AC 4366 BET 22 THE Metropolitan Borough of Bethnal Green. REPORT on the SANITARY CONDITION and VITAL STATISTICS DURING THE YEAR 1919. BY GEOFFREY EUGENE OATES, M.D., B.S. (London), M.R.C.P. (London), D.P.H. (Cambridge); Barrister-at-Law, of the Honourable Society of Gray's Inn; Lieutenant (late R.A.M.C.); Fellow of the Royal Society of Medicine; Fellow of the Royal Institute of Public Health: Fellow of the Society of Medical Officers of Health; Fellow of the Zoological Society; Member of the Royal Sanitary Institute; and Medical Officer of Health and Administrative Tuberculosis Officer for the Metropolitan Borough of Bethnal Green. LONDON: Printed by J. S. Forsaith & Son, 329, Bethnal Green Road. E. 2. 1920. 65900 Public Health Department, Town Hall, Bethnal Green, E. 2. May, 1920 To the Mayor, the Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Ladies and Gentlemen, I have the honour to present to you the Annual Report for 1919, on the Health of the Metropolitan Borough of Bethnal Green. I only took up my office on September 15th, when I succeeded Dr. G.P. Bate. Although this report emanates from myself, I was only responsible for the Health of the Borough for the latter portion of the year, and for the condition of the Borough in the earlier part of the year I have had to rely on figures collected and information given me by Dr. G. P. Bate. Many important matters are only touched on in this report, but I hope in my report for 1920 to make a detailed examination of all branches of public health work in the light of the fuller experience of conditions in the Borough which I shall have gained by then. Owing to the heavy cost that must be entailed in printing this Report it has been condensed as much as possible, and only essential information has been included. In conclusion, I should like to express my thanks to members of the Council, and especially the Public Health Committee, for the kindly consideration they have shown me during the period in which I was taking up my new duties. I must also tender my thanks for the support I have received from my brother officers both in the Public Health and other departments. I am, Ladies and Gentlemen, Your obedient Servant, GEOFFREY EUGENE OATES, Medical Officer of Health. Metropolitan Borough of Bethnal Green. PUBLIC HEALTH COMMITTEE, 1919-20. Meetings held at the TOWN HALL on the first and third Wednesdays, at 7 p.m. Councillor F. W. Wright, Chairman. Councillor J. G. Bayles, Vice-Chairman. The Mayor. Alderman T. J. Boyce. Alderman Mrs. Glinnan. Councillor G. Bayley. Councillor T. Brooks. „ H. Fitt. „ A. H. Gillison. „ Miss James. „ E. C. E. Lear. „ W. J. Lewis. „ Rev. G. E. A. Whitworth, M.A. Ex-Officio Members of the Public Health Committee (Chairmen of Standing Committees of the Council). COMMITTEE. CHAIRMAN. Finance Councillor B. Gray. Works and Stores „ J. W. Martin. Law and General Purposes „ C. I. Breslaw. Baths ,, D. J. Pickering. Electricity „ J. J. Cunningham. Valuation „ J. J. Valentine. The Chairman of the Public Libraries Committee is an ordinary member of the Public Health Committee. The Public Health Committee is also the Statutory Committee to which all matters relating to Maternity and Child Welfare stand referred. 3 PUBLIC HEALTH DEPARTMENT. STAFF. Geoffrey Eugene Oates, M.D., M.R.C.P. Londou, D.P.H. Cambridge, Barrister-at-Law, Medical Officer of Health and Administrative Tuberculosis Officer. *John Foot Chief Sanitary Inspector. Alfred W. Stokes, F.C.S., F.I.C., Public Analyst. Sanitary Inspectors. E. Ainley. J. H. Hewitt (Acting). F. T. Bare. J. E. Jones. W. Billings, Junr. E. Richards. G. I. Brighting (Acting). W. Bowsell. **A. S. Henley. ***J. O. G. Weeks. Health Visitors. M. A. Hodgkins (Mrs.). F. M. Barden (Mrs.). E. S. Crisp (Miss), Tuberculosis. A. W. Rosliug (Mrs.). E. Q. Bilham, Chief Clerk. F. G. Thomas, 2nd Assistant Clerk. ***H. A. Saunders, 3rd ,, H. W. Pendrill, 4th ,, W. H. Heron, Junior Clerk. S. Slater, Office Youth. TEMPORARY STAFF. M. Radford (Mrs.), Medical Officer (Maternity and Child Welfare Centre). V. Cornish (Miss), Health Visitor. J. Godwin, Asst. Clerk (General). C. Lane (Miss), „ (General). A. Norris (Mrs.), ,, (Fuel Control). E. Packman (Miss), ,, (Maternity and Child Welfare, and Tuberculosis). M. Rolfe (Mrs.), „ (Fuel Control). *Also Fuel Overseer. **Also Assistant Fuel Overseer. ***Acting as Food Control Officers. 4 PUBLIC HEALTH DEPARTMENT. STAFF. CHANGES IN 1919. Medical Officer of Health. Dr. G. P. Bate, resigned and retired as from 26th October, 1919. Dr. G. E. Oates, appointed 3rd July, 1919. Commenced duty 15 th September, 1919. Assistant Medical Officer of Health. Dr. J. R. Murray, resigned and retired as from 11th April, 1919. During April and May Dr. M. Ross attended the infant consultations as a part-time officer, and she was succeeded in May by Dr. M. A. Radford. Sanitary Inspectors. Mr. W. Billings returned from active service with H.M. Forces, and resumed duty on the 15th February. Mr. G. I. Brighting, 1st Assistant Clerk, acting Chief Clerk, appointed temporary Sanitary Inspector 5th June. Clerical Staff. Mr. E. Q. Bilham, Chief Clerk, returned to duty from service as Chief Clerk of the Food Control Office, 26th December. Mr. F. G. Thomas, 2nd Assistant Clerk, returned from active service with H.M. Forces, and resumed duty on the 10th February. Mr. H. W. Pendrill, 3rd Assistant Clerk, returned from active service with H.M. Forces, and resumed duty on the 13th March. Mr. W. H. Heron, 4th Assistant Clerk, returned from active service with H.M. Forces, and resumed duty on the 23rd April, 1919. Mr. S. Slater was appointed to be Office Youth. Health Visitors. Mrs. E. A. Gapper, resigned as from 5th April, on re-marriage. Position not permanently filled, but Miss V. D. Cornish was appointed temporarily, pending reorganisation of Maternity and Child Welfare work. 5 TABLE I. Vital Statistics of Whole District during 1919 and Previous Years. Year. Population estimated to Middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Under 1 Year of Age. At all Ages. Uncorrected Number. Nett. Number. Rate. Of Nonresidents registered in the District. Of Residents not registered in the District. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1916 115,552 3,171 3,438 27.4 1,784 15.5 445 425 365 106.0 1,764 15.3 1917 107,362 2,409 2,710 22.6 1,665 15.5 425 435 299 110.3 1,675 15.6 1918 103,403 1,761 2,220 19.2 2,331 22.5 384 542 289 130.2 2,488 24.1 1919 110,085 2,242 2,564 22.4 1,517 13.8 366 412 218 85.0 1,563 14.2 6 7 TABLE III. Deaths registered during the Calendar Year 1919, classified by age and cause. Causes of death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District (a). Total Deaths whether of "Residents" or "NonResidents" in Intitutions in the District (b). All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. l 2 3 4 5 6 7 8 9 10 11 All causes Certified (c) 1563 218 39 85 87 76 235 404 419 870 Uncertified ... ... ... ... ... ... ... ... ... ... 1. Enteric Fever 1 ... ... ... ... ... 1 ... ... 1 2. Small Pox ... ... ... ... ... ... ... ... ... ... 3. Measles 12 5 3 3 1 ... ... ... ... 8 4. Scarlet Fever 4 ... ... 2 2 ... ... ... ... ... 5. Whooping Cough 7 3 ... 4 ... ... ... ... ... 8 6. Diphtheria and Croup 58 1 6 32 17 1 1 ... ... 2 7. Influenza 83 2 1 2 2 18 27 20 11 26 8. Erysipelas 5 ... ... ... ... ... ... 3 2 7 9. Phthisis (Pulmonary Tuberculosis) 185 ... 1 5 12 25 67 66 9 131 10. Tuberculous Meningitis 15 2 3 3 5 2 ... ... ... 21 11. Other Tuberculous Diseases 16 2 ... 4 2 1 4 2 1 9 12. Cancer, malignant disease 120 ... ... ... 1 ... 16 55 48 54 13. Rheumatic Fever 8 ... ... ... 3 1 1 2 1 3 14. Meningitis (See note (d) 7 4 ... ... 