BET 21 THE Metropolitan Borough of Bethnal Green REPORT ON THE SANITARY CONDITION AND VITAL STATISTICS DURING THE YEAR 1915. TOGETHER WITH THE Report of the Chief Sanitary Inspector. BY GEORGE PADDOCK BATE, M D Fellow of the Royal College of Surgen,.s 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; Honorary Consulting Physician to Queen Adelaide's Dispensary ; Home Office Medical Referee, W.C.A. ; J.P. for the County of London; and Medical Officer of Health for the Borough of Bethnal Oreen. LONDON: PRINTED BY CHARLES AND SON, EMERSON STREET, SOUTHWARK, S.E. 1916. Metropolitan Borough of Bethnal Green. PUBLIC HEALTH COMMITTEE, 1915-16. Meetings held at the TOWN HALL, Cambridge Rd., E., alternate Wednesdays at 6 p.m. Councillor T. O'Grady, J.P., Chairman. Councillor C. L. Coomber, Vice-Chairman. The Mayor (Councillor W. J. Lewis, J.P.). Alderman J. J. Fleming. Councillor R. Larkins. Councillor T. Brooks. ,, J. Sigournay. „ T. A. Dean. „ J. J. Vaughan. „ F. W. Eaton. „ J. W. Ward. ,, W. T. Garner „ G. A. Wocha. Ex-Officio Members of the Public Health Committee (Chairmen of Standing Committees of the Council.) COMMITTEE. CHAIRMAN. Finance Councillor A. J. King. Works and Stores ,, G. Bayley. Law and General Purposes Alderman R. E. Pearson. Baths „ J. Pullen. Electricity Councillor J. J. Cole. Public Libraries Councillor W. Rawles. The Chairman of the Valuation Committee is an elected member of the Public Health Committee. STAFF OF THE PUBLIC HEALTH DEPARTMENT. George Paddock Bate, Medical Officer of Health. Alfred Walter Stokes, F.C.S., F.I.C., Public Analyst. John Foot, Chief Inspector. E. Ainley, Sanitary Inspector. I. R. Jones, Sanitary Inspector. F. T. Bare ,, E. Richards „ *W. Billings „ W. Rowsell ,, A. S. Henley ,, J. O. G. Weeks ,, *J. H. Hewitt, Sanitary Inspector (Temporary). Miss C. Hammond, Health Visitor. Mrs. M. A. Hodgkins „ E. Q. Bilham, Chief Clerk. F. G. Thomas, Assistant Clerk. H. A. Saunders „ „ *H. W. Pendrill „ „ W. H. Heron, Office Youth. Two Temporary Clerks. *G. I. Brighting, General Assistant (Temporary). * Sanitary Inspector Billings and Assistant Clerk Pendrill proceeded on active service upon outbreak of European War. General Assistant Hewitt was transferred as temporary Inspector to fill vacancy and Assistant Clerk Brighting was made temporary General Assistant. Two temporary appointments, made to fill the two vacant clerkships. Disinfectors. One Leading Disinfector. Four Assistant Disinfectors. One Assistant Disinfector and Messenger. 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, E. Mortuary. Church Row, Bethnal Green Road, E 3 SYNOPSIS OF Medical Officer's Annual Report, 1915. page Public Health Committee 1 Staff 2 General Summary 5 Population 6 Table " A," Population 7 Births 8 Deaths 8 Transferable Deaths 9 Table "B," Public Institutions outside Bethnal Green into which residents have been received and where they have died 9 Table "C," Public Institutions in Bethnal Green 12 Deaths in Sub-districts, Table "D" 13, 14 Death Rate 14 Table "E," Monthly Mortality Rates—London and Bethnal Green 15 Table " F," Quarterly Death Rates—London and Bethnal Green 15 Birth Rate 16 Table "G," Marriages 16 Deaths of Infants 16 Infantile Death Rates—Ten Years 17 Table "II," Special Causes of Infantile Deaths 18 Deaths of Yoiing Children 18 Senile Mortality 18 Table "I," Quarterly Mortality—Bethnal Green 19 Table " J," Quarterly Mortality—London 20 Deaths from Notifiable Infectious Diseases 21 Do. do. Table "K" 23 Deaths from the Seven Principal Zymotic Diseases, Table "L" 23 Table "M," Percentages of Deaths from Zymotic Diseases 24 Notification of Infectious Diseases 24 Table "N," Details of Notifications 25 Table "0," Condition of Premises 26 Scarlet Fever 26 4 SYNOPSIS—continued. page Diphtheria 27 Enteric Fever 28 Whooping Cough 28 Diarrhœa 29 Measles 29 Chicken Pox 29 Erysipelas 30 Appendicitis 30 Diseases of Parturition 31 Ophthalmia Neonatorum 31 Cerebro-Spinal Meningitis 31 Acute Poliomyelitis 32 Tuberculosis 32 Do. Occupations and persons notified 36 Tuberculosis Dispensary 38 Cancer 39 Health Visitors—Summary of Work 40 Maternity and Child Welfare Scheme 43, 45 Public Health (Shell-fish) Regulations, 1915 46 Army Canteen Contractors 46 Flies and Disease 47 Removal of Refuse 47 Sanitary Conditions in Shops 47 Inquests 48 Customs and Inland Revenue Acts, 1890 to 1903 48 Brady Street Area 49 APPENDIX. Table I. Vital Statistics of Whole District 63 II. Cases of Infectious Disease Notified 64 II. (a) Public Health Tubercidosis Regulations, 1912—Notifications 65 III. Causes of, and Ages at Death 66 IV., IV. (a), IV. (b) Infantile Mortality 67-69 V. Number of Deaths from the Seven Principal Zymotic Diseases in ten years, 1905 to 1914, and in the year 1915 70 Administration of Factory and Workshop Act, 1901 71-72 Street List 73-79 Memorandum by Town Clerk and Medical Officer of Health re Proposed Tuberculosis Dispensary 80 5 SUMMARY. 1914. 1915. Estimated Population of Bethnal Green 127,662 120,207 Young Children, under 5 years 16,250 16,250 Old People, over 65 years 4,820 4,820 Area—759 acres. Number of Inhabited Houses 14,758 14,729 Rateable Value £535,734 £536,107 Average number of Persons to each House 8.7 83 Average number of Persons to each Acre 168.2 1584 Total number of Deaths in the year 2,036 2,091 Total number of Births in the year 3,786 3,514 Total number of Marriages 1,009 1,536 Marriage Rate—Bethnal Green 16.4 24 2 Marriage Rate—London 191 * Death Rate—Bethnal Green 15.9 174 Death Rate—London 14.4 16.1 Birth Rate—Bethnal Green 296 27.5 Birth Rate—London 243 22.9 Infantile Death Rate (on Births)—Bethnal Green 137.0 118.0 Infantile Death Rate (on Births)— London 104.0 110.0 Young Children's Death Hate (on estimated number of Young Children) 48.3 46.4 Old People's Death Rate (on estimated number of Old People) 80.0 106.4 Zymotic Death Rate (Bethnal Green) 2.58 2.67 Zymotic Death Rate (London) 2.21 1.5 Inquest Cases 2.63 201 * Not ready for publication. Metropolitan Borough of Bethnal Green. REPORT. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Sir and Gentlemen, In this, my fortieth, annual report I beg to lay before you the vital and mortal statistics of the Borough of Bethnal Green for the year 1915. POPULATION. The Registrar-General's estimate of the population of the Borough of Bethnal Green for 1915 is 120,207 against 127,662 in the middle of 1914. This decrease of 7,455 includes the estimated number of men who have unlisted and also takes into account the normal decrease of population based upon the census figures of 1901 and 1911. 7 In a return issued by the Registrar-General in which the new population figures are used for the first time, a footnote states that these are based upon returns furnished under the National Registration Act, 1915. The official estimates of populations of Bethnal Green and of London are given below:— Year. Bethnal Green. London. 1913 127,824 4,518,191 1914 127,662 4,516,612 1915 120,207 4,310,030 Throughout this report I have used the official figures in the calculation of general death rates, but for birth and marriage rates and for the death rates of young children and old persons I have used the estimated population for 1914, as I am of opinion that this figure more nearly represents actual numbers, since women, young children and old people have not been drawn upon for military purposes. TABLE A. 1914. 1915. Estimated population in the middle of the year 127,662 120,207 Total Births 3,786 3,514 Total Deaths 2,047 2,091 Excess of births over deaths, shewing the natural increase of the population 1,739 1,423 8 BIRTHS. The children born alive in Bethnal Green during the year numbered 3,314, but in addition to the local births, I have received information from the Registrar-General that during the year, 200 infants were born of Bethnal Green mothers in some one or other of the Metropolitan institutions where maternity cases are admitted. The details of these transferable births are given below, and the adjustment of the total number is as follows :— Births in the Borough 3314 London Hospital 99 City of London Lying-in Hospital 38 Whitechapel Infirmary 19 East End Mothers' Home 20 Jewish Maternity and Nursing Institution, Underwood Street 15 Middlesex Hospital 2 Various places 7 — 200 3514 Outward Transfers Net total of Bethnal Green births 3514 DEATHS. In accordance with instructions received from the Registrar-General the deaths referred to in this report relate exclusively to the civil population; deaths of officers and men of the armed forces of this and other nations admitted to institutions for the sick,or dying at 9 their own homes, are excluded, but deaths of refugees and of interned aliens are regarded as non-transferable. The deaths of civilians actually recorded in the returns of the local Registrars number 2152, but included in these returns are particulars of the deaths of 494 nonresidents who were under treatment at one or other of the four Bethnal Green Public Institutions where sick persons are received. Eight other non-residents died sudden or violent deaths whilst temporarily residing in or passing through Bethnal Green. The monthly returns of transferable deaths forwarded by the Somerset House authorities contain particulars of 426 deaths; these include, in addition to the deaths in public institutions, the names of 15 inhabitants of Bethnal Green who have died or were found drowned in various parts of London. TABLE B. Public institutions situated outside the Borough into which Bethnal Green residents have been received and where they have subsequently died. Banstead Asylum 4 Bow Institution 1 Bulstrode House, Marylebone 1 Camberwell Infirmary 1 Cane Hill Asylum. 2 Caterham Asylum 8 Charing Cross Hospital 1 City of London Lying-in Hospital 1 Children's Hospital, Great Ormond Street 2 Claybury Asylum 13 Colney Hatch Asylum 14 10 Consumption Hospital, Kensington 1 Dartford Heath Asylum 4 Downs Sanatorium 2 Eastern Hospital 31 East London Hospital 3 Epileptic Colony 1 Fountain Temporary Asylum 1 Friedenheim Hospital 1 German Hospital. 2 Hackney Infirmary 2 Hanwell Asylum 4 Home for Incurable Children, Hampstead 1 Joyce Green Hospital 1 London Hospital 146 Leavesden Asylum 9 Long Grove Asylum 8 Metropolitan Hospital 2 Middlesex Hospital 1 Mile End Infirmary 3 Northern Hospital 5 North-Western Hospital 1 North-Eastern Hospital 8 National Heart Hospital 1 Orchard Hospital 1 Park Hospital 1 Poplar Hospital 1 Queen Mary's Hospital 2 Royal Chest Hospital, City Road 1 Royal Waterloo Hospital 1 St. Bartholomew's Hospital 9 St. Columba's Hospital 1 St. George's Home, Chelsea 2 11 St. Luke's House, Kensington 3 St. George's Infirmary 76 St. Joseph's Hospital, Hackney 1 St. Peter's Home, Hampstead 1 St. Peter's Hospital 1 Sick Asylum, Bromley 1 Shoreditch Infirmary 12 South-Eastern Hospital 8 Tooting Bec Asylum 2 Whitechapel Infirmary 4 172, High Street, Hackney (Doctor's Surgery) 2 Deaths occurring in various Institutions outside London, particulars of which were forwarded to me by the Registrar-General and subsequently verified 10 426 12 TABLE C. Public Institutions in Bethnal Green. Institution. Beds Available. In-patients Treated. Out-patients Treated. Deaths— Bethnal Green Residents. Deaths— Bethnal Green Non-Residents. City of London Hospital for Diseases of the Chest 175 947 7,928 15 103 Queen's Hospital for Children, Hackney Road 134 2,029 42,225 86 293 Mildmay Mission Hospital 50 622 11,806 18 27 Bethnal House Asylum — — — 1 42 *Bethnal Green Infirmary * * * 655 31 Five deaths also occurred in the Bethnal Green Military Hospital of soldiers under treatment there, one being a resident of the Borough and four non-residents. * Owing to shortage of staff at the Guardians' Offices consequent upon the war, I was unable to obtain the figures for the Infirmary, but in a letter I received from the Clerk to the Guardians occurs the following passage :— "On the week ending Saturday, the 25th December last, there were 396 patients at Waterloo House, 85 at St. George in the East, and 4 at Whitechapel, all chargeable to Bethnal Green." 13 SUMMARY. Total deaths registered 2152 Sudden deaths of residents outside the Borough 15 Deaths of residents in institutions outside the Borough 426 — 2593 Deductions:— Sudden deaths of strangers in Bethnal Green 9 Deaths of strangers in Bethnal Green Institutions 493 502 Net total deaths of Bethnal Green residents 2091 Note.—In accordance with instructions received from the Registrar-General (see page 8), the deaths of soldiers in the Bethnal Green Military Hospital have not been included in these statistics, but the numbers will be found at the foot of page 12. DEATHS IN SUB-DISTRICTS. In the North-East Sub-district 1,077 deaths occurred amongst the residents, and 977 in the South-West. Thirty-seven persons who had no fixed homes died in the Workhouse or the Infirmary. These details are shown in Table D. 14 TABLE D. District. Deaths. Population. North-East 1,077 59,986 South-West 977 60,221 Previous residence unknown 37 — Total 2,091 120,207 DEATH RATE. We show a mortality for the year 1915 of 17.4 per thousand persons living, calculated on the new civil population figure given by the Registrar-General of 120,207. This rate, which is 1.5 higher than that of the previous year, is 1.3 above the rate for London, which is 16.1 per thousand. The rate for London is calculated on the new civil population estimate of 4,310,030. MORTALITY RATES IN SUB-DISTRICTS. The death rate for the North-East Sub-district was 18.0, and that for the South-West 16.2. These rates are exclusive of the 37 homeless paupers who died in the Workhouse and Infirmary, although these are necessarily included in the general rate for the whole Borough. COMPARATIVE DEATH RATES. Table E shows the mortality rates for Bethnal Green and for London, compared by months, the rainfall and the mean temperature for each quarter also being shown. Table F compares the death rates for London and for Bethnal Green by quarters. 15 TABLE E. Month. London Death Rate. Bethnal Green Death Rate. Mean Temperature (Degrees.) Approximate Rainfall. (Inches). January 19.6 20.0 39.5 3.1 February 20.8 21.5 40.7 3.2 March 21.2 23.2 42.3 1.2 April 19.6 21.3 47.6 .9 May 14.6 15.9 54.4 3.3 June 12.2 12.5 59.9 .6 July 11.0 10.4 61.8 3.1 August 11.6 10.5 63.5 3.1 September 14.0 13.8 57.6 2.2 October 14.6 14.8 50.7 1.2 November 16.2 17.5 39.7 2.5 December 17.4 15.7 43.4 5.7 Average *16.0 *16.4 50.1 2.5 * The whole of these rates for London and Bethnal Green have been calcuated on the old population. The Death Rate for Bethnal Green calculated on he new population works out at 17.4, and for London, 16.1. Table F compares the death rates for London and for Bethnal Green by quarters :— TABLE F. Quarter Ending. London. al Green. April 3rd 20.5 21.5 July 3rd 15.5 16.5 October 2nd 12.2 11.5 January 1st (1916) 16.1 16.0 Yearly average *16.1 16.4 * These rates are calculated on the old population figures, but suffice for purposes of comparison. 16 BIRTH RATE. The births actually registered in Bethnal Green during the year numbered 3,314, but to these must be added the balance of transferable births (200) notified to me by the Registrar-General, which raises the total to 3,514. This gives a birth rate of 27.5 per thousand population, being 2.1 per thousand below that of last year. The general London rate stands at 22.9 per thousand. TABLE G. MARRIAGES. First Quarter 177 Second Quarter 408 Third Quarter 404 Fourth Quarter 547 Total 1,536 These figures indicate a marriage rate of 24.2 to every 1,000 persons. The London marriage rate is not yet available. DEATHS OF INFANTS. One-fifth (19.8 per cent.) of the total deaths at all ages were those of infants in the first year of life; these numbered 415, giving an infantile death rate of 118 per thousand births. This is a very considerable decrease on the figure for 1914, which was 137. The 17 metropolitan infantile death rate has risen to 110 as against 104 for the previous year. (See table of Infantile Death Rates.) INFANTILE DEATH RATES. The following table compares the total infantile death rates during the last ten years for Bethnal Green with the rates for London as a whole. Year. Bethnal Green. London. 1906 157 130 1907 138 116 1908 132 113 1909 129 108 1910 123 103 1911 123 128 1912 96 90 1913 117 105 1914 137 104 1915 118 110 Averages for ten years 127 111 18 TABLE H. SPECIAL CAUSES OF INFANTILE DEATHS Totals. Rate per thousand births. 1915 1914 1915 1914 Diarrhœal Diseases 106 140 30.1 36.9 Premature birth, injury at birth, and congenital defects, including Atelectasis 71 102 20.2 26.9 Respiratory diseases 90 89 25.6 23.5 Wasting diseases 31 47 8.8 12.4 Convulsive diseases 15 33 4.2 8.7 Common infectious diseases 57 41 16.2 10.8 Suffocation 9 24 2.5 6.3 Tubercular diseases 14 10 3.9 2.6 DEATHS OF YOUNG CHILDREN. The deaths of young children aged less than 5 years, including infants, numbered 711, and formed 34.0 per cent. of the deaths at all ages; this is equivalent to a rate of 43.7 per thousand of the population of young children. SENILE MORTALITY. The deaths of persons aged over 65 numbered 483, a proportion of 23 per cent. of the total deaths at all ages, and a mortality rate of 100.2 as calculated upon the population of elderly people. 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. Following these will be found the graphic chart showing the number of deaths week by week in the Borough, corrected for institution deaths. 1915. Deaths from all causes. 19 TABLE I. Quarterly Mortality for the Borough of Bethnal Green. Deaths from Annual Death Rates per 1,000 living. 1915. Estimated Population in the middle of 1915. Births. All Causes. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea and Enteritis (under 2 years). Pulmonary Tuberculosis. Deaths of Infants under 1 year of age. All Causes. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Pulmonary Tuberculosis. Diarrhoea and Enteritis (under 2 years) to 1000 Births registered Total deaths under 1 year to 1000 Births registered. 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 April 3rd 127,662 957 692 2 — 60 4 19 11 14 58 125 21.7 0.06 — 1. 89 0.13 0.60 0.35 1.82 14.63 131 July 3rd 127,662 880 520 1 — 34 1 15 11 13 56 88 16.3 0.63 — 1.07 0.03 0.47 0.35 1.76 14.77 100 October 2nd 127,662 757 381 1 — 6 4 4 4 55 37 109 12.0 0.03 — 0.19 0.13 0.13 0.13 1.16 72.66 1.44 January 1st, 1916 127,662 720 517 — — 1 2 3 13 53 48 108 16.2 — — 0.03 0.06 0.09 0.41 1.51 73.61 1.50 127,662 3,314 2,110 4 — 101 11 41 39 135 199 430 165 0.18 079 0.08 0.32 0.31 1.56 43.91 131 20 TABLE J. Quarterly Mortality tor the County of London. Deaths from Annual Death Rates per 1,000 living. 1915. Estimated Population in the middle of 1915. Births. All Causes. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea and Enteritis (under 2 years). Pulmonary Tuberculosis. Deaths of Infants under 1 year of age. All Causes. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough Diphtheria. Pulmonary Tuberculosis. Diarrhoea and Enteritis (under 2 years) per 1000 Births registered 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 April 3rd 4,516 612 28,240 23,159 37 3 1120 100 378 199 234 2089 3142 20.6 0.03 — 09??? 0.09 0.34 0.18 1.86 8.29 111 July 3rd 4,516 612 27,095 17,120 24 — 946 90 417 136 201 1597 2516 15.2 0.02 — 0.84 0.08 0.37 0.12 142 7.42 93 October 2nd 4,516 612 24,050 13.937 26 — 131 59 193 136 1299 1361 2711 12.4 0.02 — 0.12 0.05 0.17 0.12 1.21 54.01 113 January 2nd, 1916 4,516 612 23,803 18,184 33 75 83 158 228 808 1735 3000 16.1 0.03 — 0.07 0.07 0.14 0.20 1.54 33.95 126 4,516,612 103 18?? 72,400 120 3 2272 332 1146 699 2542 6782 11369 16.0 0.02 — 0.50 0.07 0.25 0.15 1.50 25.91 110 21 DEATHS FROM INFECTIOUS DISEASES. Chicken-pox, the only addition made to the list of notifiable diseases, was made reportable by an order of the London County Council on March 17th; the order expired on June 30th and was not renewed. In my last report reference was made to a circular issued by the Local Government Board on the subject of the notification of Measles and, following on this communication and reports of conferences held during the year 1915, the Board issued "The Public Health (Measles and German Measles) Regulations, 1915." These regulations came into force on the 1st of January, 1916; they require notification in the usual manner by a medical man called in to attend a case of Measles or German Measles, but this requirement is limited to the first case of the disease in any particular household. Subsequent cases within the next two months are not to be reported by the doctor, but the obligation to report (under penalty for failure) is thrown upon the parents or guardians of the affected person; moreover, parents and guardians are required to report all cases where they have reasonable cause to suspect persons under their care to be suffering from Measles, irrespective of the medical report. The Measles Regulations confer power upon the Local Authority to provide medical and nursing assistance in necessitous cases, and by direction of the Public Health Committee I have been making enquiries with a view to ascertaining the terms upon which this could be arranged, but nothing definite has been settled pending the action of the Central Council for District Nursing in London. This body was formed by the Local Government Board, under the Presidency of Sir W. J. Collins, M.D., to prepare a 22 scheme for the district nursing of Measles, German Measles, and Whooping-cough in London. It is much to he regretted that the Metropolitan Asylums Board are under no obligation to remove cases of Measles to or from hospital, except upon the order of a Poor Law Medical Officer. This restriction, in my opinion, is quite unnecessary and moreover causes much hardship and danger to life. It occasionally happens that a child taken to one of the general hospitals either develops Measles in the ward after admission or is found to be so suffering in the out-patient department. The hospitals have no wards for infectious cases and cannot (in justice to their other patients) retain patients suffering from infectious diseases. As a result, children with acute Measles have been sent home through the streets in bitter weather at the risk of their lives from Bronchitis and Pneumonia. Surely some arrangement could be made with the Metropolitan Asylums Board under which their ambulances could be available for the transfer of such cases, either to the homes of the sufferers, or in necessitous cases to the Board's Hospitals, on the certificate of the Hospital Medical Officer. I am informed that the Board occasionally allow their ambulances to be used for the transfer of Measles cases, but this is done as a favour only; the hospital authorities cannot demand the use of them. The following table indicates the locality (hospital or home) of the deaths from infectious diseases; in addition it includes cases of Measles and Whooping-cough which have been admitted to the Asylums Board Hospitals from Poor Law Infirmaries, etc. 23 INFECTIOUS DISEASES. TABLE K. Disease. Deaths at Home. Deaths in Hospitals. Total. Scarlet Fever — 11 11 Diphtheria 4 35 39 Enteric Fever — 3 3 Erysipelas — 9 9 Puerperal Fever — 2 2 Measles 58 47 105 Cerebro-Spinal Meningitis 3 11 14 Polio-Myelitis — 1 1 Whooping Cough 36 THE SEVEN PEINCIPAL ZYMOTIC DISEASES. (Decennial average of deaths from Zymotic Disease,287.) The total number of deaths from the diseases usually included under this heading was 322, a decrease of 8 on the previous year. In the following table the comparative mortalities for 1914-15 are given:— TABLE L. Disease. 