THE Metropolitan Borough of Bethnal Green. REPORT ON THE SANITARY CONDITION AND VITAL STATISTICS DURING THE YEAR 1916. BY GEORGE PADDOCK BATE, M.D., Fellow of the Royal College of Surgeons and Licentiate of the Royal College of Physicians of Edinburgh; Fellow of the Royal Society of Medicine; Fellow of the Royal Microscopical Society; Fellow of the Royal Institute of Public Health; Vice-President (past President) of the Incorporated Society of Medical Officers of Health; 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 Green. LONDON: Printed by J. S. Forsaith & Son, 329, Bethnal Green Road, E. 2. 1917. Metropolitan Borough of Bethnal Green. PUBLIC HEALTH COMMITTEE, 1916-17. Meetings held at the TOWN MALL, Cambridge Read, 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 E. E. Pearson. Baths J. Pullen. Electricity Councillor J. J. Cole. Public Libraries „ 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, M.D., F.R.C.S.E., 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. 0. 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. Four 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. Assistant Clerk Thomas and the junior, Heron, enlisted during the year. Four temporary clerks were engaged to fill the vacancies. Disinfectors. One Leading Disinfector. Four Assistant Disinfectors. One Assistant Disinfector and Messenger. PUBLIC HEALTH OFFICES. Town Hall, Patriot Square, Bethnal Green, E.2. Disinfecting Station. The Council's Depot, Digby Street, Globe Road, E. 2. Shelter. 3, St. James Road, Bethnal Green, E. 2. Mortuary. Church Row, Bethnal Green Road, E. 2. SYNOPSIS OF Medical Officer's Annual Report, 1916. PAGE Public Health Committee 1 Staff 2 General Summary 5 Population 6 Table "A," Population 9 Births 9 Deaths 10 Transferable Deaths 10 Table "B," Public Institutions outside Bethnal Green into which residents have been received and where they have died 10 Table "C," Public Institutions in Bethnal Green 13 Deaths in Sub-districts, Table "D " 14, 15 Death Rate 15 Table "E," Monthly Mortality Rates—London and Bethnal Green 16 Table "F," Quarterly Death Rates — London and 16 Bethnal Green Birth Rate 17 Table "G," Marriages 17 Deaths of Infants 17 Infantile Death Rates—Ten Years 18 Table "H," Special Causes of Infantile Deaths 19 Deaths of Young Children 20 Senile Mortality 20 Deaths from Notifiable Infectious Diseases 21 Do. do. Table "K" 22 Deaths from the Seven Principal Zymotic Diseases, Table "L" 22 Table "M," Percentages of Deaths from Zymotic Diseases 23 Notification of Infectious Diseases 23 Table "N," Details of Notifications 24 SYNOPSIS—continued. PAGE Table "O," Condition of Premises 25 Scarlet Fever 25 Diphtheria 25 Enteric Fever 26 Whooping Cough 27 Diarrhœa 27 Measles 27 Chicken Pox 28 Erysipelas 28 Appendicitis 28 Diseases of Parturition 28 Ophthalmia Neonatorum 29 Cerebro-Spinal Meningitis 29 Acute Poliomyelitis 29 Tuberculosis 30 Do. Occupations and persons notified 32 Tuberculosis Dispensary 35 Cancer 35 Housing of the Working Classes Acts 36 Brady Street Area 38 Maternity and Child Welfare Scheme . 38 Health Visitors—Summary of Work 41 APPENDIX. Table I. Vital Statistics of Whole District 44 II. Cases of Infectious Disease Notified 45 II. (a) Public Health Tuberculosis Regulations, 1912 —Notifications 46 III. Causes of, and Ages at Death 47 IV. Infantile Mortality 48 V. Number of Deaths from the Seven Principal Zymotic Diseases in ten years, 1906 to 1915, and in the year 1916 49 Administration of Factory and Workshop Act, 1901 50 SUMMARY. 1916. 1915. 120,207 115,552 Estimated Population of Bethnal Green Census Enumeration Young Children under 5 years Old People over 65 years 17,690 4,782 Area —759 acres. Number of Inhabited Houses 14,729 14,732 Rateable Value £536,107 £533,335 Average number of Persons to each House 8.3 7.9 Average number of Persons to each Acre 158.4 152.2 Total number of Deaths in the year 2,091 1,764 Total number of Births in the year 3,514 3,438 Total number of Marriages 1,536 1,099 Marriage Rate—Bethnal Green 19.0 24.2 Marriage Rate—London ... 20.7 Death Rate—Bethnal Green 17.4 15.26 Death Rate —London 16.1 14. 26 Birth Rate—Bethnal Green 27.5 27.35 Birth Rate—London 22.9 23.4 Infantile Death Rate (on Births) —Bethnal Green 118.0 106.0 110.0 Infantile Death Rate (on Births) —London 87.0 Young Children's Death Rate (on Census Enumeration of Young Children) 30.6 Old People's Death Rate (on Census Enumeration of Old People) 73.8 2.67 1.46 Zymotic Death Rate (Bethnal Green) Zymotic Death Rate (London) 1.5 1.04 Inquest Cases 201 192 Metropolitan Borough of Bethnal Green. REPORT. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Sir and Gentlemen, I have the honour to lay before you my forty-second annual report on the vital statistics and sanitary condition of the Borough of Bethnal Green relating to the year 1916. POPULATION In the abnormal circumstances created by the Continental war, estimates of population are necessarily vague. The following table shows the official figures for London and Bethnal Green during the three years 1914, 1915 and 1916 Year. Bethnal Green. London. 1914 4,516,612 127,662 120,207 1915 4,310,030 4,237,387 115,552 1916 The instructions contained in the subjoined letter from Somerset House have been complied with in computing the statistics throughout this report. General Register Office, Somerset House, London, W.C. 2, 31st March, 1917. Sir, I am directed by the Registrar-General to inform you that the following estimates of population have been adopted in this office for the calculation of the death rate and birth rate of your borough for the year 1916 : — For the death rate 115,552 For the birth rate 125,723 The former is an estimate of the civilian population : the latter of the total population based on the assumption that the ratio between the total and the civilian population is the same in the borough as in England and Wales as a whole. With a view to approximation to the population amongst which the births have occurred, the total population of England and Wales for this purpose has been calculated by adding to the published estimate for 1914 the natural increase up to the middle of the year 1916. A statement showing a summary of the vital statistics for England and Wales and for groups of towns during 1916 is enclosed herewith. I am, Sir, Your obedient servant, T. H. C. Stevenson, M.D., Superintendent of Statistics. The Medical Officer of Health of the Metropolitan Borough of Bethnal Green. Death-rate and Analysis of Mortality during the Year 1916. - ANNUAL DEATH-RATE PER 1,000 LIVING.* Rate per 1,000 Births Percentage of Total Deaths. Certified Causes. Inquest Cases. Uncertified Causes of Death. Measles. Violence. Diarrhœa and Enteritis (under Two Years). Total Deaths under One Year. Deaths in Public Institutions. Whooping-cough. Diphtheria. Enteric Fever. Scarlet Fever. All Causes. Small-pox. England and Wales 0.16 0.14 12.47 91 24.2 91.3 7.2 1.5 0.15 0.66 14.0 0.03 0.00 0.04 96 Great Towns,including London (Census Populations exceeding 50,000). 