1 ... 2 ... ... 8 15. Organic Heart Disease 137 ... ... ... 7 2 20 47 61 86 16. Bronchitis 208 7 2 ... 1 2 16 70 110 104 17. Pneumonia (all forms) 117 24 8 8 6 5 17 31 18 48 18. Other diseases of respiratory organs 26 3 1 1 ... 1 5 7 8 21 19. Diarrhœa and Enteritis (See note (e) 66 56 8 1 1 ... ... ... ... 79 20. Appendicitis and Typhlitis 5 ... ... 3 2 ... ... ... ... 5 21. Cirrhosis of Liver 6 ... ... ... 1 ... ... 2 3 1 2lA. Alcoholism 1 ... ... ... ... ... 1 ... ... ... 22 Nephritis and Bright's Disease 30 ... ... ... ... ... 3 15 12 11 23. Puerperal Fever 3 ... ... ... ... ... 3 ... ... ... 24. Other accidents and diseases of Pregnancy and Parturition 6 ... ... ... ... 2 4 ... ... 1 25. Congenital Debility and Malformation, including Premature Birth 69 67 1 ... ... ... 1 ... ... 43 26. Violent Deaths, excluding Suicide 48 3 1 6 8 4 10 9 7 16 27. Suicide. 13 ... ... ... ... 1 4 4 4 2 28. Other Defined Diseases. 306 39 4 11 15 11 32 70 124 175 29. Diseases ill-defined or unknown ... ... ... ... ... ... ... 1 ... ... Totals 1563 218 39 85 87 76 235 404 419 870 NOTES TO TABLE III. The Classification and numbering of Causes of Death are those of the "Short List" on page XXV. of the Manual of the International List of Causes of Death. (а) All " Transferable Deaths " of residents, i.e., of persons resident in the District who have died outside it, are included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. The total deaths in column 2 of Table III. equal the figures for the year in column 12 of Table I. (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or non-residents, are entered in the last column of Table III. (c) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as "Certified "; all other deaths are regarded as "Uncertified." (d) Exclusive of "Tuberculous Meningitis" (10), but inclusive of Cerebro-spinal Meningitis. (e) Title 19 has been used for deaths from Diarrhœa and Enteritis at all ages. (In the "Short List" deaths from Diarrhœa and Enteritis under 2 years are included under Title 19; those at 2 years and over being placed under Title 28). N.B.—Deaths of soldiers and sailors occurring in hospitals and institutions in the district are excluded from the total number of deaths registered in the district, and such deaths are in like manner excluded from column 11 of Table III. 8 POPULATION. The population of this Borough for the middle of 1919 is estimated by the Registrar-General at 110,085 persons. This figure differs considerably from the figure obtained at the last Census in 1911, viz., 128,183. None the less, it is a trustworthy estimate, as it is founded on information from the local Food Office, and based on the number of ration cards in use. For the purpose of calculating the birth-rate, one must include those men serving in the forces of the Crown, and the population for calculating birth rate is estimated at 114,676 persons. Even allowing for the continued absence of men in the forces, there has been a decrease in population since the last Census. Further comment is made on this phenomenon in the Housing Section of this Report; but briefly the following factors must be taken into consideration, the relative importance of each factor being a matter of some doubt:— (a) Decrease of population owing to conversion of dwelling houses to industrial purposes. (b) Men on active service killed and missing. (c) Spacing out of population owing to better standard of living and consequent decrease in overcrowding. (d) Decreased birth rate. MARRIAGES. The number of marriages celebrated in Bethnal Green during 1919 was 1,059 (including marriages of sailors and soldiers). This is equal to a rate of 18.5 per 1,000 total population. 9 BIRTHS. The number of births registered in the Borough during 1919 was 2,242, and in addition 322 births occurred outside the Borough to Bethnal Green residents in excess of those occurring in Bethnal Green to residents of other localities, making a total of 2,564 births. The birth rate for 1919 was therefore 22·4 births per 1,000 of population. This compares with— 1914 29·6 1915 27·5 1916 27·4 1917 22·6 1918 19·2 It will be seen that in the first year of peace the birth rate showed signs of recovery, but was still much below the rate for 1914, which was the last normal year. During the last two quarters of the year the birth rate showed signs of increase, the rate for each quarter being— First quarter 16·2 Second „ 15·1 Third „ 29·1 Fourth „ 28·8 There is every sign that the number of births in 1920 will be much increased, and will tend towards the pre-war level. ILLEGITIMACY. Of the 2,564 births credited to this Borough, 67 were illegitimate, or 2·6 per cent. of the total. This is a very low figure. 10 DEATHS, Deaths of members of His Majesty's Forces are not included in the following figures. The number of deaths of civilians that were registered during the year as having taken place in the Borough was 1517. Of these, 366 were of persons whose residence was not in Bethnal Green, 353 dying in Bethnal Green institutions and 13 in other places in the Borough. There were also reported to the Registrar-General 395 deaths of Bethnal Green persons who died in institutions in other parts of London, and 17 who died in other parts of England and Wales. This correction gives the net number of civil deaths for Bethnal Green as 1,563, making an annual death rate of 14·20 per 1,000 of civil population. Death rates of previous years are— 1913 15·7 1914 16·0 1915 17·4 1916 15·3 1917 15·6 1918 24·1 (influenza pandemic) There were no uncertified deaths during the year. SMALL-POX. One case of Small-pox was notified in July. The patient was a youth of 17, who had been vaccinated in infancy. He was removed to an isolation 11 hospital and recovered. It appears that the infection was contracted at Gravesend, where other cases had occurred. Four contacts with Small-pox were reported, and were kept under close observation. None of the contacts developed Small-pox. Three of these persons had been in contact with the disease on an incoming vessel, and one by association with a case of Small-pox in another metropolitan borough. TYPHOID FEVER. Four cases were notified. In no case was it possible to ascertain the source of infection. TYPHUS FEVER. Only one case of this disease was notified. The patient was a Polish Jew, aged 30, a cabinet maker by trade. On September 25th he complained of loss of appetite and pain in the front of the chest, followed by shivering, sweating and headache. On the 26th he was admitted to the London Hospital. He died on the 28th. Clinical Features.—Temperature 104° or more. Respirations increased, but no dyspnoea or cyanosis. Soft systolic murmur over cardiac region. Spleen palpable. No rash. Blood culture sterile. Lost consciousness and died comatose. Post-mortem Findings.—About a dozen bright red patechiæ were seen on the skin of the right hypochondrium, and a few just above the left anterior superior 12 spine. Large haemorrhage in the right frontal lobe of the brain. Very great oedema and congestion of the lungs. Diffuse hæmorrhagic conditions were found in almost every part of the body. The post-mortem diagnosis was hæmorrhagic septicaemia, probably typhus fever. There was no evidence available as to how the patient could have contracted the infection of typhus fever. The home was clean, and no body-lice were present in the bedding or clothing of the patient and his family. No further case occurred. Summing up the facts, I am of opinion that this case was not one of typhus fever, but a hæmorrhagic septicœmia of unknown toxic origin. 