1914. 1915. Small Pox — — Measles 70 105 Scarlet Fever 7 11 Diphtheria 28 39 Whooping Cough 48 36 Entoric Fever 4 3 Diarrhœa 173 128 Totals 330 322 24 The death rate from these Zymotic Diseases is 2.67 for 1915, against 2.58 for the previous year, the corresponding rates for the whole of London being 1.5 and 2.21. The deaths from Zymotic Diseases form 15.4 per cent, of the total mortality from all causes. Table M shows the percentage of deaths from each of these diseases, calculated upon the total number of Zymotic deaths:— TABLE M. Measles caused 105 deaths 32'6 per cent., or 1 in 3 0 deaths. Scarlatina „ 11 „ 3.4 „ „ 29.2 „ Diphtheria „ 30 „ 12.1 „ „ 8.2 „ Whooping Cough „ 36 „ 11.1 „ „ 8.9 „ Enteric Fever „ 3 „ 0.9 „ „ 107.0 „ Diarrhœa „ 128 „ 39.7 „ „ 2.4 „ NOTIFICATION OF INFECTIOUS DISEASE. A gross total of 1,964 notification certificates have been received from medical practitioners, but as 69 of these were duplicates (3.5 per cent.), the actual number of cases of infectious disease dealt with was 1,895, a rate of 15.7 per thousand on the estimated population of the Borough. Of the sufferers, 1,297 were removed to hospitals under the control of the Metropolitan Asylums Board, and 32 to other hospitals. In 25 instances (a proportion of about 1.3 per cent.) information was received from one or other of the Hospital Medical Superintendents that the diagnosis as stated on the notification certificate was incorrect. Table N sets out full particulars of all the notifications:— 25 TABLE N. Details of Notifications Received. Nature of Disease No. of Certificates Received Duplicate Certificates Received Actual Number of Cases Reported Treated at Home Removed to M.A.k. Hospitals Treated at other Hospitals and Infirmary Diagnosis Incorrect Diphtheria 547 22 525 18 508 - 11 Membranous Croup 1 - 1 - 1 - - Scarlet Fever 795 9 786 15 771 - 11 Erysipelas 222 25 197 197 - Enteric Fever 18 - 18 1 10 7 2 Ophthalmia Neonatorum 28 1 27 27 - - - Cerebro-Spinal Meningitis 24 - 24 3 7 14 1 Puerperal Fever 10 1 9 1 - 8 - Polio-Myelitis 7 - 7 4 - 3 — Chicken Pox 310 11 299 - - - - Small Pox 1 - 1 - - - - Anthrax 1 - 1 - - - - Totals 1,964 69 1,895 69 1,297 32 25 Also Erysipelas, 197. 26 TABLE O. Condition of Premises where Cases of Infectious Diseases have occurred during 1915. Scarlet Fever Diphtheria. Enteric Fever. Satisfactory 380 245 6 w.c.'s. or apparatus defective 65 42 1 Internal Drainage defective 5 5 - External Drainage defective 5 10 - Minor Insanitary Defects 247 195 9 Single Room Tenements 40 28 - Overcrowded 3 1 - SCARLET FEVER. Deaths, 11 (Decennial average, 16.7). This disease was prevalent in a mild form during the year; 786 cases were notified, and (with the exception of 15) removed to hospital. Eleven of the patients so removed were found upon examination not to be suffering from Scarlet Fever. There were 11 deaths in hospital, none at home. The case mortality was 1.4 per cent., as against 1.96 per cent, amongst all the Scarlet Fever cases treated in the M.A.B. Eastern Hospital. The Inspectors report that the homes of 380 of the patients were in a satisfactory condition; the W.C. or the apparatus connected with it was defective in 65 instances, the drains inside the house were leaky in 5, and the yard drainage was faulty in 5; minor insanitary defects were noted in 247 instances. Forty persons were removed from single room tenements. 1915. Scarlet fever. 1915. Diphtheria. 27 DIPHTHERIA. Deaths, 39 (Decennial average, 22.4). Diphtheria was notified in 547 cases, and Membranous Croup in one. Twentv-two of the certificates were duplicates; eighteen of the cases were treated at home, where four of them died; 508 were removed to hospital, but eleven of these were found not to be suffering from Diphtheria. Of the 497 genuine hospital cases, 35 died. making, with the home deaths, a total of 39, which gives ♦ a case mortality of 7.6 per cent, against 11.96 per cent. amongst the whole of the Eastern Hospital cases. The Inspectors report that 245 of the homes of the patients were in a satisfactory condition, but the W.C. or the apparatus connected therewith was faulty in 42 cases; the internal drains were defective in five cases, and the yard drains in ten; minor insanitary defects were noted in 195 cases. Twenty-eight patients were removed from single room tenements, one of which was overcrowded. 96,000 units of anti-toxin were supplied free to medical practitioners during the year under the provisions of the Public Health (Diphtheria Anti-toxin) Regulations, and 225 throat swabs were submitted to the Clinical Research Association for examination. 89 of these gave positive results, and 136 negative. Twenty-nine of the deaths from Diphtheria were amongst young children aged less than 5 years, a mortality of 1.8 per thousand on the estimated population of young children. 28 ENTERIC FEVER. Deaths 3 (Decennial average 7.9). Eighteen persons were notified as suffering from Enteric Fever; one of these was reported by the Medical Superintendent of the Isolation Hospital not to be so suffering, and another was found to have Cerebro-spinal FeVer. Of the sixteen actual cases, nine were removed to the hospitals of the Metropolitan Asylums Board, and five to the general hospitals; two were isolated at home subject to my approval. There were three deaths, a case mortality of 18.8 per cent., as against 21.68 amongst the Eastern Hospital cases. The Inspectors report six of the homes as satisfactory; the W.C. was defective in one case, bad drainage was noted in one other, and minor insanitary defects in nine cases. Seven samples of blood in suspicious cases were examined at the request of medical practitioners; in one case a positive reaction was reported, and a partial reaction in a further case, whilst five specimens gave negative results. In no case could the cause of the illness be definitely traced, but suspicion was cast in two cases upon fried fish eaten by the patient, shell-fish in one case, icecream in one case, and watercress in two cases. No information as to suspicious articles of food could be obtained in the remaining cases. WHOOPING COUGH. Deaths 36 (Decennial average 43.2). All these deaths were amongst young children aged less than five years, a mortality of 3.5 per thousand on 1915. Enteric Fever. 29 the estimated population of young children. Twenty of the deaths occurred at home and the remaining sixteen at hospitals. DIARRHŒA. Deaths 125 (Decennial average 116.7). Deaths from Diarrhoea were fewer by 48 than in 1914; the deaths under one year of age numbered 105, equal to a mortality of 29.9 per thousand births. MEASLES. Deaths 105 (Decennial average 82.5). The mortality from Measles rose above the average, deaths numbering 105, being 35 above the number in 1914. All the deaths except seven were amongst young children under five years of age, the mortality rate amongst such children being 6.1. During the year 747 cases of Measles were reported to the Department by the Head Teachers of Elementary Schools. All were visited, and such action taken as was possible; but, as I have previously remarked, the information arrives too late. 175 of the reports proved to be inaccurate. My remarks upon the coming into force of the Public Health (Measles and German Measles) Regulations, 1915, will be found on page 21. CHICKEN POX. As noted on page 21, Chicken Pox became notifiable in 1915, in pursuance of an Order made by the London County Council. The Order expired on June 30th and was not renewed. 229 cases of the disease were notified; in two instances the doctor in attendance was suspicious that the case might be one of Small-pox, but 30 upon examination I was able to satisfy myself that the disease was Chicken Pox only. Both children made a normal recovery. After the expiration of the Order, we received from Head Teachers of Elementary Schools notice of 327 cases of Chicken Pox; all these were visited and dealt with in the usual manner. In forty instances it was found that the information was incorrect either as to the address of the patient or the nature of the disease from which the child was suffering. ERYSIPELAS. I received 222 notifications of cases of Erysipelas, hut as 25 of these were duplicates the actual number of cases was 197, a decrease of ]10 on the previous year. As in all cases of infection, the homes of the patients were visited, insanitary conditions remedied under notice and disinfection carried out after removal or recovery, where necessary. There were nine deaths from Erysipelas, but in addition to these, six deaths were recorded from Cellulitis, which is a very similar disease, and included amongst the unclassified deaths in Table III. imder the head of "other defined diseases" were 40 deaths from various forms of sepsis. Of these ten were from abscess, the result of middle-ear disease, and eight of abscess in connection with diseased bone. APPENDICITIS. Four deaths were registered as from this cause; one was stated to be after operation. 31 DISEASES AND ACCIDENTS OF PARTURITION. Nine cases of Puerperal Fever were reported; eight were treated at various hospitals and one was attended at home. Two of the hospital cases proved fatal. The deaths of four other women were stated to be due to some one or other of the diseases or accidents connected with the puerperal state; they were returned as one each from Urœmia, Heart Disease, Embolism and Ruptured Uterus. OPHTHALMIA NEONATORUM. Twenty-seven infants were reported to be suffering from this disease; the mothers were attended by doctors in nineteen cases, by midwives in six, and by hospital maternity assistants in two. At the end of the year two of the infants were still under treatment; the remainder, wih one exception, had recovered without obvious impairment of vision. Of four cases which were under treatment at the commencement of the year, a complete cure was effected in three, but the fourth has suffered permanent impairment of the vision of one eye. CEREBRO-SP1NAL MENINGITIS. Twenty-four cases of Cerebro-spinal Meningitis were notified during the year, all but three pi the patients being under fifteen years of age. Nine of the cases were fatal. For the information of Medical Officers of Health the London County Council circulates returns, giving particulars of each case of this disease which occurs throughout London. The information is in the first instance prepared and sent by the Local Medical Officer 32 of Health to the London County Council Public Health Department, where it is duplicated and circulated. In two instances last year the notifying Medical Practitioner refused, unless paid a fee, to supply the required particulars, but in all other instances I obtained the necessary information without difficulty. ACUTE POLIOMYELITIS. Seven cases of this disease were notified during the year with one death. Particulars of cases of this disease are circulated by the London County Council as with cases of Cerebro-spinal Meningitis. TUBERCULOSIS. Deaths due to tuberculosis in various forms numbered 259, forming 12.4 per cent, of the total deaths from all causes; this is equal to a death rate of 2.15 per thousand estimated population, approximately the same as for 1914. Forty-one of the deaths were amongst young children, a mortality of 2.5 per thousand children living. Seven infants died from tubercular disease of the brain, and an equal number from other tuberculous diseases. PULMONARY TUBERCULOSIS. The deaths from tuberculosis of the lungs (phthisis) numbered 194, equal to a mortality rate of 1.61, as against 1.51 for the whole of London. NOTIFICATION OF TUBERCULOSIS. The number of notifications of all forms of tuberculosis received during 1915 was as follows :— 33 "A" Forms 544 including 110 duplicates and 4 advised to other Boroughs. "B" „ 20 „ 5 „ "C" „ 204 „ 147 „ Total forms received "A," "B," "C" Forms 768 Less Duplicates 262 Advised to other Boroughs 4 266 Net total cases notified 502 The number of discharges notified on "D" form was 183. Ihe numbers or pulmonary cases and non-pulmonary cases notified were as follows:— Pulmonary. Non-Pulmonary. On primary "A" Forms 323 107 „ "B" „ 1 14 „ "C" 49 8 Totals 373 129 Of the total 204 notifications on "C" forms, 94 were in respect of admissions to Poor Law Institutions, and 110 to Sanatoria and Hospitals. Amongst the persons referred to on the 502 primary notifications the particulars relating to National Insurance were as follows:— Insured 210 Non-insured 147 Persons removed 8 34 Information not obtainable for other reasons 24 School children 87 Infants 26 Total 502 Of the persons notified to me under the Regulations, 412 were suffering from the pulmonary form of tuberculosis and 90 from tubercular disease of the bones, joints, &c. Of the total notifications received, 365 referred to persons residing in the North-East Sub-district, and three had no fixed residence. The total deaths registered from tuberculosis numbered 259; of these, 160 had been notified during life and 99 so notified after death only. Two hundred and two specimens of sputum were submitted to the Clinical Eesearch Association for examination; the tubercle bacillus was detected in 58, but the examination proved to be negative in 144 cases. The system of visitation and rectification of insanitary conditions, and the supply of paper-lined spittoons and glass metal-capped pocket spittoons, has been continued on the same lines as in previous years, as also was the supply of disinfectants. The Inspectors complain to ine that the Doctor who notifies that his patient is suffering from Consumption sometimes neglects to inform the sufferer of this fact. It is most unfair to place the onus of conveying such bad news upon a Sanitary Official; moreover, the 35 information, in these circumstances, is received with doubt, with the result that the advice tendered by the Inspector is not likely to be followed if the patient is unconvinced of its neceshity. As a matter of interest, I append a return relating to insured persons in this Borough who made application to the County of London Insurance Committee during the years 1912, 1913, 1914 and 1915. The names were given me by the Insurance Committee, who desired to be informed as to the condition of the various persons named at the time of the enquiry towards the end of 1915:— Number of persons applying 86 Particulars as to persons treated in Sanatoria: Under treatment at date of enquiry 1 Resuming their ordinary occupations 10 Still incapacitated 5 Who subsequently died 15 Removed, or no information obtainable 4 35 Particulars as to persons not treated in Sanatoria: Resuming their ordinary occupations 25 Still incapacitated 2 Who subsequently died 10 Removed, or no information obtainable 14 51 86 36 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912, Occupations of Persons Notified during 1915. Occupation. Males. Females. Total. Artificial Flower Maker — 1 1 Bamboo Workers 3 — 3 Baker 1 — 1 Boxmakers 6 8 14 Bonecutter 1 — 1 Bookbinders 2 — 2 Boot and Shoe Trade 13 1 14 Brass Finisher 1 — 1 Builder 1 — 1 Brush Makers — 5 5 Butchers 2 — 2 Cabinet Makers and Furniture Trade 23 — 23 Cap Makers 1 1 2 Carmen, 'Bus and Tram Workers 9 — 9 Caretakers 1 1 2 Charwomen — 4 4 Cigar and Cigarette Makers 4 3 7 Clerks 9 — 9 Cook — 1 1 Coachman 1 — 1 Confectioner — 1 1 Domestic Servant 1 — 1 Eating-House Keeper 1 — 1 Electrical Worker 1 — 1 Embosser 1 — 1 Engineer 3 — 3 Errand Boy 1 — 1 Feather and Fur Workers 1 1 2 Fitters 2 — 2 French Polishers 8 — 8 Fruiterer 1 — 1 Glass-worker 1 — 1 Hairdresser 1 — 1 Hawkers 3 1 4 Housebreaker 1 — 1 House-wives — 62 62 House-worker — 6 6 Infants 17 9 26 Insurance Agent 1 — 1 Jeweller 1 — 1 Carried forward 123 105 228 37 Public Health (Tuberculosis)—continued. Occupation. Males. Females. Total. Brought forward 123 105 228 Labourers:— Genera] 12 — 12 Dock 5 — 5 Railway 1 — 1 Lavatory Attendant 1 — 1 Leather Workers 2 2 4 Machinists — 4 4 Messengers 2 — 2 Milliners — 3 3 Painters 3 — 3 Packers 2 1 3 Paper and Rag Sorters 1 1 2 Photographer 1 — 1 Porters 16 — 16 Printers 6 — 6 Public-house Employees 5 3 8 Sawyers 4 — 4 Seamen 1 — 1 Seamstress — 1 1 Shop Assistant — 1 1 Shirt Maker — 1 1 Skin Dresser 1 — 1 Soldiers. 9 — 9 Sorters P.O. 1 1 2 Sponge Cutters 2 — 2 Stationers 2 3 5 Stock Keeper 1 — 1 Stick Maker.. 1 — 1 Sweeper 1 — 1 Tailors and Tailoresses 13 5 18 Telegraphist 1 — 1 Tie Makers — 2 2 Tinplate Worker 1 — 1 Toy Makers 1 1 2 Travellers 2 — 2 Umbrella Makers — 2 2 Upholsterers 2 — 2 ,, Trimmings Makers — 3 3 Vanguards 2 — 2 Warehousemen 2 — 2 Window Cleaner 1 —. 1 Woodworker 1 — 1 No occupation 7 15 22 No information obtainable, or persons removed 11 14 25 School Children 50 37 87 Total 297 205 502 38 TUBERCULOSIS DISPENSARY. Early in the year a sub-committee of the Public Health Committee was appointed to consider the provision of Dispensary treatment for cases of Tuberculosis amongst inhabitants of Bethnal Green. The Local Government Board requires, as a condition of recognition, that such Dispensary shall be linked up with some local hospital in order that special skilled treatment shall be available in difficult cases. Accordingly, I was directed to communicate with the neighbouring hospitals, with the following result:— 1. The Mildmay Mission Hospital declined to entertain the proposal. 2. The London Hospital offered favourable terms. 3. The City of London Hospital for Diseases of the Chest declined to enter into any linked-up scheme, but claimed to be in a position to establish a dispensary, within the precincts of the hospital, for the treatment of Bethnal Green cases of tuberculosis; this dispensary to be managed by a Committee (upon which the Council would be represented) at an agreed annual cost to Bethnal Green. From the first, the general feeling amongst members of the Borough Council has been that any Tuberculosis Dispensary established in Bethnal Green should be a Municipal Institution, worked in connection with the Public Health Department, and wholly under the control of the Council. To this the Local Government Board objects on the ground of expense and delay, and they have strongly urged the Council to contract with the Victoria Park Hospital for the provision of Dispensary 39 treatment. The fact that the neighbouring Borough of Hackney has accepted this arrangement, which is actually in operation, naturally strengthens the hands of the Local Government Board. Notwithstanding this, the Council is strongly in favour of the Municipal scheme, and no settlement has been arrived at. The advantages and disadvantages of the rival Municipal and Contract schemes were fully set out in a report jointlv prepared bv the Town Clerk and myself, to which a comparative financial statement by the Borough Accountant is annexed. This report will be found in the Appendix. CANCER. Included under this head are deaths from Cancer, Sarcoma, Epithelioma and Rodent Ulcer; they numbered 101, and all occurred amongst persons aged over twenty-five years. The following list shows the organs and parts of the body chiefly affected by cancerous growths:— Stomach, Liver and Pancreas 38 Rectum 11 Female Breast 10 Intestines 8 Tongue and Mouth 8 Female Organs of Generation 7 Larynx and Œsophagus 4 Prostate and Male Bladder 3 Lung and Mediastinum 1 40 SUMMARY OF THE WORK OF THE HEALTH VISITORS. The number of births registered as occurring in the Borough during the year was 3,314, the number of notifications received under the Notification of Births Act, 1907, being 3,267. Only one notification is sent in cases of multiple births, so that, if the number of notifications is adjusted in accordance with these, 3,308 births wers notified against 3,314 registered. The following table gives details of the notifications and of the attendances at birth:— By whom attended in confinement. By whom notified. Doctors in private practice 975 815 Midwives 1,205 1,249 London Hospital Maternity Assistants, Students and Nurses 992 992 Institution Midwives 30 80 Relatives — 160 Institution Doctors 9 9 Various 56 12 41 The details of live and still births are given in the following table:— Male. Female. Not stated. Totals. Live Births— Single birlhs 1589 1579 7 3253 Twins, same sex 18 28 — ,, mixed sex 13 13 — Triplets 3 3 — Still Births— Single births 19 30 4 55 Twins, same sex 2 — — Thirty-seven of the notifications referred to twins and two to triplets. Miss Hammond's district comprises the South and West Wards of the Borough. She reports a total of 1,741 notified births; she made 2,594 visits and revisits to the homes of the mothers. The large majority of the infants were wholly breast-fed. and about 20 per cent, partially so, leaving some 15 per cent, of bottle-fed babies. Considering the poverty of the district and the fact that many of the mothers are wage-earners, this is a good record. Many mothers who go out to work stipulate that they may have time off to go home for the mid-day meal hour so that they may continue the breast-feeding of their infants. Mrs. Hodgkin's district comprises the North and East Wards of the Borough; she reports a total of 1,526 births notified. Her visits and revisits numbered 2,667. Mrs. Hodgkin reports that, with the exception of about 42 six per cent., the whole number of the infants were breast-fed so long as she had them under supervision, though probably there is a considerable falling off when Factory work is resumed. Both Visitors report that they find the mothers eager to breast-feed their infants and quite willing to take advice as to the care of their own health and that of the infant. Cards of advice are always tendered in the hope that they may be read and the instructions printed thereon followed; these are supplemented by personal suggestions at the time of the visit. Mothers are urged to bring their infants to the weighing centre for examination in all cases where they have any doubt as to the well-being of the child. Each Health Visitor attends one afternoon in each week at St. James's Eoad, where she examines and weighs each infant and makes proper records. Should anything unfavourable be discovered, simple suggestions are made and, if