14.4 0.03 0.21 91.2 1.0 0.15 0.53 29.6 0.00 0.04 0.21 16.24 99 7.8 1.8 0.14 0.14 0.46 16.4 92.5 0.15 148 Smaller Towns (Census Populations 20,000—50,000). 0.03 13.0 0.00 0.04 10.79 90 5.7 0.19 0.14 0.56 45.6 0.02 90.1 0.1 London 0.18 14.3 0.03 15.80 89 9.8 * The death-rates for England and Wales are based upon deaths in the whole population and upon an estimated total population of 30,250,000. The birth-rate similarly calculated is 21.6 per 1,000. The death-rates for the towns are based upon civil deaths and estimated civil population. The birth-rates cannot be stated. In all cases the population used relates to the year 1915. TABLE A. 1915. 1916. 3,438 Total Births 3,514 Total Deaths 1,764 2,091 1,423 Excess of Births over Deaths, showing the natural increase of the population 1,674 BIRTHS. The Local Registrars return the total number of children born alive in the Borough at 3,171, but in addition to these I have received information from the Registrar-General of 268 infants born of Bethnal Green mothers in lying-in institutions situated in other parts of London, from which number must be deducted an infant born in the Workhouse of a non-resident mother. Details of these are given below, and the adjustment of the total number is as follows : — Births in the Borough 3171 London Hospital 129 Whitechapel Infirmary 29 City of London Lying-in Hospital 26 Jewish Maternity and Nursing Insti- tution, Underwood Street 18 East End Mothers' Home 20 Salvation Army Hospital 2 Queen Charlotte's Hospital 1 Institutions unidentified 43 268 3439 Outward Transfer 1 Net Total of Bethnal Green Births 3438 DEATHS In compliance with the instructions of the Registrar- General, deaths of officers and men of the armed forces of this and other nations admitted to hospitals in the Borough, or dying at their own homes, are not taken into account in these statistics. The returns of the Local Registrars give a total of ],784 civilian deaths, but as this number includes 434 non-residents who died in Bethnal Green hospitals and eleven other non-residents who died sudden or violent deaths whilst temporarily within our borders, these 445 must be excluded. On the other hand, the returns of transferable deaths forwarded from Somerset House contain particulars of 426 deaths of persons ordinarily inhabiting Bethnal Green who have died in various parts of the Metropolis, and these must be added. I may here mention that these particulars are always closely scrutinised by us on receipt, and frequently require adjustment on our part before final acceptance. I beg leave here to record my grateful thanks to Mr. David Thomas, the Clerk to the Guardians, for his able assistance in tracing the past history of persons removed to, and dying at, lunatic asylums in or near London. TABLE B. Banstead Asylum 10 Bow Institution 1 Bromley House Institution 1 Public Institutions situated outside the Borough into which Bethnal Green Residents have been received and where they have subsequently died. Brompton Hospital 1 Cancer Hospital 1 Cane Hill Asylum 1 Caterham Asylum 3 Children's Hospital, Cleveland Street 4 Children's Hospital, Gt. Ormond Street 1 Children's Infirmary, St. Pancras 1 City of London Asylum 1 City of London Lying-in Hospital 2 Claybury Asylum 23 Colney Hatch Asylum 11 Dartford Heath Asylum 2 Eastern Hospital 23 East London Hospital 3 Epileptic Colony 2 Fountain Temporary Asylum 2 German Hospital 5 Great Northern Hospital 1 Guy's Hospital 1 Hackney Infirmary 2 Home for Jewish Incurables 1 Hostel of God 1 Infants' Hospital 1 Kensington Infirmary 1 Leavesden Asylum 10 London Hospital 140 Long Grove Asylum 2 Metropolitan Hospital 1 Middlesex Hospital 5 Northern Hospital 2 North-Eastern Hospital 17 North-Western Hospital 3 Park Hospital 1 Poplar Hospital 2 Poplar Workhouse 1 Queen Mary's Hospital, Carshalton 4 Royal Arsenal Hospital 1 St. Barnabas' Home 1 St. Bartholomew's Hospital 16 St. George's Infirmary 48 St. Columba's Hospital 2 St. Joseph's Home 1 St. Joseph's Hospital 3 Salvation Army Mothers' Hospital 1 Shoreditch Infirmary 8 Sick Asylum, Bromley 2 South-Eastern Hospital 6 South-Western Hospital 2 Tooting Bec Asylum 10 University College Hospital 2 West End Hospital 1 Whitechapel Infirmary 8 Deaths which occurred in various Institutions outside London, particulars of which were forwarded to me by the Registrar General and subsequently verified 9 415 TABLE C. Public Institutions in Bethnal Green. Out-Patients treated. Bethnal G reen Residents. Deaths. Bethnal Green Non-Residents. Beds Available. In-Patients treated. City of London Hospital for Diseases of the Chest 175 924 8,843 9 79 Queen's Hospital for Children, Hackney Road 134 2,161 43,665 87 286 Mildmay Mission Hospital 50 357 6,325 7 17 Bethnal House Asylum ... ... ... ... 31 Bethnal Green Infirmary ...† ...† ...† 526 21 * Hospital closed for necessary structural alterations during 5J months of the year. † Figures not available. NOTE. —Thirty-two deaths occurred in the Bethnal Green Military Hospital of soldiers under treatment there, being five residents of the Borough and twenty-seven non-residents. SUMMARY. Total deaths registered 1784 Sudden deaths of residents outside the Borough 10 Deaths of residents in institutions outside the Borough 415 2209 Deductions: — Sudden deaths of strangers in Bethnal Green 11 Deaths of strangers in Bethnal Green Institutions 434 445 Net total deaths of Bethnal Green residents 1764 Note. —In accordance with instructions received from the Registrar-General, 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 8. DEATHS IN SUB-DISTRICTS. In the North-East sub-district 923 deaths occurred amongst the residents and 831 in the South-West. Ten persons who had no fixed homes died in the Workhouse or the Infirmary. These details are shown in Table D. TABLE D. District. Deaths. Population. North-East 923 57,650 South-West 831 57,902 Previous residence unknown 10 ... Total 1,764 115,552 DEATH RATES. We show a mortality rate for the year 1916 of 15.26 per thousand persons living, calculated on the Registrar- General's estimate of the civil population (115,552). This rate, which is over two below that of the previous year, is one above the rate for London, which is 14.26. In the sub-districts the rate in the North-East was 16.0 and in the South-West 14.3. These rates are exclusive of the deaths of ten 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 month being also shown. Table "F" compares the death rates for London and for Bethnal 'Green by quarters. The death rates in these tables are set out here for purposes of comparison only, as they were calculated on the estimated population in the middle of 1915. TABLE E. London Death Rate. 1916. Bethnal Green Death Rate. 1916. Mean Temperature (Degrees). Approximate Rainfall (Inches). Month. 1.2 January 13.5 17.2 45.8 3.5 February 40.1 14.5 16.1 4.9 March 17.6 17.8 39.8 April 1.2 17.2 16.2 48.7 2.1 May 13.4 11.6 56.1 1.9 June 11.4 11.5 55.1 1.4 July 10.7 11.6 60.8 August 3.9 10.6 11.1 64.4 September .6 11.8 11.8 56.9 2.1 October 12.0 13.1 53.8 4.9 November 14.6 44.2 16.9 2.4 December 22.6 21.5 36.9 Average * 14.15 14.7 50.2 Total Rainfall 30.1 * Uncorrected. TABLE F. Death Rates Compared. Quarter ending. London. Bethnal Green. 