13 Cases of Notifiable Diseases Notified during the Year 1919. disease. Number of Cases Notified. All Ages. At Ages—Years. Under 1. 1 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. Small Pox 1 ... ... ... 1 ... ... ... Cholera (C) Plague (P) ... ... ... ... ... ... ... ... Diphtheria (including Membraneous Croup) 552 12 205 286 33 15 1 ... Erysipelas 164 6 12 33 18 41 43 11 Scarlet Fever 393 9 127 230 23 4 ... ... Typhus Fever 1 ... ... ... ... 1 ... ... Enteric Fever 4 ... 1 ... 2 1 ... ... Relapsing Fever (R) Continued Fever (C) ... ... ... ... ... ... ... ... Puerperal Fever 9 ... ... ... 1 8 ... ... Cerebro-spinal Fever 3 3 ... ... ... ... ... ... Acute Poliomyelitis 2 ... 1 1 ... ... ... ... Encephalitis Lethargica 6 1 ... 3 1 ... 1 ... Ophthalmia Neonatorum 31 31 ... ... ... ... ... ... Measles 469 45 250 167 6 1 ... ... German Measles 57 3 19 33 1 1 ... ... *Chicken Pox 65 2 31 29 2 1 ... ... Pulmonary Tuberculosis 254 ... 6 29 54 91 61 13 Other forms of Tuberculosis 65 1 13 29 11 11 ... ... Total 2,076 113 665 840 153 175 106 24 *Chicken Pox was only notifiable from the 14th June to 14th July, and the 2nd August to 2nd September. 14 DIPHTHERIA (Including Membraneous Croup). There were 552 cases of Diphtheria notified during the year among civilians, and 8 cases in service men. Of the 552 cases there were 12 cases under the age of one year, 205 cases between the ages of 1 and 5 years, 286 cases between the ages of 5 and 15 years, 33 cases between the ages of 15 and 25 years, 15 cases between the ages of 25 and 45, and 1 case over 45 years of age. Of the 552 cases 531 were removed to an Isolation Hospital. Fifty-eight deaths from this disease occurred during the year, 55 of which took place at hospitals. Comparison with previous years is as follows:— 1914 28 deaths 1915 39 „ 1916 26 „ 1917 19 „ 1918 26 „ Considerable difficulty was experienced during the autumn months in obtaining prompt removal of cases notified. In really urgent cases removal was generally effected forthwith, but in other cases there was often a delay of anything from a few hours to several days. SCARLET FEVER. There were 393 cases of Scarlet Fever notified during the year among civilians and 1 case in a soldier. Of the 393 cases there were 9 cases under the age of one year, 127 cases between the ages of 1 and 15 5 years, 230 cases between the ages of 5 and 15 years, 23 cases between the ages of 15 and 25 years and 4 cases between the ages of 25 and 45 years. Of the 393 cases 379 were removed to an Isolation Hospital. In the earlier part of the year there was but little Scarlet Fever about, but the disease became somewhat more prevalent in the autumn and winter. Four deaths occurred from Scarlet Fever during the year, 3 of which number took place at hospitals. Comparison with previous years is as follows:— 1914 7 deaths 1915 11 „ 1916 5 „ 1917 3 „ 1918 9 „ As in the case of Diphtheria, considerable difficulty was experienced in obtaining the prompt removal of cases notified during the last four months of the year. MALARIA. This disease became notifiable on March 1st. During the year 158 cases were notified, and 6 cases in addition were brought informally to my notice. Every patient was found to be an ex-Service man, and in no case was it considered likely that the infection had been contracted in the British Islands. As a rule patients were found to be receiving proper treatment, and in no case was it found necessary to do anything more for the patient beyond the giving of advice. 16 TRENCH FEVER. This disease became notifiable on March 1st. No case was notified. I have no doubt, however, that some ex-Service men in the Borough are still suffering from the disease contracted overseas. The effects of the disease last a long time, and are likely to be overlooked by a medical practitioner who has not had special military experience. The disease in the Army was found to be communicated from man to man through the agency of body-lice. Although families infested with body-lice are brought to my notice from time to time, there is no reason to suppose that Trench Fever will spread amongst the civil community. PUERPERAL FEVER. Nine cases were notified, all of which were removed to an institution. Three of the cases died. OPHTHALMIA NEONATORUM. Thirty-two cases of purulent eye discharge in the newly-born were notified to me, 31 by doctors and 1 by a midwife. The results were as follows:— Completely cured 26 Diagnosis changed 2 No information available 2 Died 2 These results are satisfactory, and if the present standard of care for the eyes of the newly-born is maintained, considerably less blindness should ensue in later life. \ 17 ENCEPHALITIS LETHARGICA. Six cases of this obscure and "new" disease were notified, but in only two or three cases was the disease present, the other cases being mistaken in diagnosis. INFANTILE MORTALITY. 218 deaths of Bethnal Green infants under one year of age took place during the year. This is equal to a rate of infantile mortality of 85 per 1,000 births. Comparison with previous years is as follows:— 1913 117.5 1914 137.0 1915 118.0 1916 106.0 1917 110.3 1918 130.2 Owing to a great increase in the birth rate in the latter half of the year, the above figure of 85 while statistically correct is rather too low if taken as an index of infantile healthiness. Of the 218 deaths, 50 were due to Prematurity and 58 were due to Diarrhoea and Enteritis. Only 5 deaths were certified as being due to Measles, although some of the 30 deaths ascribed to Bronchitis or Pneumonia were probably secondary to Measles. 18 Infantile Mortality 1919. Deaths from stated causes at various ages under One Year. 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. All Causes— Certified 52 17 11 11 91 38 36 27 26 218 Uncertified ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 1 3 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 1 2 3 Diphtheria and Croup ... ... ... ... ... ... ... 1 ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 1 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... 1 ... 1 ... 2 Meningitis (not tuberculous) ... ... 1 ... 1 ... 2 ... 1 4 Convulsions 5 ... ... ... 5 1 1 1 ... 8 Laryngitis ... ... ... ... ... ... ... ... 1 1 Bronchitis ... ... ... ... ... 4 ... 1 2 7 Pneumonia (all forms) ... 2 ... 1 3 5 4 5 6 23 Diarrhœa ... 1 ... ... 1 1 3 ... 2 7 Enteritis ... 1 1 3 5 10 17 12 7 51 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis 1 ... 3 ... 4 2 1 ... ... 7 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation (overlying) ... ... ... ... ... 1 ... ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 5 2 ... ... 7 ... ... ... ... 7 Congenital Malformations 1 1 ... ... 2 3 1 ... ... 6 Premature Birth 34 5 6 2 46 3 1 ... ... 50 Atrophy, Debility & Marasmus ... 4 ... 3 7 3 1 ... ... 11 Other Causes 5 1 1 2 9 4 4 3 1 21 Totals 52 17 11 11 91 38 36 27 26 218 19 MATERNITY AND CHILD WELFARE CENTRE, 505, HACKNEY ROAD. During the year 2,736 attendances of infants were recorded at the Centre. 204 new cases were brought to the Centre during the year. The Medical Officer in charge saw 2,260 of the infants, and held 162 ante-natal and other consultations with expectant and nursing mothers. 