necessary, the advisability of calling in medical aid is pointed out. 1,783 visits were made by mothers with their infants to the room in St. James's Road. The Health Visitors report that the sale of Virol and Glaxo at cost price is much appreciated by mothers who could not afford the usual retail price of these articles. It is the opinion of both Visitors that the cheap supply of these articles has been the means of preserving infant life. 43 HEALTH VISITORS. Total Visits for the Year. Birth visits 3,025 Re-visits 2,236 Ophthalmia Neonatorum 117 Puerperal Septicaemia 12 Diarrhœa 61 Measles 873 School complaints 1,353 Special visits 21 Futile visits 132 7,830 MATERNITY AND CHILD WELFARE SCHEMES. As will he gathered from the report of the Health Visitors, the legal obligations of the Council are fairly covered by the present Staff, but with this the Local Government Board is not satisfied, and demands that we shall extend our operations by the appointment of additional officers. It is the view of the Board that we should undertake the care of the mother during pregnancy and during and after delivery, also the care of the child, not merely during the few weeks after birth, but until it has reached school age, when it comes under the medical inspection of the school doctor. To carry out this plan would certainly entail a large increase in the number of Health Visitors and special arrangements for their supervision. The Local Government Board expresses much concern at the ignorance displayed by the ordinary working- 44 class woman in the management of her own health during pregnancy, and in the after care of the infant. The Board urges that arrangements should be made for the care and instruction of women during pregnancy, during and after confinement and, in addition, instruction in the care and management of infant life. I grant the ignorance; the disinclination of working-class women to enter domestic service is well known, so they get no opportunity to learn. Girls commence work in factories directly they leave school, often at the tender age of thirteen; they leave home early and return late, the result of which is that they grow up ignorant of house-management and mother-craft, unable to cook a meal, and quite incapable of washing or dressing a baby. Girls of this class marry early, knowing nothing of the responsibilities of married life; and it is for the benefit of such as these that the Local Government Board contemplates Maternity and Child Welfare schemes. The Board strongly advises the immediate appointment of two additional Health Visitors; but to set two more women to work in the Borough without proper supervision would be, in my opinion, worse than useless. In a report I recently presented to the Public Health Committee I suggested that a lady doctor should be engaged to prescribe for small ailments and give health lectures upon appropriate subjects on four afternoons in each week. But, upon consideration, I feel sure it would be much more advantageous to appoint a whole-time female assistant M.O.H. who should undertake the supervision of the two present Health Visitors and of such additional Officers and Tuberculosis Nurses as if may be found necessary to appoint. This lady doctor could 45 attend at fixed hours to give advice to expectant mothers and mothers with infants; she could undertake the visiting of puerperal fever cases, and of reported cases of Measles and Chicken Pox where no doctor has been called in. She could also give simple lectures and health talks to women each afternoon at some fixed centre (I suggest the Queen Adelaide Dispensary, which could he hired for this purpose). A CONSULTATION CLINIC FOR EXPECTANT MOTHERS. In the artificial life of the present day there are a number of abnormal conditions to which pregnant women are subject; the symptoms pointing to these may be only slightly noticeable, yet if neglected they may be dangerous to the life of the expectant mother and to the unborn child. Many women neglect these symptoms until too late; they are shy and do not care to consult a male doctor. Yet if they could have an informal talk with a qualified lady they would not hesitate to reveal their troubles; advice could then be given which would save much useless suffering, and perhaps even life. I may here mention a few of the conditions referred to: Pelvic deformities, Displacements of the Womb, Swollen legs, Varicose veins, Breast troubles, Anæmia, Constipation, Excessive morning sickness, Vaginal discharges, the prevention of Ophthalmia Neonatorum, the testing of urine and the prevention of puerperal convulsions, the prevention of miscarriages, advice as to hæmorrhages, and lastly the reference of ill-fed or very poor mothers to dinner centres. 46 PUBLIC HEALTH (SHELL FISH) REGULATIONS, 1915. During March the Local Government Board issued the Public Health (Shell Fish) Regulations, which place certain useful powers at the disposal of Sanitary Authorities. Under the provisions of these regulations, the Sanitary Authority of any district in which shell-fish layings are situated must exercise such restrictive action as may seem to them to be necessary in regard to such layings, upon receipt of a representation from another Local Authority in whose district shell fish from the layings are consumed, when there is reason to suppose that such shell fish have caused, or are likely to cause, infectious or other disease. ARMY CANTEEN CONTRACTORS. From time to time I have received information from the Local Government Board that certain contractors who were engaged in the supply of food materials for the use of the Army had factories in the district. Dr. MacFadden, on behalf of the Chief Inspector of Foods, sought my assistance in the systematic supervision of the premises of these firms who were supplying canteens, either directly or through catering contractors. Four of these firms were indicated; in each case the premises were carefully inspected and the operations watched, but in no case was it necessary to interfere. 47 FLIES AND DISEASE. Early in the year the Public Health Committee considered the best means of obviating the danger to health caused by the filthy habits of flies, as it is well known that Enterica, Tuberculosis, and Diarrhœa are commonly spread by the agency of these creatures. Mr. Councillor King took particular interest in this matter, and strongly urged the desirability of giving public notice of the proper methods to pursue. I was instructed to draw up suitable matter, and this was issued in the form of a handbill, a copy of which was left with each family in the Borough. Posters were also exhibited in suitable positions. It is satisfactory to note that there were many applications at the Public Health Office for additional copies of the handbill. REMOVAL OF REFUSE. In March the Public Health Committee took common action with other Boroughs in urging upon the Government the desirability of affording further railway facilities for the conveyance of refuse from town. Serious difficulties had been experienced in many parts of London owing to the requirements made upon the railways for the needs of the Army and Navy. As a result, effectual means were taken to remove what would speedily have become a menace to the public health. SANITARY ACCOMMODATION IN SHOPS. In July a circular letter was received from the Local 48 Government Board to the effect that a Committee, appointed to consider the further enlistment of male employees in retail distributing trades, had complained that difficulties had arisen in the case of smaller shops where women had replaced enlisted men, by reason of the requirements of the Public Health Law as to separate sanitary accommodation for the sexes. The Board pointed out that, whilst such requirements could not be dispensed with, yet in many cases satisfactory temporary arrangements could be made which would secure the object in view without involving employers in serious additional expenditure. The Public Health Committee expressed their desire that the law should be administered in Bethnal Green with the least possible friction, and that no hindrance should be placed upon any shopkeeper who was willing to allow his male assistants to join the Army; but that, whilst this was so, the Committee emphasised the fact that in no case would arrangements be sanctioned which would defeat the purpose of the law in this matter. INQUESTS. The total number of inquests held during the year was 201. Thirteen persons committed suicide and sixtyone died violent or sudden deaths. CUSTOMS AND INLAND REVENUE ACTS, 1890 to 1903. Applications during the year for my certificate to obtain exemption from Inhabited House-duty were made 49 in respect of Nos. 34 to 44 and 48 to 54, Punderson Gardens, each block containing three tenements. It was necessary, in order to comply with my requirements, that considerable alterations should be carried out, but when these were completed the certificate was granted. BRADY STREET AREA. During the whole of the year under review the Public Health Committee availed themselves of every opportunity to press forward the question of the Brady Street Area, but nothing has been done to clear any portion of the site, and the old conditions remain unchanged except for the worse. On the 24th of April, 1915, His Majesty's Treasury, in response to an enquiry of the London County Council on the subject of capital expenditure, stated that, as regards the general question, the Lords Commissioners of His Majesty's Treasury were of opinion that, in conformity with what was being required in other cases, expenditure by the County Council on the Brady Street Scheme should not be continued during the war, except so far as it could be financed otherwise than by loan. The Public Health Committee were much disappointed at the attitude adopted by the Treasury, and by direction of the Committee a letter was addressed to the Treasury calling their attention to the urgent necessity for dealing with this unhealthy area without delay, as evidenced by the abnormally high death-rate; and urging that, if the Lords Commissioners were unable to give effect to the desire of the Council to deal with the area 50 immediately, they would at any rate place the Brady Street Scheme amongst the first on which restrictions as to capital expenditure should be removed or modified. This communication was formally acknowledged, but no further reply was received. About this time some of the houses in the NorthEast corner of the area showed such signs of advanced decay that officials of the London County Council were compelled (in consequence of bulged and overhanging walls, collapsed roofs and other structural defects) to deal with certain premises as dangerous structures. Dilapidation notices were served by the officers of the London County Council calling upon the owners to take action, including timbering and shoreing-up walls, to prevent accidents, and the remarkable spectacle was now witnessed of extensive repairs being carried out on houses in a condemned area, in obedience to notices from the authority responsible for the demolition of these identical houses and the clearance of the site. These works were carried out during a period of most inclement weather, and families could be seen living in rooms from which one of the walls had been removed, with most ineffective temporary means of protection against wet and cold. In other cases roofs had collapsed, W.C.'s and outbuildings had fallen down, yet the houses were still occupied. Photographs of some of these places were taken and exhibited in the Members' room at the Town Hall for the information of the Council, before whom a full report on the whole position was laid by the Public Health Committee. I here reproduce the final paragraphs of this report:- 51 "We are fully aware of the need for economy, but are of opinion that it is false economy to withhold expenditure in urgent public health matters, especially so in cases like the Brady Street Area where it is proposed to divide the expenditure over a period of years. "At the moment the Council is being pressed by various Government Departments (among other matters) to establish a tuberculosis dispensary, to provide Health Visitors with a view to the preservation of infant life, and for other purposes, and to carry into effect a scheme relating to the treatment of measles and prevention of the spread of measles. "We are in full sympathy with such projects if they are undertaken as supplemental to a General scheme which has for its basis the prior clearance of such unhealthy districts as the Brady Street Area. "Unfortunately, the aims of responsible authorities appear to be centred upon the branches rather than the roots of the evils which not only undermine the public health of such densely populated boroughs as Bethnal Green, but adversely affect the health of London as a whole, and we regret the continued willingness of these authorities to restrict, expenditure to the cure of diseases created or fostered by areas which are notoriously unfit for human habitation. "We are still of opinion that the only satisfactory method of dealing with the Brady Street Area is by a scheme under Part I of the Housing Act, promptly undertaken and consistently acted upon until the area, 52 which has for so long been a public scandal, is swept away and remodelled to the betterment of our great metropolis. "Having regard to the conditions referred to in the foregoing report, and notwithstanding the existence of the war, we feel compelled to recommend the Council again to draw the attention of Government Departments and the London County Council to the urgent need for dealing with the Brady Street Area. "We therefore "Recommend-(i) That a communication be transmitted to His Majesty's Treasury and to the Local Government Board, praying for the removal of any financial or other restriction embarrassing the London County Council in compliance with the Order of the Local Government Board dated the 22nd September, 1914, relating to the Brady Street Area, and that His Majesty's Treasury and the Local Government Board be requested to receive a deputation, consisting of members of this Committee, on the matter. "(ii) That the London County Council be asked to support the representations made to the Treasury and to the Local Government Board, and, pending action by these uthorities, to press on with the preparatory matters in relation to the proposed scheme. "(iii) That copies of the foregoing report be forwarded to the Borough Members of Parliament and to the Bethnal Green Members of the London County council. 53 These recommendations were unanimously adopted, and the Town Clerk promptly acted upon them. Sir Edward Cornwall particularly interested himself in the matter, and in the House of Commons put certain questions to the President of the Local Government Board. Mr. Long, in reply, stated that no scheme for the improvement of the area had been submitted to him for approval; he was also aware that the Treasury had declined to sanction a loan, nevertheless he saw no reason why the London County Council should not proceed with the preparation of a scheme, and had written to them to that effect. At about the same time the Local Government Board replied to a communication from the Town Clerk that they could hold out no hope that the decision of His Majesty's Treasury in regard to restriction of capital expenditure would be altered, and the Treasury also replied in similar terms, and declined to receive a deputation. The London County Council declined to support the representation made by the Borough Council for the removal of the financial restrictions which prevented the County Council from proceeding with the scheme, but stated that certain preliminary work upon the preparation of the scheme had been put in hand. On March 25th, 1916, the Public Health Committee reported to the Borough Council as follows:- 54 "We very much regret the attitude adopted by H.M. Treasury, the Local Government Board and the London. County Council, but having regard to all the circumstances we find some difficulty in taking further steps in the matter at the moment. "It will be remembered that the representation made by the Medical Officer of Health, which forms the basis of the present controversy, was made in the year 1912 and that it was preceded in the year 1904 by a similar representation relating to the major portion of the present area. "For the information of the Council, we append a chronological statement showing the principal events which have taken place in connection with the Brady Street Area since the representation was made by the Medical Officer of Health in 1904 :- February, 1904.-Bepresentation made by Medical Officer of Health in regard to major portion of the Brady Street Area under the provisions of Part I. of the Housing of the Working Classes Act, 1890. March, 1905.-London County Council informed the Medical Officer of Health that the Housing of the Working Classes Committee of the London County Council had considered the representation, that the County Council understood it was proposed to erect new buildings on a portion of the Area, and that in view of the alterations in progress, at no distant date the area would be re-developed through private enterprise. March, 1905.-The Medical Officer of Health wrote to the London County Council countering the suggestions 55 made by that Authority as to the probable re-development of the area by private enterprise, and showing" how futile had been the efforts of the Borough Council to deal with the Area under the powers of the Council contained in the Public Health and other Acts. April, 1905.-London County Council informed the Medical Officer of Health of the decision of the Housing of the Working Classes Committee of that Authority not to recommend the County Council to prepare a scheme in respect of the Area under Part I. of the Act of 1890, having regard to the shortness of the existing leases on the Area and to the prospect of the Area being re-developed by private enterprise. November, 1905.-The Public Health Committee sought to obtain Closing Orders in respect of Nos. 9, 10, 17 and 22, Colling Street, but the owner repaired same so extensively that the Magistrate would not grant the Orders. Notwithstanding this action the premises were considered sufficiently bad to be included in the 1912 representation. December, 1906.-The Public Health Committee visited the area, and as a consequence the Council pressed the County Council to deal with the matter, and stated that due enquiry would satisfy the County Council that there was no substance in the suggestion that the Area would be re-developed through private enterprise. January, 1907.-Conference at County Hall between members of Public Health Committee of the Borough Council and the Housing of the Working Classes Committee of the County Council. January, 1907.-London County Council formally declined to proceed in the matter as, in the opinion of 56 the Housing of the Working Classes Committee, it might reasonably be anticipated that the Area would be re-developed at no distant date by private enterprise. January, 1907.-The Chairman of the Public Health Committee conferred on the matter with the County Council's Medical Officer, who reiterated the reason already given by London County Council for not dealing with the Area. June, 1907.-Conference at Town Hall, Bethnal Green, between members of the Public Health Committee and local members of the London County Council. January, 1912.-Public Health Committee visited the Area and inspected premises therein. April, 1912.-Medical Officer of Health submitted representation relating to the Brady Street Area (slightly enlarged as compared with the Area represented in 1904) under Part I. of the Housing of the Working Classes Act, 1890, and the representation was approved by the Council. April, 1912.-Visit to Area by Medical Officers of Health and other officers of the London County Council and of the Borough. October, 1912.-Council pressed London County Council to deal with the representation of April last. County Council replied that matter was still under consideration. December. 1912.-London County Council suggested conference to discuss certain proposals. January, 1913.-Conference at County Hall between members and officers of the County Council's Housing Committee and of the Public Health Department. The 57 Housing Committee suggested application of the "Nettlefold system" to the Area. The suggestion was not pressed or taken up. April, 1913.-Visit to the Area by the County Council's Housing Committee. June, 1913.-Council again pressed London County Council to deal with the matter. July, 1913.-London County Council formally resolved to take no action upon the representation of April, 1912, and emphasised the view that such schemes should not he undertaken until proposed legislation for facilitating acquisition of land under the Housing Acts had been passed. October, 1913.-Borough Council passed resolution protesting against the decision of County Council and communicated with Government Authorities. October, 1913.-Council informed by Local Government Board of intention to hold an Inquiry at the Town Hall relating to the Area. October, 1913.-Public Inquiry held by Major Norton, R.E., of the Local Government Board. March, 1914.-In response to enquiries made on behalf of the Council, the Local Government Board stated that communications were passing between the Board and the County Council on the matter. March, 1914.-Public Health Committee asked whether representations had been made by County Council to the Board since the Inquiry, and requested to be furnished with substance of the report of the Board's Inspector on the Inquiry. April, 1914.-Local Government Board sent copy of letter dated the 16th February. 1914, addressed by 58 the Board to the London County Council conveying a suggestion for dealing with the Area by four sections. May, 1914.-Local Government Board informed that the Council was opposed to the proposals, and necessity for dealing with the Area under Part I. of the Act of 1890, as shewn by evidence tendered at the Inquiry, was reiterated. June, 1914.-Conference at Town Hall between members of Public Health Committee and local members of County Council (Messrs. Edmonds, Harris, Headlam and E. Smith). June, 1914.-Public Health Committee received letter from the Local Government Board with copy of letter from the London County Council, proposing scheme under Part II. of the Act of 1890 for clearance of one of the four sections suggested by the Board, and that the Borough Council should at once deal with the section comprising Lisbon Buildings and negotiate with Brewery Company for demolition of houses in Pereira Street and construction of new street. Further that the other two sections should not be dealt with for the time being. Decided to ask President of Local Government Board to receive deputation from the Council on the matter. July, 1914.