1st April, 1917 16.0 17.0 13.1 13.8 1st July, 1917 11.1 11.5 30th September, 1917 17.2 16.2 30th December, 1917 14.7 * 14.3 Yearly Average * Corrected. BIRTH RATE. The births actually registered in Bethnal Green during the year, together with the balance of the transferable births notified by the Registrar-General, totalled 3,438. This gives a birth rate of 27.35 per thousand population (125,723), a figure which is practically identical with that of the previous year. The general London rate stands at 23.4 per thousand. TABLE G. MARRIAGES, 1916. First Quarter 256 Second Quarter 337 Third Quarter 229 Fourth Quarter 277 1,099 Total These figures indicate a marriage rate of 19.0 to every thousand persons. The London marriage rate was 20.7. DEATHS OF INFANTS. 2 per cent, of the total of deaths at all ages were those of infants under one year. These numbered 365, giving an infantile death rate of 106 per thousand births, a very considerable decrease on the figure for 1915, which was 118. The general Metropolitan infantile death rate has fallen to 87 as against 110 for the previous year. INFANTILE DEATH RATES. The following table compares the total infantile death rates during the last ten years for Bethnal Green with the rates for the whole of London: — Year. Bethnal Green. London. 1907 116 138 1908 132 113 1909 129 108 1910 123 103 1911 123 128 1912 96 90 1913 117 105 1914 104 137 1915 118 110 1916 106 87 Average for ten years 122 106 TABLE H. Principal Causes of infantile Deaths. Totals. Rate per thousand births. 1916 1915 1916 1915 Diarrhœal Diseases 70 106 20.37 30.1 98 Premature birth, injury at birth, and congenital defects, including Atelectasis 28.50 20.2 71 73 21.33 Respiratory diseases 90 25.6 8.14 28 31 Wasting diseases 8.8 Convulsive diseases 9 2.62 15 4.2 8.44 Common infectious diseases 57 29 16.2 4.07 Suffocation 14 9 2.5 Tubercular diseases 3.49 12 14 4.0 SPECIAL CAUSES OF INFANTILE DEATHS. A comparison of the causes of infantile mortality in 1916 with those of the previous year shows a general improvement, with the exception of deaths due to abnormal births and suffocation. Premature birth, the main factor in the first of these, admits of an explanation which both our Health Visitors firmly support, namely, the terror and worry caused to pregnant women by air raids. The Visitors are also of opinion that many still births (which are not registerable) are due to the same cause. I am much concerned at the increase in the number of deaths from over-laying, notwithstanding the efforts of our Health Visitors, who, I know, both do their utmost to encourage the provision of simple cradles. Out of the twelve tubercular deaths six were due to brain tuberculosis and three to the abdominal form of the disease. DEATHS OF YOUNG CHILDREN. The deaths of young children aged less than five years (including infants) numbered 538, and formed thirty per cent, of the deaths at all ages. This is equivalent to a rate of 30.6 on the census population of young children against 40.4 for the previous year. Sir Arthur Newsholme, the Chief Medical Officer to the Local Government Board, prefers to calculate the young children's mortality on the number of births; worked out this way, our figure is 156.5, as against 164 for the whole of London. SENILE MORTALITY. The deaths of elderly persons (over sixty-five) numbered 427, a proportion of twenty-four per cent, of the total deaths at all ages. They give a mortality rate of 73.8, calculated on the enumerated population of persons over 65 years of age. QUARTERLY AND ANNUAL RETURNS OF DEATH 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. 1916. Deaths from all causes. INFECTIOUS DISEASE. There was a very large reduction in the prevalence of infectious disease throughout 1916. By the new Measles regulations, which came into force at the commencement of the year, the obligation on medical men to notify this disease is limited to the first case in any particular household; subsequent cases in the same family, occurring within the following two months, are not to be reported by the Doctor, but the requirement to report these is thrown upon the parent or guardian (under penalty for failure). The object of making Measles notifiable was in order that such cases should be kept under observation so that medical and nursing assistance could be given in suitable cases, as the Borough Councils are now authorised to provide both of these at the expense of the rates. The notification of Measles threw a good deal of extra work upon the Health Visitors, but it was found possible to visit all known cases and to revisit them at the expiration of a fortnight. 1,404 cases of Measles were notified, visited and revisited; 1,175 of these were treated at home, 170 of the worst cases were removed to Metropolitan Asylums Board Hospitals, and 59 to other hospitals and infirmaries. There were 19 deaths from Measles, ten at home and nine in hospital, a case mortality rate of 1.35 per cent. The following table indicates the locality (hospital or home) of the deaths from infectious disease : TABLE K. Disease. Deaths at Home. Deaths in Hospital. Total Scarlet Fever ... 5 5 Diphtheria 2 24 26 Enteric Fever 2 ... 2 Erysipelas 1 6 7 Puerperal Fever ... 6 6 Measles 10 9 19 Cerebro-Spinal Meningitis 3 7 10 Polio-Myelitis 1 1 ... Whooping Cough 11 33 44 THE SEVEN PRINCIPAL ZYMOTIC DISEASES. (Decennial average of deaths from Zymotic disease, 275.) The total number of deaths from the diseases usually included under this heading was 169, a decrease of 153 on the previous year. In the following table the comparative mortalities for 1915 and 1916 are given : — TABLE L. 1915. Disease. 1916. Measles 105 19 Scarlet Fever 11 5 Diphtheria 39 26 Whooping Cough 36 44 Enteric Fever 3 2 Diarrhœa 128 73 Totals 322 169 The death rate from these Zymotic diseases is 1.46 for 1916 as against 2.67 for the previous year, the corresponding rates for the whole of London being 1.04 and 1.51. The deaths from Zymotic diseases form 9.6 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 19 deaths, 11.2 per cent., or 1 in 8.9 deaths. Scarlatina 5 3.0 33.8 „ „ „ „ „ Diphtheria „ 26 „ 15.4 „ 6.5 „ „ Whooping Cough „ 44 „ 26.0 3.8 „ „ „ Enteric Fever „ 2 1.2 84.5 „ „ „ „ Diarrhœa „ 73 „ 43.2 „ 2.3 „ „ NOTIFICATION OF INFECTIOUS DISEASE. A gross total of 2,565 notification certificates has been received. 2,297 of these were from medical practitioners and 268 from the parents or guardians of persons suffering from Measles. 118 of the medical certificates were duplicates, so that the actual number of infectious cases reported and dealt with was 2,447, a rate of 21.2 per thousand on the estimated population of the Borough. Table "N" gives full particulars of all the notifications. From this it will be seen that 170 sufferers with Measles and 784 with other infectious diseases were removed to hospitals under the control of the Metropolitan Asylums Board, and 59 cases of Measles and 72 cases of other Zymotic diseases were removed to general hospitals. In fifty instances, two of which related to Measles, information was received from the hospital authorities that the diagnosis as stated on the notification certificate was incorrect. 