1,341 applications for assistance on the ground of necessitous circumstances were dealt with during the year. VOLUNTARY CHILD WELFARE CENTRES. There were three Voluntary Centres working during the year at 49, Green Street, 26, Preston Street, and at the King Edward Institution, Albert Street, Spitalfields. Negotiations were in progress at the end of the year with a view to the Council taking over control and management of these Centres. SUPPLY OF FOOD. Considerable use was made of the Council's Centre at 505, Hackney Road, for the distribution of food to mothers and infants. The following was sold at cost price:— Dried Milk 4,119 lbs. Condensed Milk 264 tins. 20 The following amount was distributed free to necessitous cases:— Fresh Milk 1,073 gals. Dried Milk 1,680 lbs. Condensed Milk 271 tins. together with drugs, etc. The cost of fresh milk, food and drugs given to necessitous cases was £376 8s. 11½d. Each necessitous case was carefully investigated before assistance was given, and the usual amount given was 2 lbs. of dried milk per week to each case. SUMMARY OF VISITS PAID BY HEALTH VISITORS DURING 1919. Births (first visits) 2,874 ,, (re-visits) 8,245 Ophthalmia Neonatorum 99 Puerperal Fever 11 Measles 985 Diarrhœa 5 School Complaints 832 Special Matters 627 Futile Visits 661 Tuberculosis 3,194 Total Visits Paid 17,538 21 TUBERCULOSIS. The number of notifications of cases of Tuberculosis received during the year is set out in the Table appended hereto. Owing to duplicate notifications of cases, no deductions of much value can be drawn from the number of notifications. There were 185 deaths from Pulmonary Tuberculosis, 15 deaths from Tuberculous Meningitis, and 16 deaths from other Tuberculous diseases. SOLDIERS AND SAILORS SUFFERING FROM TUBERCULOSIS. 119 cases of ex-Service men were registered during the year. There were 8 deaths amongst these, and 4 removed. 274 visits were paid to these men by the Tuberculosis Health Visitor. WORK OF TUBERCULOSIS HEALTH VISITOR. This Officer paid 3,194 visits to cases. 22 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications received during the Year, 1919. Primary Notifications (1). Total. Cases re-notified. Total Notifications on Form A. Primary Notifications by School Medical Inspectors. Cases re-notified. Total Notifications on Form B. Years. Years. 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 10 to 15 Tuberculosis of Lungs— Male ... 4 5 5 17 11 19 27 22 22 6 138 42 180 1 4 ... 5 10 Female ... 1 4 10 13 13 22 23 13 4 7 110 32 142 ... 1 ... 1 2 Tuberculosis (other parts) Male ... 7 7 4 4 2 4 ... ... ... ... 28 14 42 ... 3 1 10 14 Female 1 6 5 7 3 2 5 2 ... ... ... 31 3 34 ... 1 1 6 8 (1) These are all new cases to Bethnal Green, but have sometimes been already notified in other Districts. 23 No. of Notifications on Form C. Poor Law Institutions. Sanatoria. Pulmonary Tuberculosis— Male 21 89 Female 17 38 Non-Pulmonary Tuberculosis— Male 9 3 Female 4 4 No. of Notifications on Form D. Poor Law Institutions. Sanatoria. Pulmonary Tuberculosis— Male 43 68 Female 42 32 Non-Pulmonary Tuberculosis— Male 6 3 Female 4 7 TUBERCULOSIS DISPENSARY. The arrangement whereby the Dispensary is provided by the Governors of the City of London Hospital for Diseases of the Chest continued in force throughout the year. Dr. G. T. Hebert was in charge of both Hackney and Bethnal Green patients at the commencement of the year, but later on he was entirely in charge of Bethnal Green patients. 24 The statistical tables given below are self-explanatory and need few remarks. 1. The Totals of New Cases. Males 388 Females 349 Total 737 2. The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 156 47 Local Practitioners 146 60 London War Pensions Committee 62 20 Contact Cases 157 5 London Insurance Committee 24 16 London County Council 30 3 Victoria Park Hospital 32 27 Other Sources 23 10 "No Card" 107 5 3. The Diagnosis of the New Cases. Diagnosis. Insured. Uninsured. Total. Males. Females. Children under 16. Males. Females. Pulmonary Tuberculosis 94 27 6 16 25 168 Non-Pulmonary Tuberculosis 9 3 12 1 ... 25 Non-Tuberculous 111 44 180 21 102 458 Doubtful 27 18 28 1 12 86 Totals 241 92 226 39 139 737 25 4. The Diagnosis of Contact Cases. Pulmonary Tuberculosis 3 Non-Pulmonary Tuberculosis 2 Non-Tuberculous 135 Doubtful 17 Total 157 5. Sputum Examinations of Insured and Uninsured Patients. Insured. Uninsured. Total. Tubercle Bacilli present 71 21 92 Tubercle Bacilli absent 226 137 363 6. Other Figures. Insured. Uninsured. Total number of Attendances 2,273 2,285 Systematic examinations at the above 693 643 Number of letters written 1,220 Number of visits to Patients at their Homes 26 10 Number of Patients sent to Hospital or Sanatorium 107 17 Number of Patients referred to— X-ray Department 27 13 Other Departments 25 18 26 BACTERIOLOGICAL EXAMINATIONS. The following examinations were carried out by the Clinical Research Association:— Swabs—submitted for examination 291 Diphtheria bacilli present in 87 Sputum—Specimens submitted for examination 121 Tubercle bacilli present in 28 Blood serum—Specimens examined 2 Both of these gave a negative Widal result to Typhoid Fever. Faeces—1 specimen submitted—Lamblia cysts present. In addition to the above, 11 samples of milk were examined bacteriologically. CUSTOMS AND INLAND REVENUE ACTS. Applications for Exemption from Inhabited House Duty. No applications for certificates under these Acts were received during the year 1919. MILKSHOPS AND DAIRIES. Two applications for registration under the Dairies, Cowsheds and Milkshops Orders were considered during 1919, and were acceded to. 27 The figures in regard to registration of Milkshops are set out below:— Number of purveyors of milk at retail milkshops on register at end of 1918 215 Deduct number of purveyors removed from register during 1919 27 Add number of purveyors added to register by resolution of the Public Health Committee during 1919 2 Number of purveyors of milk at retail milkshops on register at end of 1919 190 During the year 835 inspections of milkshops were made by the Inspectors, and 167 notices were served under the Public Health (London) Act, 1891. Legal Proceedings.—No prosecutions were undertaken under the Dairies, Cowsheds and Milkshops Orders of 1885 and 1886. ICE CREAM PREMISES. 137 visits were paid to these premises by the District Inspectors during 1919. No legal proceedings were taken in respect of the manufacture or sale of ice cream. FRIED FISH AND FISH CURING PREMISES. At the end of 1919 there were 43 fried fish vendors' premises in the Borough, at one of which fish 28 curing was also carried on. There were 19 fish curers premises, including this one. 445 visits were made by the Food Inspector to these premises. SMOKE PREVENTION. During the year 20 observations of smoke shafts were made. There were no prosecutions. REGULATED TRADES. Offensive Trades.—There is only one licensed premises for such trades in Bethnal Green, viz., a tripe dresser's in Bethnal Green Road. Five visits were paid to these premises. No legal proceedings were taken during the year. UNSOUND FOOD. Public Health (London) Act, 1891, Section 47. The Food Inspector has kept under regular inspection food exposed or deposited for sale in slaughter houses, shops (especially butchers', cooked meat and fishmongers' shops), stalls, and market places. Four seizures of unsound food have been made during 1919, as follows:— Date. Owner. Description of Article. Prosecution and Result. 30th May. A. Y. 140 lbs. Whiting Fined £5. Committed to prison in default. 27th July. S. G. 32 lbs. Cherries Fined 18s. Costs £2 2s. 6th Sept. R. C. 52 lbs. Pears Fined £2. 14th Sept. N. L. 32 lbs. Fears Fined £4. Costs £1 1s. 29 On 78 occasions during the year unsound food has been surrendered by the owners to the Food Inspector, and destroyed as trade refuse. DAIRIES, COWSHEDS AND MILKSHOPS. Cowsheds.—There were at the end of 1919 twelve licensed cowsheds in the Borough as in the previous year. They have been kept under inspection by the Inspectors, 74 inspections having been made during the year. Milkshops and Dairies are dealt with on pages 26 and 27. SLAUGHTER HOUSES. There were 3 licensed slaughter houses in the Borough at the end of 1919. Eighteen visits were made to slaughter houses by the Food Inspector during the year. RAG FLOCK ACT, 1911. No samples were taken under this Act during 1919. 