-Deputation (Public Health Committee and Sir Edwin Cornwall, D.L., M.P.), received by the President of the Local Government Board, who was satisfied as to the necessity for entire clearance of Area and subsequent Improvement Scheme, but not prepared to issue order to that effect; suggested conference between himself, representatives of the 59 County Council and Borough Council with a view to effecting arrangement for piece-meal scheme under Part II. of the Act. Further deputation (representatives of the Public Health Committee) to President of the Local Government Board, who outlined a proposal for a section to be cleared by London County Council for erection of school, the Borough Council dealing with block dwellings in Lisbon Street and by a Part II. scheme with Scott Street and Dixie Street. Deputation stated that Council preferred to await judicial decision of the Board as to result of Public Inquiry. September, 1914.-Local Government Board issued Order, addressed to County Council, requiring latter forthwith to prepare a scheme or schemes under Part II. of the Act of 1890 in respect of five areas, comprising the major portion of the area represented. March, 1915.-Council informed by London County Council of its decision to effect the improvement of the areas mentioned in the Order by two schemes, to be taken successively, the first to extend over five years and to cost £46,800 net, without making provision for re-housing. March, 1915.-Letter from the London County Council submitted to Public Health Committee, notifying its intention, and suggesting that the Borough Council should undertake the removal of Lisbon Street Dwellings not included in the Order of the Local Government Board. May, 1915.-Public Health Committee informed that the 60 Treasury on the 24th April, 1915, in reply to an enquiry by Comptroller of the London County Council, stated that, in conformity with what was being done in other cases, work should not at present be proceeded with, entailing expenditure which could not be dealt with otherwise than by loan. June, 1915.-Conference at County Hall between members of Public Health Committee and local members of County Council. June, 1915.-Town Clerk communicated with the Local Government Board and the Treasury pressing for removal of financial restrictions. January, 1916.-Council received report from Public Health Committee directing attention to the great need of additional housing facilities in Bethnal Green, to the overcrowding existing, and to the aggravation of the conditions in regard to the insanitary and defective premises in the Area, particularly in Scott Street, Dixie Street, and Neath Place where certain premises had collapsed, walls were bulging and in other respects premises had become dangerous and a serious nuisance. Council ordered communication to Treasury and Local Government Board, praying for removal of financial restrictions with regard to improving the Area, and to the London County Council seeking support to such representations. Copies of report sent to local Members of Parliament and County Council. February, 1916.-Town Clerk received the following letters:- 61 (1) Local Government Board, stating that the Board held out no hope that the decision of the Treasury would be modified. (2) Treasury, stating the Lords Commissioners were unable to withdraw their objection to expenditure in connection with the scheme. (3) London County Council, adopting the position of the Treasury and declining to support the representations of this Authority. "The foregoing summary of principal events in connection with the Brady Street Area indicates but a tithe of the action from time to time taken on behalf of the Borough Council. For years it was strenuously urged by the County Council that the Area would shortly be developed by private enterprise whilst we, on our part, steadfastly declined to adopt that view. Time alone could test the point as to re-development by private enterprise and now after the lapse of four years we can only say that we know of no such proposals. The later contention of the County Council that remedial housing legislation should be waited for is even more valueless. "The matter of the Brady Street Area therefore appears to remain sheltered behind war conditions, and the need for financial restriction. Meanwhile, however, the Government Authorities are pressing Local Authorities throughout the country to undertake schemes relating to tuberculosis, measles, maternity and infant welfare, leaving undisturbed the Brady Street Area, which creates or fosters insidious diseases, and has for many years been a menace to the public health and a disgrace to civilisation. 62 "We are keeping in touch with Sir Edwin Cornwall, D.L., M.P., with regard to this matter so that the views of the Council may be advanced at every opportunity. If Council considers anything further can be done notwithstanding the abnormal circumstances which now prevail, we shall be happy to carry out the desires of the Council. We "Recommend-That our report be received and approved. T. O'Grady, J.P., Chairman. From the foregoing it will be gathered that as a Medical Officer of Health I have some cause to be dissatisfied with the action, or rather the want of action, on the part of the powers that be. On the other hand my cordial thanks are due to the Council and especially to the members of the Public Health Committee, for their ever willing help and encouragement, and to my colleagues of the Health Department for their kind assistance and co-operation. I have the honour to be, Sir and Gentlemen, Your very obedient servant, GEORGE PADDOCK BATE, Medical Officer of Health. 63 TABLE I. Vital Statistics of Whole District during 1915 and Previous Years. Year. Population estimated to Middle of each year. births. Total Deaths Registered in the district. Transferable Deaths. Nett Deaths belonging to the District. Under 1 Year of Age. At all Ages. 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. Uncorrected Number. Number. Hate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 30.5 1,851 13.4 314 420 375 96.1 1,957 15.3 1913 127,824 3,863 4,008 31.3 2,028 15 .9 411 400 470 117 .5 2,001 15 .7 1914 127,662 3,609 3,786 29.6 2,113 16.5 434 368 519 137. 0 2,047 16.0 1915 120,207 3,314 3,514 27.5 2,152 17.9 502 441 415 118.0 2,091 17.4 Area of District, 759 acres. At census of 1911 Total Population (all ages), 128,282. Total families or separate occupiers, 27,755. 64 TABLE II. Cases of Infectious Disease notified during the Year 1915. Notifiable Disease. Number of cases Notified. Total cases notified in each locality (e.g., Parish ward) of the district) Total Cases Removed to Hospital. At all Ages. At Ages-Years. Under 1. 1 and under 5years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. Northeast sub-dist. Southwest Sub-dist. Northeast Sub-dist. Southwest Sub-dist. Diphtheria (including Membranous Croup) 515 19 189 272 27 6 2 - 237 278 232 276 Erysipelas 197 9 10 11 35 49 61 22 84 113 - - Scarlet Fever 775 10 253 467 35 10 - - 218 557 220 551 Enteric Fever 16 - - 7 3 4 1 1 9 7 9 6 Puerperal Fever 9 - - - 4 5 - 4 5 4 4 Cerebro-spinal Meningitis 24 4 9 8 2 1 - - 12 12 12 9 Poliomvelitis 7 - 4 8 - - - - 3 4 - - Ophthalmia Neonatorum 27 27 - - - - - - 13 14 - - Pulmonary Tuberculosis 371 2 9 26 89 154 79 12 174 197 - - Other forms of Tuberculosis 131 6 30 52 14 19 9 1 53 78 - - Chicken Pox 299 23 143 129 3 1 - - 125 174 - - Anthrax 1 - - - - - 1 - 1 - 1 - Totals 2,372 100 647 975 212 249 153 36 933 1,439 478 [Total 946 1,324] 65 TABLE IIA. Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications received during the year 1915. Age Periods. Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C Primary Notifications. Total Notifications (i.e, including cases previously notified by other doctors). Primary Notifications. Total Notifications (i.e. includ ing notifications by other doctors). Poor Law Institutions. Sanatoria. 0 to 1 1 to 5 6 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total U nder 5 5 to 10 10 to 15 Total Pulmonary-- Males 1 4 4 7 15 21 42 38 32 14 9 187 236 - - - - - 66 64 Females - 2 8 6 18 25 30 28 12 4 3 136 176 - - 1 1 1 18 36 Non-pulmonary- Males 5 12 21 7 2 2 6 5 4 2 - 66 75 - 6 4 10 13 2 10 Females 1 9 10 8 4 2 1 3 1 1 1 41 53 - 2 2 4 6 3 5 Totals 7 27 43 28 39 50 79 74 49 21 13 430 540 - 8 7 15 20 *89 *115 All Notifications A = 540 B = 20 C = 204 D = 183 947 Including 65 duplicate cases, Poor Law. * „ 82 ,, ,, Sanatoria. 66 TABLE III. Causes of, and Ages at, Death during the Year 1915. 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 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 - - - 2 - 1 - - l Small Pox - - - - - - - - - - Measles 105 31 42 25 7 - 33 Scarlet Fever 11 1 1 7 2 - - - - - Whooping Cough 36 18 8 10 - - - - - 12 Diphtheria and Croup 39 5 7 17 10 - - - - 4 Influenza 12 - - - - 1 3 6 2 4 Erysipelas 9 2 1 - - - - 1 5 7 Phthisis (Pulmonary Tuberculosis) 194 1 - 3 7 32 78 61 12 119 Tuberculous Meningitis 40 6 9 10 10 2 1 2 - 47 Other Tuberculous Diseases 25 7 2 3 3 4 2 4 - 44 Cancer, malignant disease 101 - - - - - 11 58 32 60 Rheumatic Fever 8 - 1 - 2 - 3 1 1 3 Meningitis 14 8 1 - 3 2 - - - 24 Organic Heart Disease 207 - - - 12 13 39 65 78 106 Bronchitis 24 26 9 - 2 1 17 69 120 116 Pneumonia (all forms) 247 66 37 29 13 2 26 45 29 145 Other diseases of Respiratory organs 29 11 1 - - - 6 6 5 20 Diarrhoea and Enteritis 128 105 23 - - - - - 125 Appendicitis and Typhlitis 4 - - - 3 1 - - - 1 Cirrhosis of Liver 11 - - - - 1 3 6 1 4 Alcoholism 2 - - - - - - 2 - 1 Nephritis&Bright's Disease 65 1 2 - 5 1 6 34 16 45 Puerperal Fever 2 - - - - 1 1 - - 1 Other accidents and diseases of Pregnancy and Parturition 4 - - - - 1 3 - - 1 Congenital Debility and Malformation, including Premature Birth 86 83 1 1 - 1 - - - 64 Violent Deaths, excluding Suicide 74 14 4 8 7 3 8 20 10 34 Suicide 11 - - - - 2 6 2 1 - Other Defined Diseases 282 28 2 11 14 8 36 82 101 199 Diseases ill-defined or unknown 98 20 3 - 1 - 1 3 70 56 Totals 2091 433 154 124 103 76 251 467 483 1276 Sub-entries included in above figures:- Cerebro- spinal Meningitis 14 8 1 - 3 2 - - - 24 Poliomyelitis 1 - 1 - - - - - - - Diabetes 13 - - - 1 3 - 6 3 9 Anthrax 1 - - - - - - 1 - - Pneumonia (other than Broncho-Pneumonia) 113 17 9 5 10 2 19 35 16 69 Septic Diseases, other than specified in above table 40 5 - 4 7 3 8 8 5 45 67 TABLE IV. Whole District. Infantile Mortality during the Year 1915. 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 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - 3 9 16 28 Scarlet fever - - - - - - 1 - 1 2 Whooping Cough - - - - - 2 2 4 9 17 Diphtheria and Croup - - - - - - - 1 - 1 Erysipelas - - - - - - 1 - - 1 Cerebro-spinal Meningitis - - - - - 3 2 1 2 8 Tuberculous Meningitis 1 - - - 1 - 2 2 2 7 Abdominal Tuberculosis - - - - - 2 - 1 - 3 Other Tuberculous Diseases - - - - - 1 1 1 1 4 Meningitis (not tuberculous) - - - - - - - 2 3 5 Convulsions 2 5 - - 7 3 4 1 - 15 Laryngitis - - - - - - 1 - - 1 Bronchitis 1 2 1 - 4 7 6 9 - 26 Pneumonia (all forms) - 2 - 1 3 7 8 24 21 63 Diarrhoea - - 1 - 1 8 26 15 4 54 Enteritis - 3 - 1 4 10 16 13 9 52 Gastritis - - - - - - - - - Syphilis - - - 1 1 2 1 - 4 Rickets - - - - - - - - - - Suffocation, overlaying 2 1 - - 3 2 2 2 - 9 Injury at birth 7 1 - - 8 - - - - 8 Atelectasis 7 2 - - 9 1 - - - 10 Congenital Malformations 2 1 - - 3 3 - 1 - 7 Premature birth 36 2 - 4 42 1 3 - - 46 Atrophy, Debility and Marasmus 4 2 1 - 7 6 11 5 2 31 Other Causes - 1 1 - 2 1 4 4 2 13 Totals 62 22 4 7 95 59 94 95 72 415 68 TABLE IV. (a). North-East Bethnal Green. Infantile Mortality during the Year 1915. Nett Deaths from stated Causes at various Ages under One Year of Age. Causes of Death. Under 1 week 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Small-pox — — — — — — — — — Chicken-pox — — — — — Measles — — — — — — 6 10 16 Scarlet Fever — — — 1 — — 1 Whooping Cough — — — 2 2 3 7 14 Diphtheria and Croup — — — — — — 1 — 1 Erysipelas — — — — — 1 — 1 Cerebro-spinal Meningitis — — — — 1 1 1 3 Tuberculous Meningitis — — — — — — — — — Abdominal Tuberculosis — — — — 1 — 1 Other Tuberculous Diseases — — — — — — 1 1 1 3 Meningitis (not Tuberculous) — — — — — — 2 1 3 Convulsions 1 2 — — 3 2 1 1 — 7 Laryngitis — — — — — — 1 — — 1 Bronchitis 1 1 — — 2 2 3 2 — 9 Pneumonia (all forms) — 2 — — 2 2 3 13 11 31 Diarrhœa — — 1 — 1 6 10 6 3 26 Enteritis — 3 — 1 4 10 5 2 21 Gastritis — — — — — — — Syphilis — — — — 2 2 Rickets — — — — Suffocation, overlaying 1 — — — 1 2 1 4 Injury at birth 3 1 — — 4 — 4 Atelectasis 2 — — 2 1 — 3 Congenital Malformations 2 — — — 2 2 4 Premature birth 19 1 — 1 21 2 23 Atrophy, Debility and Marasmus 4 2 1 — 7 3 7 5 — 22 Other Causes — — — — — — 2 2 1 5 Totals 33 12 2 2 49 23 47 49 37 205 69 TABLE IV. (b) South-West Bethnal, Green. Infantile Mortality during the Year 1915. Nett Deaths from stated Causes at various Ages under One Year of Age. Causes of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. Small-pox – – – – – – – – – – Chicken-pox – —– – – – – – – – – Measles – – – – – – 3 3 6 12 Scarlet fever – – – – – – – – 1 1 Whooping-cough – – – – – – – 1 2 3 Diphtheria and Croup – – – – – – – – – – Erysipelas – – – – – – – – – – Cerebro-Spinal Meningitis – – – – – 3 1 – 1 5 Tuberculous Meningitis 1 – – – 1 – 2 2 2 7 Abdominal Tuberculosis – – – – – 1 – 1 – 2 Other Tuberculous Diseases – – – – – 1 – – – 1 Meningitis (not tuberculous) – – – – – – – – 2 2 Convulsions 1 3 – – 4 1 3 – – 8 Laryngitis – – – – – – – – – – Bronchitis – 1 1 – 2 5 3 7 – 17 Pneumonia (all forms) – – – 1 1 5 5 11 10 32 Diarrhoea – – – – – 2 16 9 1 28 Enteritis – – – – – 10 6 8 7 31 Gastritis – – – – – – – – – – Syphilis – – – 1 1 – 1 – – 2 Rickets – – – – – – – – – – Suffocation, overlaying 1 1 – – 2 2 – 1 – 5 Injury at birth 4 – – – 4 – – – – 4 Atelectasis 5 2 – – 7 – – – – 7 Congenital Malformations (d) – 1 – – 1 1 – 1 – 3 Premature birth 17 1 – 3 21 1 1 – – 23 Atrophy, Debility and Marasmus – – – – – 3 4 – 2 9 Other Causes – 1 1 – – 1 2 2 1 6 Totals 29 10 2 5 46 36 47 46 35 210 70 TABLE V. Showing the number of Deaths from the seven principal Zymotic Diseases, inclusive of Hospital Deaths in the 10 years 1905 to 1914 and in the year 1915. Disease. 1905. 1906. 1907 1908. 1909. 1910. 1911. 1912. 1913. 1914. Annual Average of 10 yrs, 1905-1914. 1915. Small Pox – – – – – – – – – – – – Measles 48 60 71 105 78 58 128 90 59 70 77 105 Scarlet Fever 27 22 43 39 25 9 6 2 3 7 18 11 Diphtheria 31 20 18 29 20 20 6 15 11 28 20 39 Whooping Cough 50 63 53 42 37 34 44 28 30 48 43 36 Fever 9 14 7 13 4 18 3 3 4 4 8 3 Diarrhoea (and Enteritis after 1910) under 2 years 119 152 59 102 90 43 230 48 145 173 116 128 Totals 284 331 251 330 254 182 416 186 252 330 282 322 71 TABLE VI. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES & HOMEWORK. I.—Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 231 35 – Workshops (Including Workshop Laundries) 4,592 943 – Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 1,200 86 – 6,023 1,064 – Total 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred toH.M. Inspctor. Nuisances under the Public Health Acts:— Want of cleanliness 467 467 – – Want of ventilation 27 27 – – Overcrowding 6 6 – – Want of drainage of floors 3 3 – – Other nuisances 855 855 – – Sanitary accommodation insufficient 19 19 – – unsuitable or defective 451 451 – – not separate for sexes 14 14 – – Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) – – – – Breach of special sanitary requirements for bakehouses (ss. 97 to 100) – – – – Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) – – – – Total 1,842 1,842 – – 72 3.—HOME WORK NATURE OF WORK. Outworkers' Lists, Section 107. Outwork in unwholesome premises, section 108. Outwork in infected premises, sections 109, 110. Lists 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. OutWork ers. Lists. OutWork ers. Textile weaving 9 46 4 11 – – 11 15 – 1 – – Wearing Apparel—Making, &c. 64 1815 12 362 – – 365 562 – 10 – – Furniture and upholstery 7 76 – – – – 9 17 – – – – Umbrellas, &c 2 12 – – – – 18 28 – – – – Canvas Work (Military) – – 1 82 – – 8 14 – 6 – – Paper, &c., boxes, paper bags 11 407 2 37 – – 132 179 – 1 – – Brush making 4 495 – – – – 38 56 – – – – Carding, &c., of buttons, &c. 1 12 – – – – – – – – – – Leather Goods (Fancy) 1 13 – – – – 3 2 – – – – Total 99 2876 19 492 – – 584 673 – 18 – – 4. Registered Workshops. Workshops on the Register's. 131) at the end of the year. Number. Workshops, including Laundries 2,333 Food Premises 233 Bakehouses 85 Total number of Workshops on Register 2,651 5.—Other Matters. Class. Number. Matters notified to H.M Inspector of Factories Failure to affix Abstract of the Factory and Workshop Act(s. 133) 11 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but net under the Factory and Workshop Act(s. 5) Notified by H.M. Inspector 68 Reports (of action taken) sent to H.M. Inspector 68 Other 1 Underground Bakehouses (s. 101)— Certificates granted during the year – In use at the end of the year 26 73 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 Diseases. General Diseases. Total. Abbey street 3 ... 2 4 9 Bonner road ... ... 1 5 6 Abingdon buildings 2 1 ... ... 3 Bonner street ... ... ... ... ... Abingdon street ... ... 1 ... 1 Bonwell street 1 1 1 4 7 Ada place 1 ... ... ... 1 Boreham street ... ... 1 1 2 Ainsley street ... 1 ... 2 3 Boundary street ... ... 1 ... 1 Albert buildings ... ... ... ... ... Brady's buildings ... ... 1 1 2 Albion place ... ... ... ... ... Brady street 2 1 3 3 9 Alfred place ... ... ... ... ... Braemar street 2 2 1 5 10 Allas road ... ... 3 9 12 Bratlev street ... ... ... ... ... Alma road ...... ... 4 ... 4 Brick lane 2 2 2 4 10 Ames street 2 ... 4 3 9 Brierley street 1 ... 1 1 3 Angela gardens ... ... 1 3 4 Bucks court ... ... ... ... ... Anglesea street 1 ... ... 3 4 Buckhurst street 1 1 5 1 8 Anns place ... ... ... ... ... Bullards place 1 ... 1 1 3 Approach road 1 2 2 6 11 Bunsen street ... ... ... ... ... Arbery road (Except Nos. 74 and 76) ... ... ... 7 7 Burgoyne road ... ... 2 1 3 Burnham square ... 1 1 ... 2 Burnside street ... 1 ... ... 1 Archer street ... ... ... ... ... Busby square ... ... ... ... ... Arline street ... ... 2 5 7 Busby street ... 1 2 2 5 Artillery street ... ... ... 1 1 Butler's buildings ... ... ... ... ... Ashwell road ... 2 1 3 6 Butler street ... ... 3 ... 3 Auckland road ... 1 1 4 6 Buxton street (Odd Nos. 1 to 33 Even Nos. 2 to 10) ... ... ... 2 2 Austin road ... ... ... ... ... Bacon street ... 1 b 5 12 Baker's court ... ... 1 ... 1 Cadell street ... ... 1 1 2 Baker's rents ... ... 1 1 2 Calvert avenue ... ... ... ... ... Baker street ... ... ... ... ... Cambridge bldgs ... 2 ... ... 2 Bandon road ... ... 4 5 9 Cambridge circus ... 1 1 2 4 Barnet grove ... 2 3 4 9 Cambridge road (All Odd Nos. and Even Nos. from160 ) 1 5 9 8 23 Barnsley bouses ... 2 ... 3 5 Barnsley street ... ... 2 3 5 Baroness road 1 1 ... 3 5 Cambridge street ... ... ... 1 1 Bath grove 3 ... ... ... 3 Camden street 2 ... 1 ... 3 Bath street ... ... ... ... ... Camlet street ... ... ... ... ... Baxendale street. 3 1 1 3 8 Canrobert street 2 ... 7 2 11 Bellhaven street ... ... 1 3 4 Carlisle street ... ... ... ... ... Benson buildings. ... ... ... ... ... Carmel house 2 ... ... ... 2 Bessy street ... ... 1 1 2 Carter street ... ... ... ... ... Bethnal House ... ... ... ... ... Casket street 3 ... ... ... 3 Bethnal Green road 2 1 5 10 18 Caslon place 1 1 ... ... 2 Beulah cottages ... ... ... 1 1 Catherine street ... ... ... ... ... Birkbeck street ... ... ... ... ... Centre street 1 ... 1 ... 2 Bishops road 1 1 1 6 9 Chambord street 5 1 3 3 12 Blyth street ... 1 1 2 4 Chance street ... ... ... ... ... 74 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 Chapel street ... 1 ... 1 2 Cyprus street ... 1 2 7 10 Charles terrace ... ... ... ... ... Charlotte street ... 1 3 3 7 Chertsey buildings ... ... ... 1 1 Dagnall place 1 ... 2 1 4 Cheshire street 4 2 2 7 15 Daniel street 1 ... ... 1 2 Chester street ... ... ... 1 1 Darling row ... ... ... ... ... Chilton street 1 2 2 4 9 Davis place 1 ... 1 1 3 Chisenhale road 2 2 1 3 8 Davis buildings ... ... ... ... ... Church row ... ... 2 1 3 Delamere dwellings ... ... ... ... ... Church street (Except Even Nos. from 2 to 26, and Odd Nos. 3 to 7) ... ... 1 1 2 Delta street ... ... ... ... ... Derbyshire street 1 1 4 3 9 Devonshire place ... ... ... ... ... Digby street 2 1 ... 1 4 Clare street 2 2 ... ... 4 Digby walk ... 1 3 2 6 Claremont street ... ... ... ... ... Dinmont street ... 1 3 4 8 Clarence street ... 1 ... 1 2 Diss street ... ... ... ... ... Clarkson street 1 1 3 2 7 Dixie street ... ... ... 3 3 Clifton buildings ... ... 2 ... 2 Driffield road (Odd numbers) 1 ... ... 2 3 Club row ... ... ... ... ... Coate street ... ... ... ... ... Ducal street ... ... ... 3 3 Code street ... 1 1 ... 2 Durant street 1 1 1 3 Colling place ... ... ... ... ... Eastman street 5 ... 1 7 13 Colling street ... ... ... ... ... Collingwood street ... 1 4 8 13 Collyer's court ... ... ... ... ... Ebor street ( Even Nos. only) ... ... ... ... ... Columbia market ... ... ... ... ... Columbia road 1 1 1 4 7 Eckersley street 1 ... ... 1 2 Columbia square 5 1 1 5 12 Edgar place ... ... l ... 1 Conyer street 1 ... ... ... 1 Edward place ... ... ... 1 1 Cookham buildings ... ... ... ... ... Ellesmere road 1 ... 2 6 9 Co-operative b'ld'gs ... 1 ... ... 1 Elwin street ... 1 1 3 5 Cooper's gardens ... 1 2 3 6 Emma street 2 1 2 4 9 Cordova road 2 1 2 5 10 Ernest place 2 ... ... 2 4 Corfield street 4 1 5 10 20 Evesham houses ... ... ... ... ... Cottage place ... ... ... ... ... Ezra street ... ... ... ... ... Coventry place ... ... ... ... ... ... ... ... Coventry street 5 5 5 5 20 ... ... ... Cox's buildings ... ... ... ... ... Falcon buildings ... ... 1 ... 1 Cranbrook road 1 ... ... ... 1 Felix street ... 1 1 5 7 Cranbrook street 3 1 2 8 14 Fellbrigg street ... 2 2 5 9 Craven buildings ... 1 1 1 3 Finnis street ... 3 2 3 8 Crescent cottages 1 ... 1 2 4 Fleet street hill 1 ... ... ... 1 Crescent place ... 1 1 1 3 Flint terrace ... 1 ... ... 1 Cross street ... ... ... ... ... Florida street 3 2 1 2 8 Crossland square 4 ... ... ... 4 Florida terrace ... ... 1 ... 1 Cudworth street ... 1 2 3 6 Fossett's buildings ... ... ... ... ... Culham buildings ... ... ... 1 1 Foster street 1 ... ... ... 1 Cygnet street ... ... ... ... ... Fountain street ... ... ... ... ... Cymon street 1 ... ... 3 4 Fox street 1 ... 1 ... 2 75 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. Fox's buildings ... ... ... ... ... Hare court ... ... ... ... ... Fuller street 2 ... 7 5 14 Hare marsh ... 1 ... 1 2 Hare street ... 6 1 4 11 Harold street 1 ... ... 3 4 Gales Gardens 2 2 3 6 13 Hartley street ... 