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.B. Hospitals. Treated at other Hospitals and Infirmary. Diagnosis Incorrect. Diphtheria 390 383 375 7 ... 8 21 ... Membranous Croup ... ... ... ... ... ... 8 391 Scarlet Fever 403 395 4 20 ... 1 21 Erysipelas 188 167 132 34 ... 12 24 Enteric Fever 19 ... 19 2 5 7 ... Ophthalmia Neonatorum 36 34 2 34 ... ... ... ... Cerebro-Spinal Meningitis 19 19 5 14 ... 5 Puerperal Fever 17 1 16 1 10 ... 1 ... Polio-Myelitis 10 9 1 8 ... 170 Measles and German Measles 1,482 78 1,404 1,175 59 2 ... Small Pox ... ... ... ... ... ... ... Anthrax 1 1 1 ... ... ... 2,565 1,362 Totals 118 2,447 954 131 50 1916. Diphtheria. Cases, continuous line Deaths,dotted line TABLE O. Condition op Premises where Cases of Infectious Diseases have occurred during 1916. < Scarlet Fever Diphtheria. Enteric. Satisfactory 160 172 9 32 55 W.C.'s or Apparatus defective 5 3 Internal Drainage defective 11 ... 1 External Drainage defective 4 ... 135 Minor Insanitary defects 145 7 Single Room Tenements 17 19 ... Overcrowded 2 3 ... SCARLET FEVER. Deaths 5. (Decennial average, 15.5.) This disease was prevalent in a mild form during the year. 395 cases were notified and (with the exception of four) removed to hospital. Twenty of the patients so removed were found upon further examination not to be suffering from Scarlet Fever. There were five deaths, all in hospital. The case mortality was 1.3 per cent., as against 2.2 per cent, amongst the total Scarlet Fever cases treated in the M.A.B. Eastern Hospital. DIPHTHERIA. Deaths 26. (Decennial average, 22.7.) Diphtheria was notified in 390 cases. Seven of the certificates were duplicates, eight of the cases were treated at home where two of them died, 375 were removed to hospital, but twenty-one of these were found to have been incorrectly diagnosed. Of the 354 genuine hospital cases twenty-four died, making with the two home deaths a total of 26. This gives a case mortality of 7.1 per cent, as against 6.9 per cent, amongst the whole of the Eastern hospital cases. 84,000 units of anti-toxin were supplied free to medical practitioners during the year, 143 throat swabs were submitted to the Clinical Research Association for examination, 45 of which gave positive results and 98 negative. Twenty of the deaths from diphtheria were amongst young children aged less than five years, a mortality of 1.13 per thousand on the enumerated population of young children. ENTERIC FEVER. Deaths, 2. (Decennial average 7.3.) Nineteen persons were notified as suffering from Enteric Fever; in seven instances the diagnosis was reported by the hospital authorities to be incorrect. Of the twelve actual cases, five were treated in M.A.B. hospitals, five in general hospitals and two at home. The case mortality of this disease amongst all the patients in the Eastern hospital was 7.34 per cent. Six samples of blood in suspicious cases were submitted for examination; in three cases a positive reaction was reported and a partial reaction in one; the other two gave negative results. In no case were we able to trace a definite cause of the illness; three of the patients had recently eaten fried fish and another, shell fish. 1916. Enteric fever Cases, continuous line Deaths,dotted line 27 WHOOPING-COUGH. Deaths, 44. (Decennial average, 43.3.) All these deaths, with the exception of two, were amongst young children aged less than five years, a mortality of 2.37 per thousand on the census population of young children. Eleven of the deaths occurred at home and the remaining thirty-three in hospitals. DIARRHŒA. Deaths, 73. (Decennial average, 112.3.) The deaths from Diarrhoea were fewer by 52 than in the previous year, and equalled a mortality of 3.0 per thousand births. MEASLES. Deaths, 19. (Decennial average, 76.1.) Measles was prevalent, but the mortality fell much below the average, the deaths being 86 fewer than in 1915. All the deaths except one were amongst young children under five years of age, and formed a mortality rate amongst such children of 1.0 per thousand. In addition to the formal notifications required by law, between two and three hundred cases of measles were reported to us by School Authorities. All these were visited, and though the larger proportion were found to be not suffering from Measles, yet we were enabled to trace a number of cases in which the responsible person had failed to obey the law. In each of these instances a cautionary letter was written, pointing out the penalty incurred for failure to notify. In nearly every instance ignorance of the law was pleaded, and this not- withstanding the fact that early in the year copies of the new regulations as to notification were posted throughout the Borough. CHICKEN-POX. The Order requiring the notification of Chicken-pox was not renewed, but the head teachers of elementary schools reported 261 cases of this disease, all of which were visited and dealt with in the usual manner. ERYSIPELAS. I received 188 notifications of cases of Erysipelas, but as 21 of these were duplicates the actual number of cases was 167, a decrease of 30 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. There were seven deaths from Erysipelas, but in addition to these, and included amongst the unclassified deaths in Table 111. under the head of " other defined diseases," were 28 deaths from various forms of sepsis. Amongst these were seven deaths from abscess, the result of middle-ear disease and four the result of abscess in connection with diseased bone. APPENDICITIS. Three deaths were registered as from this cause. DISEASES AND ACCIDENTS OF PARTURITION. Sixteen cases of Puerperal Fever were reported; all except one were treated in hospital, where six of them died. The deaths of nine other women were stated to be due to some one or other condition associated with child-birth; four of them were returned as hæmorrhage, two as convulsions, and one each as prolonged labour and thrombosis. OPHTHALMIA NEONATORUM. Thirty-four infants were reported to be suffering from this disease. The mothers had been attended by medical men in seventeen cases, by midwives in fourteen and by maternity hospital assistants in three. At the end of the year one of the infants was still under treatment, but the remainder had recovered without obvious impairment of vision. Of two cases which were under treatment at the commencement of the year, a complete cure was effected in one, but the other had been lost sight of, as the parents had removed from Bethnal Green. CEREBRO-SPINAL MENINGITIS. Nineteen cases of Cerebro-spinal Meningitis were notified during the year; all but two of the cases were under fifteen years of age, ten were fatal. The Public Health