30 SALE OF FOOD AND DRUGS ACTS. 610 samples were taken and examined. 523 of these proved to be genuine, and 87, or 16.6 per cent., adulterated. The details are given in the following table. Summary of Analyst's Reports. Article. Samples taken formally. Samples taken informally. Total number of samples taken. No, taken. Genuine. Adulterated. No. taken. Genuine. Adulterated. Milk 267 261 6 83 38 45 350 Vinegar 78 60 18 8 5 3 86 Bread ... ... ... 22 22 ... 22 Camphorated Oil 9 6 3 12 6 6 21 Tea 1 1 ... 13 10 3 14 Butter 6 6 ... 8 8 ... 14 Margarine 13 13 ... ... ... ... 13 Glycerine 13 13 ... ... ... ... 13 Dripping 6 6 ... 6 6 ... 12 Mustard 9 9 ... ... ... ... 9 Coffee 6 6 ... 2 2 ... 8 Olive Oil 6 6 ... 1 1 ... 7 Cornflour 6 6 ... ... ... ... 6 Pepper 5 5 ... ... ... ... 5 Flour 2 2 ... 4 4 ... 6 Chocolate Cream ... ... ... 3 3 ... 3 Castor Oil 3 3 ... ... ... ... 3 Arrowroot 3 3 ... ... ... ... 3 Cocoa 2 2 ... 1 1 ... 3 Cotton Seed Oil ... ... ... 3 l 2 3 Jam 2 2 ... ... ... ... 2 Quinine and Iron ... ... ... 2 1 ... 2 Cod Liver Oil and Malt ••• ... ... 2 2 ... 2 Liquorice Powder ... ... ... 1 1 ... 1 Condensed Milk 1 1 ... ... ... ... 1 Raspberry Flavour Jam ... ... ... 1 1 ... 1 438 411. 27 172 112 60 610 Prosecutions were instituted in respect of the 27 formal samples which were reported to be adulterated. These are set forth in the following table. 31 Administrative Action regarding Samples not reported to be genuine. Name of Article. Identification Number given to the Sample. Result of Analysis. If any legal proceedings were instituted under the Sale of food and Drugs Acts, state result, showing fines and costs separately. If any legal proceedings were taken under Acts other than Sale of food & Drugs Acts, state the result, showing fines and costs separately. If no legal proceedings were instituted, state briefly the course adopted in regard to each sample. Information, if any, as to previous convictions. Remarks on any point of special interest. 1. 2. 3. 4. 5. 6. 7. 8. Milk No. 41 Contained 25 per cent. of added water. Pined £100, costs, £5 5s. ... ... 22nd June, 1905. Pined £2, including costs, for selling milk 17 per cent. deficient in fat. ... ,, ,, 42 Contained 12 per cent. of added water. Pined £100, costs, £5 5s. ... ... 8th January, 1907. Pined £4, for selling milk 14 per cent. deficient in fat. 15th August, 1911. Pined £3, costs £1 3s., for selling milk containing 8 per cent of added water. 16th May, 1912. Fined £5, costs £3 3s., on three summonses, for selling milk 7 per cent., 8 per cent. and 11 per cent. deficient in fat. 2nd September, 1915. Fined £50 on each of two summonses, for selling milk 18 per cent. and 13½ per cent. deficient in fat. ... 32 Administrative Action regarding Samples not reported to be genuine.—Continued. Name of Article. Identification Number given to the Sample. Result of Analysis. If any legal proceedings were instituted under the Sale of Food and Drugs Acts, state result, showing fines and costs separately. If any legal proceedings were taken under Acts other than Sale of Food & Drugs Acts, state the result, showing fines and costs separately. If no legal proceedings were instituted, state briefly the course adopted in regard to each sample. Information, if any, as to previous convictions. Remarks on any point of special interest. 1. 2. 3. 4. 5. 6. 7 8. Milk No. 514 Contained 9 per cent. of added water. Dismissed. ... ... ... Farmer's warranty proved. Vinegar „ 72 Contained 33 per cent. of added water. Vendor fined £1. ... ... ... ... „ „ 82 Contained 14 per cent, of added water. Vendor paid costs, 5s. ... ... 30th August, 1917. Fined 10s., for selling vinegar containing 33½ per cent, of added water. ... Milk ,, 156 Found to be 40 per cent. deficient in fat. Vendor paid £2 2s. costs. ... ... ... ... „ ,, 194 Found to be 36 per cent. deficient in fat. Vendor fined £5, costs, £3 3s. ... ... ... ... 33 Milk No. 561 Pound to be 5 per cent. deficient in fat. Dismissed. ... ... 6th July, 1916. Fined £2, for selling milk containing 5 per cent. of added water. Magistrate satisfied milk was sold as it came from the cow. Vinegar „ 154 Contained 23 per cent. of added water. Dismissed. ... ... 28th January, 1908. Fined £2, for selling milk containing 10 per cent. of added water. 4th February, 1908. Fined £4, for selling butter containing 55 per cent. of foreign fat. 8th December, 1908. Fined £8, for selling milk 26 per cent. deficient in fat. 30th August, 1917. Fined £1, for selling vinegar 65 per cent. deficient in acetic acid. Warranty proved. Vinegar No. 163 Contained 37 per cent. of added water. Dismissed ... ... ... Warranty proved ,, „ 164 Contained 28 per cent. of added water. Vendor paid £2 2s. costs ... ... ... ... 34 Administrative Action regarding Samples not reported to be genuine.—Continued. Name of Article. Identification Number given to the Sample. Result of Analysis. If any legal proceedings were instituted under the Sale of Food and Drugs Acts, state result, showing fines and costs separately. If any legal ceedings were taken under Acts other than Sale of food & Drugs Acts, state the result, showing fines and costs separately. If no legal proceedings were instituted, state briefly the course adopted in regard to each sample. Information, if any, as to previous convictions. Remarks on any point of special interest. 1. 2. 3. 4. 5. 6. 7. 8. Vinegar No. 558 Contained 38 per cent. of added water. Vendor fined 10s., costs, £1. ... ... 6th December, 1917. Fined 5s. for selling vinegar 16 per cent. deficient in acetic acid. ... „ „ 559 Contained 8 per cent. of added water. Vendor fined 10s. ... ... ... ... „ ,, 570 Contained 17 per cent. of added water, Dismissed ... ... ... Warranty proved „ „ 571 Contained 22 per cent. of added water. Vendor paid costs, £2 2s. ... ... ... ... „ „ 572 Contained 19 per cent. of added water. Dismissed ... ... ... Warranty proved 35 Vinegar No. 573 Contained 49 per cent. of added water. Vendor fined £5 ... ... ... ... Camphorated Oil „ 195 Contained 70 per cent. paraffin. Vendor paid costs, £3. ... ... 7th April, 1908. Fined £2 for selling Camphorated Oil 11½ per cent. deficient in camphor. ... „ „ „ 574 Contained 39 per cent. paraffin. Vendor paid costs, £3 3s. ... ... ... ... Vinegar „ 266 Contained 20 per cent. of added water. Vendor fined £1, costs, £1. ... ... ... ... „ 274 Contained 17 per cent. of added water. Vendor fined £1, costs, £1. ... ... ... ... „ „ 275 Contained 14 per cent. of added water. Vendor fined £1, costs, £1. ... ... ... ... „ „ 292 Contained 10 per cent. of added water. Vendor fined £3, costs, £2 2s. ... ... ... ... „ „ 338 Contained 17 per cent. of added water. Vendor fined £1 10s. ... ... ... ... 36 Administrative Action regarding Samples reported not to be genuine.—Continued. Name of Article. Identification Number given to the Sample. Result of Analysis. If any legal proceedings were instituted under the Sale of Food and Drugs Acts, state result, showing fines and costs separately. If any legal proceedings were taken under Acts other than Sale of Pood & Drugs Acts, state the result, showing fines and costs separately. If no legal proceedings were instituted, state briefly the course adopted in regard to each sample. Information, if any, as to previous convictions. Remarks on any point of special interest. 1. 2. 3. 4. 5. 6. 7. 