1 1 2 4 Garden place Violet street ... ... ... ... ... Hassard place ... ... ... ... ... Hassard street 2 2 2 2 8 Garden place James street ... ... ... ... ... Havelock place ... ... ... ... ... Hemming street ... 1 2 4 7 Gardeners road ... ... ... 3 3 Hedsor buildings ... 1 1 1 3 Garner street ... ... 2 4 6 Helens place ... ... ... ... ... Gascoigne place ... ... ... 1 1 Henley buildings ... ... 2 1 3 Gawber street 1 ... 1 1 3 Henrietta street 3 ... 1 4 8 George place ... ... ... ... ... Hereford buildings 1 ... ... ... 1 Georgina gardens ... ... ... 1 1 Hereford street ... 3 2 4 9 Gernon road ... ... ... ... ... Hersee place 4 1 2 2 9 Gibraltar buildings ... ... ... ... ... Hocker street ... ... ... ... ... Gibraltar gardens ... ... ... ... ... Holly Mansions ... ... ... ... ... Gibraltar walk 1 ... 2 3 6 Hollybush gardens 2 1 ... 2 5 Gilman street 1 1 3 1 6 Hollybush place ... ... ... ... ... ... Glass street ... ... 1 1 2 Holmes avenue 1 ... ... 1 2 Globe road (Even Not from 156 Odd from 131) 2 ... 3 8 13 Horatio street 3 2 1 1 7 Horts place ... ... ... ... ... Hunslett street ... 1 2 ... 3 Gloucester passage ... ... ... ... ... Huntingdon bldgs. ... ... ... ... ... Goldsmith's row (Children's Hospital & Nos. 8 to 62 Even) 2 1 ... 1 4 Hurley buildings ... ... ... 2 2 Gossett street 2 1 1 5 9 Iffley buildings ... ... ... 1 1 Granby place ... ... ... 1 1 Ion square 1 1 2 6 10 Granby street 1 1 ... 4 6 Ivimey street 1 ... ... 1 2 Gt. Eastern bldgs. 2 2 1 ... 5 Green street ... 3 2 10 15 Gretton houses 1 1 3 5 10 James court ... ... ... ... ... Grimsby street ... ... ... 1 1 James place 1 ... ... ... 1 Grove road (Odd Nos. from 59 Even Nos. from 110) 2 ... 2 10 14 James street (Odd Nos. from 39, Even from No. 1) 1 ... ... 4 5 Guinness' buildings 1 4 4 7 16 Jersey street ... ... 3 1 4 Hackney road (All Even Nos. and Odd Nos. from 323) 3 4 4 14 25 Kay street (Nos 3 to 53 oad, and 2 to 46 even) 1 1 1 2 5 Hague buildings ... ... 1 ... 1 Kelsey street ... ... ... ... ... Hague place ... ... ... 1 1 Kenilworth road 3 ... 5 2 10 Hague street 2 1 ... 3 6 Kerbela street ... 2 1 ... 3 Hammond's gardens ... ... ... ... ... Kirkwall place 2 ... 2 2 6 Hamilton road 6 2 3 ... 11 Kite place ... ... 1 1 2 76 STREET LIST—continued. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercula Diseases. Respiratory Diseases. General Diseases Total. Knottisford street 1 ... 1 1 3 Minerva street ... 1 ... 5 6 Minto place ... ... ... ... ... Mocatta house ... ... ... ... ... Laleham buildings 2 1 ... ... 3 Molesey buildings ... ... ... ... 1 Lansdell place ... ... 1 ... 1 Montclare street ... ... ... ... ... lark low ... ... 3 5 8 Montfort house ... ... ... ... ... lawfrance road ... ... ... 1 1 Moravian street ... ... ... ... ... Leopold buildings 1 3 ... 4 8 Morpeth street 3 2 2 6 13 Leslie house 1 ... 1 ... 2 Moss street 3 1 ... 11 15 Letchford buildings ... ... ... ... ... Mount street ... ... 1 2 3 lessada street 1 2 1 ... 4 Mowlem street ... ... 1 2 3 ligonier street ... ... ... ... ... Museum buildings ... 3 3 Lily house ... ... ... ... ... Linden buildings 1 ... 1 ... 2 Lisbon buildings ... 1 1 3 5 Nant street ... ... 2 1 2 Lisbon street ... ... ... ... ... Navarre street ... ... ... ... ... London street ... ... ... ... ... Neath place 1 ... 1 2 4 Lucas street ... ... ... 1 1 Nelson place ... ... ... ... ... Lval road (Nos. 57 i, and 58 to 88 C nsecutive Nos.) ... ... ... 2 2 Nelson street 2 ... 2 2 6 New Church street 1 ... 2 ... 3 Newling street ... 1 1 1 3 Lyte street ... ... 1 1 2 New Tyssen street 1 ... ... 7 8 Norah street 3 1 2 8 14 Northampton street ... ... 4 3 7 Mace street 2 ... ... 5 7 Norton street ... 1 ... ... 1 Manchester bldgs.... 1 ... ... ... 1 Manchester place... ... ... ... ... ... Mansford buildings 2 ... 2 4 8 Octagon street ... 1 ... ... 1 Mansford street 1 2 4 3 10 Old Bethnal Green road 4 2 4 8 18 Mape street ... 1 ... 4 5 Margaret place ... ... 1 2 3 Old Ford road (Odd Nos. to 205, Even Nos. to 36S) 2 2 7 13 24 Marian place ... ... ... ... ... Marian square ... ... ... ... ... Marian street ... 1 3 6 10 Old Nicol street ... ... 1 ... 1 Marlow buildings... ... ... ... 1 1 Olga street ... ... 1 2 3 Martha court ... ... ... 2 2 Orange street 1 2 ... 2 5 Matilda street 1 1 4 1 7 Oval 2 1 2 ... 5 Meadows dwellings 1 2 ... 4 7 Medhurst road 1 1 4 5 11 Palissy street ... ... ... ... ... Medway buildings... 1 ... ... ... 1 Palm street ... 1 1 6 8 Medway road (Odd Nos. 3 to 49, Even Nos. 2 to 62) ... 1 2 2 5 Palmer's road ... ... ... ... ... Paradise row ... ... ... 2 2 Park place ... 1 ... ... 1 Memorial Hall bgs. ... ... ... ... ... Parliament place 1 ... ... ... 1 Mendip houses ... 1 1 1 3 Parliament street 1 ... 1 ... 2 Menotti street 1 1 ... 3 5 Parmiter houses ... ... ... ... ... Merceron houses ... 1 ... 2 6 9 Parmiter street ... 1 ... 3 4 Merceron street ... ... 1 ... 2 3 Patriot square 2 ... ... 1 3 Middleton street ... 3 1 6 4 14 Peabody buildings ... ... 3 5 8 77 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. Peacock place ... ... ... ... ... Roan horse yard ... ... ... ... ... Peacock street ... ... ... 1 1 Robert street ... ... ... 2 2 Pearl yard ... ... ... ... ... Robinson road ... ... 2 3 5 Peary place ... ... 1 ... 1 Rochelle street ... ... ... ... ... Pedley street 3 ... 2 1 6 Roman road (Odd Nos to 127 Even Nos. to 142) 3 3 3 4 13 Peel grove ... ... 1 4 5 Peel grove mews ... ... ... ... ... Pelter street ... ... ... 2 2 Pereira street 4 1 5 3 13 Peter street ... ... ... 1 1 Rooks place ... ... ... ... ... Pollard place ... ... ... ... ... Ropley street ... ... ... ... ... Pollard row 1 ... 1 9 11 Ross buildings Moss street ... ... ... ... ... Pollard street ... 1 1 3 5 Portman place 2 ... ... 2 4 Royal Victor place ... ... ... ... ... Pott street ... ... ... 1 1 Royston street 2 1 5 2 10 Poyser street 1 ... ... 3 4 Russia lane 1 3 2 1 7" Preston street 3 ... 3 4 10 Primrose street ... ... ... ... ... Princes court ... ... 1 3 4 sabbage yard ... ... ... ... ... Pritchard's road (Except Nos. 57 to 117) 5 2 3 5 15 Sale street 1 1 3 1 6 Sandford buildings 1 ... ... ... 1 Satchwell rents 1 1 3 2 7 Prospect terrace 3 1 1 1 6 Satchwell street 3 ... 1 1 5 Providence place 1 ... 1 2 4 Sclater street ... ... ... 4 5 Providence yard ... ... ... ... ... Scott street 2 1 4 9 16 Punderson gardens 2 1 6 2 11 Seabright street 9 3 1 5 18 Selby street (Even Nos.) ... ... ... 1 1 Queen's buildings Princes Place ... ... ... ... ... Sewardstone road... 1 3 3 10 17 Shacklewell street ... ... ... 1 1 Queen's buildings Gossett street .... ... 1 ... 2 Sheldon place ... 1 ... 1 2 Shetland street ... ... 2 1 3 Queen's buildings Chambord street 1 1 ... ... 1 Shepton houses 2 ... 1 1 4 Shiplake buildings ... ... ... ... ... Qu'n Caroline place ... ... ... ... ... Shipton street ... 2 ... 4 5 Quilter street ... ... 2 5 7 Skinners court ... ... ... ... ... Quinns square 3 2 14 4 23 Sidney street 4 ... 3 ... 7 Smart street ... ... ... 2 2 Smiths buildings ... 1 ... ... 1 Railway arches ... ... ... ... ... Somerford houses 2 1 ... 8 11 Ramsey street ... ... ... 1 1 Somerford street 1 ... 2 6 9 Rapley place 1 ... 1 ... 2 Sonning buildings ... ... ... 1 1 Ravenscroft bldgs. 1 ... 3 3 7 S'hampton cottages ... ... ... ... ... Ravenscroft street 2 ... ... 5 7 Southampton place ... ... ... ... ... Reid's mansions Gossett street ... ... ... ... ... Southampton street ... ... ... ... ... Southampton terr. 1 ... 1 ... 2 Reuben street ... 1 1 2 4 Spencer passage ... ... ... ... ... Riders buildings ... ... ... ... ... Spicer buildings ... ... ... ... ... 78 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. Spital street (Nos. 11 to 27) ... ... ... ... ... Turin street 2 2 1 4 9 Turville street 1 ... 1 ... 2 Squirries street ... 1 ... 3 4 Tuscan street 1 ... 1 2 4 St. Andrews street ... ... ... ... ... Type street 1 ... 3 4 8 St. James road ... ... ... 5 5 Tyrrell street ... 1 ... 1 2 St. Jude street ... ... 1 2 3 St. Mark's bldgs Tagg street ... ... ... 1 1 Usk street 3 ... 5 3 11 St. Mary's place ... ... ... ... ... St. Matthias place ... ... ... ... ... St. Peter square 1 1 ... 1 3 Vallance road 1 1 5 7 14 St. Peter street 1 2 1 7 11 Venice street ... ... ... 2 2 Stainsbury street ... 2 1 ... 3 Viaduct place ... ... ... ... ... Stamp place 1 ... ... ... 1 Viaduct street 2 6 3 2 13 Stanfield road ("Stoneleigh" House & Gateway adjoining) ... ... ... ... ... Victoria park ... ... ... ... ... Victoria place ... ... ... ... ... Victoria place James street 1 ... ... 1 2 Steels buildings ... ... ... ... ... Strahan road (Odd Nos.) ... 1 ... 1 2 Victoria Park sq. ... ... 1 1 2 Violet row ... ... ... ... ... Streatley buildings ... ... ... 2 2 Violet street ... ... ... ... ... Strout's place ... ... ... ... ... Virginia road ... ... 3 9 12 Sugar Loaf walk ... ... ... 3 3 Vivian road 1 ... ... 7 8 Sunbury buildings ... ... ... 2 2 Voss street ... ... ... 2 2 Surat street 1 ... 5 8 14 Vyner street 1 ... 2 5 8 Sutton buildings 2 1 3 4 10 Sweet Apple square ... ... 2 ... 2 Wadeson street 2 ... 4 3 9 Tagg street 2 1 5 3 11 Walter street 2 1 1 1 5 Taplow buildings ... ... 3 ... 3 Walton buildings 2 ... ... 4 6 Tapp street ... ... ... ... ... Wargrave bldgs 1 ... 1 2 4 Tavistock street ... ... ... 1 1 Warley street 4 2 4 8 18 Teale street ... ... ... 2 Warner place 2 1 3 3 9 teesdale street 3 2 1 3 9 Waterloo place ... ... ... ... ... Temple dwellings ... ... 1 1 1 Waterloo road ... ... 1 ... 1 temple street 2 3 2 11 18 Waterloo terrace ... ... 1 ... 1 tent street ... ... 3 4 7 Waterlow Buildings ... 1 ... 1 2 Thorold street 2 1 2 3 8 Wear street ... ... ... ... ... Thoydon road ... ... ... ... ... Weaver street (Odd Nos.) ... ... ... ... Three Colt corner ... ... ... 2 2 Three Colt lane ... ... 1 ... 1 Weldon street ... ... 1 ... 1 Thurlow place ... ... 1 2 3 Wellington place ... ... ... ... ... Totty street 1 ... 1 2 4 Wellington row 1 2 4 8 15 Toyes buildings Old B'thnal G'n r'd ... 1 ... ... 1 Wennington road ... 1 1 3 5 Wharf road ... ... 1 1 2 Toyes buildings Mansford street ... ... 1 1 2 Wharncliffe street 2 ... 1 ... 3 Wheeler street ... ... ... ... ... Treadway street 3 4 4 5 16 Whitby street ... ... ... ... ... 79 STREET LIST—continued. Name of Street. Zymotic Diseases. Tubercular Diseases. Reppiratory Diseases. General Diseases. Total. Name of Street. Zymotic Diseases. Tubercular Diseases. Respiratory Diseases. General Diseases. Total. Whites court ... ... ... ... ... Winchester cr'sc'nt ... ... ... 1 1 Whitechapel road (Odd Nosfrom 319 ... ... 1 ... 1 Winchester place ... ... ... ... ... ... Winchester street ... 1 ... 1 2 Whitmore buildings ... ... ... 2 2 Wolverley passage ... ... ... ... ... Wilmot house ... ... 1 ... 1 Wolverley street ... ... 4 4 8 Wilmot street 3 6 5 7 21 Wood close ... ... ... ... ... Wingham street ... ... ... ... ... Wood street ... ... ... ... ... Wimbolt street 2 ... 3 2 7 No Home 1 7 8 21 37 Winchester bldgs ... ... ... ... ... 80 Memorandum prepared by the Town Clerk and the Medical Officer of Health. PROPOSED TUBERCULOSIS DISPENSARY. 1. Questions relating to the establishment of a tuberculosis dispensary for the Metropolitan Borough of Bethnal Green have engaged the attention of the members of the Public Health Committee for a lengthy period, and although but little progress has been made, it is undeniable that the Council has profited by the experiences of Authorities who launched schemes when the formulation of a comprehensive scheme for the treatment of Tuberculosis in London was in its earliest stages, and the certainty of contributions in aid was by no means so evident as at the present time. 2. The widespread prevalence of tuberculosis, the general suffering and economic waste caused thereby, and the movements to combat the disease are now matters of common knowledge. 3. The methods adopted to deal with the disease are in part comprised in what is known as the dispensary scheme. In this system the dispensary, being the first unit in the general scheme, exists as a unifying centre of a chain of institutions, its functions being to serve as a centre for diagnosis, curative treatment, examination, classification and distribution of patients according to treatment required, and for many other matters calculated to assist the work of prevention and cure of tuberculosis. 4. The chain of institutions which form the second 81 unit, consists of sanatorium, hospital, etc., for residential treatment and other matters. 5. The Council, acting as the Sanitary Authority for the Metropolitan Borough of Bethnal Green, is concerned with the dispensary portion of the scheme, as to which it appears to be limited to one of two courses of action, viz. — (a) To establish and maintain a dispensary tered and controlled by the Council, necessitating for certain purposes a linking-up with some local general hospital; or (b) To enter into an agreement for the provision of a dispensary at an existing institution. 6. There are advantages and disadvantages attendant upon both these courses of action, and it is in many cases a matter of opinion as to what really is an advantage or disadvantage. 7. The authorities to whom the Council should communicate the terms of any proposed scheme for the establishment of a tuberculosis dispensary are the Local Government Board, the London County Council and the Insurance Committee for the County of London, who will contribute in varying proportions towards the cost of any such scheme approved by them. 8. The Local Government Board is also empowered to arrange for capital grants to be made to a Council undertaking the provision of a dispensary building, with the consent of the Board, and according to a scale laid down by the Local Government Board, the maximum grant to the Council would be £240. Grants in excess of the scale have been made to certain borough councils 82 under exceptional circumstances which are unlikely to arise in Bethnal Green. 9. The Local Government Board in a circular letter dated 19th December, 1913, stated that tuberculosis dispensaries might be provided at general hospitals or hospitals for consumption or at voluntary dispensaries, or by the Borough Councils themselves. The Board also stated very definitely that where there is a general hospital or hospital for consumption situated in the borough, or sufficiently near to serve for a dispensary for the borough or some part of the borough, and the authorities of the hospital are willing to provide a tuberculosis dispensary complying with any rules of the Board as to dispensaries in London, and to work in co-operation with the Borough Council and the London County Council, arrangements should be made for such a dispensary. 10. In the circular letter referred to, the Board sketched the preventive measures which should be taken, including co-ordination of the work of the dispensary with the preventive work of the Council under the Tuberculosis Regulations, 1912. The Board also intimated that the medical officer of a dispensary established at a hospital should act under arrangements providing for complete interchange of information between the Medical Officer of health and himself. 11. The Board also stated that its approval of dispensaries will usually be given subject to conditions including:— (a) That the dispensary will be open to inspection at any time by any of the Board's officers or inspectors; 83 (b) That such records will be kept in connection with the dispensary as the Board, after consultation with the Insurance Commissioners, may from time to time require; (c) That the Board will be informed of any proposed change in the ownership or management of the dispensary, and any proposed alteration in or addition to the medical staff of the dispensary; and (d) That any rules which the Board may find it necessary to make in regard to dispensaries in London will be complied with. 12. In December, 1912, the Local Government Board informed the London County Council that the Board regarded the County Council as the central organising body of matters relating to tuberculosis dispensaries in London, and the Board requested the County Council to formulate a complete scheme for the Metropolis. 13. Shortly after the constitution of the Insurance Committee for the County of London, under the provisions of the National Insurance Act, 1911, very important questions arose as to the treatment of insured persons, and considerable time elapsed before doubts could be resolved sufficiently to enable the London County Council to complete the scheme referred to. 14. On the 26th May, 1914, the London County Council adopted a general scheme for the treatment of tuberculosis in London, in which matters relating to provision of residential accommodation, hospital beds, sanatorium beds, the treatment of advanced cases and the treatment of children were dealt with, and the 84 general scheme also included a complete scheme for dispensary treatment in London. 15. Several Metropolitan Borough Councils have so varied their tuberculosis dispensary schemes as to comply with the views of the London County Council and become entitled to grants from the County Council in addition to those received from the Local Government Board. It should, however, be borne in mind that grants made by the London County Council are taken from the County Fund, to which the metropolitan borough councils contribute out of the general rates of their borough. 16. Some time ago the Insurance Committee for the County of London agreed with certain local authorities for the provision of treatment for persons insured under the Act. Apparently, however, the financial arrangements have not worked smoothly, as, according to the statistical return which was obtained on behalf of the Council in April last and circulated amongst members, it appeared that some local authorities have not succeeded in obtaining payments from the Insurance Committee on a defined basis. 17. These financial difficulties have been the subject of consideration by the Metropolitan Boroughs Standing Joint Committee, and in or about July, 1915, representations were made by that Committee to responsible authorities. 18. On the 10th August, 1915, the Local Government Board issued a letter to the Metropolitan Borough Councils dealing with the financial difficulties which had occurred with regard to payments by the London Insurance Committee in respect of services rendered by the dispensaries for insured persons, and the Board then 85 forwarded a draft model agreement providing for payment to the Council by the Insurance Committee of a lump sum per annum by quarterly instalments, in consideration of the services provided under the agreement. The Board further stated that as all insured persons are provided with the services of a general practitioner, the dispensary services required for such persons would be somewhat less than in the case of uninsured persons, and the Board expressed the opinion that during the period ending 31st March, 1918, the sum of £9,362 per annum would fairly represent the value of the dispensary services required by the London Insurance Committee for London as a whole, and the Board set forth a statement as to apportionment of this sum of £9,362 per annum between authorities in London, showing the sum of £250 per annum allocated to Bethnal Green. 19. For a considerable time past a sub-committee of the Public Health Committee has caused inquiries to be made in relation to the provision of a tuberculosis dispensary for Bethnal Green and the principal question which the sub-committee has endeavoured to investigate for the purpose of report to the committee has been whether it would be prudent for the Council to establish a municipal tuberculosis dispensary, or whether the interests of the Council would be better served by entering into a contract for provision of the dispensary by and at a local hospital. The sub-committee has considered statistics showing the probable cost of a municipal tuberculosis dispensary, such statistics being based on knowledge then obtainable, which, in some particulars may not at this date afford accurate ground on which to base conclusions. 86 20. Enquiries were made as to the terms on which local hospitals would provide for dispensary treatment, and the most favourable quotation was that of the City of London Hospital for Diseases of the Chest, whieh, based on a charge of 2s. per head per attendance, was estimated to equal £2,080 per annum. 21. Estimates of the cost of providing and maintaining a municipal tuberculosis dispensary indicated that an establishment under municipal control would be conducted under arrangements more satisfactory to the Council than those which would obtain at a local hospital, and at considerably less cost than the sum quoted by the authorities of the City of London Hospital. 22. The sub-committee accordingly desired that a scheme for the establishment of a municipal tuberculosis dispensary should be drafted, but during consideration by the Town Clerk of a rough draft scheme prepared by the Medical Officer of Health it became apparent that, owing to the financial considerations arising out of the state of war existing, and because of other circumstances, there would be considerable difficulty in obtaining the approval of the Local Government Board and the London County Council to such a scheme, and also to obtain capital grants towards the purchase of site and erection of the necessary building. 23. Further experience also showed that the estimated number of attendances on which quotations of the hospital authorities were calculated was too liberal, and it therefore followed that the cost of the hospital dispensary would have been materially less than anticipated. 24. The Town Clerk thereupon made enquiries of the Local Government Board as to its policy with regard 87 to tuberculosis dispensaries in London, and in a reply dated the 2nd November, 1915, the Board stated to the effect:— (a) That the opinion of the Board was still as expressed in that portion of the Board's circular letter of the 19th December, 1913, favouring a contract with some local general hospital or a hospital for consumption, situated in or near the borough rather than the provision of a municipal tuberculosis dispensary. (b) That as a tuberculosis dispensary approved by the Board existed in the borough in connection with the City of London Hospital for Diseases of the Chest, the Board would find it difficult to approve a proposal to establish a municipal dispensary. (c) That the proposal for a municipal dispensary was also open to objection on the ground that there would be considerable delay before the dispensary would be at work; whereas if an arrangement were made, such as was contemplated in the Board's circular letter of the 19th December, 1913, the scheme might be brought into operation forthwith. (d) That the Board did not think the London County Council would be prepared to sanction a loan to defray the cost of a municipal dispensary, or that the Treasury would consent to a capital grant for the purpose. (e) That great difficulty would be experienced in obtaining the services of a suitably qualified 88 tuberculosis officer to take charge of the dispensary ; and that the Board were advised that the cost of maintenance of a municipal dispensary to serve Bethnal Green only would be greater than the share of the Borough Council in the cost of the dispensary provided at the Victoria Park Hospital. 