Committee decided that in cases where such a course might be definitely approved by me specimens of cerebro-spinal fluid should be submitted to examination by the Clinical Research Association at the cost of the Council, and two samples were so submitted; a positive result was obtained in one case but the other was negative. ACUTE POLIO-MYELITIS. Nine cases of this disease were notified, with one death. TABLE P. Summary of Results in Cases of Cerebko-Spinal Fever and Polio-Myelitis. Disease. No. of Cases notified. No. of Fatal Cases. Completely recovered. Recovered with Permanent Paralysis. Recovered with Slight Disablement. Result not known. Cerebro-Spinal Meningitis 19 15 4 ... ... ... Polio-Myelitis 9 1 5 1 1 1 TUBERCULOSIS. The deaths due to Tuberculosis in its various forms numbered 253, forming 14.34 per cent, of the total deaths from all causes, which is equal to a death rate of 2.18 per thousand estimated population —approximately the same as in the previous year. Thirty-two of the deaths were amongst young children, a mortality of 1.8 per thousand children living. Six infants died from tubercular disease of the brain and five from other tubercular diseases. PULMONARY PHTHISIS. The deaths from tuberculosis of the lungs (Phthisis) numbered 194, equal to a mortality rate of 1.68 as against 1.49 for the whole of London. NOTIFICATION OF TUBERCULOSIS. The Local Government Board issued an order whereby Medical Officers of Health are required to furnish to the Army Council particulars of all male persons who, being on January Ist, 1916, between the ages of eighteen and forty-five, have been notified since February, 1913, as suffering from tuberculosis. A list is also sent every week of male persons similarly notified. The object of the Order is to assist the Army Council to exclude from enlistment men suffering from Tuberculosis. The number of notifications of all forms of tubercular disease received during 1916 was 851; of these 360 were duplicates and nine were referred to other Boroughs, which leaves a net total of 482 cases. Of these 381 were cases of pulmonary disease and 101 were non-pulmonary. Of the 482 persons notified as suffering from the various forms of Tuberculosis, only 200 (41.5 per cent.) were insured persons under the National Insurance scheme, 70 were school children and 25 infants. Of the total primary notifications received, 239 referred to persons residing in the North-East subdistrict, 237 in the South-West and six were homeless. One hundred and seventy-three specimens of sputum were submitted to the Clinical Research Association for examination; the tubercle bacillus was detected in 47, but the examination proved to be negative in 126 cases. The homes of all persons notified were visited, insanitary conditions rectified under notice, and many extra visits paid to cases where reports as to home conditions were required by the London County Council or the Insurance Committee. The supply of paper-lined spittoons and glass metal capped pocket spittoons and disinfectants has been continued. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Occupations of Persons notified during 1916. Occupation. Males. Females. Total. 1 Aeroplane Worker 1 ... Army Men 14 14 ... Artificial Flower Makers, &c 1 1 2 Asbestos Worker ... 1 1 Barman 3 ... 3 Basketmaker 1 ... 1 3 ... 3 Bookbinders 10 Boot and Shoe Makers 10 ... Bonnet Shape Blocker 1 1 ... 5 6 Boxmakers, &c. 1 Blouse Makers ... 3 3 ... 1 Bottle Washer 1 Bricklayer 1 ... 1 Brush Makers, &c. 1 1 2 ... 1 Button Makers 1 Cab Maker 1 ... 1 12 12 Cabinet Makers and Furniture Trade ... 3 Cap Makers, &c. 1 4 Capsule Maker ... 1 1 12 ... 12 Carmen, 'Bus and Tram Workers Caretakers 1 ... 1 1 ... 1 Carpenters Case Maker 1 1 ... 1 Chair Caner 1 ... 5 Charwomen ... 5 Chauffeurs 2 ... 2 2 ... 2 Checkers Chemical Worker 1 ... 1 Chemist's Assistant 1 1 2 2 1 Cigar and Cigarette Makers 3 Cigar Box Paperer ... 1 1 Clerks 7 ... 7 Cloth Tester ... 1 1 Coachman 1 ... 1 ... 2 2 Collar Work Costermonger 1 ... 1 Decorator 1 ... 1 3 3 Domestic Servants ... Dry Canteen Manager 1 ... 1 1 1 Embroiderer ... Engineer 1 ... 1 1 Engine Fitter 1 ... 1 ... Engraver 1 Errand Boys 2 ... 2 Carried forward 90 33 123 Public Health (Tubebculosis) —continued. Occupation. Males. Females. Total. 90 33 Brought forward 123 Factory Worker, &c. ... 1 1 Fancy Card Mounter ... 1 1 Feather and Fur Workers 1 2 3 2 ... Firemen 2 Fishmongers 2 ... 2 1 ... 1 Fitter French Polishers 4 ... 1 Gas Fitter 1 ... 1 1 ... 1 Gate Keeper General Dealer 2 ... 2 2 ... 2 Glass Worker 1 Gold Blocker 1 ... Grocer's Assistant 1 ... 1 1 ... 1 Guillotine Cutter Hairdresser 1 ... 1 Hat Trade (Forewoman) ... 1 1 2 Hawkers 2 ... Housebreaker 1 ... 1 ... 36 36 Housewives Horsehair Dresser 1 ... 1 Hospital Nurse ... 1 1 Infants 14 27 13 Ironer ... 1 1 1 ... 1 Jobbing Smith Labeller ... 1 1 Labourers: — 1 Builder's 1 ... General 9 ... 9 Dock 8 ... 8 1 Ironwork 1 ... Ladies Hand Bags 1 ... 1 2 ... 2 Lamplighters Leather Worker ... 1 1 Licensed Victuallers 3 ... 3 6 10 Machinists 4 Messenger 1 ... 1 Milkman 1 ... 1 Mineral Water Manufacturer 1 ... 1 Motor Driver's Assistant 1 ... 1 4 ... 4 Munition Workers Musician 1 ... 1 2 ... 2 Navy Men 1 Night Watchman 1 ... Nurse ... 1 1 ... 3 3 Office Cleaner Ostrich Feather Worker ... 1 1 Onion Skinner ... 1 1 169 104 273 Carried forward Public Health (Tuberculosis) —continued. Males. Females. Occupation. Total. Brought forward 169 104 273 Packers 4 2 6 Packing-case Maker 2 ... 2 Painter, Paper-hanger, &c. 2 ... 2 Picture-frame Maker ... 1 1 Porters 9 ... 9 Pressers 1 1 2 Printers 2 ... 2 1 ... 1 Potman Road Sweepers 2 ... 2 Rope Maker 1 ... 1 1 ... 1 School Teacher Sawyer 1 ... 1 Ship-hand 1 ... 1 2 Silk-worker ... 2 Stablemen 2 ... 2 2 ... 2 Stick Maker Table Maker 1 ... 1 Tailors and Tailoresses 14 8 22 1 Tea Blender 1 ... Tie Makers 1 1 2 Toy Makers 1 1 2 Travellers 3 ... 3 Typewriter Inspector 1 ... 1 Upholsterers 2 ... 2 Umbrella Manufacturer 1 ... 1 Undertaker 1 ... 1 2 Upholsterers' Trimming Makers 1 1 Vellum Binder 1 ... 1 Vanguard 1 ... 1 Washing (Casual) ... 1 1 Waiters and Waitresses 1 1 2 2 Warehousemen 2 ... Watchmen 2 ... 2 Wheelwright 1 ... 1 Wire Stitcher ... 1 1 Woodworker 2 ... 2 No Occupation 1 5 6 No information obtainable, or persons removed 15 19 34 37 81 School Children 44 Total 297 185 482 TUBERCULOSIS DISPENSARY. During the year much careful consideration was given to the provision of a Tuberculosis Dispensary. The Council was most anxious to provide and control a municipal dispensary, but this proposal was definitely negatived by the Local Government Board and the Council was directed to enter into a contract with the Governors of the City of London Hospital for Diseases of the Chest. A scheme has accordingly been prepared, the terms of which are agreeable to the Local Government Board, the London County Council, the London Insurance Committee and the Governors of the Chest Hospital. The Seal of the Council will be affixed to the contract at an early date, after which the Dispensary will be open. CANCER. Malignant disease was the cause of 108 deaths; all with the exception of four occurred amongst persons aged over 25 years of age. The following list indicates the parts of the body chiefly affected by cancerous growths: — Stomach, Liver and Pancreas 44 Tongue, Mouth and Larynx 16 Intestines 10 Female Breast 9 Rectum 6 Female Organs of Generation 6 Lung and Mediastinum 4 Brain 3 Prostate and Male Bladder 3 HOUSING OF THE WORKING CLASSES ACTS, 1891-1909. During the year I made formal representations that the undermentioned thirty-one houses were so dangerous and injurious to health as to be unfit for habitation : — 18, Diss Street. 