8. Vinegar No. 428 Contained 8 per cent. of added water. Dismissed. ... ... ... Warranty proved. Proceedings taken against wholesale vendor who was fined £7, Costs, £5 5s., for giving false warranty. ,, „ 482 Contained 24 per cent. of added water. Vendor fined £2. ... ... ... ... Camphorated Oil „ 344 Contained 77 per cent. paraffin. Vendor fined ... ... ... ... 37 Offences other than Adulteration. Article. No. of Sample. Offence. Result of Prosecution. Vinegar No. 154 ) Giving false Warranty Dismissed, Magistrate held that when Defendant gave Warranty he had no reason to believe that the statements therein were untrue. ,, 570 „ 572 Do. No. 163 Do. Do. SAMPLES TAKEN INFORMALLY. Of 83 samples of milk taken informally, 45 were found to be adulterated. The results of the analyses were:— Numbers of Samples. Results of Analyses. 2, 28, 31, 46, 47, 50, 51, 56, 67, 75, 76, 108, 277 Less than 10 per cent. added water. 3, 5, 7, 24, 35, 36, 37, 39, 43, 44, 48, 58, 59, 65, 85, 86, 87, 92, 103,109 More than 10 per cent. and less than 20 per cent. added water. 4, 20, 32, 45, 66 More than 20 per cent. and less than 30 per cent. added water. 27, 38 More than 30 per cent. added water. 23, 88, 95, 96, 442 Less than 20 per cent. deficient in fat. 38 Three informal samples of vinegar were taken containing— No. 328 10 per cent. added water. „ 330 7 „ „ „ 497 20 „ „ Five other informal samples of vinegar were found to be genuine. Out of 13 informal samples of tea taken 10 were genuine, and 3 were adulterated, containing— No. 113 5 per cent. foreign matter. ,, 125 6 ,, ,, „ 126 3 „ „ Out of 12 informal samples of camphorated oil, 6 were found to be adulterated, containing— No. 183 50 per cent. paraffin. „ 186 50 „ „ 263 60 „ „ 270 60 „ „ 303 68 „ „ 327 75 „ Out of 3 informal samples of cotton-seed oil, 2 (Nos. 180 and 181) were found to be adulterated, containing 30 per cent. of paraffin. One sample of quinine and iron was found to be adulterated, containing 8½ per cent. of hydrochloric acid. 39 FEES PAID TO PUBLIC ANALYST DURING 1919. Food and Drugs Acts. Quarter ending March, 1919 £ s. d. 100 samples at £1 1s. 81 samples at 10s. 6d. 147 10 6 Quarter ending June, 1919 136 samples at 6s. 40 16 0 Quarter ending September, 1919 135 samples, at 6s. 40 10 0 Quarter ending December, 1919 171 samples at 6s. Retaining Fee, £10 61 6 0 £290 2 6 PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 AND 1917. The following is a report of the work done under the Regulations during the year ending 31st December, 1919. 350 samples of milk were taken, and in no case was a preservative reported to be present. No samples of cream were taken. No other contraventions of the Regulations were discovered. "APPEAL TO COW" SAMPLES. No samples of milk were taken direct from the cow during 1919, there being no requests received for such action. 40 SHELTER, 3, ST. JAMES' ROAD. This house is provided for the reception of contacts and other persons displaced during the process of disinfection, and during the year 34 persons were temporarily accommodated. CLEANSING OF PERSONS. Ten adults and 9 children were cleansed at the Disinfecting Station. SUMMARY OF WORK OF SANITARY INSPECTORS. Visits to notified cases of Infectious Disease 1,372 Complaints 2,138 House to House Inspections 254 Trade Inspections 1,069 Re-inspections 17,523 Milkshop Inspections 595 Factory and Workshop Inspections 2,114 Outworkers' Homes Inspections 1,270 Tenement House Inspections 251 New Buildings Inspections 3 Ice Cream Shop Inspections 82 Combined Drainage Inspections — Smoke Nuisances, Number of observations 20 Other Inspections or Work of Special Character 2,036 Number of Interviews at the Office 1,722 Total 30,449 41 Unsound Food Seizures 7 Samples of Food and Drugs taken 609 Police Court Attendances 228 Number of Preliminary Notices to abate Nuisances 5,477 Number of Statutory Notices to Abate Nuisances 4,671 Nuisances Abated 4,923 Number of Rooms Disinfected 1,277 Number of Articles of Bedding and Clothing Disinfected 24,447 42 Bethnal Green Metropolitan Borough. Figures for 1901. Figures for 1911 (Total of Cols. 4-11). Buildings used as Dwellings. Vessels, Sheds, Vagrants, etc. Separate Flats included in Col. 5. Buildings not used as Dwellings. Ordinary Dwelling Houses. Blocks of Flats. Shops. Hotels, Inns, and Public Houses. Offices, Warehouses, Workshops, Factories. Institutions. Others. Kind of Building. No. Column Nos.—1 2 3 4 5 6 7 8 9 10 11 12 13 14 Places of Worship 41 Number Inhabited 14,005 13,649 10,975 322 1,985 220 74 34 39 — 4,716 Govt, and Munici- pal Building 15 Separate Occupiers 28,209 27,755 19,943 4,730 2,678 226 86 36 50 6 4,730 Shops 352 Population 129,680 128,183 89,761 20,453 12,323 1,104 440 3,863 224 15 20,453 Offices 31 Uninhabited 681 522 357 — 145 1 6 1 12 - 323 Warehouses, Workshops & Factories 789 Being Built 59 9 3 - 5 - - 1 - — - Theatres and other places of amusemt. 2 43 HOUSING. General Housing Conditions in the District. The last detailed survey of housing accommodation was at the Census of 1911, and the results obtained are summarised in the subjoined table. Since the 1911 Census the change in the number and description of the inhabited buildings has not been of any great magnitude. There has been an undoubted and definite tendency for dwelling houses to be converted into workshops, either wholly or room by room. This transformation is a feature of an area such as Bethnal Green, which is a centre for cabinet-making, boot-making and tailoring. Such changes are, in my opinion, most undesirable, and most inhabitants of the Borough concur in this view. We want no more factories in our overcrowded and smoky Borough, which should remain residential and made fit for this purpose. The proper place for further industrial development is in the country or on the outskirts of London. Whatever structural changes may be made in a dwelling house, it can rarely be transformed into a satisfactory workshop, and the overcrowding, already desperate, is accentuated by the needs of the population displaced from the converted buildings. The population of the Borough at the 1911 Census was 128,183, and it was estimated by the RegistrarGeneral to be 110,085 in the middle of the year 1919. The decline in population is most marked, and it is important to ascertain its causes. These we cannot define accurately until the Census to be taken in 1921. 44 Some of the causes may, however, be generally indicated. The conversion of dwelling houses and dwelling rooms into workshops has played some part, but that this has not been of great effect in reducing population is shown by the fact that between the years 1901 and 1911 the population of the Borough decreased only from 129,680 to 128,183, although the process of workshop transformation was in being. The large and recent decrease of population is due to:— (a) Deaths of men and women in the Services. (b) Diminished birth-rate. (c) Emigration from the district. Bethnal Green, being a densely populated district with a high birth-rate, has always and of necessity sent out large numbers of men and women into the more open parts of Great Britain and the Empire. The population in the past has remained fairly stationary, the excess of births over deaths being balanced by emigration. During the war, in addition to the deaths of men and women in the Services, the birth-rate fell markedly. A more important factor, however, was the spacing out of the population, having the same effect as a large emigration of population. Bethnal Green in the past, in addition to its staple industries, has included in its population a large number of families on the verge of destitution, subsisting on casual labour or sweated trades. For reasons which I need not dilate on, the number of such families has enormously diminished during the war. A new standard of decent living has been created—and may we never look back in this change! 