25. The Local Government Board requested that the Council would give consideration tn the above observations, and stated that if the Council was of opinion that a conference between representatives of the Borough Council and the Board's officers would be of advantage, the Board would be happy to make the necessary arrangements. 26. Having regard to the views expressed by the Local Government Board, the sub-committee of the Public Health Committee requested the Town Clerk again to approach the authorities at the City of London Hospital as to the terms on which the Hospital Governors would provide dispensary treatment for residents of Bethnal Green. 27. The Hospital Authorities have replied by intimating their willingness to provide the dispensary treatment for Bethnal Green for the sum of £925 per annum, and they have forwarded a draft agreement, in terms mutatis mutandis with those contained in a proposed agreement between the Hospital Governors and the Hackney Borough Council. 28. The terms suggested by the Hospital Authorities for a formal agreement with this Council are to the undermentioned effect:— (a) The Hospital Governors to provide a tuberculosis 89 dispensary in connection with the Hospital for the examination and treatment of patients from the Borough of Bethnal Green, the dispensary being open on certain mornings and at least two evenings per week. (b) The Hospital Governors to appoint a whole-time Medical Tuberculosis Officer at a salary of not less than £400 per annum, such Officer to be experienced not only in dealing with tuberculosis, but also in general medicine. (c) The dispensary to be properly equipped with apparatus by the Hospital Governors, the whole arrangements being satisfactory to the Local Government Board, the London County Council and the Insurance Committee. (d) The dispensary to be under the control of the Hospital Governors, except administrative control devolving on the Medical Officer of Health of Bethnal Green, as Chief Administrative Tuberculosis Officer of the Bethnal Green Municipal Tuberculosis Scheme. (e) The Hospital to appoint a special Advisory Committee for the Tuberculosis Dispensary, consisting of certain members of the Hospital Committee, the Medical Officer of Health for Bethnal Green, two representatives nominated by the Council, and two representatives (one to be a panel doctor), appointed by the London Insurance Committee. (f) The treatment of uninsured persons to be given in consultation and co-operation with the medical practitioner attending the case. 90 (g) The duties of the Tuberculosis Officer to include the examination of tuberculous persons or suspects, the treatment of such persons, consultation and diagnosis of cases, visitations, supply of certain information to the Medical Officer of Health, to examine specimens of sputum, to attend meetings of the Insurance Committee, to carry out the duties required by the Local Government Board, the London County Council, and the London Insurance Committee; and other matters. (h) The dispensary to be open at all reasonable times for inspection by the County Council and the Insurance Committee. 29. There are a number of points arising upon the draft agreement as to treatment of insured persons, the times during which the dispensary is to be open, the Tuberculosis Officer, the keeping of records by the Hospital Authorities, the constitution, acts and proceedings of the advisory committee, the annual sum to be paid to the Hospital Authorities by the Council, the terms on which the agreement can be determined, and other matters. 30. If an agreement is made with the Hospital Authorities, it will be necessary for the Council to appoint a temporary Health Visitor at an annual salary of say £100, rising by increments of £5 to £120, to discharge duties in connection with the scheme. This appears to be the only material expense cast upon the Council in addition to the payment of £925 per annum to the Hospital Authorities, but it would be well to allocate a sum of £20 per annum for contingencies. 91 31. The question of finance is of much importance, and it may be convenient to state at this stage that the expenditure of the Council on an approved dispensary scheme will he defrayed as follows:— (а) £250 or thereabouts by the London Insurance Committee, (b) 50 per cent. of balance by the Local Government Board, (c) 25 per cent. of balance by the London County Council, (d) 25 per cent. of such balance out of the General Bate of the Borough, the grants being subject to due compliance with the requirements of the several authorities. 32. The proposal of the Local Government Board that the Insurance Committee grant for Bethnal Green should be £250 per annum to 31st March, 1918, calls for consideration. It is probable that the London County Council has agreed this to be a sufficient sum, but the Bethnal Green Council will require to be satisfied as to the sufficiency and certainty thereof. 33. During the course of consideration given by the sub-committee to the question of providing a municipal dispensary, estimates of capital and annual expenditure have been based on the assumption that it would be necessary to acquire the site of one house (No. 1 scheme), and, alternatively, to acquire the site of two houses (No. 2 scheme). 34. Appended hereto is a statement of capital and annual expenditure which the Borough Accountant now estimates partly on the basis of information afforded him by the Medical Officer of Health and the Borough 92 Surveyor. The statement also gives particulars of grants obtainable from other authorities. 35. It will be gathered that the estimated annual expenditure of the No. 1 scheme would be £1,222, necessitating payment by the Council of an estimated sum of £243 per annum. The No. 2 scheme is estimated to cost £1,371 annually, of which £280 per annum would be contributed by the Council. 36. A scheme at the City of London Hospital is estimated to cost £1,050 per annum during the period Ending 31st March, 1918, of which sum the Council would contribute £200 per annum. 37. In these exceptional times it is difficult to estimate the annual cost of the provision and maintenance of a municipal tuberculosis dispensary for Bethnal Green, involving as it does questions relating to site, building, prices of drugs, etc. 38. The expenditure which would be incurred under the scheme with the City of London Hospital Authorities is certainly more definitely ascertainable. 39. It will be gathered that no provision is made for contribution from any patient attending the dispensary whose income exceeds say £160 per annum. Such cases would probably be very few and might involve costs of administration in excess of revenue. 40. Having regard to the present financial restrictions placed on the local authorities, there is little likelihood of the Council obtaining sanction to any scheme for a Municipal Tuberculosis Dispensary for some considerable time, and the question therefore arises whether the sub-committee will recommend the Public Health Committee to proceed with negotiations with the City of 93 London Hospital for the provision of a tuberculosis dispensary for Bethnal Green during the period ending 31st March, 1918. 41. If further negotiations lead to the establishment of a tuberculosis dispensary for Bethnal Green at the City of London Hospital, the Council will doubtless obtain experience which will be of service in the formulation at a later date of any scheme which the Council think necessary for the provision of a municipal Institution, or for continuing or revising the Hospital scheme as the case may be. 42. It is understood that the Hospital dispensary scheme for portion of the Borough of Hackney is in operation and arrangements can be made for the members of the sub-committee to view the dispensary if they so desire. If there are material points upon which members require further information, a conference with Officers of the Local Government Board might be of service. 43. The sub-committee will doubtless readily appreciate that the working of tuberculosis dispensaries is still in an experimental stage, and that any opinions which officers of the Council have expressed or implied in this memorandum may hereafter be confirmed or varied in the light of further experience. DAVID J. KEEP, Town Clerk. G. PADDOCK BATE, Medical Officer of Health, Town Hall, Bethnal Green, 11th January, 1916. 94 BOROUGH ACCOUNTANT'S FINANCIAL STATEMENT. TUBERCULOSIS DISPENSARY. Municipal Scheme—Capital Expenditure. One House. Two Houses. Purchase of Site £ 600 £ 1,200 Building 1,000 2,000 Furniture 300 330 Instruments and Fittings 170 170 Less Maximum Grant under Finance Act, 1911 2,070 3,700 240 240 Municipal Scheme—Annual Expenditure. £1,830 £3,460 £ 500 £ 500 Tuberculosis Officer Two Nurses and Dispensers (£100 to £120) 210 210 Clerical Assistance 50 50 Drugs and Medicine 140 140 Repairs and Fittings 10 15 Loan Charges 126 226 Rates and Taxes 34 68 Light, Fuel and Water 30 40 Cleaning, One Woman at 18s. per week 47 47 Printing, Stationery and Sundries 25 25 Contingencies 50 50 £1,222 £1,371 95 CITY OF LONDON HOSPITAL. £ Annual Amount 925 One Health Visitor (£100 to £120). 105 Contingencies 20 £1,050 MUNICIPAL SCHEME—CAPITAL EXPENDITURE. — Hospital Scheme. Council One House. Council Two Houses. Grant from Insurance Committee £ 250 £ 250 £ 250 „ Local Government Board 400 486 561 „ London County Council 200 243 280 Cost to Borough Council 200 243 280 £1,050 £ 1,222 £1,371 E. W. BAILEY, Borough Acccountant. Town Hall, Bethnal Green, 11th January, 1916. Report of Chief Sanitary Inspector for 1915. INDEX. page Adulteration 15 do. Decennial Period 31 Bakehouses 51 Cases in Hand 7 Clerical Work 59 Combined Drainage 7, 63 Complaints 6 Cowhouses 58 Cream 49 Defective W.C's. 8 do. Water Supply 8 Dirty Premises 8 Disinfectants 55 Disinfecting Work 54 Drains—Defective, relaid, amended, &c. 8 Food and Drugs 15-48 Food Inspection 49 Food Premises Inspections 50 General Summary of Inspections 6,7 House to House Inspections 6,53 Houses Let in Lodgings 52 Housing, Town Planning, etc., Act, 1909 61 House to House Visitation 53 Ice Cream Premises 6, 50 Improvements Effected 9 Inspections—Bakehouses 51 Complaints 6 Cowhouses 58 Dairies and Milkshops 6 Factories and Workshops 6 Food Premises 50 House to House 6, 53 Ice Cream Premises 6,50 Infectious Disease 6 Milkshops 6, 58 New Buildings 6 Out-workers 6, 51, 52 Re-Inspections 6 IN DE X—continued. page Inspections (contd.)—Slaughter-Houses 59 Tenement Houses (Houses let in Lodgings) 6, 52 Total 7 Trade Premises 6 Unclassified 7 Verminous Homes 53 Milkshops 6,58 Milk and Cream Regulations, 1912 49 Miscellaneous Improvements 9 Mortuary Returns 56 New Buildings Inspections 6 Notices served 59 Nuisances Abated 7,9 do. Discovered 8 Offensive Trades 58 Out-workers 6,51 do. Trades 52 Police Court Proceedings 10-14, 16-28 Premises Repaired and Cleansed 9 Public Health (Milk and Cream) Regulations, 1912 49 Rag Flock Act 60 Sale of Food and Drugs Acts 15-48 Samples—Informal 32, 33 Official 15 Taken on Delivery 32 Reports of Chief Inspector 33 Sanitary Conveniences Repaired 9 Sanitary Defects 8 Sanitary Improvements effected 9 Slaughter-Houses 59 Smoke Nui-ances 7, 8, 55 Summary of Inspections 7 do. Disinfection 54 Tenement Houses (Houses let in Lodgings) 6, 52 Total Inspections 6, 7 Trade Premises 6 Unsound Food 7,49 Verminous School Children 53 Water Supply 9 Water Closets 8,9 Workshops 6 Metropolitan Borough of Bethnal Green Public Health Department, Town Hall, Patriot Square, Bethnal Green, E. TO THE PUBLIC HEALTH COMMITTEE. Mr. Chairman and Gentlemen, Herewith I beg leave to submit my Annual Report for the year 1915 on the work of the staff of the Public Health Department for which I have the honour of being responsible. The various details of the many and constantly increasing duties are so fully set forth in the following Appendices lettered A to U, that except to very respectfully commend the strenuous efforts of all my colleagues to your most favourable consideration, I do not know that anything further can usefully be added thereto. I desire to thank the Chairman, Vice-Chairman and the Members of the Committee for much personal kindness and for their valued confidence and support extended to me during a very trying and difficult period. Respectfully soliciting your best consideration to all the various matters in the report herewith submitted, I am, Mr. Chairman and Gentlemen, Your obedient servant, JOHN FOOT. 6 7 APPENDIX A. Total Number of Inspections and Particulars of Cases in Hand for the Year ended 31st December, 1915. District. Infectious Cases. Complaints. House to House Inspections. Trade Inspections. Re-inspections. Milkshop Inspections. Factory and Workshop Inspections. Outworkers' Homes Inspections. Tenement House Inspections New Buildings Inspections. Ice Cream Shop Inspections. Combined Draiage Inspections. Smoke Nuisances— Premises under Observation. Other Inspections or work of Special Character. Number of Calls. Unsound Food Seizures. Samples of Food and Drugs taken. Police Court Attendances. Nuisances Abated. Number of Cases in Hand Total Visits for the Year. Inspector. A 296 174 7 2639 72 443 851 94 26 _ 75 228 - 79 10 643 60 4905 E. Ainley. B 259 232 121 — 1805 137 269 740 84 — 59 — — 158 49 — 81 3 593 40 3913 A. S. Henley. C 358 424 12 — 2651 70 76 339 223 — 28 — — 106 88 — 117 54 796 42 4375 J. G. Weeks. D 380 42 — 4 3424 264 774 162 521 — 81 1 — 146 — — 96 23 814 35 5799 P. Bare. E 526 284 — — 2292 105 214 72 162 _ 39 — - 168 448 — 97 9 698 25 4310 J. H. Hewett. F 404 359 — — 2684 113 587 373 50 2 30 — - 98 322 8 37 - 936 42 5022 I. R. Jones. 21 39 419 12 2494 — 179 161 — 52 — — — 108 10 — — 10 324 110 3495 E. Richards. — 8 — 1196 — — — — — — — — 208 — 18 3 213 39 — — 1430 W. Rowsell. 43 60 293 — 294 — 469 622 83 — — 276 — 45 12 — — — 236 207 2201 G. Brighting. Totals 2287 1622 852 1212 18283 761 3011 3320 1217 54 263 277 208 904 1175 11 728 148 5040 561 35450 8 APPENDIX B. Total number of Defects discovered during 1915. Month. Dirty Premises. Defective Drains. Defective and Dirty W.C.'s. Defective Water Supply. Smoke Nuisances. Other Matters. Total. Jan. 241 41 129 63 5 927 1,406 Feb. 218 94 49 61 — 770 1,192 Mar. 215 33 56 37 1 531 873 April 215 40 138 80 — 630 1,103 May 295 49 105 104 1 842 1,396 June 273 74 108 107 — 677 1,239 July 196 37 110 88 — 544 975 Aug. 150 25 97 39 — 437 748 Sept. 212 22 40 53 2 322 651 Oct. 272 35 137 106 2 895 1,447 Nov. 285 46 132 106 1 823 1,393 Dee. 193 33 81 71 — 647 1,025 Totals 2,765 529 1,182 915 12 8,045 13,448 9 APPENDIX C. List of Sanitary Improvements effected during the year. Cleansing— Premises, etc., cleaned, repaired or whitewashed 3,703 Workshops ditto ditto ditto 642 House Drains— Drains relaid 89 Drains amended 96 Drains cleared 245 Drains trapped and ventilated 28 Rain water pipes and waste pipes disconnected 1 Sink and bath waste pipes trapped 72 Water Closets— W.C.'s repaired, cleansed, etc 1,203 W.C.'s fitted with new pans and traps 96 W.C.'s supplied with water, and water supply apparatus 710 W.C.'s ventilated and lighted 3 W.C.'s rebuilt 3 New W.C.'s provided 64 Partitions provided round W.C.'s to separate same from workshops 14 Water Supply— Houses provided with water supply 104 House supply disconnected from W.C. cistern Cisterns, supplied, repaired or cleansed 85 Miscellaneous— Paving of yards 475 Paving of Wash-houses 75 Forecourts and Areas paved and drained 8 Stables paved and drained 2 Removal of accumulation of Dung or other refuse 83 Removal of animal improperly kept 53 New Dung-pits provided and covers for same 2 Premises closed previous to executing the necessary repairs 78 Premises demolished following the service of notices 2 Gutters, Rainwater Pipes, and Waste Pipes repaired 903 Illegal occupation of basements discontinued — Overcrowding abated 114 Urinal accommodation provided 3 Urinals supplied with water 2 Urinals cleansed and repaired 32 Grids provided to Gullies 41 Dust Shoots repaired and Receptacles provided 613 Vacant lands cleansed 1 Areas cleansed 4 Yards cleansed 182 Indecent occupation discontinued — Verminous rooms remedied 207 Dampness remedied 395 Lighting and Ventilation improved 347 Water fittings defective 113 Total 10,903 10 APPENDIX D. (1) Police Court Proceedings—Public Health (London) Act, 1891. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1915. Jan. 28 M. L Exposing for sale unsound walnuts W. Rowsell Mr. Wilberforce Fined 9s. 6d., costs l0s. 6d. Feb. 4 D. B. Exposing child suffering from Scarlet Fever in public place F. Bare „ Fined 7s. costs 23s. „ 11 C.C.&T.M. Non-compliance with notice J. G. Weeks „ Works completed. Costs 3s. „ 18 M. D. „ „ „ „ Works completed. Costs 3s. Mar. 11 W. A. „ „ „ „ Works completed. Costs 3s. „ 11 „ „ „ „ „ Works completed. Costs 3s. „ 18 E. & Co. „ „ F. Bare „ Works completed. Costs 3s. 11 Police Court Proceedings—Public Health (London) Act, 1891—continued. Date of hearing. Defendant Offence. Inspector. Magistrate. Result 1915. April 8 G. G. Depositing unsound liquid eggs for preparation for human food W. Rowsell Mr. Wilberforce. Dismissed; Magistrate of the opinion eggs deposited just prior to seizure,pending examination by proprietor. May 20 W. A. Non-compliance with notice J. G. Weeks „ Fined 10s., costs 31s. 6d. ,, 27 J. D. „ „ „ „ „ Works completed. Costs 3s. „ 27 „ „ „ „ „ „ Works completed. Costs 3s. June 10 P.J.D. „ „ E. Ainley „ Works completed. Costs 3s. July 8 A. L. Exposing infectious patient in street without precautions J. G. Weeks „ Fined 9s., costs 21s. „ 15 G. S. Non-compliance with notice E. Ainley „ Works completed. Costs 3s. 12 Police Court Proceedings—Public Health (London) Act, 1891—continued. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1915. July 22 G. S. Exposing for sale unsound mackerel J. G. Weeks Mr. Wilberforce. Fined 9s., costs 21s. Aug. 26 T. Obstructing owner in complying with notice „ „ Withdrawn, obstruction ceased. „ 26 J. Non-compliance with notice „ „ Withdrawn, nuisance abated. Sept. 9 Owner of 62, Seabright street. „ „ „ Mr. Clarke Hall Order made to abate nuisance within 14days. Costs £l 1s. „ 9 Owner of 66, Seabright street. „ „ „ „ Order made to abate nuisance within 14days. Costs £1 1s. Oct. 7 A. H. Exposing for sale unsound mutton W. Rowsell „ Fined £10, costs 42s. 13 Police Court Proceedings—Public Health (London) Act, 1891 continued. Date of hearing- Defendant. Offence. Inspector. Magistrate. Result 1915. Oct. 7 M.S. Exposing for sale unsound plums E. Ainley Mr. Clarke Hall Fined £5, costs 42s. „ 21 F. & F Non-compliance with notice E. Richards „ Closing order made. Costs 21s. Nov. 4 J.J. Wilfully exposing infectious person in a public place J. G. Weeks Mr. Wilberforce Fined 8s., costs 42s. Dec. 2 F. & F Non-compliance with notice A. S. Henley „ Works completed. Costs 3s. „ 2 H. B. „ „ F. Bare „ Works completed. Costs 4s. 14 APPENDIX D (2). Police Court Proceedings, 1915. Dairies, Cowsheds, and Milkshops Orders, 1885-1886. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result 1915. July 8 M. L. Selling milk from infected premises J. G. Weeks Mr. Wilberforce Fined 9s., costs 21s. „ 8 „ Failing to give notice of outbreak of scarlet fever at milkshop „ „ Fined 9s., costs 21s. 15 APPENDIX E (1). Sale of Food and Drugs Acts, 1875-1907. Samples taken officially and submitted for analysis during the year. Article. Total Number of Samples taken. Genuine. Adulterated or deficient. Offences other than Adulteration. Almonds, Ground 6 6 — — Ammoniated Tincture of Quinine l 1 — — Butter 133 128 5 7 Camphorated Oil 2 2 — — Cheese 1 1 — — Cocoa 4 4 — — Coffee 5 4 1 — Cream 1 1 — — Jam, Raspberry 2 2 — — Linseed, Crushed 1 1 — — Margarine 6 6 — — Marmalade 2 2 — — Milk 540 459 81 6 Milk and Water 1 1 — — Mustard 7 7 — — Olive Oil 1 1 — — Pepper 11 10 1 — Rice 3 3 — — Sago 1 1 — — Totals 728 640 88 13 Forty-two samples of milk, although genuine, were certified to be of poor quality; five further samples were deficient in fat to so slight an extent as not to warrant legal proceedings, and the vendors were therefore cautioned; the like course being adopted in three cases of deficiency of fat where the amount remaining in the counter-pan was very small. The sample sold as milk and water contained 19 per cent, of added water. 16 APPENDIX E. (2). Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1915. Jan. 28 M. D. Selling margarine purporting to be butter W. Eowsell Mr. Wilberforce Withdrawn. Conviction on other summons re same sample. ,, 28 „ Exposing for sale package of margarine unlabeled „ „ „ 28 „ Selling margarine in unmarked wrapper „ „ Fined £10, costs £1 3s. Feb. 4 E. S. Milk 5 per cent, deficient in fat Ainley „ No conviction. Costs, £1 13s. 6d. „ 11 H. F. Selling margarine as butter Hewitt „ (Fined £2 and 23s. costs. „ 11 „ Selling margarine in plain wrapper „ „ „ 11 „ Exposing for sale unlabelled bulk of margarine „ „ 17 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant, Offence. Inspector. Magistrate. Result. 1915. Feb. 18 M. B. Selling Butter containing 82i per cent, foreign fat Weeks Mr. Wilberforce Ordered to pay 23s. costs. Appeared to have been sold as received from the wholesale man. „ 18 „ ... Selling margarine in plain wrapper „ „ „ 18 „ ... Exposing for sale unlabeled bulk of margarine „ „ Mar. 11 *M. Owen 172,Globe road Selling Milk 5 per cent, deficient in fat Ainley „ Fined £2 and 23s. costs. „ 18 F. 8. Selling Milk containing 15 per cent, added water Weeks „ Fined £5 and 23s. costs. „ 18 „ Selling Milk containing 13 per cent, added water „ „ Fined £5 and 23s. costs. „ 18 M.J. Selling Milk containing 10 per cent, added water Rowsell „ Dismissed—warranty deface *Second or subsequent conviction, reported by order of the Public Health Committee. 18 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1915. Mar. 25 *J. Sheinbaum, 32, Pedley street Selling Milk containing 27 per cent, added water Rowsell Mr. Wilberforce Fined £20, including costs. Apr. 1 J. P. Selling milk containing 6 per cent, added water Bare „ Warranty defence. Withdrawn on terms.. Costs 21s „ 1 D. W. Selling milk containing 5 per cent, added water „ „ „ „ „ 8 M. B. Selling milk 15 per cent, deficient in milk fat „ „ Fined 17s. Costs 23s. „ 8 *T. C. Thomas, 42, Longfellow rd. Selling milk containing 32 per cent, added water Weeks & Rowsell „ Fined £75. Went to prison for 3 months in default of payment. „ 8 „ Impeding Inspector „ „ *Second or subsequent conviction, reported by order of the Public Health Committee. 