1, Strout's Place. 2 and 3, Pelter Street. 16 to 29, Smith's Buildings. 17, Gascoigne Place. 1 to 20, Margaret's Place, and two unnumbered houses (one adjoining No. 17 and one down a gateway, Margaret's Place). SUMMARY OF ORDERS MADE BY THE BOROUGH COUNCIL. Inspector Richards, the Special Officer appointed under the Housing, Town Planning, etc. Act, 1909, reports as follows : — Closing Orders made in 1913 17 „ „ 01914 29 „ „ 1915 0 „ „ 1916 31 Total 77 Of these 77 houses 21 have been demolished, four have been closed and emptied but no demolition order has at present been made. Eight closing orders have been determined by the Borough Council on completion of works; 15 houses are empty (pending proceedings on closing orders). Structural alterations and repairs are in progress in nine houses, 20 are still occupied pending service of closing orders. CLOSING ORDERS DETERMINED. The closing orders in respect of six houses in Prince's Court were determined by the Borough Council on July 6th, 1916, after the structural alterations and repairs agreed upon had been completed. These included, amongst other things, the provision of well-lighted staircases in all the houses in place of dark, dilapidated central staircases. This is an instance of the additional powers conferred upon local authorities by the Housing Act of 1909. Owners can now be compelled to carry out necessary alterations in houses which are so faulty in original construction as to be unhealthy. NEW BUILDINGS. Mr. Richards reports that since 1912 new buildings have been constructed on the sites of a number of houses closed by order of the Council and subsequently demolished : — The Council Electricity Station has been constructed on the site of five houses in New Tyssen Street. Three dwelling houses have been built upon a site originally occupied by 46, 48, 50 and 52, Florida Street, and two other houses on the site of 23 and 25, Harold Street. A block of houses Nos. 32, 34, 36, Gosset Street, and Nos. 18, 20, 22, 24, 26, 28. 30, 32, 34 and 36, Chambord Street, all in a very dilapidated condition, were closed and demolished by the owners after much correspondence and an intimation that closing orders would be made in default of voluntary action. Subsequently ten houses and two workshops were built upon the site. BRADY STREET UNHEALTHY AREA. I regret to be unable to report any further progress in the scheme for the clearance of this unhealthy area. Such measures as are possible under the provisions of the Public Health (London) Act, 1891, have been taken from time to time, and a few houses have been closed and demolished by the owners. It is a public scandal that the old, dilapidated and unhealthy houses on this area should continue to be inhabited, but the Treasury is firm in its refusal to allow any expenditure of public money to effect the clearance of the site during the continuance of the war. MATERNITY AND CHILD WELFARE SCHEME. My report for 1915 contains a full exposition of my views upon this subject. On July 6th the Public Health Committee presented a full report to the Council, strongly supporting my suggestions. The concluding paragraphs of the report are as follows : — The Town Clerk, the Medical Officer of Health, and the Chief Sanitary Inspector have reported to us upon the subject of a scheme for the Borough, and the Town Clerk also has been in correspondence with the Local Government Board, particularly as to the grant to be made by the Board in respect of the cost of this work, in regard to which he received an assurance that a grant equivalent in any year to one half the salaries of health visitors and of any other approved expenditure during the previous financial year in connection with a maternity and child welfare scheme would be forthcoming. The system of grants is now in operation, and acting upon information supplied on behalf of the Council as to expenditure made by the Council in connection with Maternity and Infant Welfare work during the financial year ended 31st March, 1915, the Local Government Board has forwarded a grant of £98 7s. in aid of the Council's expenditure during the financial year 1915- 1916, the grant being equivalent to 50 per cent, of the expenses incurred in the year ended 31st March, 1915. The Medical Officer of Health has reported further to us on the subject of maternity and child welfare, and he has made a suggestion that before defining the limits of a materity and child welfare scheme for Bethnal Green, the Council should endeavour to obtain the services of a lady doctor temporarily, who would devote the whole of her time to the work of the Council. Dr. Bate is of opinion .that if such an officer were appointed she could undertake the control of the health visitors, give advice to mothers and expectant mothers, give medical treatment in small ailments, organise and develop a maternity and child welfare scheme, assist with tuberculosis work, and carry out other public health matters, all such duties being, of course, discharged under the supervision of the Medical Officer of Health. We think there is much to be said in favour of the suggestion made by the Medical Officer of Health, as amongst other things it would at once provide proper supervision and control of the existing health visitors, and tend to insure systematic development of a maternity and infant welfare scheme, and the efficient discharge of many public health duties bearing relation to infant welfare. It is debatable as to whether maternity and infant welfare schemes are of real value to the community, especially whilst such slums as the Brady Street area exist, and although we are not prepared to advise that such schemes are productive of all the benefits claimed by Government authorities, we do advise that the Council should take some step in the direction of organised effort to combat the present wastage of infant life. In all the circumstances we are of opinion that the Council should now take steps in furtherance of a Maternity and Child Welfare Scheme. We therefore recommend — (i) That the Council do refer to the Public Health Committee the formulation of a Maternity and Child Welfare Scheme for the Borough on the lines indicated in the foregoing report, in accordance with the suggestion made by the Local Government Board. (ii) That the Council do approve of the appointment of a lady medical practitioner to act as