ overdose of Colchicum 1 Run Over in street by Horse Van 2 „ „ Motor Wagon 1 6 „ „ „ Bus 3 Scalds 2 Septicaemia 2 Tetanus 1 Destitution and Poverty 2 44 Cause of death in Inquest cases —continued— Chronic Alcoholism 3 Found Drowned 1 Self Starvation 1 Suicide— Cut Throat 1 Hanging 2 4 7 Poisoning 4 Total 257 Bodies received under Public Health (London) Act— Diphtheria 2 Erysipelas 1 Measles 2 5 APPENDIX P. Inspection of certain places subject to special Bye-Laws and Regulations. Premises. No. of Premises On Register at end of 1911. Added in 1912. Removed in 1912. On Register at end of 1912. No. of Inspections. No. of Notices. No. of Prosecutions. Milkshops 256 12 25 243 607 51 3 Cow-houses 14 — — 14 37 1 — Slaughter-houses 4 — — 4 31 2 — Other Offensive Trade Premises 1 — — 1 5 — — 45 46 APPENDIX Q. Clerical Work. Intimation notices written and served, Public Health Act 4,311 Statutory do. do. do. 2,296 Notices under Housing, Town Planning, &c., Act, 1909, Section 15 362 Entries in Nuisance Register 6,685 „ Tenement House Register . 2,821 ,, Food and Drugs „ 697 „ Workshops „ 6,218 Notices respecting Combined Drainage . 16 Final notices prepared and served 888 Letters written 3,546 Instructions to Solicitor prepared 72 Summonses prepared (4 copies each) 96 School notifications prepared and dispatched . 1,877 Notices to District Surveyor 158 APPENDIX R. Housing and Town Planning Act, 1909. Summary of Results of Inspections and action taken for the year ended 31st Deceviber, 1912. Number of Houses Inspected 664 Number of Houses where admission was not obtained 21 Number of Empty Houses 26 Number of Houses where defects were found and where Notices were required 586 Number of Houses where no defects were found 55 Number of Houses where overcrowding was found 12 47 Number of Houses so unfit for human habitation as to be suitable for Closing Order under Section 17, H., T. P.,etc., Act *31 Number of Houses so defective as to be suitable for dealing with under Sec. 15, Housing, Town Planning, etc., Act 396 Number of Houses where ordinary notices under the Public Health (London) Act, 1891, met the case ... 188 Number of Houses to which it was necessary to draw the attention of District Surveyor .. ... 50 * The majority of these premises were very extensively repaired by the owners and subsequently re-let; the remainder were voluntarily closed and either remain closed or were demolished. No representations were made in 1910 or 1911 to the Council under Section 17 of the above-mentioned Act. In 1912 one representation was made and in this case, a basement, the owners filled in and abolished the rooms complained of before the issue of an Order to close. In 25 cases communications were sent to the owners of property giving notice of contemplated action under Section 17. In 18 cases the premises were demolished, in two cases premises were closed and reopened after very extensive repairs, and in five cases the premises remain closed. Under Section 15, 633 notices have been served, as follows:— 1910 15 1911 256 1912 362 In a large number of these cases the premises were closed temporarily for repairs. m : *:" - * rt*tr rt: ' BsMKHSSft*