19 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing Defendant. Offence Inspector. Magistrate. Result 1915. Apr. 8 M, T. Selling milk containing 32 per cent, added water Weeks & Rowsell Mr. Wilberforce Withdrawn on conviction of another person on same charge. „ 15 E.J. K Selling milk containing 8 per cent, added water Hewitt „ Dismissed—warranty defice „ 15 W.J. J. Selling milk 9 per cent, deficient in fat „ „ „ „ „ 15 *A. Lines, 93, Wellington row Selling milk containing 12 per cent, added water Weeks „ Fines £7 14s.; costs £2 6s. Defendant raised warranty defence. „ 15 „ Impeding Inspector „ „ „ 22 J. P. Selling milk containing 7 per cent, added water W. Rowsell „ Dismissed—warranty defice „ 22 J. P. Delivering under contract milk containing 5½ per cent, added water „ „ „ * Second or subsequent conviction reported by order of the Public Health Committee. 20 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1915. May 6 D. T. ... Selling milk containing 5 per cent, of added water W. Rowsell Mr. Wilberforce Dismissed. Warranty defence. „ 6 S. P. ... Selling milk containing 5½ per cent, added water Ainley „ Fined 9s. and 23s. costs. „ 6 I. V. Selling milk 8 per cent, deficient in fat Hewitt „ Fined £2 and 23s. costs. „ 6 J.J. ... Selling milk 8 per centdeficient in fat „ „ Dismissed. Warranty defence. May 27 T. F, Selling Milk 11 per cent, deficient in milk fat Bare „ Fined £1 18s.and 23s. costs. „ 27 *J. Sheinbaum, 32, Pedley st. Selling Milk 8 per cent, deficient in milk fat „ „ Fined £30, including costs. June 3 *E. W.Morgan, 184, Hackney road. Selling butter containing 47 per cent, of foreign fat W. Rowsell „ Fined £20 and 21s. costs. *Second or subsequent conviction, reported by order of the Public Health Committee 21 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence Inspector. Magistrate Result. 1915. June 3 E. W. M. Selling margarine in plain wrapper W. Rowsell Mr. Wilberforce Withdrawn; conviction on other summons. June 10 W.J. Selling milk containing 12 per cent, of added water „ „ Fined 19s. and 21s. June 3 *1. Cohen, 19, Cambridge rd. Selling pepper containing 60 per cent, of rice „ „ Fined £5, including costs. June 17 *F. Champness, 64, Squirries street Selling milk 6½ per cent, deficient in milk fat „ „ Costs £2 2s. „ 17 A. W. Selling milk 8 per cent, deficient in milk fat „ „ Dismissed. Warranty defence. July 1 S. D. Selling milk 7 per cent, deficient in fat E. Ainley Mr. Clarke Hall No conviction; 12s. 6d. costs. *Second or subsequent conviction, reported by order of the Public Health Committee. 22 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1915. July 1 *A. J. Parfree, 2 3,Quinns buildings Selling milk 16 per cent, deficient in fat E. Ainley Mr. Clarke Hall Fined £2, including costs. „ 1 H. S. Selling milk containing 6 per cent, added water „ „ Fined 30s., including costs. 1 *C. Bennett 118, Sewardstone rd. Selling milk containing 7 per cent, added water „ „ Fined £l, including costs. „ 1 P. S. Selling milk 9 per cent, deficient in fat F. Bare „ Fined 30s., including costs. „ 1 I. L. Selling milk 32 per cent, deficient in fat „ „ Fined £3, including costs. „ 1 L. F. Selling milk 13 per cent, deficient in fat „ „ Dismissed. Warranty defence. *Second or subsequent convictions, reported by order of the Public Health Committee. 23 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1915. July 1 H. B. B. Selling milk 10 per cent, deficient in fat F. Bare Mr. Clarke Hall Dismissed. Warranty defence. July 8 E.J. Selling milk 23 per cent, deficient in fat „ Mr. Wilberforce „ „ „ 8 J.J. Do. do. „ „ „ „ „ 8 I. M. Selling milk 8 per cent, deficient in fat „ „ „ „ „ 8 S. S. Selling milk 6 per cent, deficient in fat „ „ Fined 19s., costs 21s. „ 8 A. L. Selling milk containing 17 per cent, added water W. Eowsell „ Dismissed. Warranty defence. „ 8 „ Selling milk containing 13 per cent added water „ „ „ „ July 15 J. L. Selling milk 24 per cent, deficient in fat J. G. Weeks „ Fined 18s., costs 23s. 24 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1915. July 15 W. A. Selling milk 14 per cent, deficient in fat J. Hewitt Mr. Wilberforce Fined 9s., costs 21s. „ 15 *R. Kitzberg, 24, Newling street Selling milk 7 per cent, deficient in fat „ „ „ July 22 D. J. W. Selling milk 9 per cent, deficient in fat W. Eowsell „ Dismissed. Warranty defence. July 29 F. C. Selling milk containing 6 per cent, added water J. G. Weeks „ Costs £2. „ 29 *L. Galinsky, 57, Old Bethnal Green id. Selling milk 5 per cent, deficient in fat W. Rowsell „ Costs 21s. 29 H. G. U. Selling milk 23 per cent, deficient in fat „ „ Fined 19s., costs 21s. *Second or subsequent conviction, reported by order of the Public Health Committee, 25 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1915. July 29 E. G. Selling milk 15 per cent, deficient in fat W. Rowsell Mr. Wilberforce Dismissed. Warranty defence. „ 29 D. S. C. Do. do. „ „ „ „ August 5 T.J.P. Selling milk 16 per cent, deficient in fat A. S. Henley „ „ „ „ 5 J. P. Do. do. J. G. Weeks „ „ „ August 26 S. P. Selling milk 18 per cent, deficient in fat J. H. Hewitt „ Fined 9s., costs 21s. „ 26 W.E. Selling milk containing 1½ grains of dirt per pint J. G. Weeks „ Costs 21s. „ 26 „ Selling milk containing 3½ grains of dirt per pint „ „ „ Sept. 2 J. s. Selling milk containing 56 per cent, added water. A. S. Henley „ Withdrawn. Wholesale dealer convicted. 26 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing Defendant. Offence. Inspector. Magistrate. Result. 1915. Sept. 2 *Jenkin Parry, 68, Green street. Selling milk containing 18 per cent, added water (sample 441). A. S. Henley Mr. Wilberforce Fined £50 on each sample Nos. 441 and 445. Total fines, £100. „ 2 „ Selling milk containing 13½ per cent, added water (sample 445). „ „ „ 2 „ Selling milk containing 14 per cent, added water (sample 446). „ „ „ 2 „ Selling milk containing 13½ per cent added water (sample 447). „ „ Sept. 30 I. F. Name and address not inscribed on milk vehicle J. G. Weeks Mr. Leycester Fined 10s., costs 21s. „ 30 *John Jones trading as Jones Bros. 23, Ezra st. Refusal to serve Inspector. „ „ Fined 10s., costs 21s. *Second or subsequent conviction, reported by order of the Public Health Committee. 27 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1915. Sept. 30 R. Selling milk 27 per cent. deficient in fat. E. Ainley Mr. Leycester Fined 10s., ccsts 21s. „ 30 A. L. Selling milk containing 15 per cent. of added water. J. G. Weeks „ Dismissed Warranty de fence. Oct. 14 „ Selling milk containing 9½ per cent. of added water. „ Mr. Wilberforce. Dismissed on a variation between results obtained by Public Analyst and Somerset House Analysts. „ 14 „ Selling milk containing 8 per cent. of added water „ „ „ 14 „ Selling milk containing 22 per cent. of added water. „ „ „ 14 „ Selling milk containing 13 per cent. of added water. „ „ 28 Police Court Proceedings—Sale of Food and Drugs Acts, 1875-1907. Date of hearing. Defendant. Offence. Inspector. Magistrate. Result. 1915. Dec. 9 W. T. H. Selling butter containing 52 per cent. of foreign fat. J. H. Hewit??? Mr. Wilberforce. Fined £3 17s., costs £1 3s. „ 9 „ Selling margarine in plain wrapper. „ „ Withdrawn. Conviction on other summons re the same sample. „ 9 *E.W.Morgan, 184, Hackney road. Selling butter containing 85 per cent. of foreign fat. W. Rowsell „ Fined £50. „ 9 „ Selling margarine in plain wrapper. „ „ Withdrawn. Conviction on other summons re same sample. *Second or subsequent conviction, reported by order of the Public Health Committee, 29 It will be observed that during April in eight cases reported advantage was taken by the defendant of the provisions of the Sale of Food and Drugs Acts relating to warranties. In six cases this defence availed to secure acquittal and it was only owing to exceptional evidence plus the bad record of the defendant in the remaining two cases, that in all these instances the defence was not successful. In four of the cases referred to (and in one further case in the next month) the warranties were granted by one leading Company, and the Magistrate remarked that the number of warranty defences set up in that Court on warranties given by this Company during the time he had presided there was approaching a public scandal. The following paragraph appeared in the Press in reference to a case above reported :— After having been fined £75 at Old Street last week for selling adulterated milk, the case of Thomas E. Thomas, a milk dealer, of Longfellow Road, Bow, yesterday again came before, the magistrate on the return of a distress warrant marked "No goods." Defendant now asked for further time to find the amount of the penalty.—It was mentioned that since the fine of £75 was imposed defendant had been prosecuted for a further similar offence, and another fine of £10 was standing against him. There were also many previous convictions, and since 1907 defendant had paid £180 in penalties for offences under the Milk Act. Now he said he was ruined, though he asked for more time. Mr. Wilberforce thought not. He had no goods, and there were other matters impending. The alternative to payment was 30 three months' imprisonment. He committed Thomas forthwith for that term unless the money was paid during the imprisonment.—Thomas was removed in custody. The following is a summary of legal proceedings, etc., in connection with samples taken for analysis:— No. of Adulterated Samples. Other Offences. No. of Summonses Issued and Cases Pending at 31st Dec., 1914. No. of Convictions or Costs Obtained. No of Cases Dismissed. No of Summonses Withdrawn. No. of Cases Pending at 31st Dec., 1915. 88 13 84 46 27 9 2 Twenty-one cases were dismissed upon successful "warranty" defences. In four further cases, the complaint was dismissed on a variation between the result of analysis of milk by the Public Analyst and the analyst at Somerset House—which was not surprising in view of the fact that the first analyses were made when the milk was sweet and the second analyses when the samples were sour and extremely decomposed, and the result had to be amended or completed by calculation. In two cases complaints were dismissed that notice of adulteration was given at the time of purchase. In seven of the cases withdrawn a conviction was obtained on another summons in respect of the same sample. In two cases notice of warranty resulted in withdrawal upon terms—costs being paid by the defendants. 31 APPENDIX E. (3). Foods and Drugs. Table showing percentage Adulteration for Decennial period 1905-1914, compared with 1915. Year. No. of Samples taken. No. of Samples Adulterated. Percentage of Adulterated Samples. 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 1912 632 57 9.0 1913 710 83 11.7 1914 739 55 7.4 Decennial average percentage adulteration 9.8 1915 728 88 12.1 32 Samples taken on Delivery. The undermentioned samples were taken on delivery from wholesale firms delivering goods to retail tradesmen, and from smaller traders delivering to consumers, throughout the Borough:— Article. No. of Samples Taken. Genuine. Adulterated. Milk 44 30 14 Butter 1 1 — Pepper 1 1 — Mustard 1 2 — APPENDIX E (4). Summary of samples taken informally and submitted to the Public Analyst during 1915:— Article. No. of Samples. Genuine. Adulterated or deficient in vital constituent. Other offences. Milk 9 9 — — Butter 33 26 7 5 Margarine 22 22 — 2 Totals 64 57 7 7 33 APPENDIX E. (5). Summary of samples analysed in the Laboratory at the Town Hall, Bethnal Green, during 1915:— Article. No. of Samples. Genuine. Adulterated or deficient in vital constituent or preservatised. Of low quality. Almonds, Ground 1 1 — — Butter 69 47 22 — Cheese 1 1 — — Cottonseed Oil 1 1 — — Cream 2 2 — — Margarine 1 1 — — Milk 71 32 23 16 Mustard 1 1 — — Pepper 7 6 1 — Saffron 1 1 — — Totals 155 93 46 16 APPENDIX E. (6). REPORT OF THE CHIEF SANITARY INSPECTOR. THE ADULTERATED MILK SUPPLY. Notes on some recent cases. Gentlemen, The question of adulterated milk and of the almost endless technical defences possible to protect the vendors of the same has been brought before the notice of 34 your Committee on various occasions, and more particularly in respect of what is known as "milk warranty defences." At the risk of some repetition, and even of weariness, I am venturing, in this month's report, to once again direct attention to a few of the more special cases which have occurred in our recent experience, and which cases will, I venture to think, throw some additional light on the increased cost and difficulties of administration, as well as the amount of fraudulent trading possible, and the difficulties experienced in securing convictions under our illusory and inefficient "Sale of Food and Drugs Acts." MANUFACTURING A WARRANTY DEFENCE. Milk Sample No. 559.—Although a small case in itself, is important as throwing some light on the way in which these warranty defences have been arranged. This sample was purchased by an agent of Inspector Ainley in the ordinary way, and found upon analysis to be 27 per cent, deficient in fat or cream. The retail shopkeeper being, in all probability, the innocent victim of other people's delinquencies. When the case was heard at the Court the defendant was asked from whom the milk was purchased. He replied "from F. C. . . " and innocently added that, when he informed his wholesaler that the Inspector had taken a sample, he said, "Did you tell the Inspector that you hadn't got a warranty?" On the vendor replying in the affirmative, he said, "Oh, that is a pity, because if you hadn't said anything to them about it, I could have given you a warranty, which would have got you out of this all right." 35 REFUSAL TO SERVE. The next case is one in which a dairyman, whose proceedings had been under observation by Mr. Weeks and his assistant Saunders in the very early mornings of several days, point blank refused to serve a sample of milk for analysis on the same being demanded. He had been seen serving this self-same milk to various customers from the vessel from which the sample of milk was required, but, for reasons best known to himself, the tradesman refused to serve the officer. This transaction throws a further interesting light on the efficiency of the Act regarded as a means for the protection of the public. The maximum penalty for refusing to serve is only £10, which sum cannot be increased, and as the dairyman had the following proceedings already standing to his credit, it is quite easy to see that, for him to pay £10 for refusing to serve an official sample was, in face of his past record, not only a wise thing to do, but presumably a good investment. The following table gives this man's record within fairly recent years. 36 Date. Court. Offence Magistrate. Result. 8/1/07 Old Street Milk, 7 per cent. deficient in milk-fat or cream Mr. Cluer Fined £2, including costs 16/6/08 " Margarine in plain wrapper " Fined £3, including costs " " Butter, 89 per cent. foreign fat " Withdrawn. Conviction on previous summons 29/6/09 " Milk, 24 per cent. deficient in tat " Fined £10 10s., including costs 3/5/10 " Butter, 47 per cent. foreign fat " Fined £15, including costs " " Selling margarine in plain wrapper " Withdrawn. Conviction on other summons 3/4/13 " Milk, 5 per cent. added water Mr. Chester Jones Dismissed on warranty defence 13-5/15 " Milk, 8 per cent. deficient in fat Mr. Wilberforce " " 8/7/15 " Milk, 23 per cent. deficient in fat " " " 37 Milk Samples 367 to 372.—The next case, relating to milk samples Nos. 367, 368, 369, 370, 371 and 372, all purchased from one vendor, is of interest as showing not only the varying standards of milk that can be found in the possession of one tradesman, but, incidentally, the interesting and varied stories that can be set up by and on behalf of such an ingenious dairyman. Observation was kept on this tradesman on many occasions in the very early morning by Inspectors Weeks, Rowsell and the Assistant, Saunders. He was seen to manipulate his milk in various ways, and on the morning in question, having delivered the same to a large number of customers, Mr. Weeks and the other officers proceeded to take their first official sample by sending a boy to his barrow to purchase a 1d. of milk. The boy, not being old enough to be suspected of being an Inspector's agent, was, without question, served with what purported to be a 1d. of milk. Mr. Weeks then emerged into view, and proceeded to demand a 1d. of milk from another vessel on the barrow. The vendor, to counter this, promptly replied, "Oh, that is milk and water." Mr. Weeks replied, "Very well; I will have a 1d." Having completed that purchase, Mr. Weeks subsequently demanded a 1d. from another handcan on the barrow, to which the same reply is made, "That is milk and water." Mr. Weeks also purchased a second sample of what was offered to him—a wellknown officer—as milk and water, but which was being sold to the general public as milk. Mr. Weeks then proceeded to divide up all his samples in the ordinary way. Later, the officers kept observation and saw this 38 enterprising tradesman empty the contents of the two vessels, which he had declared to them to be milk and water, into the churn which he had previously stated was milk, and then proceed to serve the resultant mixture in small cans left on the doors of his various customers. About noon on the same day Mr. Weeks again met this dairyman in another part of the borough, and then and there proceeded to demand samples Nos. 370, 371 and 372. Mr. Weeks divided these up, and submitted them to the analyst in the ordinary way. We now arrive at the point where six samples of milk have been taken from this dairyman in one day within the space of some six or seven hours. Prior to this, Mr. Weeks and the officers assisting him had ascertained by observation kept in the early morning that all the milk in this Vendor's possession had been received by him from one delivery by his wholesale man. The Analyst's certificates are as follows :— Milk No. 367 ... 13 per cent. of water beyond that present in Genuine Milk. ,, ,, 368 ... 9½ per cent. of added water. ,, ,, 369 ... 22 per cent. of water beyond that present in Genuine Milk. ,, ,, 370 ... 8 per cent. of added water. „ ,, 371 ... Genuine. ,, ,, 372 ... Genuine. The next interesting point which should be borne in mind throughout all these various transactions is that the tradesman is purporting to be a dairyman selling milk to the public, and no customer of his has yet been discovered who had any impression that they were purchasing anything but legitimate and genuine milk. The 39 humour of all this is emphasised by the fact that, on the defendant's vehicles and vessels are the words:—"Special Milk for Infants and Invalids" and "Nursery Milk." In the exercise of my discretion, I, on the receipt of the certificates from the Public Analyst, judged it necessary to issue summonses in respect of all the adulterated samples, knowing that probably a defence would be set up on his behalf in respect of Nos. 367 and 369 to the effect that, as he had declared to Mr. Weeks that these samples were "Milk and Water" a sufficient notice had been given in accordance with the Act, and that he could not, therefore, be convicted in respect of these. The point of importance here for the public is that, although a large number of customers are seen to be served with this mixture, no notice whatever is given to the general customers, but that a notice given to the officer who defendant knows perfectly well is there for the purpose of enforcing the Act, saves him from being convicted whilst permitting the public to be defrauded. On the summons being returnable, the defence, as I had already anticipated, was set up in respect of these two samples, and with regard to the two other adulterated samples, an application was made to the Court that they should be sent to Somerset House for analysis and report—the two genuine ones to be included. At this time the Counsel contended that all four of these samples came out of one churn, and if two were genuine Mr. Stokes had made a serious mistake. The result of the Government report disclosed, as to two of them, that there was unfortunately a technical difference 40 tween their analyses and the original analyses of the Public Analyst. The difference in question largely arising from the fact that the Public Analyst examined the milk when in a fresh and sweet state, and that it did not arrive at the Government Laboratory until many days after, when, of course, it was in a sour and decomposing condition, rendering an accurate analysis more difficult. With regard to the two samples sold as milk and water, and in respect to which the results of the Public Analyst were not at first challenged, it is interesting to note that, in order to overcome the difficulties of the Government report and to give some sort of countenance to the story there was, according to Counsel's own statement made in Court, at the adjourned hearing a professional Analyst prepared to swear that the added water referred to could only have been present as one of the resultant causes of the defendant having scalded this particular milk. Any comment of mine would, of course, detract from the beauty of such an interesting theory. In the result, the defendant escaped conviction on account of these technicalities, but it should be pointed out that, even on the showing of the Somerset House certificates, here was milk being sold to the public "15 per cent. deficient in cream" in one case, and in the other case" not less than 4 per cent. deficient in cream" and with "not less than 1 per cent. of added water." The defendant's record is as follows, so far as police-court proceedings are concerned:— 41 Date. Court. Offence. Magistrate. Result. 