Assistant Medical Officer of Health at a salary of £350 per annum, the appointment to be temporary, terminable at three months' notice on either side, and that it be referred to the Public Health Committee to settle the terms and conditions of the appointment, to issue advertisements, and to arrange for three candidates to attend before the Council. Recommendation No. 1 was adopted, but No. 2, which provides for the appointment of an Assistant Medi- cal Officer of Health, was sent back for reconsideration. An attempt was made to secure rooms at the Queen Adelaide's Dispensary as a health centre, but the House Committee of the Institution was unsympathetic, and the application was refused. Other premises were examined, but all with one exception were found to be unsuitable. Since the preparation of this Report was commenced, the premises referred to (which are eminently suitable) have been secured, and a recommendation has been presented to the Council reaffirming the previous suggestion of an Assistant Medical Officer of Health. The recommendation was accepted, and a lady doctor has been advertised for. As soon as the lady is appointed, I propose to hold a conference with the representatives of the various Welfare Societies working in the district with a view to elaborating such a scheme as will utilise the efforts of these bodies and affiliate their officers to the Health Department of the Council under the supervision of the lady doctor, such scheme to be laid before, and sanctioned by, the Council. HEALTH VISITORS. Total visits during the year 9,153 Birth visits 2,546 „ Re-visits 2,630 Cases of Ophthalmia Neonatorum visited and revisited 87 Puerperal Septicœmia Cases visited 19 Measles visited and revisited 2,352 School Complaints attended to 1,294 Special visits 7 Futile visits 218 The details of live and still births notified are given in the following table : — Male. Female. Not stated. Totals. Live Births— Single Births 1,587 1,489 Triplets Still Births— ... 3 ... ' ) 3,175 5 13 33 Twins, same sex „ mixed sexes 23 22 86 J 45 Single Births 35 1 Twins, same sex „ mixed sexes 1 1 1 2 In Miss Hammond's district, comprising the South and West Wards, 1,597 births were notified. She made 2,947 visits and revisits to the homes of the mothers. By far the greater number of infants were wholly breast-fed and about 20 per cent, partially so, the bottle-fed babies amounting to about 15 per cent, of the total. As previously noted, this district bears a good record for maternal feeding. In Mrs. Hodgkins district, comprising the North and East Wards of the Borough, 1,614 births were notified, necessitating a total of 2,229 visits and revisits. Mrs. Hodgkins reports that all but 6 per cent, of the infants were breast-fed, whilst under her supervision. The return of the mothers to their ordinary avocations probably more or less seriously affected this figure. The extension of the practice of mothers going into factories and workshops, or receiving work at home, has vastly ... ... ... ... increased owing to the demand for labour on textile materials owing to the war but it is satisfactory to note that the Health Visitors still report the same anxiety as was previously noted amongst the mothers to continue breast-feeding their infants. Systematic issue of cards of advice at the time of the visit, and the giving of personal suggestions as to the clothing and treatment of mother and infant, are carefully maintained. The importance of bringing children to the weighing centre immediately upon anything wrong being noticed is urgently impressed upon all mothers, and each Health Visitor spends a busy afternoon weekly at No. 3, St. James's Road, for the purpose of examining and weighing infants and making proper records of their progress. On these occasions simple suggestions are made as to the general treatment of infants, but proper medical supervision at the centre is urgently required, and, I trust, will soon be available. 2,228 visits were paid by mothers with their infants to these consultations, this number representing 654 individual children. From the North and East Wards 1,268 visits were made by 414 mothers, an average attendance of three times each. From the South and West Wards 240 mothers made 960 visits, an average of four attendances each, the greatest number of attendances made by any one mother being fifteen. In conclusion, I wish to thank the Public Health Committee for their support and encouragement and my brother officers for their kind assistance and co-operation. I have the honour to be, Sir and Gentlemen, Your very obedient servant, GEORGE PADDOCK BATE TABLE I. Vital Statistics of Whole District during 1916 and Previous Years. Births. Nett Deaths belonging to the District. Year. 1 Total Deaths Registered in the District. Transferable Deaths. Under 1 Year of Age. At all Ages. Population estimated to Middle of each year. 2 Number. 6 Rate. 7 Number. 10 Rate per 1,000 Nett Births. 11 Rate. 13 Uncorrected Number. 3 Nett. Of Nonresidents registered in the District. 8 Of Residents not registered in the District. 9 Number. 4 Rate. 5 Number. 12 2,345 1,851 2,028 2,113 2,152 18.3 13.4 15.9 16.5 17.9 3,866 3,702 3,863 3,609 3,314 4,032 3,904 4,008 3,786 3,514 31.45 30.5 31.3 29.6 27.5 427 599 148.5 18.0 1911 128,247 391 2,316 1912 96.1 15.3 127,985 314 420 375 1,957 15.7 1913 470 117.5 127,824 2,001 411 400 16.0 1914 519 137.0 127,662 434 368 2,047 17.4 1915 120,207 502 441 415 118.0 2,091 27.4 15.5 15.3 1916 3,171 3,438 1,784 106.0 115,552 445 425 365 1,764 Area of District. 759 acres. At census of 1911 { Total P opulation ages), 128,282. (Total Families or Separate Occupiers, 27,755. TABLE II. Cases of Infectious Disease notified during the Year 1916. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Locality of the District. Cases Removed to Hospital. Deaths At all Ages. At Ages—Years. 1 and under 5 years. 5 and under 15 years. 25 and under 45 years. Under 1. 15 and under 25 years. 45 and under 65 years. 65 and upwards. N.E. Sub-dist. N.E. Sub-dist. S.W. Sub-dist. S.W. Sub-dist. No home. 383 13 162 181 19 6 2 ... 184 199 26 Diphtheria (including Membranous Croup) 197 178 167 10 29 53 41 90 ... Erysipelas 8 12 14 77 8 207 ... ... 171 ... Scarlet Fever Enteric Fever 395 10 149 18 10 ... 1 172 223 220 5 ... 1 2 5 5 4 8 19 2 ... 11 2 ... ... ... ... ... Puerperal Fever 16 ... 4 12 ... ... 4 12 4 11 6 ... Cerebro-spinal Meningitis 9 1 5 3 1 ... ... 9 19 10 10 Poliomyelitis ... ... ... 9 2 7 ... ... ... ... 6 3 1 ... ... ... ... Ophthalmia Neonatorum 34 ... 23 34 ... ... ... ... ... ... 11 ... ... ... Pulmonary Tuberculosis 78 193 0 165 87 9 381 5 37 ... 183 6 194 Other forms of Tuberculosis ... 101 15 6 50 15 9 5 1 ... 46 54 59 1,328 380 3 ... Measles 131 805 9 ... ... 918 410 145 34 19 ... German Measles 76 9 33 31 2 1 ... 28 48 ... ... ... ... ... 223 25 1,684 2,928 1,193 903 263 141 1,238 6 462 330 Totals 180 498 TABLE Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications received during the year 1916. 