45 The immediate effect of this has been to cause a demand for better housing conditions, and this demand has been accompanied by the power to pay for the improvement. What is the result in effect? Families that were content with one or two rooms now demand three or four rooms or a whole house,and once the improved accommodation is obtained, the Rent Restriction Acts give security of tenure. Similarly, the family may have taken in a lodger before, and one of the first signs of prosperity has been the eviction of the lodger, too often an intruder on the family privacy. The mere diminution in population might lead an observer to suppose that there could not be in the Borough any shortage of houses, any shortage of houses being usually accompanied as a social phenomenon by overcrowding and an increased population; yet the demand in the Borough for additional and better housing accommodation is a very real and urgent one. This is due, firstly, to the fact that during the war some families, owing to the absence of male members on military service, left their houses and were content with less accommodation. In a few cases they left the Borough. On the return of normal times they find their previous home occupied by another family, and such families, although occupying two or three rooms, would gladly move into a house if such were ready and available. Secondly, the better social conscience which, as mentioned above, has evinced itself amongst tenement dwellers in the demand for additional rooms, leads as well to the natural demand for a self-contained house or flat. There are an enormous number of Bethnal Green residents now living in tenements who would gladly 46 move to a house and pay more rent, if necessary. It is from these persons that the demand for houses proceeds. It is impossible to give any figures as to the number of houses required. It is obviously not entirely a Bethnal Green problem, as there is no land in Bethnal Green on which to build houses. Our tenement dwellers must learn to realise this, and face the prospect, unwelcome though it may seem, of living out on the borders of London, perhaps many miles from their workplace. This should be no hardship provided the workers are able to pay for the necessary transport and such transport is efficient and properly organised. This is assuming that central London will become largely extended as a collection of offices, factories and workshops; but it is for the workers of London to decide whether the process of centralising industry in the centre of a town such as London is desirable, or whether all new factories and workshops required (apart from offices) might not be situated on the outskirts of London. The feeling of East-end people on this matter is somewhat inarticulate, but there is some appearance of its favouring the future town-planning of the Borough rather on residential lines. Whatever the future of London may be, the tenement system stands condemned as a relic of mediaeval conditions, and its persistence is mainly due to the lack of proper transport facilities for the workers in our towns. Recent housing legislation places the responsibility for the provision of new houses in the Borough on the Borough Council, and for houses outside the county on the County Council. As regards Bethnal Green there is practically no land available for building operations on any large scale. Here and there, there are plots of land 47 whereon a few houses or blocks of flats could be erected and the possibility of using any such spare land is engaging the close attention of the Borough Council. The Diss Street area, which has been partly cleared and which is an unhealthy area, is likely to be the first area utilised for providing new housing accommodation. In considering the provision of additional housing accommodation the possibility of converting existing buildings into flats or tenements must be also explored. The Council has fully considered the question of converting the premises known as "Bethnal House Asylum" into separate dwellings, but it is doubtful if the scheme is practicable owing to the heavy initial cost of the necessary structural alterations. The Bethnal Green Workhouse in Waterloo Road might also appear to lend itself to adaptation. At the end of the year the possibility of renting a portion of the premises from the Bethnal Green Board of Guardians and converting it into dwellings was under consideration, and at the time of writing the scheme would appear to be about to materialize. In many parts of London there are numerous large houses standing vacant which can be converted without much expense into flats or tenements. In Bethnal Green such vacant houses are almost non-existent. To sum up, beyond converting such buildings as the Workhouse, and apart from slum-clearance, little can be done in Bethnal Green to provide new housing accommodation. 48 OVERCROWDING. At the time of the 1911 Census, overcrowding was rampant in Bethnal Green, there being then 6,445 tenements with more than two occupants per room, and 41,152 persons were living under these conditions. In other words, 32 per cent. of the population was living under such conditions of overcrowding as to be injurious to health and morals. To what extent has the recent decrease in population ameliorated overcrowding? This is a difficult question to answer, but the position appears to be as follows: The spacing out mentioned above has principally affected those families who were not "overcrowded" before the war, for instance, those who occupied a whole house. The number of families occupying two or three roomed tenements or flats under overcrowded conditions is still very large. Such families may have the breadwinner unemployed or disabled with a pension. Overcrowding is still an urgent problem in Bethnal Green, and affecting as it does so often the families of men who have served in the war and made great sacrifices, it is to be deplored the more. The Borough Council and its staff find themselves very helpless in attempting to abate these evil conditions. It is realised that the solution only lies in the provision of new houses, and this matter is outside our jurisdiction for all practical purposes. In twelve instances during the year overcrowding was so bad as to be reported to the Public Health Committee as to action. In six cases an informal notice to abate the nuisance was served, and in three cases a statutory notice was served. In all twelve instances the condition was eventually abated. 