10/5/04 Worship street Milk 46 per cent. deficient in milk-fat Mr. Cluer Fined £10 8/1/07 Old Street Milk 7 per cent. deficient in milk-fat " Fined £2 26/6/13 " " " Mr. Chester Jones Dismissed on warranty defence 23/10/13 " Milk 84 per cent. added water " Withdrawn; Council paying defendant 1½ guineas costs 15/4/15 " Milk 12 per cent. added water Mr. Wilberforce Fined £5. Magistrate refused to accept warranty in view of contradictory statements made by defendant " " Obstructing Inspector by upsetting milk over him " Fined £5 8/7/15 " Milk 17 per cent. added water " Dismissed on warranty defence " " Milk 13 per cent. added water " " " 42 Milk Samples Nos. 388, 389, 394 and 395 afford another interesting illustration of how the milk supply of this Borough is manipulated. On a given date, Inspector Weeks, assisted by the officers already mentioned, waited for and took samples from churns of milk being supplied to the same dairyman as above by his wholesale man. Previous observation kept on the dairyman satisfied the officers that he had no milk supply other than the delivery just mentioned. Later, when on his milk round, he was stopped by the officers and samples of milk demanded. The analyses of these milks side by side with those samples previously taken from his wholesale supply show that, whilst the wholesale people are delivering to him milk of unusually good quality (above the standard for both fatty and non-fatty solids) the defendant has in the interval so manipulated the milk before delivering it to his customers that it has a difference in both fatty and non-fatty solids. It had, in fact, been impoverished to the extent of close upon 10 per cent. of its butter-fat or cream, or to the extent of some 3 per cent. or 4 per cent. of added water. It is likely that he may have added a certain proportion of skimmed milk or a certain amount of water to the milk as delivered by the wholesaler, and which this ingenious tradesman evidently thought too rich to be served to the poor people of Bethnal Green. In face of all these facts, known quite well to the members of your Committee and to the officers of the Department, this man, and tradesmen of a like calibre can, with the assistance of Counsel, come into Court and coolly plead warranties and take advantage of other 43 technicalities, and so escape conviction. The point once for all is that such a class of tradesman ought not to be allowed to be in any trade supplying milk or other food to the public. Some machinery should be devised for their removal to some other sphere where their mischievous and anti-social tendencies may be restricted. Milk Samples Nos. 441 to 447.—Other cases of a similar interesting character are those of milk samples Nos. 441, 445, 446 and 447. In these cases Inspector Henley, assisted by Inspector Weeks and the Assistant Saunders, kept daily observation on another of these worthy tradesmen, and in due course and at different points of the district took the samples just referred to. These samples are certified by the Public Analyst to consist of 18 per cent., 13½ per cent., 14 per cent., and 13 per cent. of added water respectively. Another sample of milk left by this same dairyman at the shop of a small retail trader was found to be adulterated with 56 per cent. of added water, although purporting to be milk. As in the previous cases, this dairyman's customers had no knowledge whatever that they were purchasing anything but milk, and they were considerably surprised at the result of our intervention. A further interesting item in relation to this last series of cases is the notice displayed bv a tradesman in his shop to meet the legal requirements of the Food and Drugs Act, and which permits him to sell to the public with more or less impunity, milk of the character above described. 44 In the exercise of my judgment, I again issued summonses in respect of all the samples taken, judging it better that, although I may not be able to secure convictions, I should be able at least to expose the character of the business being carried on in the district, and it is so far satisfactory to be able to add that, on two of the summonses issued the defendant was—in spite of warranty defences and the assistance of a most able Counsel on any other of the various technicalities open to him— convicted on two of the summonses in the sum of £50 each. 45 His previous record is as follows:— Date. Court. Offence. Magistrate. Result. 26/7/04 Worship Street Milk 11 per cent. added water Mr. Cotser Withdrawn on warranty defence 22/6/05 Old Street Milk 17 per cent. deficient in milk-fat Mr. Cluer Fined £2 to include costs 27/9/06 " Milk 12 per cent. added water Mr. Biron Withdrawn; warranty defence 8/1/07 " Milk 14 per cent. deficient in milk-fat Mr. Cluer Fined £4 to include costs 16/3/09 – Selling margarine as butter — Fined £4 and 23s. costs 15/8/11 Old Street Milk 8 per cent. added water Mr. Chester Jones Fined £3 and 23s. costs 16/5/12 " 1. Milk 7 per cent. deficient in milk-fat Mr. Biron Fined £5 and 63s. costs 2. Milk 8 per cent. deficient in milk-fat 3. Milk 11 per cent. deficient in milk-fat 15/7/12 – Milk 17 parts of added water – Warranty defence; adjourned sine die 22/4/15 Old Street Milk 7 per cent. added water Mr. Wilberforce Warranty defence; dismissed 22/4/15 " Milk 5½ per cent. added water " " " 46 It is perhaps unnecessary for me to add that Mr. Margetts did everything possible to put these various technical matters before the Court from the public interest point of view. The learned Magistrate, after a most exhaustive hearing, refused an application for costs against us, informing Counsel that he had not expressed his opinion of the morality of the transactions which had been proved before him. John Foot. 18th October, 1915. BUTTER SAMPLES. With regard to certain butter cases recently in hand, it may be of interest to add that, with a view to ascertaining to what extent the people of the East End of London are having margarine supplied to them at butter prices, I have, at some considerable trouble, made enquiry and find that, whilst in certain instances our people were being supplied with margarine, under the pretence of its being butter, at 1s. 2d. per lb., it was possible in districts as far apart as Leyton and Lewisham, Hammersmith and Barking, to purchase butter at 1s. 2d. per lb. This in addition to several samples of genuine butter purchased in our own Borough at the same price. Although the point usually set up in these butter cases is that one cannot expect pure butter at such and such a price, I wish to point out that this really has nothing whatever to do with the matter. The essential point is that the most careful enquiry made in the various markets and purchases made do not disclose anything which justifies a common brand of margarine 47 being supplied to the poor people of the East End of London at 1s. and 1s. 2d. per lb. Moreover, as in each case "butter" was demanded by the purchaser, and the vendor sold what purported to be the article asked for, and with no margarine wrapper or other notice to the customer, it must be presumed that the tradesmen were deliberately carrying on this class of trading because of the large profit attached thereto. In any case butter was demanded and margarine substituted without notice, and to show that these transactions were not merely accidental, it may be added that the analyses of several purchases made by ordinary customers gave similar results, i.e., "butter" consisting of only 2 per cent. of butter fat. Of 13 purchases made at one shop purporting to be "butter" at 1s. 2d. per lb., six consisted of margarine, with only 2 per cent. or less of butter fat. From the columns of the trade journals and assistance received from a few of the more reputable traders, it appears that the best brand margarine, or what are termed "Fancy Margarines," are supplied at about 84s. per cet., which works out at 9d. per lb. The retail price of these best brands being generally about 1s. per 1b., a gross profit of 33½ per cent. on the initial outlay is shown. The usual standard of profit in the provision trade, being, as I am informed, about 12½ per cent., it can at once be seen that the profit on this line is much larger than the profit usually obtained for provisions generally. Many firms, in fact, seem to recognise that 1s. per lb. shows too large a profit by giving away cakes with such two lbs. of margarine, while others reduce the price to 11d., 10½d., and 10d. per lb. net. 48 With regard to the more ordinary brands of margarine, a quotation from the trade journals and from one of London's leading wholesale provision dealers shows that the margarine usually sold at 6d. per lb. is charged to the retailer at 52s. to 54s. per cwt., from which there would appear to be a gross profit of about 5½ per cent. on the cost price. Assuming, as one may very well do from the experience of numerous purchases, that the larger proportion of these margarines are sold at say 8d. per lb., the gross profit on cost price would, of course, be increased to 41 per cent. As the samples of margarine, the subject of the above proceedings, were sold at 1s. 2d. per lb., it can at once be seen to what an extent the working classes and poorer persons living in East End districts are imposed upon by what appears to be a somewhat unscrupulous form of retailing margarine containing only some 2 per cent of butter-fat at what are really butter prices. John Foot. November, 1915. 49 APPENDIX F. Report of Administration in connection with the Public Health (Milk and Cream) Regulations, 1912. 1. Milk and Cream not sold as Preserved Cream. 540 samples of milk taken in the course of sampling under the provisions of the Sale of Food and Drugs Acts, and one sample of cream were examined for prevervatives, but proved to be free from such admixture. 2. Cream sold as Preserved Cream. No contravention of the provisions of the Regulations relating to the sale of Preserved Cream were detected. 3. Thickening Substances. In no case was evidence discovered of the addition of any thickening substance to cream or preserved cream. APPENDIX G. Particulars relating to Unsound Food for 1915. Surrendered. Cwts. Qrs. St. Lb. Fish 5 — — 5 Meat 3 2 — 7 Fruit 1 — 1 3 Potatoes 56 — — — Total Surrendered 65 3 — 1 Also 5 cases of Eggs. 5 pecks Whelk6 and Winkles. Bullock's Head and Lung. 5 bundles Mandarins and 3 dozen Bananas. 50 Seized. Cwts. Qrs. St. Lb. Fish — — — 4 Meat — 2 — 7 Fruit — — 1 11 Total Seized — 3 — 8 Cwts. Qrs. St. Lb. Grand Total Weight 66 2 0 9 APPENDIX H (1). Premises where Food is Prepared for Sale. Technical Status. No. of premises on Register at end of 1915 11 Factories. 222 Workplaces. Do. removed from Register ... — Factories. 3 Workplaces. Do. added to Register 1 Factories. 17 Workplaces. No. of Inspections made 25 Factories. 1175 Workplaces No. of Notices Served 3 Factories. 83 Workplaces. No. of Prosecutions — Factories. — Workplaces. APPENDIX H (2). Particulars relating to Ice Cream Shops. No. on Register at end of 1915 110 No. removed from Register 10 No. added to Register 4 No. of Inspections made 263 No. of Notices Served 33 51 APPENDIX I. Particulars relating to Bakehouses. No. of Bakehouses on Register at end of 1914 89 Do. do. do. 1915 85 Do. above ground 57 Do. underground 28 No. of Inspections made 307 No. of Notices Served 44 No. of Prosecutions — APPENDIX J. (1). Outworkers. Year. No. of Lists received from Employers. No. of Outworkers comprised therein. Reported from other Boroughs. Reported to other Boroughs. 1914 197 2,995 2,763 1,510 1915 217 3,318 3,164 1,622 Number of Outworkers dealt with in 1914 5,758 „ „ „ 1915 6,482 52 APPENDIX J (2) Outworkers List of Trades. Artificial Flower Making 14 Belt Making 17 Blouse Making 65 Bone Needle Making 2 Boot and Shoe Making 385 Box and Match Box Making 478 Brace Making 7 Brush Making 196 Clothing 193 Collar and Shirt Making 34 Corset Making 2 Embroiderers 13 Feather Workers 20 Furriers 12 Furniture, Ac. Making 4 Glove Making 1 Haberdashery 3 Hat and Cap Making 11 Haversacks, &c. 27 Leather Work (Fancy) 5 Mantles, Costumes, &c. 64 Milliners 22 Paper Bag Making 15 Polishing 6 Pyjama Making 2 Stick Making Tailoring 756 Tie Making 33 Trimming (fancy) 82 Umbrella Making 63 Underclothing Making 18 Upholsterer's Trimmings 26 Waterproof Making Weaving 5T Unknown 92 Discontinued work 215 2,944 APPENDIX K. Houses Let in Lodgings. Number of Houses Let in Lodgings on Register at end of 1915 280 Number of Houses Let in Lodgings cancelled during 1915 17 Number of Houses Let in Lodgings registered during 1915 2 Number of Inspections made 1,217 Number of rooms overcrowded 6 Number of cellars illegally occupied 2 Cases of indecent occupation — Notices served 404 Registration notices written and served 2 53 APPENDIX L. House-to-House Inspections. Number of inspections 852 Number of notices served 391 Cases of overcrowding remedied during 1915 114 Number of defects discovered and remedied 1,713 APPENDIX M. Verminous School Children. 1910. 1911. 1912. 1913. 1914. 1915 Number of complaints received 252 329 974 928 804 977 do. inspections and reinspections made 289 358 991 1,742 1,090 1,250 do. premises found to be verminous 46 16 82 54 62 4 do. defects discovered 334 317 1,116 1,401 621 27 do. notices served 206 152 211 466 324 26 do. prosecutions — — — 1 — — 54 APPENDIX N (1). Rooms and Bedding disinfected during the Year ending 31st Dee., 1915. Month. Scarlet Fever. Diphtheria. Tuberculosis. Scabies. Enteric and Thy phoid. Fever. Cancer. Small Pox, Try sipelas. Measles. Puerperal Fever. Verminous Premies. By Request. Anthrax. Cerebro-Spinal Fever. Chicken Pox. Lupus. Schools. Total. No. of Articles Disinfected at Station. January 46 40 7 8 4 l l 1 2 2 — — — — — — — 112 4088 February 58 46 8 2 1 — (Case returned not S.P.) 2 — — 5 7 2 — — — — 131 4853 March 58 40 7 7 2 — — 2 — 2 1 — l — — 120 2821 April 39 30 13 7 1 — — 2 — 5 3 — 5 — — — 105 2979 May 41 25 10 6 2 — — — — 17 3 — 2 1 — — 107 2400 June 55 24 16 17 2 — — 2 — 21 — — 4 — — — 141 2225 July 69 39 8 3 2 — — — — 13 3 — — 1 1 — 139 2242 August 105 51 27 5 — — — — 1 26 — — 1 — — __ 216 2510 September 144 53 10 2 — — — — — 2 2 — 3 — — 2 218 3686 October 83 65 15 7 — — — — — 5 3 — 1 — — — 179 3182 November 75 60 14 — — — — — — 3 8 — 1 — — — 161 2542 December 37 54 13 9 — — — — 1 1 9 — — — — — 124 1813 Totals 810 527 148 73 14 1 1 3 8 4 100 39 2 18 2 1 2 1753 35341 Rooms disinfected during 1915, 1753. Articles of Bedding destroyed, 76. Articles disinfected in Formalin Chamber, such as Boots and fancy Materials, 3937. 18 men had a bath and clothes disinfected at Station. Wards disinfected at the Military Hospital, 11 Palliasses. Pillows and Bolsters disinfected at the Military Hospital, 123. Army Clothing Disinfected, Coats, Trousers, Belts, Water Bottle Covers, &c . from the R.E. (T.F.) Depot, Victoria Park Square, 1389. 55 APPENDIX N (2). DISINFECTANTS. Forty casks of Sanitas Powder, making up 2,800 packets, have been distributed from the Public Health Department. Nine hundred and sixty pint bottles of Sanitas Fluid and six hundred and forty pint tins of Izal Fluid have also been distributed. Three-quarters of a ton of sulphur candles were used in the disinfection of rooms throughout the year. Five gallons of Formalin Solution (40 per cent.) have been used in spraying the walls of rooms, and five pounds of Formalin Tablets have been used for fumigating articles in the Formalin Chamber. Fifteen gallons of Creocide were also used for disinfecting purposes. APPENDIX O. SMOKE NUISANCE OBSERVATION. Number of shafts under observation 59 Number of observations made 100 Number of hours occupied in observation 50 Number of intimation notices served 3 Number of statutory notices served 2 Number of prosecutions — 56 APPENDIX P. Mortuary Returns, 1915. Bodies removed to Mortuary— On Coroner's Order 189 By Police 17 From London Hospital 5 On Sanitary Inspector's Order 3 By Request of Relatives 56 Total 270 Number of Inquests held 203 Number of Post Mortem Examinations made 99 Particulars of Bodies on which Inquests were held— Bodies removed by Police from Canal 4 Do. do. Street 8 Do. do. Great Eastern Railway. 4 Do. do. found in Parcels 1 Bodies received from Bethnal Green Infirmary 30 Do. do. Bethnal House Asylum 1 Do. do. Queen's Hospital 18 Do. do. Mildmay Mission Hospital 8 Do. do. Victoria Park Hospital 2 Do. do. Private Houses, etc. 127 Total 203 Inquest cases according to age periods— Number under one year 47 Number over one year and under five years 18 Do. five do. ten do 15 Do. ten do. twenty years 6 Do. twenty do. thirty do. 6 Do. thirty do. forty do. 13 Do. forty do. fifty do. 22 Do. fifty do. sixty do. 29 Do. sixty do. seventy do. 25 Do. seventy do. eighty do. 18 Do. eighty years 4 203 57 Causes of Death in Inquest case8— Natural Causes 116 Accidental Deaths— Burns 9 Breaking of an Emery Wheel 1 Drowned 2 Falls 20 Run over in street, etc., by Motor Bus 6 14 „ Van 2 ,, on Railway 5 „ by Horse Brake 1 Knocked down by Tram Car 2 Scalds 1 Strangulation 1 Suffocation whilst in Bed 7 „ by Food 2 Accelerated by Destitution 1 Alcoholic Cirrhosis 1 Death while under Chloroform 1 Found Drowned 1 Ptomaine Poisoning 2 Septicaemia 4 Want of Attention at Birth 6 Suicide— Cut Throat 1 12 Gas Poisoning 2 Hanging 4 Poisoning 3 Revolver Shot 1 Self Strangulation 1 Total 203 Bodies received under Public Health (London) Act— Diphtheria 3 Cerebro-Spinal Meningitis 3 Erysipelas 1 Measles 4 11 58 APPENDIX Q. Inspection of certain places subject to Special Bye-laws and Regulations. PREMISES. No. of Premises. No. of Inspections. No. of Notices. No. of Prosecutions. On Register at end of 1914. Added in 1915. Removed in 1915. On Register at end of 1915. Milkshops 246 8 15 230 761 86 2 Cow-houses 14 — — 14 70 2 — Slaughter-houses 4 — — 4 27 — — Other Offensive Trade Premises 1 — — 1 5 — — 59 APPENDIX R. Clerical Work. Intimation Notices written and served, Public Health Act 3,932 Statutory Notices written and served, Public Health Act 3,106 Entries in Nuisance Register 6,863 „ Tenement House Register 1,625 „ Food and Drugs Register 795 ,, Workshops Register 5,801 Notices respecting Combined Drainage 23 Final Notices prepared and served 1,042 Letters written 2,810 Instructions to Solicitor prepared 82 Summonses prepared (4 copies each) 119 School Notifications prepared and despatched 2,402 Notices to District Surveyor 66 * Measles and Chicken Pox ceased to be notified to schools during the latter part of the year. 60 APPENDIX S. RAG FLOCK ACT, 1911. Eight samples of rag flock were taken during the year. In two cases the standard of cleanliness required by the Regulations was infringed. Matters were speedily remedied upon the facts being brought to the notice of the dealer. The position with regard to the question of the cleanliness of stuffing materials used in the manufacture of bedding still remains in a very unsatisfactory condition from every point of view, e.g. (1) A proper definition of what is "rag flock" has never yet been attempted; (2.) A mattress maker who re-made a mattress with the original flock in the original cover, the flock not having been cleaned and being in a filthy condition, committed no offence (Gamble v. Jordan); on the other hand in a similar case where the flock was put into a new cover the maker was held to have contravened the statute (Guildford Corporation v. Brown). In a further case heard during the year a second-hand dealer who dealt in bedding the flock of which contained seven times the quantity of chlorine allowed by the Regulations was held to have committed no offence; i.e., he did not in the ordinary sense of the words sell flock manufactured from rags (Cooper v. Evan Cook's Depositories). 61 APPENDIX T. HOUSING, TOWN PLANNING, ETC., ACT, 1909. Summary of Results of House-to-House Inspections for the year 1915. Number of houses inspected 384 Number of empty houses 1 Number of houses where defects were found and where notices were required 261 Number of houses where no defects were found 122 Number of houses where overcrowding was found 2 Number of houses so unfit for human habitation as to be suitable for Closing Order under Section 17, Housing and Town Planning, etc., Act — Number of houses so defective as to be suitable for dealing with under Section 15, Housing and Town Planning, etc., Act — Number of houses where ordinary notices under the Public Health (London) Act 1891, met the case 246 Number of houses to which it was necessary to draw the attention of the District Surveyor 3 EVAN RICHARDS, Special Officer under the Housing, Town Planning, etc., Act, 1909. During the year houses in the following streets were inspected :— Harold Street Treadway Street Hersee Place Ames Street 62 Digby Walk Digby Street Shacklewell Street Viaduct Street Dixie Street Scott Street Tent Street Neath Place CLOSING ORDERS. Closing Orders were made by the Council in respect of Nos. 23 and 35, Harold Street, and 5, Austin Street. The houses 23 and 25, Harold Street, have been demolished, and new houses are being built on the site. Structural alterations are in progress at Nos. 5-20 (inclusive), Princes Court, and there is no doubt that an application will be made shortly to determine the Closing Orders made by the Borough Council on these houses. 63 APPENDIX U. COMBINED DRAINAGE. The position of the law relating to liability for the repair of combined drains remains unaltered, and the vexatious anomaly due to faulty legislation still exists of public funds being mulcted for the cost of reconstruction of private drainage. In six instances during the year were owners enabled to evade their responsibility by shielding themselves behind the law and thus throw upon the ratepayers the cost of repairing the drains of private property. The premises so dealt with were :— Nos. la, 2a, 3 and 4, Artillery Street. Nos. 8, 9 and 10, Fleet Street Hill, and 25, Weaver Street. Nos. 39 and 40, Alias Eoad. Nos. 58, 60 and 62, Seabright Street. Nos. 8 and 10, Abingdon Street. Nos. 1 and 3, Chilton Street, and 162, Bethnal Green Eoad. The total number of combined drainage systems vested in the Council at the end of the year were 528 Number of properties involved 2901 64 The total approximate cost thrown upon the ratepayers for the reinstatement and repair of combined drains during the fourteen years ended March, 1915, amounted to £16,427, or an average annual expenditure of £1,173. In addition to their ordinary duties the men in the employ of the Public Health Department have been engaged during the year on the following works:— Disinfecting Station, Minor repairs and renovations. Council's Shelter, do. do. Mortuary, do. do. Town Hall, Providing connection to drain for new sinks in Mess Room. The services of the Council's men have also been applied for in respect of the undermentioned private works, for which accounts were duly prepared and submitted:— Bethnal Green Workhouse, repairs and additional drainage fitments necessitated by the transference of the Number of clearing eyes, manholes, etc., provided to give the requisite facilities for flushing and cleansing such combined drains 1083 Number of flushing operations carried out during the year 726 Number of worn and defective clearing eye covers repaired or reinstated 19 65 firmary patients to the Workhouse buildings upon the requisition of the Infirmary by the Military Authorities. Ditto, clearing and reconstructing drain from Water Softening apparatus. Ditto, clearing out sump and carting away refuse. 62, Seabright Street, relaying drain (private portion), repairing roof, and sundry small amendments under Magistrate's order. 108, Pritchards Road, amending drain. Bethnal Green Infirmary, unstopping drain and repairing soil-pipe. 8, Gibraltar Gardens, unstopping drain. r VmuUi\V\u s in r VmuUi\V\u s in