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 notifications by other doctors). Poor Law Institutions. Sanatoria. Total Notifications (i.e., including cases previously notified by other doctors). Primary Notifications. 10 to 15 Total 0 to 1 1 to 5 5 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 Under 5 5 to 10 Total ... 9 12 280 ... ... ... ... ... ... 2 5 3 10 ... 3 1 2 6 1 79 189 ... 5 6 5 16 40 2 50 3 75 4 7 17 45 ... 34 10 2 4 10 12 22 27 16 21 2 126 172 7 32 3 5 18 2 9 10 10 1 1 4 ... 43 59 5 ... ... 3 6 7 9 2 8 5 4 2 1 1 1 38 44 8 ... 32 32 44 75 71 62 22 6 396 6 20 26 555 35 *120 **117 All Notifications A = 555 B = 35 C = 237 D = 201 1,028 *Including 91 duplicate eases, Poor Law. ** „ 91 „ „ Sanatoria. m I ■ I I I I I I I I I I I I •I I i I I I I I I i I I I I I I I TABLE III. Causes of, and Ages at, Death during the Year 1916. Causes of Death. Nett Deaths at the subjoined ages of " Residents' whether occurring within or without 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 ... ... 2 Enteric Fever 2 Small Pox ... ... 19 5 7 6 1 Measles ... 5 1 2 Scarlet Fever 1 1 ... Whooping Cough 44 17 16 9 2 26 4 13 ... Diphtheria and Croup 3 5 ... 1 Influenza 10 1 2 2 5 Erysipelas 8 3 1 1 1 2 Phthisis (Pulmonary Tuberculosis) 194 31 1 13 72 69 8 Tuberculous Meningitis 28 6 9 4 5 4 5 2 2 Other Tuberculous Diseases Cancer, malignant disease 31 5 2 8 5 2 108 2 2 14 61 29 ... 6 Rheumatic Fever 1 1 2 1 1 39 Organic Heart Disease 212 1 5 13 64 90 185 23 4 3 3 10 51 91 Bronchitis 5 ... 3 21 Pneumonia (all forms) 186 49 29 16 33 30 Other Diseases of Respiratory Organs ... ... 22 10 2 3 5 2 Diarrhœa and Enteritis 73 67 6 ... 1 Appendicitis and Typhlitis 3 1 1 Cirrhosis of Liver 12 3 6 3 Alcoholism ... 49 ... Nephritis & Bright's Disease ... ... 6 23 20 6 Puerperal Fever 6 ... Other Accidents and Diseases of Pregnancy and Parturition 9 ... ... 9 Congenital Debility and Malformation, including Premature Birth 116 ... 115 1 2 Violent Deaths, excluding Suicide 66 17 7 6 5 5 7 17 Suicide 7 ... ... 1 1 5 256 7 11 6 36 78 Other Defined Diseases 37 9 72 Diseases ill-defined or unknown 81 3 9 1 1 12 55 Totals 1764 369 94 75 68 73 235 423 427 Sub-entries included in above figures : — Cerebro-spinal Meningitis 10 5 3 1 1 ... ... ... 1 Poliomyelitis 1 ... Diabetes 9 3 6 Pneumonia (other than Broncho-Pneumonia) 97 17 19 8 7 4 5 2 16 24 Septic Diseases, other than specified in above table 6 28 1 4 1 2 5 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE IV. Infantile Mortality during the Year 1916. 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. ... Small Pox ... ... ... Chicken Pox ... ... ... Measles ... 2 2 ... ... 1 Scarlet Fever ... ... ... ... ... Whooping Cough 4 3 7 3 ... ... Diphtheria and Croup ... ... ... 3 Erysipelas 1 1 2 ... ... 1 Cerebro-spinal Meningitis ... 3 3 ... ... 1 Tuberculous Meningitis ... 2 1 2 ... Abdominal Tuberculosis ... ... ... 1 ... 2 Other Tuberculosis Diseases 2 ... ... 1 ... 1 Meningitis (not tuberculous) ... ... 2 Convulsions 1 2 ... 3 2 3 ... 1 ... Laryngitis ... ... Bronchitis 1 1 3 5 4 11 ... 5 Pneumonia (all forms) 2 1 4 7 11 13 13 1 ... 1 5 Diarrhœa 1 8 16 3 Enteritis 1 ... 1 16 9 6 2 ... ... 1 1 ... Gastritis 1 1 Syphilis 2 2 4 1 3 Rickets ... 1 ... Suffocation (overlaying) 2 2 4 1 5 5 Injury at Birth 5 5 ... ... Atelectasis 1 9 1 6 2 1 ... 14 Congenital Malformations 11 2 1 ... 9 2 ... 1 Premature Birth 39 6 5 ... ... 50 5 1 ... 2 1 10 Atrophy, Debility & Marasmus 2 5 12 ... 1 Other Causes 3 4 1 ... 8 2 1 2 73 8 Totals 73 18 17 116 88 45 43 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE V. Showing the Number of Deaths from the Seven principal Zymotic Diseases, inclusive of Hospital Deaths in the 10 years 1906 to 1915 and in the year 1916. Disease. 1906. 1907. 1908. 1909. 1910. 1911. 1912. 1913. 1914. 1915. Annual Average of 10 yrs. 1906 to 1915. 1916. Measles 60 71 105 78 58 128 90 70 59 82 105 19 Scarlet Fever 39 25 9 17 43 2 7 22 6 3 11 5 20 20 Diphtheria 18 15 28 39 21 5 20 29 11 26 53 34 Whooping Cough 37 44 48 36 63 42 28 30 41 44 7 Fever 18 4 3 3 14 13 3 4 4 7 2 Diarrhœa (and Enteritis after 1910) under 2 years 59 117 90 128 43 230 173 152 102 48 145 73 Totals 331 251 330 182 322 285 169 254 416 330 186 252 TABLE VI. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES & HOMEWORK. I.—lnspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Factoeies (Including Factory Laundries) Workshops (Including Workshop Laundries) WORKPLACES (Other than Outworkers' premises included in Part 3 of this Report) Total Number of Inspections. Written Notices. Prosecutions. 200 18 ... 4,775 1,043 ... ... 1,595 130 6,570 1,191 ... 2.—Defects found in Factories, Workshops and Workplaces. Number of Defects. Number of Prosecutions. Particulars. Found. Remedied. Referred to H.M. Inspctr. ... ... ... ... ... ... ... ... Nuisances under the Public Health Acts: — Want of Cleanliness 355 355 ... 29 Want of ventilation 29 ... 3 3 Overcrowding ... 1 1 Want of drainage of floors ... Other nuisances 723 723 ... Sanitary accommodation insufficient unsuitable or defective not separate for sexes 4 4 ... 402 402 ... 4 4 ... Offences under the Factory and Workshop Acts: — » I Illegal occupation of underground bakehouse (s. 101) ... ... ... ... ... ... ... Breach of special sanitary requirements for bakehouses (ss. 97 to 100) ... ... ... ... 1,521 ... Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) ... 1,521 Total ... 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. Notices served on Occupiers as to keeping or sending lists. Instances. Notices served. Prosecutions. Instances. Orders made (Section 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Outworkers. Lists. Contractors. Work men. Contractors. Work men. 2 148 322 1558 21 8 573 ... 341 492 ... 4 ... ... Wearing Apparel—Making, &c... 1 139 ... 6 1 ... 10 ... 15 ... ... ... Curtains and furniture hangings 9 ... ... ... ... ... 2 6 ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... 2 4 ... ... 3 Cables and chains ... ... ... 2 ... ... ... ... ... 4 ... 17 1 ... 3 ... ... Umbrellas, &c ... 6 6 ... ... ... ... ... 30 643 ... ... 160 ... ... ... Paper, &c., boxes, paper bags ... ... 121 ... ... ... ... 8 ... Brush making ... 159 489 ... ... ... ... ... 138 ... ... ... ... ... Basket making ... 1 ... 1 ... ... ... ... ... ... ... ... 617 ... ... ... ... Textile weaving ... 2 20 ... ... ... ... ... ... ... 1 ... ... ... Total 587 4 202 2876 8 835 322 24 ... 2 ... ... ... 4.—Registered Workshops. Number, Workshops on the Register (s. 131) at the end of the year. Factories (Including Factory Laundries) 92 Workshops (Including Workshop Laundries) 2,095 Workplaces (Bakehouses and Food Premises) 334 Total Number of Workshops on Register 2,521 5. —Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories : — Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) 19 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Wdlkshop Acts (s. 5, 1901). I Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspector 63 63 Other 4 Underground Bakehouses (s. 101) in use at the end of the year 23