49 FITNESS OF HOUSES. Bethnal Green is an old Borough, and a large proportion of the property was never, even when new, up to modern requirements as regards planning, size of rooms, dryness of walls, etc. Add to this fact the consideration that such property is now old and beyond further repair, and is suffering from the neglect of a five-years' war period, and some idea of the conditions will be obtained. No doubt a great deal can be done in some houses to make them less unfit for human habitation, but in a very large number no amount of repair will ever make them satisfactory houses. Even when repair is practicable this may involve very heavy expense, and far more than is justifiable, having in view the fact that the cost of the repairs will fall on the landlord and tenant. There are in Bethnal Green numerous houses where, for instance, damp-proof courses should be inserted in the walls, proper foundations laid, the brickwork requires pointing, doors and windows require replacing and resetting, not to mention new roofing and guttering required. Such houses are only fit to be pulled down and carted away, and it is waste of money to do anything else. However, in an important matter such as this any exaggeration is to be avoided, and one must have in view the abnormal times in which we are living. Most of the newer housing accommodation in the Borough comprises blocks of flats, usually of four or five stories, and about 16 per cent. of the population lives in these structures. It is unnecessary for me to dilate on the disadvantages of such a mode of life. The principal sufferers are the children, who suffer from the confined life and the lack of room for playing, and the 50 aged and the invalids who find the stairs very trying. The best to be said for these structures is that they are dry, warm and watertight. There is strong local public feeling against the further erection of many-storied flats, and it is to be hoped that none will be erected exceeding three stories. UNHEALTHY AREAS. During the latter part of the year, the Council, at the request of the Ministry of Health, caused a survey to be made of the Borough to determine which areas were suitable to be dealt with by improvement or reconstruction schemes. If one were to take a high standard into mind when examining areas as to their being congested, insanitary and unhealthy, it is obvious that a very large part of the Borough would fall in this category. An attempt was made, therefore, to indicate the worst portions of the Borough, and as a result the following areas were reported as being suitable for clearance schemes. One of the undermentioned areas, the Brady Street Area, has already been represented to the London County Council and an Improvement Scheme is now about to materialize. Owing to this fact the Medical Officer of Health did not find it necessary to represent any further areas during 1919. No. 14. Brady Street Area.—7 acres, 528 houses, population 3,058. Congested and insanitary. No. 1. Green Street Area.—27 acres, 923 houses, population 5,538. Congested in parts and insanitary. Bad arrangement of streets. Many houses worn out and insanitary. 51 No. 2. Cranbrook Street Area.—13 acres, 523 houses, population 3,138. Congested in parts and insanitary. Bad arrangement of streets. Many houses worn out and insanitary. No. 3. Collingwood Street Area.—6 acres, 286 houses, population 1,716. Congested. Houses worn out. No. 4. Pott Street Area.—6 acres, 239 hovises, population 1,434. Congested. Houses worn out and narrow and badly arranged streets. No. 5. Pedley Street Area.—4 acres, 174 houses, population 1,044. Congested. Houses worn out and narrow and badly arranged streets. No. 6. Margarets Place Area.—2 acres, 148 houses, population 888. Congested and worn out. No. 7. Teale Street Area.—4 acres, 137 houses, population 822. Houses small and worn out. No. 8. Punderson Gardens Area.—3 acres, 132 houses, population 792. Houses small, damp and worn out. No. 9. Turin Street Area.—4 acres, 141 houses, population 846. Congested and worn out. No. 10. Diss Street Area.—2 acres, 70 houses, population 420., Part of area already cleared. Remaining houses insanitary. No. 11. Kirkwall Place Area.—½ acre, 24 houses, population 144. Houses more or less obstructive and insanitary. 52 No. 12. Martha Court Area.—¼acre, 22 houses, population 132. Houses old and damp, some back-toback. No. 13. Manchester Buildings Area.—¼acre, 18 houses, population 108. Houses damp and congested. STATISTICS FOR THE TWELVE MONTHS ENDED 31st DECEMBER, 1919. (1) Number of dwelling houses in respect of which complaints were made that they are unfit for human habitation: (a) By householders nil (2) Action under Section 17 of the Housing Act of 1909:— (a) Number of dwelling houses inspected under and for the purpose of the section 32 (b) Number of dwelling houses which were considered to be unfit for human habitation nil (c) Number of dwelling houses the defects in which were remedied without the making of closing orders nil (3) Action under Section 28 of the Housing Act, 1919:- (a) Number of Orders for repairs issued nil (b) Number of cases in which repairs carried out by the local Authority nil 53 (c) Number of dwelling houses voluntarily closed on notice by owner that they could not be made fit without reconstruction nil (4) (a) Number of representations made to the Local Authority with a view to the making of closing orders nil (b) Number of closing orders made nil (c) Number of dwelling houses in regard to which closing orders were determined on the houses being made fit for human habitation 2 (5) Demolition Orders:— (a) Number of demolition orders made nil (b) Number of houses demolished in pursuance of demolition orders nil (6) Number of dwelling houses demolished tarily (7) Obstructive buildings:— (a) Number of representations made (section 38 of the Housing Act of 1890) nil (b) Number of buildings demolished nil (c) Number of representations still under consideration nil (8) Staff engaged in Housing Work:- At the end of the year no special staff was allocated specially to Housing. This question was under consideration. 54 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Number of . Inspections. Written Notices. Prose- cutions. Factories (Including Factory Laundries) 90 20 ... Workshops (Including Workshop Laundries) 4,365 1,377 29 workplaces (Other than Outworkers' premises included in Part 3 of this Report) 9 ... ... Total 4,464 1,397 29 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspctr. Nuisances under the Public Health Acts:— Want of Cleanliness 539 468 1 ... Want of Ventilation 32 28 ... ... Overcrowding 3 3 ... ... Want of drainage of floors 9 9 ... ... Other nuisances 1,443 1,310 1 2 Sanitary accommodation insufficient 15 13 ... ... unsuitable or defective 449 396 ... ... not separate for sexes 8 8 ... ... Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouses (s. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 23 23 ... 3 Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) 139 139 1 2 Total 2,659 1,197 3 7 55 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. Notices served on Occupiers as to keeping or sending lists. Prosecutions. 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. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel—Making, &c. 38 4 418 25 3 163 39 4 2 242 240 3 2 ... ... Boots and Shoes 26 2 334 8 18 72 18 ... ... Trimmings 2 2 36 1 ... 32 2 ... ... 6 6 ... ... ... ... Furniture and Upholstery 2 ... 27 1 ... 2 1 ... ... ... ... ... ... ... ... Fur Pulling 2 ... 10 ... ... ... 1 ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... 2 ... 6 3 ... ... ... ... ... ... ... ... Artificial Flowers ... ... ... 1 ... 42 ... ... ... ... ... ... ... ... ... Paper, &c., Boxes, Paper Bags 24 ... 442 5 ... 231 15 ... ... 63 63 ... ... ... ... Brush Making 6 ... 339 ... ... ... 2 ... ... 59 58 ... ... ... ... Carding; &c., of Buttons, &c. 2 ... 18 ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys 2 ... 38 ... ... ... 1 ... ... 2 2 ... ... ... ... Textile Weaving 2 ... 27 ... ... ... 1 ... ... 3 3 ... ... ... ... Total 106 8 1,689 43 21 548 83 4 2 375 372 3 2 ... ... 56 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. Workshops (Including Factories and Workplaces) 1,334 Workshop Bakehouses 85 Total Number of Workshops on Register 1,419 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) 8 Action taken in matters referred by H.M. Inspector as remediable under the Public HealthActs, but not under the Factory and Workshop Acts (s. 5, 1901) Notified by H.M. Inspector 347 Reports (of action taken) sent to H.M. Inspector 347 Underground Bakehouses (s. 101) in use at the end of the year 22